Key Performance Indicators in Revenue Cycle Management: Essential Metrics to Track
Explore crucial KPIs like charge lag, days in AR, clean claims rate, and cash collection to optimize your revenue cycle process and minimize financial risks.
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Revenue Cycle Management KPIs You Should Know Gentem Health
Added on 09/27/2024
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Speaker 1: So, there's a lot of KPIs that you want to track with your revenue cycle process and we'll go through some of the highlights. Charge lag, how many days does it take you to submit a claim? One to five days is really considered the industry standard. People that we talk to, places I've been, one to five days is acceptable. Something six to ten, maybe that's the average, and over that you're really getting into the risk zone. Days in AR, this is also known in some specialties as DSO. So this is a different metric. This is the number of days from the date of service to the payment date. So how many days from that encounter are you waiting to get your paycheck? 35 days is the goal. You can be really aggressive with anything from 30 to 34. Getting 45 or higher, that's more of a risk and you need to really dig in and see is it taking you longer to get your charges out the door, back to your charge lag, or is a payer just by process taking that long? Clean claims rate. So you want your clean claims to be like a really big metric, 95% or above is a great goal. And the reason why is you want to put your resources on the front end to make sure you have went through every check and balance that you can to assure a clean claim is going to a payer for reimbursement. You don't want to have to work this stuff on the back end. You want to put your work in on the front end. AR. So let's talk about AR. We age it in 30-day buckets, right? Anything over 90 days aged from the date of service, you want that to be less than 10%. So 10%, 90 days and over, there's some things out there that take time to work. So you're waiting on an addendum with medical records, but you really want to keep that AR 90 days and below. Rejection rate and denial rate, those are just two ways a claim could get hung up and start hanging out on your AR for an extended period of time. So you want your rejection rate to be less than 10%, meaning that you've attempted to submit a claim but didn't get it there to the payer. So you want to make sure, again, you're going back to that clean claims rate and measuring to make sure you have checks and balances on the front end. This may be with your tech or software. This may be people looking at the process to make sure you're not missing anything. Cash collection. So 90 plus percent. Now across the industry, anything from 85% to 96% are the common numbers we hear. 90 plus percent, I would have a goal of 95%. That to me is aggressive, but it assures that you're getting that cash back in the door, especially with those in-network payers where you have a contract and you know what you should be paid by debt. This can be measured a lot of ways. So the metric gauges the amount of non-contractual charges, things that are right off. You really want to limit this. You don't want to work for free. So you want this to be less than 5% if at all possible.

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