Revenue Cycle Analytics Improves Claims Submissions

Healthcare revenue cycle management has undergone a radical and drastic change in the last decade. From days when most patients had $20 or so as co-payments and insurance companies paid claims in full, to today, when the physician first needs to consider medical necessity before ordering a lab test – things have certainly become more complex and challenging. Understanding and being able to meet these challenges – to thrive financially, while still providing healthcare of the highest quality, has become the need of the day. Fortunately, the constant development in computer hardware and software has made life a tad easier for healthcare facilities and professionals. To make things even better, professionals and companies adept at handling revenue cycle management and related issues have mushroomed across the nation – providing healthcare facilities and professionals with the much needed expertise to take care of their bottom lines.

While technology has definitely brought in an ease of managing revenue cycles – there is a need to analyze and find solutions to problems that come to the fore through the analysis. Healthcare providers are trained to provide healthcare – and analyzing data and finding solutions may not generally be their cup of tea. While a small number of healthcare facilities and professionals are using data analytics and reporting solutions to improve their revenue cycle, the majority have yet to look into this very important tool for robust financial health.

Basis of the research

A survey conducted to gauge the data analytics and reporting process, the challenges and technologies used by healthcare organizations across the nation, saw a participation of over 600 individuals; however, a mere 216 of the surveyed participants used data analytics and reporting solutions. Out of these 216 participants, 42% were executives, 35% practice administrators and 22% were billing managers. These 216 respondents represented a wide range of providers:

• 01 to 10 providers – 43%
• 11 to 50 providers – 27%
• 51 to 100 providers – 9%
• 100+ providers – 21%

Survey Findings

• 55% of the surveyed participants did not have any data analytics and reporting solution in place.
• 45% out of the 55%, however, said that they were in the process of looking for one.
• The reasons for not having one in place or not even contemplating one were:
  • 36% said that they did not think they needed one
  • 23% did not have the budget to get one
  • 13% claimed they did not have the time to look into one
  • 08% did not have an analytics person in their staff
  • 07% said that they did not know where to start
  • 04% did not have the IT resources required.
• 88% of the respondents felt that data analytics and reporting solution is very important to making business decisions.
• According to 55% of the respondents, denial and rejection rates and number of days in A/R were the most important key performance indicators (KPIs)
• Actively managing denials was the top revenue cycle challenge for 40% of respondents.
• The second spot in revenue management cycle challenge went to patient billing and payments, with 37% of respondents stating thus.
• However, according to 55% of the respondents, the least important KPIs were outstanding patient balance totals and patient payment plan collection rate.
• Leveraging insights from data analytics and reporting solutions creates challenges as reported by respondents due to:
  • 38% of the respondents mentioned the time and resource required and lack of it.
  • 25% felt unable to benchmark performance against peers.
  • 19% felt that getting actionable reports was difficult.
• However, the majority of respondents stated that data analytics and reporting solutions, despite the various challenges, created a positive impact on their facilities.
  • Benefits realized through these solutions:
    • 71% said that it reduced days in A/R, thus improving cash flows.
    • 56% said that it helped identify bottlenecks to getting paid and thus increased revenues.
    • 48% claimed that it helped identify additional training needs, thus improving staff productivity.
  • Revenue cycle metrics improved due to these solutions:
    • Claims submission, as per 88% of the respondents
    • 84% stated rejections were reduced.
    • Fewer denials, as stated by 78%.
    • 76% said that cash flows improved.
    • 66% stated improvement in patient billing and payments.

Actions suggested

Given the challenges of healthcare revenue cycle management and the immense competitive healthcare landscape, healthcare organizations need to look at those who are using data analytics and reporting solutions and implement the same in their facilities. Healthcare facilities should look for a data analytics and reporting solution that provides:

• User friendly and actionable system.
• A full picture from submission of a claim to its adjudication.
• KPIs presented on the dashboard.
• Root-cause analysis through interactive reports.
• Comparative analysis benchmarks.
• Enterprise reporting capabilities.
• Affected claims drill down capabilities.

According to the researchers, “Due to the complicated nature of the healthcare revenue cycle, it is important to actively monitor a variety of KPIs, especially for the top revenue cycle challenges like denials and patient billing and payments. Given the increase in patient responsibility due to high deductible health plans, patient-specific KPIs should be part of active monitoring. With limited resources and time, a data analytics and reporting solution can help streamline reporting of all KPIs such as denial and rejection rates, patient and payer payment trends, charge lag and first pass rate,”

Talking about the research findings, Jim Denny, CEO of Navicure, said, “Now more than ever, healthcare organizations are realizing the benefits of implementing a robust data analytics and reporting program. As organizations are tasked to further improve and report value, this research confirms data analytics and reporting solutions will play an increasingly important role. Implementing a user-friendly solution that streamlines reporting with actionable data will facilitate informed decision making and ongoing revenue cycle improvements, helping organizations achieve greater financial health and position them for future success.”