By Christa Lassen-Vogel, Senior Manager, ZOLL Data Systems
Healthcare reimbursement practices are under scrutiny, and payment levels are declining for emergency medical services (EMS) providers. In order to effectively negotiate payer-provider agreement terms and rates paid for air transport under the No Surprises Act (NSA), EMS providers need to have visibility into claims data and payer behavior. Such information could also provide a foundation for measuring performance and making strategic decisions to support the agency’s commercial success.
ZOLL Data Systems has introduced a new data service, ZOLL Claims Clarity, to fill these need gaps. Finally, EMS providers and industry stakeholders can obtain actionable healthcare market intelligence on charges, payments, denials, and payer behavior to foster market transparency and help ensure maximum revenue.
By analyzing actual, de-identified claims data, the ZOLL Claims Clarity data service surfaces the numbers behind payer calculations and reveals competitive rates. Providers can see actual reimbursements from payers within a user-defined region and specialty without fear of breaking anti-trust or collusion rules.
As a result, providers can now access reliable information to address commonly experienced pain points, such as:
- Negotiating payer contracts without knowing how their rates compare with competing providers in the same or similar markets — giving payers (who have this information) disproportionate leverage
- Lack of information about the economics of their own competitive market to help evaluate fee schedules, service line additions, and business expansion plans
- No industry data for medical providers, practices, and facilities against which to compare their performance and establish benchmarks and operational best practices
- Lack of insight into a payer’s actual Qualifying Payment Amount (QPA) and median in-network rates, both of which can be used by commercial payers as justification during independent dispute resolution (IDR) for lower reimbursement to some specialties that have a high percentage of out-of-network claims
The ZOLL Claims Clarity data service delivers a myriad of benefits and can support a range of business use cases. It enhances EMS providers’ understanding of their markets and ability to make data-driven decisions so that they can compete more effectively and optimize financial performance.
Readers who would like to learn more about ZOLL Claims Clarity can visit the website or call 800-231-8573.
About ZOLL Data Systems
ZOLL Data Systems, a division of ZOLL Medical Corporation, is a healthcare software and data solutions provider that empowers hospital, EMS and Fire, and billing/accounts receivable teams to deliver more—from better patient outcomes to operational efficiencies and greater revenue capture. We leverage decades of clinical expertise, relentless customer focus, and a powerful cloud-based platform to help tackle the unique challenges of healthcare from EMS dispatch to facility discharge. Our business exists to help save more lives through data-driven innovation and interoperability, opening new pathways for our customers to achieve the highest levels of care, collaboration, and efficiency.