“Real Time” Data Makes a Real Difference in Finding and Fixing RCM Issues

Author: Jonathan Farr, Senior Vice President North America, EFFY

“Real time” or near real-time data analytics in a hospital enterprise has the ability to audit massive amounts of data very quickly, automatically testing data against norms, algorithms or pre-determined values. In this way, issues that jeopardize the capability to put out a clean claim, identify non-compliance with contractual requirements, or threaten clinical performance can be quickly identified and rapidly addressed.

With the need to  aggregate and comparing data from diverse platforms, with the various  formats, using technology for identifying and correcting has become a major issue for hospital organizations. To find an issue after it has caused a denial is unacceptable.

EFFY’s innovative system overlays “real-time” data analytics on top of existing operational systems to deliver a cleaner, smarter and cost-effective solution. It’s important to understand, however, exactly what we mean by “real-time.”

“EFFY gives us the real-time information to allow us to cover any gaps in our process,” says Sheila Kuenzle, vice president of Revenue Cycle Services, Bon Secours. “A healthcare provider is given the information at their fingertips to know if there is a break in process or change in process that would mean a future loss for a revenue cycle event. By understanding the gap real time, we are able to recover and not lose net revenue”

 

Defining “Real-Time” Data in Hospital RCM

“Real time” as defined in the context of a revenue cycle management (RCM) solutions, is the time that data is first available outside the transactional system for processing. The driving factor is that data cannot be reviewed until it is processed in the transaction system in which it is used or generated.  If the transaction system is batched for a nightly process then, by definition, real time is the next day.  Therefore, “real time” means the first time data is available in an operating system for extraction or to be read. This is not necessarily the time that a data point is entered into a system.

 

In other words, when we speak of “real time” in most cases we are talking about near real time. No matter how you slice it, however, “real-time” data analytics is the key to success and an essential process that turns raw information into tangible results.

Organizations using actionable analytics define the rules and set validations, and when linked to “real-time” data create the ability to trigger action prior to sending out a bill that will be denied. This faster access to accurate data, the ability to review consolidated results, drill down to see all the component parts that make up a revenue number, and ultimately achieve a better revenue cycle for hospitals.

Whether it’s in minutes or a day later, at the point of analysis, EFFY empowers hospital leaders to rapidly take action while generating significant ROI within months of implementation.