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...

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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.

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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.

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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.

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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.

 

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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.

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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 in...

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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...

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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 i...

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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 participatin...

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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!

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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 mu...
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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.

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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 ...

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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 ...

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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 ...

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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.

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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 ...

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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.

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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...
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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 un...

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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 th...

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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.

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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 B...

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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

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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! 

 

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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      

 

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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 criteri...
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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

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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 revenu...

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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 mo...

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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.

 

 

 

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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 transfo...

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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 den...

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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!

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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.

 

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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.     

 

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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, o...
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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.

Natura...

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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 ...

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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 assumption... more

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 ...
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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 201...

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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...

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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 ...

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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.

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June 2015 Medicare Denials are Experiencing Spikes

  HME Graphic-August

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

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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 B...

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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.

 

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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 t...

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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! more

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 te...

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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...

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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 meanin...

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Differentiating comparative analytics and business intelligence

Healthcare organizations are often challenged to pinpoint the areas where they should focus their efforts to maximize performance, especially given the increasing demands being placed on their enterprises. To overcome these challenges, forward-thinking organizations are turning to advanced business intelligence (BI) solutions featuring comparative analytics to identify the areas of their businesses where improvements can make the biggest impact.

As organizations begin evaluating solutions, they may wonder how BI and comparative analytics solutions differ.

Click here to read full blog post by Brian Fugere, COO of RemitDATA

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Applying analytics to revenue cycle management

Our partner, Allscripts, recently hosted an incredible webinar on the topic of how using analytics is the solution to solving today's healthcare problems. Below is a short piece of their recent blog. Great insights from Ed Wrzesinski, Director of Revenue Cycle Management for Allscripts.

In an increasingly complex healthcare environment, physicians must base financial strategies on more than assumptions and anecdotes. They need analytics.

Frank Cohen presents a solid case for analytics in a recent Physicians Practice webinar, entitled Analytics Do Nothing for Your Practice’s Health – True or False?.

People often use limited information – what they think is true – to make management decisions. This approach can lead to three pitfalls:

Failure to observe – assuming you know what the problem is without seeing what is really happening

Failure to plan – assuming you know how to fix a problem without first finding out what is causing it

Failure to validate – assuming the action you have taken to fix the problem has worked without measuring it

Diagnosing f...

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Availity and RemitDATA Help Physicians Analyze and Improve Business Health Metrics

New Release
March 14, 2013

JACKSONVILLE, Fla. and DALLAS, Texas – Availity, with its subsidiary RealMed, and RemitDATA Inc., introduced a new comparative analytics tool for physicians to benchmark key business health metrics against state and national peers, and then use Availity to improve those metrics. The result is greater visibility and control over their practice’s business performance.

The average group practice spends $247,500 on unnecessarily complex or redundant administrative tasks, according to a 2010 survey commissioned by the Medical Group Management Association. Comparative analytics allow medical practices to optimize performance, reduce audit risk and accelerate payments by preventing denied claims.

“Running a physician practice has become much more complicated and labor intensive over the past few years, and business sustainability has never been more challenging for physicians,” said Russ Thomas, CEO of Availity. “The comparative analytics tool we’re introducing helps practice and group managers quickly identify root problems and resolv...

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Season’s Greetings from RemitDATA

Season's Greetings from RemitDATA

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A comprehensive solution to the rise of RAC Audits

Posted On 10.04.12 By Adam Atwood


There is a nationwide crackdown on Medicare fraud that has become a key priority of government ever since the Tax Relief and Health Care Act of 2006 was signed into law. A component of this act is the Medicare Recovery Audit Contractor (RAC) program, which identifies improper Medicare payments, including overpayments and underpayments, taking place across the country. As a result, there has been an increase in the number of audits being conducted among Medicare services providers such as hospitals, medical supply companies and physician practices. And, one would think, with good reason.

Since 2011, more than $200 million in overpayments were recovered by RAC auditors, whose primary task is to identify improper payments made on Medicare claims. The argument among service providers is that critical information regarding claims has only been the purview of government agencies. However, medical billing companies and physician practices are, more and more, turning to comparative analytics to help prepare for these audits and provide ... more

FastTech Recognizes RemitDATA

A feature in the Dallas Business Journal highlights some of the fastest growing and most established companies in Texas.  This year, RemitDATA is honored to be included on this list by the FastTech Metroplex Technology Business Council, sponsored in part by the Dallas Business Journal.

