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Revenue Cycle Transformation

Hospitals and health systems are constantly challenged to maintain a strong revenue cycle amid fluctuating industry dynamics. 

To improve financial health, organizations are increasingly implementing next-generation artificial intelligence (AI) and machine learning (ML) solutions.

With rising patient financial responsibilities and decreased revenues, healthcare systems are seeking advanced solutions for complex revenue cycle management challenges. 

Heavily manual workflows are not scalable solutions. Organizations have a myriad of disparate databases that are not being leveraged in the revenue cycle. Correct aggregation and consumption of these data, combined with human-like cognitive interpretation, exponentially improves the speed and accuracy of the steps that contribute to denials and collections risk during the revenue cycle.

 

Transformation at Every Step of the Revenue Cycle

Transformation at Every Step of the Revenue Cycle

Registration & Scheduling

The revenue cycle starts with patient registration and ends when the patient and insurers pay their respective responsibilities. Preventing downstream denials and uncollected patient charges requires a pivot in the way the patient-facing workflows are carried out. 

At WWT, we help systems leverage disparate data sources in unprecedented ways to transform the front-end of the revenue cycle: 

  • Proactive financial planning for patients based on cost burden or previous behavior
  • Automated payer-specific accuracy for prior authorization workflows 
  • Leveraging existing data sources in novel ways to improve provider and site data accuracy

Financial Verification

Despite advances in clearinghouse solutions and EHR features, errors made during the financial verification steps of the revenue cycle account for a large portion of denials. Patient, payer and contract specific details cannot be accurately captured each time without augmenting human, EHR, and software capabilities with AI/ML:

  • Real-time payer mapping
  • Contractual requirements
  • Coverage specifications
  • Accurate cost estimates
  • Predictive insights from historic claims

Clinical Documentation

Despite advances in native EHR functionalities and third-party framework solutions, documentation errors account for over 30% of denials. Organizations continue to invest in costly workflows like clinical documentation improvement teams to identify errors. Floating within the hospital walls are untapped data sources that can be mined and interpreted by AI/ML solutions to proactively prevent risk based on specific factors such as previous denial patterns and payer-s contract terms:

  • Provider documentation
  • Clinical documentation improvement
  • Code review
  • Charge capture
  • Charge review

Denial Management

An average of 14 percent of healthcare claims are denied, and more than half of those denials are never resubmitted. Weighed down by manual workflows and bandwidth limitations, health systems are losing millions of dollars each month as a result of avoidable denials. 

In addition to proactive solutions that help prevent denials upstream, WWT leverages advanced intelligence technologies to streamline and automate existing denial management workflows to recoup immediate revenue and reduce AR for clients.

 

Talk with a Revenue Cycle Transformation expert.