Guest Column | June 28, 2017

Improving Revenue Cycle Performance With Comparative Analytics

Healthcare Revenue Cycle Management Startup

By Chris Bodam, RemitDATA

How can you determine whether your organization’s business performance is clicking on all cylinders? Many organizations have invested in business intelligence tools to help measure their internal performance, evaluate areas in need of improvement, and identify best practices. Yet, what exactly are “best practices” and how can an organization know if their practices truly are best?

Many organizations would be surprised to discover their internal best practices may be considered poor when compared to peers. However, leveraging comparative analytics to compare performance and practices to peers can provide both financial and operational insights. Armed with this data, management teams can gain a clear understanding of the drivers impacting their internal performance and identify areas needing improvement. Moreover, analyzing financial and operational metrics on a regular basis is vital to an organization’s health. Following are some specific areas in which to use comparative analytics to analyze your business operations.

Benchmark Financial Performance
Financial benchmarking is critical in evaluating the organization’s financial performance. Revenue-related trends and statistics — whether reimbursement, claim rejections and denials, collections or payer trends — can reveal the financial health of a provider’s practice, as well as help determine processes and action items to improve operations. Common uses of comparative analytics solutions include measuring reimbursement rates against benchmarked data and the use of real-time data to benchmark against peer indicators, such as:

  • claim denial rates
  • denial reason codes
  • deviations in coding and claim types
  • payment velocity to determine if peers are getting paid faster by the same payers

For example: Providers may periodically experience a spike in denial rates or billing patterns. In these instances, providers need the ability to identify whether the spike is only occurring within their practice or if their peers are also experiencing the same spikes. Providers also need to determine if the same spikes occurred in previous years. Drilling down to obtain this level of data can help the practice better understand the spikes and address them based on the level of priority and ROI.

Analyze Operational Performance
Organizations can leverage comparative data to improve staff productivity by looking at turnaround time and enhance revenue cycle performance by measuring procedure code utilization and denials trending. By drilling deeper into the data, businesses can compare performance metrics to those of their peers, providing a better understanding of how well they perform within their market.

Establish Goals
Once you’ve established financial benchmarks and assessed operational performance, it’s important to set realistic goals that help evaluate the efficiency of the practice, improvements made over time, and compare those improvements to past data.

Using a client’s practice as a reference point to monitor their progress — take a month-to-month comparison to determine what has changed: look at workflow, how quickly payments are processed, claim rejections and which payers are rejecting the most claims.

By putting data to work, comparative analytics solutions allow practices to capture insights to use as benchmarks that were not previously easily attainable. Comparative analytics can also help RCM companies offer the value that providers are seeking now and in the near future — critical in keeping RCM companies competitive. Access to more timely data provides more accurate comparisons that reflect what is happening now so that it can be corrected or modified immediately, before any negative financial impact is realized. Routinely analyzing these metrics is vital to both an organization’s short- and long-term financial health and its ability to compete for the long term.