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Revenue Cycle Analytics

What is Revenue Cycle Analytics?

Revenue Cycle Analytics can be explained as the web-driven business intelligence tool that is known to optimize the operational and financial performance of the company. As a result, proves worthwhile in developing actionable insights and optimizing the complete operational and financial performance of the healthcare institutions. The concept of Revenue Cycle takes the administrative costs, clinical functions, data management, patient service cost, etc into account to identify the accurate revenue cycle. Hence, Revenue Cycle Analytics is a process of optimizing all the available opportunities and creating new ones to accelerate better revenue sources not merely focusing on the billing aspect.

Features of Revenue Cycle Analytics

The concept of Revenue Cycle Analytics is certainly driven by the fundamentals of Artificial Intelligence and Machine Learning which gives rise to three primary features of Revenue Cycle Analytics in the Healthcare Industry,

FeaturesDescription
AutomationThe Revenue Cycle is driven largely by repetitive tasks which are generally performed by human staff. However, the human staff takes a long time and involves more cost. As a result Revenue Cycle Analytics is important to keep the flow automated and track the performance.
Data Analytics and ReportingRevenue Cycle Analytics makes the reporting function seamless with the inclusion of data analytics algorithms in the motion. As a result, the payment process becomes visible, intuitive, and manageable for financial operations.
IntegrationsThe imperative feature of Revenue Cycle Analytics is its integrated mechanism where EMR/EHR solutions are both included in the practice. As a result, it has come into existence as the full-fledged solution for streamlining the Revenue Cycle Management in the healthcare industry.

Use Cases of Revenue Cycle Analytics

Amidst the growing challenges in the healthcare sector due to charge lag, the insurance providers have become the key role player owing to their increased coverage. Moreover, it helps to identify time to dispatch invoices and realize better revenues, As a result, Revenue Cycle Analytics is a technically refined extension of Revenue Cycle Management (RCM)  which refers to the management of clinical and administrative factors for capturing patient service revenue. Some of the crucial use cases of Revenue Analytics in the Healthcare sector are as follows.

Use CasesDescription
Validating Benefit ProcessRevenue Cycle Analytics play important role in validating the healthcare benefits relating to each patient by extracting information from EHR, Moreover, the use of advanced AI-driven technology also helps to gather benefit information using client/patient information using standard verification processes and leading to information completion.
Insurance Approval and Rejection StatusUsing this data analytics the insurance companies can easily eliminate the manual processes and ensure approval or rejection status checks using the technology called Data Analytics. For the process data from Hospital Information System (HIS) is extracted and based on that patient insurance status is decided.
Identifying and Resolving ErrorsUsing the advanced RCM process healthcare providers become more proficient to identify errors with the revenue cycle. The effective Revenue Cycle Analytic practice in place helps to decrease the probability of claim denial and prevent technical issues, Moreover, the service providers do not have to spend extra funds on investigating denied claims.
Decreasing Administrative Burden   The prevention of Claim Denials leads to a reduced burden on the administrative department and its cost. Furthermore, the availability of complete field information helps to simplify interactions between the patient and administrative staff. Also, appointment scheduling, payment processing, form filling, etc become less troublesome jobs for both staff and the patient.
Avoiding Healthcare Fraud   Generally, the fraud investigation costs revenue and reputation. Hence, the prime focus shall be on preventing such healthcare fraud and abuse. This can be done using data analytics which helps to build the true forecast and decode the fraud trends and possibilities. The service issues can be due to improper supervision, low-quality tests, unnecessary formalities, etc. Hence, Revenue Cycle Analytics also focuses on keeping the providers updated about the dynamic healthcare regulations.
Reviewing Medical Service Using Revenue Cycle Analytics the service providers analyze the data, pinpoint errors, and build a flawless Revenue Flow system in the healthcare industry. Moreover, the eliminating of shortcomings from the process benefits the provider with revenue while delivering an improved experience to the patients.
Increasing Healthcare Facility Revenue  By eliminating the technical errors, fraud investigation costs, and claim denials the service providers can enhance their revenue scale and invest better inpatient care. The improvement in the patient healthcare facilities will in turn bring better and long-term revenue.

Metrics used for Revenue Cycle Analytics

In the competitive marketplace, there is always a demand for innovative solutions.  Such innovation is backed by some factors which help to define the performance and profitability ratio of the healthcare units.

