Introducing Rivet Benchmark, a tool granting you insight into how your payer rates compare with others in your area. As part of the Payer Performance suite, this functionality empowers you with the knowledge to bolster your negotiating stance with payers. By leveraging federal Transparency in Coverage mandates, Rivet Benchmark utilizes Machine Readable Files (MRFs) to provide a comparison of your negotiated rates against those of nearby providers.
1. What Rivet Benchmark Offers
Rivet Benchmark allows you to contrast your negotiated rates for specific codes with those reported by other practices in your area. Rivet gets these rates from the Machine Readable Files (MRFs) that payers are required to publish. It enables comparisons across states, zip codes, or specific Tax IDs, highlighting where your rates stand compared to others.
2. Navigating Benchmark
Click on the Contract evaluation tab located at the top of your page.
Within the Contract evaluation section, find and click on Benchmark.
If it’s your first time using the Benchmark tool, you’ll be guided through selecting the required information to generate the first chart. You’ll pick which of your rates you want to compare the market to, and then the market rates. For your rates, you can choose any of your practices, or individual providers.
Rivet will then pull in all related NPIs to ensure we show as many relevant rates as possible. You can deselect any of the NPIs for which you don’t want to see rates.
Next, you’ll select the market data you want to compare to. You can look at the rates for individual providers, specific practices or provider groups, or a variety of location options (ZIP code, state, CMS Locality or CBSA). You can search for individual providers or practices and groups by name.
If you select a specific practice, you can further limit their rates to a specific location. This is helpful in finding relevant rates for larger practices that might have locations across several states or zip codes.
For this example, we'll compare to the market of the entire state of Utah.
Next, choose what data you want to populate. You can choose up to 5 procedure codes or DRG codes, and up to 5 payers. Nested under the payers are each of the networks or plan names that are reported by the transparency in coverage data, so you can further refine the rates you want to see.
Then you can apply any other optional filters, including filters for Credentials, Modifiers, Place of Service, and Specialty. Note that Rivet will filter out rates with modifiers TC and 26, which affect the rate, but will not filter out any other modifiers by default.
Keep in mind that credential filters will filter out any rates that are associated with Type 2 NPIs, since those don't have a credential.
When you click Complete, you’ll be able to Save the view you just created. You can make the view private, public, or shared with specific people. By default, all views are private.
You can launch the create view walkthrough at any time by clicking the button in the top right:
3. Analyzing detailed data with Benchmark
In the chart, your data is represented by the purple dots, the market data is represented by blue dots, and you will be able to see CMS baselines as a reference, represented by the green dots.
You can edit the data that is populating the graph by clicking on the Edit button in the legend.
You can hover over the dots to see the specifics of how many rates there are, the range, and the median, as well as any reference values.
You can further analyze the data by applying filters. The top row of filters (required) is what generates the chart, and the bottom row of filters is optional, and can further refine the data. Note that not all rates have each of these fields associated with them, so applying filters might remove rates from the graph that you don't expect.
You can change how the data is grouped using the Group by dropdown in the top right. You can group by code or payer.
If you've selected either one code, or one payer, you will have an additional option to group by practice:
You can click on a set of dots to open the corresponding detailed graph of that data.
You can further analyze the distribution by changing the bucket size:
You can hover over the dots to see the specifics of your rates, as well as the CMS baseline rates:
For each rate, you can see which type 2 NPIs, type 1 NPIs, and network names are associated with it by clicking on the number in the column:
Type 1 NPI example:
Network example:
Data in the table can be searched and exported, both on the histogram view and on the scatter plot view.
You can manage your view similarly to other views in Rivet worklists by clicking on the name of the view:
4. Data Updates and Accuracy
Rivet Benchmark ensures your strategic planning is based on the most current payer data with quarterly updates. This regular refresh cycle is crucial for maintaining the accuracy and relevance of the information provided for your negotiation insights. However, it's important to recognize that discrepancies can sometimes arise due to incomplete or inconsistently published payer data.
Payer data may be incomplete, with certain rates for specific codes or Tax IDs not published. Our experience indicates these omissions typically originate from the payers. Our team conducted manual verifications of payer files to search for unpublished rates, aiming to ensure the comprehensiveness of our data.
We have also seen the publication of payer rates lacks a consistent schedule. For instance, Aetna may start the month by publishing only a portion of their rate files, with the remainder appearing unpredictably within the same month. Understanding these patterns and challenges in payer data publication helps us refine the accuracy of Benchmark, ensuring you have reliable data for effective negotiation planning.
For further inquiries or assistance, feel free to reach out to our support team via chat or email at support@rivethealth.com.
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