Here at Turquoise Health, we’ve got a new take on the saying, “There’s no such thing as bad press.” We believe within the new world of price transparency that “there’s no such thing as too much data.” However, with access to a lot of data comes great data-parsing responsibility. So how do you, an intrepid employee seeking additional analytics, make heads or tails of the large swaths of price transparency data and, more importantly, use the data to make informed decisions about your charges and rates?
If you’re just now tuning in to see what all the fuss is about regarding price transparency, we’ll catch you up to speed: as of 7/1/2022, the Transparency in Coverage (TiC) Final Rule required all plans and insurers to publish their charge and rate data, but this time, it wasn’t just hospitals who received an invite to the prestigious transparency soiree. In contrast, (let’s see how many scan-related puns we can fit into one blog, shall we?) TiC extended the requirements to include charges and rates for all providers and all care locations. That means data for imaging centers, ASCs, and any other freestanding locations is available in online machine-readable files (MRFs). Lab, behavioral health, DME, and imaging center data are also included. Come one, come all!
If in your excitement over TiC you’ve joined the stampede to payer websites to download the rate and charge data, you’ll agree with us that navigating payer MRFs feels like attempting to move a sofa: it’s large, unwieldy, and may not fit in the desired final destination. You may also not have the staff resources or interest in learning how to extract data from a series of JSON files to pull the information you need…and what is a JSON file anyway?? (For the curious minds.) At the end of the day, you want to extract all the rate data available for your own practice or for a specific CPT code or codes while you have your morning coffee.
So Many Choices, So Much Parsing
With Simple Extracts, we C To (too much of a stretch for a CT scan pun? We’ll workshop it.) ensuring you have access to a made-to-order subset of data pulled directly from the larger payer MRFs. Simple Extracts provides you and your team with the most relevant data in an easily-digestible and secure download directly from the Turquoise platform. Remember when you were allowed to get ice cream from the ice cream truck as a kid, but the number of options was nearly paralyzing, so you panicked and ordered an orange pushup even though there was a box of orange pushups in your freezer at home? We do too, and will forever regret leaving that Choco Taco untouched. MRF data can be the same way. With so many files available, what is relevant? Simple Extracts simplifies the menu so you’re not wasting time hunting down MRFs and trying to pull out the relevant data. We’ll nerd out on data ingestion, extraction, and formatting while you focus on providing excellent care for patients and running the business.
Simple Extracts Simplify Solutions
Our Senior Product Manager and now fledgling Marketing Consultant, Kevin, referred to Simple Extracts as “sneaky transformational” and we couldn’t agree more. We’ve created an opportunity for business-minded end users to analyze a specific data set that can transform individual practices, clinical groups, and even pharmacy and medical device groups. The use cases extend beyond what the eye can see, and the Turquoise team prides itself on being visionaries. (You can be one too, calm down.)
Suppose you’re an established practice providing individual therapy services and are considering adding additional group therapy services. Adding services often means billing new CPT codes, so you’ll need to establish new charges and contracted rates. Turquoise is able to create an extract targeting the specific code selection you provide for the state or states in your geographic area. We then consolidate the payer and provider rates and charge data for those codes. The data could also be limited to only include specific payers you’re already in-network with to get an idea of immediate revenue impact. Ever the entrepreneur, you may be watching your established practice thrive and you’re considering opening a new location across state lines. Our state-specific extracts can be run both on the existing CPT codes you’re currently billing along with any new codes associated with services you may be considering.
Or perhaps you’re looking to go in-network with a new insurer and you’re interested in the revenue implications based on the payer’s average in-network rates for specific codes within your state. We’ve been in the negotiating rooms of yesteryear where you show up, proposed rates in hand, only to be presented with rates that are far away from the rates you were expecting. Neither party shares their calculation methods and the whole thing feels a little like you’ve somehow taken steps backward instead of toward fair and transparently-calculated rates. Simple Extracts allows you to step confidently to the negotiations table with accurate data and the ability to leverage the publicly available comparison rates. Regardless of the number of providers or patients at your practice, TiC’s requirements are increasing the publicly available data at your disposal. The broader set of price transparency laws aim to level the playing field and minimize back and forth within negotiations because all parties have access to the same rates from the start.
You’ve Got Requests, We’ve Got Results
Simple Extracts provides peace of mind that once you’ve identified a need for data, you can head to the Turquoise platform, select specific extract criteria, send the request to the Turquoise team for processing, and you’ll have your results within two weeks of the contract signature. We are here to provide simplified, targeted data sets focused on helping you achieve each of your individual strategic goals. Gone are the days of flying blind as you seek to know the revenue implications of growing and expanding your business.
CMS’s decision to include more than hospital rate data within the TiC Rule is adMRI-able (last one, promise) and allows non-hospital healthcare entities more access than ever before to rate and charge data. Turquoise is here to unlock and share that data, which gets us one step closer to transparent pricing that patients, providers, and insurers can access. We believe transparent pricing moves us toward increasing clarity and education, and, ultimately, lowers the cost of healthcare.