Client Overview
- Client: [Client name, or approved anonymous descriptor]
- Industry: Healthcare
- Engagement scope: Error reporting and claims performance monitoring across a six-stage revenue cycle management (RCM) workflow, from patient scheduling through denial recovery
- Core statistics: [No figures in source material. Add claim volume, number of facilities, payer count or similar if available]
The engagement covers the six stages a claim passes through in the client’s revenue cycle: patient intake, clinical care, coding, filing, processing, and denial management. Intuceo delivered healthcare analytics solutions that attach a reporting or monitoring output to five of those six stages.
The Challenge
Revenue cycle management is essential for a healthcare practice to stay financially viable and
to provide quality care. Done well, it improves top-line revenue by reducing claim denials, while
maintaining the overall care of the patient population.
The client set four goals for the engagement: enhance revenue growth, drive administrative
efficiency, improve the cost and quality of care, and improve the member and patient
experience.
The Solution
Intuceo mapped the client’s revenue cycle stage by stage and assigned each stage either an
error report or a rate-monitoring output, based on the activities that take place there.
- Coordination of benefits error reporting: Covers the Patient stage, where scheduling, admittance, and coordination of benefits take place.
- Documentation error reporting: Covers the Clinical Care stage, which includes the problem list, charting and documentation, Charge Description Master (CDM) coding, and preauthorization.
- Coding error reporting: Covers the Coding stage, where diagnoses and procedures in the chart are transcribed into claims processing codes under International Classification of Diseases, Tenth Revision (ICD-10), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and Procedure Coding System (PCS).
- Clean claim filing and error rate monitoring: Covers the Filing stage, which includes payer adjudication, documentation, error correction, and clean claim filing.
- Denial and reversal rate monitoring: Covers the Denial Management stage, where denials are categorized, reversed, and recovered.
Technology Used and Implementation Approach
- Technology: Not stated in source material. Add data sources, data storage and processing tools, reporting or business intelligence (BI) layer, and any machine learning (ML) models used.
- Implementation approach: The design follows the order of the revenue cycle. It separates the three stages where errors are reported from the two stages where performance rates are monitored.
| Stage | Activities in scope | Intuceo output |
|---|---|---|
| Patient | Scheduling, admittance, coordination of benefits | Coordination of benefits error reporting |
| Clinical Care | Problem list, charting and documentation, CDM coding, preauthorization | Documentation error reporting |
| Coding | Chart transcription of diagnoses and procedures into claims processing codes; coding in ICD-10, CPT, HCPCS and PCS | Coding error reporting |
| Filing | Payer adjudication, documentation, error correction, clean claim filing | Clean claim filing rate and error rate monitoring |
| Processing | Payer reimbursement reconciliation, patient account reconciliation | None shown in source |
| Denial Management | Denial categorization, denial reversal and recovery | Denial rate and reversal rate monitoring |
Error reporting at the point
of origin:
Reports sit on the three upstream stages where
benefits, documentation, and coding data are first
created.
ate monitoring at the payer-facing
stages:
Clean claim, error, denial, and reversal rates are
tracked at filing and denial management.
Results and outcomes
The source material defines what is measured but gives no before-and-
after figures. The results below are tied to the metrics the engagement
monitors and need client data before publishing.
- Clean claim filing rate: [X]% (from [X]% before the engagement)
- Claim error rate: [X]% reduction
- Denial rate: [X]% reduction
- Denial reversal rate: [X]% (from [X]% before the engagement)
Get Stage-Level Visibility Into Claim Errors and Denials
Intuceo builds reporting and monitoring around each stage of the healthcare revenue cycle,
so teams can see which stage an error comes from and how filing and denial
rates are performing.
