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.
From the Benchmark interface, start by selecting a business unit associated with your account. You also have the option to select a specific NPI. This choice determines the scope of data used in the comparison.
Choose the billing class relevant to your comparison. You have two options: Professional or Institutional.
Select the billing code you wish to analyze. These codes are crucial for pinpointing the specific rates you're comparing.
Decide on the area you want to use for comparison. You can select a specific state, and the Specific zip code(s within that state, Or a Tax ID to compare rates against a specific entity.
Optionally, you can refine your comparison further by including a service code and modifier. These selections allow for a more granular analysis of rates.
The rates will update for that state. The purple bars indicate the rates that the payer has published that are associated with your tax id. The blue bars indicate the range of rates for other providers in the selected area.
For a closer look at the specifics behind your comparison results clicking on a section of the chart or a payer's name, you can expand the view to reveal additional information. This will also give you the option to export this data to a CSV.
3. Updating codes in Benchmark
Rivet recently enhanced the Benchmark tool, allowing users to view market rates for thousands of codes requested by our customers. If a code you need isn’t available, please reach out to our chat support team or email your customer success manager with the code details. We will add these codes to be pulled on our next quarterly data refresh.
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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