Revenue Cycle Analytics Software To Improve Charge Capture And Retain Millions In Healthcare

Revenue cycle analytics software is used by large healthcare networks that cover hundreds of geographical locations, offer medical services in tens of hospitals, and employ tens of thousands of staff. Such networks implement data platforms and analytics applications to effectively manage charge capture processes, conduct root cause analysis, identify and correct compliance issues, and, as a result, receive millions of dollars in net revenue retained. In this post, experts from the healthcare software development company, Belitsoft, share their ideas about the benefits of analytics applications and what challenges such solutions help to solve.

According to McKinsey, the $9 billion payment integrity industry has grown at 7% CAGR recently, which demonstrates high expenses and sophisticated billing procedures in healthcare. Experts mention the popularity of generative artificial intelligence (gen AI) and a shift to a value-based payment model as the main drivers.

The changed reimbursement approach has resulted in changed guidelines for billing and led to compliance issues, payment denials, and general confusion among both patients and medical business staff. Payment issues, such as billing patients for manipulations that differ from the documentation, mismatches between hospital data and insurance claims, and services that were not paid for, pose significant threats to managing finances in medical institutions. Charge capture is a critical indicator of revenue performance. Wrong procedures and irrelevant data impose threats on the revenue. Even a one percent loss of charge capture in the overall healthcare net charges might result in millions of dollars lost annually.

Revenue cycle analytics is most effective when used alongside healthcare claims analytics software. The former focuses on the internal processes of a healthcare organization before claims are submitted for charge capture, while the latter addresses aspects related to external payers and guarantees smooth claims submission.

Relevant analytics tools bring healthcare providers an opportunity to generate actionable insights right on time to fix charging errors and receive improved reimbursement and compliance. Organizations retain millions in net revenue in just several months. Therefore, healthtech vendors offer their clients tailored solutions to streamline processes and reach their aims.

Challenges that Healthcare Providers Have to Address to Reduce Charge Capture Losses

Healthcare organizations need a robust revenue cycle software with embedded charge integrity analytics solution that would allow them to scale, eliminate errors, increase profitability, and cope with the following tasks:

• Develop an efficient strategy for charge integrity to sustain the organization’s financial health.

• Maintain accurate charge capture to generate revenue and comply with regulations.

• Scale processes to keep pace with the organization’s significant and extensive growth.

• Address compliance challenges, adjustments, claims denials, and dissatisfaction among patients and leaders of clinical departments.

• Comply with changing payer reimbursement and billing guidelines.

• Fill the gaps between the organization’s requirements and the performance of its revenue cycle department.

• Enhance charge integrity analysis by proactively detecting issues and offering root cause resolution.

• Acquire a solution that would scale alongside organization’s growth, make less error volumes, and improve net revenue.

Features of the Revenue Cycle Analytics Software

Robust analytics tools cope with the above-mentioned challenges and bring healthcare providers the results they strive to achieve. Here is a list of what the analytics software can perform:

• Monitor issues and reports, apply a standardized root cause analysis template, and implement executive leader scorecards.

• Identify inefficiencies and revenue losses due to missed charges, pinpoint compliance problems stemming from overcharging, and enable the tracking of erroneous charges back to their root cause.

• Provide convenient tools for conducting different types of audits:

Daily: The analytics platform automates such audits. Daily updates of the coded hospital accounts from the electronic health records (EHRs) are sent to the application. The tool examines those accounts and charges against national regulations, providing the possibility to assign staff, sort, filter, export, and report the insights. As a result, staff can more effectively track and address trends and patterns instead of concentrating on resolving individual account issues.

Systematic: The experts of the revenue cycle conduct this type of audits by clinical domain and compare similar units throughout the organization allowing for the evaluation of like-type groups. For instance, a thorough audit might uncover charges that lack significant correspondent charges, such as anesthesia for a cesarean section. Analysts can further examine related labor and delivery departments, find similar missed charges and address them.

Random: On the basis of the data acquired during the previous types of audits, certain departments are chosen for random checks.

Additional Organizational Measures to Implement Analytics Software

Applying analytics applications is not enough for the best results. Healthcare executives and staff should cooperate to take measures that can make the implementation process run smoothly.

Healthcare organizations must align their revenue cycle performance with a general strategy and the expectations of the executives. The charge integrity audit program should involve the aims of improving personnel capabilities, processes, and applied technologies.

Healthcare providers are encouraged to support their staff in improving their analytics competencies, skills of trends and high-priority issues recognition, and team collaboration. The processes should be changed from addressing individual accounts to root causes and issues. It is better to concentrate efforts on solving systematic issues, implementing improvement activities, and monitoring stable results.

Planning the schedule for systematic annual audits at the beginning of the year is also critical for the streamlined procedures. Organizations must choose the accounts for random audits related to a particular department or service line to find the areas for improvement.

Finally, healthcare networks should organize regular meetings to communicate performance results to stakeholders and share audit findings and reports. Besides that, a special executive scorecard might distribute the information to a wide audience.

Benefits of Revenue Cycle Analytics Software

Organizations that have already used the analytics in their workflow report the following improvements:

• Rapid correction of urgent charging mistakes that impact optimal reimbursement.

• Retained millions of dollars in net revenue due to hundreds of charge capture issues revealed and resolved with the help of daily audits in the analytics solution.

• Eliminated potential loss of tens of millions in additional annualized gross revenue as the result of receiving optimal reimbursement and addressing the risks of claim denials and payer audits.

How Can a Healthcare Software Development Company Help?

Healthtech providers like the healthcare software development company Belitsoft, offer assistance in developing data operating platforms and analytics applications. They build integrated data systems that allow for gathering data from various sources, storing it, processing it, and analyzing it. Data sources include electronic medical records, clinic management systems, laboratory systems, financial systems, etc. Data platforms provide their users with the following possibilities:

• Automation of the data processing workflows (cleansing, standardization, and normalization).

• Configuring scalable data warehouses.

• Customizing and implementing analytical tools for designing dashboards, reports, and data visualizations.

• Providing a high level of data security and compliance with healthcare regulations such as HIPAA

• Integrating machine learning and AI into analytics.

Healthtech companies also help build special analytical applications upon request, such as Revenue Cycle Analytics Software with the following functionality:

• Gathering data from multiple sources on a single platform.

• Analyzing the key metrics such as claim approvals, denials, and overall cash flow in real-time.

• Automation of the claims generation and tracking.

• Generating reports on patterns, trends, inefficiencies, and areas for improvement within the revenue cycle.

If your organization needs assistance in data analytics, data infrastructure, data platforms, HL7 interfaces, workflow engineering, and development within the cloud (AWS, Azure, Google Cloud), hybrid, or on-premises environments, Belitsoft healthcare software development company is ready to be helpful.