In revenue cycle management, strategic priorities are continually evolving; however, the overarching goal to improve yield remains constant. Recent surveys conducted by HFMA and FinThrive, as well as the American College of Healthcare Executives (ACHE), unveil how healthcare organizations strategically approach technology investments to address key performance indicators, especially amidst rising denials and potential cash flow slowdowns.
According to the HFMA survey results1, 70% of respondents prioritize revenue increase, 60% focus on enhancing the patient experience, and 55% aim to reduce costs. Additionally, workforce challenges topped the list of hospital CEOs’ concerns in 2023, according to the annual ACHE survey of top issues confronting hospitals2. Recognizing the interconnected nature of these goals is pivotal for maintaining financial sustainability. Healthcare organizations are homing in on crucial initiatives like reducing denials and enhancing prior authorization processes—leveraging technology, third-party solutions, and process mining to do so.
This is the second in a series of blogs that delve into three critical areas where technology solutions directly impact priorities: accelerating the prior authorization workflow to improve the patient experience, utilizing claim status and denial analytics to boost revenue, and prioritizing process mining to enhance workflows and reduce costs.
Leveraging denial analytics and claim status automation to boost revenue
The HFMA survey findings show that 75% of respondents say reducing denials is the top initiative to increase revenue. One of the greatest assets an organization has to reduce denials is to understand where they start in the first place. A comprehensive denial analytics dashboard can provide key insights into denial trends—helping health systems understand payer behavior and allowing them to proactively pivot resources where needed upstream. An additional benefit of rich denial insight tools is they allow health systems to better understand how payers stack up against each other—information that can be shared with contracting teams to level the playing field during contract negotiations. Allowing the health system to potentially benefit from greater contract terms, reaping more financial benefits for the organization.
Effectively challenging denials plays a pivotal role in healthcare claims management. To navigate denial appeals successfully, health systems require valuable insights. An enriched solution for claim status proves beneficial by seamlessly integrating data into the Electronic Health Record (EHR) or the revenue cycle workflow tool. This integration offers in-depth details and portal screenshots on the reasons behind denials, empowering health systems to proactively contest decisions with enhanced understanding and a clear path forward. As administrative expenses for claim status inquiries surge by fifty percent3, a robust claim status solution not only aids in reversing denials but also contributes to financial gains by streamlining processes. Navigating through various payer portals, each with its own unique schedule and requirements, to obtain claim status information can be a time-consuming and expensive endeavor. Automation emerges as a strategic solution, delivering a dual impact by reducing administrative overhead and facilitating smoother denial appeals.
The combination of denial insights and enriched claim status are pivotal drivers for boosting revenue and tackling those CFO priorities. Comprehensive denial analytics not only empower health systems to proactively prevent denials but also provide valuable insights for informed decision-making during contract negotiations. Meanwhile, an enriched claim status solution not only aids in reversing denials but significantly contributes to financial gains by streamlining processes and reducing administrative overhead.
Together, denial insights and enriched claim status are pivotal drivers for boosting revenue and tackling CFO priorities, ensuring sustained financial well-being and elevated operational standards.
Read the rest of the blog series:
1. HFMA, While increasing revenue is a top goal for 2024, improving the patient experience is a close second – specially for large health systems, HFMA Poll
2. CAQH, 2022, Index Report, A Decade of Progress
