It’s well-accepted that evidence-based information in an electronic health record — used real-time in the delivery of patient care — can have a dramatic impact on clinical outcomes…avoiding errors and improving health and patient-satisfaction outcomes, while often also lowering costs for both patients and providers.
The same type of improvements can be achieved with data analytics and real-time insights throughout a health provider organization’s revenue cycle management (RCM) process itself. “Turbocharging” skilled and hard-working financial and administrative staff up front has proven to make a significant difference in improving the use of financial best practices — enhancing accuracy and efficiency by delivering actionable insight and transparent, real-time updates proven to benefit Advantum Health clients and staff alike.
Denials, delays and staffing shortages: A trifecta of industry challenges
Across the U.S., healthcare executives in charge of their organization’s revenue cycle are honest in admitting their growing levels of stress. Hundreds of hospitals and clinics are downsizing or closing, shifting onto their organization services to more of the country’s aging patient population. Qualified staffing to collect payments for this complex patient volume is in increasingly short supply — both for in-house and for many of their RCM outsourcing partners.
Unfortunately, that supply is needed now more than ever to combat the volume of elevated denial rates across payers, in particular from many Medicare Advantage plans. And as a growing aged population requires more and more-complex healthcare services (persons 65 and up were 17% of the population in 2020, estimated to reach 22% by 2040), a decline or delay in payments is stretching already-low to negative operating margins past a sustainable limit.
One 2024 survey based on information collected by the Healthcare Financial Management Association (HFMA) and analyzed by consultancy firm Guidehouse reported that roughly 40% of respondents reported struggling with higher denial rates, with more than half dealing with increasing Medicare Advantage denials. Said a Fierce Healthcare article on the report, “Many payers have also increased requirements for prior authorizations, leading to more denials and increased cost to collect due to appeal activities.”
‘Another set of eyes’ in denial prevention and speed to payment
So what can these beleaguered healthcare execs do to optimize their RCM operations, reduce denials and maximize cash flow? One of the critical answers lies in integrated data analytics that helps not only analyze long-term trends to create predictive analytics — but also deliver real-time insights as coding or prior authorizations for services is performed.
“The combination of ‘machine learning’ with experienced RCM coding and prior authorization experts acts as almost a second set of eyes,” said Tarun Sharma, Advantum Health’s vice president of RCM Operations. “Together, that greatly increases the likelihood to be paid, and paid promptly to the highest appropriate level.”
Longer-term benefits
Simply put, revenue analysis helps businesses like healthcare provider organizations make better decisions by turning data into actionable insights…and insights into operational improvements. In that way, these organizations can reduce backlogs and errors, increase profitability, and achieve long-term success. They can perform more efficiently and both maintain and grow by:
- Understanding reimbursement trends: Identify patterns and trends in data to help organizations understand what drives reimbursements
- Improving forecasting of future revenue and cost streams
- Optimizing accurate billing: Use data to ensure coding, prior authorization and billing are accurate and timely to maximize revenue
- Improving customer retention and growth potential: Identify patients and the services most attractive to them, ensuring their ongoing customer satisfaction while identifying popular current and potential new programs to offer the marketplace
Advantum Ai: Supercharged RCM analytics and insights
Advantum Health provides clients with Advantum Ai, our innovative, proprietary and ever-evolving software. It’s an integrated and revolutionary suite of applications that streamlines healthcare back-office workflows and brings insight to the front end of the RCM workflow. Advantum Ai helps our clients and the Advantum Health team that supports them improve accuracy and efficiency as it supports actionable insight and transparent, real-time updates while they work at breakneck speed to deal with the ever-evolving healthcare environment.
Advantum’s skilled team and services help our providers achieve an even higher level of cost-effective success as we leverage this advanced, knowledge-based technology throughout the RCM process. That helps optimize the cost of Advantum Health’s services, and helps enable our clients to remain focused on delivering optimum health outcomes.
