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Medical Claims Billing and the Cloud

by Andrew Scutro, Senior Associate, Communications

As you may have seen already, we released the 2012 PayerView report this morning, our annual ranking of insurance payers and an in-depth look at payer performance. This is the seventh iteration of PayerView, and our analysts say it does look like the conversion to the ANSI 5010 standard caused some ripples in the supply chain: For the first time since 2008, the majority of payer groups did not show an improvement in days in accounts receivable of one or more days. Our team thinks this could be a warning sign for the upcoming changeover to ICD-10, and you can read the report here or dive right into the PayerView page on athenahealth.com.

While it’s indeed important to gather this information on medical claims billing and present it each year, the fact that we can see the data is what’s really key. Possessing this visibility and being able to share the results and provide insight, is what sets us apart from software vendors that sell siloed medical billing and electronic medical record (EMR) solutions. Instead of storing information in a traditional, closed, server-software setting, we manage data in the cloud, and provide cloud-based services for a network of more than 33,000 providers across the country. To generate PayerView findings, we evaluated 138 payers, 65 million line charges and $12 billion in services billed across 41 states for 2011. 

Being able to sift through all this information is at the core of being on the cloud. We can see this payer data  in the same way we are able to track the success of our physicians as they achieve the measures for Meaningful Use of an EMR. But this is not just about having deep visibility for its own sake. Health care delivery improves when we can see where adjustments and course corrections are warranted, and then easily implement those changes on our single instance of cloud-based software.

athenahealth exists to take on the back-office work required in medicine so care givers can get back to focusing on their patients. And it turns out, according to the 2012 PayerView report, practices still can have a hard time getting paid. What about you? How has your experience been this year with the various payers? Is the process improving and becoming more efficient, or is it getting slower and clunkier?

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