Medical billers and coders help process charges into claims that payers understand. Revenue cycle management companies help streamline the healthcare revenue cycle process, so bills are sent out correctly, and reimbursements are collected in full and without delays.

If so, what is the role of healthcare RCM analytics? Healthcare revenue cycle analytic experts ensure there are no inefficiencies in the RCM operations and identify and analyze problem areas so you can streamline the operations confidently.

How do they do that? With the help of data, of course.

Data analytics is not a new stream of business intelligence at all. It is the science of analyzing data to discover patterns, trends, conclusions, and other vital business information.

A Capital Market report of 2023 states that 25% of all data generated globally is from the healthcare industry. By 2025, this number is set to increase by another 11%.

What does the healthcare industry do with such a large volume of data? Healthcare providers have always used data analytics to improve their services and the quality of healthcare decisions and reach out to newer customers.

According to RCM experts, all revenue cycle management companies must extensively focus on analytics to improve efficiency and maximize revenue generation.

Now, the steps in using revenue cycle analytics are pretty simple.

1. Data analysis 

One of the biggest challenges in today’s healthcare RCM industry is the inability to make informed, calculated decisions. Hitting where there will be maximum impact can transform how the industry functions; data analysis is the first step to achieving it.

Revenue cycle management companies can use multiple kinds of data analytics.

• Real-time analysis
• Predictive analysis
• Prescriptive analysis
• Diagnostic analysis

2. Assessment 

Assessment involves using analytical tools to create stories that speak to the business and help make the right decisions.

Before revenue cycle management companies can start offering solutions to healthcare businesses, they must spend considerable time finding clues in the data generated that could positively and negatively impact the brand.

3. Action insights

When worked on regularly, action insights can become one of the most significant strategic advantages of healthcare practices. Action insights stem from the first two steps and are usually solutions offered to the challenges identified in the assessment stage.

For instance, let’s assume that the analytical expert identifies a rise in claim denials due to incorrect coding of anesthesia services. After analysis, they found that most errors occur when specific modifiers are omitted. Further investigation reveals that these errors are primarily made by newly hired coders during late afternoon hours. The insight: Inexperience combined with end-of-day fatigue contributes to the coding mistakes.

The company can now provide targeted training on using the required modifiers for anesthesia codes. They can also adjust schedules for new coders to match their peak concentration times.

4. Change management

Change management is the result that is expected from revenue cycle analytics. These analytical experts come up with the problem areas, their reasons, and other insights, and now it is the duty of the internal team to make relevant changes.

The change needs to be implemented wholeheartedly and with trust. Revenue cycle management companies need to remember that revenue cycle analytics is not a one-time thing.

This periodical process must be practiced regularly to ensure changes make a difference and stick long-term.

Choosing the correct analytical setup

Perfecting the setup is one of the most critical needs for successful revenue cycle analytics.

Many revenue cycle management companies in India and worldwide offer business intelligence and analytical services along with the rest of the RCM processes.

How do you get the right setup, though?

By ensuring the healthcare revenue cycle analytic tool has the following features.

1. Cloud connectivity – there is nothing more essential than this, and the tool and all its features and usage must be available on the cloud so your team can optimally use the setup from any part of the world.
2. Custom developed – while pre-built tools can have a lot of great features themselves, revenue cycle management companies that create custom-built analytical tools can offer 100% value for your money.
3. The support of experts – are you just buying the use of the tools, or are you also getting the support of their experts in understanding and assessing the data collected? The latter option is preferred as it helps you get expert advice instead of deciphering all by yourself.
4. Customer service – it is absolutely alright to work with an RCM analytical service provider sitting at the other end of the world. However, please ensure a customer support team is available 24/7 so your work doesn’t get stalled.
5. Going that extra step – all revenue cycle management companies would generate reports, analyze them, and give recommendations to the healthcare provider. However, some RCM teams go out of their way to offer more to their clients. This could be proactive recommendations, vital insider information, confidence in making the right changes, and a bit of their expertise collected over the years. All this adds to the value and makes the service exceptional.

The Quintessence difference

Quintessence is an Indian RCM tech innovator that brings positive differences and improved revenues from day one to our clients.

Our reports, analytics, and insight services aim to identify problems and nip them in the bud so that business operations and revenues don’t suffer.

Many of our clients have told us they couldn’t even comprehend the depth to which our analytics and reports go! Many of the problems we identified were hidden deep inside mundane everyday RCM operations, and changing them the slightest bit brought out remarkable improvements in the revenue generated

Not all revenue cycle management companies offer end-to-end analytics and business intelligence services like ours.

A generic problem like a high denials rate could have multiple reasons associated with it. When your RCM services partner stops identifying the top few alone, that’s not entirely eradicating the problem area.

Our experts know and go beyond what’s expected, and the solutions they put on the table tackle the foundations of your operations so the results are long-lasting.

Our reports help identify new opportunities, build strategies for operational improvements, identify and correct problem areas, and achieve best-in-class performance.

Are you keen to know how Quintessence’s reports and analytical services may help your brand? Please get in touch with us for a detailed consultation.