eSolutions Announces Acquisition of RemitDATA

Strategic Investment Allows Diversity, Growth and Advances Analytics Technology Services for Customers

Overland Park, KS, and Plano, TX, August 11, 2017 – eSolutions, Inc., a leading provider of healthcare technology and analytics solutions, today announces the acquisition of RemitDATA Inc., a pioneer of comparative data analytics technology bringing 360-degree data transparency to the healthcare industry. The acquisition allows eSolutions to further expand its footprint outside of existing markets in the healthcare industry. It also promises greater diversification within the FQHC, Ambulatory, ASC, Hospital-owned Physician markets and more.

“RemitDATA’s technology will provide significant upgrades to our customers’ reporting and analytics services,” said Gene Creach, President and CEO of eSolutions. “RemitDATA fits perfectly into our existing customer base, while also providing a featured service for the ASC market.”

“By combining expertise and offerings, we will be able to achieve results far beyond what each could achieve as stand‐alone businesses,” said Dave Ellett, CEO of RemitDATA. “The new entity will strengthen our product suite and the ability to cross‐sell into our respective customer bases.”

eSolutions is known for optimizing providers’ revenue cycle processes through built-in workflow automation, sophisticated analytics, and flexible reporting solutions. The company’s products provide custom data analytics and workflow automation products to boost staff productivity, speed up reimbursement, dive deeper into complex data for meaningful business insights, streamline the entire claim submission process and keeps customers up to date on changing regulations. These tools provide unparalleled insight and functionality across all types of payers, spanning Medicare, Medicaid, and the universe of commercial insurers. Today, the company currently processes over 50 million claims a year for nearly 30,000 providers.

About eSolutions, Inc.
Founded in 1999, eSolutions specializes in helping health care providers improve their revenue cycle management practices. eSolutions delivers high value, cost-effective, workflow automation and data analytics services in a web-based environment to thousands of providers – ranging from small, family-owned home health agencies to nationally recognized corporate health systems. Through some of the industry’s most effective workflow automation and data analytics tools, clients can maximize reimbursement for the services in the most efficient and timely manner. For more information, visit www.esolutionsinc.com.

About RemitDATA
RemitDATA is a healthcare technology company that delivers a comprehensive comparative data and analytics platform. Founded in 2000, with offices in Memphis, TN, Plano, TX and Lexington, KY, RemitDATA strives to bring collaboration and 360-degree data transparency to all entities within the healthcare industry by delivering a range of system agnostic, comparative analytic solutions. Through the use of Application Programming Interfaces (API), benchmarking and peer comparison tools, payers, providers, billing companies and other healthcare companies will gain actionable insights to better understand their business and improve operations so they can focus on what really matters, to them.

Contact:
Brian Martorana
(913) 971-4303
bmartorana@esolutionsinc.com

Guiding surgeons to lower-cost facilities can help contain costs

Did you know that the cost for some surgical procedures can vary by as much as
400%-500% amongst in-network providers for the same procedure? A close look at three years of independent Blue Cross and Blue Shield companies’ claims data found that the cost for a total knee replacement (without complications) varied nationally, from a low in Montgomery, Alabama of $11,317 to as high as $69,654 in New York City. And costs can vary widely within the same market too. In Dallas, the study found a 267 percent cost variation for total knee replacement ranging from $16,772 to $61,585 depending on the hospital.

Surgeons are typically reimbursed the same amount no matter where they perform their procedure. However, the facility’s reimbursement rates can vary greatly, costing health plans millions. 

Using comparative analytics, health plans can identify which surgeons are practicing at multiple facilities during the pre-authorization process, and then guide or incentivize surgeons to conduct the service at the lower cost facilities where they currently practice. As a result, health plans and their patients will both realize cost savings without reducing the surgeon’s reimbursement. Talk to us to learn more about leveraging comparative data to reduce site of surgeon costs.

Read this article to learn more. 

Payers: Get More Out of Your Value-Based Contracts

As the march toward alternative payment models continues, payers can prepare by digging into their value-based contracts to identify areas in which to reduce costs.

Comparative analytics is the ideal way to help payers evaluate current claims and cost data, compare internal performance against benchmarks, and see where there are trends to identify gaps and opportunities for improvement. Payers can use comparative data to:

  • Reduce wasteful spending by identifying which episodes are involved
  • Highlight specific services, and reveal the providers contributing to wasteful spending
  • Redirect providers to lower cost sites of service
  • Refer patients to lower cost providers, based on the data, and more

Our recent article offers full insights on leveraging data to get the most out of value-based contracts.

You’re an HME/DME provider. Do you have any idea how your denial rates compare to the national average?

It is more critical than ever before to understand the patterns and trends of denials so you can stay competitive and ensure your business continues to thrive.

To put it in context, if we told you that 21 percent of HME/DME claims denied can be attributed to eligibility reasons – down from 3 percent in 2016, would that help you level set benchmarks and help you optimize your own business plans?

Well good news. We’ve put our own comparative data solutions technology to work, and have put together a Q1 2017 denials report for the HME/DME space.

The critical need to compare and benchmark denial rates and other revenue cycle figures against your peers can help you understand and identify areas of improvement for your HME/DME business. 

So, do you know how you compare?

Check out the full report for additional stats regarding the HME/DME market.

Are Your Revenue Cycle Best Practices Truly Best? Let Comparative Data Guide You.

Best practice is more than just an industry buzzword. Establishing best practices can make a real impact on a healthcare
organization’s bottom line. Yet what exactly are “best practices”? How do you know if your internal best practices are really the best?

Many organizations would be surprised to discover that their internal “best” practices are actually subpar when compared to peers. However, leveraging comparative analytics to compare performance to peers can provide both financial and operational insights. Armed with this data, management teams can gain a clear understanding of the drivers impacting their internal performance and identify areas needing improvement. Plus, analyzing financial and operational metrics on a regular basis should also be part of an organization’s best practices, so if you aren’t doing so, you should!

Learn about some specific areas in which to use comparative analytics to analyze your business operations in our recently published article on the topic.

Comparative Analytics Improve Billing and Collections Processes

As healthcare organizations seek ways to improve the bottom line, comparing billing and collections data against peers provides yet another view that can help practices improve processes. Comparing this data against peers can go a long way in understanding root causes for issues, and correcting them before errors impact the bottom line.

Comparative analytics can help uncover issues by taking a deeper dive into spikes in denials and billing patterns. Comparative analytics help analyze and trend:

Allowing practices to compare their data to state and national averages to see what rates are for peers in the same specialty. 

Check out our article on the topic for additional details.

 

Business as Usual? Preparing for Value-Based Healthcare

To ACA or to ACHA? That is the trillion-dollar question. As the healthcare industry awaits looming policy changes, one area that does appear to be immune from the ongoing healthcare policy battle is the move away from fee-for-service to value-based care.

Whatever policy moves are made, healthcare organizations should ensure business processes are ready for value. From creating key benchmarks to see how they measure up to peers to analyzing claims denials, organizations should be getting their houses in order. Comparative analytics is one way to help practices analyze revenue cycles ready for any change that comes along.

Check out our article for tips on preparing for value in your practice.

Physician’s Practice – 2016 Review

Physician’s Practice – End of ICD-10 Grace Period Review

End of ICD-10 Grace Period: What the Data Reveals

We’re well into the new year, and roughly five months into the post-ICD-10 grace period. While data is still rolling in, what is the data revealing with respect to claims so far?

Overall, things are going very well. Providers appear to be getting paid faster, with fewer denials, and are realizing lower processing time.

Total claims processing time appears to be cut in half from pre-ICD-10 days, with total processing time of 26 days as of the end of Q4 2016, down from 45 days in Q4 2014 (pre-ICD-10) and 44 days during Q4 2015, which was in the midst of ICD-10.

Providers also appear to be getting paid faster than before ICD-10 went into effect, with nearly 74 percent of claims being paid within 30 days (up from 65.5 percent pre-ICD-10, and 62 percent immediately following ICD-10 implementation).

velocity 
Denied claims are down just slightly, from 15.4 percent pre-ICD-10 to 13.8 percent post-grace period.

denials management

And while our stats are likely to continue to change over the coming months as claims continue to roll in, one could probably conclude that the healthcare industry took ICD-10 preparation to heart and were well prepared to accommodate the thousands of new codes resulting from ICD-10.

We will continue to keep you apprised as new data rolls in.

 

 

RemitDATA Reveals Top Business Concerns Facing Healthcare Industry

Latest annual survey reveals varying opinions on the impact of high-deductible plans on business

PLANO, Texas, Feb. 21, 2017 /PRNewswire/ — Unpredictable changes continue to sweep the healthcare market, driving a greater need for technology and the use of comparative data analytics to help organizations solve operational and revenue cycle issues, according to a new survey of healthcare providers, billing companies and vendors conducted by RemitDATA Inc.

RemitDATA, a pioneer of comparative data analytics technology that brings 360-degree data transparency to the healthcare industry, recently conducted its second annual healthcare industry survey to identify the top challenges around market consolidation, acquisitions, the adoption of alternative payment models and the use of technology to solve business problems.

The survey revealed that top concerns include maintaining profitability and keeping current patient populations, particularly for billing companies.  In contrast, providers, billing companies and vendors all said market consolidation is not a major worry, however one-third of both providers and billing companies say they are looking to acquire others.

“As healthcare continues to evolve, this annual survey helps clarify what is truly on the minds of healthcare organizations,” said Stacie Bon, vice president of marketing. “Although certain areas revealed less concern than we anticipated, it is very clear that the use of data and technology are critical for all healthcare organizations to leverage as they continue to achieve greater transparency, optimization and revenue.”

Survey respondents were a diverse mix of providers, healthcare vendors and billing companies. Representing nearly 40 specialties from family practice to surgery and beyond. Each works with a payer mix, including government plans (Medicare, Medicaid, Tricare), commercial payers and worker’s compensation.

Chief concerns among respondents revealed that nearly 70 percent of billing company respondents believe high-deductible plans are impacting the business, contrasted with a roughly 50-50 split among providers. When it came to revenue cycle management specifically, nearly half of respondents found it difficult to obtain the data necessary to effectively negotiate with payers—something RemitDATA is working to solve through its SaaS solutions.

For more information on the survey, RemitDATA and its comparative analytic solutions visit RemitDATA.com/resource/healthcare-keeping-pace-industry/ or visit booth #5847 at HIMSS on February 20-22 in Orlando, Florida.

About RemitDATA

RemitDATA is a healthcare technology company that delivers a comprehensive comparative data and analytics platform. Founded in 2000, with offices in Memphis, TN, Plano, TX and Lexington, KY, RemitDATA strives to bring collaboration and 360-degree data transparency to all entities within the healthcare industry by delivering a range of system agnostic, comparative analytic solutions. Through the use of Application Programming Interfaces (API), benchmarking and peer comparison tools, payers, providers, billing companies and other healthcare companies will gain actionable insights to better understand their business and improve operations so they can focus on what really matters, to them. For more information, visit www.RemitDATA.com.

Media contact:
Carrie Kelly
919-308-8771
carrie@carriecomm.com

Healthcare IT: A Constant Among Uncertainty

 

The idea of change within the healthcare industry is nothing new.  We’re used to change, but that doesn’t make it any easier to adapt. In the past few years, we’ve seen many initiatives invoke change in healthcare, particularly in administration and revenue cycle management – from the Affordable Care Act (ACA) and the need for alternative payment models to ICD-10 and MACRA. As we launch into 2017, even more change and uncertainty are upon us with the repeal of the ACA.

Despite the change and uncertainty, there is a constant you can turn to in this digital age: Information Technology (IT). Thanks to incredible innovation and advances made in healthcare IT, data and analytics, we have been able to adapt to change and break the barriers of uncertainty.

So, how can we look at something like IT and data analytics as the constant among these waves of change? The first trick is to remember that technology and data are simply tools to help us, not hinder. The second trick is to find a solution that will enable you to use these tools to your advantage.

That’s where we (RemitDATA) come in.

So, as you head to HIMSS 2017, embrace all the advances in technology. They were built with your business (and your customers’) needs in mind.

In RemitDATA’s case, our goal is to show you:

  • How simple it can be to leverage data (your own or your clients’) to help accelerate business growth in spite of any changes that may come.
  • How comparative data solutions could be an additional revenue stream for your sales channels
  • How comparative data solutions can help to win more business and strengthen your customer relationships

Let us show you.

The best way to understand how comparative data can help improve the revenue cycle process and help improve your or your customers’ bottom line is to visit us at HIMSS 2017 in Orlando, Florida at Booth #5847.

In a matter of minutes, you will witness what comparative data analytics solutions can do!

If you’re anxious to learn more now, you can get a quick preview of what we can do by viewing one of these short use cases for payers, providers and billing companies in our Knowledge Center.

Also, be sure to check out our Compare Your Data page! See denial rates by specialty in your state and how they compare to the industry average!  How do you compare?

See you in Florida!

See How You Compare and Win at Medtrade 2017!

We’re gearing up for Medtrade 2017!  We have been following trends around the DME and Medical supply market to stay on top of what is important to YOU.

Lately, it seems more difficult than ever before to stay in control of your bottom line and maintain transparency between organizations. Competition in this market (as you know) is fierce. To stay ahead of the game, the trick is to understand your metrics and how they measure up against your peers/competition.

Quick example: Did you know the national claim denial rate for the DME and Medical Supply market decreased from 17.47% to 16.91%.  If your business’ claim denial average was higher than the national average, it would likely raise some red flags?  Do you have solutions to help you quickly take action?

That is what the power of comparative data analytics can do for you. With this kind of insight you can:

  • Set benchmarks for success
  • Apply intelligent actions to achieve your business goals
  • Ensure customer satisfaction
  • Stay ahead of the competition

The steps to gain this knowledge is simple, and it starts with one very easy and encouraging step. First, check out how you compare so you can begin the process to identify inefficiency gaps in administration and revenue cycle management. 

Next, when you get to Medtrade Spring 2017, come by the RemitDATA booth #832 and we will show you how you can compare, and begin to drive your business forward.

Just for stopping by, you will receive a $10 Poker Chip that can be used at the Mandalay Bay Casino (while supplies last), and be entered in for a chance to win a $100 Amex Gift Card.

If you are ready for more now, please contact us today to speak with a RemitDATA solutions expert and get ready for a very successful year!

MACRA is Coming: Tips to Prepare

Are you ready for MACRA? If not, you’re not alone. A recent Deloitte Center for Health Solutions 2016 Survey of U.S. Physicians states that 50 percent of physicians surveyed have never heard of the law, and 32 percent recognize it by name but are not familiar with its requirements.

Alarming? Yes. But it’s not too late to prepare.

For those who do not know about MACRA: it is the Centers for Medicare & Medicaid Services (CMS) Medicare Access and CHIP Reauthorization Act of 2015. MACRA is a Medicare payment law intended to drive healthcare payment and delivery system reform for clinicians, health systems, Medicare, and other government and commercial payers. MACRA is intended to create a path toward a new Medicare payment system that will more closely align payment with quality and outcomes. It offers financial incentives for healthcare professionals to participate in risk-bearing, coordinated care models and moves away from the traditional fee-for-service system. Providers participating under the Medicare fee schedule will generally choose between participating in Alternative Payment Models (APMs) or receiving payment based on individual performance under the Merit-Based Incentive Payment System (MIPS).

It’s not too late to get informed on all things MACRA, as there are tools and resources available. The American Medical Association recently introduced a series of online tools designed to help providers transition to Medicare’s new payment schemes under MACRA. In the AMA’s STEPS Forward platform there are 42 modules, including those on selecting and implementing an EHR, reporting to data registries, and complying with the law’s quality measures. The AMA also released a Payment Model Evaluator, which will help providers understand how MACRA will affect them and how best to succeed under the new law.

Bottom line: Staying apprised of all-things MACRA, taking advantage of tools, data and other information will help as you prepare your practice for this change.

Read more in Becker’s Hospital Review. 

Happy Holidaze: Be Sure Your ICD-10 Code Book is Close By

Season’s greetings to all! As we enter the busy holiday season, you are sure to begin seeing an uptick in patient visits.
You may want to be on the lookout for the following ailments:

Holiday_ICD_10_Blog_RemitDATA Comparative Analytics

As you close out the books to a successful, though likely challenging 2016 due to ICD-10, we’d like to offer a
happy holiday greeting to all, and best wishes for a prosperous 2017!

Healthcare Consumerism is Shaping Payer/Provider Relationships

Consumers today have it easier than ever before. In this digital age, information is as accessible as the air we breathe. There are apps that help us compare mortgage loans, the cost of a car, even groceries.

Consumers are savvy and are rightfully seeking pricing information from providers – before a service is performed. It’s only natural.

However, the healthcare industry has some obstacles to overcome to achieve this level of transparency, even with the mandates of the Affordable Care Act (ACA). Let’s sum it up with a few quick facts from Public Agenda’s 2015 Report. Did you know:

  • Most Americans are not aware that prices can fluctuate across healthcare providers. 57 percent of insured and 47 percent of uninsured Americans are not aware that physicians might charge different prices for the same services.*
  • 67 percent of those with deductibles between $500 and $3,000, and 74 percent with deductibles higher than $3,000 have sought out price information before getting care.

Despite the obstacles, there is hope.

  • 82 percent of those who have compared prices across multiple providers say they will do so again in the future.

The demand for medical cost transparency has led to many alternative payment models (like bundled payments), which are proving extremely beneficial.  This “82 percent” stat tells us comparative data analytics work and are increasing transparency and collaboration of medical costs like never before. 

These types of changes will ultimately help bottom lines across the industry – making it easier for the patient to make wise budget decisions. Over time, providers would see less payment defaults and payers could monitor and further reduce costs.

So, healthcare industry, what can we do to keep up?

Read the article published by AdvanceWeb to learn more.  

Fall is Football Madness: Make Sure You’ve Got the Right ICD-10 Code for That

ICD-10_Football_RemitDATA_Comparative Analytics

Go…Huskies! Bobcats! Tigers! Or…insert your favorite football team here.

Wherever your allegiance lies, just be sure that when patients begin to flood your lobby with suspicious injuries, conditions or illnesses you’ve got your ICD-10 code book handy to properly treat, code and bill accurately.

Whatever ailments you’re starting to see, many of the above are likely the cause of football – and we’re not talking the friendly game of flag football either.

Happy viewing!

For additional resources and information, visit our Knowledge Center.

Questions and Answers to Seek as you Optimize your Revenue Cycle

There are so many questions to ask in the world of healthcare revenue cycle management. Ask the right questions, and you could find some powerful answers.

