Leveraging data analytics to improve financial performance
It’s safe to say that almost every healthcare organization is looking for ways to enhance efficiency and boost revenue. However, not all organizations—especially smaller entities like physician practices—know where to start. Although you can take an educated guess on where to focus efforts, with the advent of healthcare data analytics tools, organizations now can more easily pinpoint where and how to make changes.
More organizations are starting to embrace the concept of data analytics, employing technology to sift through large volumes of data and information. In fact, according to a recent national survey sponsored by Navicure and conducted by Porter Research, nearly 90% of data analytics users indicate its importance when making business decisions. Interestingly, however, less than half of respondents actually have such systems in place.
One organization that is fully committed to data analytics is The Center for ENT (CENT) in Houston, TX. The practice has nine physicians who provide an array of services, including otolaryngology, head and neck surgery, audiology, and allergy care. Between the various providers and services, the organization submits an average of 2,000 to 2,500 diverse claims each month. In 2016, The Center for ENT onboarded a data analytics solution, Navicure Perform, with the goal of using the technology to identify inefficiencies and increase reimbursement dollars. The following are a few ways The Center for ENT uses the solution.
Narrowing the scope of improvement work
The Center for ENT used the technology to identify its top 10 CPT codes in order to prioritize improvement efforts in the areas that would have the most effect on the bottom line. To this day, The Center for ENT still generates weekly CPT code reports and shares them with physicians and staff during meetings. The reports highlight the dollar amount associated with each code and describe how the revenue trends over time. When discussing the reports, staff brainstorm about how to further drive revenue. For example, we have overhauled our collections process by leveraging the reports and our electronic health record to more accurately collect balances and apply credits to our services.
Tracking rejections and denials
The Center for ENT also uses the technology to identify patterns in rejections and denials. “We track what kinds of denials happen more frequently and work to identify and resolve the root causes so the issues and coding errors don’t recur,” says Melanie Beltran, the practice’s administrator. “Physician practices will always have denials, but when you strive to minimize their impact that makes all the difference in enhancing the revenue cycle.”
Targeting education
Through detailed reports, The Center for ENT uncovers recurring staff errors that lead to incorrect patient identification. The organization uses the reports to communicate with staff about where errors are occurring and what the effects are. “It is so helpful to be able to show our team the errors by patient, what was keystroked incorrectly, and the impact this had on the claim,” says Beltran. “By demonstrating cause and effect, we believe we offer more meaningful training sessions. Errors are going to happen, but when the exceptions start to become the norm, it can be beneficial to leverage technology to assist with retraining.”
Keeping the board informed
In addition to sharing information with front-line staff, The Center for ENT shares reports at the monthly board meetings, highlighting the top revenue drivers as well as the organization’s plans for optimizing revenue in the upcoming months. This helps the practice administrator better communicate and improve transparency with the board about the issues the organization faces and how it is handling them.
Streamlining the work
One of its top priorities was to have a system that was easy to use. “Before we began employing Navicure’s data analytics tool, something as simple as finding our top 10 CPT codes was a nightmare,” says Beltran. “To dig into a specific code and figure out how much revenue it generated was a Herculean task that took a lot of manual work. Now, the new solution allows us to find this information in about 30 minutes with just a few keystrokes.”
The data also is more reliable. “Before, if we wanted to look at a specific code, we never got consistent information,” continues Beltran. “For instance, if we performed 100 CT scans and were paid for 75, our manually generated reports would show different numbers than what the practice management system did. The manual process had various things that skewed the numbers, so it was difficult to compile an accurate report with apples-to-apples data.”
Realizing results
In the first four months after implementation, The Center for ENT saw significant improvements: The practice reduced charge lag by 37%, and the number of days from claims submission to payment dropped by 34%. In the past year, The Center for ENT has continued to experience positive results. Revenue is up by 5% percent while denials and rejections are down.
“Using a data analytics tool is key to keeping your practice as financially healthy as possible,” comments Beltran. “By constantly seeking and responding to performance shortfalls, you can be sure that you are receiving all the revenue to which you are entitled.”
