January 4, 2024

How Platform Modernization Can Boost Claims Processing Speed by 95%

By Niraj Dave

Senior Director, Enterprise Product Development

Growing revenue and reducing costs remains a top priority for healthcare organizations in 2024. As such, revenue cycle optimization, streamlining payment, and reducing billing and coding errors are critical areas of focus. Often, however, these efforts are impeded by inefficient technology that, in turn, drives human inefficiencies within the organization.

Platform modernization presents a solution. By enhancing and even replacing legacy technology with faster, more efficient alternatives—as well as automating manual processes—healthcare organizations can both reduce costs and even open additional revenue streams. With one of our clients, for example, it led to a reduction in their claim-payment cycle by 59%, and multi-tenancy enabled them to open up a new revenue stream.

Let’s walk through the connection between technology and revenue cycle optimization, then walk through two examples of how we have made this work for our clients.

Why legacy technology drives inefficient revenue cycle management

According to a recent whitepaper from Sage Growth Partners, healthcare executives are acutely aware of the need for smarter approaches to revenue and cost management:

  • 57% rank growing revenue as a top strategic initiative
  • 46% rank reducing costs as a top strategic initiative
  • 34% rank new markets or revenue streams as a high priority for 2024-2025

However, legacy revenue management technology causes problems on two fronts. First, it impedes your organization’s ability to receive and process payments, thereby limiting the impact of new revenue streams. Second, technological inefficiencies drive inefficiencies in human processes, which then increase operating costs.

If you continue to use legacy technology or processes in an increasingly complex, modern healthcare ecosystem, you’re going to run into serious problems:

  • Cash flow challenges. Inefficient processes can lead to delays in billing, coding, and claim submission, resulting in delayed payments.
  • Increased denials or rejections. Inaccurate coding or incomplete documentation can result in a higher rate of claim denials or rejections by payers, leading to increased administrative work.
  • Reduced patient satisfaction. Billing errors and delays can cause confusion, leading to frustration and dissatisfaction that can hurt patient loyalty.
  • Compliance risks. Inefficiencies may increase risk of non-compliance with HIPAA, MU, data privacy & security standards, and interoperability requirements, leading to potential fines, penalties, and legal challenges.
  • Revenue leakage. Missed charges, undercoding, or failure to capture all services provided can all lead to lost revenue.
  • Difficulty forecasting and planning. Revenue cycle inefficiencies can make it challenging to forecast revenue and make informed, strategic decisions.

These hidden costs add up quickly. So for healthcare professionals who are truly prioritizing revenue cycle optimization in 2024 and still use legacy systems, platform modernization must be a top priority.

Revenue cycle optimization: from manual submissions to automated infrastructure

One of our clients, a growing mental health service provider, needed to optimize their revenue cycle to support their business growth goals. The client’s legacy system relied on manual claim submission, which led to errors and prolonged processing times. What’s more, because their system held reliability issues, the client was limited in how they could leverage it.

Thankfully, they recognized these issues, and we were excited to partner with them in building a solution. Using the Microsoft Azure cloud platform, we modernized their infrastructure to enable scalability and multi-tenancy. This process involved redesigning their database and code to streamline claim submission, as the previous manual process had been highly error-prone.

Additionally, we updated the user interface to be more responsive and customizable, with the dual goals of driving user adoption and providing the capacity for growth and scale in the future. New features included:

  • Interoperability & integration with payers
  • Process automation
  • Workflow management for claims preparation and denials management

The end results to the client were undeniable:

  • Boosting claims processing speed by 95%
  • Maintaining 90% accuracy while reducing costs
  • Enabling a new HIPAA-compliant SaaS product revenue stream

Not only did platform modernization materially impact the client’s revenue cycle operations, but it paved the way for future innovative business models and new streams of revenue.

Why platform modernization drives revenue cycle optimization

Platform modernization, by removing manual processes and inefficiencies, can significantly contribute to revenue cycle optimization. Here are some reasons why.

Streamlined processes

Modern platforms often contain automated, digital workflows for every standard action: claims submission, coding, billing, and payment processing. This reduces both the need for repetitive tasks and manual intervention, as well as the risk of human error.

Data accuracy

By leveraging advanced data management practices and technologies, such as unified data stores, data warehouses, and more, modern platforms can centralize data storage and employ robust validation mechanisms. This can minimize discrepancies, improve coding accuracy, and reduce the risk of claim denials or rejections.

Enhanced billing efficiency

Automated platforms can facilitate real-time eligibility verification, automated coding suggestions, electronic claims submission, and more. These technologies can accelerate the billing process and enable organizations to submit claims promptly, leading to faster reimbursement and improved cash flow.

Scalability and flexibility

As the healthcare ecosystem continues to evolve and grow more dynamic, it’s critical for organizations to have scalable revenue architectures in place. This enables the ability to accommodate fluctuations in transaction and claims volumes, expand service offerings, and integrate with new technologies seamlessly.

Compliance and risk management

Platform modernization enables organizations to maintain compliance with evolving healthcare regulations, guidelines, and security standards. By implementing robust compliance controls, audit trails, and encryption protocols, organizations can mitigate risks and keep patient data safe and secure.

Final thoughts on revenue cycle optimization & platform modernization

Both of these client stories illustrate that targeted, focused platform modernization efforts can not only lay the groundwork for long-term growth, but drive value in the short term. However, this requires a partner both with expertise in platform modernization, and an approach that prioritizes minimizing time to value, solving for user need, and excelling at change. If you’re interested in seeing results like those clients above, contact 3Pillar Global and we’ll work with you to find the right solution.