Most Bang: Impactful Metrics For RCM

Editor’s Note: Analyzing your revenue cycle from start to finish can lead to recouping significant revenue dollars for your organization. Knowing what are the most impactful metrics sets revenue cycle experts apart. Schedule a call with a BHM advisor CLICK HERE and identify which metrics save the most.

impactful metricsHave you analyzed your revenue cycle lately? Do you know where to begin? To you know what are the impactful metrics, how to measure, and how to analyze the results? Whether just arriving to the revenue cycle management environment or a veteran of many budget cycles, data continues its vital role for revenue cycle improvements. If only you could focus on the optimizing just the trouble spots. Knowing what Level of Care needs attention so it meets medical necessity criteria the first time. Optimize your productivity by using your case review data to identify:

  • Training targets
  • System enhancements
  • Workflow process improvements

BHM services target the key areas your organization for improvement. Here are a few key areas you should review on a regular basis. Check if your current systems allow data manipulation of these data points.

  • Concordance rates
  • Level of Care
  • Review types
  • Case manager submissions
  • Reviewers utilized

Why Data Analytics and Impactful Metrics?

The Healthcare Financial Management Association released an outstanding primer on Leveraging Data Analytics to Improve the Revenue Cycle. For the full article, click HERE.

“In today’s evolving healthcare climate, hospitals and health systems are challenged to provide higher-quality care while operating on leaner budgets. Namely, the shift away from fee-for-service to fee-for-value aims to make higher-quality, lower-cost care more accessible to patients.

Unlike some aspects of health care, the revenue cycle is comprised of highly quantifiable elements and is typically facilitated by modern IT infrastructure systems. This makes it easier to collect revenue cycle data, track metrics, and apply analytics.

“Data tells a story and can be used to change behavior or establish policies and procedures,” says Margaret Schuler, vice president of revenue cycle at OhioHealth

Organizations that use data analytics also have more opportunities for continuous process improvement through diagnostic reporting, root cause analysis, key performance indicator (KPI) tracking, impactful metrics, and trend projections.

“Data gives hospitals the ability to look at processes over time and identify breakdowns, including systemic issues that affect specific revenue cycle processes,” says Margaret Schuler, vice president of revenue cycle at OhioHealth. “From pre- to post-visit, analytics are able to shine a light on various functions and components, including workflows, as well as individual and department performance.”

Data analytics also reveals opportunities for efficiency, such as replacing manual workflows with automated solutions or streamlining processes that free staff to concentrate on accounts that would benefit more from human intervention.”

Review

A review of your revenue cycle should be high on your mind. When is the last time you analyzed your revenue cycle from start to finish? Many practices lose significant amounts of revenue by not doing their due diligence with their revenue cycle. Just making a few tweaks can make the difference between operating in the red and being in the black. Very simply, the revenue cycle consists of three stages: pre-visit, visit, post visit. impactful metrics

Pre Visit

Getting the patient in the door is half the battle. A significant amount of revenue is lost during the scheduling process which can lead to missed appointments. Missed appointments are missed opportunities for revenue. Appointment calls, texts, and/or emails the day before or the morning of will reduce the number of “no shows”. In addition to appointment reminders, insurance information should be obtained and verified prior to the visit to ensure there are no surprises and validate whether or not the service will be “covered”.

Analyzing Your Revenue CycleVisit

Revenue can be lost through different stages of the visit. One of the biggest areas is failure to collect copays and coinsurance. Collecting these amounts after the patient has left your office becomes more and more difficult. The average time to collect is about 3 months if you are able to collect at all. Collecting copays and coinsurance when the patient walks through the door is critical to the revenue cycle. Meticulous clinical documentation is also essential to make sure the service can be billed appropriately. Making sure medical necessity is documented and the correct codes are included in the medical record will help to ensure that claims will be paid appropriately.

Post Visit

Ensuring your bases are covered for the time period up to and including the visit doesn’t let you off the hook. Post visit brings opportunities for revenue recoupment as well. Correct coding is critical especially with regulatory changes. Failure to adapt to new codes can lead to denied claims. Submitting claims correctly requires crossing your “t”s and dotting your “i”s. An audit process should be in place to thoroughly review each and every claim prior to submission. Each payer has different requirements. Ensuring these specific requirements are adhered to will increase the probability of the claim be accepted and paid upon initial submission. Many dollars are lost through careless errors in claim submission process. Much time, energy, and resources are spent correcting and resubmitting claims. Many organizations don’t take the time to appeal a denied claim, hence another opportunity to recoup revenue. In general about 50% of denied claims are over turned. 50% is certainly better than nothing and certainly worth the time and effort to go through the process.

Summing it Up

The revenue cycle is very complex. Millions of dollars are lost as a result of failing to understand and properly analyze each step of the process. Additionally, knowing what and how to track in terms of key performance indicators and industry benchmarks can be a daunting task. BHM Healthcare Solutions has been extremely successful in assisting organizations in recouping significant revenue for our clients. Visit our Revenue Cycle webpage to learn more about our expertise.

Analyzing your revenue cycle from start to finish can lead to recouping significant revenue dollars for your organization. Knowing what are the most impactful metrics sets revenue cycle experts apart. Schedule a call with a BHM advisor CLICK HERE and identify which metrics save the most.

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