Revenue Intelligence
Key Performance Indicators (KPIs) for Revenue Integrity and Cost Management: Revenue Cycle Rx can provide real-time, actional intelligence using your EHR and RCM operations data. Our reports are created for billing personnel as well as for executives. We can set up thresholds and get alerted when your KPIs are out of bounds. We have the ability to drill down to ensure that we can understand the root cause of issues and take action. The following sets of KPIs are a sampling of what is available to report on. Please contact us to learn more about our powerful Revenue Intelligence Offering.
Missed Appointments The Revenue Cycle commences with appointment scheduling. Frequent cancellations and no-shows can adversely affect your financial performance. By monitoring the percentage of appointments canceled or missed, your practice can identify recurring patterns and adapt appointment procedures to mitigate last-minute scheduling gaps.
Claim Lag Time Claim lag time represents the average number of days between a patient’s visit or procedure and the submission of a claim to a payer. Despite the streamlining effect of integrated practice management and EHR systems on billing, some practices encounter challenges in submitting claims promptly. Prolonged billing lag time hinders the revenue cycle and elevates the risk of missing claims filing deadlines. Utilizing an average billing lag time KPI can function as an early warning system for issues within medical billing workflows.
Clean Claims Ratio The clean claims ratio signifies the portion of claims that are accepted and paid upon their initial submission. A low clean claims ratio indicates that your claims are frequently denied or require additional clarification, potentially highlighting issues with your coding, documentation, or claims submission processes.
Denial Rate Similar to the clean claims ratio, the denial rate represents the proportion of all submitted claims that face denials. A high denial rate necessitates further examination to identify the root causes of incorrect claims. Utilizing tools that offer denial statistics categorized by reason for denial can aid your practice in recognizing common errors.
Gross Collection Ratio The gross collection ratio is calculated as your total payments divided by your total charges. A high gross collection ratio indicates that your practice successfully collects the majority of its billed charges, signifying strong medical billing procedures.
Net Collection Ratio The net collection ratio is derived from your total payments divided by the total allowed charges. Unlike the gross collection ratio, the net collection ratio focuses specifically on allowed charges rather than total charges. This metric provides a more precise view of the portion of available reimbursements your practice was able to collect. A low net collection ratio may indicate challenges in timely and accurate claims filing.
Accounts Receivable Aging Accounts receivable encompass all billed charges that remain unpaid, including both insurance and patient bills. Your average accounts receivable days estimates the time it takes for your practice to receive payments. Additionally, your practice should track the percentage of accounts receivable that remain outstanding for more than 30, 60, and 120 days. Practices with robust revenue cycles generally clear accounts receivable within 50 days or less.
Bad Debt Rate Bad debt refers to any medical bill that goes uncollected. Your bad debt rate is calculated by dividing your total bad debt by the total charges. Patients often encounter difficulties when paying medical bills, resulting in some amount of bad debt for your practice. However, you can reduce your bad debt ratio by collecting patient co-pays upfront, verifying insurance coverage, and offering online payment options.
