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Reimbursement optimization doesn’t stop at billing—it requires active oversight, efficient workflows, and cross-functional collaboration. While part one of this series focused on identifying reimbursement variances and understanding payor contracts, this follow-up explores how to sustain those gains and take your strategy further.
Use Payor Scorecards to Track and Improve Performance
Payor scorecards give organizations the ability to monitor how each payor is performing over time. By tracking denial rates, payment speed, and contract adherence, your team gains valuable leverage when addressing issues or renegotiating terms.
“Scorecards let us evaluate payors side by side,” says Brian Kenyon, AVP of AI and Revenue Services, PMMC . “At a glance, we can see how long it takes them to pay, what services they deny most, and use that data to optimize contract negotiations and appeals strategies.”
With payor scorecards, you can:
- Identify which payers consistently underperform or delay payments.
- Track key metrics such as denial percentage and days to pay.
- Make data-driven decisions to improve your revenue and strengthen payor relationships.
Streamline Workflow Management with Automation and Insight
Efficient workflows are essential to maximizing your recovery efforts. Analytics helps teams move away from reactive processes by flagging bottlenecks and automating the most repetitive parts of the reimbursement cycle.
With analytics, we can identify specific areas where improvements are needed to find the root cause of denials. Automation helps us group similar underpayments and generate appeals or pricing reviews—freeing up staff to focus on higher-value work.
With structured, analytics-driven workflows, your team can:
- Automatically flag overdue claims for follow-up.
- Trigger reminders for pending documentation or next steps.
- Prioritize efforts based on volume, payor timelines, or dollar value.
The result? Less manual work, faster resolutions, and more recovered revenue.
Foster Continuous Improvement Through Collaboration
Analytics doesn’t just drive better decisions—it also unites departments with a shared understanding of what’s working and what’s not. By embracing a culture of continuous improvement, organizations can ensure sustainable results over time.
“We all have the same end goal,” says Brian. “When teams collaborate and are adaptable to change, improvement becomes part of the workflow—not a one-time project.”
Here’s how analytics helps your team continuously improve:
- Track performance in real-time, including claim submission speed and resolution rates.
- Set realistic, data-driven goals tailored to your organization's specific reimbursement landscape.
- Improve communication across departments by sharing insights that impact coding, billing, and registration.
Unlock Long-Term Reimbursement Success
Maximizing reimbursement isn’t just about resolving today’s claims—it’s about future-proofing your financial strategy. When teams use payor scorecards, automation, and collaboration effectively, they create a recovery process that’s proactive, efficient, and scalable.
“There are things you don’t realize are happening until you see the data,” says Brian. “When you show results in a dashboard, it creates buy-in across the organization. That’s when things really start to change.”
Looking ahead, the next frontier for reimbursement analytics is AI. As payers increasingly rely on AI to deny claims, provider organizations must harness the same technology to detect trends, predict risks, and respond faster than ever before.
AI is already being used by insurers to deny claims. Now you can use AI to analyze denial and underpayment trends—allowing your team to get back to recovering revenue quicker and smarter.
Want to learn how PMMC analytics can transform your reimbursement outcomes?
Let’s connect. Contact us or schedule a demo to see how our contract management solutions deliver clarity, control, and results.
Explore how PMMC’s payor scorecards, collaborative workflows, and automation tools can drive even greater reimbursement results. Discover how to align teams, track payor performance, and streamline your revenue recovery process from end to end.
