Claims denial and length-of-stay BI
Clinical operations and billing on one model, tracking claim denials by payer and reason and length of stay by unit and specialty.
- Occupancy rate
- 84.6%
- operational beds
- Average length of stay
- 4.2 days
- all specialties
- Claim denial
- 6.8%
- on billing submitted
- Revenue per bed-day
- $2,140
- net of claim denial
Illustrative figures · fictitious client · under NDA
The challenge
A hospital network lost revenue to claim denials it could not explain and could not see length of stay in time to manage capacity, with clinical and billing data apart.
What we built
We brought clinical operations and billing onto a governed model and built Power BI dashboards for claim denials by payer and reason and length of stay by unit and specialty, built with HIPAA in mind.
- A governed model joining clinical operations and billing.
- Claim denials by payer and reason.
- Length of stay by unit and specialty.
Outcomes
- Denials traced to payer and reason so they can be worked.
- Length of stay visible in time to manage capacity.
- Clinical and billing on the same numbers.
The dashboard we delivered
Claim denial over billing
Monthly percentage, against the 5% target
Billing by unit
Click to open by specialty
Encounters in the slice
One row per hospital account submitted
Illustrative dashboard with the structure delivered on the project. Client names and figures are fictitious and under NDA.
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