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Case Study: Root Cause Analysis and Revenue Recovery for Healthcare Client
Project Overview: We partnered with a healthcare organization to conduct an in-depth root cause analysis aimed at resolving discrepancies in their physician billing process. The goal was to uncover and rectify issues impacting the accuracy of Revenue Value Units (RVUs), which are crucial for physician compensation and billing.
Challenge: The healthcare organization experienced significant revenue discrepancies due to an error in their RVU calculations for physicians. This issue resulted in unrealized payments and affected their overall financial performance.
Solution: Our team utilized SQL Server Management to perform detailed root cause analysis on their data, specifically targeting the ETL (Extract, Transform, Load) processes. During our investigation, we identified a critical error in the ETL process that had gone undetected, leading to inaccuracies in the RVU reporting.
Results: By rectifying the error in the ETL process, we helped the organization recover over $400 million in unrealized payments. This significant revenue recovery had a direct impact on their bottom line and improved the accuracy of their physician billing systems moving forward.
This case study showcases the impact of data analytics and highlights the importance of accurate data management in healthcare revenue cycles.
