EXL RCM 360 Analytics

EXL leverages its deep expertise in healthcare and AI to optimize revenue cycle management operations. Our solutions seamlessly integrate into customers Azure Cloud environment, enhancing financial performance, reducing denials, and improving operational efficiency.

Revenue Cycle Management Analytics Solution Implementation In today’s ever-evolving healthcare industry, Revenue Cycle Management (RCM) plays a vital role in maintaining financial stability and streamlining operations. A well-optimized RCM process—from patient registration to final payment—helps minimize denials, accelerate collections, and improve overall financial health.

How It Works Our RCM experts collaborate with key stakeholders to understand your current data capabilities, business goals, and challenges. We offer a prefabricated set of KPIs, dashboards, and models, enabling a structured approach that accelerates implementation. We define the scope, timeline, and cost estimates upfront and follow a milestone-based delivery model to mitigate risks and ensure cost efficiency. The solution is seamlessly deployed in the client’s Microsoft Azure environment, giving them full control and flexibility to customize it to their needs. Here’s how EXL enhances RCM operations with advanced analytics and AI insights:

Patient Access Analytics • Identify inefficiencies in appointment scheduling, wait times, and registration processes to streamline operations and enhance patient experience. • Automate insurance verification and pre-authorization checks to minimize denials and avoid unnecessary delays in patient care. • Provide real-time cost estimates for patient responsibility, helping improve financial transparency and engagement. • Leverage AI-driven insights to anticipate missed appointments and cancellations, allowing for proactive rescheduling and revenue protection.

Financial Services Analytics • Detect and correct missing or inaccurate charges to prevent revenue loss and ensure precise billing. • Compare expected vs. actual reimbursements to identify underpayments, delays, and contract discrepancies, enabling better financial oversight. • Track payment cycles, outstanding balances, and reimbursement trends to strengthen financial planning and improve cash flow management.

Accounts Receivable (AR) Analytics • Monitor accounts receivable (AR) aging, track outstanding balances, and optimize collection strategies to improve cash flow. • Analyse payer reimbursements, claim denials, and payment discrepancies to strengthen contract negotiations and maximize revenue. • Gain deep insights into AR drivers, segmented by payer, service type, and location, to identify key areas for improvement.

Denial Management Analytics • Uncover the root causes of claim denials, analyse patterns, and implement proactive strategies to minimize denial rates. • Leverage machine learning to predict high-risk claims before submission, reducing denials and the need for rework. • Track denials in real time, enabling quick resolution and minimizing revenue leakage. • Measure the effectiveness of denial appeals and recovery efforts, optimizing reimbursement outcomes.

Self-Pay Analytics • Categorize self-pay patients based on payment history, demographics, and financial status to tailor collection strategies. • Evaluate pre-authorization rates, eligibility denials, and patient responsibility estimates to enhance front-end revenue cycle efficiency. • Detect documentation gaps and ensure adherence to ICD-10, CPT, and DRG coding standards, reducing revenue loss. • Leverage AI-driven automation to send personalized payment reminders, increasing patient collections and reducing overdue balances.

Bad Debt Analytics • Utilize AI-driven models to predict accounts at risk of becoming bad debt, enabling better financial planning and risk management. • Analyse self-pay patient behaviour to forecast payment likelihood and enhance collection strategies. • Identify and prioritize high-recovery potential accounts, maximizing collection efficiency and reducing write-offs.

Workforce Management Analytics • Analyse workforce activity & productivity, patient volumes, and demand patterns to optimize staffing. • AI-driven forecasting to create efficient shift schedules. • Monitor claims processing, billing accuracy, and staff performance to enhance efficiency.

Why Choose Our RCM Analytics Solution? • Proven track record in helping providers and payers optimizes financial performance. • You own the IP. Securely deployed in your Microsoft Azure environment, ensuring scalability, compliance, and full control. • EXL’s domain expertise, AI first approach to deliver actionable insights. Contact us today!