The majority (80%) of patient data practices collect today are unstructured and do not provide actionable insight to clinicians, let alone adding value to quality and compliance. While 50% of providers' time during visits is spent in the EHR, denial and rejections for claims are high mostly because of lack of clinical documentation and justification. There is also lack of transparency on financial responsibility from patients' point of view, and payers are missing data related to patients’ treatment adherence across time. As RCM is done retroactively, implementing a tailored technology can provide clinical justification for ancillary services and qualify patients for ancillary services during onboarding. Treatment guidelines can be included in the patient onboarding process as "Clinical Algorithms as a Service (CaaS)," which can collect automated clinical and administrative justification and increase quality and compliance while decreasing reimbursements. With an end-to-end patient engagement platform, the speaker’s organization was able to demonstrate revenue increases of more than 15% by implementing clinical onboarding before visits and decreasing denials and rejections by more than 10%.
Learning Objectives:
Solve interoperability challenges with automated systems integration within onboarding process.
Discover how clinical guidelines can be applied to onboarding processes that increases efficiency.
Demonstrate how to prevent claims rejections and denials by automating clinical justification tailored to practices.