How is your business performing?  Do you have the data and insight you need to know if your business performance is specific to your organization or is it impacted by industry wide trends?

In a market where shifting payment models have a direct impact on your business, your patients and your clients, it is critical to know the root causes of your biggest business issues and how they are impacting your bottom line.

Did you know that you can leverage the power of healthcare analytics to identify these inefficiencies and overlay the power of comparative analytics to truly understand how your business compares to your peers in the market?

Once you identify your greatest challenges and how you compare to your peers, you can more quickly resolve these administrative and revenue cycle inefficiencies, and put into action a plan to improve.

The main question of course is where do you get the data to compare yourself against your peers? How accurate is the data and what do you do with the data when it is sitting in front of you?

It sounds overwhelming. The good news is, it is not. That is where we come in.

When you get to Medtrade 2016, come by the RemitDATA booth #1451 and we will show you just how simple it is to leverage your own data to quickly identify inefficiencies, and see how you compare against your peers at the state and national level.

View a short demo and walk away with a $10 iTunes gift card! And you will be entered for a chance to win a $100 American Express gift card.

Looking forward to seeing you in Atlanta!  

Follow the conversation on social media. 

ICD-10: The One-Year Mark, and Preparing for End of Grace Period

Happy anniversary! Or perhaps we should say congratulations for making it through the first year of ICD-10.RemtiDATA_Comparative_Analytics_ICD10_One Year

If your organization reflects what our data is revealing, the past 12 months have likely been relatively uneventful. Taking a look at our data, we are continuing to see a steady decrease in claims processing and payment velocity. Reviewing average processing time from October 2015 through September 2016, we are noting that processing time is down.

And yet, by the time you read this blog, we’ll be well into October, the grace period for getting the correct code will have ended. As you are likely aware, the Centers for Medicare and Medicaid Services (CMS) stated that it will not extend the ICD-10 grace period beyond October 1, announcement released in August.  When ICD-10 went live in 2015, CMS said it would not deny claims as long as healthcare providers used codes in the correct “family” related to the treatment. This is now changing.

Claim denials, already one of the largest areas of lost revenue for healthcare organizations, have even greater potential to impact the bottom line as the grace period ends.

In order to minimize the impact, be sure to benchmark your performance and implement a denials management process, to identify any coding discrepancies or process road blocks.

For additional resources and information, visit our Knowledge Center.

3 tips for orthopedics coding & billing

3 Tips for Coding and Billing Common Orthopedic Procedures:

1) Keep Abreast of Coding Updates

The American Medical Association rolls out a number of changes to its Current Procedural Terminology code set each year.

Changes in 2014, according to Becker’s ASC Review report, included:

Codes related to removal of foreign bodies, prosthesis removal and knee procedures. The new codes include 23333 to 23335, 27415 and 27524. “Code 27415 for open osteochondral allograft, knee, open, is an existing CPT code, which is newly-added to the Medicare ASC list for 2014 with an average Medicare payment of $2,242,” said Stephanie Ellis, RN, CPC, president of Ellis Medical Consulting, in the report. There were also changes made to arthroscopic knee synovectomy codes 29875 and 29876. “Medicare no longer allows either of these codes to be billed when any other arthroscopic procedure is performed on the same knee in the same surgical case, due to strict enforcement of the CCI edits,” said Ms. Ellis. Strict CCI edit enforcement has also extended to include codes involving some arthroscopic shoulder procedures. The AMA is expected to announce the 2015 CPT code change, which will go into effect Jan. 1, 2015.

2) Track and Avoid Common Denials and Reason Codes

Here are the five most common unexpected orthopedics claim denials that occurred from Oct. 19, 2013 to Jan. 16, 2014, according to RemitDATA.

  • CPT code 99213: Outpatient doctor visit, level 3
  • CPT code 20610: Aspiration and/or injections; major joint or bursa
  • CPT code 99203: Outpatient doctor visit, new patient, level 3
  • CPT code 99214: Outpatient doctor visit, level 4
  • CPT code 97110: Therapeutic exercises

The top reason codes for these unexpected denials include:

  • Reason code 45: Charge exceeds fee schedule
  • Reason code 23: Prior payer(s) adjudication affected this payment and/or adjustment
  • Reason code 18: Duplicate claim/service
  • Reason code 59: Processed based on multiple or concurrent procedure rules
  • Reason code 223: Mandated adjustment code when other code not applicable

Track the root causes of common denials and put processes in place to avoid these denials in the future. Three key actions to take to avoid denials, according to a Health Information Services report, include:

  • Diligent insurance verification
  • Accurate patient information collection
  • Selecting an automated billing service

3) Understand ICD-10 Changes

ICD-10 affects every specialty in medicine, including orthopedics. Here are five ICDA-10 changes in orthopedics coding to expect, according to Kareo.

  • Site specificity. Many orthopedics diagnoses will require documentation of specific regions of the body. For example, a diagnosis of spondylosis or spinal stenosis will require physicians to indicate the specific region of the spine.
  • Laterality. ICD-9 codes did not capture laterality, but in the ICD-10 code set physicians must document left, right or bilateral for a number of conditions, such as joint disorders and fractures.
  • Type of encounter. Physicians will need to document with a level of specificity high enough that coders can understand if the encounter was initial, subsequent or sequela.
  • Combination codes. There are not many orthopedic combination codes in ICD-10, but they do exist. For example, M54.4 indicates lumbago with sciatica.
  • Place of occurrence codes. ICD-10’s largest demand is for more specificity. Payers will need to see documentation of where an injury occurred, for example code Y92.250 indicates an injury took place in an art gallery.

help-me-resolve-denials

Happy 90th Anniversary, MGMA!

We are now less than a month away from MGMA. And what better way to celebrate MGMA’s 90th anniversary than in the beautiful city by the Bay.

Let’s think about how far the medical field has come in the past 90 years. We are innovating in areas of medicine, treatments and medical technology at lightning speeds, taking medical care to unprecedented levels.

Innovation is also occurring on the administrative side, and to be more specific, in revenue cycle management. That’s why, at RemitDATA, we believe in the power of comparative analytics.  We innovate and develop comparative data solutions that help healthcare organizations compare their data to industry peers and help create benchmarks to improve revenue cycle performance and reduce medical costs of care.

We are consistently looking for ways to improve these solutions to help payers, providers and billing companies. This is where you come in.

When you get to MGMA, please be sure to stop by booth #1425 to take a quick survey so we can get to know YOU. What keeps you up at night?  And share your biggest business challenges in 2016.

When you stop by and take the survey, you will automatically get a $10 iTunes gift card and you will be entered to win super fun prizes including an Apple Watch, a Drone or a GoPro!

We can’t wait to see you in San Francisco!

Pokemon Go: There’s an ICD-10 Code for That?!

RemitDATA Comparative Analytics ICD-10

 

It’s been all the rage this summer. Unless you’ve been living under a rock, you know what we’re talking about: Pokemon Go, the most successful mobile game ever in the U.S. based on peak daily active users. The busiest day for Pokémon Go in the U.S. was likely July 14, when SurveyMonkey estimated that just over 25 million smartphone users played the game.

The nature of the game, which combines GPS and augmented reality, means providers will see, or have already seen, a growing number of Pokemon Go-related injuries, ranging from broken bones to headaches. As such, providers better be ready to provide the closest corresponding code when submitting claims for payment. And, with the October 1 end of grace period for ICD-10 codes looming, it’s important to get your codes right….or risk having your claim rejected.

These are just a few to consider. Be sure to consult your ICD-10 code book for more specific code needs.

RemitDATA Launches Second Annual Survey at HBMA 2016 Fall Conference

PLANO, Texas, Sept. 20, 2016 /PRNewswire/ — RemitDATA Inc., a pioneer of comparative data analytics technology that brings 360-degree data transparency to the healthcare industry, is launching a second annual survey to highlight the top concerns and challenges of healthcare providers, billing companies and vendors.

Last year’s survey revealed that managing denials to resolution, among other things, was a top business issue. Those results prompted RemitDATA to announce it will launch the new 2016 survey next week – in an effort to continually understand the business priorities and concerns of healthcare organizations.

The annual survey will launch in Atlanta at the Healthcare Billing and Management Association’s 2016 Annual Conference, September 21-23, at the Omni Atlanta Hotel at CNN Center. Attendees can take the survey at RemitDATA’s booth #606 to receive a $10 iTunes gift card and be entered to win an Apple Watch. The drawing will take place at the conference on September 23rd.

For those unable to attend HBMA, the survey will be available online at https://www.surveymonkey.com/r/Fall2016RemitDATA.               

The survey will also be available at the RemitDATA booth #1425 at the MGMA 2016 Annual Conference on October 30November 1 in San Francisco. The survey will close on November 20, 2016.

“The level of interest in last year’s survey results were very promising,” said RemitDATA Chief Technology  Officer, Jim Harter. “Most participants were very curious to see if their peer organizations were experiencing similar issues. The information we were able to collect helped validate and clarify the direction of our development, and ensure we understood our clients beyond secondary data research.”

When complete, the survey data will be aggregated and shared publicly in early 2017. The data from the survey will help providers, billing companies and vendors better understand what issues are shared across the industry and point toward solutions through comparative analytics. 

Harter also remarked, “The goal with this year’s survey is to garner even more insights to ensure we are very mindful of what the industry needs to improve the revenue cycle management process.”

For more information on RemitDATA and its comparative analytics solutions for healthcare organizations, visit the company’s website www.RemitDATA.com.

About RemitDATA
RemitDATA is a healthcare technology company that delivers a comprehensive comparative data and analytics platform. Founded in 2000, with offices in Memphis, TN, Plano, TX and Lexington, KY, RemitDATA strives to bring collaboration and 360-degree data transparency to all entities within the healthcare industry by delivering a range of system agnostic, comparative analytic solutions. Through the use of Application Programming Interfaces (API), benchmarking and peer comparison tools, payers, providers, billing companies and other healthcare organizations will gain actionable insights to better understand their business and improve operations so they can focus on what really matters, to them. For more information, visit www.RemitDATA.com.

Media contact:
Carrie Kelly – Carrie Communications – (919) 308-8771 – carrie@carriecomm.com

The Powerful Combo of BI Solutions and Comparative Analytics

We are lucky to be operating in a world where data and intelligence are readily available…at our fingertips. It makes all of us more accountable, and gives us the ability to deliver reliable results to healthcare organizations looking for ways to be more profitable and more productive.

That said, there are two types of data solutions that can help you define your future:

  1. Business Intelligence Solutions
  2. Comparative Data Solutions.

Although the differences might seem subtle, it is important to understand those differences.  An organization needs to ensure that their BI solution has comparative analytics and/or can align with a comparative analytics solution.

To be clear, Business Intelligence (BI) is a term that encompasses all knowledge we seek – current and historical business data that helps you to achieve a solid outlook.

Comparative analytics takes business intelligence to another level, building upon the concept of BI, taking data a step further by enabling an organization to compare the performance of their data to that of their peers.

Combine the two and… begin to define the future of your organization.

Read the full story to see for yourself.

StarHealth Provider Solutions Partners with RemitDATA

StarHealth will leverage RemitDATA solutions to deliver powerful comparative data analytics resources to customers to optimize revenue cycle.

PLANO, Texas, Aug. 16, 2016 /PRNewswire/ — RemitDATA Inc., a pioneer of comparative data analytics technology bringing 360-degree data transparency to the healthcare industry, announces a new partnership with StarHealth Provider Solutions to power an innovative comparative data analytics tool, ClaimACT.

ClaimACT is designed to guide StarHealth’s Accounts Receivable (AR) customers to greater transparency through healthcare comparative analytics and benchmarking capabilities. These customers will have the ability to obtain key operational and financial performance insights with the support of StarHealth’s revenue cycle management team. 

StarHealth Provider Solutions deliver consolidated services that help healthcare organizations improve processes, reduce costs and improve cash flow. Through this partnership, StarHealth will access RemitDATA’s SaaS-based solutions leveraging ANSI 835 Electronic Remittance Advice data. StarHealth’s customers can access revenue cycle data – compare and trend payment history, monitor denials, create KPIs and benchmarks – to better run their practice.

“We believe that healthcare comparative analytics can help providers and billing companies better understand their bottom line and address issues that have the greatest impact on their revenue cycle.  We are excited to partner with StarHealth so that more organizations are able to make a difference for themselves and their patients,” said Dave Ellett, CEO of RemitDATA.

In addition, StarHealth will use RemitDATA’s revenue cycle solutions to monitor and optimize business performance internally, across their entire customer base.

“RemitDATA’s solutions allow us an expanded level of transparency into our customers’ data, giving us the ability to better address the needs of our clients and help our own internal processes,” said CEO of StarHealth Provider Solutions, Christopher Hettich. “We plan to roll this solution out to our customers and adjust internal processes to account for these additional insights.  We also see an opportunity to better help our clients with recruiting and performance management through analytics. We are excited about the opportunity this solution provides our customers.”

About StarHealth Provider Solutions
StarHealth Provider Solutions, LLC provides revenue cycle solutions that help healthcare providers and healthcare organizations improve processes, reduce costs and improve cash flow.  Additionally, StarHealth’s Business Management services allow Physicians, Dentists and other healthcare providers to focus 100% on patient care. StarHealth focuses on the business and administrative tasks of operating a healthcare business so the Healthcare Professionals can focus on their patients. For more information visit, www.starhealthsolutions.com.

About RemitDATA
RemitDATA is a healthcare technology company that delivers a comprehensive comparative data and analytics platform. Founded in 2000, with offices in Memphis, TN, Plano, TX and Lexington, KY, RemitDATA strives to bring collaboration and 360-degree data transparency to all entities within the healthcare industry by delivering a range of system agnostic, comparative analytic solutions. Through the use of Application Programming Interfaces (API), benchmarking and peer comparison tools, payers, providers, billing companies and other healthcare companies will gain actionable insights to better understand their business and improve operations so they can focus on what really matters, to them. For more information, visit www.RemitDATA.com.

Media contact:
Carrie Kelly – Carrie Communications – (919) 308-8771 – carrie@carriecomm.com

 

Denials Management: How to Create an Action Plan with Comparative Analytics

Does your denial management plan provide you the necessary data to work through the root cause?

Author: Amber Civitarese & Stacie Bon

It’s a common problem seen in practices nationwide: the billing department sees an uptick in denials. The billing manager expresses concern to the clinic manager, who provides what he or she feels is the root cause for these denials. The billing manager chases down what they believe is the solution, only to realize months later that what they “thought” was causing the bulk of denials is in fact only a minor issue and not the driving reason at all. Their “root cause” was based on guesswork, and the reason for the high denials remains a mystery.

Claim denials are one of the largest areas of lost revenue for healthcare organizations. Nationally, U.S. hospitals lost approximately $42.8 billion in uncompensated care – care provided for which no payment is received – in 2014, according to Health Forum, AHA Annual Survey Data, 1990-2014, January 2016 update.

Implementing a denial management process

The first step in implementing a denial management process is to assess the causes and evaluate trends in denials. For example, perhaps claims sent to a specific insurer are frequently denied, or a particular diagnosis code is causing a high denial rate.

To get to the root cause of denial issues, practices need to implement a denial management process that leverages comparative data to reveal the true reasons for denials. Key points to consider include:

  • Managing high-cost claims associated with high dollar procedures
  • Evaluating time spent on high-volume denials, including reworked claims that per claim are not expensive, but drain resources while working to resolve
  • Identify hidden cost denials – billing for procedures that the practice expects to be denied and will never appeal the denial, and as a result, consistently inflate their A/R
  • The ability to identify trends in payer denials, including implementing a simple method for tracking and monitoring payer denials
  • Implementing a simple process for sharing payer denial trends data with your payer provider rep to resolve denials that may be occurring due to incorrect processing on the payer side

Leveraging healthcare comparative data can help you establish benchmarks and baseline standards needed to create a denial management plan. Comparative analytics can track denial trends to identify problem areas and develop corrective actions. For example: are claims being submitted with the correct code? Is the front office staff billing properly? Without good data, any potential resolutions are based solely on guesswork.

Here is a step-by-step guide that can be useful in implementing a denial management plan:

Step 1:  Identify claims that are taking longer to be paid due to an increase in denials.

Step 2:  Compare the denial rate year over year.

Step 3:  Trend denials by reason code and specialty compared to state and national averages. For example, if top denials are all related to eligibility, work with staff to determine what part of the process is breaking down.  Confirm employees are checking eligibility during patient registration or prior to. Depending on your process, your practice might benefit from purchasing a tool to assist in automated eligibility checks.

Step 4:  Evaluate high volume or high dollar procedures, evaluating key areas such as length of time to process a claim, whether or not that time is increasing, and how it compares to state and national averages.  After evaluating the data, if you find delays in getting claims posted in the PM system, look at other business processes to determine reasons for the delays.

Step 5:  Check the average time it takes for payers to process your claims.  If the average time is increasing, review your data against state and national averages to determine if others are experiencing the same spike. 

Step 6:  Prioritize issues based on the greatest ROI and review workflow to ensure best practices are implemented and followed. 

And, on an ongoing basis:

  • Make denials management a team effort between your billing departments, front desk and coders/physicians.
  • Ensure your team is communicating clearly, and work with the front line staff to help them manage denials by providing them with relevant data to help manage denials.
  • Be sure your billing department is approaching the front desk and coders with an action plan that contains relevant data and identifies next steps.
  • Schedule a meeting, create a joint solution and monitor the outcome as a cohesive team.

While the reasons for claim denials can vary, being proactive in implementing a claim denials management process that leverages actual data instead of guesswork can save your practice millions of dollars in otherwise lost revenue.

This Article was first published in Billing, the Journal of the Healthcare Billing and Management Association, Vol. 21, May 2016.

ICD-10: June Year-Over-Year Report

While we presented the mid-year report card which included June 2016 data based on date of service, we thought it ICD-10 Healthcare Comparative Analytics - Request more info
would be interesting to compare June 2016 with stats from one year ago, based on check date. This will illustrate
how the industry is doing based on claims processed in June. Here’s what we found:

In almost every category – from DME to procedures and imaging – the denial rates were down from June 2015.
July_2016_ICD_Service_level_RemitDATA_Comparative Analytics

Processing time: this category was especially of interest, as our data is reflecting an overall reduction in staff processing time.
Payers are processing claims 3 days slower this year than in 2015, but staff processing time is 5 days faster.
In almost every category – from DME to procedures and imaging – the denial rates were down from June 2015.      
July_2016_ICD_processing_RemitDATA_Comparative Analytics

Remittance velocity: Another interesting find, in that claims are being paid faster during June 2016 than during June 2015
– with only 16.3% reaching into the 61+ category.
July_2016_ICD_remittance_RemitDATA_Comparative Analytics

The data continues to be of interest, as one would assume ICD-10 to slow things down.
But, important to note that the year isn’t over yet and claims are still rolling in.
We’ll continue to monitor the data, check back again soon.

