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I sometimes ask myself why there isn’t more analysis going on. We’ve explored subjects like practice management, where the billing systems aren’t particularly great at analytics. There may be other issues in terms of healthcare as an industry, the culture, and those kinds of things, but it feels like sometimes other things are taking place.

Where do you get your data?

Why is it so hard? I think one of the things is that it’s hard to get data. It’s hard to access data. Again, I referenced a little bit of this before concerning getting data out of billing systems or practice management systems. But then, the obvious question would be, “Okay, why don’t we go around them? Why don’t we access the data directly and then run our analysis?”

I think the challenge is, it’s not just that the systems stink at doing this, that they can’t run the analyses. It isn’t just that you can’t get the data out of those systems. I mean, that’s one of the things that we’ve talked about at length. There’s a huge problem: Good luck if you want to get the data out of your billing system. I mean, it is so hard and so challenging to get the information you want in a format that’s usable, where the tables tie out to each other and all kinds of other things. We’ve talked about that.

Data sources

Why not just go and get it somewhere else? If you can’t get it out of the billing system, where else does that data exist? If we think about where this exists in the world, the payers have this information because they submit the information and deny things. They have all the info: they have payment information, they receive the claims. They have it, but, of course, they’re not going to give it to you. So you can’t get that.

Where else do you want to get that information? Where is it possible to get it? The providers only have it in their billing systems, so that’s not an option. Where else does this information exist? Clearinghouses. An obvious answer, right? Okay, so go to where the data is. Of course, if we’re looking for this type of data, how would we get that information, what kind of information would we be looking for, what would we want, charge information, which we can get out of billing systems? For the most part, they’re pretty good at that. So that’s not a problem.

Keep it simple

Now, we’re looking for remittance data, like payments, denials, and detailed information on that. And we’ve already said we can’t get it quickly out of billing systems, and we want it out of clearinghouses. That’s going to be remittance information, frequently 835, and other ANSI files.

Let’s think in simplistic terms: 835s, ERAs, payment information, remittance information. Okay, so go to clearinghouses, get that data. It should be pretty easy because they have the information. Not only that, but they have the information in a structured format, like these ANSI files, 835s, and more. They could give us those pre-existing files. We don’t need it to be modified. We don’t need it to be in a database. Just give us the raw 835 files. 

It should be easy, right? Well, guess again. Not only should it be easy to access the information, but they have already sent this to people. I mean, like they receive this information. So there is nothing other than a hub and spoke. That’s essentially what a clearinghouse is. They receive these transaction files from the insurance companies. They send them to providers. They take them from providers and send them back to insurance companies. 

So they deal in the transaction of data in structured data formats. So it should be the easiest thing on the planet. It should be one of the easiest things in all of healthcare. It’s to get the files they have that their entire business revolves around, accessing, and sending, and receiving. Pretty simple. God! Why can’t it be that simple?

It doesn’t have to be painful

We’re in the middle of this right now where a client wants to do data warehousing, wants to do a bunch of analytics and things like that. We can’t get the data quickly out of their billing system. It’s eClinicalWorks. It’s a vast, well-known system and stuff like that, but that transactional data is not available. 

So we’re going to the clearinghouse and saying, “Okay, give us the information.” God, you want this to be easy. It really should be. I mean, it should be available in their portal. All you should have to do is go into the portal and download the ERAs. This is all we need to do. But God, it’s painful. I can’t tell you how difficult it has been to try to get it and the number of hours we’ve put in so far.

Key takeaway

In the following podcast, I will share with you how painful it has been, where we’ve gone, and some of the ridiculous things that have come out of their mouths where I want to tear my hair out, or sometimes I feel like just shooting myself or banging my head against the wall. And I am an optimistic person. I’m a positive person. Although you hear me railing on negative things sometimes, the reality is why this is like the world shouldn’t be this complicated. It really should be much easier. I think people need to get their shit together. Please!