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Importance of Business Intelligence in Revenue Cycle Management

What is Business Intelligence?

We all know that data is a strength, be it in any industry or domain. It is the most important aspect of organizational growth and sustainability. But disorganized data can only make things worse. It can even lead to complete deterioration of business profitability even with efficient productivity. Any organization must know how to organize and manage its data.

How do we do that? That’s where Business Intelligence (BI) comes in. BI serves as a key to data organization and management to effectively communicate productivity levels. It incorporates tools, technologies, and strategies that help to turn raw and disorganized data into purposeful information. It displays the acquired meaningful information in the form of reports, graphs, dashboards, charts, analytics, and various other forms to efficiently communicate the trends, customer behaviors, and patterns.

BI is an essential component to ensure the longevity and stability of any business.

Need for Business Intelligence in Healthcare

Business Intelligence plays a crucial role in the healthcare sector as well. BI when combined with the technology for healthcare RCM, brings about strong analytics and decision-making in accord with modern-day industry standards.

Insights gained for BI can help bring in enhanced practice management by predicting patient outcomes, evaluating patient, and practice performances through proper structuring of all the practice data including electronic health records, operational, financial, and such.

Implementation of BI in the healthcare industry can aid in reducing the costs of business by enhancing the incoming revenue and overall financial structure. BI has now become a necessity for the persistence of the healthcare sector rather than just a necessity.

Let us see a few ways in which BI helps the healthcare sector:

  • Medical history tracking
  • Preventive medication treatment strategizing
  • High-volume patients tracking
  • Appointment scheduling for both new and old patients
  • Effective claims processing and management

Let us drill down to how Business Intelligence in Revenue Cycle Management benefits the healthcare industry:

1. Financial Streamlining

Business Intelligence in general is designed in such a way that it implies or comes out with effective measures that are cost-effective. It builds a healthy revenue cycle through decisive insights and best patient care. The specialized analytics by BI helps to identify and structure KPIs and convert them into meaningful reports so that, it becomes easy to evaluate patients and practice information for enhanced decision-making.

In recent times, it was found that revenue wastage contribution was too high in the US healthcare industry. With BI to the rescue, practices and revenue cycle managers can view their revenue wastage contribution outlined under the intelligence tools which can further be broken down into actionable insights.

A major contributor to the financial bleeding in healthcare is a weak RCM. It comes in many ways – incorrectly denied claims, weak eligibility verification systems, and wrong processing of claims due to unavailability of data. All these factors can majorly impact the practice cash flow.

Fortunately, BI analytic tools come in handy with their ability to generate state-of-the-art and relevant information for RCM processing including claims billing, claims processing, encounter documentation, accounts receivables, and payment posting.

2. Reimbursement Analysis for Accounts Receivables

Healthcare organizations bring about benchmark analysis to identify the efficiency of practices in comparison with similar specialties and geographic locations. There are multiple goals under this umbrella, but the ultimate goal for this analysis is to effectively recover lost revenue and maintain continuous patient engagement, without having to compromise on the payer demands and claims processing efficiency.

Business Intelligence helps to optimize AR Reimbursement analysis by clearly setting out KPIs for AR touch points that could affect the practice growth. These aspects include the number of days in AR by site, revenue per patient case, payer mix, and revenue per payer, denial rates, remaining payments, charge lags, cancellations, and trending bad debts.

Business Intelligence in RCM Accounts Receivables brings about effective KPIs and reports on all the touch points, for practices of any size. This will improve the AR workflow, highlighting opportunities that could help enhance the operational and revenue process flow.

3. Effective Analysis of the RCM workflow

Workflow analysis for Revenue Cycle Management helps to streamline processes, thereby, reducing the operational expenses due to essential profits. Business Intelligence when used appropriately will help healthcare sectors to carefully evaluate, analyze, and provide meaningful insights on practice workflows.

Having a clear understanding of the entirety of the RCM process will allow managers and employees to make effective decisions and solutions to rectify issues or to further enhance the revenue. It also helps in identifying the productivity of the insurance payer to strategize re-negotiations.

Business Intelligence facilitates transparency across the entire staff-related workflow as well, ensuring optimized workflow efficiency.

4. Data Integrations and Aggregations

Business Intelligence tools encompass extensive data metrics through clean dashboards that can be accessed on a regular basis. Data from different departments, internal and external can be integrated together as a single source of truth. It will help RCM processes be way more streamlined as they can have a clear picture of each operation.

The data aggregation feature in Business Intelligence allows healthcare and revenue cycle managers to have comprehensible insights that are both technical and non-technical. These data will have them on top of the process and can be better equipped to make quick responses and make decisions. They can also drill down to the underlying data easily whenever necessary.

5. KPIs to improve RCM effectiveness

KPIs contain crucial information on healthcare revenue and RCM productivity. It carefully monitors the claims processing to identify any duplicate and repeated submissions and evaluates denial rates and lag times for reimbursements. It thereby helps to gauge revenue streams and streamlines the process activities. The KPIs facilitated by BI for RCM include success rates, billing days, and denial and rejection rates. This information can bring in effective transformation in the productivity and revenue stream.

ALSO READ –  RCM KPIs That You Need to Keep Track of at Your Practice


Implementation of Business Intelligence into healthcare practices and revenue cycle can bring in high levels of efficiency and reduce the wait time for successful reimbursement. With technology within their reach, they can uncover insights to focus on improvements. BI is the future of data management, and it guarantees the efficient growth and sustainability of practices.

Practolytics believes in efficient data analysis using BI, enabling practices navigate easily through the complicated maze of insurance guidelines and processing rules.  Talk to us to understand how we analyze data and come up with efficient techniques to address the key operations in the Revenue Cycle Management.AdvancedMD-ehr