Working from Claims Data

Claims data are more difficult to work with to extract the necessary information about patient conditions in relationship to costs. There can be multiple claims for the same patient episode from different sources. A physician visit after an inpatient claim can be followed up for the inpatient stay rather than to consider the inpatient stay as the start of a new patient episode or a new patient problem. Therefore, in addition to analyzing patient conditions as represented by ICD9 codes, we must also attempt to define an episode and to distinguish between new problems and follow up of old problems.