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...


Payers: Get More Out of Your Value-Based Contracts

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

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

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

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


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

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

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

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

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

So, do you know how you compare?

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


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

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

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

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


Comparative Analytics Improve Billing and Collections Processes

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

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

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

Check out our article on the topic for additional details.



Business as Usual? Preparing for Value-Based Healthcare

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

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

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


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).

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

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...