 

Revenue Cycle Management is a Top Challenge for Healthcare Practices

Data is our business. Well, it’s the focal point of our business. We believe data, whether primary research focused, aggregated or anecdotal helps any business make empowered business decisions.

Naturally, we look to data to inform our own business, which is why the survey we conducted among providers, RCM companies and healthcare vendors was so beneficial.

From that survey, we were able to aggregate and report some key findings on the four biggest concerns among healthcare organizations. For example, nearly half of providers (41 percent) cited acquiring new patients and competition as a top concern. More than 50 percent of RCM companies and vendors reported acquiring new customers as a top challenge.

Want to know more? Becker’s Hospital CFO published an article on these key findings from our survey. To learn more, click here.

NEW Claim Level Detail Reports in TITAN

It is a common practice among health plans to review claim level detail when working with 835 data. Providers can now get this same level of information straight from the 835 file, and get a complete view of claim level detail and related adjudication information.

We are proud to announce that this new capability is now available in TITAN!

Here is the low down:

Currently in TITAN, all metrics are based on service line detail. With the addition of claim level detail, you now have access to more metrics along with the service line information you have become accustom to monitoring.

New Reports Based on 835 Metrics include: 

  • Average Claim Processing Time Analysis: Analyze claim counts vs. service line counts to track patterns and reveal issuesClaim Average Processing Time Analysis
  • Claim Denial Analysis – Identify and track denial trends at the claim levelClaim Denial AnalysisClaim Denail Analysis 2
  • Claim Dollar Overview – Determine which payers have the highest or lowest billed amount per claimClaim Dollar Review

These new claim level reports give you access to the following features.

  • New filters including: claim status and claim filing indicator
  • New query logic, such as claim status, enables more clarity and insights
  • Expanded comparative capabilities via 835 database
  • Review overall claim volume and/or dollar totalsReview Your Overall Totals
  • Analyze claim status breakdown by payer
    Analyze a breakdown by Payer
  • View a report of service claim details with service line detailsSee Claim Level Details from the 835 combined with the service line details

If you are a TITAN user, we encourage you to contact us with any questions you might have.

If you are not currently using TITAN, click here so we can show you how healthcare comparative data could help improve your revenue cycle.

RemitDATA’s New Knowledge Center: Tools to Help Solve Your Business Challenges

As a medical practice, chances are you’ve experienced spikes in certain claim denials with very little insight into the root cause. Right?

As a billing company, perhaps your clients need you to pull reimbursement tracking information TODAY, but your systems can’t pull it quickly enough to satisfy. Been there?

And Payers, is it possible that quick data insights might help you better control costs more accurately during the pre-authorization phase – so you have the wherewithal to inform in network surgeons about the huge cost variances within their contracted facilities – redirect surgeons and help your members  lower costs, at high quality locations?

From managing claim denials to navigating the Affordable Care Act, payers, providers, and billing companies alike need help navigating the healthcare ecosystem to ensure a healthy bottom line.

RemitDATA is responding to your needs with information and news you can use. Our new Knowledge Center gives you access to case studies, videos, white papers, webinars, podcasts and more. Access these resources  to better understand how your peers are solving some of their business challenges and how you can do the same.

You’ll find:

  • Use cases from current TITAN users, who share their challenges and solutions to help save time, reduce frustration and improve business operations.
  • Best practices and tips through white papers, webinars, podcasts, and videos.
  • Valuable insights and data from RemitDATA experts.
  • And other critical information.

For access, visit www.remitdata.com/knowledge-center.

ICD-10: 2016 Mid-Year Report

Good news on the ICD-10 front, the data continues to reveal a decrease in claims processing and payment times.

At the mid-year mark, our data is reflecting a steady decrease in claims processing and payment velocity. Reviewing average processing time from January 2016 through mid-June 2016, we are noting that:

  • Average staff processing time has shown a steady decrease during the year, with average staff processing time in January of 17 days to an average of 8 days in May.
  • Average payer processing time has decreased throughout the year, with an average of 15 days in January to 12 days in May.
  • Total claims processing time was reduced by nearly 60%, with total processing time of 32 days in January to 12 days in June.

 Processing Time ICD-10 June Blog

Payment velocity data also reveals excellent news for providers: as of June, our data is reflecting that on average nearly 80% of all claims are being paid within 30 days.

Remittance Velocity ICD-10 Blog June

However, denial rates are holding relatively steady. June denial rates are 1% less than January.

Denial Rate ICD-10 Blog June

It’s important to note that claims are still rolling in, especially for May and June, so the numbers may vary, though we don’t expect any major changes. As we move closer to October 2016, when the expected grace period for specificity on ICD-10 codes ends, will the data show huge shifts? Or, will we see the data continue to stay steady?

We will continue to monitor the data as October approaches. Stay tuned.

Get Started Today

ICD-10 Update – Read all about it in ADVANCE

What’s the real story with the ICD-10 rollout?

We took a snapshot of the data over the past six months (Oct. 1, 2015 – March 31, 2016) and compared to the same six-month period from a year ago (Oct. 1, 2014 – March 31, 2015). What we found was that overall, all continues to be quiet with no major issues on the ICD-10 front. But the story that isn’t being told is that denial rates and processing times are down, and claims are getting out the door faster – which we would chalk up to being an overall improvement post-ICD-10.

Check out our results in today’s ADVANCE online.

Healthcare Costs Are Still Rising. Let’s Figure Out Why.

We are halfway into 2016, and the U.S. healthcare expenditure estimates continue to climb beyond $3 trillion. That’s trillion with a “t.” How many zeros is that?

In our relentless journey as an industry to solve this growing number, we did our own investigating to see what we could learn. So, we listened again to some insightful information from our own Brad Hill in a podcast recorded at this year’s HIMSS conference.

To set the stage, the podcast opens with this very question: “Why are healthcare expenditures in the U.S. so astronomical, especially compared to other industries?”

Brad began his conversation with some interesting insights, one of which includes the fact that this is the only industry where consumers actually accept paying for services without the ability to shop around, compare costs and make informed financial decisions. With health being such an important component of our lives, healthcare costs can vary up to 400% between providers! That makes the revenue cycle process all kinds of complicated for everyone.

This was only one small point Brad made in this interview.  Have a quick listen to the full podcast and let us know what YOU think, and let’s keep working to figure out how we can help drive change.

Get Started Today

 

Is Your State Making Patients Pay More Out of Pocket?

Every quarter, we have made it a mission to review the data that flows through RemitDATA_Physicians_practice_May 2016
our solutions to reveal the latest insights around revenue cycle management for healthcare organizations.

In Q1, we did a study on the average amounts, by state, that patients are paying out of pocket for services. Interestingly enough, this information can help the way you modify processes within the revenue cycle and how you evaluate your processes for collecting patient funds.

For instance, did you know that 72.4% of the time a routine venipuncture lab test has one of the highest out of pocket costs for patients?

Check out all our findings in this infographic featured on Physicians Practice.

ICD-10 Healthcare Comparative Analytics - Request more info

Revenue Cycle Services: Put your data to work for you and your clients

Request More Information on Revenue Cycle ServicesRevenue Cycle Services

 

It’s no surprise that more ambulatory practices are outsourcing their billing and collection processes due to complex regulations and changing payment models that make it more difficult than ever to get paid. Read the complete white paper.




 

ICD-10 Watch

Based on recent ICD-10 data from our ICD-10 Resource Center, Carl Natale, Editor of ICD10 Watch shares some fascinating insights on the current trends we’re seeing with denial rates! And, it’s pretty interesting information.

We frequently share this kind of data that Carl has written about with our subscribers, share your information below and stay informed about the latest data analysis trends for healthcare denials! 

 

Leveraging Comparative Analytics

Helping payers control healthcare costs through greater transparency

Payers who believe big data provides all the answers they need to establish competitive pricing are only getting half the picture. Comparative analytics take big data to a new level, allowing payers to achieve reduced costs by providing pricing transparency.

Many organizations believe they already have an analytics solution. However, the missing piece is often the comparative component. Comparative analytics offer the ability to help lower the medical cost of care, enhance member engagement and reduce administrative costs. As a result, payers have the data they need to help reduce their medical cost of healthcare by enabling their members to compare pricing in the ever-changing healthcare services market-delivering information that patients otherwise would not have. 

Click here to read more. 

ICD-10: The 6 Month Mark

ICD-10 Healthcare Comparative Analytics - Request more infoICD-10 Claim Denials Management

Here we are, six months into the ICD-10 conversion.

While the headlines continue to trumpet “all is quiet” what is the real story?

We thought it would be interesting to take a look at this six-month period and compare it to a year ago. Below is a snapshot of our data for the last six months (Oct. 1, 2015 – March 31, 2016), which we compared to the same six-month period from the previous year (Oct. 1, 2014 – March 31, 2015) – the results are quite interesting:

  • By Type of Service Level I, denial rates appear to be down slightly.
  • Processing times are down.
  • And claims appear to be getting paid faster.

What we can conclude is that yes – all continues to be quiet with no major issues on the ICD-10 front. But the story that isn’t being told is that denial rates and processing times are down, and claims are getting out the door faster – which we would chalk up to being an overall improvement post-ICD-10.

What remains to be seen is how those may or may not change in October 2016, when the grace period ends. Stay tuned!
RemitDATA_Healthcare Comparative Analytics_ICD-10

 

 

ICD10_April2016_Processing_time_updated

ICD10_April2016_Remittance_Velocity_RemitDATA_Healthcare      

 

 

 

 

Coming Soon: TITAN Filter Library is becoming Report Controls

Easily create healthcare denial and analysis reportsThe Filter Library – located on the left side-panel – will now be the Report Controls.   The Report Controls Center is more comprehensive and houses both the Report Lens and the Filter Library.

The new design will simplify the user experience and save time.

  • The user will be able to select all criteria at once versus making one selection at a time.
  • All controls and filters will be centralized to one location.
TITAN_Report_Lens_Updated_RemitDATA

In addition, users will experience the following updates in the new design:

The Apply Button, will now be Apply Selections.

  • The Apply button will be relocated to the top of Report Controls section and renamed Apply Selections.
  • As with the previous Apply button, Apply Selections will only be active when a change is made within the Report Controls.  This includes any change to Dimension, Date Type, Timeframe or Frequency – in addition to any added filters. 
  • Once selected, Apply Selections will retrieve the chosen criteria and refresh the report data.

Filter Sets

  • Apply Saved Filter Set will still immediately apply the saved filter criteria and refresh the report data.
  • Clear All Filters will be removed from the Apply Saved Filter Set wrench and made its own button.  It will remain inactive until filters have been added or applied.
  • Selecting Clear All Filters will remove the filter criteria but not refresh the report data until Apply Selections has been selected.
  • Selecting Clear All Filters will not refresh the Filter Category filter counts until Apply Selections is selected.

 



 

Fear a RAC audit? Reduce your risk with comparative analytics

If the words “audit” make you break out in a cold sweat, we have good news. You can minimize your risk for a RAC audit by being proactive, knowing what can trigger an audit, knowing what the market is looking for, and digging into your organization’s data and comparing it to your peers to see if you are an outlier. Leveraging comparative analytics is the best place to start.

The best place to begin is with research of your internal data to determine what may trigger an audit. Research and identify ways to increase the transparency of your historical claims data. Comparative analytics can help you analyze large amounts of data to pinpoint potential problems so corrective action and preventative action can be prioritized based on risk.

To learn more about using comparative analytics to help reduce your chance of an RAC audit, check out our article in ADVANCE for Health Information Professionals, or contact us!

Request a Demo - Revenue Cycle Management

Revenue Cycle Management: What to Consider as You Prepare for Alternative Payment Models

Revenue Cycle Management

Ensure you have clear insight into your practice’s financial picture

The healthcare payments shift away from fee for service to value-based payment models are showing great promise. However, to adopt these new payment models, providers need to take a close look at their businesses, beyond just looking at the bottom line. The best way to obtain a complete financial picture is through comparative analytics. Quality data can help uncover information such as which costs can be controlled, which payers have the highest denials, which claims are being rejected altogether, and other valuable insights.

To best prepare for shifting payment models, practices need to have a clear understanding of their financial picture, and consider the impact an emerging payment model agreement will have on your practice.  

The American Medical Association’s “Evaluating and Negotiating Emerging Payment Options” (2012) provides some practical tips and resources that practices should consider as they evaluate proposals, negotiate agreements and manage the revenue cycle associated with a specific payment model. Robert Barbour’s chapter, “How to establish baseline costs,” offers some excellent recommendations and steps on where to begin.

Points to consider:

  • Establish baseline costs and know your true costs of conducting business. As you consider risk-based payment models, your practice may require more sophisticated accounting practices than are required under fee-for-service. Be sure to calculate your true cost of doing business as your baseline for assuming risk.
  • Analyze your practice’s revenue cycle. Analyze service costs and reimbursements for each, to determine if you are in-line with your peers.
  • By payer, determine whether there are issues in reimbursement for specific payers or if the problem is broader in nature. For example: was there a sudden drop-off in payments from a specific payer? Looking at the data can help solve that mystery.
  • Capture data analysis for practice improvement. With emerging payment models, practices not only will need staff with expertise in evaluating data, but also with knowledge in how to make business adjustments necessary to keep the practice profitable. For example, if your costs are exceeding your reimbursements, you’ll need data to prove to payers that your costs cannot be further reduced, reporting that proves your practice is meeting quality and outcome requirements, and potentially reasons for cost discrepancies in what the payer is willing to pay, and what your practice can accept.

Healthcare comparative analytics can help analyze your practice’s financial health by providing insights into how your practice compares to your peers. Do you have a higher percentage of denied claims for a specific service than your peers? Ensuring your business finances are in-line will help ensure success for new payment models. As you consider alternative payment models presented to your practice by payers, take a close look at each, and compare with your revenue cycle to determine whether you can afford to participate in a specific payment program.

 

 

Alternative Payment Models: What’s Next?

RemitDATA_Alternative_payment_infographicWe hear story after story about patients receiving financially devastating medical bills. If only they knew how much the cost of a procedure can vary, perhaps they could make a more informed decision.

Unfortunately, it’s not that simple. Part of the problem has been traditional fee for service pricing models. Factor in complex payer/provider contract rates and little transparency or consistency from patient to patient, and you have a recipe for potential financial disaster.

With the Affordable Care Act targeting how healthcare is organized, delivered, and paid for, alternative payment models are taking shape – including bundled pricing. As payers begin to invest in implementing more bundled payment initiatives, comparative analytics can help guide them toward the greatest opportunities to impact cost of care.   By examining historical claims data, payers can identify their highest volume and highest cost procedures (grouped by episode of care) to establish actual prices. By applying these pricing methodologies, payers can reduce costs with a consumer-driven model that focuses on value-based choices.

The need for Alternative Payment Models

  • Bundled pricing shows great promise
  • Minimize sticker shock
  • Give members transparency around true costs

Factors to consider around Alternative Payment Models

  • Provider willingness to embrace risk/reward models
  • Ability for providers to collaborate amongst themselves & effectively manage payment distribution for episodes of care in a coordinated fashion
  • The alignment of plan benefit designs that encourage members to use providers in bundled payment arrangements. 

Alternative payment models allow for bundled pricing models that can drive significant change in the industry through a lower cost of care and improved outcomes!

Learn more about the future of alternative payment models and what is in store on EMR & EHR’s website. 

 

How can our data, combined with yours, help you evaluate Alternative Payment Models?

Request a demo and we can show you the power available in big data reporting and comparative analytics! 

 

ICD-10: A Look at Payer Processing Time

As we keep an eye on what the data is revealing, this month we’ll take a look at how payers are doing since the transition to ICD-10.

Our data is showing the national average for payer processing time is 13 days. State-by-state, our data is showing:

  • 18 states have payers with processing times longer than the national average
  • 20 states that are equal to the national average
  • 12 states have payers with processing times shorter than the national average
RemitDATA_ICD-10_March Blog_Payer_Processing_Time_Map

As we examine denial rates, we are definitely seeing an upward tick in denials across the board between mid-January 2016 and mid-March 2016. Payers also are beginning to take longer to pay claims, as the data reveals below for each:

RemitDATA_ICD-10_March Blog_Comparative Analytics_Denial Rates

Evaluating Payment Velocity for Q4 2015

RemitDATA_ICD-10_March Blog_Comparative Analytics_Remittance Velocity

Be sure to check back in April, as we will look at Q1 2016 compared to Q4 2015 statistics.

 

 

 

Comparative Analytics

Helping health systems and physician practices optimize performance with ICD-10

Analyze Your Revenue Cycle Management Data in One Place, Quickly and Simply

  • Reduce time spent searching for data
  • Organize data the way you want to see it, based on your role
  • Intuitive revenue cycle analytics solution highlights opportunities in minutes
  • Create benchmarks based on state and national comparison data
  • Prioritize improvement initiatives based on maximum ROI

Do you have the solutions today to answer these questions and to benchmark yourself against your peers, by specialty, both state and nationally?

  • Are you getting more denials from a specific payer?
  • Is your staff’s productivity better or worse than others?
  • Do you know which payers are taking longer to pay you?
  • Are your coding practices making you an outlier and subject to audit risks?

Comparative Your Data Now

Upon receiving client data, 10 days from implementation to dashboard access

State and National Data Compare

 

Proactive Alert Notifications

 

Increase Productivity

 

Determine Root Cause of Data Trends

 

Reducing RAC Audits

Comparative analytics can help healthcare providers minimize the risk for audit and better understand market demands.

The threat of a RAC audit strikes fear in most provider organizations.

Although there was a temporary lull in RAC activity during 2014 and 2015 while the Centers for Medicare & Medicaid (CMS) procured new contractors, the program restarted in November 2015, making now the ideal time for provider organizations to take proactive steps to help reduce their audit risks.

Minimizing Risk: Begin with Research

While there are numerous factors that can trigger RAC audits, organizations can mitigate their risks by conducting research to determine what may trigger an audit.

Research your internal data and identify ways to increase the transparency of your historical claims data through the use of comparative analytics.

