Mining Data for More Revenue

If a cardiologist in the state where you practice is being paid more than you, wouldn’t you like to know that? Or if an internist is being reimbursed by Medicare faster, and being denied claims less frequently, isn’t that information worth having? Of course it is, because that information can help you identify potential improvements in revenue and productivity.

It used to be that information of this nature was only available to payers, Medicare and regulators. But with TITAN, a SaaS solution from RemitDATA Inc. of Memphis, Tenn., that provides real-time comparative analysis of ANSI 835 electronic remittance notices, physicians and medical practices now have the ability to identify and correct revenue-cycle performance issues.

“It’s about transparency,” says Michael Sanderson, president of RemitDATA. “Physicians have been flying in the dark.” But now, he says, the playing field has been leveled.

Targeting Areas for Improvement

According to Sanderson, TITAN provides the most statistically valid sampling available with data accumulated from RemitDATA customers and partners over the course of a decade. RemitDATA draws upon approximately 25% of the electronic remittances processed in the U.S., encompassing 300 million to 350 million notices per year. TITAN provides physicians, administrators and staff with customized weekly or monthly “Insights” via electronic updates to target areas for improvement from financial performance to staff productivity. With mobile-device accessibility, the information can be available anytime, anywhere.

“If a sales rep at a conference shows a physician a new cardiovascular thingamabob and says, ‘Doc, you need to buy one of these; you’re going to make a fortune,’ up until now the doctor had to take the sales rep’s word for it or have some anecdotal information. What TITAN will allow that doctor to do is say fine, what’s the code? Plug in the code, look at Ohio, look at the nation, and say, 'What’s Blue Cross paying? What’s Coventry paying? What’s Medicare paying? How long does it take to get paid? What are the reasons for denials? What things can I do up front to make sure when I put this new thing in that I can get paid more rapidly?' It’s finally transparency for doctors at a level they never had before.”

Physicians can set up data Insights that matter most to them. For example, do you want to know when you’re at risk for an audit? Or if you’re performing twice as many cataract surgeries as your peers? Depending on a physician’s specialty and the information he or she seeks, an Insight will be emailed providing that information.

“Doctors told us what was important to them,” Sanderson says. “Utilization issues, reimbursement issues, and productivity issues. Should you open up a sleep clinic within your practice? With TITAN you can do the research to see what the market will bear.”

Mining Data Through Mobile Applications

Enhanced Revenue Solutions, a Houston, Texas-based revenue-cycle management service that works with healthcare practices, took part in the Beta testing for TITAN.

“Having information in a snapshot that is unique to your practice is a tremendous benefit for physician practices in terms of quickly identifying and resolving where there are problems, rather than delaying the processing of claims, receiving reimbursements, or cash flows,” says Kristeen Pruit, CEO and president of the company, noting that a physician can identify dominant reasons for a claim being denied “Is it a copay, or is it diagnosis coding errors? Without that information, it could take 90 days for you to figure out what the problem is, and by then it’s too late.”

Sacheen Mallette, central business operations director for the Boice-Willis Clinic in Rocky Mount, N.C., which also participated in the Beta testing, explained that, “The functionality of TITAN makes it a valuable tool for instantly drilling down to share a variety of critical business issues with our leadership team. The ability to dissect a variety of important metrics for comparison against peers allows us to make more informed—and more strategic—business decisions.”

With TITAN, a physician or a member of his or her staff can use a mobile application and receive customized information via a smartphone. The service is available through several leading practice-management and EMR firms, including Allscripts, Dell, Doc-tor.com, LeonardoMD, MedEvolve, and NextGen Healthcare through the RemitPARTNER program. It will also be available for demonstration at the HIMSS11 Annual Conference and Exhibition, Feb. 20 to 24, in Orlando, Fla.