RemitDATA aims for greater transparency in provider finances

“Transparency” is a widely used word, but it hasn’t been used enough when it comes to the healthcare sector’s finances. That, however, is about to change, said  John Stanton, vice president of consulting for RemitDATA.

“Healthcare has been behind other industries,” Stanton notes, “but most people consider transparency critical. Moreover, the federal government is going to require more transparency” on the part of healthcare providers. The irony, he points out, is that both federal officials and the healthcare payers already have “lots of information” on provider billing and payment practices.  “Yet most practices don’t even have good visibility to their own data.”

RemitDATA aims to change that. Using its powerful “TITAN®” solution, Stanton says, RemitDATA can help doctors see everything they get paid for, as well as everything for which they don’t. TITAN takes all of a provider’s remittance data – and its database is updated nightly – and with a unique algorithm it enables providers to see how they compare to their state or national peers.

“Is a certain payer paying us slower than the overall trend over the last few weeks?” is just one question TITAN enables providers to ask. “Are we an outlier or not?”

Determining the answer to that question can help providers avoid an audit, Stanton says. “Most providers are not submitting incorrect claims intentionally,” he points out. “But healthcare as a sector needs to become much more sophisticated when it comes to managing financial matters.”

For Frank Cohen, founder of the Frank Cohen Group, which specializes in analytics, data mining, and applied statistics, two things set RemitData apart from the competition: “They have a humongous database, and they have really smart people working for them.”

Echoing Stanton, Cohen points to the fact that most providers rarely take a comprehensive look at their financial data.

Noting that having data is critical to understanding any organization’s financial situation, Cohen says, RemitData has “a very eloquent interface by which they provide data to organizations that will enable them to become more efficient.”

In a nutshell, RemitData’s goal is to use both its own technology solutions and a constantly growing network of partners to help providers get more data and provide more clarity to what’s happening with their finances.

“Simple changes in a provider’s process can have a huge impact,” Stanton says. Furthermore, provider financial data is increasingly of interest both to providers and to government officials who are monitoring them. Noting that payment reform is already a big issue, Stanton says, it’s only going to get more complex as efforts to reform payment processes continue at both the federal and state level. 

Providers, consequently, need to be ready. They need to get more and better data, and they need to have access to the networks that will help them figure out what to do with it.  After all, the government understands the data; providers should too.

“We aim to bring clarity to a provider’s financial operation,” Stanton says. “There’s a lot of noise out there. Our goal is to reduce it.”