Financial viability of the healthcare delivery is extremely crucial in the current times. It is true
for both large hospital chains as well as small individual clinics. No matter what your daily
transactions are, if you want to your business to survive and grow, you have to be up to date with
your revenue cycle management. While some of the hospitals and other healthcare facilities have
their own in house team, some prefer to outsource the work to competent teams of professionals.
Either way, the management should keep on evaluating the quality of RCM services for hospitals.
Here are some important measures to know how your revenue management is faring. You can keep this
checklist handy to know what changes to make to your RCM. Read on to know more.
1.Are the RCM services for hospitals comprehensive enough?
The revenue cycle is indeed a very complicated procedure. Each step of the way has a separate way of
dealing with issues. However, the RCM services for hospitals must ensure that these issues are
resolved. The resolution must come in a comprehensive manner and not hover over singular points.
Check if the revenue management in place has a proper workflow with repeatable processes. A
comprehensive outlook to a range of occurring issues will help you to improve your cash flow and
reduce the individual burden on employees.
2.Is the staff training up to date?
In case you have an in house team handling your entire revenue cycle, then the staff should be well
experienced and trained. For revenue leaders, industry expertise is a must to predict the latest
trends in the market. They can also design regular training programs for staff members who can get
to know about the latest modifications.
Collection and analysis of correct data is the key to take future decisions in any kind of service.
Leveraging these analyzed reports along with industry knowledge from experts, the organization
should design and improvise on staff training programs. If you are outsourcing the RCM services for
hospitals from another company, then they can guide you to take the correct decision.
3.Is your denial rate increasing or decreasing?
This is one of the key metrics to determine how the RCM services for hospitals are faring in the
practical scenario. The denial rate is calculated simply by dividing the number of denied claims by
the total number of claims filed in a billing cycle. Studies show that 80% of the denied claims can
be avoided if they are analyzed carefully before submission.
The issues for claim denials can range from anything- from a minute spelling mismatch to incorrect
insurance information. Each denied claim amounts to severe losses for the healthcare organizations.
A recent report by Medical Group Management Association revealed that the overall cost of managing
denied claims can amount to around $36,000 each year. With
competent RCM services for hospitals, the denial rate
should keep on decreasing with time. This can only be possible if the RCM department identifies the
recurring issues so that they are avoided in the future.
4.Do the RCM services for hospitals know about the latest guidelines?
Hospitals and other healthcare organizations are reeling under extreme pressure to cater to the
medical needs of the patients. Hence it is very difficult for them to keep up with the frequently
changing federal and state guidelines. The RCM service vendors should take care of these issues
properly. As competent healthcare partners, the revenue leaders must be up to date with the latest
guidelines published by the federal agencies like The Joint Commission, CMS among others.
The best practices should be adapted swiftly into the workflow management. Similar steps should also
be taken to ensure that the latest technological systems are incorporated into the working pattern.
All these steps will help the hospitals to stay current on the RCM guidelines, without having to
compromise on the patient support.
5.Do the RCM services for hospitals provide regular reports about the system improvement?
There are certain parameters that you need to track to know if your revenue management is in place.
The leading RCM services for hospitals provide data analysis reports keeping these parameters in
mind. If you have an in house team, you must analyze the reports at least once a month.
If your outsourced RCM services do not provide you with such reports, you can ask for them when
discussing the contract details. These reports will highlight how these services are actually
affecting your practice. Make sure that the metrics are moving in the same pace and direction as
your revenue goals.
6.Are the RCM services capable of tracking the KPIs?
You need to check frequently if you have the right business intelligence to track the KPIs. The RCM
services for hospitals should have a robust technical setup to track the metrics in real time. The
Chief Innovation Officers of leading healthcare organizations across the USA are stressing on the
need for harnessing the
right technical tools
to take more informed financial decisions within a shorter span of time.
The RCM vendors should be able to provide you these features so that you don’t have to establish
another separate system to track the KPIs. The leading RCM teams of current times should cater to
every single process that completes the Patient-to-Payment cycle.
RCM KPIs you should track
Measuring and analyzing KPIs is a great way to track your performance in revenue cycle management.
With more than one department involved in the end-to-end billing process, it is crucial to focus on
each segment separately. This way you can integrate the different independent islands of the revenue
cycle management in your healthcare organization.
Self-pay Cash Collection at Point of Service:
There are various tools to measure the collections from patients at the point service. This includes
the time from the beginning of the service for co-pays and deductibles to a fixed extent of time
after the services are rendered.
DNFB:
DNFB stands for days in total discharged not final billed. This metric is extremely beneficial in
tracking the loopholes and issues in your current workflow. Divide the amount due in DNFB by the
average daily gross patient service revenue to get the metric. This metric will help you determine
whether there is an issue of delayed billing in your organization.
Bad debt tracking:
You need to track the bad debt that your health organization is reeling under to ensure that similar
issues do not crop up in the future. As the bad debt value goes up, it shows a red flag to ascertain
loopholes in your financial services. It is also an indicator for lack of transparent communication
with the patients regarding the financial services.
Trend in Cost to Collect:
The HFMA defines the cost to collect as the total cost of the revenue cycle divided by the total
cash collected in the cycle. The goal of the healthcare organization is to reduce the cost to
collect for better financial management. Revenue cycle leaders across the USA are measuring this
trend to determine the efficiency level of their teams.
Changes in Resolve Rate:
Resolve rate is the number of claims that get reimbursed by the insurance company divided by the
total number of claims during a specific time period. According to surveys, a provider needs to
spend at least 10 to 30 minutes to work on each claim. If the graph moves upwards, it means that
your billing team is efficiently doing a great job taking care of the revenue. Experts believe that
a flat line on the curve could indicate issues with credentialing, patient eligibility verification
process, and coding.
Late Fees:
To make your revenue cycle management highly efficient, you must identify and cut off the
unnecessary costs involved in the process. Once such cost is the late fee or charge due to delay in
claim submission. Calculate the late fees as a percentage of total charge to see if it is on the
rise. This could explain any lag in cash flow of the organization.
7.Do the RCM service vendors implement the MACRA?
The Medicare Access and CHIP Re-authorization Act, better known as MACRA, has been designed to make
the practice standards more robust. Make sure that the RCM vendors are experts at implementing the
law as designed. Only then will you be able to gain the required benefits from the federal
regulators. Did you know that the MACRA non-participation would mean a 4% loss in Medicare billings?
Make sure that your RCM vendors are providing you with these crucial details so that you can make
the most out of your services. The returns on investment will automatically improve when your RCM
vendor is competent enough to implement these regulations.
Hope this blog gave you good tips about the evaluation process of RCM services for hospitals. What
metrics do you use to evaluate the revenue cycle in your company? Do let us know! For any queries or
suggestions, please leave a comment below. We will get back to you. For more updates on healthcare
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