Common Roadblocks to Improving Revenue Integrity and How Innovaccer’s Denial Prevention and Recovery Accelerator Can Help Providers Overcome Them

The pandemic has ushered a paradigm shift in healthcare, with the focus on digital technology becoming stronger than ever. For providers, however, accelerating digital transformation in claims management remains a struggle.

With the increasing financial and administrative burden on healthcare organizations, ensuring process efficiency and optimizing the payment cycle while ensuring regulatory compliance has become a prerequisite for improving financial performance and patient experiences.

To improve revenue integrity, taking proactive steps to identify and fix revenue gaps while reducing the administrative burden (especially in the face of increasing levels of healthcare worker burnout) is the key. Providers need to equip themselves with the right technology to address their day-to-day claims processing challenges.

Finding and Bridging Revenue Gaps for Better Financial Outcomes

Compliance in coding and billing practices can help providers reduce the risk of denials significantly, saving them time while strengthening revenue integrity. Coding errors, incorrect charge capture, and gaps in clinical documentation can cost health systems a considerable amount of otherwise revenue and negatively impact the overall patient experience. The good news is that there are now technology solutions to address revenue leakage.

Here are some of the common factors that result in revenue leakage and affect the providers’ bottom line. Many if not all of these will likely be familiar to you. But what might be unfamiliar—they can all now be addressed through advanced technology:

• Coding errors
• Lack of adherence to reimbursement policies
• Gaps in clinical documentation
• High cost of reworking claims (average cost of rework being $25 per claim) with increased manual intervention and knowledge gaps
• Lack of contextual pre-bill edits based on organizations’ historical claims data
• Transfer diagnosis-related group (DRG) anomalies
• Missed billable charges
• Write-offs due claims crossing timely filing limit (TFL)
• Underpayments and overpayments (payment variance)
• Payer contract mismatch
• No customized dashboards to monitor RCM and HIM operations and review the financial and operational status
• No continuous feedback loop to reduce errors
• Lack of billing automation
• Little to no coordination between siloed revenue cycle departments and a reporting system to compare financial growth and team performance

How Innovaccer’s Denial Prevention and Recovery Accelerator Plugs Revenue Leakage

Innovaccer’s Denial Prevention and Recovery Accelerator is a fully managed, scalable revenue cycle management solution that follows a pragmatic approach to claims management, and puts data and analytics at the forefront to improve revenue integrity. The customizable platform does not address revenue challenges in silos or as a point solution, but rather, integrates revenue cycle data to create a unified data platform that offers meaningful insights into the claims cycle to facilitate better decision-making and financial outcomes.

Using the power of the Innovaccer® Health Cloud’s Data Activation Platform—the #1 healthcare data and analytics platform according to KLAS—providers can unify data from disparate sources and use predictive analytics to identify and fix potential errors that can trigger denials. This helps providers manage claims better and improve the recovery prospects, achieving true RCM digital process transformation in as little as six weeks.

Solution Highlights

• A unified data model supported by Innovaccer’s Data Activation Platform (DAP) to address the cascading effects of data fragmentation on the revenue cycle
• Denial prediction with machine learning capabilities using historical claims data specific to the health system, which can be leveraged to convert into pre-bill edits that are more contextual to the organization
• Front-end, mid-cycle, and back-end process improvements in as little as six weeks
• Identification of potentially missed billable charges, customized to the health system’s billing methodology and industry best practices
• ~98% first-pass clean claim rate with denial predictions (generated as pre-bill edits based on payer policies)
• Integrated workflow management and customizable revenue intelligence dashboards to monitor denial trends, identify root causes, and provide potential reason codes for denials
• Helps decipher denials accurately, prioritize and re-submit them faster (with prescriptive recommendations for fixes), and reduce revenue loss due to re-submission delays or missed deadlines
• A centralized workbench to monitor and manage denials in one place
• ROI grows over time as the system becomes smarter, with improved charge integrity and optimized workflow
• Reduction in unnecessary follow-ups by as much as 90%
• Transfer DRG claim alerts based on Post-Acute Care Transfer (PACT) rules for potential underpayments

The result: reduced claims denial rates, a streamlined appeals process, less administrative overhead, improved revenue velocity—and revenue integrity that’s as strong as it gets.

Gain Visibility Into the Revenue Cycle

Innovaccer’s Denial Prevention and Recovery Accelerator addresses data fragmentation that causes a lack of visibility into claims, driving suboptimal decisions. Using the power of the Health Cloud with data activation and analytics capabilities, the Denial Prevention and Recovery Accelerator helps providers simplify claims management, prevent denials, and accelerate payments while staying focused on delivering exceptional patient care and experiences.