> Case Study>A SaaS Based Medicare Compliance Management System for Healthcare Organizations
A SaaS Based Medicare Compliance Management System for Healthcare Organizations
A SaaS based enterprise Big Data application for maintaining Electronic Health Records (EHR)
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A US based startup ISV in healthcare domain wants to maintain and grow its leadership by creating an automated solution for Centre for Medicare and Medicaid compliance needs for healthcare providers
Manual process for understanding over 200+ business rules for compliance management
Develop a customizable and flexible model to facilitate varied customer needs and frequently changing compliance rules
Need for systematic reporting of real-time compliance data
Provide a Scheduler based automated system audit and calendar events for planning internal/manual audits
Need for a central knowledge base for latest compliance updates
Developed a compliance rules engine based on a decision table methodology. Business rules were defined, data fields associated with a particular compliance rule were identified and mapped with the decision table.
Application deployed on SaaS model so that customers can enable / disable rules and decision tables according to their specific needs for auditing and compliance purposes
Real time compliance data shown in visually appealing formats such as pie charts and tile view. Utilized Jasper Reports to extract reports in different formats like pdf, xls, .doc etc.
Implemented a scheduler for automated system audits and calendar events for users to assign, set frequency and schedule internal/manual audits. Application sent automated email notifications to users assigned to handle various events like compliance exception, assignment of exceptions and audits.
Integrated openKM as the document management system and a centralized knowledge base. It provided role-based access and facility to import, add, modify or delete internal documents along with search and bookmarking features
Technologies & Tools
A compliance rules engine facilitated in proactive identification and reporting results on exceptions, for Centre for Medicare and Medicaid audit requirements
Improved flexibility and adaptability to changing rules at every health plan level
Enabled users to access the compliance level and drill down to specific compliance exceptions easily in real time. The users could also track historical data for trends, compliance and exceptions, with the help of customized reports.
Automated system audits & timely notifications led to increase in workforce efficiency
Implementation of a document management system resulted in improved information sharing and knowledge management