Comparative Analytics Helps Benchmark Performance

With all the changes health care is experiencing - even without bringing the Affordable Care Act into the picture - there is a fact on which we can all agree: Practicing medicine has become more and more challenging. Beyond adhering to new standards stemming from health care reform, the costs and risks associated with the business of medicine are being impacted by the decreasing reimbursement rates.

As a result, many physician practices have turned to business intelligence technology like comparative analytics to determine the efficiency of their administrative and clinical processes. As a result of using real-time comparative analytics, practices can refine day-to-day processes so they can reduce denial rates, accelerate cash flow, increase administrative efficiencies and anticipate audits.

This powerful technology can analyze tens of millions of lines of data to benchmark how practices are doing by region or specialty compared to their peers.

In addition, using comparative analytics can help a practice:

• Assess its claim denial rates, determine why claims are being denied and see what the impact is on cash flow.
• Evaluate how long it takes to get paid compared to its peers.
• See how the practice ranks against its peers according to region or the type of medicine on benchmarks such as denial rates.
• Manage or avoid an audit by knowing if the provider is an outlier on a code that is an “audit-trigger.”
• Reduce costs by identifying staff or system issues and incenting the right behavior.

Providers now have access to more data extraction and analysis technologies than ever before. Technologies like comparative analytics are invaluable in their ability to help reduce unnecessary claim denials and help providers improve their billing processes as a whole.
For example, we recently worked with one medical equipment provider to use comparative analytics with its billing process. The results were a reduction in unexpected claim denials to 15 percent from 25 percent, a decrease in paper storage costs by $10,000 per year and an improvement in financial performance through increased reporting capabilities.

Michael Sanderson is president of RemitDATA, a provider of comparative analytics that works with health care providers to improve revenue and cash collections by identifying and correcting performance issues in the post-adjudication stage of the revenue cycle.