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Case Study

Enabled the client to to optimize revenue cycle performance

Client Background

The client is a Health Tech company offers product and solutions to the US Health Plans, Providers, and Hospitals.

We have developed a solution to meet the CMS two final rules on the hospital price transparency and coverage transparency. The new system will help providers and patients to understand the costs, providers to check the accuracy of the charges, analytics on the pricing to maximize revenue and intelligence platform for denial management.

Client Need

  • Enhancement and development related to Pricing transparency can be useful for the patient so that there would be transparency in the prices and can be accessible during the changes in prices or any details related to facility, payer, plans to patient
  • With Pricing Analytics, Denial Intelligence and Charge Accuracy solutions provided, facilities and physicians can maximize their net revenue and can sustain in the competitive market

Our Solution

  • An interface to facilitate the Pricing transparency which offer more transparent prices to patients for the items and services they provide. Publish Excel reports with validations for the data present for CDM standard charges and shoppable services which include all the facility, payers, plans information
  • An interface uses by the providers to measure the Charge accuracy of provider so they can identify and correct errors to ensure compliance and optimize net revenue.  Using claims data (HCPCS, revenue codes, ICD-10, etc.) submitted to payors
  • An interface which helps providers  to describe accurately marketing, financial and internal pricing strategies and priorities
  • An interface which helps provider to generates a rich set of Denial Intelligence reports on all claim and remit activity and allows to admins to act up on and take action against the denial which has biggest impact on their revenue loss

Tools & Technologies

Java, RabbitMQ, PostgreSQL, Ext JS, Dropwizard

Key Benefits

  • RCAprovides different solutions that enables providers to optimize revenue cycle performance. It helps providers to view their current pricing strategy where it stands in the current market, compare, identify any issues and finally resolve them to get maximum benefit for their revenues
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