Do Your Financial Processes and Respective Toolbox Include Effective Analytics of Your Revenue Cycle?

Revenue cycle analytics in a provider setting refers to the use of data-driven insights of the financial processes (Billing, Collections, Registration, etc.) for healthcare organizations. It involves tracking, analyzing, and improving various components of the revenue cycle, from patient registration to final payment collection. Revenue cycle analytics is vital in improving overall financial outcomes for any provider setting. By harnessing internal systems for furthering your data insights, organizations can reduce inefficiencies and maximize revenue generation while enhancing patient satisfaction streamlining operations. Key components of revenue cycle analytics include:

• Claims & Denial Management
• Billing & Payment Optimization
• Accounts Receivable (A/R) Management
• Patient Access & Front-End Processes
• Financial Compliance
• Charge Capture

A few benefits of revenue cycle analytics would be:

• Increased revenue capture by identifying and fixing revenue leakage points.
• Improving efficiency through automation of manual processes.
• Better cash flow through optimizing collections and reducing A/R days.
• Enhanced patient experience via transparent billing and financial counseling.

And as with any initiative, there are challenges in Implementing revenue cycle analytics as well, such as:

• Data fragmentation across multiple systems.
• Complexity of payer contracts and reimbursement models.
• Resistance to change among staff and stakeholders.
• The need for significant investment in analytics tools and staff training.

Some key areas of focus and respective questions to ask would be:

• Fee Schedules – Is your rate offer competitive with others in the marketplace?  Could you negotiate higher rates with compelling data analysis and provide the payer with a rational and data-driven counteroffer?
• Are you being paid correctly according to your contract?  Are you able to extract the proper data elements to perform an accurate analysis of your payer reimbursement and subsequent variance report in which to pursue underpayments?
• Creating / Managing a budget, Proformas, Business Planning – Do you need a budget and help creating and deploying?  Are you thinking of adding a new service or purchasing a new CT scan?  Are you looking to add a new physician and not sure of a competitive market rate based on Relative Value Units?
• Rural Healthcare Clinic set up / conversion – Is it financially advantageous for you to set up your practice as an RHC?
• Market Share – Where do you stand, relative to the competition?  Are you conducting analysis of the volume in your market to determine your market share and potential opportunities?

SHP has a team of very experienced professionals with various technical and EMR skill sets to accomplish these necessary objectives. Whether it’s the hospital setting, independent practice, ambulatory surgery center, or other ancillary providers, our team can provide the data gathering and respective analysis to move the dial. Give us a call or email us to find out how we can help your organization evolve its financial performance.