Comparative analytics help healthcare organizations analyze large amounts of data to pinpoint potential problems so corrective action and preventative action (CAPA) can be prioritized based on risk.

Provider organizations can use comparative analytics to determine if they are consistently coding for higher-levels of reimbursement than their peers.

For example, in the use of existing patient E&M codes, are your physicians coding more 99214 and 99215 than their peers in the same specialty?

Do you know how your specialty compares?

Procedure Code Utilization for Q4 2015

Procedure Code

All Specialties

National Average

Internal Medicine

National Average

99211

1.8%

3.4%

99212

5.7%

2.7%

99213

48.6%

41.3%

99214

40.9%

48.9%

99215

3.0%

3.7%

Another area to keep an eye on is the use of modifiers 25, 50 and 59. These codes improve reimbursement on a given claim.

However, high use of these codes compared to your peers can increase your risk of an audit. A few examples are:

  • Modifier 25: “Significant, separately identifiable evaluation and management (E/M) service by the same physician on the day of a procedure.”
  • Modifier 59: “Distinct procedural service identifies procedures/service not normally reported together, but appropriately billable under the circumstances.”
  • Facet joint injections and the use of modifier 50

Modifier Utilization for Q4 2015

Modifier

Variance between Internal Medicine and All Specialties

25

13%

50

1%

59

8%

Some denial types and errors are more prone to trigger audits, so using comparative analytics to identify these denials and implement CAPA can help reduce your risk. A few areas to monitor are:

  • Duplicate claims and payments
  • Medical necessity mistakes
  • Place of service coding errors – The OIG has indicated that the Medicare program will be taking a closer look at Part B claims that can be performed in multiple locations, since physicians earn higher reimbursement when the service is performed in their office versus a hospital.

If you are unsure about which areas you need to monitor, the following sources produced by government entities provide insight into areas in which auditors are actively looking for outliers and errors. These sources include:

  • The Office of the Inspector General (OIG) Work Plan, which is published annually and lists the agency’s focus areas that will trigger audits.
  • The Medicare Learning Network Quarterly Provider Compliance Newsletter, which lists findings from RAC audits.

Additionally, access the RAC website for your region and gather any information it lists about RAC findings and areas of focus

Summed up, to minimize risk for for audit, know what the market is looking for, and compare your data to your peers to see if you are an outlier. Taking a proactive approach gives provider organizations greater control over their revenue cycle, compliance efforts, and their futures.

As seen in ADVANCE for Health Information Professionals.

RemitDATA Reveals Top Business Concerns Facing Healthcare

Survey reveals market shifts like new payment models and ICD-10 among top business concerns

PLANO, Texas — Healthcare data analytics can inform and guide organizations to help them plan for and overcome primary business issues in today’s complex healthcare environment, according to a survey of health care providers, billing companies and vendors conducted by RemitDATA Inc.

RemitDATA, a pioneer of comparative data analytics technology that brings 360-degree data transparency to the healthcare industry, conducted the recent survey to gauge what is truly important to these organizations in today’s complex healthcare environment.

The survey revealed that managing denials to resolution is the top business issue providers and RCM companies are facing. For vendors, keeping up with government mandates and regulations was the number one issue, followed closely by benchmarking revenue cycle data against external data. The survey further showed that most of the leading business concerns could be identified and managed through the application of comparative data analytics.

“We launched this survey to get a fresh perspective on the greatest business issues facing healthcare today in an effort to continue evolving our solutions based on market needs. Technology is intended to make it easier for stakeholders to navigate the complexities of today’s healthcare environment and we want our solutions to make a difference,” said Aaron Hood, VP of Marketing and Product Management.

Survey respondents were a diverse mix of providers, healthcare vendors and billing companies, representing a wide range of specialties, including nearly 40 different areas from family practice to orthopedic surgery. Each works with a payer mix, including government plans (Medicare, Medicaid, Tricare), commercial payers and worker’s compensation.

Chief concerns among respondents were identified in the survey. Respondents are concerned with improving visibility into their business through better healthcare data analytics, the ability to manage claims denials to resolution, acquiring new patients or clients, and the ability to navigate the impact of ICD-10. When it comes to revenue cycle solutions, respondents expressed interest in comparing internal data with external sources, workflow and data analytics, staff productivity, the ability to trend data, and the ability to view data in a single solution.

For more information on the survey, RemitDATA and its comparative analytics solutions for healthcare organizations, visit http://remitdata.com/resource/navigating-todays-healthcare-ecosystem/ or visit us at booth #3860 at HIMSS 2016, February 29March 4 in Las Vegas.

The Need for Healthcare Transformation is Upon Us

We are at the eve of HIMSS 2016 and this year, the theme, Transforming Health through IT is more relevant than ever.

As a SaaS-based provider of healthcare comparative data analytics, transforming health through technology is what we live by. We do this by listening to our customers and understanding the ever-changing market at its very core.

So, as we head to HIMSS 2016, we are very excited to share the results of a recent survey we conducted with healthcare providers, billing companies and vendors to capture and gauge their needs today.

The survey revealed that market shifts like new payment models and ICD-10 are among top business concerns, and most are looking for ways to address these changes with technology to help simplify the transition, to identify issues causing the biggest impact – all in an effort to minimize and reduce claim denials.

The information gleaned from respondents enables us and other healthcare IT solution providers, to better understand their true pain points and allows us to evolve our solutions based on market needs and continue to transform healthcare through IT.

While you are at HIMSS 2016, please come visit us at booth #3860 to learn more about these survey results and how healthcare comparative analytics can help your business.

Be sure to check out our new online resources:

  • ICD-10 Resource Center: Follow the latest trends, see varied results, hear how others are affected and dealing with the changes of ICD-10
  • Compare Your Data: See denial rates by specialty in your state and how they compare nationally. How do you compare?

See you in Las Vegas!

Request a Demo - Revenue Cycle Management

ICD-10: The Data is Showing Some Change, Now 4 Months In

As we continue our journey post-ICD-10 conversion, while it’s important to note that it’s still early in the game with many claims still outstanding, we are starting to see some change in claims processing times.

According to our data, the national average for staff processing time is 15 days, and 11 days for payer processing time, which echoes the industry buzz. There is also talk about the difficulties coders are experiencing getting claims out the door as they adjust to the thousands of new codes associated with ICD-10.

Taking a state-by-state look at processing time, approximately 1/5 of the country is meeting the national average for processing time, with a nearly even split among those states taking longer to process vs. processing faster. Our data is revealing that approximately:

  • 18 states are taking longer than the national average of 15 days to process claims
  • 10 states are on par with the national average
  • 22 states are processing claims faster than the national average
RemitDATA_Healthcare_Compartive_Analytics_Feb_ICD-10_Blog

As we examine denial rates, we are beginning to see an upward tick in denials between mid-January 2016 and mid-February 2016, as follows:

RemitDATA_Healthcare_Compartive_Analytics_Feb_ICD-10_Blog1

With respect to payment velocity, we also are beginning to see payments slowing down, per category, as follows:

RemitDATA_Healthcare_Compartive_Analytics_Feb_ICD-10_Blog2

With a few changes in data this month, it will be interesting to see what March data reveals, stay tuned for additional information next month.

 

Lower your ICD 10 denials - request a demo with your data!



 

 

Medtrade Spring 2016

The last Medtrade event was only 25 days after the transition to ICD-10. Since then, most of us have been working tirelessly to stay ahead of the aftermath: claim denials, denials to resolution, to name a few.

Although the long term effects and benefits of ICD-10 are still unfolding, we have kept a close eye on the market since October, and slowly, we have started to uncover small glimpses of change in areas of overall productivity. We are using our own comprehensive data analytics to show claim denial rates in each state to help you better understand how the market is performing, visit our new ICD-10 Resource Center.

So what does this mean to you? In a market where shifting payment models have a direct impact on business, patients and clients, it is critical to know how you compare so you can identify inefficiencies in administration and revenue cycle management. 

When you get to Medtrade Spring 2016, come by the RemitDATA booth #141 to let us show you how you compare and you could WIN a $100 Amex gift card.

Looking forward to seeing you on March 1!

RemitDATA Teams with CliftonLarsonAllen

CliftonLarsonAllen will leverage RemitDATA solutions to gain deeper insight into the revenue cycle performance of its healthcare customer base.

PLANO, Texas, Feb. 18, 2016 /PRNewswire/ — RemitDATA Inc., a pioneer of comparative data analytics technology bringing 360-degree data transparency to the healthcare industry, announces it will work with leading professional services firm CliftonLarsonAllen LLP (CLA).

CLA is a leading professional services firm, with more than 4,500 professionals including more than 1,800 CPAs in nearly 100 locations across the United States. CLA uses RemitDATA’s industry leading comparative data and analytics solutions to better identify and solve their healthcare clients’ revenue cycle challenges, and in some cases, encourages them to leverage RemitDATA’s comparative analytics solutions in-house.

“We are excited to join forces with CLA and to give the professional services industry access to comparative data analytics. As an organization focusing on public accounting and consulting, it is able to provide its customers increased insight into their revenue cycle process – from identifying ICD-10 related denial issues to improving the revenue cycle health of its client base – to help it gain a deeper understanding of how it compares to its peers in the marketplace,” said Dave Ellett, CEO of RemitDATA. “CLA’s combined professional expertise with our comparative data analytics allows it to deliver superior, dedicated healthcare solutions to the industry.”

“RemitDATA’s solutions allow us to have a better understanding of the revenue cycle process relating to physician practices across our entire healthcare portfolio,” said CLA consulting manager Anthony Werner. “Adding the RemitDATA benchmarking and analytics to our deep industry specialization and seamless, integrated capabilities, we are able to dig deeper into each customer’s claims data to identify the root cause of business issues, helping us to drive improvements in their revenue cycle performance.”

About CliftonLarsonAllen
CLA is a professional services firm delivering integrated wealth advisory, outsourcing, and public accounting capabilities to help enhance clients’ enterprise value and assist them in growing and managing their related personal assets — all the way from startup to succession and beyond. Our professionals are immersed in the industries they serve and have specialized knowledge of their operating and regulatory environments. With more than 4,500 people, nearly 100 U.S. locations, and a global affiliation, we bring a wide array of solutions to help clients in all markets, foreign and domestic. For more information, visit CLAconnect.com. Investment advisory services are offered through CliftonLarsonAllen Wealth Advisors, LLC, an SEC-registered investment advisor.

MGMA 2016 Annual Conference: Oct 30-Nov 2, San Francisco

The MGMA 2016 Annual Conference brings together managers, administrators, chief executive officers and chief operating officers from various specialties and practice sizes who are looking for products and services like yours to help improve their practice operations.

Date of Event: October 30-Nov 2, 2016
Location: Moscone Center, San Francisco, CA
RemitDATA Event Contact: Stacie Bon, Senior Director of Marketing (Marketing@RemitDATA.com)

Click here to visit event website.

 

Thank you for attending!

MGMA 2016 Annual Conference

We hope that you were able to interact with medical practice executives, administrators, physicians, vendors, industry experts and speakers to share your challenges and discover the right benchmarks, operational improvements, quality measures and solutions necessary to become and remain an MGMA high-performing practice.
 

Extend your MGMA16 learning experience with recorded sessions

If you missed an educational session during conference, they are now available to be viewed online. Additionally, you can take exams and apply them to your professional license with AAPC or CEU. CMPEs and FACMPEs can earn ACMPE credit by simply watching the educational sessions and submitting it to the ACMPE transcript.

Attendees can view unlimited online sessions and take five exams toward continuing education credits, at no charge, for 60 days. Additional exams are available for purchase.

You will be prompted to log in prior to viewing the complimentary sessions and exams.

View Sessions & Exams

Learn how to apply these credits to your certification.

Didn’t attend conference?
These sessions and exams are available for purchase. Learn more.

Continuing education credit

Registered MGMA 2016 Annual Conference attendees can earn ACMPE, AAPC, CPE and CEU credits for having attended conference sessions. Learn how.
 

Mobile app

The MGMA16 mobile application is still available for your use. Please navigate the app to access your conference materials and notes.

Session handouts

View the session from MGMA16.

 

MGMA 2017 Financial Management and Payer Contracting Conference

Feb. 19-21 | Las Vegas
FMPC17

Join your peers to interact and share contracting, reimbursement and risk-sharing challenges and solutions. You’ll learn what you really need to know to transition to value-based contracting, successfully manage risk and revenue streams, and reduce costs while maintaining high-quality outcomes.

Invest in your future. Register for FMPC17 today.
 

MGMA/AMA 2017 Collaborate in Practice Conference

April 9-11 | Chicago
CiP17

The Collaborate in Practice Conference, hosted by MGMA and the American Medical Association (AMA), honors the importance of both physicians and administrators as part of a leadership team in a practice’s success. This collaborative conference emphasizes successful and practical approaches to help you achieve a quadruple-aim focus: enhancing the patient experience, improving population health, reducing costs and improving the work life of healthcare workers.

Partnering for practice transformation. Learn more about CiP17 today.

 

Get Started Today

Request a Demo Now

Call 866.885.2974 to speak to a technical client support expert.

HBMA 2016: The Healthcare Revenue Cycle Conference, Sept 21-23, Atlanta

Mark your calendar to attend the HBMA 2016 Conference in Atlanta. These sessions are designed to assure your continued success in the billing industry. The conference features a variety of sessions focused on the best educational content for exceptional operational performance for billing companies of all sizes.

Date of Event: September 21-23, 2016
Location: Omni Atalnta Hotel, Atlanta, GA
RemitDATA Event Contact: Stacie Bon, Senior Director of Marketing (Marketing@RemitDATA.com)

Click here to visit event website.

 

HBMA 2016: The Healthcare Revenue Cycle Conference

Make your plans now to join us for HBMA 2016: The Healthcare Revenue Cycle Conference this September 21-23 at the Omni Atlanta Hotel in Atlanta, GA.

The Healthcare Revenue Cycle Conference features an exciting array of sessions focused on the very best educational content around successful operations and exceptional performance for individuals in the revenue cycle management industry and billing companies of all sizes.

 

 

Click the buttons below to view the session details and to begin planning your attendance at this important conference.

     
CHBME Certification

11.5 CHBME Credits are available for the conference and
4 CHBME Credits are available for the pre-conference workshops. 

Learn more about the HBMA CHBME

This program has the prior approval of AAPC for 15 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

This program has been approved for 16 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.

 

FULL CONFERENCE ATTENDEE REGISTRATION

Registration Date

Member
Full
Conference Registration

Non-Member
Full Conference Registration 
Guest Registration  
April 21 – August 31, 2016 $595 $775    $199
September 1 – September 21, 2016 $695 $875 $199

 

 

 

 

Full Conference Registration includes entrance to the reception on Wednesday, September 21 and the awards luncheon and reception on Thursday, September 22. 

Guest Registration is for spouses, significant others, or personal friend, not a business associate or colleague. Guest registration will not allow access to any of the educational sessions. Guests will have the opportunity to attend both of the evening receptions.

PRE-CONFERENCE ATTENDEE REGISTRATION

There will be two pre-conference sessions offered concurrently on Wednesday, September 21, 2016 from 8:00 am – 12:00 pm. There are four (4) credits offered for either of these sessions. The two (2) sessions offered are: 

  • Revenue Cycle Management Data Forensics and Artificial Intelligence
  • Microsoft Excel VLOOKUP & Business Intelligence Tools & Techniques
Registration Date Member Non-Member
April 21 – September 21, 2016 $149 $149
 

Omni Atlanta Hotel

HBMA has negotiated a special discounted rate of $199 for our attendee room block from September 19-24. These 392-square-foot deluxe rooms are handsomely appointed with dark woods and various views of Atlanta. Offering two double beds or one king bed, these rooms are all beautifully furnished with flat screen HD televisions, an oversized work desk, and two dual-line telephones. Book your room by Wednesday, August 31, 2016 to take advantage of this special rate.

Rooms may be available at the group before and after these dates based upon hotel availability. For your booking convenience, our conference will be taking place in the hotel’s North Tower.

     

Why you should stay at the Omni Atlanta Hotel:

Luxurious comfort embraces pure style at the elegant, Four Diamond Omni Atlanta Hotel at CNN Center. Located in the heart of downtown Atlanta within the bustling Luckie Marietta District, this luxury hotel treats you to views of the spectacular downtown skyline or picturesque Centennial Olympic Park. 

Omni Atlanta Hotel at CNN Center is connected to Philips Arena and the Georgia World Congress Center, and it is the nearest hotel to the Georgia Dome. For convenient arrivals or departures, Atlanta Hartsfield International Airport is a mere 15-minute commute (12 miles).

 
EXHIBITOR REGISTRATION

If you are interested in a sponsorship or exhibit at the conference, please visit the Exhibitor Registration page to review exhibit booth pricing, see the exhibit hall floor plan, and review sponsorship options.

 

 

Get Started Today

Request a Demo Now

Call 866.885.2974 to speak to a technical client support expert.

ICD-10: The First 90 days

We are now more than 90 days into the ICD-10 conversion. While the experts continue to give the transition a thumbs up, we believe the full story has yet to unfold.  We believe there is going to be more to the story once the grace period – set forth by the CMS and private payers – ends.

Though for the time being, our data continues to reflect that all appears to be going well. Claims are getting paid, and denials are actually lower in Q4 2015 than during Q3 2015. In fact, quarter-over-quarter, evaluating payment velocity, 5.1% more claims are being paid within 30 days since the ICD-10 transition:

ICD10_jan2016_blog

Denial rates by type of service also reveal that across the board, denials are down: 

ICD10_jan2016_blog

However, we believe it’s too soon to pop the cork on the champagne. Beyond the grace period, there may be claims outstanding that have not yet been processed. Time will tell – check back next month as we continue to monitor the data.

 

Request a Demo

 

 

 

 

Revenue Cycle Management – What to Look for When Choosing an RCM Partner

What to look for in an RCM Partner

Revenue Cycle Management

Vendor relationships can sometimes feel like a marriage. When things are good, they are very good. When things are bad, well…

Given the close relationships we have with our vendors, selecting the right Revenue Cycle Management partner is crucial.

While many of us have criteria in choosing a life partner, most are stumped when it comes to selecting a Revenue Cycle Management vendor. And when it comes to outsourcing your important RCM functions, choosing the right partner takes on even greater importance.

There are the obvious criteria – pricing, checking references, reading the fine line of the contract, etc. But a vendor’s ability to prove how they will leverage comparative data to improve your bottom line should be top of your list. Data transparency, establishing benchmarks, and access to real-time information are crucial elements your RCM partner should deliver.

