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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 55,000 providers. Explore by specialty, and compare national and regional figures against your own.Start Now Methodology and Legal
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.
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 55,000 providers, and utilize it to inform the industry and help practices achieve financial health.
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:
All providers access a single instance of our cloud-based software, continually updated and always available
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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]