RemitDATA ranks best billers

Wednesday, December 31, 2003

MEMPHIS, Tenn. - The Region B DMERC denies 5.8% of all the claims that Clay Home Medical sends to the carrier. That’s not only good news, but the very best news to come out of a ranking of about 600 HME provider locations that do their own billing and that are customers of RemitData, a claims management company that analyzes CMS remittance data.

The ranking, which was compiled using a formula that RemitData is now trying to patent, involves 150 different companies that represent about $350 million, or 5-6%, of annual reimbursement that Medicare pays to DME providers. The average denial rate for all of RemitData’s customers is 23%.

In this new ranking system, RemitData weights billings per HCPCS code so that the analysis computes an ‘equalizer’ score that allows RemitData to rank its entire customer base, whether the company is doing predominantly oxygen, rehab or infusion, on the same continuum.

Clay Home Medical’s ‘equalizer’ score was negative-67%, which essentially means that Clay had a 67% better DSO and denial rate performance than the average of companies billing the same products as Clay.

“If you are a Medicare respiratory biller, you may have lower denial rates than a great rehab biller because respiratory has lower rates than rehab,” said RemitData President, Bently Goodwin. But in this ranking, “it doesn’t matter what your denial rates are, but how well your rates are against the average.”

At Clay Home Medical, President Sam Clay attributes his company’s billing success to billing personnel with longevity in the industry and specialization in the department.

“I don’t have the same person billing Medicare and other third parties,” said Clay. “I want my Medicare specialists to be working with just one set of rules.”

The other great credit goes to a new software system that includes editing safeguards to catch omissions during intake.

“This allows us to send in clean claims and has improved our DSO and denial rates significantly,” said Clay.