Advanced Revenue Cycle Analytics: An Overview

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Practice managers today are focused on improving the efficiency of their revenue cycle. One way managers can track and improve the productivity and efficiency of their revenue cycle is to benchmark performance using Key Performance Indicators, or KPIs. KPIs help managers identify and address problems with productivity, reimbursement, claims submission, and other processes.

How to Use KPIs

The first step when using KPIs is to establish your benchmarks for each KPI you want to track using historical data. This helps you set measurable, achievable goals. Once your benchmarks are set, track progress over time.

Tip: Tracking KPIs separately for each payer can assist in isolating the root cause of issues. 

17 Revenue Cycle KPIs to Track

  • Days to final bill—number of days from time of service until provider generates and  submits claim
  • Days to payment—number of days from time claim is submitted until provider is paid
  • Claims acceptance/rejection rates—percentage of claims accepted/rejected during payer  front-end edits (before entering the payer’s adjudication system) • Consider using these  criteria to gauge potential issues: 1. Aging 0-30, 31-60, 61-90, 91-120, 121 + days from time  of service; track by payer & dollar value 2. Days in accounts receivable, by payer
  • Claims denial rate—percentage of claims accepted into the payer’s adjudication system  that are denied • Consider keeping separate tallies of authorization and coding denials
  • Revenue Cycle Productivity—encounters processed per hour per FTE
  • Encounter Review Rate—percentage of encounters reviewed by biller or coder
  • Encounter Change Rate—percentage of encounters changed by biller or coder
  • Payment amounts—amounts provider receives for specific services (focus on  high-volume, resource-intensive services)
  • Reimbursement rate—cents on the dollar provider receives on claim versus amount billed
  • Volume of coder questions—number of records coders return to clinicians with requests  for more documentation to support proper code selection
  • Requests for additional information—number of requests from payers for additional  information required to process claims
  • Daily charges/claims—number of charges or claims submitted per day
  • Clearinghouse edits—number and content of edits required by clearinghouses, or claims  accepted/rejected by clearinghouse
  • Payer edits—number and reason for edits required by payers
  • Use of ICD-10 codes on prior authorizations and referrals—number of orders and referrals  that include ICD-10 codes
  • Incomplete or missing charges—number of incomplete or missing charges, weekly or  monthly
  • Incomplete or missing diagnosis codes—number of incomplete or missing ICD-10  diagnosis codes on orders Use of unspecified codes—volume and frequency of unspecified code use

White Plume Analytics

These are just a few of the ways you can measure your practice operational efficiency. The problem is, in the midst of a busy schedule, it’s hard to take time out of your week to aggregate and analyze data. White Plume provides our clients with quarterly analytics reviews. We pull together all of the data in a clear, easily digestible format, and then review that data to highlight notable changes. Learn more about our Advanced Revenue Cycle Analytics.