Revenue Cycle: Establish KPI Goals
Q: What KPIs show I have strong Revenue Cycle Management practices?
A: Industry experts suggest that every team member have performance goals, engage in monthly feedback sessions with their team and manager, and receive incentives for performance improvements. If you have such a system in place, here are several business KPIs that will demonstrate a positive impact on your bottom line.
1. Our CSRs meet or exceed their Patient Intake goals.
When establishing goals, discuss ways to:
- Shorten the time an intake remains in a certain state
- Reduce or eliminate issues impacting their ability to confirm an order
- Reduce the number of touch points on a document before acceptance
- Reduce the number of document rejections
2. Our Collection Team is meeting or exceeding their revenue goals.
Here are a few areas to consider:
- Number of touches until payment
- Percent of a collector’s claims resulting in a payment
- Number of denials being worked daily
3. Our Reimbursement Rate is improving month over month.
If this is true, you have strategies in place to ensure:
- Payers are not paying less than their contracted rates
- All of your staff are trained to enter orders accurately the first time
4. Our Denial Rate is decreasing.
To make this true, implement tactical decisions to reduce and prevent denials by:
- Denial Code
- Intake Owner/CSR
5. We have less claims on hold than we did at this time last year.
This can be true if you have done feedback sessions and rewarded improvements within each team involved in the process:
- Documentation team
- Authorization team
- Confirmation team
- Billing team
- Respiratory team
6. We know the reasons for Write-Offs and have strategies to reduce them.
Being able to say this statement means you monitor your reports to find preventable bad debt write-offs:
- By Referral and reason
- By Collector and reason
- By Insurance and reason
In summary, you can rate the success of your Revenue Cycle Management processes by challenging your business with each of these KPI statements. If any statement causes concern, look for proof in your reporting, and then develop and implement a tactical plan with the team. Your people are your best resource to overcome any challenge.
Let's schedule some time to see what your
Key Performance Indicators are telling you.
This article was originally written by Dan Greyn of Computers Unlimited for the 2018 Smart Talk column in the HME News Magazine. Published 2018-03-27. Modified 2018-06-27.