Revenue Cycle Analytics Software is frequently used by many large integrated healthcare systems with annual net operating revenues in the billions of dollars who want to enhance their charge capture performance. They report increased revenues and an improved number of overlooked charges detected in the initial months through the updated solution. What approaches do these health systems implement to ensure sustainable results?
A healthcare system’s financial success relies on efficient charge capture processes, as failing to implement them effectively prevents the organization from generating revenue for its services.
Revenue Cycle Analytics Software is part of the healthcare revenue cycle management ecosystem and works in tandem with insurance claims analytics software to optimize financial outcomes. Revenue cycle analytics tools work on the internal operations of a healthcare organization before claims are submitted and are responsible for charge capture. Insurance claims analytics software focuses on the external payer and ensures clean claims submission.
Charge capture is the process through which a healthcare system secures payment for the services it provides, relying on its comprehensive list of billable items and corresponding prices. This catalog, also called the charge description master or chargemaster, serves as the foundation for assigning costs to services rendered. Usually, the EHR system or a staff member attaches a code to a certain medical service (e.g., a primary care visit), and sends it as a reimbursement request to insurers, payers, or government entities like Centers for Medicare and Medicaid Services (CMS).
When healthcare systems rely on automation, modern payment integrity solutions, and approaches, they are rewarded with the ability to scale charge capture efforts across the revenue cycle without additional resources and increase annual revenue by millions of dollars in just one year.
However, charge capture is rather complex, so it allows for significant potential for error. Organizations often lack the appropriate tools to improve charge capture accuracy, reduce payment denial rates, and improve revenue integrity and clinical documentation.
This is where healthtech product companies come into play. They equip healthcare organizations with data management and analytical tools that streamline workflows and provide valuable insights. The Belitsoft healthcare software development company develops and tailors advanced reporting and analytics solutions like Revenue Cycle Analytics Software for healthtech providers.
Challenges that Health Systems Face in Revenue Integrity and Charge Capture
Organizations lose revenue due to a charge capture process that is unable to keep up and lacks quick adaptability. In their efforts to avoid losing valuable revenue, healthcare organizations face challenges related to areas such as weaknesses in charge capture processes. Large healthcare systems must address the following issues to meet their targets:
Technological Limitations
- Using aging technology and vendors that don’t meet needs
- The current charge capture analytics tool and patient accounting system are unable to offer the insight needed to uncover enhancement opportunities
- Absence of integrated data related to the revenue cycle
Operational Inefficiencies
- Inefficiencies and revenue losses caused by poor charge capture processes while also ensuring compliance
- No sustainable improvement in сharge capture performance
- Late coding, late charges, and missed charges
Compliance and Accuracy Risks
- Risk of non-compliance
- Misunderstanding of charge capture and compliance processes
- Claims that are submitted can include errors and deletions
- Additional information or verification is required to process claims.
Features of Healthcare Revenue Cycle Analytics Software
To identify inefficiencies, optimize processes, and increase revenue, healthcare organizations leverage data operating platforms with a set of analytics apps like Revenue Cycle Analytics tools. Here are the tasks the software helps cope with:
- Tracking all the areas of daily charge capture performance
- Auditing every stage of the charge capture workflow to pinpoint issues and their root causes
- Analyzing charge capture and regulatory compliance opportunities (along with overcharges and missed charges).
- Assessing how late coding and late charges reflect the impact of any registration or modifications on charges
- Resolving all charge challenges at one time with high-value data and analytics provided to the analysts in the app
- Leveraging the data not just as drivers for the work queue but also for assessing capture issues over an extended period and tackling root causes to avoid further problems.
What Benefits Practices Get from Using Revenue Cycle Analytics Software
By performing healthcare software modernization and implementing data analytics software (including the charge integrity analytics solutions), healthcare systems enhance their clinical outcomes, streamline operations, and boost performance. The reported results include:
Revenue Growth and Financial Impact
- Millions of dollars increasing in annual revenue over year as a result of improved charge capture accuracy tied to services rendered
- Enhancing revenue cycle charge capture to an acquired hospital — with no further added resources — via automation
Charge Capture Optimization
- Identifying tens of thousands of unique accounts — patient, financial or billing records — for checking and enhancement
- Increasing in the number of missed charges identified in the first few months via modernized solution
- Creating, implementing and optimizing a rule to detect outpatient surgeries and procedures with missing coding
- Detecting charges for injections and infusions in the outpatient surgery environment that lack a comparable charge for a procedure or surgery
- Identifying charges for injections and infusions for bedside procedures
- Pinpointing charges for delivery and labor
- Detecting drug charges and service units for a new expensive medication
- Identifying charges for diagnostic and interventional cardiovascular procedures (for instance, electrophysiology studies, angioplasty, etc.)
- Pinpointing language and speech charges
Billing Process and Accuracy Improvements
- Significant reduction in the number of key performance indicators for billing
- Enhancing clinical documentation, allowing for the submission of comprehensive, error-free claims and timely collection for the services rendered
- Detecting bills submitted for payment prior to the completion of coding
- Adjusting the timelines to allow coding to be completed before bill submission
- Appropriate charging for the services rendered before the bill is sent for payment
- Pinpointing new opportunities for case reconciliation and closure
Productivity and Efficiency Enhancements
- Monitoring performance, including the productivity of individual analysts and teams, through automated reports
- Significant growing of charge capture team member productivity that makes it possible to conduct enhanced performance audits, issue detection, and problem resolution.
In addition to the above benefits, using Revenue Cycle Analytics Software enables organizations to effectively audit one hundred percent of all charges to maintain consistent compliance with regulations.
How a Healthcare Software Development Company Can Help
An outsourcing company like Belitsoft that specializes in healthcare software development assists top healthcare data analytics companies in building robust data operating systems.
For integrated data platforms developed to collect, store, process, and analyze large volumes of data from various sources (Electronic Medical Records, clinic management systems, laboratory systems, financial systems, etc.), the healthcare software development companies:
- Automate data processing workflows (cleansing, standardization, and normalization)
- Configure scalable data warehouses
- Set up and implement analytical tools for creating dashboards, reports, and data visualizations
- Ensure a high level of data security and compliance with healthcare regulations such as HIPAA
- Integrate machine learning and AI into analytics.
If you are looking for expertise in data analytics, data infrastructure, data platforms, HL7 interfaces, workflow engineering, and development within cloud (AWS, Azure, Google Cloud), hybrid, or on-premises environments, a healthcare software development company like Belitsoft also can serve these needs.