Learn more, What to look for in an RCM partner.     

 

Request a Demo - Revenue Cycle Management

ICD-10 Reality Check: Impact on Productivity

Though things continue to be relatively quiet on the ICD-10 front, there have been rumblings over theDec_ICD-10_blog_graphic past month regarding the impact ICD-10 is having on productivity. The latest sampling of headlines includes reports of:

  • Decreased coder productivity. Healthcare outsourcing solutions provider Himagine Solutions Inc. recently reported that the ICD-10 transition is negatively impacting inpatient and outpatient coder productivity at some health care facilities.
  • Frustration by physicians, who feel the ICD-10 transition has taken time away from patient care. According to a poll conducted post-transition by SERMO, of 200 physician members surveyed, 86 percent feel the transition is taking time away from patient care, mainly due to documentation issues.
  • Declines in hospital productivity and claims submissions delays. Politico’s David Pittman recently reported that the ICD-10 switchover has caused some hospitals’ productivity to suffer. According to the Advisory Board, hospitals surveyed say it took an average of 3.8 days to submit claims after care during September, or pre-ICD-10 conversion. However, post-conversion, it took them an average of 6.6 days to submit claims in October.

With some hospitals reporting claims submissions delays, RemitDATA is showing that data for professional claims processing time, year-over-year continues to hold steady. Comparisons in numbers between October 2014 and 2015, and November 2014 and 2015 are nearly identical in terms of what has been paid (based on check date). However, it is also worth noting that we do not have information in terms of what has yet to be filed, denied, or paid or what is in the process of being reworked.

As always, we will continue to monitor the ICD-10 situation, and will report back in January what the data reveals.

Healthcare Payer News Article

As seen in Healthcare Payer News

Bundled pricing strategies and price variation

By Brad Hill, RemitDATA

The conversation regarding rising healthcare costs in the U.S. continues to swell with tension and uncertainty. Why do U.S. healthcare costs continue to climb at rates far outpacing other industries?

Costs this year alone are expected to rise by 6.8 percent, according to a study by PricewaterhouseCoopers. The answer is, there is not one answer. And unfortunately, there is not one steadfast solution to solve this issue. However, one key contributing factor is the lack of published pricing and comparative information available to patients.

Unlike the clearly marked prices on consumer goods and services, fees for healthcare services are largely unknown, making it difficult for patients to see the tremendous price variances between providers and locations. A recent study revealed that the quoted hospital charge for a routine hip replacement ranged from $11,000 to $125,798.1

One increasingly popular method to help identify and control pricing variances is a bundled pricing strategy. As with consumer products and services, it is not uncommon to receive cost savings with a bundled technique. Healthcare doesn’t have to be any different. Procedures such as an MRI or an entire episode—a joint replacement—can be priced at a flat “bundled” rate to help payers and patients better control costs.

Bundled pricing strategies provide a consistent and measurable methodology to identify which aspect of the service or procedure is driving up the cost. With this level of transparency, payers have more information at their fingertips to better educate their members to make value-based choices. This consumer-driven model reduces costs and encourages providers to offer competitive fees.

In 2010, the Centers for Medicare & Medicaid Services (CMS) implemented bundled pricing programs, and by the end of 2013 had more than 450 provider organizations signed up to participate in the program. CMS has since stated that its goal is to have 50 percent of its payments tied to quality- or value-based payment models by 2018.

In addition, a growing number of commercial payers have adopted bundled pricing strategies. Only 1.6 percent of commercial payments were flowing through bundled pricing models in 2013. Now, bundled pricing programs are used by numerous commercial payers, including United Healthcare and several Blue Cross Blue Shield affiliates.2

As the trend develops, other stakeholders are looking to adopt similar methodologies. States such as Arkansas and Tennessee have implemented bundled payments within their Medicaid programs for specific episodes of care that have high costs and price variability.3 Several hospital systems have also entered into bundled payment programs with some of the nation’s largest self-insured employers, such as Walmart, Lowe’s and McKesson.

Historically, insurance companies have been responsible for negotiating prices with providers and reimbursing them at the negotiated rates, limiting the amount of data available to a patient regarding their healthcare costs. This model is rapidly changing. Patients are becoming financially responsible for a larger portion of their healthcare costs. As this continues, it becomes more critical for patients to have the ability to seek out the best value for their healthcare services.

Bundled pricing makes it easier for patients to compare and understand how certain variables of a procedure effect the overall medical cost of care. This approach enables patients to be price savvy and gives them the transparency they need to make an educated decision on the facilities and providers who deliver low cost and high value care.

In a matter of simple economics, giving the power to the patient helps create valuable competition in the marketplace. Research has confirmed that the more insight patients have into their cost of care, the more likely they are to seek options of greater value, thus payers across the board could decrease their cost of care.

For example, insured patients who change providers are more likely to switch to a lower-cost provider. When price and quality are well-reported to consumers, about 90 percent chose the high-value option. If price transparency were implemented nationwide, Americans with employer-sponsored insurance could save $36 billion per year.

Establishing a bundled pricing strategy starts by selecting specific episodes of care to target. A good example would be to price out a procedure with high cost variances, and with a specific start and end date (e.g., joint replacements, oncology, births). One must first determine all costs incurred during that episode. This has traditionally been a labor-intensive process, but many businesses are adopting data analytics technology to examine historical claims data, group costs by episodes of care, and determine actual prices.

Disclosing price information and making it available to health plan members and providers creates true pricing transparency that drives informed decisions.

A pricing strategy creates educated and price-conscious patients who become better engaged in their care as they shop for high value providers. Ultimately, patients and payers become aligned in their efforts to focus on value and cost reductions.

A pricing strategy also creates incentives for providers to become more efficient and cost effective in their care delivery. With price transparency, providers who fail to offer high value care may lose business if consumers choose to take their business to other network providers who offer a better value.

Healthcare, like many business-to-consumer companies, is there to meet patients’ needs. There is not a one-solutionfor-all, but as every facet is examined and improved, progress will be made. A bundled pricing strategy is a powerful way for payers to enhance the value that they provide to employers and members. It gives the control back to the member and keeps the market competitive. With the proper tools, technology and motivation in place, payers, employers and members can make a positive impact and help maximize the value of every healthcare dollar spent.


Brad Hill is vice president of payer solutions at RemitDATA.
1. Lauer and Tu (2009) evaluate state-based transparency regulation in California and New Hampshire and find no reduction
in prices. Rosenthal and Sinaiko (2011) find that New Hampshire’s transparency laws had no effect on price variance .
2. A Bundle of Potential and Risk: Bundled Payment and its Impact on Innovation. The Network for Excellence in
Health Innovation. November 2014.
3. Susan Delbanco. The Payment Reform Landscape: Bundled Payment. Health Affairs. July 2, 2014. http://healthaffairs.org/

Download the Healthcare Payer News Article PDF

Keep More Business – Using Comparative Data to Show Value to Your Clients and Prospects

Amber Civitarese – Director, Product Management, RemitDATA

As changes in the healthcare landscape drive healthcare providers to outsource their revenue cycle management functions, establishing and maintaining a strong relationship with your clients is more important than ever. In response to healthcare reforms, including the shift towards value-based payment systems and the ICD-10 conversion, providers are looking to Revenue Cycle Management (RCM) companies to not only improve their business processes, but do so while also realizing positive return on investment. RCM vendors who don’t meet this challenge are at risk of losing clients, as healthcare executives look to cut costs to keep pace with this rapid transition, according to healthcare executives surveyed as part of the “Healthcare Revenue Cycle Management” report by peer60.

Replacing lost clients costs money. It is more expensive to go after new business than proving your value to your current clients. The best way to prove your value is to understand your clients’ pain points and help resolve them. Providers are increasingly relying on revenue cycle analytics to create key benchmarks and trends in business cycles to identify problem areas that are impacting profitability. RCM companies who can aggregate and use this data to help clients address these problem areas will make themselves invaluable partners.

Comparative analytics solutions give RCM companies and providers the data they need to improve revenue cycle processes. In the past, data limitations have prevented many RCM companies from simply analyzing clients’ revenue cycle performance in one location. Leveraging technology to aggregate data allows you to compare your clients’ current and historical data with national and state benchmarks based on industry ERA data, creating a 360-degree view in areas such as code utilizations, claim denial rates, and more. Comparative data also provides insights to help resolve issues today helping providers minimize risk during the switch to ICD-10, while establishing ICD-10 baselines and resolution plans.

As you embark upon a new client relationship, it is important to ensure that your clients and your prospects have benchmarked themselves using internal and external data. This will provide a foundation from which to compare and evaluate their business functions before and after outsourcing, and will provide you with the opportunity to showcase how your services have improved their revenue cycle performance with data.

Comparative Data Enables Benchmarking to Improve Business Performance

Comparative data enables RCM companies to benchmark key metrics and compare the performance of themselves and their clients against peers – by specialty and geography. Benchmarking provides a snapshot of the business performance and shows where providers compare in relation to a particular standard.

For example: if accounts receivable averages more than 50 days, benchmarking can provide a comparison to reveal where a provider compares to peers to determine whether this is a normal range or if there are internal issues impacting a specific provider’s ability to get paid in a timely manner.

Revenue-related trends and statistics ­– whether reimbursement, claim rejections and denials, collections or payer trends – can reveal the financial health of a provider’s practice, and help determine processes and action items to improve operations.

The following example looks at denial rates, and provides a step-by-step guide that can be useful in evaluating a client’s data:

Step 1:  Identify claims that are taking longer to be paid due to an increase in denials.

Step 2:  Compare the denial rate year over year.

Step 3:  Trend denials by reason code and specialty compared to state and national averages.

If a trend is client specific, review the data to determine the root cause. For example, if top denials are all related to eligibility, providers can work with their staff to determine what part of the process is breaking down.  Confirm employees are checking eligibility during patient registration or prior to. Depending on your process, your practice might benefit from purchasing a tool to assist in automated eligibility checks.

Step 4:  Evaluate high volume or high dollar procedures, evaluating key areas such as length of time to process a claim, whether that time is increasing, and how it compares to state and national averages.

After evaluating the data, if you find delays in getting claims posted in the PM system, look at other business processes to determine reasons for the delays. Perhaps physicians are not entering the data in an EMR. Or, perhaps there is a connectivity issue between a practice’s EMR and PM, creating issues with charges not flowing over as expected.

Step 5:  Check the average time it takes for your payers to process your claims.

If the average time is increasing, review your data against state and national averages to determine if this is a client specific issue or if their peers are experiencing the same issue.  A customized claim edits system may be able to flag issues prior to reaching the payer, helping your clients prevent rejected claims.

Step 6:  Prioritize your issues based on the greatest ROI and review workflow to ensure best practices are implemented and followed.  Issues should be addressed and resolved in a timely manner in order to optimize your clients’ business.

Case Study: Oncology Practice Reduces Denial Rates through Comparative Analytics

Through the use of comparative data, a six-provider oncology practice realized significant benefits including a reduction in denial rates, improvement in cash flow, and a reduction in staff processing time.

The practice was experiencing an 8 percent denial rate, and wanted to determine why denials were so high.

Many practices experienced increased anxiety with the looming ICD-10 implementation; there was a sense of urgency in reducing denial rates as providers anticipated the CMS estimated 100 percent increase in denial rates as providers transitioned to ICD-10.*

The practice first compared its year over year denial rate, and then compared that data to state and national averages. They also evaluated their high dollar and high volume procedures and the average time it was taking payers to process their claims. The data revealed that the practice had several areas they could improve.

By putting comparative analytics to work as part of its revenue cycle process the practice realized a financial gain of 3 percent (of their overall allowed amount) and collected income of $365,000 – an amount that otherwise would have been delayed or never collected.  Implementing comparative analytics into their revenue cycle process also reduced soft costs associated with staff not having to spend time filing appeals. These providers also saw a reduction in their staff processing time (in this case, time between the date of service and the date the payer pays) from 32 days to 13 days.

Establish Goals

Once you’ve established your client’s benchmarks set realistic goals that help evaluate:

  • Efficiency of the practice today
  • Improvements over time, compared to past data
  • How far a practice needs to go to reach its goals

Using a client’s practice as a reference point, take a month to month comparison to determine what has changed: look at workflow, how quickly payments are processed, claim rejections and which payers are rejecting the most claims, and other benchmarks.

By putting data to work for clients, comparative analytics solutions allow practices to capture insights to use as benchmarks that were not previously attainable. RCM companies that leverage comparative analytics solutions will offer the value that providers are seeking now and in the near future – critical as healthcare executives determine which vendors to keep or cut, and also key in helping you win more business.

This Article was first published in Billing, the Journal of the Healthcare Billing and Management Association, Vol. 20, November/December 2015.

How FISHY Can ICD-10 Codes Get?

October 1, 2015 has finally arrived – a day that marks an industry-wide operational disruption for healthcare. I’m of course talking about the launch of the updated International Classification of Diseases (ICD)—ICD-10, the highly anticipated new coding system that will affect every facet of the healthcare industry and offers tremendous new opportunities for healthcare providers and payers.

Let me provide a little context for the dramatic introduction. Healthcare has been operating under ICD-9 for more than 30 years. That’s right, three whole decades. When ICD-9 arrived, Reagan was president, the Berlin Wall divided Europe, and “We Are the World” was the number 1 song.

The world has changed. Think about the advances in medical technology since the early 80s: the procedures, the medicines and especially the smart devices used to enhance medical care. The transition to ICD-10 is designed to align with these advances, so providers and payers alike can better manage their revenue cycles, and of course, take better care of their patients and members.

Naturally, with this magnitude of change, there are bound to be obstacles and complexities. A recent study on the impact of ICD-10 implementation (click here to see the infographic) estimates a period where claim error rates will be two times higher, and denial rates could increase even more! Why? Because ICD-10 carries exponentially higher amounts of data and codes associated with a diagnosis. To put it in perspective, the level of detail is so meticulous, there are even hundreds of codes associated with event-related injuries!

Now I’ve got a whopper of a fish story for you. One example I like to reference is the hundreds of codes that are associated with fishing. That’s right, for something as obscure as a fish bite, or swallowing a hook…well, there’s a code within the ICD-10 data architecture for that. Under ICD-9, there were a grand total of nine results related to fish. Under ICD-10, however, that figure jumps to 272 results and five classifications—a thirty-fold increase! Similar levels of detail extend across the entire ICD-10 system.

Along with this incredible increase in complexity and detail comes opportunity. ICD-10 offers a more precise evaluation of new medical procedures, something lacking in the old system, which often grouped new procedures with old ones. This greater detail will allow providers to evaluate their performance relative to their peers, better allocate resources, and promote themselves to patients and referring physicians.

Opportunity abounds for payers as well. Both providers and payers can utilize ICD-10’s increased specificity to achieve cost savings through a more accurate analysis of diagnosis and care. This greater detail can improve a payers’ ability to forecast healthcare needs and trends and better analyze costs. Payers and providers can harness the data to monitor service and resource utilization, monitor outcomes and measure performance.

Of course, these long-term benefits don’t eliminate the business challenges that will come with the transition. However, it is our priority at RemitDATA to help reduce the estimated financial impact of the ICD-10 integration through the use of benchmarking and peer-to-peer comparisons with comparative data analytics solutions to monitor errors and provide proactive corrective actions to help minimize cycle disruptions.

In a nutshell, our solutions can help payers, providers, and billing companies track and monitor the impact of ICD-10 from a revenue cycle, claims adjudication, and administrative cost perspective. So, no matter how “fishy” the codes can get in ICD-10, comparative data and benchmarking from RemitDATA is a surefire way to gain insights for proactive resolutions.

On that note, anyone want to go fishing?

Payer Analytics

Comparative Analytics Saves Payers Millions with Surgeon Site of Service Data

Cost savings for payers is more important than ever. Yet, in a typical fee-for-service pricing model, surgeons performing the same procedure at multiple facilities are generally unaware of the reimbursement rates negotiated between the facility and the individual health plan.

Surgeons are generally reimbursed the same amount no matter where they perform the procedure. Since most facilities’ reimbursement rates can vary greatly, there are wide price variances that can range as much as 400%-500% amongst in-network providers for the same procedure.

In order for health plans to manage these cost variances, they need transparency to understand the complete costs associated with a procedure and the ability to identify the surgeons practicing at multiple facilities.

Increased transparency can be achieved through the use of comparative analytics.

In this case, RemitDATA’s Surgeon Site of Service comparative data reveals detailed and actionable information allowing payers to identify top surgical procedures by surgeon, and the healthcare facilities where they are practicing.

Now, during the pre-authorization process, the payer can easily identify which surgeons are practicing at multiple facilities. This level of information allows the health plan to direct or incentivize surgeons to conduct the medical procedure at a lower cost facility where they currently practice.

The end result creates a ripple effect of value across all parties – health plans and their members both achieve cost savings without reducing the surgeon’s reimbursement.

See how a large national carrier is realizing savings of approximately $1.8 million for a specific procedure leveraging RemitDATA’s Surgeon Site of Service data.

ICD-10 Reality Check: The First 30 Days

ICD-10_Infographic_11.15The headlines would lead one to believe all is well post-ICD-10. “ICD-10: Smooth Transition for Claims…” and “ICD-10 is here – and it’s going great” are among just a few tidbits.

And while things have been admittedly pretty quiet during the first 30 days’ post-conversion – with just a few glitches reported here and there – we feel a reality check is in order.

It’s far too soon to tell how ICD-10 is going.

Results are still developing, according to RemitDATA’s data analysis.

In fact, year-over-year data reveals that when you compare October 2014 claims processing figures to October 2015, only 24 percent of the anticipated claims volume has been processed for the month of October.

To give some perspective: when you look at payment velocity for October 2014, 69 percent of claims were processed within the first 30 days of submission; 16.9 percent hit the 31 – 60 days’ mark; 4.4 percent were processed 61 – 90 days; and 9.7 percent were over 91 days. The data doesn’t lie, and it’s telling us to be patient, and to avoid making assumptions as to how ICD-10 is really going.

Most industry experts would agree that reports hinting at smooth sailing post-ICD-10 are extremely premature, as the vast majority of industry experts expect a gradual rise in issues related to claims processing. However, today many are making assumptions, without the data to back up their predictions.

RemitDATA will be monitoring the claims processing cycle, and will provide monthly updates revealing what the data is telling us with respect to ICD-10 and its impact on claims processing. Visit our “ICD-10 Reality Check” blog in December, when we provide another report on the status of processed claims at the 60-day mark.

