Provider
Cancer Care Provider
Technology
Microsoft Fabric
Microsoft Power BI
OncoEMR
Key Outcomes
Reduced Claims Denials and Faster Payments
Increased Revenue Cycle Efficiency
Improved Financial Performance
VNB Health enabled a leading oncology practice to enhance revenue cycle efficiency and financial growth with Healthcare Revenue Cycle Analytics. With real-time insights, they achieved streamlined operations and optimized resource allocation.
Customer Profile
The customer is a prominent healthcare insurance provider serving a vast population. With a rich history in the industry, they are committed to delivering comprehensive healthcare solutions and enhancing member experiences. The organization operates in a highly regulated environment, necessitating robust and compliant systems. Due to the sheer volume of transactions and complex nature of healthcare data, the customer handles a significant workload, demanding efficient and reliable IT operations.
Customer Situation
The customer handled 270/271 Healthcare Eligibility Benefit Inquiry transactions to verify patient healthcare eligibility, coverage, and benefits. The customer relied on custom API interfaces built on Microsoft BizTalk Server to connect with multiple insurance payers. This complex integration environment, characterized by high transaction volumes and frequent changes, was prone to instability. Updates to one payer’s interface often disrupted connections with others. To mitigate this risk, accelerate development and ease the build, deployment and testing process, the customer sought an automated solution that would enable continuous integration and continuous delivery (CI/CD) with robust automated testing.
Customer Profile
The customer is a prominent oncology practice located in the Pacific Northwest, specializing in comprehensive cancer care. Renowned for their patient-centric approach, they provide high-quality, personalized care to a diverse patient population across multiple locations. Their extensive range of oncology services includes advanced diagnostics, tailored treatment plans, and supportive care, all aimed at enhancing patient outcomes. Committed to delivering exceptional care while navigating the complexities of the healthcare landscape, the organization prioritizes both clinical excellence and financial stability.
Customer Situation
The oncology practice faced significant challenges in managing their revenue cycle, impacting their financial health and operational efficiency. Limited visibility into financial data made it difficult to identify bottlenecks and proactively address performance issues.
Complex claims processes, intricate payer requirements, and inconsistent billing practices led to increased denials and delayed payments, affecting cash flow. Manual reporting and fragmented analysis methods were time-consuming and prone to errors, hindering timely insights. Additionally, the lack of accurate revenue and expense forecasting complicated financial planning and resource allocation.
These challenges not only strained administrative resources but also hindered the organization's ability to optimize revenue capture and fully dedicate resources to patient care.
VNB Solution
To address the customer’s challenges, we customized our Healthcare Revenue Cycle Analytics solution built on Microsoft Fabric. Covering every stage—from patient access and pre-authorization to charge capture, claims submission, payment posting, and denial management—the solution delivered comprehensive visibility and actionable insights. This end-to-end view helped the practice overcome limited visibility into financial data, enabling them to identify bottlenecks and optimize processes across all key stages of the revenue cycle.
The solution’s advanced analysis and predictive modeling capabilities played a crucial role in addressing the practice’s manual reporting and forecasting challenges. By replacing error-prone reporting with accurate forecasts, the practice gained deep insights into financial performance and identified future revenue trends. Automated reporting and customizable financial dashboards allowed leadership to monitor key metrics, enhancing strategic financial planning and decision-making. This empowered them to make proactive, data-driven financial decisions and strategically adjust their financial planning, effectively overcoming revenue and expense forecasting difficulties.
Additionally, the solution tackled complex claims processes and denial management, which were leading to increased denials and delayed payments. The integrated claims analytics module provided detailed insights into claims processing and payer requirements, enabling the practice to optimize claims submission and reduce denial rates. Automated denial tracking and resolution workflows expedited payment cycles, directly enhancing revenue integrity and cash flow. Streamlined Accounts Receivable (AR) management further improved cash flow by proactively addressing potential payment delays.
Overall, VNB Health’s Revenue Cycle Analytics solution enabled the oncology practice to overcome their revenue cycle challenges, optimize financial performance, and allocate more resources to delivering exceptional patient care.
Customer Benefits
- Increased Operational Efficiency: Centralized data analytics enabled seamless operations across appointment scheduling, insurance verification, and billing processes.
- Enhanced Financial Performance: Improved visibility into revenue and expense forecasting allowed for informed decision-making and strategic financial planning.
- Reduced Claims Denials and Faster Payments: Advanced claims and denial management analytics reduced denial rates and expedited payment cycles.
- Improved Patient Care: By optimizing revenue cycle efficiency, the practice reduced administrative burdens and improved financial stability, freeing up more resources for high-quality patient care.