Revenue Performance Advisor Flashcards
What is Optum’s Revenue Performance Advisor (RPA)?
It’s an end-to-end revenue cycle management software solution for healthcare providers that centralizes billing and payment workflows. RPA helps organizations simplify complex revenue cycle tasks, from verifying insurance and submitting claims to processing payments, in order to reduce denials and maximize revenue collection  .
What are the core benefits of using RPA in a healthcare practice?
RPA streamlines the entire billing process, which improves efficiency and reduces manual work for staff. Key benefits include faster reimbursements from payers (thanks to cleaner claims and quicker turnaround) , fewer claim denials (due to upfront validation and AI denial prevention) , and increased patient payments collected (through upfront cost estimates and easier payment options) . Together, these lead to better cash flow and a more predictable revenue cycle.
What revenue cycle tasks or use cases can RPA support?
RPA can handle virtually every stage of the revenue cycle. For example, it verifies patients’ insurance eligibility and benefits before visits, ensures clean claim submission by editing claims in real time, attaches any required documents to claims, and electronically submits claims to payers . It then tracks claim status and helps manage any rejections or denials (including generating appeal letters). Finally, it supports patient billing by issuing statements and taking payments. In short, from patient check-in to payment posting, RPA provides tools for all major RCM functions .
What are some key features of Revenue Performance Advisor?
Notable features of RPA include: Insurance eligibility verification (with connectivity to thousands of payers for instant coverage checks) , a claims management module that scrubs and corrects claims in real time to achieve a high first-pass acceptance rate , and an advanced denials management system that uses AI to predict and prevent denials . It also provides electronic attachments for supporting documents, an extensive library of pre-built appeal letters for contested claims, and comprehensive reporting & analytics dashboards to monitor performance and trends .
What distinguishing features make Optum’s RPA stand out from other RCM solutions?
RPA is distinguished by its all-in-one breadth and intelligent automation. It connects with over 2,200 payers for eligibility and claims, giving it one of the largest networks for coverage verification and electronic claim submission . It also uniquely incorporates AI-driven denial prediction to flag high-risk claims before they are sent, helping providers avoid lost revenue up front . Additionally, RPA offers peer benchmarking analytics, allowing a practice to compare its revenue cycle metrics against industry peers for deeper insight . These features – along with outcomes like a ~99% first-pass clean claims rate – set RPA apart as a cutting-edge solution for revenue cycle management .