Matt Waltrich Joins RemitDATA

I’m excited. It’s as simple as that – to tell you about a comparative analytics solution that can enhance your collaboration efforts, guide initiatives and build stronger relationships within your network.

I recently joined RemitDATA, as VP, Payer Solutions, where my sole focus is to help payers overcome business challenges through the use of comparative analytics.

Comparative Analytics might not be as exciting as jumping out of a plane or traveling the world. However, the mere fact that we develop solutions that make a difference in the way healthcare organizations utilize data to achieve business optimization is what does it for me.

Through comparative analytics payers can lower their medical cost of care, reduce administrative costs and enhance member and provider engagement.

With all of the complexities that payers are dealing with in healthcare today, the most valuable resource we can give back is comparative data that is simple to digest.

That’s the value RemitDATA brings.

  • large national databasethat enables health plans to explore a wide range of longitudinal and comparative cost studies.
  • A robust and unique cost of care analytics tool that measures episode of care based on pricing performance and key cost drivers.
  • A data perspective that health plans can leverage to guide their providers and strengthen their networks.

In simple to view dashboards, payers can see key areas for savings potential, and benchmark their provider network to industry peers.

Here is an example of a dashboard in the Episode of Care Pricing Analytics solution:

Matt Blog

 

 

 

 

 

 

 

Intriguing?  Visit, Payer solutions.

To learn more email me, MWaltrich@RemitDATA.com.

Medtrade Fall is Next Week

When we all walk into Medtrade October 26, it will have been exactly 25 days since the launch of ICD-10. Chances are, few of us have truly felt the impact of it, YET.

Although the implementation of ICD-10 is expected to benefit the industry, the early days will wreak havoc. Many will experience increased revenue cycle and administrative inefficiencies.

It’s probably going to feel like you’re walking through a dark, scary jungle with no sense of direction.  This is when it’s time to call for reinforcements, or at least, helpful tools that can guide you.

TAKE ACTION!  Now is the time to resolve current claim denials and begin to mitigate future denials!

The question we often hear is, “Where do I begin?”  A great place to start is to know how you compare to your peers – on a state and national level – are your denials higher or lower, are your peers being reimbursed faster, is your processing time comparable to others in the industry? How many other medical equipment businesses are challenged with missing diagnoses codes?

When you get to Medtrade 2015, come by the RemitDATA booth #1316 for a quick demo to see just how simple it can be to find your way out of the ICD-10 jungle.

We will even give you a free $10 iTunes gift card for the journey and the chance to win a $100 AMEX gift card.

Looking forward to seeing you on October 26!

Follow the conversation on social media.

Most Commonly Unexpected Denied Procedures: Aug. 2015

Physician's Practice_August Data

Influence Tomorrow’s Solutions…

And walk away with a $10 iTunes gift card and the chance to win an Apple Watch!

All you have to do is take a quick survey or complete a demo!

A few weeks ago we launched our fall survey. The objective is to better understand the issues you are facing so we can continue to create relevant comparative data solutions.

Based on the collective responses from billing companies and providers, we will analyze the data and share our key findings in early 2016.

Our mission is to gain a deeper understanding of customers’ priorities within revenue cycle management – business issues, solution gaps and more.

RemitDATA seeks to continually optimize and better align solutions with the nuances industry priorities.

Here is how you can make a difference.

If you are attending MGMA on October 11-13 in Nashville stop by our booth #1220 and take the survey.

The survey will be open until November 24th and results will be announced in in early 2016.

The more responses we get, the more conclusive the results!

So, be sure to stop by our booth #1220 to take the survey, or let us show you a demo of our comparative data analytics solutions and learn how they can help you.

Anyone who requests a demo or takes the survey will receive a $10 iTunes gift card and will be entered into a drawing to win an Apple Watch!

Take the survey now.

See you in Nashville!

FOLLOW US ON SOCIAL

For Practices, the ICD-10 Roller Coaster Has Just Begun

ICD-10 is finally here! After more than a decade of discussion, delays, and planning, the ICD-10 implementation deadline has officially arrived. Physician practices will now see whether their ICD-10 preparations are adequate, in need of some fine-tuning, or require a complete overhaul.

Read more at Physicians Practice.

 

For Practices, the ICD-10 Roller Coaster Has Just Begun

ICD-10 is finally here! After more than a decade of discussion, delays, and planning, the ICD-10 implementation deadline has officially arrived. Physician practices will now see whether their ICD-10 preparations are adequate, in need of some fine-tuning, or require a complete overhaul.

 

Even the most thoroughly prepared organizations are likely to experience some steep hills and deep valleys during the early days of ICD-10 usage. In fact, CMS predicts that claim error rates will be more than two times higher with ICD-10, reaching a high of 6 percent to 10 percent in comparison to the 3 percent average using ICD-9 codes. CMS is also predicting that denial rates will rise by 100 percent to 200 percent and days in accounts receivable (A/R) will grow by 20 percent to 40 percent.

To thrive in the ICD-10 environment, physician practices need greater transparency into their revenue cycle. One way organizations can achieve higher levels of transparency is through the use of comparative analytics, which organize and analyze revenue cycle data, create benchmarks, and define actionable insights. For example, using comparative analytics, a physician practice can identify the root cause of revenue cycle issues, correct the issues, and minimize or avoid their impact entirely.

Comparative analytics can provide practices with a comprehensive view into their data and organize the data to guide them as they create benchmarks, assess business impact, and identify trends related to ICD-10 implementation in the following areas:

• Claim denial rates

• Denial reasons

• Deviations in coding and claim types

• Staff productivity

• Payer performance

• Compliance

• Utilization

Leveraging internal and external data on a state and national level provides a baseline for organizations to better understand where they stand compared to the industry and their peers. This additional layer of data helps inform physician practices of actions they need to take and also helps them prioritize their initiatives based on achieving the greatest return on investment.

Creating Benchmarks

A big concern with the switch to ICD-10 is a practice’s ability to achieve revenue neutrality. In essence, will practices generate roughly the same reimbursement with ICD-10 as they did with ICD-9? Benchmarking capabilities within comparative analytics software can provide insights to answer questions like this.

Benchmarking enables practices to analyze historical ICD-9 claim payments and compare them to equivalent claims that utilize ICD-10. Findings from the analysis can help identify business issues. For example, do coding processes need modification? To further assess the impact of ICD-10, practices have the ability to identify their current high-dollar or high-volume diagnoses and answer the following questions:

• Have our high-dollar or high-volume diagnoses changed with ICD-10?

• Is revenue and/or diagnoses changes related to ICD-10 coding or changes in patient case mix?

There is also value in benchmarking the before and after impact of ICD-10 implementation, across multiple areas of the business, such as:

• Billing staff productivity. Are new processes or staffing changes impeding productivity?

• Claims denial rates. Are your denials the result of payer errors, billing staff errors, or medical necessity edits?

• Payment turnaround times. Are payers experiencing payment backlogs?

• Reimbursement. Is your organization receiving the full amount of reimbursement that it is entitled to?

And most importantly, are your peers experiencing similar results? If not, how do you explain the differences and where do you need to prioritize your focus?

A visit to the amusement park can be fun, but most businesses don’t want their revenue cycle to experience the ups and downs of a roller coaster. Comparative analytics can provide the transparency — or insights — that allow physician practices to see what is ahead and what is behind them.

 

Get Started Today

Request a Demo Now

Call 866.885.2974 to speak to a technical client support expert.

Patrick Kennedy Joins RemitDATA Board of Directors

Healthcare expert brings 30 years’ experience guiding payers in their quest for transparency

PLANO, Texas, Sept. 17, 2015 — RemitDATA Inc., a pioneer of comparative data analytics technology focused on bringing 360-degree data transparency to healthcare, announced the appointment of Patrick Kennedy, founder of PJ Consulting, to its Board of Directors, effective immediately.

“Patrick brings a valuable perspective to RemitDATA and a deep understanding of the challenges healthcare companies face managing their medical and administrative costs and processes in today’s environment,” said Dave Ellett, Chief Executive Officer of RemitDATA. “We appreciate his desire to serve on the board and help RemitDATA further expand our footprint within the payer market, bringing transparency tools to all healthcare entities.”

Kennedy joins the RemitDATA board with 30 years of experience in the healthcare industry. In addition to joining the RemitDATA Board of Directors, Kennedy runs a healthcare consulting firm, PJ Consulting, Inc., established in 2001. Kennedy has consulted with payers and vendors – 39 Blues and 12 of the largest commercial payers – to create successful electronic networks that guide their transparency and collaboration initiatives, helping them to strengthen provider and member relationships.

“RemitDATA’s solutions provide business intelligence that enables payers and providers to review, compare and discover relevant operational and administrative data points, with an industry-wide view for analysis, insight development and benchmarking. This is a level of transparency that enables healthcare entities to reduce their administrative costs and medical cost of care,” said Kennedy. “As a member of the RemitDATA board, my goal is to help expand the availability of comparative analytics solutions further into the payer market.”

Prior to PJ Consulting, Kennedy held executive positions with GE, GTE, NEIC, Avicenna Systems and CareInsite, and has also worked with pharmaceutical companies and service vendors to create member communication programs. Having served on several boards in the healthcare industry, including GEMMS, the market leader for Electronic Medical Record Systems and MRO focused on disclosure management of Protected Health Information (PHI), Kennedy is a respected industry expert in areas such as payer processes and healthcare e-commerce.

Patrick received his Bachelor’s degree in mathematics from Mount St. Mary’s College and a Master’s degree in mathematics from theUniversity of Maryland.

RemitDATA Launches Landmark Survey at HBMA 2015 Fall Conference

Survey Designed to Identify Business Issues and Objectives for Revenue Cycle Management Companies and Providers

PLANO, Texas, — RemitDATA Inc., a pioneer of comparative data analytics technology that brings 360-degree data transparency to the healthcare industry, announced it will introduce a new market survey this month to take the pulse on revenue cycle management by identifying issues faced by providers and billing companies to point the way toward relevant solutions.

The survey will launch at the Healthcare Billing and Management Association’s 2015 Fall Annual Conference (HBMA), September 10-12 at Caesars Palace in Las Vegas. Attendees can take the survey at RemitDATA’s booth #505 to receive a $10 dollar iTunes gift card and be entered to win an Apple Watch. The drawing will take place at the conference on September 12. In addition, the survey will be available online at https://www.surveymonkey.com/r/RemitDATAFallSurvey2015.

The survey will also be available at the RemitDATA booth #1220 at the MGMA 2015 Annual Conference on October 11 – 13, 2015 inNashville. The survey will close on November 23, 2015.

The survey is designed to identify the priorities within revenue cycle management – business issues, solution gaps and more. RemitDATA seeks to gain a deeper understanding of customers’ needs so it can continue to optimize and better align solutions with the nuances of healthcare providers and vendors.

“With this survey, we are trying to ensure we keep our customers top of mind and stay current in our understanding of their ‘pain points’,” said Aaron Hood, vice president of product management and marketing at RemitDATA. “With the ever-changing healthcare landscape – changing payment models, ICD-10 and the rising cost of care – this will help us create a product roadmap dedicated to improving the revenue cycle management process through data transparency.”

When complete, the survey data will be aggregated and shared publicly in early 2016. The data from the survey will help providers, billing companies and vendors to better understand which issues are shared across the industry and point toward solutions.

Help Us Learn about YOU at HBMA

We are headed to Las Vegas for the HBMA Fall Conference and we couldn’t be more excited. The agenda has caught our eye with many interesting discussions, from ICD-10, report customization, employee productivity to gambling with claim denials, to name a few.

What a great time for us all to learn. Beyond our goal to attend sessions, we will launch our fall survey and we hope to hear from YOU. The objective of this survey is to better understand what issues you are facing so we can point toward viable solutions.

Based on the collective responses from billing companies and providers, we will analyze the data and then share our key findings in early 2016.

Be sure to stop by our booth #505 to take the survey, let us show you a demo of our comparative data analytics solutions, or just come say hi.

Did we mention that anyone who takes the survey or participates in a demo will walk away with a $10 iTunes gift certificate and be entered into a drawing to win an Apple Watch?

See you in Las Vegas!

Follow us on social media.

For more information on our fall survey, read the announcement here.

 

Ready to Engage – Greenway ENGAGE Conference is Next Week

We are excited to attend Greenway’s ENGAGE conference right here in Dallas.

It is always a tremendous opportunity for us to learn directly from our partners and customers.

We are looking forward to the sessions and conversations led by the Greenway leadership team and customers. After all, the best way to ensure solutions meet market and customer needs is to be part of that conversation.

Follow us on social for updates throughout the conference.

Interested in learning more about Greenway solutions, click here.

June 2015 Medicare Denials are Experiencing Spikes

 

HME Graphic-August

Check out the RemitDATA Denial Tracker in the August issue of HME News.

Boost Your Business With Benchmarking

Log in to HBMA Billing here to read the full article.

HBMA Billing Cover

How Benchmarking Can Help Guide Your ICD-10 Transition

In healthcare today, a common cause of heartburn might not be diet based, as you would typically expect. The answer today would probably be the highly anticipated transition to ICD-10 (insert nervous laughter here).

All jokes aside, ICD-10 is serious. However in the case of ICD-10, it is going to happen, and cannot be avoided. Revenue cycle management and billing teams will carry a large portion of the burden – working with new codes, trying to keep denial rates as low as possible while keeping administrative performance steady.

One way to manage the chaos is to leverage comparative analytics – to know where you stand based on internal and external data.  Comparative benchmarking is a proven method that gives you the insights to drive process improvement and business optimization.

We are thrilled to share our recently published article in the July/August issue of HMBA Billing Boost Your Business with Benchmarking, where we discuss benchmarking best practices, the benefits it can provide and actionable outcomes.

To read the full article please login to HBMA Billing , Boost Your Business with Benchmarking

If you are nervous about ICD-10 see how comparative analytics can help you manage the process, check out this infographic, There is Still Time to Prepare.

Join the conversation. Follow RemitDATA on Facebook, LinkedIn and Twitter.

 

RemitDATA is a proud sponsor of the Allscripts Client Experience (ACE) 2015!

The Allscripts Client Experience (ACE) is a unique learning and networking opportunity for thousands of Allscripts clients and industry professionals. The ACE conference is taking place August 5-7 in Boston. Allscripts clients can visit www.allscripts.com/ace2015 to learn more and register.

 

ACE15_SponsorLogo

Market Insights: Most Commonly Unexpected Denied Procedures for Endocrinology

Overall Market Denials vs. Endocrinology

View the The Top 5 Unexpected Denied Procedures and Reason Codes Infographic
endoICD-10 Healthcare Comparative Analytics - Request more info

RemitDATA, in partnership with Physicians Practice magazine, delivers analysis of medical claims data and denial trends for the physician practice market.

The analysis generates a list of the top five denial codes across the entire market and also for a particular specialty.  This month focuses on Endocrinology.

Endocrinology and the overall market rankings for March and April 2015 share three of the top five denied procedure codes.

Procedure codes 82962 (Glucose blood test) and 83036 (Glycosylated hemoglobin test) appear only on the Endocrinology top-five list. These are high-volume procedures for Endocrinology practices.  Uncovering the reasons behind these denials is important and resolving the denials can help a practice reduce their denials and improve their cash flow.

Endocrinology: Comparison of 2014 and 2015 Data

Last year, RemitDATA performed a similar analysis on the endocrinology specialty using June 2014 claims data. The top-five lists for the 2014 and 2015 analyses are similar; however, there were two notable differences:

  1. In the 2015 analysis, procedure code 82962 (glucose blood test) ranked as the third most commonly unexpected denied procedure, yet that code was absent in the 2014 top-five list.
  2. Reason code 96 (non-covered charge) ranked fifth in the 2014 analysis, but was replaced by reason code 29 (time limit expired) in the fifth spot on the 2015 analysis.

View the Infographic

A detailed infographic of this information can be viewed at the Physicians Practice website, which partners with RemitDATA to publish the top-five lists.

Let Us Know How We Can Help You

If your organization is looking to optimize its revenue cycle processes, contact us to get a demonstration of our solutions.

 

 

Benchmarking: Data-driven best practices to improve performance

Co-authored by Amber Civitarese and Stacie Bon

Whether you are the owner of a revenue cycle services (RCS) company or you are responsible for managing specific aspects of the business, it is important to know the answer to the following question: How do you compare?

Benchmarking is a tool that provides a snapshot in time that enables businesses to compare their performance metrics against internal and/or external measures. These comparisons help businesses better understand their operations and identify areas that need attention – leading to improved performance.

Benchmarking is especially important for RCS companies, since they are faced with a dual challenge −  to manage the billing and collections of their clients while simultaneously focusing on the business performance of their own organization.

RCS firms that want to expand their programs by incorporating benchmarking methodologies should address the following areas:

Internal and External Comparisons

Used internally, benchmarks can help businesses compare their current performance to previous time periods. Metrics may include accounts receivable (A/R) days, staff productivity, claim denial rates, claim processing time, and more. These internal benchmarks provide quantifiable data to base decisions, enabling organizations to focus on the areas of the business that have the most impact on performance.

Trending this data over time provides additional value, so a business can determine whether changes in performance are seasonal, related to regulatory measures or are impacted by other factors. Identifying these trends will help organizations pin point outliers in the data and what caused them. Additionally, this trending data helps them prepare for future events that may impact performance.

While internal measurements are important, they only compare the organization to themself, allowing an organization to see only half of the story.  They may see vast improvements compared to their data and still not meet industry standards and best practices. It is important for organizations to compare their performance internally and also to external benchmarks.

External benchmarks come in many forms, ranging from industry reports and surveys, to best practice metrics established by trusted associations and other sources of data. Comparing internal performance to these external sources is of value, but organizations should realize that these external benchmarks represent a snapshot in time that is often months or years old. The healthcare industry changes rapidly, so a benchmark from several months or years ago may not represent what is currently happening within the industry.

Real-time performance metrics provide a more accurate comparison, enabling organizations to view their performance in context with the industry’s current state, whether it’s experiencing the impact of new regulatory measures, economic variables or other factors.

Apples-to-Apples Comparisons

A wealth of data is generated when medical claims and reimbursement are exchanged between clinical organizations, health plans and the entities that support them. However, much of the data lacks relevance, context or meaning, which prevents it from being actionable. This creates challenges for organizations looking to extract meaningful insights from their transaction data to improve business performance.

When using benchmarking data, it is vital that the metrics share the same definition to allow for apples-to-apples comparisons. This is important whether the data is being used for internal benchmarking or for external comparisons.

