How Presbyterian Health optimized month-end, reduced denials and improved revenue integrity with MedeAnalytics

In recent years, health systems have made huge technology investments, generating massive amounts of data that now must be analyzed to drive effective change. Transforming this data into actionable insights is one of the greatest challenges in healthcare revenue cycle management today.

During a Becker's Hospital Review webinar sponsored by MedeAnalytics, three executives from Presbyterian Healthcare Services (PHS) shared their revenue cycle management (RCM) journey and described how MedeAnalytics tools have helped PHS optimize month-end reporting, decrease denials and improve revenue integrity.

Presbyterian Healthcare Services is the largest multi-specialty, nonprofit health system in New Mexico, with nine hospitals, 32 clinics, 13,000 employes and $5 billion in revenue.

The presenters from PHS were:

  • Laura Calkins, VP, revenue cycle management
  • Jay Olive, director, information governance and business intelligence
  • Soyal Momin, senior vice president and chief analytics officer

Three key takeaways were:

1. PHS faced several business analytics challenges stemming from its diverse technology investments. According to Mr. Momin, the organization had a proliferation of new applications data, which made PHS "data rich but insights poor." 

"The intent behind our data and analytics journey was to move our organization from reporting to analytics," he said. "Back in 2014, 80 percent of what we generated was reporting, with only 20 percent giving us insight. Our goal was to flip that so 20 percent would be reports to meet ad hoc needs, with 80 percent of our work profile providing actionable insight."

2. The organization wanted its businesses to be able to "self-serve" its own reporting and analysis needs. PHS deployed MedeAnalytics tools with its Epic EMR system to enable drill-downs to claim-level details, identify gaps in collections and denials, track revenue cycles across multiple care settings and engage physicians to improve capture rates. 

"With MedeAnalytics tools, we've been able provide self-serve analytics in the moment," Ms. Calkins said. "We want people [throughout PHS] to think of these tools when they're trying to solve a problem."

3. PHS realized significant benefits in multiple revenue cycle management areas. Mr. Olive outlined three use cases, which together resulted in a 344 percent return on investment and a nine-month payback from PHS's investment in MedeAnalytics.

  • Revenue cycle analytics. MedeAnalytics replaced manual month-end report preparation with efficient standard reports and the ability to drill down to generate self-serve business insights. This reduced PHS's cost to collect by $450,000 and decreased the organization's time spent consolidating data by 75 percent.
  • Physician denial analytics. By using MedeAnalytics, PHS reduced manual investigation into denials and became more proactive and strategic in addressing denials. As a result, PHS reduced denials by more than $800,000 and lowered bad debt and charity care by $680,000.
  • Revenue integrity. To improve coding and documentation processes related to compliance auditing, PHS revamped its methodology and strategically targeted its auditing needs. This resulted in a $1 million increase in CMI reimbursements and a 10 percent drop in audit management time.

By investing in a data analytics solution like MedeAnalytics, healthcare systems can transform their vast amounts of revenue cycle data into actionable insights, resulting in significant savings and revenue generation, with a high return on investment and a fast payback. 

Check out more success stories from MedeAnalytics here




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