We’re best known for bringing revenue cycle management to a whole new level in the healthcare industry and consider recognition by FastTech a strong endorsement of our ability to serve outpatient providers with comparative analytics.

With the industry’s largest provider-focused ERA/ERN and EOB database, RemitDATA’s TITAN technology has earned acclaim for revolutionizing the healthcare industry.  We are committed to delivering a level of transparency the industry has never before experienced, and there’s still plenty of work to be done.  As we continue to keep pace with the ever-changing healthcare industry, we plan to work even harder to earn a spot on next year’s list as well.

 

 
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The Economics of The Cloud

The economics of private and hybrid cloud approaches are making it possible for companies to conserve capital expenditures and employ budgets for more strategic endeavors.   To see how, look no further than our own experience as a leading source of comparative analytics for reimbursement, utilization and productivity data for the healthcare provider market.

When we decided to move from a public cloud solution to a hybrid (combination of public and private) solution, the decision came down to price and performance.

It’s paid off.  Since the transition, we pay roughly a third of the costs we did, which has allowed us to expand product offerings and maintain low subscription fees for our software as a service (SaaS) solutions.  The beauty of a hybrid cloud solution, however, is that we’re still able to use our public cloud provider, Amazon Web Services, for data storage, development, offsite data redundancy and disaster recovery.  Amazon's data storage costs are low, and processing fees are based on usage, so once the data is stored, it doesn’t incur any p... more

The Power of Transparency

Imagine walking into a prospective sales or consulting engagement knowing exactly what the prospect’s pain points are and having the ability to point out exactly what you could help them with?  No subjective guesses, but armed with analysis of the prospect’s actual data regarding:

Denial Rates – By Top 10 Payers, Top 10 Procedures and Top 10 Physicians or Practices.

Cash Flow – What Payers are paying promptly? Which are taking longer than others? How does the prospect compare to its peers from a cash flow perspective?

Processing times – For their staff or practices and their Top 10 Payers.  You’ll be able to identify their worst performers and make recommendations for solutions.

Utilization – Who on their staff is most at risk for audit? What specific procedures are being over or under utilized?

Locations – Which office locations are generating more revenue than others? Which are more efficient than others?

Overall Performance – How do they stack up comparatively on all of the data above?

RemitDATA is now offering a new service to their partner... more

ICD-10 for Physician Practices: It’s Still Coming. Is your practice preparing?

Practices across the nation up are gearing up for some major changes in billing taking place over the next couple of years. Many are asking the same question, “Will we be ready?”

Michael Sanderson, the President of RemitDATA, co-authored a thought-provoking article with Deborah Robb, Director of Physician Services at TrustHCS, for Advance for Health Information Professionals entitled, “ICD-10 for Physician Practices: It's Still Coming. Is your practice preparing?

Sanderson and Robb believe that it is important for practices to prepare now for the ICD-10 transition in time for the October 1, 2014, due date. The article provides details regarding why this is important and what a practice should do to ensure a smooth transition.

RemitDATA’s comparative analytics technology provides practices with data to help them benchmark their denials against the denials that other companies are experiencing. This data can help a practice figure out what they can do to decrease denials as they move forward with the new regulatory compliance requirements.

Feel free to c... more

Provider Performance

I read in this article that The Centers for Medicare and Medicaid Services (CMS) intends to allow certain Medicare organizations to produce aggregated public reports that provide a more accurate snapshot of the performance of physicians for consumers in an effort to identify which providers and hospitals deliver the highest quality and cost-effective care.  The agency announced its proposed rule on June 3rd and final comments are due in early August.  IF everyone agreed, this data would not be available until 2013, and that’s in a perfect world.

Practice analytics are needed today, right now.  Providers need better transparency into the economic areas of their business so they can spend less time worrying about financial matters and more time understanding their patients’ needs.  We agree with CMS that providers have had “limited availability to healthcare claims data,” and that they “can receive multiple and sometimes contradictory reports from a variety of insurers.”  Unfortunately, providers and their staff haven’t had access to the data ... more

Big Data Analytics, 5010, ICD-10…all hot topics at the HBMA Spring Show

RemitDATA recently attended the HBMA (Healthcare Billing and Management Association) Spring Conference in New Orleans where several hot topics of conversations included big data analytics, the 5010 conversion nightmares and the preparation strategies for the upcoming ICD-10 conversion.

