The Healthcare Revenue Cycle: How to Optimize Performance
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The document discusses the importance of optimizing the healthcare revenue cycle, emphasizing that effective revenue cycle management is crucial for healthcare organizations to navigate patient journeys and collect payments efficiently. It highlights the reliance on data-driven strategies to reduce claim denials, increase collections, and improve billing accuracy, especially in light of challenges posed by the COVID-19 pandemic. By leveraging analytics, health systems can enhance financial outcomes and sustain improvements as they face growing organizational complexities.
The Healthcare Revenue Cycle: How to Optimize Performance
- 1. The Healthcare Revenue Cycle: How to Optimize Performance
- 2. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Healthcare Revenue Cycle Patient care tends to get top billing in the healthcare industry, but many behind-the- scenes activities make each encounter, procedure, and life saved possible. Healthcare revenue cycle management, for example, is a critical function within an organization that keeps the business operating and servings its community.
- 3. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Healthcare Revenue Cycle The revenue cycle encompasses processes from creating a patient account to collecting payment for healthcare services and each step in between. As such, health systems rely on effective revenue cycle management to follow the patient journey, navigate claims, and ensure the organization collects payment for its services.
- 4. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Healthcare Revenue Cycle Revenue cycle management today is about much more than billing and collecting payment. As the healthcare industry grows, traditional, time-consuming (often manual) approaches to managing the revenue cycle require too many resources and leave unacceptably broad margins for error. Meanwhile, out-of-the-box revenue cycle solutions don’t allow customization or integrations with payer and EMR data.
- 5. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Healthcare Revenue Cycle The contemporary healthcare landscape requires a comprehensive, standardized, and data-driven revenue cycle process. Additionally, lost volume due to COVID-19 has furthered the need to transform revenue cycle management, as organizations can’t afford to miss an opportunity for payment.
- 6. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Three Ways Data Improves Healthcare Revenue Cycle Management Health systems that leverage data to support comprehensive and accurate revenue cycle management improve their financial outcomes in three significant ways: 1. Reduce Denials 2. Increase Collections with Propensity-to-Pay Insight 3. Improve Discharged-Not-Final-Billed Efforts
- 7. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Three Ways Data Improves Healthcare Revenue Cycle Management 1: Reduce Denials Within the revenue cycle process, claim denials cost each healthcare provider an average of $5 million every year. Organizations can recover some of this loss by using an analytics solution to integrate data from multiple sources to understand the denials’ causes. With such insight, health systems can implement denial prevention plans and procedures for recovering the denials.
- 8. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Three Ways Data Improves Healthcare Revenue Cycle Management 1: Reduce Denials Billings Clinic, for example, found opportunities to reduce its denials when it pinpointed the sources of the denials. The organization leveraged the Health Catalyst Data Operating System (DOS™) platform and a robust suite of analytics applications to implement a revenue cycle analytics application.
- 9. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Three Ways Data Improves Healthcare Revenue Cycle Management 1: Reduce Denials The resulting insights informed data- driven improvement efforts that have yielded positive outcomes, including a $4.5 million reduction in denials in just 12 months, resulting from an 8 percent relative reduction in overall denial dollars.
- 10. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Three Ways Data Improves Healthcare Revenue Cycle Management 2: Increase Collections with Propensity-to-Pay Insight With patients responsible for an increasing amount of their healthcare costs, self-pay accounts are now the top contributor to bad debt for hospitals and health systems. Bad debt accounts for more than $55 billion in healthcare revenue loss annually. Health systems need strategy-driven processes for patient collections—in other words, a reliable propensity-to-pay predictive model—to get ahead of bad debt.
- 11. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Three Ways Data Improves Healthcare Revenue Cycle Management 2: Increase Collections with Propensity-to-Pay Insight Allina Health leveraged DOS to navigate its bad-debt challenges by creating a predictive model to support a propensity-to-pay strategy. The resulting propensity-to-pay machine learning model uses artificial intelligence to predict the probability that the patient will pay their bill during the month in question.
- 12. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Three Ways Data Improves Healthcare Revenue Cycle Management 2: Increase Collections with Propensity-to-Pay Insight Propensity-to-pay predictions have helped Allina increase overall collections by $2 million in just one year, including collecting more than $660,000 in additional patient payments during the strategy’s first two months.
- 13. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Three Ways Data Improves Healthcare Revenue Cycle Management 3: Improve Discharged-Not-Final-Billed Efforts Managing discharged not final billed (DNFB) cases, where bills remain incomplete due to coding or documentation gaps, is one important way hospitals can improve revenue cycle performance. However, without analytics to support efforts, meeting a target for DNFB improvement remains a serious challenge.
- 14. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Three Ways Data Improves Healthcare Revenue Cycle Management 3: Improve Discharged-Not-Final-Billed Efforts Thibodaux Regional Medical Center invested in analytics and resources targeted at improving its DNFB rates. The health system deployed a DNFB analytics application on top of the analytics platform (DOS) to leverage the clinical, financial, operation, claims, and other data aggregated in the analytics platform.
- 15. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Three Ways Data Improves Healthcare Revenue Cycle Management 3: Improve Discharged-Not-Final-Billed Efforts The analytics applications enabled quick and easy access to the information Thibodaux Regional needed to effectively manage its DNFB efforts and create a more efficient workflow process for coders and physicians. Two years after the organization launched its initial DNFB improvement effort, it has achieved $1 million in additional annual reimbursement and a 66.7 percent relative reduction in DNFB dollars, significantly improving cash flow.
- 16. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Data and Analytics Reveal Critical Revenue Cycle Management Opportunities Revenue cycle management today must navigate mounting organizational complexity while maintaining financial health through emergency situations, such as COVID-19. Health systems can meet these demands with robust analytics that help them identify opportunities to improve the revue stream and data-informed strategies to sustain improvements as organizations grow and challenges emerge.
- 17. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. For more information: “This book is a fantastic piece of work” – Robert Lindeman MD, FAAP, Chief Physician Quality Officer
- 18. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic Link to original article for a more in-depth discussion. The Healthcare Revenue Cycle: How to Optimize Performance Healthcare Revenue Cycle: Five Keys to Financial Sustainability Marlowe Dazley, Senior VP and Managing Director of Financial Advisory Services Todd Halpin, Senior VP, Financial Advisory Service Details and Dollars: Using Data and Analytics to Optimize Revenue Cycle Performance Health Catalyst Webinar VitalCDM™ Ranked #1 in KLAS Revenue Cycle, Chargemaster Management Category for Third Year in a Row - Health Catalyst News The 2021 Healthcare Financial Forecast: What to Expect, How to Prepare Bobbi Brown, MBA, Senior VP Artificial Intelligence and Machine Learning in Healthcare: Four Real-World Improvements Health Catalyst Editors
- 19. © 2021 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company that helps healthcare organizations of all sizes improve clinical, financial, and operational outcomes needed to improve population health and accountable care. Our proven enterprise data warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more than 65 million patients for organizations ranging from the largest US health system to forward-thinking physician practices. Health Catalyst was recently named as the leader in the enterprise healthcare BI market in improvement by KLAS, and has received numerous best-place-to work awards including Modern Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for Millenials, and a “Best Perks for Women.”