5 ways to use analytics to improve the Medicare RCM workflow

April 19, 2017 Manisha Sharma

The Medicare fee-for-service payment model continues to undergo significant changes, making it extremely difficult for healthcare organizations to accurately predict their Medicare reimbursement levels. In response, healthcare providers have started using a number of new technologies—you’ve probably heard buzzwords like “big data” and “predictive analytics”—to positively impact their revenue cycle. Here, we’ll review 5 ways that RCM professionals can make analytics work for them:

  1. Reduce aging of receivables

Typically, 20% of receivables age beyond 60-90 days. But with analytics, organizations can identify collection problems sooner in the A/R process with automated alerts for individual claims, as well as high-level reports on aging trends. This improves aging of receivables, which has downstream effects on reimbursement. The sooner billers and collectors know a claim has a problem, the higher the chances of minimizing bad debt and improving cash acceleration.

  1. Shift from denial management to denial prevention

It can be difficult for providers to identify the root cause of underpayments, as well as the correlating downstream impacts to cash flow and the overall productivity of the billing team. Most billers and collectors fix similar types of problems and continue filing appeals. But this is not a profitable way to run business office operations. Instead, billing offices should analyze the root causes of problems and identify patterns over a monthly, quarterly, or annual basis. This can be done with a report that outlines the top reasons for denials, which helps managers easily see the big picture. They can then adopt a proactive approach to prevent future underpayments and denials.

  1. Gain complete visibility into A/R inventory

Billing team members need different pieces of information to help them be most effective in their roles. While billers need details about individual claims, managers need a quick high-level view in addition to the ability to drill down into A/R reports. Having tools like an A/R dashboard helps managers communicate and provide appropriate direction to staff, while identifying any hotspots and their magnitude of impact.

  1. Monitor underperforming KPIs

Establishing key performance indicators (KPIs) is essential for measuring and monitoring A/R management. KPIs such as Date of Service (DOS) to Paid, DOS to DDE, DDE to Paid, and Percent Reimbursed can be useful measures to start with. Once KPIs are implemented, A/R managers can compare results monthly to study trends and compare with industry data. This process helps highlight underperforming KPIs and identify process gaps that could be causing a loss or delay in collection. With this data, managers can quickly focus on issues and allocate the proper resources to the problem area.

  1. Quantify underpayment gaps

Providers are increasingly seeing gaps between reimbursements and the originally billed amount. This requires all billing professionals to understand payment discrepancies and why underpayments are occurring. Regular A/R audits should be done to identify inconsistencies and their reasons. In addition, managers can work with their teams to outline next steps for uncollected amounts based on the reason, so that A/R is not written off too quickly.


Ready to learn more about setting up and using analytics reports for Medicare RCM? Click here for a recorded webinar!


The post 5 ways to use analytics to improve the Medicare RCM workflow appeared first on ABILITY Website.


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