Is NHIC getting The Job Done?
By Caleb Dixon
The data does not lie. Read the facts regarding DSO and Denial Rates following the DMERC to MAC change for Region A.
Effective July 1, 2006, NHIC took over processing claims for Region A. Much in the media has been said about this change but no one has had empirical proof of what it has meant to your cash flow…. until now.
The chart below displays the number of Days Sales Outstanding (DSO) and Denial Rates for Infusion products and the HME industry as a whole. June represents HealthNow’s last month of processing claims and the NHIC data is from Q4 2006. This data represents dollar weighted averages and is statistically valid (RemitDATA processed over 30 million claim lines in 2006). Dollar weighted averages place value on those claims that matter most to you: the ones with the most cash. It allows those products you sell higher quantities of but receive lower reimbursement for, to not skew the data.
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HealthNow
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NHIC
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DSO
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JUNE
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OCT
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NOV
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DEC
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INF
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90
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135
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84
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85
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All HME
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47
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60
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60
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64
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Denial Rates
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JUNE
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OCT
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NOV
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DEC
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INF
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29%
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19%
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32%
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32%
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All HME
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17%
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18%
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18%
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19%
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Regarding DSO for infusion products, we can see a drastic difference from HealthNow in June (90) to October (135), but DSO in November (84) and December (85) outperforms June (90). Contrast that to all HME products where Q4 (60 to 64) under NHIC performed 28% to 36% worse than June (47).
Analyzing the Denial Rates shows a dip in October (19%) compared to June (29%), but is then followed by 2 months of 32% denial rates. Contrast that to all HME products where the denial rate has changed slightly from June (17%) to December (19%).
The transition from HealthNow to NHIC has, in fact, produced higher DSO and Denial Rates. The data shows a larger increase for HME as a whole compared to Infusion products. If you would like to see how your company’s DSO and Denial Rates compare to this data, please contact us at MoreInfo@RemitDATA.com.