New Advanced Analytics Appeals Dashboard Provides Deeper Insight to Improve Appeals Success

The XiFin team is constantly working to develop new ways for our customers to get more value from their revenue cycle management (RCM) data. This includes making it easier to spot trends and discover the cause of any changes. Recently, we launched six new Advanced Analytics dashboards designed to help you do just that.

Today’s article focuses on the new Advanced Analytics Appeals Dashboard. This dashboard helps customers answer several important questions, including:

• How much additional revenue is being collected through the appeals process?
  
• Is the appeals process worth the effort?
  For example, is the revenue received worth the effort and expense being invested into the appeals process?
• Could outcomes be improved on those appeals with lower rates of return?
  
• How long is it taking to resolve the appeals?
  
• What steps can be taken up front in the RCM process to eliminate the need for some appeals?
  For example, suppose a customer has a high success rate with appeals for a particular procedure code at a particular payor. In that case, it probably makes sense to look into what is driving the appeal success and determine if that action can be taken in the regular RCM process (e.g., providing a particular piece of information or documentation), which may help avoid the appeal altogether.

The Appeals Dashboard provides an analysis of appeals identified or conducted in XiFin RPM. The dashboard displays appeal success metrics by Payor Group and provides a drill-down to Appeal Payor Name. Users can also see top Procedure Codes based on appeal count for the selected period with a drill-down from Procedure Code to Appeal Payor Group. As part of XiFin RPM business intelligence, a number of capabilities come standard, including appeals related reports at the accession/encounter/visit/test level. XiFin also offers advanced analytics as an option which provide a much more granular view of the appeals process so that customers are better able to identify payor policy changes affecting reimbursement.

From the dashboard, users can drill down to the accession/encounter/visit/test-level data, and both the drilldown details and dashboard can be easily exported for further analysis.

Below is an example of the “Success Metrics by Appeal Payor Group” view with the payors deidentified. Customers will see their specific payors in this view. In the upper left corner, the chart illustrates the appeal success rate based on total completed appeals (successful plus unsuccessful) by payor group during the selected time period.

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In the upper right corner, the chart illustrates the additional revenue captured by each appeal cycle by payor group. This can help customers determine the value of completing additional appeal cycles for specific payor groups. At the bottom of the screen are detailed success metrics by payor group including appeal count, the additional benefit collected, the average number of appeal cycles, etc. From this chart, users can also drill down from Payor Group to Payor Name.

In the Advanced Analytics Appeals Dashboard, users can also see “Top Procedure Codes by Appeal Count,” an example of which can be seen below. This view illustrates the top procedure codes based on the appeal count for the selected time period. Users can drill down in this view from procedure code to payor group and from the “Grand Total” chart at the bottom of this view, users can drill down to the accession/encounter/visit/test detail.

Click to enlarge.

In a third view in the Advanced Analytics Appeals Dashboard, users can see “Appeals by Resolution State.” In this view (see example below), users can see detailed data on appeals by resolution state (i.e., successful, unsuccessful, pending, canceled, etc.) by payor group.

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In the final view, the “Appeals Trending Dashboard,” an example of which is seen below, users can see an analysis of appeal performance over time with several charts that indicate, among other things:

• Completed appeal counts with success rates
• Gains from successful appeals
• The impact of each appeal cycle
• Appeal resolution and success rates, which displays all appeals, resolved appeals (successful plus unsuccessful), compared against successful appeals

Click to enlarge.

The new Advanced Analytics Appeals Dashboard provides important information to help customers track the productivity of their appeals process and ensure that they are achieving the additional revenue to make the effort of the appeals process worth it. It can also help identify payors where there may be a payor policy issue for the customer’s market access team to investigate further. Finally, this data can help a customer’s Finance team better understand the expected timing of revenue based on the latest appeals data.