Ruth's Reading List 5/22/15

Using KPIs to Measure Revenue Cycles

Today’s post is dedicated to our clients who operate in the healthcare industry. Ongoing changes in the U.S. healthcare system now require increased record keeping, quality of care, and, soon to come, the implementation of much more detailed coding under the ICD-10 transition. Meanwhile, revenue collection is being negatively impacted by the bundling of payments and increased patient responsibility under high-deductible health plans.

More than ever, it is critical to measure your revenue cycle Key Performance Indicators (KPIs). One best practice is to capture detailed information being returned with each explanation of benefits, to provide data for analytics. KPIs should be measured by various financial/payer classes, including analyzing patient pay on its own basis. Significant KPIs to measure, trend, and review include:

  • Days to bill
  • Days to collect
  • EDI Rejection
  • Non-Contractual Write-off
  • Timely Filing Write-offs

The following articles provide some general information on critical trends for the revenue cycle in 2015. In the JP Morgan report highlighted, we noted significant patient pay data as follows:

“Intriguingly, the McKinsey study found that 74 percent of insured consumers indicated that they are both able and willing to pay their out-of-pocket medical expenses up to $1,000 per year and 90 percent would pay for medical expenses up to $500 per year.

When asked why they would opt not to pay a medical bill, the survey respondents indicated that a lack of options for payment plans, poor timing of bills and difficulties coping with confusing statements or policies were major barriers to paying.”

CFORuth & Associates recommends consideration of the following practices to increase patient communication, satisfaction, and payment compliance for your business:

  • Access the patient payment responsibility information at the time of service or pre-authorization.
  • Collect patient payment up-front, if possible, or issue the patient bill simultaneously with the medical claim.
  • Provide prompt payment discounts, credit card acceptance, and defined payment plans.
  • Initiate patient bills frequently vs. traditional monthly billings.

CFORuth & Associates can assist you with optimizing your revenue cycle and cash flows. We have extensive experience in developing KPIs and dashboards, automation for posting of EOBs and denial management, templates to assist with coding and compliance audits, and providing best practices for your business.

Working better. Achieving more. Together.