Role of Analytics in Revenue Cycle Management

Data Analytics for Revenue Cycle Management: The Way Forward for Healthcare Businesses

US healthcare industry is becoming increasingly competitive with new players joining the market regularly. To add to the woes, difficult reimbursement process, poor revenues, bad debts and changing government regulations are making Revenue Cycle Management (RCM) challenging for healthcare businesses to manage.

One of the innovative ways to stay ahead in the race is by using technology to improve your revenue cycle management. From registration, medical coding to denial, the huge amount of data you collect on a daily basis can produce meaningful insights when analysed with proper statistical tools. With data analysis you can find out patterns to understand payment behaviours and insurance trends.

Here’s how data analytics can help you better manage your Revenue Cycle Management.

Denial prevention instead of denial management: Predicting denials can help you get regular cash flow and enhance business operations. Instead of wasting precious hours in filing appeals, you can avoid common mistakes by identifying patterns from the previous data. When you know the root cause in case of majority of denials or underpayments, you can take proactive measures to minimize the denial rate.

Establishing KPIs and monitoring them regularly: If there were no finish line, a marathon runner would never know where they completed the race. Similarly, in order to determine if business is improving, it is important to establish KPIs to identify the areas that bring down the speed. Once the under performing KPIs are spotted using analytics, an action plan with a goal can follow. Below are some of the KPIs you can monitor.

  • Debit A/R Days
  • Percentage of Debit A/R >90 days
  • Overall Denial Rate
  • Claim turnaround
  • Percent clean claim submission / Billing Accuracy Rate
  • Claims rejected at clearing house
  • Count of follow-ups with insurance on claims status
  • Denial Recovery Ratio
  • Correspondences Processed/ FTE
  • Accuracy of the work done

Audits to identify underpayment areas: Gone are the days when laboriously auditing all departments, looking for a problem that might or might not exist was the norm. With the help of analytics, it is easier for organizations to identify missed charges, overcharges and predict them. With easy ways to identify payment discrepancies, you can quantify the uncollected amounts along with the reason and come up with exact measures to deal with the problem. And finally avoid writing-off accounts receivables.

Improving accounts receivable: With the help of analytics, RCM Managers can dig deeper into the data of increasing accounts receivables and find out patterns and work on a plan to improve the numbers.

While implementing data analytics to your healthcare business is the way forward, it is also important to carefully choose your analytics partner for bringing in better efficiency. Promantra observes industry trends carefully and advises clients with the best ways to optimize RCM. 

For more information about our Revenue Cycle Management services and solutions,

call 1-732-414-3678 and speak to one of our experts.

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