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Denials Management Analytics Reduces Denials by Nearly $5M

On average, claim denials cost each healthcare provider $5 million every year. This loss of revenue resulting from claim denials is a concern for healthcare providers. Billings Clinic sought to determine the cause of claim denials and realized that it needed an analytics solution that could integrate data from multiple sources. The health system leveraged its data platform and analytics applications to pinpoint the sources of the denials, allowing the organization to implement prevention plans and procedures for recovering the denials. Billings Clinic achieved significant results, including:

Featured Outcomes

  • $4.5M reduction in denials in just 12 months, the result of an eight percent relative reduction in overall denial dollars.

Using Analytics to Improve Clinical Coding

Responsible for coding approximately 380,000 episodes annually, clinical coders at Guy’s and St Thomas’ NHS Foundation Trust review documentation across several systems. The overwhelming amount of data, burdensome manual review processes, and limited coding resources made reviewing all data unfeasible. To address its coding challenges, Guy’s and St Thomas’ leveraged its data platform to combine and standardise data across disparate source systems. The organization now has access to data and technology that can be used to augment coders’ work, automating data gathering to better identify patients whose diagnostic coding could be improved.

Featured Outcomes

  • 800 patients with missing obesity diagnosis code identified in just one month, representing a value of £1.5M ($1.9M) annually.
  • 250 patients with AKI and/or CKD identified in just one month, representing a value of £100K ($130K) annually.
  • 50 patients with vitamin D deficiency identified in just one week, representing a value of £100K ($130K) annually.

Optimizing Space Utilization Improves Patient Access and Revenue

Texas Children’s Hospital had dramatically improved patient access, yet it recognized that it could advance access further by improving space utilization and proactively reallocating underutilized exam rooms. The organization developed a space visualization analytics application, and conducted a comprehensive space assessment, identifying opportunities to improve utilization of current space to increase clinic offerings—resulting in improved access for patients and families by utilizing space efficiently.

Featured Outcomes

  • $86K in additional revenue in just six months, the result of adding approximately 550 additional appointments.
  • Improved visibility of room demand and availability.
  • 20+ outpatient specialties actively using the space utilization analytics application.

Improved Patient Scheduling Enhances Care and Boosts Revenue by $8.3M

The amount of time a patient may have to wait for a scheduled appointment at Texas Children’s Hospital varied greatly as a result of a lack of standardized processes. After taking a deeper look at its scheduling process with the help of analytics, it was able to develop an improvement strategy aimed at improving access to care—enhancing patient care and boosting revenue.

Featured Outcomes

  • $8.3M increase in revenue, the result of adding more than 53,000 appointments annually.

Reducing Clinic No-Show Rates Increases Revenue by $1M Annually

Memorial Hospital at Gulfport (Memorial) knew that decreasing clinic no-show rates was an opportunity to increase revenue, eliminate delays in care, and improve care coordination for its patients. With a robust data platform, Memorial leveraged its data and analytics to better understand the reasons behind its high no-show rates. With actionable data, the organization implemented measures to effectively improve its no-show rates and increase revenue.

Featured Outcomes

  • Nearly $804K in additional revenue in just seven months, more than $1M annually, the result of a 28 percent relative reduction in the no-show rate.
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