PayerView 2011

Days in accounts receivable, denial rates, provider collection burden, and more – it’s all here with PayerView. Get a brief overview below but be sure to explore the full listing and rankings by visiting this site on a device that supports Adobe Flash Player 9. Need Flash? Get it now.

2011 Overall Top 10 Performers

  1. #1 BCBS-RI
  2. #2 Aetna & Aetna-US Healthcare
  3. #3 Humana
  4. #4 UnitedHealthcare
  5. #5 BCBS-MA
  6. #6 HealthPartners
  7. #7 Medicare B-WA
  8. #8 BCBS-OH
  9. #9 BCBS-PA Capital Blue Cross
  10. #10 Medicare B-OR

2011 Highlights

Top performers included payers from across a variety of groups, signaling healthy competition.

  • National Commercial Payers — Aetna, Humana, and UnitedHealthcare — outperformed regional payers.
  • State Medicaid performance improved across key areas, but continued to lag behind industry standards.
  • BCBS-RI maintained its #1 overall ranking.
  • Medicaid-NY significantly improved their overall ranking.

To learn more, view our webinar on-demand.

Overview

PayerView®. Bringing transparency and process integrity to the health care system.

With unprecedented change and uncertainty rattling the health care industry — a trend that is sure to continue through 2011 and beyond — the need for more certainty and consistency in day-to-day provider-payer interactions takes on a new level of importance. Describing the complex provider-payer relationship and identifying areas for improvement requires objective data and the kind of visibility into transactions that only PayerView provides.

PayerView is an annual project of athenahealth and Physicians Practice. It is the industry's leading quantitative report, providing unprecedented insight into the provider-payer relationship with objective, data-driven methodologies. PayerView data helps create an industry-wide dialogue on how breakdowns in the medical claims billing process can be addressed. The objectives of PayerView are:


  • Discovery. We continuously assess and refine the metrics represented in the data to ensure that the measures reflect the dynamics that create inefficiency and cost across the health care supply chain.
  • Transparency. PayerView data provides a framework to inform initiatives aimed at creating transparency between providers and payers.
  • Continuous Improvement. We provide our client base and payers at large with a comprehensive tool that explicates the interdependencies in the health care supply chain, helping both the payer and provider to improve.

We track the details of every client transaction for tens of thousands of providers. PayerView is a natural product of the unique data that athenahealth continuously compiles and manages on behalf of its clients. Unlike other medical billing, practice management, EMR, and patient communication solutions, athenahealth uses a combination of centrally-hosted, cloud-based software tools and robust back-office services. Our providers share a single web-based instance of software, enabling pooled data and intelligence through a powerful network effect. Every detail occurring during a medical claims billing transaction — patient eligibility check, claim submission, processing time at the payer, claim denials, receipt of electronic or paper remittance, and more — is captured electronically across our network.

We distill our information into quantitative rankings. Each year, we distill our extensive medical claims billing data and draw on it to create comprehensive and objective rankings of payer performance. athenahealth widely publicizes the PayerView rankings, and uses PayerView claims data to collaborate with payers to improve the overall provider-payer relationship.

Reflecting the complex dynamics occurring across the health care supply chain, PayerView brings reliable evidence to claims, a process long dominated by imperfect data, hearsay, and anecdotes.

Interested in Learning More?

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Industry Trends

The 2010 results revealed the emergence of three defining payer trends across the industry:

  • Despite the economy, payers continued to pay promptly with less administrative burden. However, transfers to patient responsibility saw double-digit growth.
  • The Electronic Remittance Advice (ERA) transaction fell short of its true potential as payers struggled to adopt the standard ERA code set, causing providers to rely on the paper equivalent.
  • The eligibility transaction proved a good predictor of backend eligibility-related denials (yes/no patient eligible), and has significant potential for providing transparency into plan design and coverage.

To learn more, visit the Trends section.


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