CodeView

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Methodology and Legal
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CodeView from athenahealth

Bringing transparency to physician reimbursement

CodeView gives you access to physicians' average reimbursement payments, per procedure—not just for Medicare and Medicaid, but also for commercial payers, extracted from our cloud-based network of more than 59,000 providers. Explore by specialty, and compare national and regional figures against your own.

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Making Health Care Easier for Physicians

To be medical care givers' most trusted service, athenahealth eases practices' administrative burden, making it easy to access and share data, freeing up physicians' time so they can focus on patients, and helping them get paid for the care they deliver. Here's a look at how we do it.

What's behind the data?

The key to CodeView and other athenahealth insight is the technology and intelligence of our cloud-based network. We continually compile data for more than 59,000 providers, and utilize it to inform the industry and help practices achieve financial health.

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What is athenahealth?

We are the leading cloud-based provider of practice management, EHR and care coordination services, delivering an integrated solution designed to get providers more pay and greater control.

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The athenahealth approach

In our mission to help make health care work as it should, we deliver our Best in KLAS* cloud-based services by combining three essential health IT elements:

Cloud-based Software

All providers access a single instance of our cloud-based software, continually updated and always available

Networked Knowledge

athenahealth intelligence teams ensure that all clinical and revenue workflows are streamlined and up-to-date

Back-office Services

Our service teams work behind the scenes to take on your most onerous administrative tasks, freeing up your staff to focus on patient care

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Revenue Insight

Achieve financial health at your practice: Take advantage of athenahealth data, insight and expertise with these useful tips and tools.

7 Tips for Contract Evaluation

When considering payer agreements, be prepared and well-informed with these best-practice tips.

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Your Revenue Calculator

Quickly find out how much extra revenue your specific practice could be earning with athenahealth services.

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PracticeVitals Performance Tool

How well is your practice performing? See how athenahealth clients are doing, on average, with performance metrics that determine success.

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5 Questions for Your HIT Vendor

Looking for a practice management system? Check out the five essential questions you should ask any health IT vendor.

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5 Questions to Ask Any Practice Management Vendor

Selecting the right practice management system is not easy. The ideal offering should boost your overall efficiency, and greatly
ease your staff's administrative burden. How can you assure that experience? Ask any vendor these five essential questions.

  • Do you provide real-time performance insight?
    The right vendor should give you full visibility to how well your practice performs against specific metrics and peer benchmarks.
  • Do you have an automated database of "rules" to keep claims clean?
    Your vendor should stay on top of denial issues and integrate them into their service. There, any problems are automatically flagged for your attention before you submit a claim.
  • Do you follow up on claims for my staff?
    You shouldn't spend hours each week tracking submitted claims and fixing broken ones. Your vendor should have services teams, with extensive payer and claim experience, doing that for you.
  • Do you have an intelligence team to help me manage change?
    How are you preparing for ICD-10? A strong vendor stays on top of regulations like these, continually researching changes and implementing them into your workflow. Keeping you both compliant and productive.
  • Do you provide support and coaching? At no extra cost?
    If a vendor is invested in your practice's success, they should offer free one-on-one support, partnering with you to identify inefficiencies and opportunities based on your performance.

Gain financial health

Our Best in KLAS practice management solution helps more than 38,000 providers on our cloud-based network get paid more, faster. Find out how your practice can achieve financial health during these times of change, with far less administrative burden.

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Methodology & Legal

Methodology & Legal

CodeViewSM uses clean claims data, from January through Dec 2013, to estimate average contracted rates for select procedure codes across several classes of payers. We employ the following process to produce these estimates:

1. In order to limit the data set to payers for which we have significant and reliable transaction volume, we first remove data from any payer that isn't included in our PayerView® report, which uses a robust vetting process to ensure data quality.

2. We then restrict the data to primary charges on claims billed to primary insurance that did not receive a denial (i.e., they either resulted in a payment or an explanation of benefits that resulted in a transfer to either secondary insurance or the patient).

3. Because mid-level providers are often reimbursed at a different rate, procedure code modifiers can impact reimbursement, and practices located outside of the lower 48 states often see reimbursement that is not comparable to practices elsewhere in the U.S., we remove data to control for these factors.

4. For each payer, the remaining allowable amounts are then analyzed to find the most common amount for each practice/procedure code (this is used to control for anomalies, like the effect of deductibles that have not been satisfied early in the year). If the most common allowable amount is found a material number of times and constitutes the sizeable majority of results for that practice and procedure code, it is assumed that this allowable amount reflects the contracted rate for that practice and procedure code.

5. Using these estimated contracted rates, we calculate the 25th percentile, median, and 75th percentile, for each procedure code, by provider specialty, nationally and in each region of the country, for Private, Medicare B, and Medicaid payers. To comply with Department of Justice guidance, we only display results for private payers if the data behind those results come from at least five payers, no one payer constitutes more than 25% of the charges used in the calculation, all data is at least 90 days old, and the data used in the calculation was taken from multiple practices (Medicare and Medicaid data is obviously not subject to these limitations). Data for each specialty must also be available for at least two regions of the country.

*Practice management (1-10 physicians & 11-75 physicians); ambulatory EHR (1-10 physicians), as reported in the 2012 Best in KLAS Awards report]

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