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Reliability Score

81

3181(+50 pts)

Is our reported readmission rate of 13.3% accurate?

BayesIQ's audit surfaced 3 findings and enabled targeted remediation that improved the reliability score from 31 to 81.

Board approved CMS compliance filing based on overstated readmission rate — potential $500K+ penalty exposure

Reported

13.0%

readmission rate · 2025-12

Audited

12.3%

Overstated 5.7%

Decision Exposure

Board approved CMS compliance filing based on overstated readmission rate — potential $500K+ penalty exposure

Reported readmission_rate for 2025-12 is 13.0%, but recomputed value from raw events is 12.3%. Discrepancy of +5.7%.

Illustrative Example

BayesIQ Data Reliability Audit

Hospital

Audit Period: December 2025

81

Reliability Score

Good — some issues need attention

Illustrative example — representative of BayesIQ audit deliverables

BayesIQ audits a healthcare organization's patient data infrastructure across readmission tracking, patient identity matching, and outcome reporting. The audit identifies 3 material discrepancies — including 50 near-duplicate patient records inflating aggregations and null patient IDs breaking downstream filters — directly affecting board-reported readmission metrics. After targeted remediation, the reliability score improves from 31 to 81 and the readmission rate discrepancy narrows from 5.7% to within acceptable tolerance.

3 findings2 high1 medium

Key Metrics: Reported vs Audited

MetricPeriodReportedAuditedDelta
readmission_rate2025-1213.0%12.3%overstated 5.7%

Top Findings

medium

readmission_rate misreported for 2025-12 (off by +5.7%)

Board approved CMS compliance filing based on overstated readmission rate — potential $500K+ penalty exposure

high

Near-duplicate rows detected

50 duplicate patient records inflating readmission counts, distorting quality metrics reported to CMS

50 rows affected

high

Null values in required column: patient_id

25 records missing patient_id — these patients are invisible to outcome tracking and compliance reporting

25 rows affected

Recommended Actions

  1. 1

    Investigate duplicate records. Add dedup logic keyed on non-key fields.

    Owner: Data Engineering|Effort: Mediumhigh
  2. 2

    Fix null values in required column 'patient_id' at the source.

    Owner: Data Engineering|Effort: Mediumhigh
  3. 3

    Investigate root cause of readmission_rate discrepancy for 2025-12. Check for duplicate events, missing data, or filter logic differences.

    Owner: Data Engineering|Effort: Smallmedium
Prepared by BayesIQ · 2025-12

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