Utilizing Data Analytics and AI for Optimal Revenue Cycle Performance
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The document discusses the application of data analytics and artificial intelligence (AI) in optimizing revenue cycle performance within healthcare. It emphasizes transforming data into actionable information, monitoring production quality, and automating clerical tasks to enhance efficiency. The use of AI in processes like natural language processing and claim status tracking is highlighted as a means to reduce labor and improve decision-making.
Utilizing Data Analytics and AI for Optimal Revenue Cycle Performance
- 1. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com Presented By Steve McCoy | CEO Healthcare Resource Group Utilizing Data Analytics & Artificial Intelligence to Optimize Revenue Cycle Performance
- 2. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com OVERVIEW USING DATA ANALYTICS • Transforming data into information • Understanding the big picture • Highlighting problems and opportunities • Rooting out “root causes” • Monitoring production and Quality Assurance (QA) USING ARTIFICIAL INTELLIGENCE • Eliminate menial tasks • Reducing labor • Programmatic decision making • Optimizing workflow
- 3. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com DATA ANALYTICS Actionable Information Complex relationships High transaction volume Disparate computer systems Data
- 4. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com DATA ANALYTICS: ATB REIMAGINED
- 5. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com DATA ANALYTICS: ATB REIMAGINED
- 6. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com DENIALS: ANALYZING 835S
- 7. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com Registration -- Amount Coding -- Amount Billing -- Amount DENIALS: ANALYZING 835’s
- 8. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com PRODUCTION & QUALITY ASSURANCE PRODUCTIVITY BY COUNT (excluding Initial Bill) Representative 3/6/2020 3/13/2020 3/20/2020 3/27/2020 4/3/2020 Ahansen 317 363 379 401 328 asly 210 190 111 177 158 astice 199 213 157 253 168 athieren 125 111 120 241 197 aunterberg 101 89 117 68 159 ayoerger 283 249 303 211 155 bdubose 122 71 31 16 20 cconnolly 190 238 153 156 217 cpaulson 407 452 324 272 287 csanchez 245 101 95 51 109 cwalker 136 189 130 149 135 thiggins 204 198 140 226 241 tkokinda 238 232 183 131 118 tlott 164 142 104 242 324 tmacdonnell 292 359 282 323 359 tpirello 133 133 182 158 178 vabaradari 254 251 216 13 24 vhokkanen 71 51 39 65 65 WEEKLY AVERAGE 359.4 331.4 288.5 320.4 328.0 DAILY AVERAGE 71.9 66.3 57.7 64.1 65.6 Self Pay Daily Scorecard Stats Representative Talk Wrap Total Calls Calls per hr Aux % Bianca 2.9 3.42 45 5.46 23% Liz 3.7 2.28 41 6.20 14% Inesa 4.1 1.41 44 5.27 13% Jeanny 4.7 3.06 49 5.57 10% Catherine 3.5 4.19 32 4.33 18% Vanessa 5.3 3.95 30 3.83 33% 4.03 3.05 241 5.11 19% QA Scorecard Results Rep Pat Acct Num Question Score Possible Points Comment date Scored Note Includes required elements 1 1 4/28/20 Note reflects review, findings and action 2 2 4/28/20 Account Status Reflects Current State of Account 1 1 4/28/20 Applicable supporting documents attached 1 1 Appeal documents were previously saved in Helix, good job. 4/28/20 Applicable steps taken to move account forward 8 8 Great job calling to try to verify that the appeal was received. Good job noting expected time of 30-45 days for appeal to show on file. 4/28/20 Total 13 13 100%
- 9. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com ARTIFICIAL INTELLIGENCE (AI) AI DEFINITION: Computer systems able to perform tasks that normally require human intelligence scripting Natural language processing
- 10. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com AI: NATURAL LANGUAGE PROCESSING HIM Computer Assisted Coding (CAC) Converts medical record freeform text to appropriate ICD-10 and CPT codes Difficult and expensive installation Required “learning” time for the program Different “learning” period and accuracy rate for each clinical area Not suitable for inpatient setting; too complex
- 11. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com AI: BOTS 1. • Execute query for all unpaid claims for a particular payer in the AR 2. • Sign onto the payer website 3 • Query the website for each specific claim 4 • Capture and record the claim status for each claim 5 • Sign onto the AR system 6 • Update each account, if the claim status has changed 7 • Queue the account for action Claim Status Example – each “bot” is unique to each payer The “bot” is queued to run overnight and performs the following:
- 12. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com AI: BOTS Eligibility Authorizations (simple, limited) Address Verifications Repetitive, Clerical Tasks Can be utilized in the following areas:
- 13. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com SUMMARY Data Analytics Transforming data into actionable information Artificial Intelligence Getting more done with fewer human resources
- 14. © 2020 Healthcare Resource Group, Inc. ALL RIGHTS RESERVED. hrgpros.com