The concept of apples-to-apples comparisons also applies to the organization types that are being compared. For example, an RCS company serving primarily home health providers will have different metrics than a billing firm serving radiologists or other specialties. This also applies when RCS companies compare the performance of their clients. Getting meaningful data requires comparing clients to their peers, such as by size, specialty, market or other factors.

Monitor Your Data

Benchmarks represent a snapshot in time. They are not static and will change over time, making it important for organizations to monitor their metrics on an ongoing basis. Performance improvement efforts can be greatly assisted by creating notifications that alert the appropriate staff when metrics hit a specified high or low. This enables organizations to take action before the issue can negatively impact the business.

Key metrics to monitor include:

  • Utilization of codes and modifiers – Are coding practices making you an extreme outlier and subject to increased audit risks?
  • Claim denial rates – Have your denials spiked for a specific payer or across the board?
  • Payment velocity – Are specific payers taking longer to pay you than your peers?
  • Staff productivity and efficiency – Is your staff’s productivity higher or lower than your peers?

Prepare for Regulatory Changes and Industry Trends

The October 1, 2015 ICD-10 implementation deadline is one of the biggest regulatory changes to hit the industry in years. While there are many unknowns about ICD-10’s impact, organizations can use benchmarking to prepare for the implementation by:

  • Optimizing existing processes as much as possible so current performance issues won’t need to be resolved while addressing ICD-10 related issues
  • Determining where ICD-10 will impact processes (e.g., denials, reimbursement, reconciliation, etc.) and put performance measurements in place to monitor and address these issues following the implementation deadline

Additionally, trending data can be used to prepare for other industry changes. For example, organizations can analyze previous data to determine how quarterly and annual coding updates impact their business. Once trends are identified, they can take steps to minimize or eliminate the issues for upcoming changes.

Cross-Functional Benchmarks

Benchmarks can also be used as a basis for organizations to set internal and external goals. As an example, RCS companies can establish goals for their internal operations and external goals for their clients. RCS companies can help their clients reach the external goals, which adds value to the relationship and also improves the metrics that affect RCS business performance.

Furthermore, RCS companies can set up notifications to alert staff when clients’ metrics reach predetermined thresholds, so issues can be proactively addressed. These notifications can also be used to alert staff when clients reach specific milestones, so RCS companies can reward and celebrate clients for their efforts.

Benchmarks established at the beginning of a relationship between an RCS company and their clients are important. These benchmarks open the door to meaningful discussions.  An RCS company can level set with clients where they are today and can compare against future benchmarks to document improvements and the client’s return on investment.

Establishing and Recalibrating Goals Based on Benchmarks

Today’s healthcare organizations are essentially having to do more with less. They face higher standards, while reimbursement continues to decrease. Under these circumstances, improving performance with existing resources is challenging, which is why it is critical to focus efforts on the areas that can deliver the most value to the business.

Benchmarks help identify the areas that can have the most impact so that resources can be focused. Organizations can use benchmarks to track the metrics that will help them achieve short-term goals or long-term business objectives. Once the goals are established, organizations can monitor the metrics that drive improvements, whether it’s to meet an industry standard or best practice, decrease A/R days, or focus on correcting coding issues that consistently result in denials from payers.

As benchmarks change, so must the goals. Once improvements are realized, elevating goals help organizations reach for higher levels of achievement. Additionally, industry changes dictate the need for goal reassessment and even complete shifts in direction. To accommodate these changes, organizations should establish periodic reevaluations – monthly, quarterly, etc. – to assess and prioritize goals based on trends within the organization and throughout the industry  – ultimately achieving overall business objectives.

Clear Communications Are Essential for Success

Goals provide people with direction, but only if those goals are clearly communicated. For performance improvement efforts to be successful, organizations need to clearly articulate not only what the goals are, but also how they’ll help the business. These communications help people better understand the goals and become aligned with how to achieve them.

It is also important to communicate when improvements are realized and when goals are achieved. Acknowledging these moments – and even celebrating them – rewards people for their efforts and shows the team how data-driven processes can drive success.

This Article was first published in Billing, the Journal of the Healthcare Billing and Management Association, Vol. 20, July/August 2015.

ICD-10: There Is Still Time To Prepare

ICD-10_infographic_6

Preparation for the ICD-10 transition is critical. The challenge is, determining what steps to take ensure a smooth transition. You’ve probably been inundated with mounds of information and it’s becoming white noise. But have no fear.

Let’s start off by stating a simple fact. No matter what, every healthcare entity will most likely experience some form of latency – whether it be a slight increase in claim denials, or a slight increase in claim errors for a short time.

The trick is, to understand and eliminate the challenges you are facing today so you can come up with a game plan for how to address the issues that arise with ICD-10.

To help you figure out some steps to take, we have created a simple infographic – designed to help you understand the possible impacts the ICD-10 transition might have on your business and how you can keep those challenges to a bare minimum with comparative analytics.

Check it out!

Revenue Cycle Management – Where do you stand in the outsourcing trend?

It seems that every year, managing the revenue cycle process is becoming more and more complicated for healthcare organizations. There are so many nuances that go into the process – coding claims, the impact of ICD-10 (coming in October), and mis-informed communications. Managing this process internally becomes incredibly cumbersome and is taxing on everyone.

In one of our recent whitepapers, Revenue Cycle Services: Put your data to work for you and your clients, we discuss the increasing trend of outsourcing revenue cycle services.

In support of this trend, many revenue cycle service companies are implementing and offering comparative analytics solutions to increase transparency into the revenue cycle process to help improve operations – for themselves and their clients.

Based on research, slightly more than 80 percent of physician practices (whether networked, independent or part of a large group or hospital system) anticipate declining-to-negative profitability in 2015 due to diminishing reimbursements and underutilized or inefficient billing and records technology.*

This is a vicious cycle, but it is a cycle that can be reversed.

Beyond just organizing information, comparative analytics solutions can help identify and proactively address issues BEFORE they impact cash flow, and encourage data driven communications.

The end result is truly understanding your entire business and that of your clients based on comparative data so you can create benchmarks, identify insights and prioritize initiatives based on the greatest return on investment.

Revenue Cycle Services: Put your data to work for you and your clients, breaks down some critical factors that are contributing to revenue cycle outsourcing, and the positive impacts of comparative analytics. Check it out!

Have more questions? Visit us on social media!

 

 

*Hoy, Veronica. “ICD-10 Requires a Strategy for Managing the Coder Shortage.” ICD-10 Monitor. http://www.icd10monitor.com/ slideshow/231-icd-10-requires-a-strategy-for-managing-the-coder-shortage

It Takes a Team to Make Great Things Happen

We are excited to announce that RemitDATA is honored as one of Dallas Business Journal’s Top 100 Best Places to Work in 2015. These top 100 companies were recognized at a special awards luncheon where  RemitDATA ranked 12th in the small business category, one of five categories in the competition.

We are extremely humbled to receive this honor next to so many amazing organizations in the DFW area and even more so that our rank was based on a survey given to RemitDATA employees.

As part of the assessment the Dallas Business Journal asked companies to define their organization in 5 words.  At RemitDATA, the five words that best describe our company (our employees) are:  Agile, Collaborative, Energetic, Entrepreneurial and Motivated. Need we say more?  It is a privilege to work among a group of people defined this way.

The Top 100 companies of 2015 were also asked to describe a super hero that defines their office and why?  We chose Ant Man and here is why.

Ant Man (based on the Marvel comic book super hero) is, above all, smart. He knows how to use his mind to solve problems. The unique thing about Ant Man is his super-human strength comes into play when he’s small – the size of a mere ant. He might be small but he is fierce, fast and incredibly agile. On top of Ant Man’s super-human powers, he garners the help, respect and collaboration of “his fellow ants.” Together, no matter how small, they have the collective power to move mountains.

On behalf of RemitDATA and our entire team, we want to thank the Dallas Business Journal for this wonderful honor. We will do our best to honor this recognition for years to come.

A huge round of applause also goes to the employees of RemitDATA for making RemitDATA the company that it is.

RemitDATA Drives Mission to Enhance Strategic Alignment with Payer Market

Company initiatives to bolster 360-degree comparative data solutions; enhance benefits to payer market

PLANO, TX – June 2, 2015 – RemitDATA Inc., a pioneer of comparative data analytics technology that brings 360-degree data transparency to the healthcare industry, today announced new strategic steps to further strengthen its position as a solutions provider in the payer market.

In support of this vision, Michael Sanderson, president and co-founder of RemitDATA, will transition from his day-to-day involvement and responsibilities to become CEO of Health Data Analytics (HDA), a SaaS-based company  focused on the advancement of statistical data models that support the self-insured employer market.

“After 13 years with RemitDATA delivering transparency to the healthcare industry, we have worked very hard to bridge the communications gap between providers and payers,” said Sanderson. “Both HDA and RemitDATA are in an exciting space and share a common goal. I am excited to watch both businesses work in tandem to accelerate this transparency mission.”

Sanderson will remain a member of RemitDATA’s Board of Directors and a shareholder.

“Michael has been instrumental in the success of RemitDATA and he is a respected member of the team. His willingness to launch this new employer-facing opportunity is a testament to his ongoing dedication to deliver much needed transparency to the healthcare industry,” said Dave Ellett, CEO of RemitDATA. “There is still so much disparity in the cost of care across the healthcare industry. Our drive to enhance payer solutions is part of a larger mission to bridge the communications gap between all healthcare entities via 360-degree data transparency.”

This strategic move enables RemitDATA to redefine roles within the company to focus on building a stronger network with payer entities and gain a deeper understanding of the payer market.

Additionally, Brad Hill will step up to Chief Revenue Officer, assuming full responsibility of business development and partner efforts. Hill joined RemitDATA in March 2015 and has since hit the ground running. Hill plans to bolster dedication to the payer market by adding strategic business development resources.

The RemitDATA board will also appoint Patrick Kennedy, partner at PJ Consulting, Inc., to the RemitDATA Board of Directors.  As a subject matter expert in the payer market, Kennedy will be an advocate of the payer market as RemitDATA expands its payer-focused solutions.

RemitDATA will attend America’s Health Insurance Plans (AHIP) Institute event on June 3-5 in Nashville, Tennessee, as part of its overall expansion into the payer market. To schedule a meeting with RemitDATA – or to meet at AHIP – contact us atMarketing@RemitDATA.com.

Medical Claim Denials and Remedies: Trends for Spring 2015

Each month, RemitDATA provides Physicians Practice with the latest data on unexpected denials — and the key reasons why — at medical practices nationwide.

Here, RemitDATA’s vice president of product management, Aaron Hood, provides commentary for the data from March 1, 2015, through April 30, 2015, with a specific focus on endocrinology, including recommendations to help your practice avoid future denials.

 

Comparative Analytics: Increase transparency into the claims lifecycle to identify areas needing improvement.

The Oct. 1, 2015, ICD-10 implementation deadline is one of the biggest regulatory changes to hit the industry in years. While there are many unknowns about ICD-10’s impact, organizations can use benchmarking and comparative analytics to minimize their risks as they prepare for the implementation.

By applying comparative analytics to big data, organizations can increase transparency into the claims lifecycle to better assess the effectiveness of processes, identify areas needing improvement and begin fixing those issues prior to the deadline.

Click here to read the full article at ADVANCE for Health Information Professionals.

PracticeMax Chooses RemitDATA Solutions to Achieve 360-Degree Data Transparency

 

Healthcare businesses enhance operations via TITAN and ClarifyRCM, comparative analytics solutions that provides intelligent data analytics.

PLANO, TX, – May 14, 2015 – RemitDATA Inc., a pioneer of comparative data analytics technology that brings 360-degree data transparency to the healthcare industry, announced that Scottsdale based PracticeMax selected Titan, as an Application Programming Interface (API) solution to deliver revenue cycle transparency and comparative analytics to improve their clients’ business operations.

“As a provider of medical practice management and technology services, our clients have diverse needs when it comes to billing, reporting and data,” said Bill Carns, CEO at PracticeMax. “RemitDATA’s solutions help us ensure optimal billing and reimbursement processes for our clients. Leveraging the API gives us a centralized view of all client accounts enabling us to accurately assess the health of their businesses.”

A system agnostic, comparative analytics solution, TITAN allows healthcare entities to gain actionable insights through the use of benchmarking and peer comparison tools. With the flexibility to leverage APIs, TITAN allows the businesses multiple ways to access their data, delivering clear analytics that can help address issues before they impact cash flow – for themselves and their clients.

PracticeMax has also implemented ClarifyRCM, RemitDATA’s subscription-based billing and reporting tool. The power of Clarify and TITAN gives PracticeMax the comparative data intelligence they need to proactively help their clients identify business opportunities and areas of improvement in revenue cycle performance. Furthermore, PracticeMax can leverage TITAN to understand and improve its own organization.

“In the healthcare industry, having the ability to simply assess your data and define actionable insights that will optimize your business while also understanding your business compared to your peers allows healthcare entities visibility and transparency of information between all parties,” said Dave Ellett, CEO of RemitDATA. “Our solutions are designed to take the burden off of these businesses with tools that simplify the comparative data analytics process.

About PracticeMax

PracticeMax is a national provider of medical practice management and technology services, including billing, software and consulting for medical practice management and clinical operations. PracticeMax’s expertise and advanced information technology capabilities, including PM, EHR and HIE solutions, maximize revenue and results for hospital- and office-based physician groups, outpatient centers, health systems, ACOs, school-based professionals and billing services.

About RemitDATA

RemitDATA is a healthcare technology company that delivers healthcare’s most comprehensive comparative data and analytics platform. Founded in 2000, the Memphis, Tennessee and Plano, Texas-based business strives to bring collaboration and 360-degree data transparency to all entities within the healthcare industry by delivering a range of system agnostic, comparative analytics solutions. Through the use of Application Programming Interfaces (APIs), benchmarking and peer comparison tools, payers, providers and other healthcare companies will gain actionable insights to better understand their business and improve operations so they can focus on what really matters, to them. For more information, visit www.RemitDATA.com.

RemitDATA Acquires IF Technologies, Creating a Powerhouse Suite of Comparative Data Analytics Solutions for the Healthcare Market

Deal empowers healthcare businesses to gain business insights via data transparency

PLANO, TX and LEXINGTON, KY, April 13, 2015RemitDATA Inc., a pioneer of comparative data analytics technology that brings 360-degree data transparency to the healthcare industry, today announced it has entered into an agreement to acquire IF Technologies, a company that offers episode of care pricing analytics and transparency to insurers and cost containment companies with its software as a service (SaaS) solutions. RemitDATA’s acquisition of the Lexington, KY-based company is a major milestone in its quest to empower payers, providers and other healthcare entities to gain transparency, enhance communications, drive collaboration and improve business operations.

“IF Technologies has made significant contributions to the healthcare market through the use of comparative data analytics,” said Dave Ellett, CEO of RemitDATA. “IF Technologies and RemitDATA share a strong mission to enhance the transparency of data between healthcare entities, making it easier to operate and conduct business.”

“Our goal is to continually enhance our value proposition of 360-degree transparency,” said Michael Sanderson, president and co-founder of RemitDATA. “Acquiring IF Technologies is a huge testament to that goal.”

Along with RemitDATA’s recent 15-year anniversary and its hiring of Brad Hill as vice president, Payer Solutions, the acquisition of IF Technologies is another step as RemitDATA focuses on expanding its capabilities to better serve the needs of the payer market. RemitDATA’s pioneering technology is now relied upon across the entire healthcare industry – payers, providers, healthcare systems and RCM services.

“Payers are faced with incredible disparities in pricing and need the technological tools to control costs,” said Patrick Kennedy, Partner, PJ Consulting, Inc. “Data transparency is essential in this industry for everyone, including the patient. With the focused services of companies like RemitDATA, we can help to impact the healthcare deficit and improve outcomes.”

Now added to the RemitDATA portfolio will be IF Technologies’ full breadth of services and solutions, including HealtheReports, a comparative data solution that delivers pricing, by provider, to empower insurers and their members to find the best healthcare value; and Episode of Care Analytics, a solution that provides insight to drive significant savings and empowers insurers to lower their costs as well as costs for employers and their members.

Jim Freedman, CEO and co-founder of IF Technologies, stressed that the “cost of care within the healthcare industry is unsustainable and episode of care pricing analytics is key to reducing costs. We have always looked at RemitDATA as a strong innovator of comparative data technology for healthcare businesses.”

Freedman added, “We are proud to join such an esteemed industry leader in offering many different comparative data analytics solutions. Our technology perfectly complements their existing portfolio, and together we will deliver the best possible options to healthcare entities.”

Freedman will join the RemitDATA leadership team as senior vice president, Payer Solutions where he will guide strategy and business development.  Additionally, Mike Issac, president of IF Technologies will also join the RemitDATA leadership team as senior vice president, Payer Operations where he will guide product strategy and development.

“This transition should be fairly seamless for customers, other than the obvious changes of packaging and marketing communications,” said Ellett. “We’re looking forward to delivering even more game changing solutions to the healthcare industry.”

RemitDATA will be showcasing its comparative analytics suite at HIMSS15, Booth #4009.

For a full list of the IF Technologies solutions portfolio, visit www.ThinkIFT.com.

###

About RemitDATA

RemitDATA is a healthcare technology company that delivers healthcare’s most comprehensive comparative data and analytics platform. Founded in 2000, the Memphis, Tennessee and Plano, Texas-based business strives to bring collaboration and 360-degree data transparency to all entities within the healthcare industry by delivering a range of system agnostic, comparative analytics solutions. Through the use of Application Program Interfaces (APIs), benchmarking and peer comparison tools, payers, providers and other healthcare companies will gain actionable insights to better understand their business and improve operations so they can focus on what really matters, to them.

About IF Technologies

IF Technologies provides healthcare pricing transparency information based on next generation analytics through their software as a service (SaaS) solutions available to insurers, preferred provider organizations, self-insured employer plans, and their members.  The company, based in Lexington, KY, offers solutions, which empower all parties who pay for healthcare to engage in the process of reducing healthcare costs.  For a demo, or to learn more, go to www.ThinkIFT.com.

RemitDATA to Showcase 360-degree Data Transparency Solutions at HIMSS15

Includes comparative analytics solutions for real-time peer comparatives, benchmarking, improving cash flow, tracking provider performance and increasing revenue cycle management

PLANO, TX, April 6, 2015 – RemitDATA, a healthcare technology company that leverages comparative data to bring transparency and collaboration to the healthcare industry, will demonstrate its system agnostic comparative analytics solutions at booth #4009 at the Healthcare Information Management and Systems Society (HIMSS) annual meeting in Chicago, IL, April 12-16, 2015.

