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With the healthcare technology revolution in full swing, organizations are seeking better strategies for integrating their clinical and financial data. At the same time, healthcare payers are employing increasingly complex auditing methods to identify areas where clinical and financial information doesn't match up - and demanding massive overpayments as a result. Financial data is quickly becoming a top strategic asset.
While data analysis is nothing new in healthcare, the game is quickly changing. To stay one step ahead, organizations must have sophisticated interplay between IT and finance systems that ensures close analysis of the organization's entire claims data universe and reliable ways to identify errors, pinpoint problematic trends and implement corrective actions.
This whitepaper will examine the strategies organizations are using to develop comprehensive dashboards and sophisticated trending analyses that prevent millions of dollars in claims denials and hundreds of hours of lost labor.
We've also pulled out the first several pages of the whitepaper for you to read. Download the PDF on the right to read the rest.
So, you know you need to take action to increase your hospital’s revenue and rein in costs. Maybe you've experienced a dramatic increase in insurance denials or are worried that government auditors – the dreaded Recovery Audit Contractors, Medicaid Integrity Contractors, Zone Program Integrity Contractors, just to name a few – will identify areas where clinical
and financial information doesn’t match up and demand you return massive overpayments. Or perhaps you are experiencing the rise of patients in high deductible health plans struggling to pay their large deductibles out of pocket.
A growing number of hospitals and healthcare systems are meeting these challenges head on by implementing revenue cycle “dashboards” to automatically mine clinical and financial data and objectively analyze their revenue cycles.
While data analysis is nothing new in healthcare, using a data dashboard can enable your organization to spot a trend of denials within a few days and take corrective action immediately and can help key executives and stakeholders, such as the CEO, CFO, and hospital board of directors, to quickly and easily bring their organization’s financial picture into focus – in real time.
“Historically we waited for reports, but by the time we got them, it was later than we hoped to get our hands around the solution. Thirty days of a negative trend is a serious issue for a facility,” says Donna Gilley, a Nashville-based consultant at Lattimore, Black, Morgan & Cain.
This eBook by FierceHealth-Finance highlights how some hospitals are using comprehensive dashboards to boil down sophisticated trending analyses into quick, easy-to-read snapshots that highlight potentially costly errors. You’ll learn what a revenue cycle dashboard is, what it can measure, how it can help your organization prevent millions of dollars in claims denials and wasted labor costs, and why a top-notch system can more than pay for itself – sometimes within the first year.
A data dashboard – sometimes called a scorecard – is a software system that allows you to extract selected financial metrics from other health information systems and feed the information into charts, graphs or other visual displays so you can track your performance on everything from average length of stay and percentage of beta blockers administered to insurance denials and bad debt. The software system pulls the data and sends it to the dashboard as often as it’s programmed to do so.
It can either be built into a hospital’s health information system or sit on top of it. The program can be leased or purchased; and some are web-based, which enables users to access it from any location.
“The dashboard helps you know if you’re in the range of where you want to be,” explains Cathy Dougherty, assistant vice president of revenue management at Lawrenceville, Georgia-based Gwinnett Medical Center, which installed a comprehensive dashboard system in 2008. Gwinnett, which operates two hospitals and other medical facilities in several locations in Georgia, has more than 4,100 employees and 800 affiliated physicians.
The metrics on a dashboard are specific and measurable towards a numeric target. When metrics dip below target levels, the hospital can take corrective action. Many data dashboards use the traffic light colors of green, yellow and red to flag the status of areas being measured, giving the viewer a quick sense of issues or trends that may signal that further action is needed, says Gerry Blass, a consultant in Colts Neck, N.J.
For instance, the dashboard can monitor claims coding to flag possible missed charges before a bill is finalized, send an alert that a managed care contract is up for renewal, and report that the number of surgical procedures are down from the prior week. That might mean checking to see if the claims contain an outdated CPT code, comparing the codes used to the services provided and contacting the payer to get the claims corrected and resubmitted, says John Freedman, M.D., of Freedman Healthcare in Newton, Mass. If your dashboard shows that surgical procedures have dropped, for example, you may want to look into whether area physicians are referring patients to a competitor and why.
A data dashboard enables users to view detailed, specific information on the data being measured and can be programmed so that different people receive different reports on the same data. For instance, while the board of directors, CEO or CFO may only need a larger snapshot of billing and collections, the director of patient accounts requires more details about the codes on a particular bill.
“It’s not as useful to [only] have the data on the CEO’s computer. One of the points of a dashboard is creating alignment and impacting behavior,” says consultant John Hansel, Emeryville, Calif.