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!
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.
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.
- Apply Saved Filter Set will still immediately apply the saved filter criteri...
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!more
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...more
We 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...more
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
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:
Evaluating Payment Velocity for Q4 2015
Be sure to check back in April, as we will look at Q1 2016 compared to Q4 2015 statistics.
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...more