Proactively controlling costs involves anticipating and preventing unnecessary expenses before they occur, requiring a forward-looking data review approach.
Option A (Retrospective): Retrospective reviews analyze past data, useful for identifying trends but not proactive cost control.
Option B (Prospective): This is the correct answer. The NAHQ CPHQ study guide states, “Prospective data review analyzes planned interventions or patient care to prevent unnecessary costs, such as avoiding inappropriate procedures” (Domain 2). Examples include pre-authorization reviews.
Option C (Administrative claims): Claims data is retrospective, analyzing costs after services, not proactively controlling them.
Option D (Clinical records): Clinical records are typically retrospective, not forward-looking for cost prevention.
CPHQ Objective Reference: Domain 2: Health Data Analytics, Objective 2.5, “Use data for cost control,” emphasizes prospective reviews for proactive management. The NAHQ study guide notes, “Prospective reviews prevent costly errors by evaluating plans in advance” (Domain 2).
Rationale: Prospective reviews enable cost control before services are rendered, aligning with CPHQ’s data analytics principles.
[Reference: NAHQ CPHQ Study Guide, Domain 2: Health Data Analytics, Objective 2.5., , , , ]
