PayerView. Providing unprecedented insight into the healthcare reimbursement process.
In many ways, 2011 was business as usual from a medical claims billing performance perspective for the health care industry, although large changes occurred behind the scenes. The entire supply chain was preparing for ANSI 5010 compliance, and the specter of ICD-10 compliance in 2013 loomed large. The near future seems destined to bring industry changes that will challenge payer and provider performance, but also give both opportunities for performance improvement. The closer that payers and providers can work together during these transitions, the better the chances for positive change. PayerView encourages this dialogue by describing the complex provider-payer relationship, and identifying areas for improvement using objective data and visibility into transactions.
PayerView, an annual project from athenahealth and Physicians Practice, 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. The goal is to ensure that measures accurately reflect those dynamics that create inefficiency and increase 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 with a comprehensive tool that explicates the interdependencies in the health care supply chain, encouraging improvements for both payer and provider.
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, EHR, and patient communication solutions, athenahealth uses a combination of centrally hosted, cloud-based software tools and robust back-office services. Because each of our more than 35,000 providers shares a single web-based instance of EHR software, data and intelligence is pooled through a powerful network effect. This means that every detail of every 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 national network of providers.
We distill our information into quantitative rankings. Since its launch in June 2006, PayerView has provided a unique framework that systematically addresses unnecessary administrative complexity between payers and providers. PayerView is designed to evaluate each payer's performance based on a number of key metrics which, when combined, provide an overall ranking that attempts to quantify the ease of doing business with that payer. All data comes from the actual claims performance of payers that work with athenahealth providers, and reflects athenahealth's experience in dealing with individual payers across the U.S. While our claims billing data set isn't perfect—as no single set can be—through PayerView we strive to bring transparency and process integrity to the analysis of the provider-payer relationship.