Healthcare revenue cycles are drowning in inefficiencies, costing the industry a staggering $265 billion annually. This loss stems from a fundamental disconnect: clinical and financial systems don’t talk to each other. Without bridging this gap, healthcare organizations will continue to bleed revenue and resources.

Clinical and financial data integration is the essential first step in addressing this challenge. Without unified data, health systems cannot identify how clinical decisions impact reimbursement, leading to missed revenue and inefficient operations. According to an HFMA survey, only 15% of health systems feel "very prepared" to handle modern healthcare demands with their current data processes and solutions. This data gap isn't just a technical problem; it's a strategic imperative for health systems striving to remain competitive.

At Sift, we’ve developed an innovative solution to this challenge through Sift’s Payments Intelligence Platform. This platform powers sophisticated data aggregation that unifies information from clinical documentation, coding systems, EHRs, and remittance files. By connecting these disparate data sources and transforming them into actionable insights, the platform resolves fragmentation and paves the way for scalable, AI-driven revenue cycle optimizations. This industry-first integration creates a foundation for transformative solutions like Autonomous CDI and clinical denial predictions, meaningfully improving revenue cycle operations, reducing manual efforts, and preventing adverse payment outcomes.

The Complexity of Healthcare Data

Healthcare organizations face a unique data challenge impacting how claims get created. Patient information flows through multiple systems: clinical documentation platforms capture care delivery, coding systems translate that care into billable services, EHRs maintain patient histories, and remittance files track payments. Each system speaks its own language and serves its own purpose, creating natural silos that impact both patient care and financial outcomes. These silos lead to higher costs, slower revenue cycles, and staff burnout—all symptoms of a system designed for inefficiency.

Previous attempts to solve this problem have focused on individual parts rather than the whole. Traditional solutions that target isolated workflow challenges—like standalone documentation tools or separate billing systems—can't provide the comprehensive view needed to connect clinical decisions to financial outcomes. Even sophisticated healthcare organizations struggle with basic questions: Which clinical practices lead to better reimbursement rates? How do documentation choices impact denial likelihood?

The consequences are clear. Administrative complexity has become the largest source of waste in healthcare, primarily driven by the inability to effectively connect clinical and financial data. Without this connection, health systems remain caught in a cycle of reactive responses rather than proactive management of their revenue cycles.

The Foundation: Data Aggregation

Modern healthcare solutions start with a simple premise: connect clinical care to financial outcomes. But achieving this connection is far from simple. It requires bringing together data from systems that were never designed to communicate:

• Clinical documentation platforms tracking patient care
• Coding systems translating care into billable services
• Electronic Health Records maintaining patient histories
• Remittance files (837s and 835s) documenting payments and claims

Sift's unique approach begins with aggregating these disparate data sources into a unified system (our Payments Intelligence Platform). Our continuous Data Integrity process goes far beyond collecting data - we clean, normalize and augment the information. As a result, a patient’s clinical care is linked directly to their financial outcome, with history showing how clinical inputs impacted payment and with terminology aligned across systems.

This foundational work of unifying clinical and financial data creates the bedrock for everything that follows. Clean, connected data is necessary to build effective ML and Generative AI (LLMS) solutions that identify meaningful patterns accurately. Unified data creates critical connections for workflow optimizations. Without this foundation, health systems remain trapped in reactive cycles rather than moving toward proactive revenue cycle management.

Building Intelligence From Data

With a foundation of unified clinical and financial data, Sift deploys machine learning models that connect clinical decisions to financial outcomes in real time. Unlike black-box AI solutions that simply provide predictions, Sift's approach maintains transparency about why predictions are made, allowing health systems to understand and address the root causes of payment issues.

The unified data enables Sift's ML models to:

• Identify which clinical documentation patterns lead to successful payment
• Predict denials before they happen by recognizing high-risk patterns
• Spot opportunities to improve documentation across the care continuum
• Guide workflows toward optimal payment outcomes

These capabilities emerge from the combination of comprehensive, unified data and sophisticated AI, creating a learning system that becomes more intelligent over time. As the system processes more interactions between clinical decisions and financial outcomes, it continuously refines its ability to guide better decisions.

Healthcare organizations face significant challenges, spending an estimated $20 billion annually on claims denials. With an average initial denial rate of 12% and mid-revenue cycle denials (clinical denials) comprising 17% of all denials, the need for better, data-driven solutions is clear.

This integration between Sift’s industry-leading data aggregation, ML and GenAI, reshapes traditionally reactive processes into proactive management. Sift’s unified data approach addresses the root causes of revenue leakage and enables advanced innovations to improve operational efficiency, reduce manual workloads, and ultimately free up more resources for delivering exceptional patient care.

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