Business KPIs are vital to every company’s growth since they provide data-driven information necessary for decision-making and change. Revenue cycle managers must have a defined plan before implementing the processes because they operate as intermediaries between the practice and insurance carriers.
KPIs in revenue cycle management dig down on their skills efficiently and interestingly, assisting managers in laying out practical guidelines for raising productivity and profitability. RCM takes care of the entire processing procedure, from scheduling the patient’s appointment to securing reimbursements for the practice.
They can improve the performance of the revenue cycle and introduce a productive revenue cash flow cycle using precise details. By monitoring these 9 KPIs, practices or RCM specialists may keep track of the revenue cycle process and strike a balance that enables them to concentrate more on providing patient care.
9 KPIs for revenue cycle management optimization.
Rate of preregistration
The Preregistration KPI shows whether or not the patient onboarding procedure and scheduling of appointments have gone smoothly. Therefore, medical professionals can guarantee correct demographic data and prompt registration procedures.
Verification rate for insurance
By standardizing procedures, the insurance verification rate guarantees precise patient eligibility documentation. It supports the preservation of the necessary industry standard for collecting valid claims. More than 98% of insurance verification requests are approved following the standards.
Cash Collection at the Point of Service
Payments taken from patients before, during, or up to seven days following discharge are referred to as POS cash collections. Co-payments and co-insurance are a couple of them. The KPI value for this is calculated by dividing the POS payments by the amount of patient self-pay. These KPIs help the POS team’s accounting efficiency by enabling them to spot and address POS-related problems that impact the overall RCM processes.
The frequency of claim denials
A denial rate of less than 5% and a positive cash flow are indicators of a good revenue cycle. However, practices can continue operating within the range of 5% to 10%, but anything over 10% necessitates immediate attention due to widespread credentialing problems, eligibility verification, and coding examination for errors and relevancy.
The total number of claims denied by payers is divided by the total number of claims submitted for a given period to determine the KPI for the claim denial rate.
The frequency of clean processing claims
A clean claim rate is a portion of submitted insurance claims successfully reimbursed following the first filing. It indicates that processing insurance coverage and accounts receivable was completed quickly and accurately. Managers can determine how effectively they submit claims by measuring KPIs for clean claims, practices, and revenue cycles while learning the typical processing time and resubmission fee.
Number of Days in Receivables
Less than 40 days is the reference period for The Days in AR. The corresponding KPI assists in determining the typical time required by the AR team to collect fees for the services they have provided. It is determined by: The total number of days in the given period multiplied by the average daily rate for the preceding months.
Income Per Patient Visit
Per-contact revenue enables a thorough understanding of the effectiveness of the revenue cycle. It is derived by dividing the overall collections for a particular month by the overall encounter total.
Unbilled Discharges
This indicator aids in the comparison of different other practices in a specific geographic area. To make sure that the services provided are turned into money, it is essential for techniques to preserve this component. Methods may experience severe revenue leakage without appropriate unbilled charges tracking. This metric is calculated by dividing the unbilled amount for discharged patients by the average daily revenue.
Failure to Submit Discharges to Payer
This specific indicator shows the total number of claims generated and submitted. It aids in ensuring improved revenue cycle efficiency and spots any problems with cash flow or with the submission of claims. A maximum of 7 days is permitted by industry standards for unbilled charges.
Selecting the correct RCM service provider to work with is crucial for maintaining control over your revenue streams. Utilizing cutting-edge technology and solutions, a partnership with RCM Matter can help you improve your reimbursement processes and expedite your revenue cycle.