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A RevEval Assessment: AI and Benchmarks to Assess RCM Health

by Ivan Bradshaw
 

Introduction

As a healthcare leader, managing your revenue cycle effectively is critical to sustaining and growing your organization. With evolving challenges like the transition to value-based care, regulatory mandates, and staffing shortages, maintaining financial stability is a growing concern. A thorough revenue cycle health assessment with benchmarks can provide actionable insights, allowing your organization to optimize performance, reduce inefficiencies, and recover lost revenue.

This blog explores how the WhiteSpace Health RevEval assessment, uses AI to deliver a report containing practical steps, detailed insights, and industry-standard benchmarks, that equip you to address financial bottlenecks and elevate your organization’s financial health.

RevEval, a unique offering from WhiteSpace Health Platform, combines AI-powered analytics with actionable insights to diagnose revenue cycle inefficiencies. With its ability to pinpoint revenue leaks and streamline processes, RevEval empowers healthcare leaders like you to focus on achieving measurable financial improvements.

What Is RevEval Revenue Assessment?

RevEval is not your typical assessment; it is a data-driven solution designed to deliver transparency and actionable insights into your revenue cycle. As a one-time evaluation, RevEval uses AI and analytics to process your 835, 837, and aged trial balance data, providing a detailed report on your financial health.

The unique strength of RevEval lies in its ability to:

Diagnose Problems: Pinpoint revenue leakage and its root causes.
Provide Clarity: Offer a comprehensive view of your revenue cycle’s performance.
Deliver Solutions: Provide actionable steps to improve financial outcomes.

By incorporating MGMA benchmarks, RevEval ensures that your organization is not just meeting but exceeding industry standards.

How to Conduct a Revenue Cycle Health Assessment with Benchmarks

Conducting a revenue cycle assessment guide requires a systematic approach that uses the following key steps:

Step 1: Collect the Right Data

The foundation of any effective revenue cycle analysis is accurate data.

835 Data: Remittance advice data providing details on payments and adjustments.
837 Data: Claims data that showcases the status of claims submissions and denials.
Aged Trial Balances: A snapshot of outstanding receivables categorized by age that corresponds to the 835 and 837 data.

This data provides a complete picture of your revenue cycle’s current state and highlights areas for improvement.

Step 2: Define Key Benchmarks

To measure success, you need a clear set of benchmarks. Industry standards like MGMA provide metrics to evaluate your performance. These include:

Denial Rates: Benchmarked at 5–10%.
Days in Accounts Receivable (AR): Targeting a range of 30–40 days.
Net Collection Rate: Aiming for 95–99%.

Using these benchmarks allows you to gauge your organization’s financial health and identify areas needing attention.

Step 3: Analyze with RevEval

Deploy RevEval to analyze your collected data. This AI-powered tool is designed to:

Identify inefficiencies and revenue leaks.
Provide root cause analysis of denied claims and underpayments.
Offer actionable recommendations for improving revenue cycle health.

RevEval goes beyond identifying problems—it provides step-by-step solutions tailored to your organization’s unique needs.

Step 4: Develop an Action Plan

Once the analysis is complete, implement changes based on RevEval’s insights. Focus on:

Reducing denial rates by addressing recurring issues in claim submissions.
Optimizing follow-up processes to shorten AR days.
Enhancing coding and billing accuracy to maximize reimbursements.

Step 5: Monitor and Adjust

Revenue cycle health is a continuous process. Regularly review KPIs and adjust strategies to align with organizational goals and evolving industry trends.

What Opportunities Does a RevEval Assessment Find?

A healthcare revenue cycle assessment with RevEval uncovers opportunities to:

Enhance Transparency

RevEval provides a clear, comprehensive view of your revenue cycle workstreams, ensuring you understand where inefficiencies exist.

Identify Revenue Leaks

Whether it’s denied claims, underpayments, or delayed collections, RevEval identifies where money is being lost.

Optimize Financial Performance

By addressing identified issues, your organization can accelerate cash flow, improve margins, and achieve sustainable financial health.

MGMA Benchmarks Used in RevEval

To ensure accurate and meaningful evaluations, RevEval incorporates widely recognized MGMA benchmarks. These benchmarks act as performance metrics, helping you understand how your organization measures up against peers. These benchmarks are essential for creating a performance baseline and driving targeted improvements.

Key metrics include:

Claim Denial Rate: RevEval identifies reasons for denials and offers strategies to reduce them.
Days in AR: The platform helps you lower AR days by improving collection efficiency.
Net Collection Rate: RevEval ensures you are collecting close to 100% of what is owed.

Three Phases of a RevEval Assessment

The RevEval process is designed for simplicity and impact. Here are the three phases of work in the assessment.

Data Extraction

RevEval ingests your organization’s 835, 837, and aged trial balance data for analysis.

AI-Powered Insights

Advanced analytics and AI algorithms process the data to uncover inefficiencies, revenue leakage, and their root causes.

Actionable Reporting

RevEval generates a detailed report with visualizations, insights, and specific recommendations for improvement.

This streamlined process minimizes disruption while delivering high-impact insights that drive meaningful change.

FAQs

Who Can Use a RevEval Assessment?

RevEval is a versatile tool designed for healthcare leaders across various roles and organizations:

Healthcare Executives

For CEOs, CFOs, and COOs, RevEval provides clarity on financial health, helping you make informed strategic decisions to enhance margins and cash flow.

RCM Leaders

As a VP or Director of Revenue Cycle, RevEval helps you identify and resolve bottlenecks, streamline workflows, and achieve industry-leading performance metrics.

Organizations That Benefit

RevEval caters to a wide range of healthcare organizations, including:

Conclusion

A comprehensive revenue cycle health assessment with benchmarks is essential for every healthcare organization. With RevEval, you gain the insights, tools, and guidance needed to optimize your revenue cycle, eliminate inefficiencies, and drive financial success.

Whether you’re a healthcare executive, an RCM leader, or managing a physician practice, RevEval provides a clear path to improved performance. Take control of your revenue cycle today and experience the transformative power of data-driven analytics with WhiteSpace Health’s RevEval.

Empower your organization to thrive financially by conducting your revenue cycle assessment guide with RevEval. The path to optimized revenue cycle health is clear—start your journey now!

About Ivan Bradshaw

Ivan Bradshaw is the vice president of product management at WhiteSpace Health. As a revenue cycle management executive with over 20 years of experience, Ivan is adept at building high-performance teams and creating RCM solutions that stop revenue leakage, improve operational efficiency, and grow top line performance. Ivan.Bradshaw@whitespacehealth.com