Collector - October 2017 - 26
OF HEALTHCARE DATA
WILL BE IN THE CLOUD
AT SOME POINT DURING
ITS LIFECYCLE BY 2020.
Using this information, healthcare
* Automate processes that don't need
human intervention so staff is freed up for
activities that need it.
* Target coding problems related to changes
from the Affordable Care Act and ICD-10.
* Make proactive decisions to reduce nonvalue-added rework.
* Reduce administrative costs related to
For some health organizations, learning
how to use big data can be confusing.
Fortunately, nearly every phase of
care delivery can be analyzed to find
improvements, including pre-service, point
of care, pre-billing, billing, claim denials
and self-pay collections. Providers can use
their own reporting system or third-party
software to track this data.
Aggregating all this information,
especially when more than one format is
being used, can be difficult, so it's crucial
to make sure that data is normalized to one
IMPROVING THE PATIENT
Health providers often take a behind-thescenes approach to the revenue cycle, but
the patient experience has a big impact
on revenue. Big data can be used to find
areas where staff can assist patients with
insurance coverage and financing options,
improving the bottom line on the back end
weeks or months later.
Providers are encouraged to use several
different strategies, including:
* Verifying insurance coverage and
patient contribution. Patients
shopping for services can get cost
estimates based on aggregate analysis of
payer contract pricing, deductibles and
* Increasing patient collections. Big data
can be used to discover aging accounts
that can use the help of friendly staff, who
can personally connect with patients.
* Guiding patients toward charity or
government coverage. Many patients
don't know what they qualify for, but
nationwide patient analytics can easily
show who is eligible for programs like
Medicaid, Medicare and Affordable
Care Act coverage.
* Improving patient satisfaction. Big
data can improve outcomes at lower
costs, meaning patients will be more
willing to pay their fair share of the bill.
By implementing consistent processes
with information gleaned from big data
analysis, healthcare organizations can
ensure a positive patient experience. A
big part of this effort should be focused
on standardizing communications so that
patients get the help they need at every point
of the process.
DEALING WITH CLAIM DENIALS
According to a report by Modern
Healthcare, hospitals lose $262 billion
annually due to denied private insurance
and CMS claims. This is a huge cost both
in terms of lost revenue and the extensive
labor needed to deal with appeals.
Analysis of the causes of claim denials
using big data, however, can prevent these
issues and assist staff in finding effective
ways to fight appeals. Even if a particular
provider isn't facing problems with certain
claims, information about trends provided
by nationwide networks can alert hospitals
to oncoming issues. Ongoing monitoring
should be used to deal with everything from
coding issues to improper documentation.
In addition to denials, revenue can be lost
from claims due to non-traditional leaks.
Revenue cycle technology that can analyze
all aspects of claims will be able to pinpoint
revenue losses in areas that would be hidden
from human view. Software can model
contracts between payers and providers
and compare the data with real-life claims
information to see where any leaks may be
INCREASING STAFF PRODUCTIVITY
Staff is a big expense at any healthcare
provider. Inefficiencies, non-value labor
and unproductive workflows can all eat into
revenue cycles. Identifying these problems,
however, can be difficult.