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How new data tools can improve revenue cycle management

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Federal and industry regulations are forcing healthcare organizations of all sizes to review and upgrade many business and operational processes. And with mandates now requiring companies in the healthcare industry to measure and report on practically all aspects of their business, in combination with the digitization of health and financial records, one area that they would significantly benefit from improving is their data access and preparation strategy.

Data serves as the foundation for reporting procedures, business decisions and operational processes, in areas ranging from clinical analysis for improving patient treatment and preventative care, to operational efficiencies for revenue cycle management and the patient experience.

While the use cases for data in healthcare are endless, revenue cycle management deserves special attention—this involves pulling information from thousands of data sources and digitized systems, such as EHRs and EMRs, financial systems and insurance claim processing/denials, for revenue collections.

The efficiency of a medical practice’s billing operations has a critical impact on financial performance. But most healthcare providers still grapple with disparate revenue cycle systems, poor operational processes and manual data access and preparation, which drive up costs and negatively impact net revenue. Let’s examine why this is the case.

The data most valuable for revenue cycle processes is often locked in multi-structured or unstructured reports, PDFs, databases, invoices, billing statements and spreadsheets, or closely guarded by IT gatekeepers. Additionally, patient data is diverse, comes from disparate sources, and rarely presents itself in the format required to perform reporting and analysis.

As a result of these data access and preparation challenges, most finance administrators are spending countless hours manually rekeying and reconciling data from EMRs, standardized 835 and 837 remittance files, and other sources, or waiting days for IT to share a requested report.

The CFO at a large healthcare system in the Northeast succinctly described this (far too common) challenge: “Finance always needs to be able to link the patient to the provider. Access to data is king, but the dirty secret is that the data is usually not user friendly and needs to be scrubbed and converted into a readable and workable format.”

Manual data access and preparation processes are not only time-intensive and error-prone, but they lead to important decisions being based on incomplete, inaccurate or outdated data. And timely access to reliable data is no longer a ‘nice-to-have’; it now affects the bottom line, causes delays in claims processing, increases outstanding AR and slows revenue collection. Additionally, information errors can negatively impact patient care, regulatory compliance and all phases of revenue cycle management.

Many healthcare finance teams say they believe they are handcuffed by manual data access and preparation processes, but they believe there’s no other viable option, and thus revenue cycle management is affected. One option is self-service data preparation technology, that promises to offer healthcare finance professionals a cure for common hurdles to data access, reconciliation, and financial and compliance reporting.

Self-service data preparation automates and simplifies data retrieval and preparation processes, giving financial analysts, accounting teams and even novice business users, the ability to:

  • Easily and quickly extract, manipulate, enrich and combine disparate data from virtually any internal or external source (for example, PDF reports, text files, CSV, JSON, EHRs/EMRs, HL7 messages, 835/837 insurance remittance forms and claim denial documents) from any system (including Cerner, Epic, MEDITECH, McKesson and others).
  • Quickly prepare it for analysis and reporting, without coding, manual data entry or involvement from IT.

The technology eliminates manual processes and the accompanying potential for human error. Governance features—such as data masking, data redaction, data lineage and role-based permissions—can support the security of patient data.

The following are potential business benefits for finance teams aiming for revenue cycle improvements. Self-service data preparation can enable organizations to:

  • Find, access, blend and prepare data from static reports, files and databases, and integrate it with vital financial, clinical and operational metrics, dashboards and information from a variety of other disparate sources to produce more reliable data and gain a holistic view of the revenue cycle for more strategic decision-making.
  • Leverage shared and reusable models to expedite analysis, reduce time-to-insight, simplify reporting and ensure greater collaboration.
  • Streamline the collection, reconciliation, scrubbing and submission of patient healthcare and financial information to recognize and report revenue faster.
  • Eliminate manual, risk-laden spreadsheet processes to maximize cash flow, see revenue across service lines, cut costs, drill down into claims, review aging claims, identify areas of increased profitability and identify gaps in the revenue cycle process.

Improve financial performance through process efficiency, HIPAA compliance and correct payments

In a recent webinar, Forrester Senior Analyst Richard Joyce noted that just a 10 percent increase in data accessibility can result in more than $65 million additional net income for a typical Fortune 1000 company. Regardless of size, healthcare companies that overcome traditional data access and preparation challenges increase the likelihood that they’ll be able to collect more revenue, faster, and with less manual work.

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