Public health organizations experience revenue leakage through documentation, coding, billing and payer workflow processes. Denials, underpayments, and missed charges go unrecognized and unrecovered. Since leakage exists at an operational level between different systems, it is not easily detectable via regular EHR reporting.
Created end-to-end revenue cycle visibility in the enterprise data warehouse and paired it with both recovery efforts and permanent process fixes. All denial and revenue gap patterns were pinpointed to their upstream cause, allowing documentation, coding, and workflow improvements to prevent future leakage.
End-to-end revenue cycle data model covering encounters, charges, claims, remittance, denials; analytics for denials, underpayments, and cause attribution; revenue recovery work queues for the revenue cycle team; dashboards for yield, denial rates and A/R days; revenue cycle analysts embedded in the client’s operations.
Generated over $100M in increased hospital revenue. Specific revenue leakage patterns were identified for service lines and operational processes, resulting in sustained corrections. Revenue cycle intelligence became an ongoing operational process instead of an occasional audit.
