EPM Series: Providers, Follow these Best Practices to Optimize your Revenue

With the healthcare industry continuing to shift away from fee-for-service, healthcare organizations still face the challenge of properly tracking all their efforts and ensuring they are being appropriately reimbursed. A recent Healthcare Informatics report noted that:

“Ongoing changes in both public and private payment are shifting the landscape around revenue cycle management these days, and U.S. physicians and hospitals are facing considerable impacts on their healthcare reimbursement.”

The report also notes, that healthcare organizations are conducting procedures that are “more complex,” and so are the payments. Now more than ever, organizations need to be laser focused on their billing processes and revenue cycle. The ability to access data is obviously a key factor for success but transforming that data into a strategic plan to tackle revenue remains difficult.

The challenges around creating plans can come from a lack of leadership accountability, insight into performance metrics, transparency and progress tracking. These factors all play a role in losing sight of tactical actions that drive results. Critical data gets lost in various outlets within the organization which creates a gap between setting goals and achieving them.

Enter, Enterprise Performance Management, which offers a “closed-loop” system that organizations can use to combine robust data analytics with real-time action planning and progress tracking. Enterprise Performance Management enables organizations to clearly define, track and execute on strategic and operational objectives by empowering employees to track their day-to-day activities with the big-picture strategic plan in mind. For revenue, there are three potential goals to keep in mind:

  1. Increase point-of-service collections – Verify eligibility, confirm demographics and fully understand patient portions after insurance, so your registrars can collect payment prior to service.
  2. Understand denial root causes – Denials come from all parts of the revenue lifecycle. By linking denial trends to their origins, you can resolve errors and oversights that lead to payer rejections and denial write-offs.
  3. Monitor audit risk and reduce take-backs – Improving your financial health isn’t about finding maximum revenue. It’s about finding accurate revenue. By proactively identifying compliance risk areas, you can avoid revenue take-backs and track the audit appeal process.

The creation of a universal goal and plan within your institution is important, however, the right procedures need to be in place to ensure everyone is marching towards it. Here are three best practices to ensure your organization is on the right track to achieving alignment and consistency:

  1. Define key performance indicators – Each step towards the overall goal is important. However, there needs to be a clear roadmap that outlines the steps to achieving it.
  2. Build in accountability – Everyone within the organization is responsible for achieving and following the strategic plans in place. Establishing an assigned leader for these initiatives will enable them to keep track of progress and instill accountability.
  3. Track overall progress –  Dashboard, scorecards and alerts help an organization monitor the progress of its initiatives and ensure that all performance goals are being met. Creating regular check-ins and status updates to ensure employees are following the strategic roadmap helps ensure success continues to be made.

The healthcare industry will continue to face increased pressure and financial restraints under the continued transition to value and with the potential changes from the current administration. Although the industry is in a state of flux, healthcare organizations must follow the course of action with the adoption of robust data analytics and creation of strategic plans to ensure they are meeting their goals, no matter how small or large.

To learn more about how our EPM solution can help your organization on its journey – request a demo with us here. For more on revenue lifecycle management and putting a stop to revenue leakage, click here and here.  


MedeAnalytics is a leader in healthcare analytics, providing innovative solutions that enable measurable impact for healthcare payers and providers. With the most advanced data orchestration in healthcare, payers and providers count on us to deliver actionable insights that improve financial, operational, and clinical outcomes. To date, we’ve helped uncover millions of dollars in savings annually.

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