UnitsDescription
Census by Payer MixWith the technology enhancement and enablement like Revenue Cycle Analytics, the institutions are able to improve their everyday operations. Ensuring that the diversified payer sources provide timely payment and reduce the impact of payer reimbursement changes is a key indicator for a healthy revenue cycle.
Days to PaymentThe complete understanding of the Revenue Cycle from predicting cash flow to managing cost helps to identify operational issues, scheduling opportunities, and payer’s revenue cycle too.
Place of Service (POS) cash collectionsHere, the total cash collected from patients at or before the time of service upto the period of 7 days post-discharge is considered. It is calculated by dividing the POS payments by total self-pay cash collected. As a result, it enables service providers to track the efficiency of the POS systems and troubleshoot the prime POS cash collections enabling you to track the efficiency of your POS problems too.
Rejection and Denial ManagementUnderstanding the time and resource requirements for protecting revenue and delivering services is the key metric for defining the efficiency of Revenue Cycle Analytics. Furthermore, improving claim acceptance and avoiding payment delays helps to review the claim and minimize its impact on the organizational revenue cycle.
Clean Claim RateIt is defined as the percentage of insurance claims submitted and reimbursed successfully on time. Hence, the clean claim rate defines the time spent in getting compensated. Using this metric of Revenue Cycle Analytics the efficiency of the claim submission process is calculated while considering the cost involvement in claim reprocessing.
Discharge Not Fully Billed (DNFB)As the name indicates such a metric is meant to calculate and compare the unbilled amount for charges and figure out the average daily revenue. This metric becomes applicable in the situation where patients are discharged but no complete bill payment has been made. As a result, DNFB is helpful in analyzing the revenue leakage and the Emergency departmental settings.
Claim Denial RateClaim Denial Rate is calculated by dividing the claims denials by payers by the total submitted claims. According to industrial standards, the denial rate of 5% to 10% is acceptable while the rate below 5% is remarked as the indicator of a healthy Revenue Cycle in the industry. On the other hand, the denial rate above 10% indicates the problem and creates the need to analyze, verify, and improve the overall process.
Revenue per EncounterThis metric is defined as the net collection from a total number of patients in the given month.  Here, the number of patients refers to the “patient visited” to the hospital and clinics. As a result, it helps to identify and review the health of the overall Revenue Cycle Analytics.

Revenue Cycle Analytics Companies

The sudden shift of Revenue Cycle Management from the traditional approach to the technological approach has widened the software hemisphere too. As a result, the increase in the number of companies providing Revenue Cycle Analytics platforms has been observed too. Some of the highly prominent names in the industry are mentioned below.

CompaniesDescription
Care CloudIt is a cloud-based software with flexible and meaningful Revenue Cycle Management solutions. This is an integrated platform that offers the benefits of data analytics, benefits verification, charge entry, payment posting, patient billing, charge entry, supporting remittance and collection processes, etc. Hence, it ensures regulatory balance for all day-to-day changes and tasks.  
Athena IDXThis Healthcare IT solution company is known for its scalable and flexible solutions for the healthcare key aspects. These key aspects include authorization management, charge entry, and coding, claim denial resolution, patient refund issuance, performance reporting, insurance verification, co-pay collection, add-on services, etc.
Dr ChronoIt is the famous EHR and medical billing tool which helps to manage Clinical charting, patient intake, Revenue Cycle Management, and billing processes. Furthermore, it ensures a steady income inflow by allowing service providers to focus on patient care. The perks of choosing Dr Chrono are the support for billing services, coding review, claim denial analysis, continuous claim monitoring, patient collections, Electronic Remittance Advice  (ERA), etc. Most importantly, it allows reporting through various Business Intelligence tools.
WayStarThis cloud platform serves the healthcare providers on their financial and operational grounds using AI-powered solutions. Some of the well–known AI solutions WayStar provides are Analytics, Reporting, Claim Management, Revenue Capture, Payment Management, and Denial Prevention. Precisely, the three core solutions it offers are – Charge integrity, Detecting Anomaly, and Facilitating Transfer.
KareoIt is an electronic health record solution that specializes in serving providers with independent practices and tools. Medical Billing is the prime focus of Kareo which takes place through automated workflow. The key features of Kareo are Billing tasks, Billing Analytics, Point-of-care charge capture, Claim tracking, scheduling calendar functionality, etc. Hence, plays important role in tracking KPIs, trends, opportunities, and threats.

Scope of Revenue Cycle Analytics

According to the study of Fortune Business Insights, the global Revenue Cycle Management (RCM) market size was recorded at USD 96.27 billion in 2019 whereas the projection is set to reach USD 258.16 billion in 2027. Moreover, the survey of the Healthcare Financial Management Association indicates that 75% of the healthcare providers are aiming to bring AI strategies into practice out of which 43% are concerned with reducing their cost. As a result, the ecosystem of Revenue Cycle Analytics is ready to accept the advanced automation using data analytics and leverage its benefits to the healthcare providers. 

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