Hospitals Revenue Cycle Management (RCM) KPIs Darya Khripkova - - PowerPoint PPT Presentation

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Hospitals Revenue Cycle Management (RCM) KPIs Darya Khripkova - - PowerPoint PPT Presentation

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Hospitals Revenue Cycle Management (RCM) KPIs Darya Khripkova Vice President RCM November 1, 2018 Introduction EqualizeRCM s experienced professionals provide platform-agnostic revenue cycle management (RCM) services to healthcare

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Hospitals Revenue Cycle Management (RCM) KPIs

Darya Khripkova

Vice President RCM

November 1, 2018

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Confidential

Introduction

EqualizeRCM’s experienced professionals provide platform-agnostic revenue cycle management (RCM) services to healthcare providers across the United States. We design solutions and pricing models that enable healthcare providers to:

  • Access our specialized resources to solve their

RCM problems

  • Decrease the total cost of their RCM
  • perations by leveraging our scale, software

solutions and international operations

  • Increase their own in-house productivity and

efficiency

  • Increase their profitability through improved

reimbursements and collections at a lower total cost of operations.

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Darya Khripkova

Vice President RCM

Over 15 years of healthcare experience, managing healthcare practices and hospital RCM

  • perations. She is an

MBA (Healthcare Administration), Fox School of Business and Management, Temple University, and a member of the American College of Healthcare Executives (ACHE).

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Confidential

Facility RCM Performance Measures KPIs: What and Why

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What’s RCM KPIs?

  • Key Performance Indicators (KPIs) that one must monitor in order to

assess their revenue cycle health

  • Essential part of RCM, different from financial and clinical reporting
  • That which is measured, improves. But it’s not enough to just report

and measure – analyze!

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What’s the Most Important

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What’s Important?

  • How to look?
  • Trends, Outliers, Projection
  • When to look?
  • Daily / Weekly / Monthly

How Much Detail is Too Much?

  • Don’t drown but pay attention
  • It is YOUR facility and KPIs
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Complexities of Reporting

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Patient Accounting Systems DO NOT have sufficient Reports/Dashboards Consistency Who will do it? Involving 3rd Parties – BE CAREFUL with the Software Companies’ promises! Outsourcing of RCM usually helps with reporting

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Main Key Performance Indicators (KPIs)

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If You Can Only Choose 5, What Will They Be?

Charges / Collections / Adjustments Collections Rates Unbilled / DNFB Denials (Denial Rates) Rejections (Clean Claim) Volumes AR

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Charges and Volumes

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  • Volumes
  • You are likely already looking at the admissions and

discharges daily and monthly

  • Charges – Daily / Weekly / Monthly
  • Daily – Totals
  • Weekly – Totals / By Department
  • Monthly – Totals / By Department / Service Type / Payer
  • Unbilled Charges and DNFB
  • What’s in DNFB?
  • Lag Days, Not Coded, System Edits, Other Holds
  • Benchmark – 4 days (3 lag + 1 extra). Could vary based on

the service type

  • $ Unbilled Charges / $ Average Daily Charges
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Collections

  • Measure Daily / Weekly / Monthly
  • Daily – Totals
  • Weekly by Payer (including self pay)
  • Monthly by Payer / Service type / Non-AR
  • Time to Pay
  • Collection Rates
  • Payment Projections (bonus info)
  • Medicare, Other Payers through Clearing House

Reports

  • Daily Received Projected for the Month
  • More Complex Projections
  • Paid according to Contract (bonus info)

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Adjustments

  • Reports – Daily / Weekly / Monthly
  • Daily – Totals
  • Weekly – Split by Patient / BD / Insurance
  • Monthly – Totals / Split by Payer

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Accounts Receivable

  • Reports – Daily / Weekly / Monthly
  • Report Daily on Patient / Insurance / 90+ / MCR 60+
  • Monthly – Slice and Dice it
  • Days in AR (DAR)
  • Goals:
  • Insurance 90+ at lower than 15%
  • MCR 60+ at lower than 10%
  • Insurance DAR at 40-45 days
  • Total DAR – variable depending on Self Pay policies
  • Credit Balances

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Denials and Rejections

  • Report on Weekly and Monthly
  • Work Daily!
  • Analyze!
  • Hardest Rate to Calculate? $ Denied (Rejected) /

$ Billed (also #s)

  • Aim for 99% clean claim rate, 5% denials rate

(first pass)

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Important Formulas

  • Collections Rate
  • Payments / Charges
  • DAR
  • Outstanding AR / Average Daily Charges (90 days)
  • DNFB
  • Outstanding unbilled / Average Daily Charges (90 days)
  • Denial / Rejection Rates
  • Denied (Rejected) $ / Billed $

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Questions

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Contact Us

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Michael Hill

President, EqualizeRCM

202.277.6225 Michael.Hill@EqualizeRCM.com

Darya Khripkova

Vice President of Hospital Services

202.559.0243 Darya.Khripkova@EqualizeRCM.com

For additional information, visit:

EqualizeRCM.com

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Thank You