Data analytics was definitely a high priority for most of the larger billing companies we spoke with. TITAN was a perfect conversation for them. We got lots of "wow you can do that" type comments.

The issues around the 5010 transition have required billing services, providers, health plans, and clearinghouses to be compliant by January 1, 2012. Every piece of the billing process had to be ready to accept these new 5010 files in order for a claim to be processed properly, posing quite a dilemma for billing companies as some claims that were not changed over properly were lost completely. The conversion led to an initial slowdown in payment from payers and a steep increase in payments outstanding as billing companies across the nation began to fully understand and implement the new sy... more

Viva Las Vegas: HIMSS, here we come!

The beginning of the year is an exciting time for the RemitDATA team, as we are preparing for the largest healthcare trade show, the annual Healthcare Information and Management Systems Society Annual Conference & Exhibition. This year we will be jet setting off to Las Vegas to showcase our innovative solutions while learning about the latest trends and issues affecting the healthcare industry today. If you will be at HIMSS this year, we would love to see you – stop by our booth to learn how our solutions are changing the way people think about comparative analytics of structured healthcare data.

Where to find us in Las Vegas:

Dates: February 20-24, 2012, BOOTH #8510

Location: Venetian Sands Expo Center in Las Vegas, NV

Visit HIMSS12 Website

In addition to showcasing our solutions, we will also be a part of the Accountable Care Organizations (ACO) Knowledge Center at HIMSS, new this year. Designed to bring a one stop experience to the analytics/intelligence, cloud computing and ICD-10, the Knowledge Centers will bring HIMSS-generated education sessions, Knowledge... more

Metrics Matter

Managing a SaaS business is straightforward if you know the right financial metrics to watch and understand how important long-term customer satisfaction is to the success of the SaaS business model. Here are some of the metrics I follow closely:

Bookings versus Revenue:  Bookings from new customers (as well as existing customers that have added additional services) is arguably more important than revenue as an indicator of the health of the business since revenue follows bookings.

Bookings versus Sales and Marketing Expense:  In total, the annual value of new sales bookings must be greater than the amount poured in to sales and marketing. Otherwise, you’re upside down on your sales and marketing expense.

Renewal Rates:  The investment to bring in new sales bookings usually pays off when the customer renews and thus the company is able to make a healthier margin. If bookings renewal rates aren’t 85% or higher year over year then there is a problem.

This last metric is particularly important to us at RemitDATA. Having satisfied customers is a direct link to bei... more

What does good Product Management look like for customers?

It starts with a customer question: What happened to the enhancement request that we discussed last month to add a new feature in the product? It will make my life much easier…

Possible answers:
A) The Client Service team created a ticket with the details of the request and submitted it to Product Management.
B) The request was reviewed by Product Management and is being evaluated against other priorities in our product roadmap.
C) It went into a black hole.
D) Both A & B
E) All of the above.

While the correct answer is D, a common perception is that most product requests from customers go into a black hole.

We are changing this perception for everyone involved in the process. We want our customers and partners to have an active voice in the direction of our products. Ultimately, we build solutions that will meet the business needs of our customers and partners. We believe that we do a fairly good job of communicating what we’ve done, but we recognize that we can improve on telling customers on what we’re going to do.

So what have we done to change this perc... more

Great Podcast on Revenue Cycle trends in 2011

For only a 10 minute podcast, this interview by Richard Pizzi (Editorial Director for Healthcare Finance News) is packed full of good information on what RCM trends we will see in 2011 and over the next 12 months.

Three key areas this podcast focuses on:
1. The first step is to provide staff and management the analysis tools that they need to manage the RCM process but then making sure they understand how to get the most value out of the analysis tools
2. Be thoughtful about how your new technologies will integrate with older legacy technologies - staff training, internal communications plan explaining a new roll out and the ongoing game plan on how to measure the performance and impact the new technology is having on patient care
3. Reinforcing messaging with doctors, clinical staff and operations management that having qaulity information means better patient outcomes - this is the ultimate goal and it helps everyone in the RCM process

At the end of the day, every practice, no matter the size, will need to adjust to the changing healthcare environment and how RC... more

A Simple Approach to Effective Client Training

In healthcare, there are a multitude of Practice Management systems, EHRs, and many other applications that are meant to make a provider’s life easier within their practice.  However, what those system vendors typically don’t say on the front end is this: Without the proper implementation and training on the software, none of those systems will  make a positive impact for the provider.  And, most healthcare IT systems take months for implementation and training.

