Get to know Health Prime Datalytics, an RCM and analysis platform that allows you to focus on your metrics to determine areas for improvement in your medical practice and monitor its overall health.
On our webinar Datalytics: The RCM platform you need to know about, Health Prime’s Business Process Analyst Karin Johnson gave an overview of Health Prime Datalytics. Our analysis platform will give you insight into your medical practice and allow you to gain transparency into your medical billing collections process.
You will also be able to identify areas for improvement that will help you upgrade your medical practice management and obtain the maximum reimbursement possible.
Health Prime’s Datalytics focus on insights that other medical billing business intelligence solutions neglect.
With Datalytics, you will be able to see your Key Performance Indicators (KPIs) to:
- Track how your practice is doing
- Determine if you are meeting your targets
- Analyze how your practice is compared to last year
Datalytics Raises the Bar for Medical Billing Analysis. With its predictive modeling, Datalytics provides awareness of what your medical practice holds in the future. By drilling down into details, you can understand the story behind your numbers and have that decision supported by data to make process improvement modifications in your medical practice.
Once you log into the platform, your practice’s dashboard is displayed, providing a glance view of every KPI. Each KPI includes an information icon that provides a brief definition and a bookmark icon that gives access to additional details. The data is displayed for all providers, service locations, and practice specialties. You can also filter this information depending on what you want to see.
What KPIs can you monitor using Datalytics?
1. Gross Charges and Net Payments
Datalytics provides the ability to look at this metric in a different manner.
In terms of Gross Charges, you will see a year-over-year comparison of charges and a projection for the current year based on the average monthly charges and the variance from the previous year. Gross Charges are presented in a year-by-month view, as a Payer mix, and by provider. Net Collections are presented with these last three features, including Payment Type and Payment Place.
2. Clearinghouse Acceptance
Percentage of claims year to date that made it to the clearinghouse on first pass. Datalytics offers a “Claim Rejection Category Distribution” detail that will give you a claim rejection detail analysis to get to the root cause of rejection so you can identify it and work on it to improve your processes.
3. Collection Percent
Percentage of charges converted to payments in the current 12 months. This metric is suitable for forecasting. Datalytics also has a Financial Class Payment to Charge Ratio Performance report that provides a breakdown by year, the financial class of the PCR, and the overall average.
4. A/R Management
For Accounts Receivable, the dashboard allows you to analyze two key metrics: days in AR and the percent of primary insurance over 90 days from the first billed date.
The industry objective for this metric is less than 50 days. However, Health Prime’s best practice is 28 days for Total AR (20 days for Primary Insurance, 2 days for all additional insurance, and six days for patient). The AR detail tab shows more information, such as Total AR, Insurance AR, and Patient AR. On Datalytics, you can see the breakdown by Financial Class, aging buckets, or even claim level.
5. Charge Acceptance
The percentage of charges paid on the first pass to the payer without being denied for controllable reasons. Health Prime’s best practice is 98%. On this KPI, you can also see your denial rate by percentage, allowing you to quantify the effectiveness of your RCM processes. The industry average is 5-10%. However, HPI’s best practice is <2%.
You can export your data and analyze the denial details to develop performance improvement plans to reduce or eliminate denial or a group of denials.
Health Prime’s benchmarks are above the industry average, so you can monitor your medical practice by focusing on best practices.
6. No Show Rate
The percentage of expected appointments that were No-Shows by the patient for the current month. However, this metric is only available if the Appointment Scheduler is used in the PM system. Cancellations and Rescheduled appointments are not included in this KPI calculation. Health Prime’s target for No-Shows is 6% or below.
Datalytics offers a breakdown by Appointment type to help you better understand the source of the No-Shows. You will also have access to a trending graph that provides the percent and dollar amount of No-Show appointments by month.
7. +One Patient per Day
Value-added feature not typically captured on your typical billing company dashboard.
With this Datalytics feature, you can also access the procedure code summary breakdown that provides the units, charges, payments, adjustments, payment per unit, charge mix breakdown, and per unit payment by financial class.
8. Claims Timeline
Average number of days between Date of Service, Date of Posting, and First Billed Date for the last 30 days. How does it work?
- Number of days from Date of Service to Date of Posting: How long does it take for the provider to send the charges?
- Number of days from Date of Posting to First Billed Date: Time it takes the biller to submit the claim to insurance.
With our platform, you can see the timeline for each provider in the practice. This enables practice managers to be aware of potential delays in claim submission.
9. Unbilled Claims
This KPI shows the number and dollar amount of claims in an unbilled status. You can get detailed breakdowns of this KPI by patient ID, encounters, and procedure department. You can also drill down into the encounters to view any notes pertaining to the reason for the unbilled status.
Which claims are included?
- Claims in queue daily for claims submission
- Claims that are on hold awaiting answers to billing tasks
- Claims that have failed pre-bill edits
- Claims that the clearinghouse has been rejected
10. Adjustments
There are two types of Adjustment cards:
11. Coding Profile
Datalytics offers a Coding Profile of your practice for information purposes.
It provides practices with visibility for examining how their office bills high-complexity E/M visits compared to the CMS profile for the same specialty. Thus, you can determine whether your practice is a high-profile or low-profile coder.
12. Payment per WRVU
Total payments received year to date divided by the year-to-date work RVUs. Providing the WRVU detail allows practices to compare the measure of work performed from one year to the next and compare one provider against another.
If you want more information about Health Prime Datalytics and how to improve your medical practice by using it, set up a one-on-one training with your Health Prime’s Client Success Consultant. If you are not a client yet, email us at [email protected]. Set up a meeting to discuss how Health Prime can help you get your practice back in its prime.
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