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:
With patients responsible for an increasing amount of their healthcare costs, self-pay accounts are now the top contributor to bad debt for hospitals and health systems—accounting for more than $55 billion annually. Allina Health partnered with Health Catalyst, using catalyst.ai™, to create a predictive model that could successfully support a propensity to pay strategy.
Increased Visibility into Value-Based Performance Results in $2.1M in Additional Pay for Performance
Data-driven decisions and analytics are critical for organizations and physician practices attempting to thrive under value-based care. With the help of data analytics, UTMB Health was able to focus on improvement efforts for specific patient populations and boost reimbursement based on DSRIP performance.
Financial challenges rank as the number one issue hospitals face. As a result, these organizations are constantly looking for strategies to improve outcomes, manage costs, and boost revenue. Learn how Thibodaux Regional Medical Center sustained and improved its discharged not final billed (DNFB) efforts.
CMS denies nearly 26 percent of all claims, of which up to 40 percent are never resubmitted. The bane of many healthcare systems is the inability to identify and correct the root causes of these denials, which can end up costing a single system tens of millions of dollars. Yet almost two-thirds of denials are recoverable and 90 percent are preventable.1 Despite previous initiatives, The University of Kansas Health System’s denial rate (25 percent) was higher than best practice (five percent), and leadership realized that, to provide its patients with world-class financial and clinical outcomes, it would need to engage differently with its clinical partners.
To effectively reduce revenue cycle and implement effective change, The University of Kansas Health System needed to proactively identify issues that occurred early in the revenue cycle process. To rethink its denials process, it simultaneously increased organizational commitment, refined its improvement task force structure, developed new data capabilities to inform the work, and built collaborative partnerships between clinicians and the finance team.
As a result of its renewed efforts, process re-design, stakeholder engagement, and improved analytics, The University of Kansas Health System achieved impressive savings in just eight months.
$3 million in recurring benefit, the direct result of denials reduction.
$4 million annualized recurring benefit.
Successfully partnered with clinical leadership to transition ongoing denial reduction efforts to operational leaders.
Effective practice management includes tracking and reporting patient outcomes, and effectively managing revenue cycle, as well as keeping an eye out for market changes and growth opportunities. Well-managed practices effectively balance supply and demand on a daily, weekly, and long-term basis, actively managing encounter volume, panel size and scope, timeliness of available appointments, and payer mix.
John Muir Health faced challenges in obtaining data that would provide leaders with strategic decision support information that fostered effective practice management. John Muir Health had attempted to use its EHR to obtain this information, but discovered it was unable to meet the complex demand. As a result, the organization relied on burdensome manual work processes, resulting in delays and a backlog of data requests, and limited ability to make well-informed, data-driven decisions.
After leveraging the information within its data warehouse and analytics platform to create a network leadership encounter application, John Muir Health acquired the following capabilities:
All leaders have on-demand access to performance data at multiple levels from the organization-wide performance down to the patient and provider level.
Senior leaders are making data-driven decisions for strategic responses across John Muir Health to shifts in market, growth opportunities, and emerging markets.
The regional management teams are using the application to inform:
By leveraging these new capabilities, John Muir Health has achieved:
Transparency of the data and accountability of the regional management teams for key performance indicators
14 percent improvement in completed physician encounters, resulting in faster revenue capture, when compared with the previous year.
Eliminating the encounter-associated report backlog.
At MultiCare Health System, the processes for denial management were not as effective as they could be, negatively impacting net patient revenue and financial performance through millions of dollars in adjustments. While only two-thirds of denials are recoverable, nearly 90 percent are preventable. MultiCare looked at improving denial management as an opportunity to improve appropriate revenue capture for services provided. Through targeted improvement efforts that included standardized workflows and increased data visibility, the health system is improving the root cause of denials.
$14.99M reduction in denials and avoidable write-offs.
A hospital’s core mission is to provide the best care possible. To continue to do so, however, hospitals must be paid promptly. Discharged not final billed (DNFB) cases—where bills remain incomplete due to coding or documentation gaps—represent an ongoing challenge for hospitals around the country.
Thibodaux Regional Medical Center, like other hospitals, faces a myriad of new government regulations that have made hospital bill collection efforts more onerous. Its leaders recognized their inadequate manual DNFB process left hospital staff overburdened and put at risk the necessary cash flow to best serve patients.
The hospital automated and streamlined this process to relieve the burden on physicians, provide an integrated view of data, optimize visibility and workflow, and reduce the need to “downcode” reimbursements due to missing documentation. The hospital leveraged analytics to provide actionable feedback to continuously improve the process.
Thibodaux has already achieved significant improvements to cash flow and operational efficiency:
44.4 percent improvement in delinquency rate
8.2 days reduction in A/R days
70.5 percent decrease in the number of billhold accounts outstanding
50 percent decrease in physician portion of DNFB dollars
97 percent improvement in operational efficiency
In an era of steadily declining operating margins, hospitals are seeking ways to increase their profitability. Learn how one hospital system integrated financial and operational data in near real-time, giving their leaders visibility into how their decisions are impacting the bottom line. Leadership is now making more informed decisions and they are addressing problems as they arise. Budgets are consistently being managed close to target and variances for each cost center are readily explained with drill-down capabilities into the general ledger. A significant manual effort associated with over 1,000 cost center spreadsheets has been eliminated and the organization has saved $12 million in labor savings.
$74M in Healthcare Operational Improvements: How Texas Children’s Hospital Is Delivering on Its Vision
Federal and state funding reductions, along with increased competition, are the latest profitability challenges facing healthcare organizations. Texas Children’s recently faced this challenge head-on when projections indicated they would fall $50 million short of what was needed to build capital reserves and to maintain their bond rating. To improve financial performance and prepare for the future, the leadership team launched a system-wide performance improvement project called “Delivering on the Vision” (DOTV). DOTV would involve increasing accessibility for patients as well as driving healthcare operation savings. Texas Children’s goal, of increasing operating margins over 18 months by achieving $60 million in savings, has been surpassed — realizing $74 million in cost savings to date.
To run efficiently and use the money they earn to improve the health of a community, healthcare institutions must manage their revenue cycle well. Crystal Run Healthcare, one of the fastest growing multi-specialty group practices in the country, anda physician-led accountable care organization (ACO), is committed to ensuring that the dollars it earns serve its patient population and are not wasted on inefficient processes. To that end, Crystal Run recognized that to minimize manual reporting and make quick, well-informed decisions related to revenue cycle management, they needed to employ analytics. With the implementation of an advanced analytics application, on top of their EDW platform, this ACO now accesses data up to 99% more quickly, has reduced staff time to identify variance root causes by 97%, and is actively identifying financial management improvement opportunities.
With cash flows declining, margins tightening and bad debt increasing, it’s more important than ever for healthcare organizations to maintain their bottom line. Efficient, effective revenue cycle management that ensures timely payment is one key to an organization’s financial health. Learn how this healthcare system: a) improved their data timeliness, b) realized an estimated $380K in annual operational savings, and c) reduced manual work.
The demand on hospital coders continues to rise – and even more so with the ICD-10 rollout. At the same time, health systems want to make sure professional billing charge captures are accurate. Learn how North Memorial Health System leveraged their hospital enterprise data warehouse – and the Health Catalyst Professional Billing Module – to: a) increase the number of provider notes with sufficient clinical data for billing, b) increase their monthly net income and c) improve their hospital coding staff productivity by 25%.