In contrast, RemitDATA has simplified our implementation and training approach so that our clients have the ability to quickly adopt our solutions to positively impact their bottom line.  For each of our three solutions, TITANWebScan PRO, and Reimbursement PRO, we provide a step by step process to assist our clients through the implementation phase. Our goal is to create a seamless transition while our new clients begin to incorporate our solutions in their every day workflow. Given the basic steps needed to get from signup to go live, our training and implementation team moves at a pace comfo... more

Matthew Holt and The Health Care Blog

Over the past couple of weeks, I’ve been exploring the blogosphere for good, HIT-related reads.  I’m sure I’m late to the game, but The Health Care Blog is a good example of a well-rounded, informative blog with lots of engagement. Matthew Holt and team have assembled a wide range of bloggers, guest writers, re-posts, etc. to provide a one-stop shop, must-read. I’d recommend you check it out.

Brian Fugere - CMO more

Partner Profile: MedEvolve

On April 13th, our partner MedEvolve announced the availability of TITAN to their customers. It's an exciting first step for our partnership. Located in Little Rock, Arkansas, MedEvolve offers a full range of PM, EMR and RCM solutions to their outpatient providers. The company was started, and is still managed, by an Orthopaedic surgeon, Dr. Bill Hefley.

Dr. Hefley was recently interviewed by The Medical News of Arkansas, for the article "MedEvolve services focus on practice profitability and efficiency." It’s a great article to learn more about their Mobi and EHR solutions.

With over 10,000 customers, and an approach grounded by an Orthopaedic surgeon, MedEvolve is on track to be a great partner of ours because they also believe in making healthcare more transparent and more efficient for providers. At the end of the day, providers need innovative solutions like TITAN, that help them in areas of Reimbursement, Utilization and Productivity because it improves their performance as a practice and enables better experiences for their patients. It's all abou... more

RemitDATA and Scrum

In January of 2010, RemitDATA adopted an Agile development methodology. Our particular flavor is Scrum. Since our adoption of Scrum, the development process has become more efficient and has enabled our product development velocity to increase significantly.

Here are seven of our values:

1. We have prescriptive short cycle iterative development performed by self-managing teams. Our developers are craftsmen. They are artisans who take great pride in their work product.

2. We are Transparent. We provide the entire company insight into our velocity of development and roadmap/queue of feature work.

3. We are customer centric. Our development process is focused on feature descriptions that are based on a story told from the customer perspective. We want to understand what our customers do and what problems we can solve for them.

4. What we do is not easy. Being open and honest about the performance of your team and yourself is a difficult exercise. Success as a group or failure as a group creates a fault tolerant team effort. We avoid knowledge silos and single poi... more

Wow, Orlando then Vegas! NHIA and MedTrade, here we come!

April will be an exciting month for RemitDATA.  We will be attending two large tradeshows back-to-back. The first of our two upcoming shows will be NHIA in Orlando.  We’re excited that one of our long time customers, Reimbursement Concepts, will be sponsoring the Reimbursement Track.  Reimbursement Concepts is a great billing and consulting organization that uses our solutions.  We’d love to see you come by our booth to learn how you can receive the same powerful solutions that they use.

Where to find us in Orlando:
Dates:  April 4th- 7th 2011, BOOTH 111
Location:  The Hilton Orlando – Orlando Ballroom in Orlando, FL
Visit NHIA Website

The second show we will be attending in April is MedTrade Spring in Las Vegas.  At MedTrade, I would highly recommend planning your visit by first reading the blog of a 60 year ambassador to the industry.  Shelly Prial’s blog can be read here. He recommends participating in some of the industry efforts that we ,at RemitDATA, have supported for over ten years.  The state associations and billing consultants who ... more

One Year Later

It is hard for me to believe that it has been a year today since I took the CEO position here at RemitDATA. It has been a year with so much going on that it has flown by very quickly for me. I am also told that tends to be how you feel when you get older. I wouldn’t know from personal experience of course.

