Provider credentialing is a detailed process that reviews a provider’s qualifications and career history including education, training, residency and licenses, as well as any specialty certificates.
One of the fastest ways to ensure positive cash flow is to improve your process that generates and mails patient statements. Expedite patient payment collections with automated processes.
Accounts Receivables Management & Follow-up
Accounts Receivables (or AR) is money owed to the provider based on the different patient accounts for services rendered. AR is payable by insurance firms and patients.
Denial Management & Appeals
A high percentage of claims put forth by patients or providers are denied by insurance companies due to incomplete claim forms, wrong diagnosis code, incorrect modifiers, and more.
Charge entry process is the most critical and important feature of the medical billing cycle where the claims are actually created.
Medical categorization or medical coding is the method of converting medical diagnoses reports and dealings into a collective list of assigned medical code numbering.
Claims Scrubbing & Submission
The number of denied or rejected claims is reduced drastically when you incorporate successful claims scrubbing that detects and eliminates errors in billing codes before submission.
Insurance Eligibility Verification
Insurance eligibility verification is an important process wherein a provider’s practice or healthcare facility checks into a patient’s insurance coverage to learn what services or treatment will be covered by insurance in order to offer better consultation and care.
Your registration process will capture your patients’ information, including insurance information. Ensuring an optimized process ensure you get paid faster for services rendered.
A solid revenue cycle management (RCM) strategy must track certain key point indicators (KPIs) in order to understand patterns and optimize processes and flows.
If you manage your revenue cycle yourself or hire in-house office staff for the task, you know how tiresome and tedious it is to create a strategy that runs smoothly and efficiently. Not to mention, that having a weak process in place nearly guarantees touch point mistakes, leading to high rates of avoidable denials and rejections.
Consider the following KPIs as the vitals you need to track to ensure your revenue stream is healthy:
- Days in Accounts Receivable
Tracking the days in A/R will reveal how long it takes you to get paid for your services on average. This information is critical in determining the efficiency in this particular point in your RCM workflow, as you’ll discover how long it takes your office to obtain payment for services.
How To Find this KPI: Divide the total A/R by the average daily net patient service revenue. (To get the average daily net patient service revenue, divide total annual sales by 365.)
- Denial Rate
If you have a high rate of denials, you’ll need to put certain tactics in place to prevent future rejections, especially since our research shows that up to 90% of denials are avoidable. Document the reasons for denials and then put an action plan in place.
Example: Dr. Fields tracked the top 5 KPIs for his practice and discovered that he had a high rate of denials. After checking past claims and documenting the reason for denials, he realized that there were a high number of errors in coding. After spending a high cost for training material and professional development sessions to train his staff and implementing quality assessment checks on all postings, Dr. Fields’ denial rate was reduced.
- Clean Claims Rate
Having a high clean claims rate fuels your practice’s cash flow, so it’s imperative to send out clean claims the first time around. This KPI will tell you whether or not the first touchpoints dealing with patient registration and insurance eligibility in your RCM flow is working accurately and efficiently. Even small mistakes in demographics or insurance information can result in a denial, so be sure to train your staff to quality check information before submitting a claim.
- Pending Claims Rate
Check your current rate against last year’s rate. Has it increased, decreased, or remained the same? Your ideal rate is either low or steadily decreasing until you hit your goal. This KPI can give you information on your documentation, authorization, confirmation, billing, and respiratory teams.
- Reimbursement Rate
Is your reimbursement rate improving month after month? If so, it means you’re ensuring that patients aren’t paying less than the contracted rates and your staff is properly trained to enter orders accurately the first time. If not, you’ll need to analyze these two touchpoints in your RCM workflow and optimize them.
Remember, it’s not enough to simply track these data points. After gathering the information, it’s important that you examine the data and find ways to strengthen weak points in your process and optimize it as much as possible.
The fastest, easiest, and most cost-efficient way to track these KPIs and optimize your process is by partnering with an outsourcing RCM solutions firm like Plutus Health.
Not only do our RCM experts create optimized workflows for practices and specialty labs, but we do it using Zeus, our robotic processing automation software offered as a service. Enjoy more time to focus on patients and more money when you save on overhead costs by allowing us to create an end-to-end RCM strategy that will track these 5 vital KPIs to increase the health of your revenue stream.
CONNECT WITH A PLUTUS REPRESENTATIVE TODAY TO LEARN HOW OUR RCM SERVICES CAN HELP YOUR PRACTICE OR LAB ELIMINATE HUMAN ERROR, DECREASE OVERHEAD COSTS, AND INCREASE YOUR REVENUE.
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