6 Revenue Cycle Management Kpis To Track Medical Efficiency With Medical Billing And Coding Services

Medical Billing And Coding Services

Practice medical billing and coding bridges the business and clinical sides of healthcare. It encompasses the entire process from scheduling patient appointments to receiving reimbursements from insurance companies. KPIs are a key part of RCM as they drive data-driven decision making and create business transformation projects. RCM KPIs allow you to benchmark your revenue cycle’s performance against industry peers.

They can be used to measure the responsiveness of the patient access team, the quality of your clinical documentation and the effectiveness of the cash flow cycle. There are many industry-standard metrics. The HFMA has 29 standards metrics. We have selected 6 key indicators to highlight here.

You can keep your revenue cycle under control, no matter if you run a doctor practice or hospital. You can get the most from your revenue cycle by measuring and monitoring these KPIs and finding the cash you need to invest in technology or patient care.

Medical Billing And Coding Services

Medical Billing And Coding Services
6 Revenue Cycle Management Kpis To Track Medical Efficiency With Medical Billing And Coding Services

Cash Collections from POS (Place Of Service)

POS cash collections are defined by the HFMA as any cash that is collected from a patient prior to or at the time of service, or up to seven business days after discharge. POS collections also include copays and self-pays. Divide the POS payments by self-pay cash to arrive at a value. Many practices still rely on manual patient access workflows. With technological advancements and personal smartphones, however, patients are becoming more computer-savvy. This allows practices to streamline the process by using features such as automated and bi-directional communications.

You can track the efficiency of your POS systems and your staff accounting for the POS by measuring POS cash collection. This can help you identify and fix core POS issues that are affecting your RCM process.

Clean Claim Rate

The percentage of insurance claims that are successfully refunded within the first 24 hours after they were submitted is called the clean claim rate. A high clean rate means that both the time it takes for providers to receive compensation and the time they spend in AR is greatly reduced. If claims are not settled on the first submission, it can cause significant rework and cost for both payer and provider. Healthcare organizations can track the efficiency of claim submission while also calculating the average time and cost for a claim being reprocessed.

Discharges Not Fully Billed (DNFB)

Discharged not final Billed (DNFB) is a measure that allows you to compare hospitals within a region. DNFB is a major source of revenue leakage in emergency departments that are often very busy.

  • It is possible to reduce back-end problems by optimizing your revenue cycle processes at the front end. The front end is where patients first interact with you when they visit your practice. This is a crucial point to make your patient experience extraordinary. One director of patient accessibility said that how you handle the front-end can have a significant impact on the rest of the visit.
  • Your practice’s ability to verify the right patient demographics, enter insurance correctly and collect the financial responsibility of patients upfront will help reduce the amount of rework needed for the remainder of the revenue cycle. It also helps to reduce the risk of claims being denied.
  • Many practices still rely on manual patient access workflows. With technological advancements and personal smartphones, however, patients are becoming more computer-savvy. This allows practices to streamline the process by using features such as automated and bi-directional communications.
  • It is possible to streamline processes such as patient registration. Patients and doctors can now register electronically using contactless technology. Digital patient intake allows patients to easily take a picture of their ID and insurance card, verify their demographics, then digitally sign consents.

You can stop revenue loss by keeping up with changes

Your facility will not pay any claims if they do not file the correct paperwork. It is crucial to ensure that all codes are correct and that you comply with all requirements. Failure to adhere to medical billing changes and coding modifications will result in errors, delayed submissions and ultimately revenue loss. To ensure compliance, practices must delegate responsibility of following all regulations and deadlines. Your billing process can be accurate and efficient by keeping up with changes in healthcare.

Days in AR

For days in AR, the MGMA gives a benchmark of less than 40 days. This KPI allows you to identify the average time taken by your team or system to collect payment. The average days in AR can easily be calculated using:

  • Calculate the average daily charge – Add daily charges from the previous months to the total amount and divide it by the number of days within the selected period.
  • Divide the total accounts receivables by the daily average computed charges.

Claim Denial Rate

Divide the total dollar amount denied by payers by total claim amount within the period to calculate the claim denial percentage. A claim denial rate between 5% and 10% is acceptable. However, a lower claim denial rate than 5% or less indicates financial stability and a good revenue cycle management process. If your claim denial rate exceeds 10%, you should examine your eligibility verification, coding and credentialing functions. It is possible to reduce back-end problems by optimizing your revenue cycle processes at the front end.

The front end is where patients first interact with you when they visit your practice. This is a crucial point to make your patient experience extraordinary. One director of patient accessibility said that how you handle the front-end can have a significant impact on the rest of the visit. Your practice’s ability to verify the right patient demographics, enter insurance correctly and collect the financial responsibility of patients upfront will help reduce the amount of rework needed for the remainder of the revenue cycle. It also helps to reduce the risk of claims being denied. Many practices still rely on manual patient access workflows.

With technological advancements and personal smartphones, however, patients are becoming more computer-savvy. This allows practices to streamline the process by using features such as automated and bi-directional communications.It is possible to streamline processes such as patient registration. Patients and doctors can now register electronically using contactless technology. Digital patient intake allows patients to easily take a picture of their ID and insurance card, verify their demographics, then digitally sign consents.

Revenue per Encounter

You can calculate revenue per encounter by multiplying net collections by the number of patient visits in a given period. This can give you a quick overview of the health of your revenue cycles. A great back-office team, modern technology and a keen eye on revenue and reimbursement rates are essential to running a financially successful hospital/practice.

Medcare Medical Billing Services, an RCM expert, can help you get on the right path to financial success. We bring together data-driven processes, experienced revenue cycle professionals, top-notch technology, and will help improve your revenue collection. We can help you build a better RCM system.

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