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Healthcare Practices are Missing 10%+ of the Revenue They’re Owed: Why Revenue Intelligence is the Key to Unlocking Their Potential

The Revenue Cycle check engine light is on. You do not know why. On average, a practice is missing 10-15% of the revenue it should be collecting from payers. This is a result of so many cracks in standard issue RCM.

The Status Quo

If you’re managing operations or finance within healthcare, then you undoubtedly know that the proverbial ‘check-engine light’ is on somewhere within your revenue cycle organization. With all of the ‘jobs to be done,’ from eligibility verification to denials management, revenue leaks and operational inefficiency is inevitable.

Understanding where to invest time, resources, and focus is, at times, a lost cause and often ends in little to no clarity. As revenue cycle organizations continue to introduce new point solutions to address the ‘key jobs’ within the revenue cycle, data that's integral to painting the right picture continues to splinter as a result.

Extracting this data from systems of record like: patient finance applications, practice management software, electronic health records, claims clearinghouse repositories, is no simple task. In fact, the best run technology companies in the world, invest millions of dollars into their ‘business intelligence’ capabilities, oftentimes led by highly specialized data scientists and engineers, who are experts in complex data modeling techniques.

At Adonis, our core belief is that the key to unlocking peak revenue potential and efficiency lives within the siloed data that each organization generates on a daily basis, to the tune of millions, if not billions of records.

Stitching together the various domains of data across clinical systems, finance applications, and payer remittances is a technical challenge that Adonis specializes in solving.

Our Answer to the ‘Age-Old’ Problem

Revenue Intelligence is a new category within healthcare. In order to truly understand the value of Revenue Intelligence, we must first describe the difference between ‘intelligence’ and ‘reporting.’

Reports fundamentally represent a ‘point in time,’ their core functionality is to provide an objective view into a particular domain of revenue cycle. When stitched together over time, reports can provide a powerful view into how certain key performance indicators are trending.

There are many challenges with reports, however. While a ‘point in time’ view of key performance indicators is important, Finance and Operations leaders need immediate access to information that can be actioned upon. A quarterly digest on key performance indicators, like (1) first pass acceptance rates, (2) net collection rates, (3) denials rates, and (4) patient collections, is simply not enough.

This is the precise role of ‘revenue intelligence.’ Leaders within an organization need to be able to use data to make better business decisions. An intelligence platform is an omnipresent force that constantly evaluates weekly, daily, and sometimes hourly trends across multiple domains of data to flag key risks. These insights are then flagged to key decision makers and action takers to ensure they’re given the right level of attention.

‘Intelligently’ Drive Revenue Impact

Using reports to make decisions about your revenue cycle is like bringing a knife to a gunfight. Our nation’s payers are pumping millions of dollars to heighten error detection and implement new coding rules – generally to the detriment of payers, who incur costly denials and heavy overhead costs.

To best illustrate the difference between reporting and intelligence, here’s an example:

  • Reporting: ‘Payer denials are up 25% over the last quarter, since Q1 our organization has experienced nearly a 15% denial rate.’
  • Revenue Intelligence: ‘Payer denials are rapidly spiking due to coding rule updates with Humana. Mitigating future growth in denials requires the publishing of a custom scrubbing edit.’

In this example, a Revenue Cycle Leader not only understands that an alarming trend has manifested, but also has access to actionable information that can help mitigate the trend turning into a major business risk. Intelligence represents a new and refreshed approach to making decisions in healthcare.

If you’re relying on reports to inform prioritization within your organization, you’re likely learning about trends weeks or even months after they’ve first started occurring. Revenue Intelligence enables you to understand key insights immediately, helping organizations improve key performance indicators.

Getting Started with Adonis Revenue Intelligence

To learn more about Adonis’ Revenue Intelligence, you can schedule time with us here, or tune in to the next installment in this series on Revenue Intelligence!

Aman Magoon
Verified writer