Top 8 Medical Billing KPIs to Boost Your Revenue Cycle Success

Healthcare is transforming as organizations have begun tracking industry trends to improve revenue cycle management (RCM). Medical organizations must operate at maximum efficiency to keep up with high competition. The status of medical billing and revenue cycle are two important focus areas that allow healthcare setups to excel. Healthcare RCM steps in at this point to streamline processes at each stage of the revenue cycle.

Parameters like revenue cycle key performance indicators (KPIs) or medical billing key performance indicators (KPIs) can help analyze and address the gaps in revenue cycle stages.

Here’s a list of some critical medical billing KPI metrics:

Point-of-sale service (POS) cash collections

POS cash collection, a KPI for the billing process, used to determine the effectiveness of POS systems. It tracks payment status before providing services and its receipt, after seven days. This KPI can also identify problems in POS operations that affect RCM. Expert observations indicate that collections and revenue losses increase as efficiency decreases in upfront payments.

This revenue cycle KPI can be calculated by dividing POS payments by the total self-pay cash collected.

Clean claim rate

Clean Claim Rate is a part of medical billing KPIs. It determines the average of daily passed claims and efficiency of the claim submission process. It also helps hospitals calculate the cost and average duration for claim reprocessing which can be expensive unless passed in the first submission.

Bad debt

Another useful medical billing KPI is bad debt. It demonstrates the effectiveness of your collection efforts. A higher bad debt value can be indicative of inefficiency in certain areas of the revenue cycle, such as POS collections and financial counseling. Bad debt is the division of allowed charges by bad debt write-offs; expressed in percentage.

Cost to collect

Cost to Collect is an essential revenue cycle KPI that measures the efficiency and productivity of collection processes. It can be expressed in two forms — gross cost and net cost. The gross cost to collect is the division of payments by the billed charges. Using this metric healthcare organizations can account for cash flows and future collections.

Resolve rate

Resolve rate highlights the efficiency of your RCM process. If the resolution rate is high, it means your staff and process are functioning optimally. If the rate is low, analyze eligibility verification, coding and other authorizations. Resolve rate is the division of number of claims for a given period by total claim; expressed in percentage.

Days in accounts receivable (A/R)

Days in (A/R) denote the average time to get paid for the services rendered or number of days medical bills spend in A/R. It determines how effectively an organization obtains payments for its services and how well it manages A/R.

Day in (A/R) is one of the most critical medical billing KPIs. To calculate this metric, find the value of total A/R from the balance sheet and income statement; divide it by the average daily patient service charge.

Late charge as a percentage of total charges

Late charge as a percentage of total costs is the revenue value not received on time. This metric measures revenue capture efficiency, identifies and addresses process gaps to improve revenue capture, cut unnecessary costs, improve compliance and speed up cash flow.

Month-over-month revenue

One of the more significant revenue cycle KPIs, month-over-month revenue, can be used to determine the origin of profits. This metric tracks funds from payers, tests, and clients every month. It can help identify your most profitable clients; see which tests are causing reimbursement or if any lab needs an upgrade to work efficiently.

Medical establishments might get overwhelmed dealing with all these numbers.

Don’t worry! HelioNext has got you covered with an intelligent revenue cycle KPI dashboard to host all your billing data in one place.

It gives you access to:

  • actionable analytics
  • critical performance alerts to keep track of these KPIs and
  • take corrective measures in real-time

HelioNext ensures error-free billing, reduces claim denials, enhances patient experience, and reduces overall cost.

Our medical billing KPI dashboard is accessible anytime, on any device. The dashboard uses artificial intelligence and stored data to answer your queries instantly. Book a demo or get in touch today and take the first step towards improving your revenue cycle management.