We have accomplished a great deal in the last year, and we have a lot to be proud of.

We restructured the company to focus on our partners for as our primary channel to the market. To this end, we have signed 15 partnership agreements in the last 12 months, including with Allscripts, NextGen, Dell, ACS, Ingenix, and several others. These partners bring us a much larger market footprint than we could ever have on our own. We bring them our full suite of products, most notably our latest comparative analytics product, TITAN. We are early into these partnerships, but we see already are seeing many exciting opportunities emerge.

Our direct sales team has reduced in size significantly as we have put more emphasis on our partners. Despite the change in focus and the... more

How the ASCRS-ASOA Show has Changed

There was a time when many physicians weren’t as interested in the “day to day” management of a practice as they are today.  Their focus and passion was (and remains) patient care.  As the cost of providing care has risen due to audit risk, lowered reimbursement, and other changes in the law, patient care has been in danger of being negatively affected.  These practices are a business, and if they can’t run a profitable business, there is no patient care. Not surprisingly, physicians are now becoming much more interested in the business of healthcare.

The ASCRS-ASOA Symposium and Congressshow is just around the corner (Mar 25-29, San Diego).  For the last 7 years I have attended this show with RemitDATA and we have had a front row seat to the change in focus in the Ophthalmology market.  In my first years at the show, physicians would rarely speak to us. They were cordial, but typically not engaged, and would quickly introduce us to back office.  As sales people we were happy to focus on the contacts provided to us, but we rarely spoke to the physi... more

TITAN has arrived!

Wow, TITAN is finally here! It has taken a few years to get here but now it has finally happened. The idea for TITAN has existed for a while among the RemitDATA founders, but we needed a few important pieces to make it a reality. One, we needed enough data to make sure the comparisons in our “Comparative Analytics” were statistically sound and applicable to most major specialties; and, two, we needed technology to advance to a degree so that we could build a tool which was easy to use and powerful. Both requirements happened in the last 12 months.

The partnerships we have, coupled with the data from our current clients, reached a “critical mass” approximately 9 months ago. We are currently digesting about 360 million remittances per year. This is estimated at 25% of the U.S. outpatient market. This massive amount of data allows us to do amazing things in regards to the financial performance of providers and payers. We can also surface some other metrics previously unavailable to providers such as procedure utilization compared to their peers.

Technology ... more

Get Enlightened at HIMSS 2011 Annual Conference

Orlando, Florida welcomes the 2011 Annual Healthcare Information and Management Systems Society (HIMSS) Conference & Exhibition, Feb. 20-24, 2011, at the Orange County Convention Center. Some 29,000 healthcare industry professionals and 900 exhibitors are expected to attend and discuss cutting-edge technology and innovative healthcare solutions designed to improve patient care.

RemitDATA is proud to be a new exhibitor and sponsor at HIMSS11.  All of our employees are working hard in preparation for the show, which is just days away. We aren’t planning just to show up at HIMSS11.  Instead, we’re making a big splash this year!

RemitDATA is sponsoring the Opening Reception on Sunday, February 20th.  Come celebrate HIMSS’ 50th Birthday Anniversary with us. Attendees will have the opportunity to network with industry leaders and build relationships before the conference begins. This special event is open to all registered HIMSS11 conference attendees.  Join us and the other 5,000 expected attendees for an evening of live music, food and cocktails.  While you... more

Business Development, RemitDATA Style

In many cases, Business Development is just a new age, politically correct word for sales.  That is simply not the case at RemitDATA.  After 10 years of double digit growth, we re-evaluated our business and identified areas where we could improve how our product was purchased, supported and used.

Based on customer feedback, we changed how our products are delivered in the market by partnering with PMS/EMR systems, clearinghouses and RCM companies.  This change allows our customers to purchase and receive support from their current vendors – they told us, quite clearly, that they didn’t need another relationship to manage.  And, working more closely with technology and service partners allows RemitDATA to minimize redundant steps to deliver the information a practices needs to succeed in today’s constantly changing environment.  For example, if a payer trend is illuminated in TITANto show a longer processing time and higher denial rate for a specific procedure, wouldn’t it be better to directly link to those claims within the Practice Management Syste... more

Pride in Partners

Earlier this week, we announced our new solution to the market, called TITAN. Like all companies that launch something new, we’re proud, excited and looking forward to showing it off. We’re making a big splash at the HIMSS11 show (as much as our CFO will let us – see his blog entry here); so if you happen to be attending, stop by our booth (#1017) to check us out.

