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All right, this is an update on a podcast we did a couple of weeks ago about getting data and how hard it is to get data to do analytics. One of the things we talked about was, there are so many challenges to being able to put in place a good analytics program. One of those is just getting access to your data because billing systems, practice management systems, and so on are so bad at accessing this. We had suggested that a possible way around this was to go to the clearinghouses. And we had talked a little bit about how difficult it was even to get data out of a clearinghouse as well. This is an update now a couple of weeks after that one. It’s going to be another bit of a downer, so we’re going to do the wha-wha-wha-wha-wha.
Let’s talk remittances
Good news first. We’ve been able to download about a thousand remittances in the form of a PDF. But PDF is not a particularly useful format. I mean, we have an ERA or an 835 parser built. We can do that. Now, we can figure out how to parse a PDF, but it does take some work. It’s not the easiest thing to do and certainly not what most people are going to be able to do. The average billing company or the average provider is not going to get a thousand-page PDF and figure out how to parse it into discrete data that goes in all the fields in a database. That’s a lot of work.
It’s now been more than two weeks since we had that long conversation and sort of the technical support conversation with the clearinghouse. They said to contact them if we don’t hear back from them in a week. A week went by, two weeks went by. We didn’t hear anything. Of course, we still don’t have the ERAs, the 835s downloaded. So we chased them, and we got them back on the phone. We set up a call with their higher-level technical support and spent an hour on the phone with technical support. We’re making progress going through stuff.
Identifying the right steps
We figured out there’s an application you need and there’s a certain process you have to go through and all those kinds of things. Great! We’re doing all of that. And at the end of an hour, there’s still no 835s in our possession. We had to set up a call for another day to do another probably hour-long session to try to figure out why it’s not working and why we don’t have any 835s or ERAs.
The good news is that someone technical-ish is saying that we can get access to the 835s and download them. Unrelated to that person and that process, separately, just our investigation of their portal, we found that way to download the PDF. So in a worst-case scenario, we can build a PDF parser that uses that for ERAs. Again, we can do that. It’s not ideal, but okay.
A tedious process
The bad news though is, if you or anyone else wants to do this, it’s a giant nightmare. It’s a process that takes weeks to months, and that’s assuming that we’re going to be successful in the end. It takes an incredibly long period. You have to be incredibly persistent. You can’t take no for an answer, and you have to be able to cut through a lot of the stuff that they’re saying because they will say, “Oh, yeah! You just do this.” You’re like, “Well, no, no! That’s not working. That doesn’t work.” You have to be able to understand both the confluence of technology and revenue cycle management.
What you might find
For example, one of the problems we’ve run into with this clearinghouse is, when you “download”, it creates duplicates in the billing system. So those ERAs get downloaded twice to the billing system, and you create duplicates, so double posting. That’s the real problem. Then, we figured out that if you don’t do the timing right, you have the opposite problem, which is, if we download them first and we access them before they get downloaded to the practice management system (in this case eClinicalWorks), then they never get pushed out to the practice management system and they just disappear. They never get posted. That’s also a problem.
I don’t know how realistic it is for all but a few really rare organizations to be able to go through this monumental process just to be able to access their data to be able to try to drop it into something like data warehousing or to be able to do basic analytics.
The best thing about all of this, this clearinghouse, is when you’re on hold with them (and we’ve been on hold a lot), they have the marketing spiel that they’re talking to you. The things they say are (this is a beautiful irony) that they work with top-performing systems and “smooth technical integration”. I just about fell out of my chair laughing as I’m sitting there and going like, “No integration. We can’t even access simple data. But I’m glad you’re telling me that my experience is not real, that there is smooth technical integration. Thank you so much!”