Posts Tagged: predictive analytics

Doing More with Less, The Value of Automated Claims Status Reporting

Automating claims statusing takes the manual and tedious and helps focus precious resources on claims that matter. Still, it’s not just THE solution to transform hospital business offices. It’s A sophisticated tool forward-thinking hospitals should have in their business office tool kit, to maximize productivity and achieve the revenue cycle results necessary to continue to offer excellent healthcare.

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Population Health Initiatives Need to Take a More Holistic Approach

The ability to approach population health initiatives requires a holistic view of individual patients, the context of their community environment and the barriers that prevent access to resources. Continued, “siloed” use of claims and clinical data without socio-demographic and behavioral insight to define targeted patient populations will only provide a superficial view of those in need of strategic interventions.

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A Credit Score Caution

A Common approach to prioritizing self-pay collection efforts borrows from the claims collection process – focusing resources first on high-balance accounts. But many high-balance accounts are less likely to pay and require more effort to resolve than low-balance accounts. This has led some organizations to begin using “propensity-to-pay” scores as a way of prioritizing resources and making smarter decisions about how to collect from patients. The most common propensity-to-pay scores are calculated using credit bureau data. This approach has significant downside that providers should consider.

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Four Tools for More Effective Claims Management, Part 4: Activity Monitoring & Reporting

Predictive analytics help answer important questions about what will happen in the future that might cause you to do something differently. But there’s still another important tool for effective claims management that allows revenue cycle teams to determine the most effective follow-up pathways, and manage and improve performance over time – namely, account-level activity monitoring and reporting.

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501(r) Q&A Forum Series, Part 2: What Are the Risks of Using Scoring?

What are the risks of using scoring to determine presumptive eligibility for financial assistance? The biggest risks of using scoring to determine presumptive eligibility for financial assistance are if your scoring process is not adequately described in your Financial Assistance Policy (FAP) or if you are using scoring in a way that’s inconsistent with your policy.

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Four Tools for More Effective Claims Management, Part 1: Predictive Analytics

Predictive models can accurately stratify claims and allow hospitals and health systems to think differently about which accounts to collect (and how) and which to outsource. With these models, you can predict with great confidence which claims are worth very little money, regardless of how much effort is put forth, providing hospitals and health systems with an opportunity to change the claim management paradigm.

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Are You Prepared to Engage Your Patients?

Providers face a myriad of challenges to the revenue cycle. From shrinking reimbursements and bundled payments to the eventual roll-out of ICD-10, the need to optimize revenue cycle performance continues to increase. But many (if not most) of these challenges impact the well-established relationship that exists between providers-payers. Providers have processes and systems in place to engage commercial and government payers in the claims resolution process (albeit not always optimized). They are much less prepared to turn their focus toward engaging patients in the payment process.

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Caring For The Whole Patient With Context

I’m a native New Englander, so cold weather doesn’t bother me too much. Even so, I still look forward to the early signs of spring (especially after the winter we just experienced). So when the temperature begins to consistently hover above thirty-five degrees, I know that the snow and ice will soon begin to melt

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Juggling the Revenue Cycle

Every now and then I think revenue cycle executives are actually circus jugglers in disguise. First, we get the ICD-10 plate spinning on its stick — push it harder to keep it stable on the stick. Introduce high deductible health plans and rapid escalation in patient receivables – add another plate and get it spinning. Let’s add more contract complexity and push denials and underpayments – add another plate, get it spinning. ICD-10 get’s pushed out – that plate needs a push. Exchanges open and high deductibles get even more pervasive – that plate needs to be spun again. Oh, here come IRS 501r regulations – new plate, this one likely to stay around for a long time. Maybe that’s the end. Nope…

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