Healthrise, a health care consulting and technology firm in Farmington Hills, has expanded its Quality Audit Platform with Smart Account Selection, a new capability designed to help health systems move beyond random account sampling and prioritize the accounts most likely to require attention.
Smart Account Selection uses configurable risk metrics and data signals to surface accounts with specific, evidence-based reasons to be reviewed. These signals can include elevated financial risk, payer-specific behavior, and indicators associated with billing errors or downstream denials.
Reviewers and managers can select and filter by risk metrics aligned to their specific audit objectives, creating focused audit populations without relying on manual account selection. This helps teams spend less time on low-value reviews and more time investigating accounts with greater potential financial or operational impact.
“Revenue cycle teams can only look at so many accounts in a day, so every account should have a reason to be there,” says Tiffany Naughton, principal data scientist at Healthrise. “Smart Account Selection puts the accounts with the greatest risk and potential impact in front of reviewers first, helping teams find issues faster, see patterns sooner and get more value from every audit.
“When front-end and back-end teams can act on risk-flagged accounts quickly and with confidence, they stop chasing problems after the fact and start preventing them at the source. That is how quality audit becomes a true driver of revenue cycle performance.”
Selection logic and risk models can run automatically, allowing prioritized accounts to be available for review on an ongoing basis. This helps shorten the gap between when an issue occurs and when it is identified, giving revenue cycle teams an opportunity to address problems before they contribute to downstream denials, rework, or additional financial impact.
The approach also can help organizations identify patterns across payers, account types, and staff, according to Healthrise. When multiple accounts share a common risk characteristic, audit findings can provide actionable insight into where billing issues are occurring and where targeted coaching, training or process improvements may have the greatest return.
The new capability reflects a broader shift in health care quality auditing from retrospective, random-sample reviews toward more targeted, proactive approaches. While random sampling can provide a broad view of performance, it also can give equal weight to low-risk and high-risk accounts. Data-driven selection allows health systems to direct limited audit resources toward accounts with specific risk signals and potentially intervene before issues become denials or rework, according to the company.
Building on this targeted approach, Healthrise also is introducing Real Time Alerts to help revenue cycle teams move from identifying an issue to correcting it in the same workflow.
When an auditor flags an issue during an account review, Real Time Alerts immediately notifies the team member responsible for the account by email and in the application, including the flagged account and auditor’s comments. The team member can correct the issue and mark it resolved, with the notification, response, and resolution automatically documented in the team member’s monthly assessment.
By replacing fragmented handoffs through email, Teams, and manual tracking, Real Time Alerts helps close the gap between identifying an error and fixing it, before a claim moves downstream and the issue becomes a denial, rework, or lost revenue.
“The point of an audit isn’t to document what went wrong, it’s to stop it before it costs the organization,” says David Farbman, CEO of Healthrise. “Smart Account Selection puts the highest-risk accounts in front of auditors first, and Real Time Alerts gets those findings to the right person while there’s still time to act. Together, they turn quality auditing from a retrospective exercise into a real-time driver of revenue cycle performance.”
Together, Smart Account Selection and Real Time Alerts create a more proactive quality audit workflow, helping revenue cycle teams identify the accounts that matter most, surface issues earlier, focus audit resources where they can have the greatest impact, and connect findings directly to the people responsible for correcting them.
To learn more about Healthrise’s Quality Audit Platform and data-driven approach to revenue cycle performance, visit healthrise.com.
