Case Study

Gravity Diagnostics: AI Powering Revenue Cycle Success

Executive Summary

Gravity Diagnostics, a state-of-the-art laboratory, confronted the challenges of a high-complexity reimbursement environment by partnering with Gistia. They leveraged AI, automation, and machine learning to enhance their revenue cycle performance. Gistia's system processed enormous financial and operational data, unmasking hidden risks and delivering actionable insights, leading to a 24% reduction in denial rates, a 370% boost in denial resolutions, and a 27% increase in average payment rates. This case underlines the profound potential of tech in revolutionizing healthcare finance.

Outcomes

  1. Denial Rates Decreased: A substantial 24% YOY reduction in denial rates (2021-2022).
  2. Resolution of Denials Amplified: A staggering 370% increase in denial resolutions (May 2021 - April 2022).
  3. Average Payment Rates Boosted: A 27% YOY increase in average payment rates (2021-2022).

About Gravity Diagnostics

Gravity Diagnostics is a CLIA-certified, CAP-accredited laboratory, licensed in all 50 states. Serving a diverse clientele, from small private practices to universities and Fortune 500 companies, they offer innovative laboratory testing across various fields.

The Challenge

High denial rates threatened Gravity's financial health due to the complex reimbursement environment and a large test compendium. The crucial requirement was a system capable of intelligently analyzing extensive data and unmasking threats to their revenue cycle performance.

Key Features

Gravity's RCM Team partnered with Gistia to devise an innovative approach. Gistia's machine learning algorithms processed extensive data to detect potential risks and alerted the team of factors impacting denials and average payment rates.

Key RevenueIQ Features:

  1. Real-time KPI Monitoring: One of the key features of Gistia's RevenueIQ system that Gravity Diagnostics utilized was Real-time KPI Monitoring. This feature allowed the RCM team to constantly monitor their revenue cycle performance and receive real-time notifications of potential risks. This allowed the team to be proactive in issue resolution and focus their efforts efficiently. The ability to monitor KPIs in real-time was crucial to the success of the partnership and contributed to the significant improvements in denial rates and average payment rates that Gravity Diagnostics experienced.
  2. Underpayment Detection: Gravity Diagnostics utilized a feature of Gistia's RevenueIQ system called underpayment detection. This feature allowed the RCM team to identify situations where they were not receiving the full payment amount for services provided. Gistia's system analyzed the data and flagged cases where the payment received was less than expected based on the services provided. This enabled the team to take corrective action and recover the underpaid amounts, which played a significant role in improving Gravity Diagnostics' revenue cycle performance.
  3. Claim-Based Revenue Forecasting: Gistia's RevenueIQ system offers a claim-based revenue forecasting feature that allows Gravity Diagnostics to forecast their revenue based on their claims. By analyzing the data, this tool predicts future revenue, giving the RCM team valuable insights into their revenue performance. This feature is an essential tool for Gravity Diagnostics as it helps them make informed decisions and adjust their revenue cycle performance to stay ahead of potential revenue risks.
  4. Payer Behavior Monitoring: Gistia's RevenueIQ provides a payer monitoring feature that allows Gravity Diagnostics to gain insights into payer behavior. By analyzing data, this feature helps the RCM team identify payer trends and optimize billing practices to align with payer requirements. By better understanding payer behavior, the team is able to reduce denial rates and increase average payment rates, resulting in improved financial performance for Gravity Diagnostics.