Healthcare Revenue Cycle Analytics to Cut Claim Denials and Save Millions

Managing claim denial costs is an acute issue. In 2022, healthcare systems spent almost $20 billion in efforts to challenge denied claims. According to McKinsey, the percentage of the initial claims denied for payment has grown to 15% in 2023 from 9% in 2016. 

That is why integrated multi-specialty group practices that employ thousands of employees and serve tens of thousands of patients in multiple locations wish to define the cause of claim denials. They utilize healthcare claims analytics to integrate data from various sources, define troublesome areas, and address them. Healthcare systems manage to receive multiple millions reduction in denials with the help of proper revenue cycle analytics applications.

Among the ways that can swiftly boost revenue cycle performance, McKinsey experts mention partnering ecosystems of services and technology vendors. Reliable healthtech partners offer a champion-challenger approach model that implies examining several innovative solutions and selecting the most efficient one to implement at scale. In this post, representatives of the custom healthcare software development company Belitsoft deliver their expertise concerning claim analytics, its benefits, and features.

Claims analytics software helps carry out a root cause analysis of the claims denials. Therefore, healthcare systems manage to reach industry standards and make sustainable progress. Besides that, revenue cycle analytics applications provide organizations with real-time and actionable data to optimize their revenue cycle and financial results.

Challenges on the Way to Claims Denial Management

Healthcare providers lose revenue as a result of claim denials. Addressing healthtech vendors still hides some pitfalls for healthcare organizations. Here is a list of troubles companies have to deal with:

  • Providers are unable to determine the root causes of denials due to time-consuming manual reports and inaccurate data.
  • Lack of knowledge regarding the sources of denials limits organizations’ claims management processes and collection and improvement efforts. 
  • Absence of relevant analytics tools complicates the process of an accurate analysis of denials and recoveries and delays its timely delivery.
  • Out-of-the-box solutions for managing healthcare revenue cycles are not customizable, they fail to integrate payer data and electronic medical records (EMRs) and do not provide the data necessary for recovery efforts.

Healthcare Revenue Cycle Analytics Useful Functionality

Healthcare analytics enables organizations to leverage the data and pinpoint the causes of the denials. Further, organizations may develop prevention plans and actions that would recover the denials. Other useful functionality includes:

  • Data integration from various sources for insights generation.
  • Embedded financial advisory applications for a better understanding of the complete healthcare revenue cycle and establishing strategies and operational actions required for performance acceleration.
  • Determination of the trends and variances.
  • Improved reporting process to ensure reliable data is brought to stakeholders and guarantee the organization is fairly rewarded for the value it provides.
  • Access to running on-demand reports, provided to coding and registration departments, allowing them to generate insights and share responsibilities with revenue cycle employees.
  • Integration of AI to automate medical coding, eliminate errors and administrative problems, and double-check the data. 

Benefits of Revenue Cycle Analytics for Healthcare Systems

Analytics applications allow providers and executive leaders to acquire a high level of confidence in the quality of their insights. That data allows for removing the report backlog and generating accurate and actionable reports on time. Healthcare organizations that have already implemented revenue cycle analytics receive recognition in prestigious awards for granting access to clear, reliable, and actionable data. They report the following positive results in their processes:

  • Even a minor relative reduction in overall denial rates can result in millions of dollars in savings over the course of a year.
  • Hundreds of thousands of dollars in cost savings as the result of managing small-dollar claim denials internally rather than outsourcing this task.
  • A nearly 50% reduction in denials related to authorization issues.
  • Alleviating the workload associated with denials for the staff.
  • Ability to grant ad-hoc report requests of any complexity in several minutes instead of hours or days.

Organizational Measures to Get the Best out of Analytics

The implementation of the proper analytics applications is critical yet not exhaustive for successful and sustainable outcomes. It is also important to make some additional efforts and guarantee the participation of all the stakeholders. First, detailed data and analytics should be available to both clinical and operational partners for them to get engaged in understanding and enhancing the root causes of denials. Second, senior leaders must monitor key performance indicators and come up with ideas for improving operational and financial performance. Merging efforts impact the organization’s performance.

Addressing a Healthcare Software Development Company

Healthcare data analytics companies cooperate with healthcare software development companies like Belitsoft to develop and customize data analytics applications and platforms. Data operating systems and integrated analytics platforms assist healthcare organizations in analyzing their current performance results, identifying the gaps, and improving processes to gain results from the new reimbursement model.

Healthcare software development companies create integrated data platforms that allow for collecting, storing, processing, and analyzing large datasets from such sources as electronic medical records (EMRs), clinic management systems, laboratory systems, billing systems, etc. Those platforms provide the following functionality:

  • Workflow automation (cleansing, standardization, and normalization)
  • Setting up scalable data warehouses
  • Implementing analytical tools for designing dashboards, reports, and data visualizations
  • High level of data security and compliance with healthcare regulations such as HIPAA
  • Integration of machine learning and AI into analytics.

Healthcare software development companies can also assist in building specialized analytical applications like Revenue Cycle Analytics for: 

  • Data integration from multiple sources
  • Real-time data processing
  • Filtering data and customizing date filters to alter timeframes
  • Visualizing financial and operational performance with a possibility to drill down to payers, clinics/practices, providers, and CPT levels
  • Automated reporting
  • Highlighting key denial reports
  • Gathering and analyzing denial causes
  • Demonstrating denial trends in graphs and diagrams.

Technological solutions like Revenue Cycle Analytics make the aim of reaching better outcomes for patients and smart budget allocation totally achievable.

For those searching for competent advice 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, a custom healthcare software development company like Belitsoft can become useful.