EDIminer™: Identifying Revenue Opportunities

Do you have a high denial rate? Do you suspect you are leaving money on the table?

Hayes has a proprietary tool that can validate your intuition with HIPAA data. Using your EDI data and a business intelligence (BI) tool, Hayes uses EDIminer to analyze your revenue cycle. This tool can drill down to individual invoice/encounter, allowing Hayes to identify problem areas.
Using EDIminer will help you focus on areas for improvement and assist you to:  

• Determine whether the problems are caused by technology, process, people or combinations of these factors. 
• Develop a plan for remediation, such as training, system optimization, process redesign, etc.
• Leverage technology to free up resources for other initiatives
• Focus and prioritize your efforts
• Allow you to balance competing priorities
• Improve the patient experience

Why use EDI files to improve the revenue cycle?

The information extracted from EDI files provides a new, unadulterated perspective on your revenue cycle. Claims can be analyzed at the time of submission and remits can be analyzed upon receipt. The data is not subject to the configurations of your patient accounting system. Setting up dashboards and reports using EDI/BI will allow you to see issues much sooner, which will reduce the amount of rework. Further, with the 5010 deadline looming, which is also a requirement to move to ICD-10, the standardization and benefits gained from using EDI files will only increase. 

Take this opportunity to leverage the data and convert it into meaningful information to help improve your revenue cycle.  Knowing where your revenue cycle is breaking down will be paramount not only to revenue, but also to patient experience and your organization’s competitive advantage.