Using data to manage your revenue cycle: 4 keys to success


The right data can make a significant difference in how health systems identify revenue cycle problems and improve processes along the way. 

During a May 11 webinar, hosted by Becker's Hospital Review and sponsored by Availity, Availity discussed the powerful analytics organizations need to get a true picture of their business and make these improvements.  

Presenters were:

  • Linda Perryclear, product line director at Availity Revenue Cycle Management
  • Justin Greer, product line manager at Availity Revenue Cycle Management

Four keys to success:

1. Identify a focus area that aligns with your goals and strategies. Availity recommended a narrow focus when it comes to using data to improve the revenue cycle. "You want to make sure you're keeping your focus narrow as you're doing this, so you're not getting an overload of information and trying to cover everything," explained Mr. Greer. "You want to make sure you're being as focused as possible to get to what you want to look at when you're digging into" data. 

2. Perform consistent analysis. For the greatest success, health systems should be consistent and perform consistent analysis of their revenue cycle, according to Availity. The aim is to compare "apples to apples." Availity said this means adjusting data as needed, such as thresholds for claim denials, but eventually getting to a consistent dataset and looking at that in a consistent time frame. 

3. Communicate findings to the right people. Availity stressed the importance of getting the right data findings to the right people at the health system. These are the team members who can act on the data to improve the revenue cycle metric being looked at. 

4. Focus on metrics that will answer questions related to revenue cycle processes. In the claims submission area, Ms. Perryclear suggested looking at average date of service to submission to identify areas of lag. In the claim editing space, she said health systems should drill into the clean claim rate report using information about payer rejections of claims. Availity then suggested looking at the claim status report — and whether claims have the appropriate status connected to them — and looking at information of claims that have remittance matched back to them. With denials, drill into the denial rate report to look at denials by remark codes. "That's going to be the key to identifying some specific actionable things on your denials," said Ms. Perryclear. Availity also suggested looking at the remittance received report to see the percentage of adjustments being made.

For more information about Availity, click here

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