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Harnessing 835 EDI Data for Better Cash Flow

Visit ihs.gov and read that, “the 837 data string is broken out line-by-line so you can see the loops, segments, and data elements.”  That “the 837 file is one long data stream.”  That ANSII Standard X12 835 allows for receiving reimbursements and adjustments in an electronic format, aka ERA or electronic remittance advice.  According to one Director of Patient Accounts, buried in reports of 18 columns and 130,000 rows (2,340,000 data cells) is the answer to why the claim was adjusted or denied!

The 835 ERA includes information about the payee, the payer, the amount, and any payment identifiers.  The 835 indicates the difference between what the provider charged and what the payer paid.  Multiple checks and payment information can be bundled within the same 835 file. 

By unlocking the 835 remittance files, the provider accesses detailed patient, clinical, operational, and revenue cycle analytics.  And acting on the data has a significant impact on revenue and cash flow.  But we need to be able to access that data! 

Getting at that data trapped in 835 EDI remittance files impacts the financial health of payers and providers of all sizes.  Plus, unlocking key data elements  provides a competitive advantage to hospitals.  A reduction in denials of 3% to 5% has the potential to produce a $5,000,000 to $10,000,000 revenue increase.

According to CHIME, ACOs will need more data analysis capabilities because revenue cycle management is a high priority.  Financial gains from these efficiencies are felt by all members.

This is where Visual Data Discovery (VDD) and the ability to work with virtually any data source (EDI, PDF,…

Continue

Posted by MM Franclemont on April 21, 2014 at 11:29am

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Latest Activity

Srinivasan TV added a discussion to the group 6.0 Users
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Home Medication upon reconcile and Hold

While Reconciling a Home medication if one of the Meds is kept on Hold with reason and saved, does this reflect in Pharmacy as Home Meds on Hold with Reason Does it appear?In our current 6.06, I do not see this happening; I wonder Is there an enhancement in 6.07 or It does not update in Pharmacy at all !Or is there anywhere a setting in OM or Pharmacy Dictionaries or Parameters ?See More
6 hours ago
Kristie Evans added a discussion to the group Meaningful Use
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Should a copy of the PHS be saved in the patient's medical record?

Has anyone considered if a copy of the PHS should be saved in the patient's medical record? We are planning to store a copy in the HCIS file library as recommended, but have wondered if we should also include a copy in the patient's medical record.  Any thoughts?See More
8 hours ago
Bill Sims replied to Bill Sims's discussion Advance Directive / Living Will in the group DR/SQL
"Y'all are awesome.  Wish I'd been on this Forum a week ago.  Found what I needed - the mnemonics for the elements I need and found them in DMisGroupResponseElements.  So...do I use what is in AbsQueries or use…"
11 hours ago
Lori I replied to Bill Sims's discussion Advance Directive / Living Will in the group DR/SQL
"Bill, Someone needs to tell you the mnemonic of the query for "Advance Directive on File".   As far as the group responses (Living arrangements, Smoking etc) you'd also access them somehow by knowing the query mnemonic for…"
12 hours ago
Bill Sims replied to Bill Sims's discussion Advance Directive / Living Will in the group DR/SQL
"Wow - thanks for the fast reply.  Three newbie questions: - When does the data from AbsQueries vs AdmVisitClinicalQueries get used (same/similar data - can't figure out when it is captured / updated)? - How do you refer to a specific field…"
13 hours ago
Lori I replied to Bill Sims's discussion Advance Directive / Living Will in the group DR/SQL
"What version Meditech? We are 6.0 and I think what you are talking about is the Yes/No query that asks if an Advance Directive is on file? If so, the DR/SQL Discussion titled "Vitals" might be of some assistance. It discusses where to find…"
13 hours ago
Bill Sims added a discussion to the group DR/SQL
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Advance Directive / Living Will

Ok, I'm stumped (and possibly because I'm a newbie).  Does anyone know where to get Advance Directives on File indicator in the DR?Thanks,BillSee More
13 hours ago
Bill Sims joined Howard Minor's group
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DR/SQL

Discussions and technical resources related to the growing importance of the Data Repository. See More
13 hours ago
Profile IconBill Sims, James Perkins, Kevin Buchanan and 4 more joined MEDITECH Connect
13 hours ago
Kenneth Orr replied to John Gath's discussion CPOE scheduled procedures? in the group Patient Care Management
"Any update on how users are handling the pre-op orders to pacu orders to post-op orders? We are having a lot of push back from physicians in a couple aspects, such as ob patients being managed by a hospitalist and an OB doctor.  If the patient…"
15 hours ago
Profile IconChris Daglow, Steve Mogg and Christian Bermudez joined MEDITECH Connect's group
15 hours ago
Chris Daglow replied to Joel Garcia's discussion NDC information in the group NPR & RD Report Writers
"Hi Joel, I believe those are all built on the transaction level via CDS - you'd just need to build a report that pulls that CDS/Query you created and attached in the Procedure Dictionary..."
15 hours ago
 
 
 

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