We’re also really proud of our partners.  For a small company like us, we’ve lined up a pretty impressive stable of partners to bring TITAN to market: Allscriptsdoc-tor.com,LeonardoMDMedEvolveNextGen Healthcare, and Post-n-Track.  We have more potential partners in the contract stage, so we’ll be announcing those once the deals close. I’m amazed every day at how enthusiastic and supportive our new partners have been!

Another cool thing about our partners is that they all have different ideas about how to build off of the TITAN platform.  Some will bring TITAN to market “as is”; some under their own label; and, some have already begun mapping out how to integrate TITAN w... more

Health Systems Need Physician Transparency Too!

Regardless of your political leanings, there seems to be little doubt that healthcare reimbursement models are continuing to move rapidly towards integrated systems which focus on quality over quantity (such as ACO, Medical Home, etc.).  To prepare for this change, hospitals and physicians are aligning at a dramatic pace.  In a recentMedaxiom survey, over 60% of physicians were considering, or were actively engaged in ‘merger discussions’ with their local health system.

Like it or not, physicians have and will continue to control over 90% of the healthcare spending (Medscape Medical News) in the U.S.  And yet, from a comparative standpoint, physicians are the least informed with no real-time, actual comparative data on reimbursement, productivity and utilization metrics outside their own practice.  Ask any doctor you know how often Blue Cross underpays them versus their peers?  Or, how their staff’s effectiveness would rank across the state?  Or, if they are utilizing certain codes that might make them an extreme outlier and subject to higher audit ri... more

Challenges of managing the finances of a growth stage company

As CFO of a growth stage, venture capital-backed company, there are many facets and challenges to my job.  First and foremost is preaching the message that “cash AND cash flow are king.”  Like many companies that have transitioned from an early stage to a growth stage, we’ve added people that aren’t necessarily familiar with the early days of the company and how much cash matters.  The message tends to get diluted over time.  However, when more cash goes out than comes in every month, every little bit counts.  Even though RemitDATA is growing and doing well, being cash flow positive will make everyone feel better – the founders, our employees, and our investors.  Fortunately, we’re well on our way there.

The second challenge is forecasting revenue.  When a company is experimenting with different channels and developing new products, predicting success in terms of revenue – both in timing and magnitude – is extremely challenging.  We have exciting products in the works that we believe will enlighten and transform the physician’s office.  ... more

In all things are patterns. In all patterns are revelations.

This simple understanding was the beginning of our enlightenment. There has been a lack of transparency for healthcare providers that is far overdue for correction. And we want to share this revelation of transparency with you beginning on January 24th.

To experience your own revelation that will provide a level transparency into your practice never seen before, visit www.EnlighteningHealthcare.com and sign up to receive an email alert for our January 24th unveiling.

You can also stop by booth 1017 at HIMSS2011 to Get Enlightened. more

Keeping a Promise is Critical

Before joining RemitDATA in June of this year, I had spent the last 12 years of my agency career helping companies with their brand strategies and go-to market planning. Rebranding a company that has changed strategies is a critical step in shaping that companies’ new future, and the process has to involve everyone, including customers most importantly. Since we re-launched our website in October, we’ve received a few questions about our new branding, so I wanted to take this opportunity to present some background on why we made the change.

In the world of marketing, perception is king, and so is consistency, but the most important aspect of launching a revitalized brand is delivering on your brand promise. Your entire organization must eat and breathe the promise and understand what it means whole-heartedly. Just as in life, when you break a promise you can lose respect and your reputation. The true driver of success is always the people behind the brand. After all, they ARE the brand.

Our keys to rebranding were: find the core value of what we’re deliverin... more

Myth-Busting the CIO Archetype

CIO Insight presents seven of most classic “myths” about the CIO personality. Our own Chief Technology Officer, Wade Wright, and the CIO of Quest Software, Carol Fawcett, offer real-world counterpoints to these common myths.  Read more: Myth-Busting the CIO Archetype
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Success is in the Details

Too often companies underestimate the degree of difficulty in developing and cultivating profitable partnerships.  So much effort is placed on getting the deal signed that often times the integration components that it takes to actually process a deal are overlooked.  How will a customer access your product? What level of integration is required? How does an order get fulfilled? How does each party get paid?  All things that can stall a relationship and kill the momentum that surrounds a deal signing.

