What is a Site of Care?
MedScout is moving to a more accurate way of identifying where providers are practicing.
Previously, data was tied to the billing NPI on a claim, which wasn’t always where care took place. A physician who billed through a medical group could show up at the group's office address even when the procedure happened at a hospital across town.
This new model rolls those billing identifiers up into a single real location, so providers are attributed to the places where they actually practice. We are also consolidating multiple billing NPIs for the same site of care to better reflect what is happening under one roof.
Claims Deduplication
The migration to Site of Care includes better deduplication of claims billings to ensure the most accurate utilization counts possible
Claims are typically billed through two different forms for the Institutional (facility) side and the Professional (provider) side of a service. While both claims refer to the same patient service, they usually have completely different claim identifiers. MedScout may not always receive both forms, we may only see the Professional claim or the Institutional claim.
Site counts are deduplicated at the service level to ensure each claim is only counted once and is mapped to the most accurate location
How we determine a Site of Care for a Claim
Consolidation of organizational NPIs
Type 2 NPIs for the same “location” are grouped using a combination of signals including, standardized address, name, taxonomy, CMS enrollment, etc. A valid address is required for an address to be grouped.
Retired NPIs are not currently consolidated
NPIs within the same hospital campus are grouped using a general catchment area, even if the address lines are not exactly the same
NPIs for non-hospital types are grouped at the “rooftop” level, meaning they must be registered with the same standardized address
Group NPIs will be rolled up to the true site when possible (e.g. AdventHealth medical group registered at the same address as AdventHealth Orlando hospital)
A primary type will be assigned to the Site of Care
Surgical Events Mapping
MedScout is using a series of logic to determine the true location of a claim. This includes de-obfuscating centralized billing scenarios when possible. MedScout will only do this when we are confident in the true location.
Site of Care Types
Sites of Care are designated by the following types and sub-types. Derived from a combination of taxonomy, service utilization, and CMS enrollment.
Types:
ASC
DME Supplier
Endoscopy Center
Home Health
Hospital
Laboratory
Office / Clinic (generally a fallback for anything unclassified)
Pharmacy
SNF
Urgent Care
Sub-Types:
Acute Care Hospitals
Childrens
Critical Access Hospitals
Long-term
Psychiatric
Rehabilitation
Rural Emergency Hospital
Veterans Administration
Inpatient / Outpatient Flag
Filter sets now include a flag to filter to inpatient or outpatient services for a given provider or site. This allows additional granularity for Sites, mainly Hospitals, which can have multiple departments for outpatient surgery or admitted patients.
Platform Changes
Filter Sets
Place of Service is now removed as a filter type and replaced with Site of Care Type + Subtype.
Physician and Site specialty filters can still be used, and they can be used in conjunction with a Site of care type (e.g. Urologists practicing at an ASC or a Urology Office)
Provider specialty
Site specialty
We have added a new “Inpatient/Outpatient” filter to allow more granular filtering and separation, specifically for Inpatient and Outpatient Hospital.
Analytics
Analytics can now be viewed and filtered by Site of Care types. All claims are classified with a Type, even if they don't have a valid NPI.
Profiles
Top locations, affiliations, and primary addresses are now derived from the new site of care model.
