DALLAS – A lot of talk these days has focused on transparency in government. Transparency in healthcare is important, too.

 

The problem, said Michael Sanderson, president of Dallas-based RemitDATA, which specializes in tools for analyzing reimbursement and productivity, is that when it comes to gaining insight from comparative performance metrics, too much of that transparency is disproportionate.   

 

"Everybody's got the data except the docs," he said. "The Office of the Inspector General has it. Payers have it. Pharmaceutical companies can buy it. Auditors get handed the data for RAC audits. But doctors don't have it. And the systems that support those physicians don't have it. We want to change that."

Earlier this year, RemitDATA introduced TITAN ("Transparent Insights To Act Now"), which the firm bills as a powerful tool offering physicians the ability to identify and correct revenue cycle and performance issues in their practices with a level of insight heretofore only available to payers and regulators.

 

The Web-based SaaS tool enables practices to benchmark performance against regional peers, based on specialty and geography, thanks to real-time comparative analysis of ANSI 835 electronic remittance notices. That helps refine day-to-day processes that reduce denial rates, accelerate cash flow, increase administrative efficiencies and anticipate audits.

 

Vendors such as Allscripts, Dell, MedEvolve and NextGen are offering TITAN to customers through RemitDATA partnerships.

 

“The fact that we’ve already secured an impressive roster of healthcare IT leaders as strategic partners is a compelling testimony for the power and appeal of TITAN,” said Dave Ellett, RemitDATA's CEO.

 

“RemitDATA is an innovative company, delivering powerful revenue cycle solutions that help our physician clients navigate the business of medicine,” said Lee Shapiro, president of Allscripts. “We are excited to bring solutions to market with them.”

 

The appeal, said Sanderson, lies in using the ANSI 835 remittance file – which "has the most information on it – what did the doctor do, what did the patient have and what did the payer adjudicate" – to help practices look at how they're doing compared to their peers.

 

"We've amassed a huge database, a set of these remittances" accumulated from RemitDATA customers and partners over the course of the past decade, said Sanderson. It represents, he said, "more than 25 percent of the outpatient remittance market" in the United States, encompassing 300 million to 350 million notices per year.

 

Clients ranging from McKesson and Walgreens to academic practices and solo doctors are finding that to be useful because comparative analysis is more important now than ever.

 

"There is unprecedented fear and doubt in the market," said Sanderson. "I've been in healthcare 20-plus years, and I've never seen physicians so freaked out. They're worried about reimbursement cuts, they're worried about EMRs, about meaningful use, that the legislation that might be reversed. They're worried about RAC audits. They're worried about ACOs and medical homes, whether they're going to align with the hospitals in their market, or whether they should sell out to them."

 

Sanderson said the key is to offer doctors the choice of what data they want to gain insight from. Is it reimbursements? Is the practice underpaid, denied too often or paid too slowly? TITAN helps show how a physician office's rates compare to its' peers, he said.

 

Productivity is another important issue, he said. "Is my staff as productive as they need to be? I'm a cardiologist in Tupelo, Miss. How do I possibly know if my staff is doing well, unless I compare it to my peers in the market that I'm in?"

 

The other important metric is use. "As an orthopedic surgeon in Florida, how do I know that the number of knee surgeries I'm doing per hundred new patients is even in the realm of being an outlier or not?"

TITAN gives physicians and their staffs insights into these areas via customized weekly or monthly reports, helping them target areas for improvement.

 

“The ability to dissect a variety of important metrics for comparison against peers allows us to make more informed – and more strategic – business decisions," said Sacheen Mallette, central business operations director for the Boice-Willis Clinic, a large practice group based in Rocky Mount, N.C. "Now, we can quickly and easily understand where to focus our resources to ensure that we are operating as efficiently as possible to achieve revenue goals.”

 

RemitDATA's vendor partners find this comparative analysis useful, too. "Allscripts doesn't have a good way of looking across their client base to see who's in pain," said Sanderson. TITAN helps them ask, "Which physicians are having the most problems with compliance, or which need education on certain modifier codes? Which are getting denied the worst, or which are getting paid the least? How can I help the practices I serve?"

 

Kristeen Pruit-Coronado, president and CEO of Houston-based RCM firm Enhanced Revenue Solutions, has high praise of TITAN (She’s such a believer, in fact, that she spoke to Healthcare IT News about it from her honeymoon.)

 

"I've never seen anything like this before," she said. "It's a powerful tool."

Working off raw 835 files, TITAN takes "from a uniform platform, so there's no chance for error," she said.

"And I can access this data instantly." The tool offers a new level of visibility. "If you've got issues, you're going to see them by payer, by CPT code, by denial code."

 

That allows for useful increased efficiencies, obviating the need to "run 10 different reports to even put the data together." In one case, she said, an issue with an out-of-whack denial that once would have taken a month to figure out was solved in a day.

 

Pruit-Coronado said TITAN helps flag problems early, which allows her to go to clients when necessary and tell them, "you're about to see a problem" with a particular payer, that "they're out this many days, and here's the story.”

 

"If I didn't have that warning, there's no way I could prepare them for that dip in cash flow,” she said. “They make me look good, and that's what I like about them."