Data analytics is invaluable as organizations carefully scrutinize data over time. But with some analytical tools, it can take many months — sometimes years — for busy team members to find the time to discern actionable trends for improvement.
But combined with real-time insights, this invaluable data-gathering and analysis can make a huge difference…faster.
Features of Advantum Ai
- Holistic, tech-enabled service
- Single ecosystem
- Ai machine learning
- Predictive analytics
- Modular and customizable tools
- Smart workflows
- Technology-agnostic. Advantum Ai easily overlays on a client’s existing practice-management (PM) solutions to simplify implementation and speed results
- Industry & internal benchmarking
- Real-time status
- Tableau dashboard
Benefits of Advantum Ai
Staffing shortages in healthcare RCM are a significant and ongoing challenge, impacting the financial health and efficiency of healthcare providers. Staffing is chronically tight, and costs for skilled RCM team members are only increasing. Optimizing and empowering RCM staff brings them satisfaction — and, hopefully, job retention — while:
- Proving them near-real-time visibility into invaluable business intelligence that supports continuous process improvement and promote early intervention into implementing improvements
- Streaming the billing process itself
- Increasing payment efficiency — helping ensure billing and coding compliance by maximizing error-free coding and cash-posting submissions, promptly implementing fixes and reducing delays as provider organizations seek to optimize payment while protecting themselves from legal and financial complications
- Reducing overall administrative burden
Predictive analytics = proactive denial avoidance
Advantum Ai’s predictive analytic capabilities helps enable our customers’ Advantum team to proactively avoid denials. When claim denials do arise, Advantum supports a provider organization’s staff by jumping into action to facilitate prompt resolution. Advantum’s team is adept at managing efficient communications and leveraging Advantum Ai’s artificial intelligence to support denial-management workflows.
Seamless prior authorization and accurate eligibility verification
As process-optimization experts, Advantum Health takes prior authorization and eligibility verification off of our clients’ plate. We streamline collection and verification of health insurance status and patient eligibility as well as the submission of all necessary information to receive prior-auth approval. Supported by the robust Advantum Ai tech platform, Advantum efficiently and effectively facilitates the RCM process, saving our clients time and money.
The bottom-line results of leveraging Advantum Ai
- Maximized reimbursements and revenue
- Healthy cash flow
- Increased speed to payment
- Expedited payer enrollment and credentialing
- Reduction in outstanding accounts
- Fewer denials and expedited resolutions
- Reinforced compliance and fine avoidance
- Reduced administrative burden and costs
Even with the power of Advantum Ai, Advantum Health isn’t done in leveraging the latest technology to streamline and speed other essential aspects of the RCM cycle.
Advantum EVE is a powerful web-based, provider-enrollment platform that helps streamline the enrollment process for a wide range of healthcare provider organizations, ranging from group practices to IPAs, PHOs and hospitals.
End-to-end process management and improvement are key to streamlining enrollment. Advantum EVE centralizes each client’s provider records, facilitating a multi-user pipeline that enables the Advantum team to share the workload and complete tasks faster. Completed provider profiles offer clients a single comprehensive file, and workload projections help plan ahead and avoid backlogs.
The Advantum EVE advantage
Whether an organization has 10 providers or 1,000s, Advantum EVE manages the intricacies of the enrollment process to reduce errors and control workflow. With a robust suite of features — including document management, issue tracking, expirations management, workload projections and reporting capabilities — there is simply no better tool to stay on top of provider enrollment.
EVE enhances:
- Process management and workflow
- Document management
- Complete provider file availability
- Re-credentialing projections
- Issues tracking and alerts
- Expirations tracking and management
- Customized reporting
- Managed care contract organization
Combining advanced analytics with an expert team to improve financial outcomes
In the right hands, advanced analytics that detect trends and enable continuous process improvement can have a major positive impact on healthcare financial operations and the bottom line. It not only affects a reduced denial rate in real time, but generates a wealth of data that enables predictive analytics for the road ahead.
For more information on how Advantum Health’s advanced technology used by our expert RCM team can help you, contact us.
