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How RCM Data Analytics Optimize Healthcare Billing Cycles

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Operating an organization in a highly regulated industry such as healthcare comes with many challenges. Accurate claim information, securing reimbursement, and collections are critical for profitability but can be difficult to obtain. And it’s getting more challenging than ever for providers: a recent survey found that 89% had an increase in denials over the past three years. Furthermore, 51% even stated that the rise was “significant.”

That is why forward-looking healthcare companies are looking to harness the potential of data to help them overcome these hurdles. Data is used in almost every area of healthcare operations, such as customer service and diagnostics, but revenue cycle management (RCM) offers businesses the most immediate and measurable impact.

When leaders can aggregate data from ERP, EHRs, medical billing, RCM, and various healthcare information technology systems to build intuitive dashboards and analytics, they are able to glean insights like never before. From coding to billing to claims and more, organizations will have the 360-degree view needed to find patterns and understand how best to respond.

As businesses face increasing pressure to maintain profitability with higher standards, leaders need end-to-end visibility that provides real-time analysis of trends and insights that will empower analysts, CFOs, and other staff members to make better decisions.

Healthcare organizations that don’t have a cohesive view of their data are at risk. Between increasing denials, wasted time and resources, and delayed payments, they will experience a drag on productivity and profit on even their most basic queries.

Here is what you need to know about RCM dashboards and analytics and how they help drive efficiency, productivity, and revenue.

What Is an RCM Dashboard?

Most modern cars come with high-tech dashboards. They provide drivers with everything they need for a safe and easy drive, such as automated parking assistance, GPS, and a digital tire pressure monitoring system. They compile and organize all the information to optimize daily travel and enable drivers to see what’s happening with their cars in real-time. With all the benefits of a car dashboard, why would you use only the odometer?

Likewise, RCM dashboards and analytics give organizations the insights and support they need to optimize performance. Running a healthcare practice can be tricky, particularly in highly competitive markets. Dashboards offer providers the analytics they need to get ahead of all the challenges of running a business. From delays in accounts receivable (AR) collection to claim denials to billing errors, a dashboard enables leaders to identify, resolve and even prevent issues before they become significant cashflow issues.

A dashboard takes the raw AR data providers collect. It processes and analyzes it to generate a summary and insights to help them improve their collections and the practice’s financial stability.

Benefits of an RCM Dashboard and Analytics

RCM dashboards and analytics give organizations deep insights into their billing workflows and help leaders find ways to improve their revenue integrity. Here are some of the most significant advantages dashboards offer healthcare companies now and in the long run.

Provide Proactive Denial Management by Identifying Defect Patterns

From when a claim gets scheduled until it is paid, it is prone to errors that lead to denials. There are multiple stages that each claim must pass through, and a mistake at any point will accumulate within AR and denial management. For example, if a staff member makes one error posting a payment, it becomes a denial or AR. Likewise, if there is a mistake in the demographic, a wrong code, CCPT, or modifier, it will become a denial. Errors happen at any point, from pre-encounter paperwork to post-encounter coding. They occur daily, all the time, because so much precision is required at each process step.

Because there are many potential mistakes, they can easily slip by unnoticed. It may go to the insurance company as a claim and get denied. These defects accumulate within AR and denial management queues, leading to overwhelmed staff and lower profits.

Analytical dashboards help organizations proactively tackle defects and denials at their very first instance. It not only repairs these denials reactively and reverts them to the payer’s insurance company but also uses the data to understand the origination of the defects. It helps stop the accumulation of denial management queues.

Proactively tackling denials and finding patterns to prevent recurrences of defects requires a systemic approach to large amounts of data. It’s impossible for providers to manually access and log this information on a simple Excel spreadsheet. It takes the support of a digital tool to run the amount of data needed from every touch for every patient in the ecosystem to glean meaningful insights and patterns.

Considering that many providers see a significant increase in denied claims, a proactive approach to reducing them is critical for maintaining a healthy margin. Only over the past few years was the technology required to recognize these defect patterns and prevent denials from becoming available. However, healthcare organizations can harness the intelligence of digital tools to manage extensive inventories of data to prioritize and organize intelligent workflow allocations for effective analytics systematically.

Provide Analytical Feedback

Knowing where errors happen is critical to improving the RCM cycle, but analytics help organizations take it a step further to pinpoint essential issues. Leaders get more profound insights to help proactively guide and improve their processes to tackle errors. Dashboard analytics enable leaders to manage their claims proactively and avoid overwhelmed denial management queues.

Analytical dashboards can answer critical questions about defects at every step in the RCM cycle. It tells organizations which mistakes are happening in each zone and can answer vital questions, such as the magnitude and recurrences of defects. For example, suppose an organization has credential issues. In that case, the dashboard can catch a repeated mistake, and analytics will let leadership know if it repeats every day, week, or month, despite any front-end correction.

With analytics, providers pinpoint and stop claim denials where they occur. It cuts down on the time and resources spent resubmitting claims and ensures that leadership is tackling their specific issues instead of educated guesswork.

View Every Spectrum Within RCM Cycle

As we mentioned earlier, the entire claims process comprises the whole spectrum and multiple steps. Each phase has critical components and, when not handled correctly, can lead to a denial. It’s overwhelming information for leadership to parse through to get meaningful insights to inform their decisions.

