The IHA analytics platform provides access to consolidated and comparable data under the IHA membership allowing hospital leaders to compare their own performance against that of their peers. Standardized metrics and comparison data provide leaders with critical insights to better allocate resources and improve revenue cycle efficiency.
eobee® joins the hospital claim (837) data and the payer payment (835) data into preset dashboards to quickly view and analyze MAP keys like Payer Performance, Net Days in A/R, and Claim Denial Rate with real-time drill down into the dashboard to identify root cause on delays or denials. The dashboard also provides trend lines to grant quick visibility that performance is headed in the right direction.
The platform offers a self-service reporting tool to build and create your own reports, dashboards, and charts in shareable and exportable formats. Create insights that can be easily consumed by the C-Suite and operational teams to help drive change and make improvements in the revenue cycle.
IHA Claims Management Software
- Dynamic generated preset dashboards
- Real-time drill down capabilities
- Self-serve report & dashboard builder with exportable visuals.
As part of this new partnership, member hospitals will receive an initial analysis along with quarterly analyses with paid annual subscriptions.
Analyses include:
- Payer Performance
- A/R Payment Velocity
- Claims Denial Rate Metrics
The analysis of claims data is large and complex taking hours to manually compile and report at the level that this platform can do in minutes.
H4 Technology is recognized for their expertise in the development of a software that makes quick work of reporting and analyzing claims and payment data along with the guidance from our revenue cycle experts Kem Tolliver and Taya Gordon who authored and published the MGMA publication, "Revenue Cycle Management: Don't Get Lost in the Financial Maze."
Newsletters
Denials can be a silent killer to any healthcare facility when they aren't evaluated and mitigated. Our industry is usually reactive when it comes to denials, handling them once they've handed with no look to the future. It is common that billing staff reach out to make appeals and drive collections forward, but many are not taking the next step. Once you've received payment it's time to evaluate why that payment was initially denied.
The Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) give insight into the reasons behind the denial and from that insight you should be looking at trends.
The goal is preventive denial management. This means you are tracking and trending denials, reviewing the cause, and implementing mitigation processes.
Tracking & Trending
As with any data analysis, assessing timely and accurate data is essential. Then you can evaluate all of your denials by payer to determine which payers make up the bulk of your denials. From there, dive in by payer and review the top three or four denial CARCs. For this activity disregard any that already make sense like deductibles that are the patients' responsibility. Evaluate the total dollar amount that the remaining claims represent. This is the bucket of money we want to go after to receive faster next time.
Identify the Cause
Let's say during review, you see several denials for "coordination of benefits" or "patient cannot be identified as our insured". This should alert you that there is either a skill gap or a process breakdown with the front desk/intake staff. If you see several denials for "services were already paid under a capitated arrangement", this indicates that your staff is still submitting fee-for-service (FFS) claims on patients who may have been attributed into a value-based care arrangement.
Implementing Mitigation Processes
Mitigating processes can be a challenge if this isn't something you've done before. Let's use the examples above to draft several mitigation steps.
For the first scenario:
- Consider skill gap evaluation and re-education of your intake staff
- Scheduling regular recurrence of training
- Evaluate the support systems that exist for staff to identify the right insurance information and plans,
- Listen in on calls and workflows. Are there areas where the script can be updated and optimized?
For the second scenario:
- Review your contract and ensure the accuracy of the claims being denied
- Assess your internal policies for tracking, updating, and flagging attributed patients
- Review the billing processes and where they identify attributed/FFS patients prior to submitting claims.
There are a lot of ways that you can implement denial prevention processes. Observe the issue from all sides including every individual and piece of technology that touches the issue you want to solve for. How can you optimize each component of that process to avoid denials in the future? This will improve the velocity of your revenue cycle while decreasing the costs associated with filing appeals.
11.07.23
Low-Cost Data Solution: Compass Claims Data Management Module
IHA recently announced a new partnership with H4T to provide data solutions for its members at only $350 per user, per month to enable Indiana hospitals to view claims data, understand denial information, assess trends, and create and share custom reports and dashboards. The purpose of this partnership is to provide a resource for IHA members and the Association to utilize in state and federal advocacy efforts, to identify revenue cycle improvement opportunities, and to provide operational benchmarks. Through this arrangement, IHA serves as a data administrator of the H4T Compass Claims Data Management Module (i.e. eobee) on behalf of those members contracting for those services.
If you are interested in learning more, or subscribing to the eobee platform, please email
Adam Scott, Senior Director of Field Engagement.
9.20.23
Effective Sept. 1, 2023, following a 3-year pilot program, IHA announced a new partnership with H4T to provide low-cost data solutions to help IHA members view claims data, understand denials information, assess trends, and create and share custom reports and dashboards. Through this partnership, IHA serves as a data administrator of the H4T Compass Claims Data Management Module (i.e. eobee) on behalf of those members contracting for those services. The purpose of this partnership is to provide a resource for Indiana hospitals and the IHA to utilize in state and federal advocacy efforts, to identify revenue cycle improvement opportunities, and to provide operational benchmarks. As a participating IHA member, your investment is only $350 per user, per month to gain access.
In honor of the new partnership announcement, H4T is offering a complimentary assessment to any IHA member who
subscribes to the eobee platform. This assessment, which has a value of $2,000, will help you identify where your RCM is today while benchmarking against peer hospitals. You'll also gain recommendations from H4T's Taya Gordon and Kem Tolliver, who co-authored MGMA's "Revenue Cycle Management: Don't Get Lost in the Financial Maze" publication as well as the MGMA Revenue Cycle Management Certificate Program.
If you are interested in subscribing to the eobee platform, and gaining the complimentary assessment, please email
Adam Scott, IHA Senior Director of Field Engagement, by
Sept. 29. Please reach out to Adam directly with any questions or to discuss further.
Webinars
How to Use Data to Combat Payor Challenges
Case Study: How to Increase Revenue & Improve Cashflow Through Preventive Denial Management
