A Comparative Performance Reporting Tool
Payer and contract performance is critical to maintaining consistent revenue levels in healthcare. Provider organizations typically don’t have the reporting tools to effectively monitor payer performance and related adverse events and trends. Vortext’s new PayerScorecard™ is the solution. Vortext® has implemented PayerScorecard™ as a downstream product incorporated into their best of breed RCM Analytics Suite. Vortext® PayerScorecard™ utilizes relative payer performance metrics within a toolset that allows any combination of comparison sets including:
- Payer to Peer (1 to 1)
- Payer to Peer Group (1 to many)
- Payer type comparisons (e.g. commercial to government)
- Medicare isolated
- Plan level comparisons (plan vs plan)
- Inpatient and Outpatient segregated scoring
Rollup Comparison Score
PayerScorecard™ features a rollup comparison score (Overall Rating) that allows the user to immediately see how a selected payer is performing overall. Finer level detail reporting drives into specific payer performance metrics (against the selected comparison group) including:
- Percent of Allowable Collected
- Denials as a Percentage of Claims
- Appeals as a Percentage of Overturned
- Average Days to Pay
Metrics are provided as both six- and 12-month rolling averages.
As is common with Vortext Analytics® tools, visualizations can be exported in multiple formats and the underlying data driving the visualizations is available for export. Visualizations may also be deidentified to enable blinded payer comparisons, allowing payers to see how they perform against their peers without identifying specific comparisons.