Advanced Revenue Cycle Analytics: An Overview

AdobeStock_57455938A lot has changed in healthcare IT in the past 10 years, but for most physicians the technology behind your code scrubber hasn’t. Chances are that your code scrubber was designed to solve revenue cycle problems from 10 years ago, but it hasn’t kept up with the times. If you are like most practices, you continue to hire more billing and coding staff to keep up with the additional workload.

If Coding Edits are everywhere, why is this so hard? There are coding edits built into different pieces of technology from the front end to the back end of the revenue cycle. Everyone is trying to help prevent denied claims. Coding is difficult and different payers have different requirements. From the claims clearinghouse, to the PM systems, to your EHR, all of these applications may have edits built in to alert an end user to a potential coding problem.

At a bare minimum these edits should be:

  • Comprehensive
  • Up to date
  • Flexible
  • User-friendly

Are Medically Unlikely Edits included in addition to CCI Edits? Edits should be updated at least on a quarterly basis. Can your staff update edits that are specific to your providers, workflow, payers,etc? Or do you have to submit a request to an outside vendor to make these types of changes? Can you turn off unnecessary edits to prevent irrelevant edits that contribute to alert fatigue?

These questions are only the tip of the iceberg. The bigger problem is that most code scrubbers are only designed to help prevent a denied claim. They are not designed to maximize coder productivity, identify missed revenue opportunities or provide manager visibility into actionable revenue cycle analytics.