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Methodology

Our goal was to rank payers based on how well they worked with us and with our physicians by measuring their performance in seven areas, including:

  • Days in accounts receivable (DAR)
  • First pass resolve rate
  • Percent patient liability
  • Denial rate
  • Claim denial transparency
  • Percent of claims requiring medical documentation
  • Percent non-compliance with the Correct Coding Initiative (CCI)

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Overview

PayerView empowers our industry with important payer rating information.

We know how important it is for payers and medical practices to work together well – not just for their individual financial benefits, but also for the well being of the entire health care system. Until now, however, there has been no objective data to drive improvements. That’s why we started PayerView.

PayerViewSM is an annual project of athenahealth and Physicians Practice.

It’s the industry’s first quantitative report that spotlights payers' performance based on specific metrics. Combined, the metrics provide an overall ranking aimed at quantifying the "ease of doing business with the payer." Needless to say, any data set – including ours – isn’t perfect. But every day, we strive to bring transparency and process integrity to thousands of physicians.

We at athenahealth are committed to bringing transparency to the administrative burden associated with physician payment, and PayerView is proof. Like no one else, we empower clients and practices at large to make payers accountable. Outcomes may include better payer processes, less administrative hassles, streamlined records, less paper, improved cash flow, and better accuracy.

We track the details of every client transaction for thousands of providers.

PayerView is a natural outgrowth of the data that athenahealth dynamically manages and processes on behalf of its clients. Unlike other billing, practice management and EHR solutions, athenahealth uses centrally hosted web-based software tools and behind-the scenes support for clients. So every detail that occurs during a billing transaction – every claim submission, denial, number of days in accounts receivable (DAR) and more – is captured electronically in a secure manner.

We distill our information into quantitative rankings.

Each year, athenahealth draws on this objective, comprehensive dataset – such as how long it takes providers to get paid – to rank the “ease of doing business with” payers. athenahealth widely publicizes the PayerView rankings, and uses PayerView data to collaborate with payers to make improvements in the payer/provider relationship.

PayerView is the industry’s first objective, comprehensive data set that reflects the dynamics that occur across the complex provider/payer supply chain. It sheds light on (and offers hope to) a realm dominated by imperfect data, hearsay and anecdotes.

How medical practices benefit:

  • Payer improvements for all providers. Whether or not you’re an athenahealth client, your practice benefits from PayerView. Whenever we help one of your payers improve its days in accounts receivable (DAR) or first pass resolve rate, your practice will see benefit from the ripple effect of their improvements.
  • Leverage in payer negotiations. PayerView’s data provides a standard “language” to use with payers. These metrics can become a shared vocabulary for payers and providers to use when resolving issues or negotiating contracts.
  • Better control over practice performance. PayerView metrics give you a set of day-to-day variables to measure and track. Using these figures to gauge your practice performance can reveal strategic ways to increase profitability and focus on patient care.

Payers benefit too.

One of the more tangible benefits to payers is the cost savings associated with streamlining claims submission and follow-up procedures. This is the common ground where payer and provider goals are aligned – and where athenahealth has built a conduit to facilitate better relations, patient care, and positive change in our industry.

To learn more, contact athenahealth

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