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Healthcare Technology for A&G: Why Data-Driven Reporting is the Path to Operational Improvement

Authored by: Jon Swisher 

Wouldn’t it be nice to get a little time back each week? Ask any member of an Appeals and Grievances (A&G) team, and the answer is a resounding ‘Yes!” These folks find themselves under the weight of tight deadlines and large caseloads facing regulations that are a seemingly always moving target.  

Reporting is necessary, yes.  

But time-consuming reporting? Not so much…  

And while you can’t necessarily add more hours to the day, you can achieve improved operational efficiency with healthcare technology tools like data-driven reporting. 

 

In case you’re interested in learning how to leverage healthcare technology for reporting, we’ll break it down for you here:  

Healthcare technology and compliance  

We’re all facing deadlines of some sort, but with appeals and grievances, missing those deadlines is costly, which is why data-driven reporting is so helpful. It supports you in more effectively identifying, resolving and addressing any potential issues before you slip out of compliance.  

 

Data dashboards can help you view key metrics — like average time to completion for cases, how many are due in the next three days and how many are due today — in a single place. You can leverage this information and make more informed decisions about where to focus your time and energy.  

 

For example, maybe you need to put more resources into staying on top of cases that are due within the next 72 hours. If so, you could set a threshold, such as 20 cases, with data-driven reporting. Once you reach that threshold, you’ll know it’s time to ring the alarm.  

Also, you can view critical data about your team.  

Who are your rock stars? What team member completed the most cases over the past several days, and, conversely, who has completed the fewest? With this data, you can help those struggling find more support, training and resources to get up to speed. 

 

This visibility also allows managers to make quick pivots when necessary. For example, if a staff member is unexpectedly out of the office, their manager can easily reallocate those cases to keep them moving.  

A&G healthcare technology: alarms, alerts, and notifications  

In addition to data-driven reporting, you’ll want intelligent notification capabilities — with the ability to make manual adjustments. To return to that earlierexample, perhaps you want to change the threshold for cases reaching 72 hours or less from 20 to 15. You should be able to do this in your dashboard. You never want notifications to be an annoyance, so you’ll want the ability to customize them based on internal workflows.  

A&G healthcare and financial risk assessment  

Financial risk management is a critical part of any business, but especially so for appeals and grievances departments. Every case comes with potential exposure, and together, they add up to a large amount of liability. Data-driven reporting can give you visibility into total exposure.  

 

For example, we have a financial risk dashboard that allows you to view critical metrics, such as total claims amounts, average claims amounts over a specific period, current appeals risks, and more.  

CMS compliance and reporting efficiency  

Staying compliant with Centers for Medicare & Medicaid Services (CMS) requirements isn’t always easy. Data-driven reporting can help you generate CMS-compliant reports, ensuring standards are met automatically.  

 

You also have a single source of truth, which ensures all data is accurately captured and adequately formatted. This capability supports you in proactively managing the quality of reports, ensuring compliance, and avoiding penalties for report untimeliness issues. Also, once you create the reports, which help you coast through an audit, you can share them with other users.  

Appeals and grievances: healthcare and the future  

As you move into the new year, one thing is certain: operational efficiency will continue to increase in importance. When you have healthcare technology tools such as data-driven reporting that support that efficiency, you can get ahead in your workload, better support staff, and help reduce risk.  

 

And with appeals and grievances being critically important to mitigating potential risk and serving your members, these capabilities will improve member experiences while helping you stay on track with internal goals.  

Are you curious about how data-driven reporting can support improved compliance? Contact us and we’ll walk you through how the right tool can help.

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