The goals of every healthcare provider’s revenue cycle management (RCM) operations are complex but basically simple: operate as efficiently and as quickly as possible, leverage the right resources and enable optimal reimbursements to return to the organization as soon as possible so its team can continue delivering quality healthcare services
How you do that and which key performance indicators (KPIs) you track makes all the difference.
As we’ve noted in other articles, managing all the interrelated but spinning plates of the entire RCM process can be a bit like playing whack-a-mole. You get a few parts under control — for instance, automated provider enrollment and credentialing services (what we call PES), eligibility verification and those (pesky but necessary) prior authorization requirements — and you’re still left with other day-to-day challenges. So, in total, what do you focus on and measure in your RCM operations to track and measure success as the industry changes constantly?
Six Essential Financial KPIs
Virtually real-time data, advanced analytics with alerts and easy-to-interpret dashboards enable Advantum Health’s RCM experts to quickly note downward trends and which actions to take, particularly when monitoring and addressing these six revenue cycle KPIs proven critical for success today and beyond:
- Denial rate: Percentage of total claims denied as a percentage of total claims submitted during a specific period
- Days in accounts receivable: The average number of days it takes to collect payments on billed charges (A/R Days=Average Daily Gross Charges Total /Accounts Receivable)
- AR greater than 120 days: The percentage of total accounts receivable that are older than 120 days
- Gross collection rate (GCR): The percentage of total payments received compared to total gross charges billed
- Net collection rate (NCR): Percentage of total payments received
- First-pass claim-acceptance rate:The percentage of claims accepted and processed by the payer on the first submission without rework or resubmission
Optimizing these is a time-consuming process, especially for providers who don’t use an electronic health record (EHR) and an integrated practice management system to rapidly pass along claims to their RCM partner for completion and submission. Paper superbills take a practice much longer to process and errors occur more easily. And if claims aren’t correctly processed and within a health plan’s timely filing criteria, it’s money left on the table that is often never collected.
That’s why Advantum Health has been for more than 20 years, serving hundreds of provider organizations of all sizes and specialties. With our laser focus on partnering with providers to effectively manage and operate their RCM practices, Advantum’s combination of a skilled team of RCM experts leverage constantly evolving best practices and advanced intelligence (AI) tools that increases the speed and accuracy of clean-claims submission, optimizes RCM resources and efficiency and ultimately maximizes each provider organization’s performance.
In addition to the solutions mentioned above, Advantum delivers a full, integrated set of advanced RCM services, including:
- Clean and accurate medical coding: We’ve found new clients who have lost thousands of dollars because their short-staffed internal teams were unable to keep up with current coding structures. Our coding experts ensure accurate, compliant coding to prevent revenue leakage.
- Claim submission and rejections: We manage the full claim submission process to ensure clean, timely submissions. If a claim is rejected in the clearinghouse, it never reaches the payer, which risks missing timely filing deadlines. Our team resolves issues early to keep claims moving.
- Denial prevention and management: We identify root causes of denials and apply proactive, first-pass accuracy strategies that reduce denial volume and minimize the delays and administrative costs they create.
- AR follow-up services: We provide focused, timely follow-up on outstanding accounts to prevent aging receivables, recover missed revenue and ensure no claims or patient balances fall through the cracks.
- CMS-compliant coding audits: Our Certified Professional Medical Auditor (CPMA) – credentialed team conducts proactive, CMS-compliant audits that assess documentation, coding accuracy and potential underpayments. We provide detailed analysis and deliver training to strengthen a client’s internal compliance and revenue integrity.
Whether you’re launching a new practice, clinic or location or ready to scale up your RCM operations across your organization, the more than 600 skilled professionals of Advantum Health are ready to help—fast. Explore recaps of our solutions, client case studies, our awards and our latest news on the Advantum website and contact us here.