ZirMed first pass claims acceptance rates among best in industry

Attributes performance to power of network and modern, flexible platform

ZirMed®, a leading health information connectivity and management solutions company, today announced that the company is consistently achieving a 98 percent or greater running average on its first pass claims acceptance rates. This acceptance rate performance is among the highest in the healthcare industry, where company research found that most practices experience significantly lower rates and according to HFMA’s “HFMA Toolbox: key revenue cycle metrics,” the best practice target rate for clean claims is 97%.

ZirMed’s industry experience and deep commitment to customer results, combined with the flexibility of the company’s cloud-based, SaaS, responsive solutions, are cited as key contributors to this exceptional achievement. ZirMed leverages the power of crowd sourcing through its network of more than 160,000 providers and millions of patients to learn from each claim and remittance and put that knowledge to work immediately for all of its clients.

“Through our network, we immediately detect any spikes in unaccepted claims and then work to determine exactly what changes caused these specific claims to bounce so that we can quickly embed a global fix that benefits the universe of ZirMed clients,” said Tom Butts, CEO, ZirMed. “This closed-loop process includes communicating root cause analyses back to our clients, allowing them to adjust internal processes often within days or even hours of the issue being detected. The result is a claims and overall revenue-cycle function that is less time- and resource-intensive, allowing provider organizations to devote more attention to patient care.”

For providers, there are many reasons why a claim might not be accepted by the payer on first pass, including medical necessity, patient eligibility, coding errors or changes in a payer’s payment rules.

“A high first pass claims rate helps streamline the workflow across our practice so that we submit claims appropriately the first time and focus more on our patients,” said Leigh Anne Stiltner, Director, Patient Financial Services, St. Claire Regional Medical Center. “We’re also taking advantage of ZirMed’s advanced revenue cycle management tools to help automate our billing process which significantly reduces the time that our team spends reprocessing paperwork.”

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.


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