We often hear a lot of questions when we talk about healthcare clinical data warehouse, such as: Is data warehousing in healthcare necessary? How important it is to have a tool like a clinical data warehouse for Hospitals and Medical Centers? Can business intelligence (BI) be the answer for hospitals looking for data-driven improvements and cost reduction? Yes… with new and improved techniques to handle BI and clinical data warehouse you can unlock the value of data and here’s why.In a rapidly transforming healthcare industry, the need for business intelligence (BI) and analytics is perhaps not too difficult to surmise, especially if you look at your organization’s business intelligence strategy in terms of long-term and sustainable clinical data warehouse. You need to ask is: What exactly is my organization’s business intelligence strategy? But regardless of your organization’s answer, the term business intelligence can still no doubt be difficult to define and may have multiple meanings, which leaves organizations wondering where to turn for a solution.Understanding BI and Healthcare Data WarehousingSimply put, data aggregated from different transactional sources of a corporation or health system can be organized, catalogued and structured according to your need. All these huge quantities of data generated from multiple source systems of your organization enables understanding and facilitates informed evidence-based decision making.Data/information generated from both internal and external source systems facilitates population-based queries, research and analysis. Internal data can be from costing or financial systems or electronic health records (EHR) systems or EMR or clinical sources and external data can be from state or federal government. The more you use data, the more you achieve a greater understanding of it and helps you make informed decisions which are intrinsic to any organization’s operating efficiency and cost reduction efforts.Conversely, locating the data you want from the right source can be a time-consuming manual process. People spend a lot of time and effort to gather or compile the desired data from the diverse systems of your organization and finally come up with something that makes sense for your executives to be up to date with the required information. This is where Business Intelligence comes into the picture. It helps in streamlining and scaling the process of converting raw data into meaningful bits of information that enables healthcare managers to take effective decisions and gain better business insight. That’s what BI means.On the whole, business intelligence integrates business, financial and clinical data into an effective data warehouse. In other words, healthcare providers use the data gleaned from these data warehouses to be able to streamline patient care, patient safety and outcomes while also complying with regulations and standards. Using data gleaned from the data warehouse, executives can base their decisions on facts and not merely on intuition.Think of a data warehouse as a large kind of reliable, centralized library of hospital, clinical and financial data and information that can be repeatedly accessed not only for the purpose of information processing or management reporting but also address specific concerns relating to patient safety, patient health outcomes and state or federal government-regulated healthcare reforms implementation.Healthcare delivery is definitely going digital. According to a recent prediction made by Gartner, in the current year the business Intelligence and analytics market is going to touch $16.9 billion (that is £11.6bn), growing at 5.2 per cent. In this context, we can say that the demand for data-driven operational care takes on new urgency.Cloud and Predictive In Healthcare Data WarehousingThrough cloud-based technology: Rather than having information scattered throughout an infrastructure abyss, a cloud-based technology centralizes stored information in turn allowing for speedier access and scalable solutions that can be used or marketed to a variety of practices. There is no need for a highly complex, expensive IT infrastructure and access to numerous features conveniently located at a secured data warehouse facility, thus eliminating the need for a user to be trained on multiple programs. Cloud-based platforms can help your business grow, regardless of its size and type.Through predictive analytics platform: Predictive Analytics component (or standalone option) enables data to be absorbed from diverse source systems. This platform draws patient data from various source systems and condenses that information to identify, analyze, diagnose, and treat according to patient symptoms and history. The predictive analytics framework identifies concrete evidence for successful diagnosis.As far as the technology-specific domain of healthcare, medical claims processing is concerned, advanced analytics tools can help organizations analyze real-time information on their claims. This will ensure that the right information is presented to the right users at the right time. The specialized services can include service offerings in conjunction with medical claims processing, these are application development, product engineering, and essential managed services catering to the key segments of the healthcare ecosystem covering providers, payers, and pharmaceutical companies.Put it all together, healthcare data warehouse with business intelligence are playing a major role in providing customizable dashboards, reports, and application features by creating a user-friendly environment that staff and multi-tier user levels can easily navigate and access the appropriate information in real-time. To be able to tackle the core internal information management issues, data warehousing techniques can help you maneuver all your pertinent data assets, logically and securely, while reducing your spiraling costs.
The Healthcare industry transition from fee-for-service to value-based care reimbursement impacts the traditional RCM (Revenue Cycle Management) in different ways. Every healthcare organization or an individual veteran practitioner needs to be financially balanced or strong to deliver their uninterrupted services. This is a time where best healthcare RCM service comes in.Revenue Cycle Management in healthcare is the financial process that facilitates the control of complex administrative processes and clinical functions such as patient eligibility, claims processing, reimbursement, denied claims management, and revenue generation.RCM is the backbone of healthcare organizations that helps them to pay their bills, manage their resources and much more. According to international standards report, in medical billing, more than 25% of claims have been rejected and up to 40% of those claims are never re-submitted i.e. the healthcare organizations suffer from major revenue loss.On the bright side, with proper RCM process, the healthcare sector can get greatest benefits with minimum bad debt write-offs. To understand the exact phenomenon of healthcare revenue cycle management, first, you have to understand its basics in the medical billing process.Basics of Healthcare RCM:
It starts from the appointment of a patient to seek any medical assistance and completes when the health organizations collect their payments.
At the beginning, the health group administrative staff manage an array of processes like scheduling, insurance eligibility verification and creation of patient’s account.
“From the perspective of Revenue Cycle Management, immaculate submission of patient information at the time of patient scheduling and registration improve the cash flow of the healthcare organization.”
After the patient’s treatment, the process of claims submission begins. An advanced coder submits the claims with right ICD-10 codes, the codes define the value of reimbursement and an approved code prevent claims denials.
Then comes the important part of private or government payer for payment. They evaluate the claim values, verify the details i.e. insurance coverage, contracts, etc. and process for reimbursement.
Most claims are denied due to improper coding, incomplete patient accounts, patient chart errors, etc.
Then comes the last outcome of revenue cycle management i.e. maximum claims reimbursement. RCM helps the healthcare organizations to get paid maximum claims reimbursement on time with fewer denials.
After that, the healthcare groups or the individual veterans perform the AR Follow up in which they create Healthcare claims i.e. manually or automatically and sends them to various Insurance companies.
In the final stage i.e. Payment Posting, the medical billing management software records every patient’s payment with accurate information including patient’s name, account number, denial info, service dates, etc. for future reference.
Importance in Healthcare:It can help the healthcare organizations to track the exact performance of their financial growth. They can easily determine the claims approval and denial rates via proper RCM process. With immaculate RCM process, the healthcare organizations managed their medical billing process effectively and fixed their claim denial issues quickly.Here are some key benefits of effective RCM:
Fewer denied claims
Improved patient care
Immaculate administrative records i.e. no other penalties or fees
Faster Turnaround time for claims payments