Unlocking the Power of Data: How Medical Groups Can Optimize Revenue Cycle Performance

The difference between a top-performing medical group and an average or even struggling one will likely come down to actionable insights based on data this year.

In its latest Better Performers data report, the Medical Group Management Association (MGMA) noted that top-performing medical groups reach their goals because they “transform data into action.” The Better Performers collect as much as 8% more revenue in the first 30 days, reduce their A/R over 120 by up to 7%, and earn nearly $100,000 more in medical revenue per physician.

Everyone is catching onto the idea that actionable insights based on data are the key to stronger business performance. Indeed, the number of organizations across all industries that consider themselves “data-driven” has doubled in the last year.

What does it really mean to be a data-driven organization in healthcare revenue cycle management? How does an organization transform a firehose of data into actionable insights that improve processes, reduce waste, and increase revenue?

The Data & Analytics team at Ventra Health has been laser-focused on answering those questions for our facility-based physician clients. We believe that a best-in-class data and analytics strategy is built on the following principles.

Data Governance is the Foundation for a Data-Driven Migration

Aggregating revenue cycle data across internal systems, external client platforms, and even public sources offers a holistic view of financial performance. Acquiring data from this number of disparate sources can be a major headache in and of itself. Ensuring data accuracy and consistency is an additional hurdle, and it requires a robust data governance program.

By implementing a centralized data strategy, Ventra Health has aggregated typical revenue cycle data (demographic, insurance, medical coding, etc.) with provider behavior, payer denial tendencies, and reimbursement timelines. This creates a single source of truth as a starting point. However, data quality remains crucial. Implementing data governance processes, such as data cleansing, standardization, and validation, ensures consistency and minimizes errors. Additionally, applying access controls and audit trails protects sensitive patient information to comply with HIPAA regulations.

Powerful analytics platforms leverage data to identify trends, optimize revenue cycle processes, and improve financial forecasting. Ultimately, providers must ensure that their analytics are based on clean, accurate data.

Real-Time Transparency

Medical groups want to be able to access their own data—at any time. In-the-moment analytics are extremely impactful, providing opportunities to evaluate RCM metrics and to make billing practice adjustments to improve performance. This is particularly true for clinical billing documentation, where retroactive reports may be too far removed from care delivery for physicians to fully engage. Real-time visibility closes the gap, helping teams identify physician education opportunities to demonstrate where documentation changes can improve reimbursement.

This data can also provide transparency into how medical groups are performing against peers in the same specialty, geographic region, or practice size. When identified and aggregated, this data delivers targeted insights that are valuable additions to industry-standard benchmarks such as MGMA and HFMA.

Predictive Modeling

We can use historical data to tell a story about the future. Leveraging machine learning technology, models can predict overall collections as claims mature through the billing process. Drawing on revenue cycle subject matter expertise and large volumes of data, data scientists are able to identify key levers that drive collections and put projected collections directly into the hands of providers. The next step for us will be to incorporate the ability to perform what-if analysis—for example, if additional provider training resulted in a change to acuity, how would that impact future collections?

Automation Strategy

Medical groups that leverage artificial intelligence can develop autonomous coding solutions that reduce the burden of manual data entry, as well as build predictive models to root out and prevent claim denials. In circumstances where electronic interfaces are not possible, we can integrate with generative AI models that better support a variety of paper forms. Robotic process automation (RPA) can improve processes where we do not control the end product, such as integration with a payer portal for claim statuses or an EHR for supporting provider documentation .

Targeted Innovation

Data-driven organizations look at all technology and innovation with an eye toward data. Retro-fitted analytics platforms are never as seamless as solutions designed from the ground up for data functionality. Medical groups and their RCM partners should be focused on improving data quality in order to improve accuracy in billing processes, accelerate cash velocity, and increase yield. This year, Ventra Health is launching a solution designed to quickly and easily digitize paper charts and improve providers’ experience with the billing process. We created a smartphone-based chart-capture solution that will limit data entry requirements and improve real-time access to chart information all while leaving zero PHI information on the end-user's device. This solution was developed completely from the providers’ perspective and will allow medical groups to increase productivity for physicians and reduce days to bill – ultimately contributing to improved cash velocity. As with all our solutions, we will continually use the latest technologies (e.g. natural language processing, artificial intelligence) to find ways to improve processes and efficiencies.

Expert Engagement

Even the most advanced data technology requires human insight. To fill this need we have created a new team of data scientists solely focused on monitoring client progress, mining the data, and identifying issues that can be resolved immediately to improve reimbursement. Our Performance Surveillance Team is building automated alerts based on key lead indicators, applying their data analysis skills to provide root cause support for our operations team. This team facilitates a highly proactive approach to identifying trends and issues that can be mitigated, in many cases, before they have any immediate impact on performance.

In fact, partnership should be at the heart of any data strategy. It improves data quality, creates transparency, and ensures that models are built collaboratively to deliver on the right goals. With a strong connection between data and expertise, medical groups are poised to “transform data into action.”

To become a top-performing medical group, it is not enough to collect data and generate reports. Data must be transformed into action through a comprehensive strategy that includes real-time transparency, targeted innovation, and expert engagement. Ventra Health offers an innovative data and analytics solution that empowers facility-based physicians to optimize their revenue cycle performance, improve their provider documentation, and increase their cash velocity. We also work hand-in-hand with our physician strategic advisors to ensure the analytics align with clinical practice. By partnering with Ventra Health, medical groups can leverage the power of data and deep industry expertise to achieve their financial goals and deliver outstanding care to their patients and communities.


David Reck is Chief Technology and Data Officer for Ventra Health, leading the Technology team in creating web applications, advanced analytics, predictive models, and automated solutions. He has more than 20 years of experience using technology to solve complex healthcare problems.

Ventra Health is a leading business solutions provider for facility-based physicians practicing Anesthesia, Emergency Medicine, Hospital Medicine, and now Radiology, through the recent combining of forces with ADVOCATE RCM. Focused on Revenue Cycle Management and Advisory services, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

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