What Are The Fundamental RCM Metrics Your Practice Should Know Banner

Are you having difficulty in keeping revenue cycle integrity? Various independent practices are under extreme tension to function at the highest efficiency as the healthcare industry is swiftly developing. It is quite crucial to evaluate your healthcare RCM performance according to industry standards. Though, it is vital to identify the market trends to improve the capability of your revenue cycle by shifting to the right way when things are going in the wrong direction.

There are three categories of key performance indicators of RCM which are; reconciliation, productivity, and accuracy. These benchmarks help you assure complete validity and lower the compliance risk. However, each facility has its own necessities and aims so it varies depending on these choices too. 

RCM Foundations 

To master the basics and enhance your revenue you have to consider the following 3 factors; 

  • Good Communication Establishment 

What do you do when you are having a problem with your one claim? Even a professional firm can not resolve this issue digitally. According to a report, approximately 90% of billing errors arise due to ineffective procedures at your front-end desk. So, before the claim leaves your office you must double-check them to avoid revenue losses. Otherwise, these errors will bother you in the form of rejections and denials. You can solve these problems with help of the best physician billing agency which fixes the loopholes in your billing systems on your behalf. So, to prevent errors it helps you to keep in touch with your billing experts. Moreover, they use up-to-date methods at various phases of the billing procedures & enable you to solve problems that require close communication between people.

  • Utilize Latest Technology

The market is full of different types of software that help you handle RCM procedures. On the other hand, insurance companies are very strict and often reject some claims even due to a minor error. Besides, you don’t want to set yourself up for losing revenue and facing denials if you are using out-of-date software. While an efficient practice management system enables you to scrutinize every single claim before sending it further. It will suit well with your existing IT systems and make you 100% certain during the submission of a particular claim. It helps you automate the billing processes and stay fully compatible with the latest insurer standards. You will get reimbursed fully on time when all details of the submitted claim would be precise. 

  • Ready To Do the Work

Plan to do the work instead of expecting miracles to happen. You must train or educate your administrative staff to implement effective procedures. Your staff should be active and diligent in the task. Because powerful staff engagement helps you cover up the challenging minutiae of your healthcare revenue cycle management. At this point, professional billing experts help you capture the revenue that otherwise could have been lost and rectify the problematic issues that hinder your financial growth. 

Basic RCM Metrics You Must Know

The fastest route for laboratories to improve financially is to streamline RCM processes. While the question is how do you know if your procedures are efficient to capture the revenue you have made. 

Here are the following metrics that help you run your practice smoothly while ensuring the highest possible reimbursements. 

  • Clean Claim Rate

You can identify obstacles and inefficiencies in claim processing with the help of KPIs. Denied claims may cost money and take a lot of time to correct. The longer you take to resolve or submit a claim, the more it takes to get payments and checking eligibility. You can see the rate of the total number of claims accepted and clean claims through other KPIs that help you enhance the claim processing.

  • Bad Debt Value

This value helps you to witness the effectiveness of the collection efforts. With a higher bad debt value, you can clear the inefficiency in previous revenue cycle areas such as POS collections, etc. In this way, you can estimate the number of receivables that may be eventually uncollectible. You can find its value by the formulae given below; 

Bad debt income statement / Set time patient service gross revenue. 

  • Cash Collections (POS)

With this KPI you can track and access the efficiency of the Point Of Services collections systems. This helps you see a comparison of payments that you received before the rendered services and after. When you divide the payments of POS with the total self-pay cash collected, you get this KPI value. You can also figure out the intricacies affecting RCM in the POS system with this metric. 

  • Resolve Rates

You can see the efficacy of the revenue cycle management to billing & coding from the eligibility verification with the help of this metric. To figure out this KPI, you can divide total paid claims for a particular time by over the specific period of the total number of claims. If the percentage is higher, consequences would be even better. But, wait, what does this signify? It means your process or staff must be capable enough to handle the entire RCM process. Contrarily, if your rate is low you must look at the authorization, coding, and credentialing eligibility authentication. Right at this time, flat rates will influence staffing costs and cash flow since the physician spends $50/ rework claim & ten-thirty minutes on average. 

  • A/R Days

This helps you better analyze & reveal the approximate time when to get paid for services. You become able to see how your account receivables are working and take an estimate of when to get the reimbursement for services. You can find its value by dividing the total A/R with the approximate net patient service daily revenue after fetching the data from income statements and balance sheets. You can also find the average daily net patient service revenue if you divide total yearly sales by the total days in a year (365). 

  • Late Charge As % Of Total Charge

This KPI identifies opportunities to boost profits and measure revenue capture potency. You have to enhance compliance, reduce unnecessary costs, and speed up cash flow to get opportunities for improving revenue capture. 

  • Measure Net Collection % 

You can figure out its value by;

  • By removing the contractual adjustments from the total charges.
  • Subtract the refunds from the total receipts.
  • By the second value, divide the first one. Net collection % depends on 3 factors: adjustments, payments, and orders. Results of net collection % will be improved if the adjustments are maximum correlated to charges and payments. Hence, your staff must accurately post adjustments to prevent accounts from being written off.

What’s the Next Step 

Check thoroughly if you are working with the right billing firm. To ensure this you can perform a test. First, your billing system must support you 100%, & second, all problematic issues must be timely handled before they further create any issue. If your billing service is not up-to-date then get in touch with Physician Billing Company now. 

It will help you capture lost revenue in need of hours when you have a mess of things. We work with many practices in cardiology, pain management, urology, dermatology, as well as several other specialties. Billing experts at PBC help you identify exactly where you may be losing revenue, understand the current state of your billing, and provide you potential opportunities to recover unpaid claims.