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Saturday 14 December 2019
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Improving your Revenue Cycle Management with technology

Improving your Revenue Cycle Management with technology

Summary of an article In a recent Health IT Outcomes,  Jeff Wood, vice president of product management at Navicure, discusses three steps healthcare can improve their revenue cycle management

How to leverage Analytics for Improved revenue cycle management

With Healthcare IT still in the beginning stages, we often look to what the next trends to work on in the industry.  Analytics promises to be one of the ways to make this industry work more effectively and efficiently. Gartner like to help give industries guidance to what the trends are.  Analytics is usually top focus with patient care and reducing the readmission rates.  Now in their latest report published in February, they are stating that Revenue Cycle Management could leverage analytics to improve its results.

As healthcare organizations begin to see the benefits of Big Data and the ways in which to use it, the apprehension implementation will subside.   A robust plan and execution of a BI program can pay off early in the process, if all stakeholders are invested.  Some of the top benefits can be an increase and acceleration of revenue stream, this will be directly tied to how efficient your system is running.  Along with increased revenue stream, healthcare organizations can even reap benefits from the value-based reimbursement system, something most do not believe will be an easy task.  The long term vision can help a healthcare organization to position itself to attain near and long term positive results.    These three areas should be evaluated to ensure you’re creating the optimal analytics program:

  1. Leverage High-Impact KPIs First
    As you develop your analytics program, it’s helpful to review revenue cycle key performance indicators (KPIs), so you can determine which are most beneficial to measure initially. A few core KPIs to evaluate include:
  • First Pass Rate — Also called clean claims rate, this KPI shows your staff’s proficiency in successfully submitting claims to the payer the first time.  A first pass rate can provide insight into several important factors such as staff productivity, a shorter revenue cycle and better cash flow.
  • Denial Rate — For most organizations, denials represent one of the greatest revenue cycle bottlenecks; therefore, denial rate is also an effective KPI for the first phase of your data analytics program.  By tracking the percentage of denied claims by payer and provider, you can identify and correct issues the first time — and prevent them from reoccurring and impacting cash flow.
  • Charge Lag — Charge lag represents the amount of time between the date of service and the date the claim was submitted electronically. Minimizing the time your staff is submitting claims, is a metric that is especially important, especially since this is completely within your organization’s control.

There may be more revenue cycle metrics that are on your radar screen, but you must ensure you take a complete view of your organization’s financial picture.  A complete and effective BI program can benefit your organization very quickly, even in the initial stages.

  1. Use Insights For Optimal Efficiency
    If you have a high denial rate, you can dig deeper into this area and add other denial-related KPIs to your analytics program:
  • Denial Trends
  • Denial Totals 

To get a complete picture of your team’s performance related to the denial rate, you should review the KPIs.  You can use this information to optimize your process and train your staff to reduce the challenges.  Continuous improvement is the way to make your revenue cycle effective and efficient.

  1. Make Data Actionable
    Many healthcare leaders will cite a lack of actionable data as their biggest hurdle.  This is where the importance of dashboards within your system to drill down into the underlying data, or have a system when you are not receiving too much data to process to make meaningful decisions.   Make sure the data you receive is actionable, working with your vendor partner to customize your reports is one way to make sure your team has the data they need to be effective.

Leveraging Data To Help Win The Race For Value
As healthcare organizations are tasked to further improve value, BI and data analytics programs will play an increasingly important role. Implementing a plan with specific, measurable goals will facilitate ongoing revenue cycle improvements, help your organization achieve greater financial health and position you for future success.

Latest Articles about claims denials

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