One of the largest health systems in the nation, with over $4 billion in net revenue, relied on an inefficient, resource-intensive rules-based revenue cycle system. The low revenue opportunity findings with high false positives and high resource cost led to millions of dollars in lost net revenue due to missed charges and coding errors.
RevCaptureAi streamlined the charge reconciliation process and identified potential areas of opportunity. Predictive analytics to identify complex charging patterns and identify missed charges at account level for both hospital and professional charges. Fully automated integration with a variety of EMR systems in different regions. Leverage feedback models to learn from auditor’s responses and make intelligent predictions.
confirmed missed charges
outpatient accounts analyzed
$40m+ confirmed missed charges. 100% of outpatient accounts analyzed through automated pre-bill and post bill process. Identified top departments/areas with systemic gaps in charge capture e.g., Injection/Infusions, EKG, surgery, implants & medical devices.
The client is a top 3 wireless provider. Lack of visibility into customer experience trends and use of siloed data insights resulted in ineffective retention programs and a continued lack of understanding of customer’s needs. The client wanted to address customer lifecycle challenges to differentiate customer acquisition and retention.
Leveraged a global model with other hospitals’ findings to offer insight into missed charges in the initial phase. Worked with the hospital system to identify billing challenges and adjusted thresholds accordingly. User friendly dashboards that offer insight into potential problem areas and educate departments.
confirmed missed charges
outpatient accounts analyzed
$14m+ in confirmed missed charges. 100% of outpatient accounts analyzed through automated pre-bill and post bill process.
A large healthcare services provider in Tennessee, with close to 90 campuses in 30 states and $5B+ in revenue had no system in place to track billing practices or identify missed charges. The client was looking for a solution to quickly stop revenue leakage without having to roll out a new platform.
With only 35 faculty of the 89 utilizing the tool, auditors were able to confirm $9.7 million. Prioritized daily workload so auditors could confirm and resolve missed charges that yielded the highest returns at the most efficient rate.
confirmed missed charges
outpatient accounts analyzed
$9.7m+ in confirmed missed charges. 100% of outpatient accounts analyzed through automated pre-bill and post-bill process.
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