And it can be challenging for leadership to get real insights into each step of the process and an overall view of workflow progress, if any issues need to be addressed, and how the organization‘s RCM cycle can improve. With this information, leaders can be more confident in their decisions and reduce denials.

The visibility of a dashboard enables the CFO or executive of a hospital or institute to see precisely what claims are sitting in denial management and what error is holding them back. They get critical insights at each step of the RCM cycle.

With the correlative data across the RCM cycle, executives can make more informed decisions that help drive a more effective process. They can pinpoint problematic parts of the RCM cycle and fix errors where they occur instead of making assumptions.

Monitor Business Outcome Metrics

One of the essential advantages of having critical dashboard analytics is leadership’s ability to view the business outcome metrics. Strong business outcome goals drive most organizations. For example, those working on AR typically aim to collect the maximum. However, it’s impossible to be goal-driven when organizations don’t have insights into outcomes and performance.

Dashboards give companies the insights they need to monitor their business outcome metrics. Monitoring them on a real-time basis with the most current data ensures that the organization is on track with its claims. An RCM dashboard allows leaders to see what comprises the claim and all the data which is processed by the team.

With an RCM dashboard, leadership can see business outcomes with easy-to-read graph charts and understand what’s going right, what’s going wrong, why it’s going wrong, what actions need to be initiated, and the outcomes.

Monitor Cash Flow

The most vital part of a healthcare organization is cash flow. Every hospital, lab, and physician needs to have cash flowing in. With a healthy cash flow, they can ensure everything is paid for and running smoothly and have the margin to invest in new technologies and treatments.

Denials seriously impact cash flow. As denials increase, leaders may even have issues running their organizations. RCM dashboards give leadership the information they need about every aspect of cash flow, including what’s getting paid, what’s not getting paid, and what is delayed. They also get critical insights into payer-specific behavior. Using historical data, they can predict when insurers will pay claims, which helps them manage the revenue cycle process and forecast revenue.

With access to data across their enterprises, executives can make informed budgetary decisions to increase revenue, enhancing their payment, revenue cycle, and pricing. They use the data to determine what their organization needs and when it needs it to make budgeting easier for the financial staff.

Dashboards are critical for helping leaders meet their cash goals and use their budgets most effectively.

Identify Uncollected AR Inventory

No responses are a frustrating part of claims. While some claims payers deny and communicate that back to the provider, getting no response from the payer for a claim requires more work for staff following up and ensuring they submitted everything correctly. For many organizations, uncollected AR builds up, leaving many claims unpaid. They may not even realize that they are missing out on these payments because there was no communication from the payer.

Analytical dashboards help organizations track uncollected AR inventory. They track the number of days in AR, remaining payments, and bad debts to help leaders identify these claims so that they can get paid. They can enhance the workflow and the organization’s bottom line by highlighting these opportunities.

Right-Sized Staff

Healthcare organizations with poor RCM habits risk staff burnout, poor patient experience, and a poor balance sheet. With over half of American workers experiencing burnout, finding ways to automate tedious tasks could be essential to maintaining a more motivated staff. Considering that the industry already experiences thin margins, adequate staffing is critical for ensuring workers are not overwhelmed and used most effectively. It eliminates wasteful spending and ensures that more staff is added when needed.

Analytical dashboards enable organizations to right-size their workforce on particular processes. Leadership can get insights into how many agents are required, how many touches accounts have, and what shrinks are happening. The analytical dashboard helps leaders plan the right resources at the right time.

Enable Robotic Process Automation and Digitize Workflows

As we progress to the next generation of technology, automation is at the forefront. Healthcare organizations want ways to improve their bottom line and prevent errors, and robotic process automation (RPA) and digitized workflows are the ideal way to do that. Revenue-cycle-management analytics are at the forefront of providing these new tools with the data necessary for healthcare organizations to use them most effectively.

With an analytical dashboard, RPA tools get the data to see which patterns and actionable steps need to be taken. The dashboard can highlight the digital processes with high automation potential, relieving staff of tedious and repetitive labor. It has the information on the granular level, meaning it has the level of detail it needs to work most effectively.

Reach Your Organization’s Full Potential with RCM Dashboards and Analytics

As denied claims continue to rise, healthcare organizations need more efficient and effective RCM methods to save resources and increase cash flow. RCM dashboards and analytics play a critical role in providing leaders and staff with insights and information that would otherwise be lost in massive amounts of data. These insights allow leaders to make data-driven decisions, optimize workflow processes, drive efficiency, and save money.

A dashboard can help organize and streamline claims management so that companies can take a proactive approach to the process and prevent denials. The right tools are critical for assisting leaders in making strategic decisions with their budgets and efficiently using their resources and staff. The right tools not only help providers increase their bottom line but prevent staff burnout and provide patients with a better experience during the payment process.

With the dashboard and analytics built to serve your organization best, you can create a compelling and productive RCM process to reduce denials and improve profits. GeBBS Healthcare Solutions iAR tool can help you recover those profits by accelerating and automating collection activity, showing you payer trends, resolving inventory, and monitoring liquidation/resolution ratios across facilities and payer groups.

To learn more about how GeBBS Healthcare Solutions can help you get a more streamlined and cohesive view of your claims, request a consultation with one of our world-class experts today at gebbs.com.

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