Hospitals Use Business Analytics to Reduce Denials, Improve Finances

Hospitals are working ever harder to develop efficiencies on all levels of their operations, and an increasing number are turning to outside experts for help in optimizing their organizations’ financial systems.

As Jason Williams, vice president of business analytics for RelayHealth, puts it, “There is industry-wide recognition that a provider’s financial success is intrinsically tied to processes upstream of the billing office.”

RelayHealth provides connectivity and health information exchange solutions, helping hospitals improve patient care and enhance financial management.

Given the myriad reform efforts underway when it comes to compensating healthcare organizations, a hospital’s reimbursements will be tied, on one level, ever more closely to clinical outcomes, Williams says. How far those reimbursements go depends on how effectively hospitals manage their overall revenue cycles.

What RelayHealth brings to the table, Williams says, is the ability to dig more deeply into a hospital’s finances – even using data that is updated daily – in order to see how they stack up against similar organizations across the healthcare sector.

In addition to helping hospitals understand their revenue streams more thoroughly, RelayHealth also helps them reduce claims denials.  

“One of the things we do with denials is segment them according to where they fall in the revenue cycle," Williams says. "We help providers determine whether the denial was connected to pre-, during-, or post-patient service activity, and we help them determine where they need to improve.”

Viewed another way, Williams says, RelayHealth helps providers “prioritize better.” He points out that “a lot of times in any organization, absent real data, it’s just the squeaky wheel that gets the attention. Our approach to data is to help providers decide where they can go to make the biggest improvement, to help them make decisions for which they’re going to get the most bang for their buck.”

Another part of the reimbursement equation is to increase payment velocity by reducing A/R days, as well as developing an understanding of how different payers contribute to the stability of a hospital’s overall revenue stream.

Finally, RelayHealth helps providers focus on both the present and the future.

“How are our operations performing today?” is the first question providers should ask, Williams says. Then, “Are we focused in the right areas in order to survive in the future?”

RelayHealth’s suite of analytics tools, Williams says, are designed to help providers get the best answers to both those questions, thus helping them ensure a sound financial base to provide quality care both for today and for long into tomorrow.