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

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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:


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

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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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