MGMA Webinar: Reinventing the Revenue Cycle with Ai, Analytics, & New Benchmarks
Healthcare revenue is bleeding margin. Learn how AI, analytics & ruthless performance benchmarks can stop the waste before system flatline.
"The outcomes to date from MedEvolve solutions have exceeded our expectations. The team has been very hands-on providing us with consultation that is positively impacting our staff capacity, workflow processes and most importantly, the bottom line. We look forward seeing what the future holds for this partnership.”
Closed balance NCR went from 96% to 99%, which is over the industry benchmark of 98% due to all of the process improvement initiatives.
By identifying why denials are occurring and fixing the problem, avoidable touches decreased leading to less labor required and improvements to net revenue. DBH reduced avoidable touches related to denials by 68% which is the equivalent to ~$300K in labor cost per year.
Tasking causes tremendous waste as those avoidable touches require another human to help solve the problem. By ensuring team members are trained to solve the issue, touches related to tasks dropped by 65% which is the equivalent of reducing ~$275K in labor cost per year.
This is the pinnacle of the new benchmarks. By centralizing and cleaning up front end processes and holding the team accountable, more claims are being processed and paid without a human touching them post coding.
By improving key RCM processes and holding people accountability for quality outcome and effectiveness there will be a material improvement in net revenue. DBH has seen a 75% decrease in avoidable write-offs related to prior authorization denials
DBH collects an additional $3.6M per month off the first touch compared to the baseline which materially reduces the need for AR team members ultimately reducing Days in AR and labor cost.
As zero and first touch payments increase not only does cash flow accelerate dropping days in AR but labor cost associated with collecting money decreases materially which further improves operating margin. DBH has continued to improve collections which is attributed to improving key areas of the revenue cycle and holding team members accountable for quality work.
They went from 1.4 to 1.1 touches per visit which is at benchmark. The lower touch per visit means more payments collected on the first touch leading to material margin improvement.
"We wanted to get ahead of nonproductive work that essentially minimized the capacity of our staff and delayed reimbursement timelines. Unfortunately, the infrastructures that we used for billing only provided high level detail related to claims activity. We needed to understand the actions our staff were taking to resolve claims and drill down into more detail to inform better processes.”
Unprecedented financial challenges are placing significant burdens on today’s revenue cycle leaders and their teams. To maintain a healthy operational margin, financial executives at DBH needed to implement strategies that would simultaneously accelerate accounts receivable and reduce the cost to collect.
Accomplishing this end-goal is difficult for all provider organizations due to uncontrollable macroeconomic trends related to rising operational costs and decreasing reimbursements. Recognizing that these head winds were not going to subside in the near-term, DBH set out to impact the one area that was still in their control: administrative waste, especially as it relates to revenue cycle processes.
Financial executives at DBH recognized that reducing administrative waste hinged on their ability to improve staff productivity and effectiveness, but the lack of insight into the daily work efforts of their billing team limited their ability to identify process improvement opportunities.
For instance, without visibility into fundamental metrics such as the number of “human touches” a claim receives before it gets paid, it was impossible to devise tactics that would improve collections and reduce write-offs. Lacking this insight, Discovery Behavioral Health was unable to determine the root cause of the issues.
DBH turned to the team at MedEvolve to help them implement an infrastructure built on workforce automation and AI-powered analytics to help them identify opportunities for process improvement. The first step was to deploy MedEvolve’s Effective Intelligence solutions to help staff work smarter and provide visibility into daily work effort—essentially tracking every “human touch” a claim received.
Workflow automation solutions allow DBH to evaluate human generated data along with the common data found in their EHR and practice management system. In addition, automation now provides the guidance needed to ensure DBH staff are not only productive, but also effective in their work. These tools highlight tasks that have potential to produce the most ROI, rather than having staff waste time on claims that need little to no attention.
The value of the MedEvolve partnership speaks for itself. DBH has seen significant productivity improvement and bottom-line impact. By leveraging the touch data (instead of subjective measures) for team member quality reviews, they can hold staff accountable to the work they’re doing and set and manage expectations.
Discovery Behavioral Health (DBH) is committed to providing accessible, affordable treatment for mental health, eating and addiction disorders. The organization is based in Irvine, CA with hundreds of centers across the United States. DBH offers a full continuum of services through outpatient, intensive outpatient, partial hospitalization/day treatment, residential treatment, inpatient detox and online treatment. All programs include aftercare and support groups for patients and their families, for life. DBH’s mission statement is: “We help hurting people heal with personalized, proven and lasting care.”
Going forward, DBH plans to expand their relationship with MedEvolve by deploying the company’s financial clearance solutions to improve front-end processes. By automating and centralizing pre-registration functions, staff can ensure the claims process begins as accurately as possible. It also equips staff with work drivers to ensure all the necessary information, authorizations and payments are collected up front to reduce denials later on. Another next step will be deploying MedEvolve’s Generative AI model to help further streamline their revenue cycle with smarter workflows.
View this session from the 2025 MGMA Summit and learn how Discovery Behavioral Health’s approach using Effective Intelligence® has realized a 5.2% improvement in cash flow, created 30% more capacity in its revenue cycle team and benefitted from a 13% improvement in zero-touch rates, a key performance indicator that illustrates the percentage of claims that get paid without any human intervention.
Don’t make high-stakes decisions for your healthcare organization with incomplete or misleading data. Traditional metrics barely scratch the surface. Using Effective Intelligence®, you can generate and track new revenue cycle benchmarks that focus on understanding where in the process avoidable touches are happening and effectiveness of staff. The ability to measure against these new benchmarks is key for a sustainable business today.
Effective Intelligence combines Patient Financial Clearance Automation, Medical Billing Workflow Automation, and Real-Time RCM Analytics in a cloud-based platform designed to integration with your current EMR/PM technology to measure the effectiveness of your RCM staff.
Review and assess your practice’s financial status in 5 min or less and know exact where you are losing money and why. Measure the work effort of every revenue cycle employee, incentivize and retain your top performers, and help employees that need improvement.
You can prevent most common denials, rejections and write-offs during the scheduling and pre-registration process in advance of the appointment. Configure checkpoints and use central task management to quickly clear patients and keep your front office staffing needs at a minimum.
As team members log in to the web-based application and record each “touch” of a claim, outcome, and next task, key data points are recorded like who completed the task and when, outcome, task notes, internal / external messages sent, collection success and other data points that feed into our real-time analytics.
Reduce RCM labor dependence with financial clearance, insurance A/R, & patient A/R automation modules with real-time analytics.
Increase productivity and simplify front & back office processes while keeping your staff focused with our flagship PM system.
Healthcare revenue is bleeding margin. Learn how AI, analytics & ruthless performance benchmarks can stop the waste before system flatline.
Under OBBBA, you as a healthcare executive are being forced to change “the way we’ve always done it.” With more uninsured patients seeking medical help and fewer federal dollars to
In this episode of Disruption/Interruption, Matt shares how generative AI and a focus on human accountability can help providers achieve “zero touch” claims, reduce waste, and improve access to care,
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