Three KPIs and Three RCM Practices for Improving Medical Billing Performance

by | January 25, 2022 | 1:41 pm
Three KPIs and Three RCM Practices for Improving Medical Billing Performance

The success of your healthcare business depends on understanding key performance indicators and enhancing revenue cycle management. This allows you to identify areas of weakness in your organization and take the necessary steps to increase revenue. Evaluating KPIs and RCM practices will improve your insurance claim process, reimbursement procedures, and collection rate.

These three medical billing KPIs and three RCM strategies can provide solutions to maintain cash flow and increase profit.

Three KPIs for Improving Medical Billing Performance

1. Days in Accounts Receivable (A/R)

The reimbursement process for claims takes days, as it prevents cash flow and decreases new business opportunities. To continue with proper cash flow in the healthcare business, maintain the average in A/R.  Knowing the average number of days in account receivable can help you manage your finances. These medical billing KPIs indicate gained and missed income.

To have a proper cycle for cash flow, submit your claims at least 90 days from when the services were provided.

The more efficiently you file the claims, the quicker the response you will receive from the provider. If you file claims within 60 days, the provider can process reimbursement sooner. Filing claims on time will decrease workload during rush hours as well as reduce days in account receivable.

2. Clean Claim Ratio or First Pass Resolution Rate

A Clean Claim Ratio (CCR) means having the claim accepted on the first submission attempt. These types of claims are never rejected because they are filed accurately at submission. To improve CCR, create repeatable RCM strategies and understand reasons for denial. Filing accurate claims helps reduce rework and time spent on claim denials.

Your healthcare practice should focus on improving CCR and creating the best strategies to decrease denial rates. One of the best ways to reduce denial rates is by outsourcing medical billing KPIs roles to skilled and experienced resources. This allows your team to focus on core competencies.

3. Net Collection Rate (NCR)

NCR indicates how effective your business is at collecting reimbursement for services, which is the amount owed after contract adjustments are made. NCR shows a potential loss of revenue.

To calculate NCR, divide payment by charges minus contractual adjustment into 100%.

If you get a result below 90%, you should consider reviewing your accounts and billing practice.

Three RCM Practices for Improving Medical Billing Performance

1. Decrease Denial Rates

Decreasing denial rates should always be a priority to increase revenue. Each denial causes revenue loss and increases the cost of submission. One way to decrease denial rate is to have a team of experts review claims before submitting to a provider. This could verify that insurance claims are filed accurately on time.

Crosscheck for Insurance Claims

  • Verify claims and insurance policy
  • Check for accurate data processing
  • Verify patient information on each level
  • Help patient fill in all the important details
  • File claims on time

2. Technology Advancement

Adding advanced technology to your practice can help you automate regular tasks to increase productivity. In addition, technology aids in processing information correctly and quickly. Moreover, it allows patients to pay for services online with multiple payment options. Using technology is one of the best strategies to improve the collection process and cash flow.

Advantages to utilizing the latest technology

  • Collect and maintain patient information efficiently
  • Automate regular tasks
  • Enhance accounting and bookkeeping
  • Single screen view dashboard to track resources
  • Payroll processing and staff management

3. Add Expertise

Outsource Medical Billing Services to a strategic partner to focus on core competency and improve productivity. An outsourcing partner can provide skilled and experienced professionals to manage your medical billing process. From managing patient claims to data processing, they can offer an end-to-end solution.

Benefits of Outsourcing

  • Claim management
  • On-demand experienced resources
  • Focus on core competency
  • Decrease workload
  • Process patient requirements faster

You can follow medical billing best practices for your organization and increase revenue with ease. You should consider other KPIs and RCM practices too.

Next Steps

  • Learn more about key performance indicators and revenue cycle management from our experts and understand how Analytix helps your business grow.
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