In the intricate landscape of revenue cycle management (RCM), the pursuit of accuracy, compliance, and efficiency hinges on eliminating inefficiencies. In healthcare, such inefficiencies significantly impact bottom lines across the revenue cycle continuum, affecting everything from coding practices and billing compliance to revenue integrity.
Forward-looking healthcare organizations understand the importance of identifying and eliminating ineffective RCM processes as part of an overarching strategy to achieve an optimized revenue cycle and support equitable and patient-centric care practices. Many are also discovering the powerful combination of storytelling data and analytics as transformative RCM tools to achieve this goal.
Storytelling Data Unveils Objective Insights
Storytelling through data goes beyond the presentation of numbers and graphs; it weaves a narrative that encapsulates the journey and nuances within the RCM landscape. In doing so, this data empowers billing compliance, revenue integrity, and HIM/coding professionals to tell compelling stories that unfold through comprehensive analytics, revealing patterns, trends, and anomalies that might otherwise remain concealed.
By presenting data in a coherent, narrative-driven format, healthcare professionals gain a deeper understanding of the underlying factors influencing revenue management. Data reveals relationships and patterns between teams and processes that often go unnoticed. This information can empower decision-makers with the reporting and automation necessary to streamline end-to-end revenue cycle management.
Root Cause Identification
Analytics serve as the backbone of objective decision-making. Advanced analytic tools leverage machine learning (ML) algorithms and predictive modeling to uncover actionable insights, which in turn empower healthcare professionals to:
- Identify discrepancies in coding practices
- Pinpoint areas susceptible to compliance risks
- Identify the root cause of denials
- Streamline revenue integrity processes
Analytic-driven solutions enable proactive interventions, facilitating timely corrective actions to address potential inefficiencies before they escalate. Early identification and intervention are particularly critical as the Centers for Medicare and Medicaid Services (CMS) and commercial payors rachet up claims scrutiny to ferret out instances of fraud and overpayments, resulting in a fourfold increase in billing audit volume in 2023, according to MDaudit’s 2023 Benchmark Report.
Not only do these audits come with short response times, but they are also more complex than in past years. Some current audit demand letters exceed 100 pages, requiring the diversion of greater resources to research and formulate accurate and comprehensive responses to mitigate revenue risk from missed deadlines, poor outcomes, and potential clawbacks.
When it comes to billing and revenue compliance, what a health system does not know can hurt the bottom line. Driven by data, MDaudit helped a nearly 200-bed Level III Trauma Center to improve revenue and establish risk-based auditing practices for long-term success. This was accomplished by using pre-built analytics and peer benchmarking tools to leverage charge data regularly ingested from claims to identify healthcare billing compliance insights. The ability to drill deeper into to the data for tailored reporting have also helped the health system detect billing and coding anomalies and identify root causes and areas of risk.
For example, streamlined audit workflows enabled the health system to identify one interventional cardiologist who had no billable procedures charged in their first 60 days due to charting errors. Because this provider was a locum, they never would have known about the unbilled procedure without data. The impact would have been hundreds of thousands of dollars – and that was only two months. Within 12 months of deploying technology that allowed data to tell its story, the health system completed 1,000 cases, with 1,660 audit case findings, $182 thousand non-agree findings, and $1.59 million charges audited.
By analyzing historical data trends and patterns, healthcare organizations can better fortify their revenue strategies.
Leveraging Storytelling Data and Analytics
Streamlining billing compliance, revenue integrity, and HIM/coding, and eliminating inefficiencies through the power of storytelling data and analytics is paramount. Further, collaborative efforts between technology, data, and healthcare expertise are imperative to cultivate a culture rooted in objectivity and transparency.
Effectively leveraging storytelling data and analytics requires advanced technology tools that empower cross-departmental collaboration. Healthcare organizations should seek out a scalable enterprise platform with daily billing data ingestion, layered with sophisticated analytics and AI capable of rendering immediate insights into revenue leakage and opportunities, ensuring a healthier bottom line.
The future of healthcare revenue management is anchored in a narrative of unbiased data-driven excellence – a future that can be shaped one insightful story at a time.
Dana Finnegan
Dana Finnegan is Director of Market Strategy with MDaudit, a leading healthcare technology provider that partners with the nation’s premier healthcare systems to reduce compliance risk, improve efficiency, retain revenue, and enhance communication between cross-functional teams. Finnegan’s multi-faceted background includes more than 20 years of experience in healthcare revenue cycle and revenue integrity. His provider-side experience includes positions with Mass General Brigham and other large academic institutions. On the payor side, he worked at a small Massachusetts Medicaid provider and at the commercial carrier Athena.
