Rx: A Dose of AI-Powered Revenue Capture for the Healthcare Industry

While the healthcare industry has grown leaps and bounds in delivering advanced medical treatment and care to its patients, it still has a lot of ground to cover in maximizing revenue capture, mitigating missed charges, and improving bottom lines. With the massive growth of digital data, hospitals have invested heavily in solutions that claim to be powered by Machine Learning (ML) technology. But in reality, they are rule-based and misleading! With a rule-based approach, coupled with audits, the entire revenue cycle system becomes resource-intensive, expensive, and continues to miss charges yet to be identified or codified as rules.

With missed charges being a widespread challenge across the healthcare industry, an urgent need for innovative, cutting-edge solutions to recover the billions of dollars typically lost yearly. The current state of the healthcare industry, with high costs and limited labor, makes this an opportune time to stop missing legitimate charges. This is where ML can help hospitals look across staggering amounts of data, analyze patterns and look at outliers to deliver extraordinary insights. State-of-the-art technology today allows scanning of the entire revenue cycle, covering administrative and clinical operations that capture and manage patient services revenue. As a result, they navigate the complexities of billings, coding mistakes, insurance claims, payer denials, and the collection process to identify missed charges and plug unnecessary revenue leakages.

At Daitrix,we call this Consequential AI!

RevCaptureAi, the only ML-powered product that captures missed charges in weeks

Daitrix’s pre-built AI and ML solutions empower healthcare facilities to analyze data across diverse hospital and physician systems, uncover anomalies, and generate insights to optimize revenue capture. Our solutions help achieve operational excellence by identifying potential sources of the leaks and then fine-tuning the processes to avoid such leaks in the future.

No more reinventing the wheel. No more heavy investments from scratch that yield results after several iterations. No more replacing your existing systems with a new one that doesn't guarantee a predictable outcome. Our solutions’ pre-built, containerized capabilities make it easy to deploy and can be implemented on-premise or hosted as a service while supporting leading EHR or EMR software. The model prioritizes predictions for revenue realization using payer contract data and historical payments data.

What's more—it has an intuitive, modern, and aesthetic user interface, giving a smooth and seamless user experience. Its highly customizable dashboard enables users to access, slice and dice, and analyze data to draw comprehensive, meaningful, and actionable insights to power your operations.

Here are some examples of how Daitrix helped global healthcare facilities harness the power of AI and ML to capture missed charges, reduce costs, and boost revenue cycle.

• Daitrix helped a large health system provider, with USD 4 billion in net revenue, streamline their charge reconciliation process and identify potential areas of opportunity. It employed predictive analytics to identify complex charging patterns and locate missed charges at the account level for both hospital and professional accounts. Our solution identified over USD 40 million in confirmed missed charges annually and analyzed all 100% outpatient accounts through automated pre-bill and post-bill processes. Additionally, it spotted top departments with systemic gaps in charge capture, such as Injection/Infusions, EKG, surgery, implants, and medical devices.
• A mid-size hospital had limited resources to deal with revenue leakage challenges. The low revenue opportunity findings with high false positives and high resource cost led to millions of dollars in lost net revenue. We helped the client identify identified billing challenges, adjusted thresholds accordingly, and leveraged its customizable dashboards to offer deep insights into potential problem areas and educate departments. As a result, the hospital captured over USD 14 million in confirmed missed charges, with 100% of outpatient accounts analyzed through automated pre-bill and post-bill processes.
• A large healthcare services provider, with close to 90 campuses in 30 states and more than USD 5 billion in revenue, had no system to track billing practices or identify missed charges. With only 35 faculty of the 89 utilizing the tool, we helped the auditors confirm USD 9.7 million of missed charges. We helped the client prioritize daily workload so that auditors could confirm and resolve missed charges that yielded the highest returns at the most efficient rate. Not just that—the product enabled 100% of outpatient accounts to be analyzed through automated pre-bill and post-bill processes.

Connect with us today to explore how you can harness our cutting-edge solutions to unlock your growth story!