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How to empower provider revenue cycles with intelligence

Taking charge of revenue cycles in healthcare can be a daunting task. The revenue cycle is full of different touchpoints, approvals, and payers, and regulations are constantly changing. To stay on top of revenue cycle management (RCM), providers need the right analytic tools to prevent denials, empower employees to meet RCM goals, and speed payment times.

Use analytics to prevent denials

Many healthcare providers experience workflow inefficiencies and lost revenue as a result of claims denials. One research report found that healthcare organizations saw $262 billion in denials out of $3 trillion in total claims in a one-month period. That amounts to an average of $5 million in denials per provider.1 A majority of denied claims are never resubmitted, which leads to a significant loss of revenue for providers. For appeals that are submitted, the process can be cumbersome and time-consuming, and the success rate of appeals has been on a decline in recent years.

The best way for providers to improve RCM is to increase their first pass yield rate; that is, the number of claims that are approved on their initial submission. Improving that rate involves tracking the root causes of initial claims denials. Denial trend analytics help providers spot issues earlier in the process and allow them to focus on the most common, or most expensive, denial causes first. By solving issues early in the revenue cycle, companies can safeguard revenue and increase operational efficiencies by improving their first pass yields.

Get payments faster

Optimizing RCM isn’t just about reducing denials and appeals; getting payments faster also can help enhance revenue cycles. Just as the right analytics can help providers to spot problems in the claims cycle, they also can help identify billing delays.

In addition to tracking denials, providers can also monitor payer trends to identify those that may require special attention or focus to achieve timely payment.

Providers also are seeing more and more of the financial burden falling to the patient rather than the insurance provider. Research shows many patients don’t pay their portion in a timely manner, often because they don’t have an up-front opportunity or know in advance how much the service is likely to cost. Providers can use data-based tools to verify eligibility before the patient even walks through the door, enabling the patient to pay at the point of care.

Enhance workflows for staff retention

Denial prevention analytics are a crucial part of improving revenue cycle key performance indicators (KPIs). But analytical tools can do much more than that; they can be used to align your staff’s daily tasks with your larger organizational goals and drive employee engagement.

In the wake of the Great Resignation, employee satisfaction has never been more important. One way to encourage engagement is to define performance-based metrics based on an employee’s role in the organization. Staff want to understand what they’re working toward and what impact they have on company operations and revenue.

Employees thrive when they’re working toward more than just a paycheck. Defining clear, analytics-based goals can build accountability and promote higher productivity. When goals are aligned throughout an organization, employees feel more invested in influencing outcomes. And, at the end of the day, automating routine tasks with analytics reduces the expense of rework, allowing employees to get more done with less.

Ultimately, enhancing the revenue cycle requires accurate and agile data analytics. RCM Intelligence is a powerful tool that provides an unparalleled view into revenue cycle performance. With just a few clicks, providers can see what’s working and where they might be losing revenue.

Learn more about RCM intelligence and performance scorecards here.

Learn more about how you can help clients improve RCM utilizing more than analytics.

1 “Success in Proactive Denials Management and Prevention,” Glen Reiner, HFMA, May 18, 2021,

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By Inovalon