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Article - Is your Practice Analyzing KPIs to Determine Loopholes in RCM?

If you wish to keep a track of your revenue cycle, you need to keep analyzing KPIs such as A/R days, claims processing and patient access quality. Analyzing these KPIs against industry benchmarks will help you identify loopholes in your revenue cycle. For instance, if your net revenue is reducing and AR days are increasing, your practice can land into serious financial trouble.

Industry Facts

A/R days for high-performance hospitals are 30 days or less and for low-performance hospitals, A/R days are 60 and above
It has been observed that between 5-25% of payment for physicians is either denied or delayed due to coding errors and lack of denial management
According to a new survey by Black Book rankings, investment in RCM technology is increasing to combat rising debt levels and falling profits

How to assess and Manage RCM KPIs for Better Performance

Effective RCM solutions should be utilized for enhancing cash flow through higher collections. From reducing AR days and mitigating increase in denial rates during ICD-10 transition to improving documentation and claims processing, special attention is required in assessing and managing the KPIs.

  • RCM solutions should be tailored according to the needs of a medical specialty because it is not a one-size-fits-all process. Desired results can be achieved only when the RCM solutions are specialized
  • Physicians need to implement specialty-specific technology and proven processes for enhanced financial performance
  • Days in AR should be monitored and measured to know the efficiency of the revenue cycle. Aged AR should also be measured as it indicates delays in payment and the ability of the revenue cycle to liquidate AR. It is necessary to hire RCM experts who can look for underpayments and issues in the revenue cycle that is extending the time it takes to recover AR from insurance companies
  • Improve denial management by outsourcing this service to a team of experts who can easily track the reason behind payer denials and also make necessary improvements to reduce the denial rate
  • Clinical documentation strategies need to be improved because it is the key to long-term financial stability. From using the right technology to capture actual clinical impression of the physician to assessing documentation quality and coding on a regular basis, necessary efforts should be made to bring improvements

Practices Benefitting from MBC’s Streamlined RCM Solutions

Many practices focus on AR and denial management tasks but fail to work on other priorities mentioned-above. Unless all aspects of RCM are handled effectively, practices will not be able to improve their net revenue. In such cases, outsourcing is an effective option because medical billing companies such as MBC assign a team of AR experts and experienced coders and billers to ensure that revenue cycle loopholes are handled expertly and revenue is maximized.

MBC helps physicians realize the importance of effective RCM solutions. More than 15 years into business, MBC is a trusted RCM solutions provider for many medical practices across the US.

Published By - Medical Billers and Coders
Published Date - Sep-22-2015 Back

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