How Can Revenue Cycle Analytics Help Healthcare Industries?

The healthcare industry and hospitals have a serious responsibility to protect the general population’s health. The most important thing for them to do is to fulfill that responsibility with ardor and passion; nevertheless, they have to keep in mind that they must also maintain their own financial health while doing so. Financial strength decline is one of the most obvious things that can draw the attention of a company away from its core function if it is experiencing financial difficulties.

It is essential that healthcare revenue cycle management is carried out by managed IT services for healthcare in order for them to keep their finances in good shape. In the healthcare industry, revenue cycle management refers to the process of combining administrative and clinical functions in order to generate revenue for healthcare providers. This is done by managing the financial processes involved in processing claims, payments, and revenue creation. The healthcare revenue cycle management can be simply described as being what keeps hospitals and clinics in a position to maintain the flow of revenue they are receiving.

What is the Healthcare Revenue Cycle?

Revenue cycle managers are responsible for overseeing a provider’s revenue generation process. An appointment is scheduled by the patient, and the process is completed once payment is received by the healthcare service provider. Administrative functions within a healthcare revenue cycle include:

• Verification of insurance and payment schedules
• Coding of medical records, demos, and charges
• Checking and resolving claims
• Posting and processing of payments
• Management of denials
• AR follow-up
• Patient Statements
• Auditing & Quality

Health care providers, payers (insurance companies), and patients must maintain smooth communications as part of Revenue Cycle Management.

Revenue cycle

Revenue cycle refers to the administrative and clinical processes that contribute to capturing, managing, and collecting revenue from patient services, according to the Healthcare Financial Management Association (HFMA).

A revenue cycle consists of the following steps:

Charge capture: Creating billable charges for medical services.

Claim submission: Making claims to insurance companies for billable fees.

Coding: Claiming diagnoses and procedures correctly.

Patient collections: Collecting payments from patients and determining their balances.

Preregistration: Obtaining information about the patient before an inpatient or outpatient procedure, such as their insurance coverage.

Registration: The process of collecting the following patient information after the initial registration is conducted, in order to create a medical record number and meet the regulatory, financial, and clinical requirements applicable to patients.

Remittance processing: Rejecting or applying payments.

Third-party follow up: Recovering payment from third parties.

Utilization review: Assessing the need for medical care.

How does it help healthcare industries?

Every level of your organization can benefit from PMMC’s revenue cycle analytics software. We deliver insights in a set of reports tailored to the needs of different audiences, including executives who want quick insights to analysts who want to investigate and analyze the data and the root cause of a problem. As a result, you will be able to identify and remove obstacles to revenue growth.

Healthcare providers can optimize revenues by using a good Revenue Cycle Management service. Professional RCM companies can help overcome healthcare challenges in a number of ways.

1. Helps handle the complexity of regulations

Hospitals are ill-equipped for navigating the labyrinth of laws that surround RCM services. They train their employees constantly on changes and updates in HIPAA regulations as well as other regulations to ensure compliance.

2. Saves significant time and cost

By utilizing their experience, automated systems, and trained staff, Revenue Cycle Management Companies save considerable time and cost. By passing these savings along to their clients, they are able to reduce costs

3. Increases ability to invest in new technologies

Healthcare RCM service providers operate on a larger scale and are more likely to invest in the latest software and advances. These systems also generate useful data when they are used. The data can help healthcare service providers formulate strategies and goals for the future.

4. Real-time data to make efficient decisions

Data that is near real-time and reliable accelerates the decision-making process. Set alerts when performance thresholds are not met and leverage data-based recommendations for better healthcare revenue cycle analytics. It’s easy to access data, so you don’t need IT resources to get information.

5. Refine payment processes to support patient engagement

To support the goals of patient engagement, improve patient payment processes. The use of analytics systems for healthcare revenue cycle can significantly enhance your patient access, improve billing efficiency, enhance payer relations, and improve patient satisfaction.

