What are the key metrics to measure RCM performance and patient satisfaction?

In most fee-for service environments a difference exists between billed charges and the amount(s) expected to be collected. It seems simple, but so many practices fail to properly and timely adjust contractual write offs before producing an aging report. Then productively organizing the aging report by major payors and lines of business makes the aging report a useful management tool.

"A stitch in time saves nine." In RCM, key metrics include Days in Accounts Receivable (AR), Denial Rate, Collection Rate, and Net Collection Rate. Patient satisfaction can be gauged through surveys, timely billing, and resolution of billing inquiries. Metrics like Patient Net Promoter Score (NPS), complaint resolution time, and accuracy of patient billing statements are crucial. Regularly monitoring these metrics ensures a proactive approach to RCM performance and enhances patient satisfaction, preventing potential issues.

This metric measures the average number of days it takes to collect payments after a service has been delivered. A lower number of days in AR indicates a more efficient revenue cycle management (RCM) process.

**RCM Performance Metrics: - Days in AR: Average time to collect payments. - Net Collection Rate: Portion of collectible revenue collected. - Denial Rate: Percentage of claims denied. - Cost to Collect: Expense of collecting payments. - First-Pass Resolution Rate: Claims paid on the first submission. Patient Satisfaction Metrics: -Satisfaction Scores: Ratings from surveys or feedback. - Net Promoter Score (NPS): Likelihood of recommending the practice. - Average Wait Time: Time patients wait for service. - Resolution Time: Time to resolve billing or service issues. - Patient Retention Rate: Percentage of returning patients.

I agree, if a practice is only monitoring the denial rate without digging into and fixing the root causes they should stop monitoring. In my experience a lot of denials are caused by payers not setting their systems correctly. Of course there’s many issues to be found but payers are a big one.

I agree, Paula. Then there is the clearinghouse. We recently had a change in clearinghouse and it produced a wealth of denials among other issues. The claims weren't even making it to the payer. So digging and correcting root cause(s) is critical; however the majority of our denials are due to the payer and it's gotten worse over the last couple of years.

In my experience, this is one of the most critical KPI’s to monitor in RCM. This KPI can give you insight to many issues within your billing (coding,policy coverage, proper ICD10). Digging into the denial rate will always produce good results.

In addition to reviewing the claim denial rate, reviewing it by department or workflow group is a great way to identify issues with people, processes, or technology that are slowing your revenue cycle velocity.

The claim denial rate shows the percentage of claims that are denied by payers. A lower denial rate suggests that your billing and coding processes are accurate and that there are fewer issues to resolve, which can streamline the RCM process.

This metric measures the percentage of collectible revenue actually collected. It’s a crucial indicator of the efficiency and effectiveness of your RCM processes. A higher net collection rate indicates that your organization is successfully capturing the revenue it’s owed.

Patient satisfaction scores provide insight into the patients' experience with the billing and payment process. Higher patient satisfaction scores can indicate clear communication, ease of payment processes, and overall positive patient interactions with the financial aspects of their care.

In my experience, one needs to also consider the amount and impact of (as well as the reason for) administrative adjustments. Many organizations are erroneously writing off collectible insurance balances to internal administrative adjustment codes.