Best RCM Business Intelligence & Reporting Tools Products

HealthNautica’s eORders™, software is a comprehensive, easy-to-use, cloud solution for managing the entire perioperative process and surgical scheduling without changing your scheduling system. It begins with the physician’s office filling out an online surgery scheduling or procedure request.

Gone are the days of illegible, incomplete, inaccurate faxes sent back and forth between the physician’s office and the facility’s scheduling department. The cumbersome and error prone faxing process is replaced by an electronic form that is configured to each facility’s exact specifications and reacts to the user’s input thereby assisting the physician’s office in getting it right the first time.

All orders are legible, complete, screened for CMS Medical Necessity, incorporate SCIP, VTE, SSI and ACS NSQIP measures, verified for insurance eligibility, pre-certified and satisfy edits by CMS, commercial payers and the facility. Our solution ensures efficient surgery center scheduling and block time management while streamlining processes such as prior authorization.

Our single platform approach provides immediate visibility into revenue cycle opportunities, tackling some of today's biggest challenges with the following Productized Analytics Suite Modules:

• Workforce Quality Insights (WQI) – Links front-office actions to financial KPIs
• Patient Access Insights (PAI) – Enhances financial experience pre-service
• Revenue Integrity Suite (RI) – Reduces denials and compliance risks
• Productivity Analytics (PA) – Improves staff productivity in real-time
• Cost Insights (CI) – Targets controllable costs
• Business Office Suite (BOS) – Unifies patient accounting data

Clinical denials require focus and clinician intervention. With more than 100 clinicians on staff, R1 Physician Advisory Solutions can help. We support physicians and case management by navigating the regulatory environment and providing concurrent recommendations to increase billing compliance and reduce clinical denials. Services include remote utilization reviews, admission status reviews, payer peer-to-peer reviews, chart audits, appeals management, and customized education programs for physician and case managers.

Payers constantly change the rules. Sift evens the playing field. Sift equips healthcare organizations to fully leverage their payments data to work smarter, protect their margins and accelerate cash.

Actionable Denials Intelligence, delivering a longitudinal view of clinical, coding, claims and remittance data. Sift establishes a data foundation that gives providers unprecedented access to their payments data and intelligence tools to better manage their denials, identify root causes and prevent future denials. 

• Unified, normalized and organized claims and remittance data.
• Delivering an accessible and complete picture of claim behavior, payer trends and the drivers of denials.
• Curated, consultative analysis pinpointing where your team can take action to prevent denials and optimize workflows.

Denials Prioritization & Intelligent Automation to better manage touches and lower the cost of delivering each dollar of cash.

• Sift’s machine learning optimizes workflows by prioritizing your team’s denial work efforts around ROI and by delivering Smart Claim Edits that improve first-pass yield. 
• Active-Learning Claim Scrubber analyzes daily claims and remittances to curate high-impact claim edit recommendations.
• Machine learning models that score denials at an atomic claim level, using over 500 attributes to determine each denial’s likelihood to overturn.
• ROI-based denials worklists seamlessly integrate into your EMR, prioritizing high-recovery denials in staff workqueues.
• Scoring that enhances existing automation capabilities, enabling the strategic automation of low-yield accounts while avoiding over-automating recoverable accounts.

Denials Prevention. By unifying clinical, coding and payments data, Sift's ML predicts denials before claims are created and provide recommendations for upstream interventions. 

Sift’s ML models predict the likelihood of denial and provide pointers for intervention and prioritized user analysis, working to optimize payment outcomes.

• Machine learning models score encounters around their likelihood of being denied, proactively flagging encounters for intervention before claim submission.
• Denial category prediction and root causes pointers enable routing to the appropriate mid-cycle workflow for mitigation.
• Mid-Cycle Denials Intelligence that ties back-end billing, denial and overturn patterns to upstream workflow data inputs to deliver root cause analysis and prevention recommendations.

Unprecedented access to your payments data. Sift’s Rev/Track reporting dashboards and Insights Reports deliver custom, enhanced operational intelligence that enables better benchmarking and data-driven decision-making. Sift's Rev/Track tools provide a comprehensive analysis of historical and current billed procedures, forecasting how payments will perform as a result of current payer and payment trends – and what can be done to improve outcomes.

Access and learn from your data at any time with Sift’s Rev/Track command center. Sift’s dynamic Rev/Track dashboards provide detailed, granular reporting for all levels within a provider organization, from the C-Suite to functional team leaders.

• Full lifecycle view, tracking the impact of every claim
• Early warning system – trend tracking and alerts
• Payer Scorecards
• Portfolio views of payments, covering both Payers and Patients

Delivery of a complete picture of your payment behavior. Sift's detailed Rev/Track Insights Reports serve as actionable analyst reports that highlight trends, problems and opportunities that directly impact revenue.

Sift integrates clinical and coding data to enhance root cause analytics. Sift predicts the weighted contributions of upstream clinical workflow data inputs by tying together concurrent and back-end denial and overturn patterns. This enables deep drill-downs of the clinical and account data that contribute to predicted denials.