3 ways revenue cycle analytics can help you navigate the shifting payer landscape

As providers continue to seek out strategies to boost their margins, they face a host of challenges: An aging population increasing the Medicare patient base, a shift to more care being provided in non-acute settings, rising inflation, and rapidly changing regulations, to name a few. But there are also glimmers of promise for providers, like a growing segment of patients moving from Medicaid to commercial insurance. These shifts represent a valuable opportunity to make some much-needed progress on increasing profit margins — if you have the right revenue cycle analytics at your disposal.

Here are three ways enhanced RCM analytics can work in your favor in the evolving payer landscape.

1. Predict cash flow by payer

Any billing office manager can tell you that no two payers are alike. They don’t reimburse or reject claims on an even basis. Some turn around payments faster, others more slowly. It doesn’t make sense, then, to treat payers with equal weight when projecting cash flow.

Knowing which portion of your claims are in the hands of which payers arms you with a more accurate understanding of how much revenue you can expect to capture, and when. Detailed, payer-specific performance trends delivered by revenue cycle analytics can help you better anticipate which claims will be paid on the first pass and how much cash they’ll bring in.

This intelligence pays off in two major ways. First, financial leaders can use the full picture of their predicted cash flow to make smarter decisions on strategy and expenditures. Second, payer-specific insights can be used to inform corrective measures that will reduce errors, improve healthcare biller productivity, and in turn, improve first-pass yield.

2. Identify payer trends and rules

Claims denials are on the rise and reimbursements are taking longer than in years past. At the same time, payers are making more frequent changes to their policies, which only exacerbates the increase in errors that lead to denials.

Providers can’t afford to be reactive, responding to denials only after they occur and playing catch-up to chase those lagging reimbursements. Instead, billing managers can use payer-specific trend reporting to proactively get ahead of denials. With healthcare payer scorecards in revenue cycle analytics, providers can drill down to learn the key reasons behind each payer’s rejections. Armed with this knowledge, billers can be more mindful of the unique rules required by each payer to minimize denial-causing errors.

Fewer errors mean more claims paid upon first submission, a.k.a. a higher first-pass yield and stronger financial metrics.

3. Improve payer negotiations

When you’re buying a home, you don’t walk into an open house off the street and throw out a random number as an offer. Instead, you preview the listing online, walk the neighborhood, and learn as much as you can about how much similar homes are selling for before you name a price. In other words, you gather all the relevant data ahead of the negotiation.

Providers can improve their financial outcomes by taking the same approach in their conversations with payers. The right data gives providers a more solid footing to start from, resulting in more productive conversations and ultimately, more favorable decisions.

As a result, reimbursements move faster and A/R aging is reduced. Providers also enjoy more amicable relations with payers at a time when these relationships are becoming increasingly complex.

Gain a comprehensive view of payer performance with Inovalon’s revenue cycle analytics solution

Ultimately, if providers want to improve financial performance, they must focus on where the money is coming from: payers. Gain complete visibility of payer-specific performance with RCM Intelligence, an end-to-end revenue cycle analytics solution.

RCM Intelligence gives healthcare financial leaders a real-time view of revenue cycle health. Predictive insights into denials, turnaround times and more empower providers to take an active role in getting paid the right amount, the first time around.

Learn how RCM Intelligence can help you reduce denials by up to 40% while increasing cash flow by 15%.¹ Schedule a demo today.

Sources:

1. Inovalon internal reporting. Average of customer results, February 2023

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