Altruis shares 5 key performance indicators your revenue cycle manager should track for optimal healthcare performance.
How Can a Healthcare Organization Improve its Revenue Cycle Management?
A big way healthcare organizations can identify ways to improve their billing and revenue cycle management is by establishing key performance indicators (KPIs). KPIs show the strength and health of an organization. By monitoring KPIs, a revenue cycle manager can establish whether a healthcare center is hitting or missing benchmarks for industry standards and strategic goals.
Together, your KPIs indicate whether your organization is stable enough to stay profitable. How do your KPIs measure up? Here are 5 key KPIs to track:
- Third-Party Payments
- Clean Claims Rate
- Accounts Receivable
- Denials
- Code Summary
Third-Party Payments
Third-party payments are the financial sustenance of community healthcare organizations. Payors like Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), and private insurance provide a constant reimbursement flow for enrollees’ medical care.
Keep an eye on the rolling 12-month year-over-year revenue from third-party payments. Look at trends in third-party payments over time by month and carrier group to see if there are any red flags, especially if certain carrier groups are trending downward.
Address any negative trends immediately and determine if underlying issues limit revenue captured from certain sources. The revenue cycle manager should take fast action to optimize the revenue cycle to prevent losses in third-party reimbursements.
Clean Claims Rate
An organization’s clean claims are the reimbursement claims that make it through the process the first time without rejections or denials. A high clean claims rate typically means a healthcare center follows excellent reimbursement procedures.
The Medical Group Management Association (MGMA) calls clean claims “hidden treasure” in a healthcare organization. A consistently high clean claims rate has a strong connection to healthy revenue.
KPIs closely related to clean claims include the collection rate, payment velocity, and aging.
- Collection rate: This is the number/dollar value of paid vs. unpaid services by month or year.
- Payment velocity: This measures how quickly an organization is paid by insurance companies/patients, typically measured in the number of days from service.
- Aging: This shows the age of outstanding invoices and typically focuses on unpaid invoices after 30, 60, 90, or more days.
Accounts Receivable
The revenue cycle manager should always have a firm grasp on a health organization’s accounts receivable (AR), which shows money due but not collected. The AR over 90 days, also called the “percentage over 90,” shows how successfully the health center is collecting amounts due within 3 months of the service date.
In addition to examining the short-term picture, it’s vital to pay attention to trending AR data over long stretches of months and years. Choose a benchmark and strive to hit it consistently every month.
Watch the net AR day rolling figure over 12 months to see any concerning trends that indicate the collection rate isn’t as strong as it could be. Look at year-over-year trends, clarifying the healthcare center’s long-term financial status.
Denials
Reimbursement denials and rejections are a constant challenge. More than half of all providers have seen increases in denials in recent months. However, review of the top issues causing these denials and rejection can identify the most impactful action items to improve reimbursement. Typically resulting in training opportunities for Front Office or process flow improvements that may be required.
While a certain level of denials/rejections is a normal part of the reimbursement process, a high rate indicates a need for refinement of revenue cycle management. Check the following indicators for signs of trouble.
- Number of denials and rejections by month, rolling over 12 months
- Dollar value of denials and rejections by month, rolling over 12 months
- Denials in the current month vs. the monthly average
- Denial volume and dollars by category
- Trends over time
The primary categories to track regarding denials are eligibility errors, provider issues, member issues, non-covered claims, missing/invalid information, and procedural codes/modifier issues. Always keep in mind that denied claims are not the same as rejected claims, and these should be separated into two paths for resubmission and appeal as needed for maximum reimbursement.
Coding Summary
Coding issues are among the top reasons for denials and rejections in medical billing. This is why the revenue cycle manager should prevent coding errors from happening in the first place. When they do happen, address them as quickly as possible to minimize the impact.
What are your organization’s top 5 coding issues? Track these carefully to get to the bottom of persistent coding problems that hinder revenue-capturing activities. Identify training needed and consider utilizing Certified Coders to ensure accuracy and compliance.
Altruis has found that the top coding issues tend to be:
- Diagnostic (DX) adjustments
- Evaluation and management (E&M) level adjustments
- Televisit code adjustments
- Modifier additions
- Point of sale (POS) corrections
As you examine coding-related KPIs, check for coding outliers and errors while comparing your practice to national statistics. Look carefully at your trending numbers over time to see if you’re making a measurably positive impact on revenue.
Altruis: Your Revenue Cycle Manager
When you need to track and improve your KPIs, Altruis can help. We’re your full-service healthcare revenue cycle management partner. We’d love to show you how we use KPIs to drive measurable improvements in healthcare performance, so please schedule a call now.
