6 Revenue Cycle Management Kpis To Track

Revenue cycle management is the link between the medical and business sides of the healthcare industry. It refers to the entire strategy, from organizing a patient appointment through receiving reimbursement from insurance companies.

KPIs are critical in RCM since they help to encourage data-driven decision-making and build business transformation programmes. RCM KPIs enable benchmarking of your revenue cycle's overall performance with business associates at the responsiveness of your impacted person entry team, the caliber of your medical documentation, the effectiveness of your cash flow cycle, and compliance with rules.

While there are hundreds of available enterprise-well-known metrics, the Healthcare Financial Management Association (HFMA) identifies 29 fashionable metrics, and we've chosen six of the key indicators to focus.

Following the 6 KPIs given below allows you to maintain your healthcare revenue cycle under control whether you're walking a doctor's office or a hospital. You may be able to get the most out of your revenue cycle and discover the funds you need to spend in technology and patient care by measuring and tracking specific KPIs.

1. Cash Collections at POS (Points of Service)

HFMA defines POS cash collections as all money collected from the patient prior to or at the time of service or up to seven days after discharge. Self-pays and co-pays are also included in POS Collections. Divide the POS bills by the accrued self-pay cash to arrive at a cost for this KPI.

Measuring POS cash collections allows you to monitor the operation of your POS structures or your personnel that accounts for the POS. It can also assist in recognizing and troubleshooting center POS issues affecting your global RCM technique.

These provider collecting factors (POS collections) are critical for revenue cycle management. A solid POS collection system can boost your cash flow and reduce back-end office labor.

2. Rate of Clean Claim:

The clean claim rate is the percentage of insurance claims that are submitted and effectively reimbursed at the time of filing. An overly smooth declare charge reduces the time spent in AR and the time it takes for the issuer to be compensated.

When claims aren’t resolved at the preliminary submission, it creates massive rework & value for each issuer & payer.

Measuring the smooth declare charge allows healthcare organizations to track the performance of the claim submission technique while determining the average length and cost for a claim to be reprocessed.

3. DNFB (Discharges Not Fully Billed):

Discharged Not Fully Billed is a measure used to evaluate a few hospitals in a specific region. DNFB is determined by dividing the unbilled amount for expenses to discharged patients by the average daily revenue.

DNFB relates to any situation in which a patient has been discharged and a claim is submitted without billing for all medical services rendered. It is critical to keep the DNFB within industry standards so that the services given can be converted to cash. DNFB is a significant source of income leakage, particularly in high-volume Emergency Department settings.

4. Days in AR:

For days in AR, They provides a standard of less than forty days. This KPI informs you of the average time it takes your team or device to collect money for the services provided. Average days in AR can be calculated as follows:

Calculate the average daily expenses - Add the average daily expenses for the previous few months and divide the total amount by the total number of days in the chosen period. Divide the total bills receivable using the calculated daily common expenses.

5. Claim Rejection Rate:

Divide the total dollar amount of claims denied by payers by the total amount filed in the given time to calculate the declare denial rate. A denial rate of 5% to 10% is acceptable, while a denial rate of less than 5% indicates a healthy revenue cycle management strategy and economic flow. If your refusal rate exceeds 10%, look at your eligibility verification, coding, and credentialing functions.

6. Encounter Revenue:

Revenue based on encounter can be characterized and computed by dividing net collections by the number of patient visits in a particular month. This indicator can provide a quick snapshot of the health of your revenue cycle.

Running a financially successful health facility or practice necessitates a fantastic back-office crew, new equipment, and careful attention to income and payback rates. Partnering with medical billing outsourcing companies like can puts you on the path to financial success by assisting you to deliver data-driven approaches, pro revenue cycle pros, and top-tier generation to improve your revenue collections.

Contact us to see how we can provide you with a more powerful RCM system.

Important Takeaway:

• Medical practices prefer to pay particular attention to the billing information. It will ideally track critical overall performance indicators in medical billing.
• Tracking medical billing KPIs can help us be aware of metrics to improve, such as the bad debt charge.
• Dedicated software allows us to present records such as accounts receivable and the rate of denials or unbilled claims, which can mean the difference between profitability and having to lay off employees.
• Compare daily cash reception variances to various factors such as fluctuating patient volume or the addition of new staff to your team