Healthcare Business Intelligence Tools Are Delivering Real Value to Large and Small Hospitals With SaaS Platforms That Have Catchy Names, Such as Healthcare Payment Specialists‘ (HPS) Stingray Revenue Intelligence Platform.
Healthcare business intelligence tools are becoming more the norm than the exception in hospitals these days. Analytic software can identify root causes for claim denials, ensure hospitals received the greatest reimbursement for bad debt cost reporting and many other revenue producing activities. Smaller hospitals and even single practice physicians can make use of business intelligence tools, and experience a predictable return on investment. One example of a cutting edge business intelligence tool is Healthcare Payment Specialists new SaaS application called Stingray. The Stingray Revenue Intelligence platform identifies lost reimbursement through automated auditing of Medicare and Medicaid reimbursement opportunities for bad debt cost reporting, DSH reimbursement, Medicare Shadow Billing and situations where patients are transferred to other facilities and are due reimbursements, such as transfer DRG payments.
Capturing every revenue source possible is critically important in today’s competitive healthcare provider environment Revenue reimbursement and improving cash flow are at the top of the list of priorities for every hospital Chief Financial Officer. Healthcare business intelligence tools are now becoming an essential part of a successful revenue cycle operation.
An excerpt below from an article on the Healthcare Finance News website talks about the value healthcare business intelligence tools bring to providers:
Revenue cycle management is critical for all provider organizations – none more so than cash flow-challenged physician clinics, says Taylor Moorehead, partner for Carmel, IN-based Zotec Partners’ west region.
To help physicians collect the maximum amount of revenue from payers and patients, the Zotec Partners BI system uses analytics to look at pay patterns so that physicians can negotiate better contracts with payers and establish payment terms with patients, said Moorehead.
To illustrate how BI works for claims processing, Moorehead uses this example: if a clinic sends in 1,000 claims and the insurer pays 700, there is a 30 percent denial rate, and it is up to the provider to figure out why those claims weren’t paid. Using BI principles, the accounting staff can track CPT codes, ICD-9 edits and all the carrier-required elements to figure out why those claims weren’t paid.
“If you’re not tracking, slicing and dicing, you can’t improve or educate anyone about the process,” he said. “Without it, you’re DOA.”
Primary care physicians are among those providers at greatest risk of revenue loss due to reimbursement cuts and a growing number of uninsured patients, adds Jim Rose, senior vice president of business development for Burlington, VT-based Patient Engagement Systems.
He summed up the situation this way: “How can primary care providers improve their revenue position? The only thing they can do now is fill their appointment books and charge people for canceling appointments. It is an airlines type of mentality – people better show up or we’ll lose money. So if physicians are adapting those practices, they are going in a bad direction.”
To achieve the goal of a more “comfortable” reimbursement position, Rose says practices need to use BI to “create meaning out of loose, disparate data.” That means harnessing and presenting data to payers to prove quality patient care.
Indirect ROI benefits
Since adopting a BI system from Orlando, FL-based Pentaho, Loma Linda University Health Care in Loma Linda, Calif., has upgraded its decision support capabilities “without breaking the bank,” said analyst Duncan Henry. While the health system expects to see upfront and ongoing cost savings with the system, Henry points out that he has seen some indirect benefits to the ROI as well.
“Being able to download and evaluate the product was also beneficial,” he said. “We looked at one proprietary product that had a very siloed approach and would have required significant tailoring to our existing setup to get it to fit, whereas Pentaho hooked right up to our data warehouse without a hitch or having to resort to lots of service calls to either IS or the vendor.”
As Henry and his team begin to automate many of Loma Linda’s manual processes, they have started to increase their data output to match growing demand without having to add extra staff, he said.
To read the rest of the article, click on the following link: Business Intelligence Improves the Bottom Line