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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Organized by IHM | Type: ihm
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Organized by Summit Healthcare | Type: summithealthcare