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.

Medical Billing – 5 Insurance Eligibility Steps For Every Practice

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.

Click here to read full article at Revenue XL

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.

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.

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.