Company representatives will be available to discuss and demonstrate how RemitDATA’s comparative analytics platform offers customers multiple ways to access data, including Application Program Interfaces (API), benchmarking and real-time peer comparison tools that lead to actionable insights – especially useful in areas such as ICD-10.

“Payers, providers and other healthcare services are able to more rapidly identify and prioritize areas of concern when they have transparency and insight into their data,” explained RemitDATA President, Michael L. Sanderson. “This transparency enables business optimization and collaboration that positively impacts the bottom line for each entity.” Sanderson also noted that the company’s momentum is “expanding through unprecedented demand for data transparency which is being met by RemitDATA’s comparative analytics solutions.”

Through strategic partnerships, RemitDATA has the most comprehensive professional services Electronic Remittance Advisory (ERA) database in the industry, providing real-time access to peer comparatives that bring optimization, collaboration and transparency to businesses. This database enables healthcare providers to assess areas that can have a significant impact on their business, including:

  • Identifying and monitoring denials
  • Monitoring E&M Code usage
  • Identifying and addressing factors driving claim denials, reimbursement payment delays and other issues impacting a businesses’ bottom line

To see a demo of its solutions at HIMSS15, please visit them at booth #4009.

RemitDATA Names Brad Hill Vice President, Payer Solutions

Brad Hill Bio Pic

Hill’s analytics and health plan expertise will lead RemitDATA to forefront of the payer market

PLANO, Texas, April 1, 2015 – RemitDATA Inc., a pioneer of comparative data analytics technology that brings 360-degree data transparency to the healthcare network, today announced that Brad Hill has joined the company as vice president, Payer Solutions. In his new role, Hill is charged with leading efforts to enhance RemitDATA solutions that are aligned with the specific needs of payers within the healthcare market.

“The payer market is extremely fast-paced and constantly evolving, which means managing operations and understanding the business landscape requires a 360-degree analytical view for payer entities to stay ahead of the curve,” said Michael Sanderson, president and co-founder, RemitDATA. “Brad’s knowledge of the payer market and his deep expertise of payer operations and comparative data analytics will help us create solutions that address the unique needs of this particular market.”

Hill comes to RemitDATA with more than 20 years of experience in healthcare operations, data analytics and business development within the industry. He has held several leadership positions within healthcare information technology companies and is known for leading multiple initiatives to enhance the way healthcare companies conduct and measure operations.

Most recently, Hill was vice president, Payer Solutions at Passport/Experian Health. His responsibilities included the development and growth of various divisions within the company including Data Services, Third-Party Liability, Coordination of Benefits and the creation of other payer-specific product lines. His introduction of products and solutions dedicated to the payer market soon became the fastest growing segment of the Experian Health portfolio. Hill was also vice president of Operations and Program Integrity at HMS, Inc., where he managed the data analytics, credit balance, provider audit, and fraud, waste and abuse services representing 55 million Medicaid lives. Prior to HMS, he served as vice president at AIM Healthcare Services until its sale to Optum, a division of United Health Group.

Comparative Analytics, Big Data and Your Successful ICD-10 Transition

With less than six months left before the October 1, 2015 ICD-10 implementation deadline, there is still time to proactively address some issues that will help guide your organization through the transition. By applying comparative analytics to big data, you can increase transparency into the claims lifecycle so you can better assess the effectiveness of your processes, identify areas needing improvement and begin fixing those issues prior to the deadline.

What to Expect

ICD-10 will have an additional 135,000 codes for documenting a patient’s medical status and reason for a doctor’s visit. Based on the additions of these codes, the Centers for Medicare & Medicaid Services (CMS) predicts that claim error rates will be more than two times higher with ICD-10, reaching a high of 6% to 10% in comparison to the current 3% average using ICD-9 codes. CMS is also predicting that denial rates will rise by 100% to 200% and days in A/R will grow by 20% to 40%.

Leverage Comparative Analytics

Comparative analytics allow you to organize big data to better understand its meaning and gain actionable insights from it. Specific to ICD-10, analytics will increase the level of transparency into your medical claims (837 transactions) and remittance data (835 transactions). With transparency, your organizations can peer into vast amounts of data and extract meaning using an unbiased and consistent methodology. The result is apples-to-apples comparisons of data within your organization and against your peers on a state and national level. This provides you with a baseline to better understand where you stand and the actions that you need to take.

Using comparative analytics, organizations should take the following steps prior to ICD-10 implementation:

  • Create Baselines – Gain a better understanding of your current performance metrics by benchmarking billing staff productivity, claim denial rates and payment turnaround times. You can compare these benchmarks to industry averages that rely on historical data or use comparative analytics to get real-time comparisons against peer organizations.
  • Assess Business Impact – Identify current high-dollar or high-volume diagnoses and procedures, as these will have the most impact on your business when you transition to ICD-10. Determine how coding for these will change with ICD-10.

Other steps to take include:

  • Evaluate Filing Rules – Document timely filing rules for each payer to ensure you don’t get denied for slow staff processing. With the ICD-10 transition expected to increase denials, you’ll want to minimize any denials that are within your control.
  • Scorecards – Work with payers to create a scorecard and a real-time feedback process so impacts can be communicated and resolved quickly.

Post Implementation

After the ICD-10 implementation, use your analytics to establish new benchmarks that you can compare against pre-implementation benchmarks. Identify problem areas and seek solutions to minimize the impact of ICD-10 on your organization.

Questions about Analytics and ICD-10?

Contact RemitDATA to learn more about using analytics with big data to help your organization make a successful transition to ICD-10.

ICD-10 Healthcare Comparative Analytics - Request more info

Five Common Payer Denials and Remedies: January 2015

RemitDATA’s vice president of product management, Aaron Hood, provides commentary for the data from Oct. 1, 2014, through Dec. 31, 2014, with a specific focus on OB/GYN, including recommendations to help your practice avoid future denials.

Click here to see Five Common Payer Denials and Remedies: January 2015.

RemitDATA Expands Leadership Team to Meet Business Growth in 2015

New appointments in operations, marketing and partner strategy will continue company’s momentum

 PLANO, TX, February 3, 2015 –RemitDATA Inc., the leading provider of comparative analytics and real-time transaction data, today announced the addition of new staff members to support the company’s growth. The new appointments include Laura Hescock, who was named the company’s Director of Strategy and Operations, and Stacie Bon, who is RemitDATA’s new Senior Director of Marketing. In addition, Jason Whiteaker was promoted to Vice President of Partner Strategy from his previous position as Director of Sales.

“RemitDATA’s rapid growth is due to unprecedented demand for real transparency from our comparative-analytics platform,” said Michael Sanderson, President and Co-Founder, RemitDATA. “Our expanded leadership team can better support our many clients and partners with innovative use cases and creative consumption models to enable providers and payers to reap the trust dividend — the financial benefits of operating with transparency.”

Laura Hescock brings more than 13 years of experience in executive management and organizational leadership to her role as RemitDATA’s Director of Strategy and Operations. She serves as a resource across RemitDATA to drive collaboration, from the strategic planning stages through implementation. Hescock’s experience in translating strategies into actionable and quantitative plans using data-driven solutions spans across multiple industries in corporate and government sectors.

Stacie Bon brings 15-plus years of marketing and advertising experience to the RemitDATA team. She leads, develops and implements the company’s integrated marketing strategy, and also plays a key role with channel partners and their marketing initiatives. Prior to joining RemitDATA in 2014, Bon was an Account Director at Rodgers Townsend where she worked on the AT&T Small Business account. Bon also led the business development and marketing teams for Javelin and KerstenDirect, two Dallas-based agencies.

Following nearly a decade working at RemitDATA in varying leadership roles, Jason Whiteaker will now be responsible for the management of the company’s strategic partners as Vice President of Partner Strategy. Whiteaker has held several positions while working at RemitDATA, including Director of Sales, Business Development Manager, Director of Client Services, and Product Manager for WebScan PRO.

 

Medical Billing and Collections Quiz

Are you a clever coder or a denials dunce? Put your knowledge to the test with five patient claims and denial questions provided by RemitDATA, a provider of comparative analytics in revenue cycle, utilization, and productivity data. The questions are based on data from the fourth quarter of 2014.

Click here to take the Medical Billing and Collections Quiz.

Medical Billing – 5 Insurance Eligibility Steps For Every Practice

According to RemitData, two of the top five claim denial reasons for Q3 2016 were insurance-coverage related. Millions of claims were denied because eligibility had expired or the patient or service was not covered by the plan in question.

Putting a solid insurance verification process in place can reduce these types of denials in your practice, making medical billing practices more efficient and raising your overall bottom line.

Insurance should be verified before clinical services are provided and should never be a task the medical billing staff handles on the back end. Follow these five steps to reduce the chance your billing team deals with constant eligibility-based denials.

To read the full article, click here.

EMR & Medical Billing Best Practices Series: #6

According to RemitData, two of the top five claim denial reasons for 2013 were insurance-coverage related. Millions of claims were denied because eligibility had expired or the patient or service was not covered by the plan in question. Putting a solid insurance verification process in place can reduce these types of denials in your practice, making medical billing practices more efficient and raising your overall bottom line.

Insurance should be verified before clinical services are provided and should never be a task the medical billing staff handles on the back end. Follow these five steps to reduce the chance your billing team deals with constant eligibility-based denials.

Create a Verification Checklist

Ask the right questions during insurance verification. Front office staff should enter information gleaned from the insurance card, phone calls with the insurance company, or electronic eligibility systems. Verification information in each patient’s electronic medical record for your practice should include:

  • Insurance name, phone number, and claims address
  • Insurance ID and group number
  • Name of insured, as it isn’t always the patient
  • Relationship of the insuraned to the patient
  • Effective date of the policy
  • End date for the policy
  • Whether coverage is currently active
  • Whether the insurance covers the procedure, diagnosis, or services to be provided
  • Whether your practice participates with the plan
  • Limitations of the policy, including exclusions or documentation requirements for bills
  • Whether a referral, pre-authorization certificate of medical necessity is required for payment
  • The amount of the patient’s copay and deductible

Get a Copy of the Patient’s Insurance Card

Begin the process of collecting information by asking for a copy of new insurance information from the patient. It’s a good idea to ask for a copy of the card even if the patient states that insurance hasn’t changed. An updated image of both sides of the insurance card in your electronic health record provides informational backup in case someone mistyped insurance information into the record. Medical billers should double check ID numbers against cards before sending claims.

Contact the Insurance Provider

Don’t take information on cards at face value. Even a few weeks after a card is issued, insurance coverage may have changed or been discontinued. Contact the insurance company directly to ensure eligibility. Place a phone call using the provider hotline provided by the payer or use your integrated EMR and Billing System to ping larger payers such as Medicaid, Medicare, or Blue Cross for eligibility data. When you can set up electronic eligibility systems for payers, this is the most efficient option. You may be able to import data directly into electronic medical record systems, making the process even faster and avoiding possible data-entry errors.

Record Accurate Information

Train office staff to take extra care when transcribing information into the patient record. The information builds the foundation of the medical claim, and a single transposed number can mean the difference between a clean claim and a denial. Rushing through insurance verification practices and making data errors may cause days or weeks of delay on payments, or the claim could go completely unpaid, which is bad for any medical practice.

Follow Up With Patient as Needed

If there are any questions or concerns, follow up with the patient about insurance information. Using a patient portal to inform patients of eligibility through email or online communication is efficient, but office staff can also phone the patient to let them know about copays or other issues. Informing the patient as early as possible about out-of-pocket expenses increases the chance you’ll collect those funds.

For information about setting up connectivity with clearinghouses to verify eligibility from your integrated EMR and medical billing software, contact Revenue XL.

 

Get Started Today

Request a Demo Now

Call 866.885.2974 to speak to a technical client support expert.

11 ASC specialty coding & billing tips

Orthopedics

1. Keep abreast of coding updates. The American Medical Association rolls out a number of changes to its Current Procedural Terminology code set each year. Changes in 2014, according to Becker’s ASC Review report, included:

Codes related to removal of foreign bodies, prosthesis removal and knee procedures. The new codes include 23333 to 23335, 27415 and 27524.

“Code 27415 for open osteochondral allograft, knee, open, is an existing CPT code, which is newly-added to the Medicare ASC list for 2014 with an average Medicare payment of $2,242,” said Stephanie Ellis, RN, CPC, president of Ellis Medical Consulting, in the report.

There were also changes made to arthroscopic knee synovectomy codes 29875 and 29876. “Medicare no longer allows either of these codes to be billed when any other arthroscopic procedure is performed on the same knee in the same surgical case, due to strict enforcement of the CCI edits,” said Ms. Ellis. Strict CCI edit enforcement has also extended to include codes involving some arthroscopic shoulder procedures.

The AMA is expected to announce the 2015 CPT code change, which will go into effect Jan. 1, 2015.

2. Track and avoid common denials. Here are the five most common unexpected orthopedics claim denials that occurred from Oct. 19, 2013 to Jan. 16, 2014, according to RemitDATA.

• CPT code 99213: Outpatient doctor visit, level 3
• CPT code 20610: Aspiration and/or injections; major joint or bursa
• CPT code 99203: Outpatient doctor visit, new patient, level 3
• CPT code 99214: Outpatient doctor visit, level 4
• CPT code 97110: Therapeutic exercises

The top reason codes for these unexpected denials include:

• 45: Charge exceeds fee schedule
• 23: Prior payer(s) adjudication affected this payment and/or adjustment
• 18: Duplicate claim/service
• 59: Processed based on multiple or concurrent procedure rules
• 223: Mandated adjustment code when other code not applicable

Track the root causes of common denials and put processes in place to avoid these denials in the future. Three key actions to take to avoid denials, according to a Health Information Services report, include:

• Diligent insurance verification
• Accurate patient information collection
• Selecting an automated billing service

Click here to read full article at Becker’s ASC Review

100 ASC benchmarks to know — 2014; October print issue.

Click here to read full article at Becker’s ASC Review

Steer Clear of the Top 5 Reasons for Unexpected Denials

If you are wondering why your practice is receiving an unexpected number of denials for certain codes, you may want to check out a recent study published in Physicians Practice which ranks the top five unexpected denials in various specialties. Data was collected by RemitDATA from May 1, 2014 – May 31, 2014 via electronic remittance claims service lines. Here were some of the results:

Top five most commonly unexpected denied procedures:

  1. 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity.
  2. 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity.
  3. 36415 Collection of venous blood by venipuncture
  4. 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
  5. 99232 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity.

Click here to read full article at AAPC News

Comparative analytics: Manage revenue cycle

Q. How can I make my revenue cycle most efficient?

A. Managing the revenue cycle is more challenging than ever. HME/DME providers need to identify and analyze the issues that impact performance and streamline processes to stay competitive.

Efficiency is a key component to the revenue cycle of any HME provider. Getting the money in the door starts with the provider documenting all aspects of the business completed in a timely manner.

Click here to read full article at HME News

Successful collaborative care requires meaningful financial transparency

With the goal of providing more integrated, or collaborative, care, many Accountable Care Organizations (ACOs) have been formed in recent years but several have already discontinued operation.

Part of the reason for this failure is that most ACOs still rely on typical fee-for-service reimbursement models, and the data sharing that has taken place has failed to provide the expected financial improvements in the provision of care.

Click here to read full article at HIMSS Future Care

K0005: Reasons for Medicare Denials

RemitDATA provided the following Medicare funding statistics for ultralightweight manual chairs, HCPCS code K0005, from Dec. 16, 2013, through March 24, 2014.

Click here to read full article at Mobility Management

ASC Key Specialties: Ophthalmology, GI & Orthopedics Coding & Billing Issues to Know

ASC Key Specialties: Ophthalmology, GI & Orthopedics Coding & Billing Issues to Know

Ophthalmology, gastroenterology and orthopedics are the most common ambulatory surgery center specialties. Ophthalmology accounts for 29 percent of all ASC case volume, gastroenterology 17 percent and orthopedics 17 percent, according to VMG Health‘s ASC Intellimarker Survey 2011.

Here are a few important coding and billing issues and statistics for leaders of ophthalmology, GI or orthopedics-driven ASC leaders to know.

Ophthalmology
Several changes have been made to the 2014 Current Procedural Terminology code set. Code 0192T has been deleted and replaced with code 66183, which refers to the insertion of an anterior segment aqueous drainage device without an extraocular reservoir, according to president of Ellis Medical Consulting Stephanie Ellis, RN, CPC, in a recent Becker’s ASC Review report.

Cataract surgery with IOL insert 1 stage was the most frequently performed ASC procedure in 2012 at 16.9 percent of total volume, according to MedPAC data. Of total billed amounts from Nov. 15, 2012 to Feb. 11, 2013, 7 percent of total denied claims were for cataract surgery with IOL insert, 1 stage, according to RemitDATA.

Gastroenterology
Approximately a quarter of the 2014 CPT code changes affect GI codes, according to the American Medical Association. Additions to the 2014 CPT code set cover procedures such as esophagoscopy, esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography and image-guided fluid collection drainage by catheter, according to Ms. Ellis.

Upper GI endoscopy with biopsy and colonoscopy with biopsy are two of the five most frequently performed ASC procedures at 8.1 percent and 5.8 percent of total case volume, respectively, according to MedPAC data. From Nov. 15, 2012 to Feb. 11, 2013, colonoscopy and biopsy accounted for 9 percent of all claims denials and upper GI endoscopy with biopsy accounted for 8 percent, according to RemitDATA.  

Orthopedics
There are a number of significant CPT code additions to the 2014 Medicare ASC list. “[For example], code 27415 for open osteochondral allograft, knee, open,  is  an existing CPT code, which is newly-added to the Medicare ASC list for 2014 with an average Medicare payment of $2,242,” says Ms. Ellis.

An AIS Health report released early this year indicated that orthopedic and spine procedures may be faced with increased scrutiny. One such procedure, joint replacement, has a 12.6 percent Medicare improper payment rate. Medicare contractors are now conducting pre- and post-payment review of joint replacement procedures. They expect proof of exhaustion of conservative treatment prior to surgery.

Spinal fusion has also been placed on the Program for Evaluating Payment Patterns Electronic Report list of risk areas. Coders are tasked with understanding the technologies surgeons use to ensure the codes accurately reflect procedures performed.

Click here to read full article at Becker’s ASC Review

 

Get Started Today

Request a Demo Now

Call 866.885.2974 to speak to a technical client support expert.