Electronic Health Reporter

ZirMed, a leading health information connectivity and management solutions company, today announced that its ambulatory surgery center (ASC) clients in the 10 states reporting the highest denials rates are consistently achieving denial rates that are 10-36 percentage points lower than reported averages. ZirMed attributes its ASC clients’ success to its modern platform, which enables real-time claims processing, and the ability for providers and staff using its solutions to customize rules to reject claims or add information before the claims are sent to payers.

According to a 2013 report by RemitDATA, an independent source of comparative analytics for reimbursement, New York providers have the highest percentage of claims denied, at 37%; by contrast, ZirMed’s clients in the state reported a mere 0.97% average denials rate, showing a considerable gap between ZirMed clients and the state average. ZirMed utilizes outpatient code edits (OCEs) that perform checks and balances on medical necessity for outpatient claims that dramatically lower rejection and denials rates. The company also leverages the power of crowdsourcing through its growing network of more than 190,000 providers and millions of patients to learn from each claim and remittance and put that knowledge to work immediately for all of its clients.

“Lost and denied claims were averaging about 7% of our business, representing a lot of lost reimbursement revenue,” said Steve Fiore, CEO, Orthopaedic Specialty Group. “If a claim does get rejected, the ZirMed system has tools that let us sort out the problem quickly and re-submit right away. With ZirMed processing our claims, our ongoing revenue enhancement now accounts for a 15% increase in our business.”

The practice of checking eligibility can account for a dramatic reduction in denials. With ZirMed’s Eligibility Verification solution, outpatient facilities are able to drill down into specific ASC benefits, improving provider coverage for outpatient procedures in the ASC setting. Other ZirMed solutions that impact lower denials rates include:

• Clinical Link: the company’s HIPAA-compliant, and cloud-based communications platform that assists providers with transitions of care between caregivers and specialty physicians that reside in the ASC setting.
• ZirMed Analytics: identifies trends in non-payment on particular codes that are either unpaid or denied. This detection and uncovering of codes can assist providers in correcting future claim submissions.

“As our network continues to grow, we are leveraging the data we collect for the benefit of all of our clients,” said Tom Butts, CEO, ZirMed. “In today’s healthcare landscape, provider organizations are operating on tighter margins and under increasing regulatory pressures, so getting paid in full and on time is truly necessary in order to thrive in this challenging environment. We are proud to report a low denials rate for our ASC clients and provide them with the tools that allow them to spend less time reworking denied claims and spend more time caring for their patients.”

ZirMed leverages its national database of healthcare payment information to cure administrative burdens and increase financial performance. ZirMed’s solutions equip providers with the tools to facilitate, manage, and analyze clinical and financial communications among providers, payers, and patients. ZirMed solutions include clinical connectivity solutions, comprehensive analytics, eligibility verification, credit/debit card processing, claims management, coding compliancy and reimbursement management, electronic remittance advice, patient statements, patient estimation, patient e-commerce solutions and lockbox services.

About ZirMed
Founded in 1999, ZirMed is one of healthcare’s premier health information connectivity and management solutions companies, modernizing critical connections between providers, patients, and payers to improve the business and process of healthcare. ZirMed combines innovative software development with the industry’s most advanced transactional network and business analytics platform to give organizations a clearer view of their financial and operational performance. ZirMed’s industry-leading technology and client support have been recognized with awards from KLAS®, Healthcare Informatics, Best of SaaS Showplace (BoSS), and Black Book Rankings. Our nationwide network facilitates, manages, and analyzes billions of healthcare transactions, driving bottom-line performance with clinical communications, comprehensive analytics, eligibility, claims management, coding compliance, reimbursement management, and patient payment services—including credit card processing, online payments, statements, estimation, and payment plan management. For more information about ZirMed, visit www.ZirMed.com.