At RemitDATA, we have implemented a process to ensure that the details are not overlooked.  Within 30 days of an agreement, we pledge to have four key plans presented to our partners and agreed upon:

  • A support and implementation plan that outlines Level 1 and Level 2 support responsibilities, the training required to accomplish onboarding a customer and supporting that customer throughout the relationship.

  • A marketing plan that clearly states objectives, tactics and timelines to generate killer visibility and interest.

  • An integration plan that outlines development w...
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The Puzzle is Complete

I became a manager for the first time on the day I reported for duty as a young second lieutenant in the Air Force eighteen years ago. They handed me a team and said, “Go.” That was a little scary. Yet, over the years, I learned how to build and lead teams to face the challenges ahead of us. Each of those teams had a life span – form, mature, conquer, excel, and then evolve again.

Dave Ellett, our CEO, mentioned in his blog entry a couple of weeks ago that our company is transitioning in many ways. In the past seven months, we’ve changed our approach in every department: sales, marketing, finance, and development.  But each of those pales in comparison to the transformation our “team” has gone through. The evolution has been simply striking.

Like a puzzle forming on your kitchen table, our team was assembled from a variety of pieces. We have grizzled veterans who fought to successfully grow the company from an idea on a laptop to back-to-back appearances on the Inc. 5000 list. We have newcomers, like our whole marketing team, who each bring different ... more

You can’t Manage what you can’t Measure

This adage is as true as its always been, and never more relevant in healthcare than today!

I’ve been in the healthcare industry, working with providers, since 1989. During my 20+ years in the industry, I’ve observed that providers in general, and physicians in specific, have never had the tools to properly measure their performance or compare their effectiveness on key business metrics. The best the industry has ever done for providers is to offer up a lame survey, filled out voluntarily, with self-reported (read “suspect”!) data, from a small number of (bored) physicians. These statistically questionable, and often inaccurate surveys are then paraded around the industry as the baseline for comparative purposes.

In the past, these fluffy surveys have been enough for the providers. No longer. Reimbursement rates are dropping. Costs are increasing. Regulations and risks are on the rise (RAC, ZPIC, CERT audits to name a few!). Productivity is decreasing. And quality of life for providers is almost non-existent!

Physicians have been “flying blind,... more

Change for the Better

Change is always hard. Changing something that is successful is really hard, and some would say unnecessary. “If it ain’t broke, don’t fix it.” Despite the challenges, we have been making dramatic changes at RemitDATA lately.

Our company has been growing steadily for the last several years. We have been fortunate enough to be recognized in the Inc. 5000 for both 2008 and 2009. We have tremendous customer loyalty, with over a 90% renewal rate every year for the 10 years we have been around. Both of these are signs of success. Even so, the senior team here all felt we could be doing better; for our customers first and foremost, and for our employees and shareholders as well.

To that end, we are in the middle of two major initiatives. First, we are transforming from a direct sales organization to one going to market primarily through partners. In talking with our customers, we realized that there are several situations where it would be easier, and preferential, for our customers if we were more tightly integrated with some of the other solutions they work wi... more

The Future is Transparent

Welcome to our new website and our new blog!  I’m so excited to welcome you to the “new” RemitDATA. We’re a bold company making big moves in healthcare by delivering transparency to providers that are so desperately needing it in order to survive the business of healthcare. Our new blog will be dedicated to addressing the reimbursement, utilization and productivity problems facing providers in today’s ever-changing environment. We are focused and well positioned to solve those problems.

Our goal in this blog is to share our knowledge and experience with the healthcare community so we can help providers and develop strong partnerships. We will bring undeniable clarity to how providers are being paid, why they are not being paid and enabling them to benchmark themselves against their peers. There are many layers to each of those issues and we’ll bring transparency to each layer.

As you explore our new website, you’ll see our new colors, icons, and logos. All bold. Just like us. My promise to you is that we’ll push the boundaries of what you thought ... more