A SaaS Based Medicare Compliance Management System for Healthcare Organizations

A SaaS based enterprise Big Data application for maintaining Electronic Health Records (EHR)

a-saas-based-medicare-compliance-management-system-for-healthcare-organizations

Situation

    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

Challenge

  • 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

Harbinger Solution

  • 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

  • J2EE
  • Spring
  • JBoss
  • MySQL
  • CAS
  • Jasper ETL
  • jQuery

Benefits

  • 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