Physicians Practice - June 2008 - (Page 33) DENIAL RATE 5.05% 3.17% 3.90% 4.81% 6.22% 7.56% 7.31% 6.35% 5.50% 7.92% 6.83% 7.20% 5.82% 7.41% 5.20% 9.91% 8.26% 6.80% 6.96% 16.04% 15.88% 6.12% 11.24% 6.46% 5.74% 8.25% 12.99% 6.15% 16.12% 8.25% 8.86% 7.37% 8.16% 16.38% 13.84% 15.23% 9.76% 15.15% 21.66% 14.40% 10.79% 13.81% 33.81% RANK 4 1 2 3 11 21 18 12 6 22 15 17 8 20 5 29 26 14 16 39 38 9 31 13 7 24 32 10 40 25 27 19 23 41 34 37 28 36 42 35 30 33 43 DENIAL TRANSPARENCY RANK 63.40% 72.78% 83.55% 85.25% 87.79% 89.41% 84.47% 82.12% 89.26% 84.52% 83.60% 81.11% 91.66% 84.84% 86.99% 81.01% 84.73% 86.14% 79.43% 88.15% 88.13% 83.72% 91.91% 89.61% 78.95% 84.90% 84.00% 88.22% 82.04% 74.24% 81.26% 84.69% 83.68% 78.71% 81.87% 76.34% 81.41% 86.12% 78.75% 77.09% 77.72% 81.36% 65.82% 43 41 24 13 9 4 19 25 5 18 23 31 2 15 10 32 16 11 33 7 8 21 1 3 34 14 20 6 26 40 30 17 22 36 27 39 28 12 35 38 37 29 42 PERCENTAGE OF CLAIMS REQUIRING MEDICAL DOCUMENTATION 0.80% 0.31% 1.17% 1.46% 1.06% 1.03% 2.01% 1.85% 26.76% 2.28% 0.98% 2.64% 1.97% 1.37% 1.27% 0.79% 1.07% 4.14% 3.59% 2.77% 1.44% 1.37% 1.28% 2.26% 1.93% 4.18% 1.83% 6.94% 2.22% 1.08% 1.64% 8.47% 1.37% 1.15% 4.93% 1.40% 1.73% 9.14% 1.56% 2.75% 3.50% 10.75% 5.12% RANK 3 1 10 18 6 5 26 23 43 29 4 30 25 15 11 2 7 35 34 32 17 13 12 28 24 36 22 39 27 8 20 40 14 9 37 16 21 41 19 31 33 42 38 PERCENTAGE OF NONCOMPLIANCE WITH CCI 0.30% 4.42% 0.61% 1.26% 0.32% 2.15% 0.85% 0.94% 0.31% 2.67% 0.91% 0.97% 0.78% 0.93% 1.52% 0.21% 0.30% 0.10% 0.35% 0.33% 0.29% 2.08% 0.55% 0.35% 0.66% 0.50% 0.76% 0.98% 0.81% 0.21% 1.65% 0.29% 1.58% 0.74% 1.33% 0.57% 1.46% 2.59% 0.99% 1.43% 2.35% 1.37% 5.60% RANK 6 42 16 29 9 38 22 25 8 41 23 26 20 24 34 3 7 1 12 10 4 37 14 11 17 13 19 27 21 2 36 5 35 18 30 15 33 40 28 32 39 31 43 If the NPI transition had a slight, negative impact on 2007 performance, you can bet your bottom dollar it will really mess things up this year, when the requirement goes fully into effect. A small increase in patient liability also hurt overall performance. The increase was just 0.4 percent for the national payers compared with a 19 percent increase in 2006. Lukowski calls it “planned growth.” Patient liability isn’t so much of an issue for physicians if they are WWW.PHYSICIANSPRACTICE.COM able to figure out what the patient owes at the time of service and collect there and then. And payers are stepping up with online, real-time claims adjudication systems. Both United and Humana, leaders in the consumer-directed movement, offer real-time adjudication to at least some practices. Real-time adjudication lets a checkout person see within seconds where a patient stands with his deductible and exactly what he owes. A great tool. But even when it’s available not every practice uses it, says Lukowski. Why not? It might be that the checkout staff isn’t comfortable collecting large amounts. Or it may be that payer solutions aren’t what practices really want. “The payers tout these ‘investments’ but the problem for payers is that there [are so many] of them. Providers don’t want to deal with eight or 10 different mousetraps,” explains Nathan Kaufman, a consultant for Davies Public Affairs. JUNE 2008 | PHYSICIANS PRACTICE | 33 http://WWW.PHYSICIANSPRACTICE.COM
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