Revenue Cycle Optimization

Intelligent revenue cycle management with 68% denial rate reduction and 42-day collection cycle.

Business Challenge

A health system with $2.8B annual revenue experiences 12% claim denial rates, 95-day average collection time, and $340M in outstanding receivables, with 1,100 FTEs managing revenue cycle.

Agent Collaboration Architecture

Detailed Agent Workflow

1. Sindhan Discover - Revenue Process Mining

• Input: Claims data, denial records, payment histories
• Processing: Identifies revenue leakage points and process inefficiencies
• Output: Denial root causes, process gaps, opportunity analysis
• Finding: Discovered $45M in preventable revenue leakage

2. Sindhan Analyze - Documentation and Coding

• Input: Clinical documentation, coding data, payer rules
• Processing: Analyzes documentation completeness and coding accuracy
• Output: Documentation gaps, coding opportunities, compliance risks
• Impact: Identifies $2.3M monthly in undercoding

3. Sindhan Predict - Financial Forecasting

• Input: Claim characteristics, payer history, patient factors
• Processing: Predicts denial probability and payment timing
• Output: Denial risk scores, payment predictions, collection forecasts
• Accuracy: 91% accuracy in denial prediction

4. Sindhan Decide - Revenue Optimization

• Input: Predictions, payer policies, resource constraints
• Processing: Optimizes coding, prioritizes appeals, targets collections
• Output: Coding recommendations, appeal strategies, work prioritization
• Intelligence: Maximizes revenue while maintaining compliance

5. Sindhan Execute - Automated Processing

• Input: Optimized claims, appeal strategies, collection plans
• Processing: Automates claim submission and follow-up
• Output: Submitted claims, filed appeals, patient communications
• Automation: 83% of claims processed without manual intervention

6. Sindhan Optimize - Continuous Enhancement

• Input: Payment outcomes, denial trends, process metrics
• Processing: Learns from outcomes to improve future performance
• Output: Enhanced algorithms, process improvements, training needs
• Learning: 5% monthly improvement in first-pass rate

7. Sindhan ROI & Strategy - Revenue Leadership

• Input: Financial performance, payer relationships, market dynamics
• Processing: Strategic revenue cycle planning and optimization
• Output: Payer strategies, technology investments, process redesign
• Vision: Guides transformation to autonomous revenue cycle

Implementation Results

Financial Performance

• Denial rate reduced from 12% to 3.8%
• Days in AR decreased from 95 to 42
• Cash collections increased by $127M annually

Operational Efficiency

• FTEs reduced from 1,100 to 420
• Cost to collect decreased by 68%
• Clean claim rate improved to 97%

Strategic Benefits

• Payer contract negotiations improved by data insights
• Revenue predictability increased by 84%
• Working capital requirements reduced by $230M

Key Features

Automated Coding

• AI-powered Coding: Intelligent medical coding assistance
• Clinical Documentation: Real-time documentation guidance
• Code Validation: Automated compliance checking
• Charge Capture: Comprehensive charge capture optimization

Denial Management

• Root Cause Analysis: Automated denial reason analysis
• Appeal Automation: Intelligent appeal generation
• Payer Pattern Analysis: Payer-specific denial patterns
• Workflow Optimization: Streamlined denial workflows

Patient Financial Services

• Payment Plans: Automated payment plan setup
• Financial Counseling: Pre-service financial counseling
• Collections: Intelligent collections prioritization
• Self-service Portal: Patient payment portal

Getting Started

Ready to optimize your revenue cycle?