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How interactive analytics improve revenue cycle management: 5 takeaways


As healthcare organizations develop strategies to secure financial well-being during the COVID-19 pandemic, they can glean critical insights from workflow, business intelligence and denial management technologies.

That was the key message put forth by National Medical Billing Services' Nader Samii, CEO, and Jessica Thurston, senior director of business development, during Becker's Spine, Orthopedic and Pain Management-Driven ASC + Future of Spine Virtual Event in June.

During an online workshop, Mr. Samii and Ms. Thurston shared five advantages of revenue cycle management technology:

1. Gaining deeper understanding. The ASC reimbursement landscape is more complex and challenging than ever before, according to Mr. Samii. ASC claims are being denied more than ever before, and the claims that get denied tend to represent larger dollar amounts. These costly denials can be avoided if facilities use carefully curated dashboard insights to understand why the denials are happening.

"Generally, if you understand where issues and denials are coming from, you can fix the process flaw," Mr. Samii said. 

2. Identifying problem areas. Mr. Samii and Ms. Thurston showed multiple dashboards that revealed whether opportunities for improvement lie in the front, middle or back ends of the revenue cycle.

Since many denials around the nation are never worked, it's important to know what kind of denials your organization is experiencing and whether they're being addressed properly, Ms. Thurston said.

For most organizations, the primary reasons for ASC denials involve front-end registration and eligibility issues, missing or invalid claims data, and authorization and certification errors, according to NMBS data..

3. Enhancing visibility. If a certain percent of claims do not pay on a consistent basis, Mr. Samii said, organizations can leverage analytics to drill down into whether preauthorization, documentation or something else is to blame. Being able to identify these issues in a clear and visible fashion that "tells a story" allows ASCs to maximize their cash flow, and to expedite the timing of that cash flow.

4. Monitoring revenue boosters. A dashboard can track high dollar procedures and identify how many cases performed in a given month involved expensive products such as implants. The data can be further filtered to a select location or the entire organization, depending on what is most relevant to the conversation at hand.

"You can monitor high-cost procedures, where you're at with [billing and reimbursement], and potentially fix problems if there are any," Ms. Thurston said.

5. Capturing production insights. For the same reason, organizations can benefit from tracking very detailed operational specific metrics to ensure that each and every step of the revenue cycle is in lock step with its key performance indicators, thus ensuring a highly efficient and effective revenue cycle process.  

"The data, when laid out in a highly systematic fashion, should truly tell you a story about how your organization is performing, and should further guide you to understand 'why' it is performing in that way. When you can view your analytics and immediately glean this level of information, then you know you have set it up correctly," said Mr. Samii.

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