Revenue Cycle Analytics

Revenue Cycle Analytics is a multi-view approach to all of your data using various methods.  Here are the various types of revenue cycle analytics:

Contract and Payer Analytics

This type of analytics helps organizations understand the financial performance of their payer contracts. It helps identify problematic contracts, underpayments, and trends to negotiate more favorable terms.

A tablet with graphs and a stethoscope on it.

Predictive Analytics

This type of analytics uses statistical algorithms and machine learning techniques to identify the likelihood of future outcomes based on historical data. In the context of revenue cycle management, predictive analytics might be used to anticipate payment delays or identify which patients are most likely to have trouble paying their bills.

Prescriptive Analytics

Prescriptive analytics uses advanced tools and technologies to recommend various courses of actions. It helps in making informed decisions about the processes involved in revenue cycle management. For example, it can help in identifying the best way to approach a patient about an unpaid bill or how to optimize the claims submission process.

Descriptive Analytics

This is the simplest class of analytics which deals with historical data to draw conclusions about the past. For example, healthcare providers may look at the number of denied claims in the past year to identify common reasons for denials and find ways to address these issues.

Diagnostic Analytics

Diagnostic analytics uses the data and analyzes it to answer the question “Why did it happen?”. In terms of revenue cycle management, this could involve drilling down into the details of why certain claims were denied or why a particular month had lower revenue than usual.

Real-Time Analytics

This involves analyzing data in real-time as it enters the system. For example, as new claims are filed, real-time analytics could be used to flag potential issues before the claim is submitted to the insurer.

Comparative Analytics

Comparative analytics involves comparing a healthcare organization’s revenue cycle performance to that of other similar organizations. This can help identify areas where the organization may be underperforming and highlight opportunities for improvement

Revenue Cycle Management (RCM) analytics can provide a wealth of information to healthcare organizations or single providers. Data is the key to understanding financial performance but also allows an organization to streamline operations and enhance patient services. Here’s a snapshot at some of the various types of data and insights that can be gained through RCM analytics:

Patient Financial Data 

This includes information related to patient payments, insurance coverage, and outstanding balances. Analytics can provide insights into trends in patient payment behavior and the effectiveness of collection strategies.

Example insight

An analysis might show that a significant number of patients delay payments beyond 30 days. As a response, the healthcare provider could introduce early payment incentives to improve collection times.

Claim Denial and Underpayment Data

Data from claims analytics can provide information on common reasons for denied claims, which departments or procedures are most affected, and the financial impact of these denials. Additionally, claims analytics can provide detail on what claims are underpaid. 

Example insight

If data reveals that a high percentage of spine surgery claims are denied due to coding errors, the organization will want to initiate additional training for the coding team or even consider adopting a computer-assisted coding solution.

Payer Performance Data

This encompasses data related to the performance of different insurance payers, such as denial rates, payment timeliness, underpayments, and contract adherence.

Example insight

If an insurance company consistently underpays compared to the contracted rate, an organization could use this data to renegotiate the contract or decide whether to continue partnering with that payer or potentially seek reimbursement on any penalties that may be allowed.

Coding and Billing Data

Data on coding accuracy, charge capture, and billing practices can be used to identify areas of revenue leakage or inefficiencies in the billing process.

Example insight

If an analysis at an organization uncovers recurrent missed charges in the emergency department, the organization could implement a charge capture tool to ensure all services rendered are being billed appropriately. This could also identify areas of system issues, human error, etc.

Operational Data

This includes data on the efficiency of different revenue cycle processes, such as the time taken for claims processing, collection times, and staff productivity.

Example insight

If the data shows that the average days in accounts receivable (A/R) is rising, the billing department might need to re-evaluate its follow-up processes with payers, identify areas where RPA processes may be effective, or AI solutions could assist.

Patient Access Data

This involves data related to patient registration, insurance verification, and benefit eligibility. This can help identify issues in the patient access process that may lead to claim denials or delays in payment.

Example insight

If a significant number of claims are denied due to insurance eligibility issues, the organization might automate the insurance verification process at the time of patient registration in addition to pre-billing verification to confirm continued eligibility, especially in an in-patient setting.

Contract Management Data

Data on payer contracts can help organizations understand the financial implications of different contracts and identify opportunities for renegotiation.

Example insight

If an analytics tool shows certain payer contracts consistently result in lower payments, the healthcare provider could use this data during contract renegotiation to argue for more favorable terms.

Medical Practice Success has worked with several vendors who have tools that can assist your organization with obtaining the clarity that they need from patient collections to payer contract performance; you can quickly identify opportunities for revenue recovery. Reach out to us today and let’s discuss your specific needs.