New solution to use longitudinal patient records and financial data to maximize analytical and predictive accuracy by closing EHR, PMS, and RCM data gaps that impact revenue integrity
Innovaccer Inc., the Health Cloud company, unveiled its Denial Prevention and Recovery Accelerator, the latest addition to the company’s Revenue AI suite of vendor-neutral solutions that help providers rapidly drive revenue cycle improvements—in as little as six weeks—to markedly improve their financial performance.
In contrast to RCM point solutions, Innovaccer’s Denial Prevention and Recovery Accelerator starts by using the power of the Innovaccer Health Cloud—the #1 healthcare data and analytics platform according to KLAS—to ingest, normalize, harmonize, and activate data from every available source that can influence RCM performance. That includes EHRs, referrals and authorizations, other RCM applications, clearinghouses, health plans, practice management, EDI, unstructured data sources and more.
“Health systems are losing revenue due to factors such as siloed data, missed charge capture, increasing denials, and lack of transparency and collaboration across the process”
The resulting unified patient record provides a single source of clinical and financial truth about the patient that eliminates information gaps that exist in virtually every RCM operation. This gives the Denial Prevention and Recovery Accelerator’s advanced analytics algorithms the most complete claims information to analyze and act on. Now, with unparalleled accuracy, providers can minimize revenue loss due to missed charge capture, avoidable denials, payment variances, missed filing deadlines, gaps in clinical documentation and myriad other common issues, challenges, and “gotchas” that routinely hurt revenue cycle integrity.
“Machine learning and even rules-based systems are only as good as the scope and quality of the data the algorithms have to work with,” said Kanav Hasija, co-founder and chief product officer at Innovaccer. “We start with the industry’s most comprehensive data aggregation platform to give providers high-quality, unified records that eliminate the data silos and fragmentation that hamper their efforts to improve the revenue cycle. The result is that our Denial Prevention and Recovery Accelerator is simply unrivaled in its ability to help providers reduce and manage denials, payment variances, missed charges, and a whole host of other issues that, at the end of the day, can have a dramatic impact on revenue integrity.”
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According to the Healthcare Financial Management Association (HFMA), up to 90% of all denials are preventable, yet claim denials continue to cause significant revenue leakage for providers. Out of $3 trillion in total claims submitted by healthcare organizations, $262 billion were denied, translating to nearly $5 million in denials, on average, per provider. Moreover, up to 65% of denied claims are never resubmitted or appealed.1
“Health systems are losing revenue due to factors such as siloed data, missed charge capture, increasing denials, and lack of transparency and collaboration across the process”
Innovaccer’s Denial Prevention and Recovery Accelerator helps providers get and stay ahead of this problem with a host of revenue-enhancing capabilities:
- Improves the efficiency of front-end, mid-cycle, and back-end processes in as little as six weeks.
- Delivers 2-4X ROI within the first year, with improved charge integrity and optimized billing workflow.
- Delivers a ~98% first-pass clean claim rate with denial predictions (pre-bill edits based on payer policies). Denial predictions are based on historical claims and pattern recognition, and converted to pre-bill edits from current denials.
- A centralized workbench monitors and manages denials in one place, with integrated workflow management and customizable revenue intelligence dashboards to monitor denial trends, identify root causes, and provide potential reason codes for denials.
- Offers transfer DRG claim alerts based on Post-Acute Care Transfer (PACT) rules for potential underpayments, and auto-alerts any underpayment or overpayment.
- Reduces unnecessary follow-ups as much as 90%; and identifies potentially missed billable charges, customized to each health system’s billing methodology and industry best practices.
- 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.
- And much more.
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The result of these comprehensive, integrated capabilities: reduced claims denial rates, a streamlined appeals process, less administrative overhead, and improved revenue velocity.
“Health systems are losing revenue due to factors such as siloed data, missed charge capture, increasing denials, and lack of transparency and collaboration across the process,” said Brian Gray, senior director, Revenue AI Product Innovation at Innovaccer. “By unifying the revenue cycle, we’re able to deliver a truly unique solution that can harness the full scope of patient clinical and financial data, and use it intelligently to close the RCM IT and analytics gaps so providers can optimize revenue capture. This comprehensive solution leverages our unmatched expertise in data unification and activation to help providers manage claims better and get paid more, faster.”
