835 Auto - Analysis
Denials Identification
Client Background:
A short-term acute care center in the upper Midwest with 439 beds, and has a centralized business office but little to no revenue cycle analyst teams

Primary Issue:
The center had little to no insight into denials or performance improvement areas across their organization or history. The only data asset that was easily available were there 837/835 file sets.

Solution Provided:
Using only 835s, Etyon parsed, integrated, and conducted a denial management analysis and assessment and delivered it back using a free interactive visual platform for easy ingestion across financial leadership.

Client Benefits:
Extracted, parsed, and analyzed in under a week, resulting in on of the first times that denial data was clearly viewed, resulting in a saved costs of over $50k
Data-Driven Rapid Assessment
Process Improvement
Client Background:
A hospital system in the state of Michigan with 96 beds and  a strong community short term acute care center in the area, and has a small business office located on campus.

Primary Issue:
The system brought on a team of consultants but lacked the IT resources and cash to produce data that was easily analyzed via Excel based manual practices.

Solution Provided:
Etyon integrated, auto-analyzed, and parsed 835 files for the consulting team prior to their arrival to conduct in-person interviews and gave the system a quantitative background on their RCM performance.

Client Benefits:
Ingested, parsed, and analyzed all disjointed data in a matter of one week on rush order, and helped identify over $12 million (6.6% NPR uplift) for the consulting teams to get working on right away.
Process Improvement Augmentation
Denials Management
Client Background:
Large Academic Medical Center in the Midwest,. 2700 beds and 1500 board-certified physicians, and has an independent centralized business office on its main campus.

Primary Issue:
Continuous and project improvement teams spent many laborious hours manually mining data to come up with new projects that were worth the resources. PMs spent more of their time analyzing than they did fixing issues.

Solution Provided:
Implemented an auto-assessment that scoped, created, priced, and assigned projects automatically with suggested step by step ways to fix the issue based on best practices.

Client Benefits:
Extracted, created, and delivered the assessment in under 1 week, found in total $250 million dollars of improvement opportunity, and saved them over $90k dollars in potential consultant costs.
Payment Optimization
Service Margin Improvement
Client Background:
Independent genetics testing lab on the East Coast, top 10 drug discovery providers in 2017. $10M in annual patient revenue and has a mix of in-house and outsourced billing management.

Primary Issue:
Little insight into uncollected cash at the test level. Current reporting out of the LIS wasn’t enough to operationalize quantitative revenue cycle management.

Solution Provided:
Implemented custom integration of extracts to produce a monthly report that calculated revenue and payments at the test level, prioritized follow up accounts at the rep level, and gave step by step instructions as to which denials to go and solve and how.

Client Benefits:
Reduced backlogged AR by over 21% over the course of 10 months, increased insight into test level performance, and mitigated the need to acquire more expensive consultants and software to calculate month end revenue.
Denial Management
Denial Response Insights
Client Background:
Multiple middle-market healthcare systems across the United States.

Primary Issue:
Payer remittance data (835/837) was going unanalyzed, resulting in limited denial response visibility and a lack of proactive operational improvement planning.

Solution Provided:
Implemented the Prism Engine to automatically parse 835s and 837s at the line-level and analyzed, segmented, and delivered insights into improvement opportunities.

Client Benefits:
Eliminated the need for manual data analysis, freeing up internal capacity. Issue identification quality was improved by increasing the level of detail within the analysis and allowed internal teams to take corrective action without outside consultants.
Denial Management
Registration Denial Optimization
Client Background:
Large globally renowned health system, ranked #1 for Heart Care in US News and World Report. 1,440 beds and a centrally managed revenue cycle business office.

Primary Issue:
The volume of registration claims that were being productively worked timely was a struggle and was resulting in millions of dollars of registration denial write-offs on a yearly basis.

Solution Provided:
Implemented enterprise data integration and embedded algorithms to detect incoming registration denials and match to correctly paid patient claims to identify the registration discrepancy and re-bill timely.

Client Benefits:
Reduce non-productive touches and reduced registration write-offs by $65,000,000 dollars a year, resulting in a one-time balance sheet impact of almost $275,000,000 dollars.
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