Claim Analytics to Optimize the Revenue Performance of a Clinical Laboratory

Gistia's predictive analytics team helps Kellison & Company optimize their revenue cycle operations.

The Challenge

Kellison & Company is a Revenue Cycle Management company. They specialize in clinical laboratories and healthcare providers to optimize their revenue performance. Kellison approached Gistia Healthcare with the following problem:  

A Kellison client requested greater visibility and a deeper understanding of their business:  

  • Which claims are being paid well?  
  • Which providers order tests that pay well?  
  • Which denial codes are most common for which payer, CPT code, and provider? 
  • Which regions are being paid well?  
  • Where should we focus our sales team for greatest value?

Answers to these questions are buried within the thousands of claims and remittances data stored in Kellison's billing system. Yet, manual review of these datasets is time-consuming and highly labor-intensive.

Gistia and Kellison teamed up to build a common vision in order to craft a data-driven solution. For two months they reviewed Kellison's business model, users, project and technical requirements, challenges and opportunities. Armed with this common vision, Gistia built the tools Kellison required.

“[With the interactive report] I can answer in less than ten seconds, in two screens, which diagnosis codes are problematic, which clients, which providers, which CPT codes, where they’re getting denials and payments. So that’s huge.”

Rhonda Merrill

VP of Operations at Kellison & Company

Goals

Kellison's client needed to understand their business better, to be able to view their business from a bird’s eye view. They needed to know at a high level, ‘how is my business doing?’  

A clear view of the business is important to help understand the big picture, and it needed to come first. Yet, many of the issues that arise with revenue payments are too nuanced to answer from a high level perspective. 

In addition to birds eye, the client also needed a magnifying lens. They needed to identify trouble areas to know where to focus their sales and account strategy.

Education is so valuable, being able to educate our clients on what they can do to improve their business is key. 

- Kellison's VP of Operations, Rhonda Merrill

Solution

Kellison required an Analytics Report that included both a written and an interactive version:  

Written report: 

An in-depth explanation of Gistia Healthcare’s methods, key findings, and specific recommendations. The written report included a comprehensive guide with examples. This tool shows how to find actional insights and answer questions.  

Interactive report: 

A powerful interactive tool with 30 dashboards, allowing for the exploration of claim and remittance data. Kellison and their client could investigate providers, payers, denials and claim aging within seconds.

Gistia’s Fine-tuned Approach

Gistia built these powerful claims reports after close collaboration with Kellison. This interactive approach allowed for continuous delivery, validating what Gistia had built as valuable and relevant. Gistia could analyze the results and give immediate actionable insights.

Figure 1: An example of one of the 30 interactive dashboards. One need only to click on the values to filter and slice their claims data from any angle. Kellison quickly and intuitively understand their numbers to answer key business questions. 

Business Benefits

Kellison can now answer questions far more quickly. This allows them bandwidth to dig deeper and resolve issues that are more nuanced. Arguably, Kellison's improvements show that questions are being answered over 100-fold faster. They optimize not just the big picture but the tiny details that make up a major portion of overall revenue.  

Estimates suggest Kellison's client will see a revenue improvement of 5-10% within the first 3 months. Additionally, the interactive report will likely provide ongoing revenue benefits.

Gistia’s Claim Report allowed:  

  • Immediately actionable, high-impact recommendations  
  • Improved revenue performance  
  • Understanding and reduction of denials  
  • Valuable insights about diagnosis codes  
  • Understanding of payer behaviors and patterns  
  • Deep understanding of client and provider performance  
  • Identifying key focus areas for account management and sales

[With Gistia’s Interactive Claim Report] I can answer questions in less than ten seconds, in two screens. Which diagnosis codes are problematic, which clients, which providers, which CPT codes, where they’re getting denials and payments. So that’s huge.

I’m much more in tune about my client, and their client base. I look at my top four clients and understand in ten minutes what payer mix, what diagnosis code, what CPT, what response time they’re getting.

So now with this information I can educate their sales team on what kind of business to go after. I’m much more in tune with what’s happening with their [claim] aging, I’m seeing where my denial issues are. It’s giving me a quick visual without having to go into the system and hunt.
 

- Kellison's VP of Operations, Rhonda Merrill

“There’s a narrative here, a beautiful story, the health of our clients, [our priorities, and our opportunities]. We know which clients we need to focus on.”

Rhonda Merrill

VP of Operations at Kellison & Company