6. Cross-functional views to improve efficiency

With healthcare revenue cycle analytics software, you can manage your revenue cycle performance across multiple functions through digestible data, even when you use multiple revenue cycle systems. Furthermore, gain insight into cross-functional interdependencies and financial performance.

It is without a doubt the perfect solution if you are faced with operational inefficiencies and dwindling revenues, in which case you ought to consider partnering with a Revenue Cycle Management Service Provider. As a world-class service provider, Rannsolve offers its clients a wide range of revenue cycle management services that embrace all aspects of medical billing. Since its inception, the company has been providing its clients across the globe with timely and cost-effective RCM services. Get a free trial of Rannsolve’s service by contacting our team today.  With Rannsolve, you are assured uninterrupted cash flows, a robust growth in your revenue, and an emphasis on compliance that will ensure your cash flows are uninterrupted.

Also learn How HealthCare Workforce Logistics helps healthcare industry by ensuring right professionals with right skills, in the right place and at right time, leading to higher revenue.

What are the popular revenue cycle analytics solutions?

A revenue cycle analytics solution (formerly AppRev) optimizes revenue cycle performance for hospitals and providers. Cloud-based software allows providers to identify, quantify, resolve, measure, and resolve key revenue cycle issues. There are many solutions including Charge Accuracy, Pricing Analytics, Pricing Transparency, and Denials Intelligence.

Charge Accuracy

By using predictive analytics, hospitals are able to identify and correct errors in provider charges, ensuring compliance and maximizing net revenue. With Charge Accuracy, provider charge errors are found, quantified and valued to improve revenue cycle accuracy and integrity. Over 500,000 predictive analytical tests are applied to claims data sent to payors to identify charging, coding, and billing errors. As a result of artificial intelligence (AI), it is possible to identify potential inaccuracies in massive amounts of provider claims through pattern recognition. The results can be used by providers to improve future claims’ accuracy and correct current claims.

Key Differentiators

• Identifies and corrects millions of payor-specific errors, including those on clean post-edit claims.
• Installs no software, offers quick implementation.
• Files in standard 837/835 format.
• Simple user environment with customizable rules and workflows for each hospital/health system.
• Supports clinical and financial decisions to maximize return on investment.
• Validates results and reviews individual claims using Service Supported SoftwareTM.
• Measures change’s financial impact to ensure desired results are achieved.

Pricing Analytics

Providers develop and understand their pricing strategy with the help of pricing experts who translate custom business rules into mathematical algorithms. Keeping an eye on the bottom line is incredibly difficult when it comes to developing and implementing defensible pricing strategies. Pricing Analytics solution allows them to analyze and adjust their pricing strategy based on actual data and projections. Various strategies can be developed based on market, payer, revenue, department, or service goals.

A hospital’s marketing, financial, and internal pricing strategies and priorities are accurately described by experts through custom business rules and mathematical algorithms. By working with revenue, or using their own pricing models, providers can maximize price-sensitive net revenue, with great flexibility.

Key Differentiators

• Assesses net revenue, position in the market, and pricing relationship.
• Customer-selected peer benchmarks are incorporated into the model.
• Installs no software, allowing quick implementation.
• Provides users with an easy-to-use, powerful interface.
• Models pricing strategies accurately, allowing nearly endless possibilities.
• Assists with understanding and implementing, analysis and price recommendations through expert consultants.
• Monitoring the results of the pricing strategy on an ongoing basis.
• Supports clients with a partnership approach – any time support is available.

Price Transparency

Using the cloud-based solution, hospitals can comply with CMS’s recently announced pricing transparency rules. Hospitals are required to provide patients with more transparent prices for the items and services they provide under new rules enacted by the Centers for Medicare & Medicaid Services (CMS).

The implementation of these complex rules can take a great deal of time, but with turnkey solution, hospitals can comply with the mandate quickly and efficiently. CMS requires two major components of Price Transparency: 1) publishing Charge Description Master prices along with their associated negotiated rates, and 2) publishing 300 shoppable services with detailed information.

