Reimbursement practices are under scrutiny and payment levels are declining. Now, more than ever, healthcare providers — from emergency medicine, to specialists, to emergency medical services (EMS) — need more visibility into reimbursement rates and payer behaviors to battle No Surprises Act (NSA) disputes, negotiate payer contracts, and make strategic business decisions. Our ZOLL® Claims Clarity data service delivers healthcare market intelligence on charges, payments, denials, and payer behavior to foster market transparency and help ensure maximum revenue capture.
Since the NSA went into effect, reimbursement from commercial payers has been decreasing for some providers who have a high percentage of out-of-network claims. Historically, providers have had no insight into a payer’s Qualifying Payment Amount (QPA) and median in-network rates, giving payers an unfair advantage.
Our ZOLL Claims Clarity data service helps restore balance to negotiations by giving healthcare providers reliable reimbursement rate data by taxonomy (excluding payer “ghost rates” that artificially depress the QPA calculation). Armed with actionable healthcare claims data back to January 2019, providers filing a dispute can better develop and defend their position during the open negotiation period and Federal independent dispute resolution (IDR) process.
Without insight into the economics of their own competitive environment, healthcare providers take on unknown risks when they make decisions about pricing models, new service lines, or business expansion. Evaluating the strategic and commercial impact of paths under consideration is easier with the right data in hand. Our ZOLL Claims Clarity data service gives providers easy visibility into what their competition is charging for similar procedures in their geographic area. In addition, the data can be used to forecast revenue from reimbursement by payer.
Our ZOLL Claims Clarity service provides reimbursement rate data and insight into payer behavior. Providers can use this information to negotiate payer agreements and maximum reimbursement more confidently, with no fear of breaking anti-trust or collusion rules. At a time when revenue from fees is declining for some specialties, capturing every allowable dollar — and knowing when to walk away from an undesirable agreement — is more important than ever.
Many healthcare providers have little insight into their own data, let alone access to industry data against which they can measure themselves. Emergency medicine, specialty healthcare, and emergency medical services (EMS) providers can benefit from visibility into industry and local market reimbursement rates. Our ZOLL Claims Clarity solution data can be used to benchmark performance, establish key performance indicators, forecast revenue, and more.
News Alert: ZOLL Claims Clarity Data Service for Healthcare Providers Delivers Claims Data To Foster Market Transparency and Support Data-driven Negotiations and Decision Making