Healthcare reimbursement is mission-critical for any organization, but revenue shortfalls continue to occur due to growing admission denials and the rising cost of addressing these denials - both prospectively and retrospectively.
According to CMS, 1 in 5 claims are denied, and almost two-thirds of lost or denied claims are never resubmitted. Change Healthcare estimates that hospitals submit approximately $3 trillion of claims per year, with an estimated $262 billion being initially denied.
Revenue reimbursement is reliant on healthcare systems providing the clinical evidence needed to support prospective pre-authorization, clinical documentation improvement, and retrospective appeals management workflows. But the clinical narrative, which makes up 80% of the electronic medical record and carries 10 times the value of structured and coded data, is long and unstructured, making it largely inaccessible to revenue cycle management staff.
Help secure reimbursement and avoid denials
CLiX revenue helps solve the problems associated with denials and revenue shortfalls by rapidly reading and understanding the entire medical record, and quickly locating the supporting clinical evidence needed to strengthen hospitals’ clinical documentation, utilization review and appeals management workflows.
The technology can process millions of documents in hours instead of days, saving hospital staff valuable time, and helping to more effectively recoup revenue from denied claims.
CLiX revenue unlocks the clinical narrative using Clinical Natural Language Processing (CNLP) technology, a highly specialized branch of AI that enables machines to understand human language. CNLP is able to understand billions of different word and phrase combinations that relate to hundreds of thousands of detailed clinical concepts.
CNLP technology is able to process lengthy, chronologically ordered content within a patient’s records and apply it to the revenue cycle workflow, improving reimbursement by helping prevent denials from ever happening in the first place, and giving revenue cycle management staff the tools to successfully overturn 90% of denials.
Northwell Health, the largest healthcare provider in New York State, signed a ten year agreement to use CLiX revenue to improve accuracy in its revenue cycle management operations. The healthcare provider, which operates in more than 100 medical specialties, and delivers healthcare to over two million people annually, uses CLiX revenue to automate the initial chart review. Read here for more information.
“With Clinithink, we have extended our revenue cycle review without increasing staff costs. This, along with support for denials management has enabled us to use Clinithink’s cutting-edge technology in critical revenue cycle activities, which in turn ensures that we can continue to meet the needs of our patients.”
Dr. Gerard Brogan, MD, Chief Revenue Officer for Northwell Health
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