APIs: Your Revenue Cycle’s New Best Friend

Sep 16, 2019 | Blog Article

A growing number of healthcare organizations are now using Application Programming Interfaces (APIs) to deliver information to patients and to work more intelligently with payers, partners, and government agencies.

But how exactly do they help?

Whether you want to enable web and mobile access to diagnostic tools, connect with providers, patients, and payers, or provide faster, more up-to-date patient information, APIs can make it easier to interact with your target audience. APIs can also be used for sharing patient data, giving the patient, provider, and payer access to data using their chosen application, or allowing for the aggregation of medical history. 

To facilitate a patient-facing open API, hospitals must gather data from many applications into one intelligent stream. An interoperable layer will then serve as the health data platform to transfer information between applications, allowing IT departments to break free from data silos and gain an enormous amount of intelligence transmitted between systems. 

Healthcare data is commonly exchanged using HL7 V2 messages via TCP/IP connections, but thanks to the various levels of adherence to the HL7 standards between vendors, it actually creates a few challenges when dealing with data interoperability.

APIs offer a cheaper, lighter, and easier format, where providers can connect to internal systems and gain the flexibility to facilitate external data-sharing requests by simply sharing the approved API standard. 

Create the Experience You Envision

APIs help providers add richer, more accurate, actionable content from payers, automating the revenue cycle to achieve better outcomes. You load the details about the patient encounter, and your API responds with account updates throughout the processing cycle. 

Here’s what you get when you interface with our API:

1. Enriched Data. You can get enhanced eligibility, authorization, medical necessity, and patient estimation content brought by EDI and our ReconBot technology. 

We automate the discovery of an individual’s current levels of coverage before and after services, determine patient financial responsibility, show detailed benefits, and leverage price transparency. 

Recondo’s API also gives you access to a full authorization suite with over 1 million rules, including commercial and government plans, CCI edits, procedure modifiers, LCD, and ABN. 

2. Logic Engine. Our logic engine resolves benefits, normalizes the variation of payer data, interprets the meaning of responses, finds the best routes for information, and uses rules for accurate content creation. In other words, we turn your complexities into communication and strategize your content.

Our API model was designed specifically around the patient encounter. So we treat that encounter as holistically as possible. When there are changes to a patient’s location of service, procedures, or coverage, it affects the encounter. Sometimes drastically. Rather than generate a large number of API endpoints, we’ve limited them, driving simplicity in design to your specification.

3. Next Best Actions. Our API shows you when authorization is needed, what benefits to use for an estimate, alerts to take preventative action for denials, and what next step is the best action to take in your revenue cycle workflow. 

The bottom line is this: we’re building tools to empower and enrich your healthcare business. Tools that shorten the gap between patients, payers, and providers. 

A Quick Recap

According to the 2014 HIMSS Analytics Cloud Survey, 82.7% of healthcare providers report using cloud services of some sort. Healthcare IT departments need a central command, an “eye in the sky” if you will, to help guide the flow of data between applications and systems and to ensure that staff have the right patient data with the right insights at the right time.

An EHR might only allow HL7 V2 via TCP/IP, while a population health system only exchanges SOAP web service messages. That’s a problem. Now add to the mix the vast array of additional applications your organization has, and the build starts to get more complicated. And quickly. 

A modern integration engine can accept and send data in any format or protocol.

The shift to API is coming, and the hype will only continue to grow from here. Luckily, with a little help from us, you can stay one step ahead.

See how you can leverage Recondo’s content via our API.


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