Key Features

• Excel files are created that include billing codes, HCPCS codes, and other identifiable features as well as prices, payor-negotiated rates, and de-identified minimum and maximum rates.
• Publishes an Excel file(s) which contains information about shoppable services identifies with HCPCS, DRG, or other identifiable features, along with services typically provided with the shoppable services; an analysis standard on which services should be included in the analysis; as well as, the prices of each primary service and included service.
• Adapts strategies to each hospital’s specific needs
• Provides quick implementation without the need to install software

Denials Intelligence

The Denials Intelligence solution generates detailed reports on claim and remit activity that are used in the denials management process. As a result, hospitals and physicians are able to work the denials that have the greatest impact on their bottom lines. A comprehensive report with trending is included. Through rebill and payment, detailed, drill-down reports are available on denials. A monthly variance report is also available, as well as trends by issue, payor, and recovery.

Key Differentiators

• Utilizes HIPAA-compliant, cloud-based software that can be implemented and started up quickly
• File formats 837/835 are accepted
• Removing duplicate, misgrouped, and miscounted denials
• With our dashboard, you can drill-down to a variety of levels of detail
• Measures and trends denials
• Analyzes trends and metrics related to payors
• Workflows are customized and detailed
• Increases workforce efficiency and cash flow
• Identifies, tracks, and recovers patients

Additional Services

Various revenue cycle analytics services are offered, such as Lesser Of Analytics and Charge Description Master Transformation. By leveraging our in-house expertise, hospitals and providers can improve key revenue cycle performances.

Lesser of Analytics

Lesser Of Analytics solutions help providers identify the scope and details of their lesser positions and develop key pricing strategies to mitigate losses. The client’s managed care contracts are used by us to conduct an analysis of the claim or service for outpatient and inpatient care that has been paid based on a lesser quality of care, as well as the calculated net revenue impact of each quantity of service at the patient type and plan code level based on the client’s provided data.

Charge Description Master Transformation

To assist hospitals with CDM projects that transform the hospital, the team uses analytical processes such as:

•       Standardization of corporate practices
•       Acquiring and developing hospitals
•       Installation/change of Hospital Information Systems
•       As a result of CDM expertise, Pricing Analytics tools allow to model all hospital objectives in these changes to the CDM. Providing timely and cost-effective solutions will enable hospital staff to focus on other crucial aspects of a project.

Disproportionate Share Hospital Recovery

Disproportionate Share Hospital Recovery (DSH) Services are designed to increase the amount of revenue a hospital receives by increasing the accuracy with which Medicare Disproportionate Share payments are calculated on behalf of the hospital for its current or previous fiscal years. During the inpatient stay, a comprehensive review of the patient’s medical history to determine the Medicaid eligibility status of each patient during their stay in the facility. The Medicare DSH program offers a complete package of documentation and support for all care provided to patients eligible for reimbursement under the DSH program, which can be audited by the federal government.

References

1. Becker’s Healthcare (2019), June 201). Denial rework costs providers roughly $118 per claim. Retrieved from https://www.beckershospitalreview.com/finance/denial-rework-costs-providers-roughly-118-per-claim-4-takeaways.html
2. Davis, R. & Brabander, E. (2007). ARIS design platform: Getting started with BPM. Springer-Verlag.
3. Kaiser Family Foundation (2019, February 25). Claims denials and appeals in the ACA Marketplace plans. Retrieved from https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans/
4. Z. Newitt and B. Robertson, “HFM ToolBox: Key Reve-nue Cycle Metrics,” Healthcare Financial Management, Vol. 61, No. 5, 2007, pp. 105-107.
5. B. Tinnermon, “Revenue Cycle: Time for a Change in Your Revenue Cycle Technology?” Healthcare Financial Management, Vol. 63, No. 3, 2009.
6. S. Few, Now You See It: Simple Visualization Tech-niques for Quantitative Analysis. 1st Edition, Analytics Press, Oakland, California, 2009.
7. D. B. Sommer, R. Sallam and J. Richardson, “Emerging Technology Analysis: Visualization-Based Data Discov-ery Tools,” Gartner Publication ID Number G00213778, 2011.