KPI Metrics in Healthcare Revenue Cycle Management

Unpacking the Top 7 KPIs for Effective Healthcare RCM

As the healthcare industry evolves, efficient Revenue Cycle Management (RCM) becomes increasingly critical. The intricate web of processes, from patient registration to final billing, has made RCM more complex than ever before. Amid this complexity, Prochant stands tall as an industry leader, ushering in technological advancements to simplify and optimize these processes. In this guide, we delve deep into the essential RCM metrics, their evolving significance, and how Prochant is helping businesses navigate this challenging landscape.

The Transformative Journey of RCM: From Manual to Digital

RCM's evolution has been nothing short of transformative. What began as a manual, paper-driven process has now embraced digitization, making tasks more streamlined and efficient. Yet, the digitized realm brings its own set of challenges. Understanding these challenges and the metrics to monitor them can be the game-changer for home-based care providers.

Core Metrics Every Healthcare Provider Should Track

1. 90+ Accounts Receivable (A/R):

   Understanding the Metric: A/R is the financial representation of your billing efficacy. But why focus on the 90+ bracket? Because older bills are at a higher risk of non-payment. A rise in this metric might point to systemic inefficiencies or external factors affecting collections.

   Prochant's Solution: By integrating AI-driven analytics, Prochant offers predictive insights, helping businesses identify potential collection bottlenecks before they become critical.

2. Denial Rate:

   Understanding the Metric: Denial rates directly influence your cash flow. High denial rates can signify issues ranging from coding errors to mismatched patient information.
   Prochant's Perspective: With real-time claim verification and payer-specific guidelines integrated into the platform, denial rates have never been lower for Prochant’s partners.

3. Write-Off Rate:

   Understanding the Metric: It’s critical to distinguish between necessary and unnecessary write-offs. While some write-offs are inevitable, others stem from preventable administrative errors.
   Prochant's Solution: Our software offers root cause analysis for write-offs, pinpointing areas for process improvement.

4. Hold Days:

   Understanding the Metric: Every held day signifies a delay in cash flow. These holds, often due to missing documentation or data errors, are a silent revenue killer.
   Prochant's Perspective: By automating data validation and document tracking, Prochant dramatically reduces the occurrences and durations of holds.

5. Open Order Days:

   Understanding the Metric: Open orders are a liability. They indicate inefficiencies in order confirmations, often resulting from documentation gaps or slow manual processes.
   Prochant's Solution: Our platform integrates with various EMR systems, streamlining order confirmations and minimizing open order days.

6. Credit Adjustment Rate:

   Understanding the Metric: This metric offers insights into billing accuracy. High rates signify frequent billing errors, which can erode patient trust and result in financial discrepancies.
   Prochant’s Perspective: With an emphasis on training and an AI-assisted billing process, we've seen a significant decrease in billing errors among our clientele.

7. Adjust Allowable Rate:

   Understanding the Metric: This reflects the precision of your pricing mechanisms. Inaccurate pricing not only leads to financial losses but also increased administrative overhead due to necessary adjustments.
   Prochant's Solution: Our dynamic pricing tool ensures up-to-date and accurate billing, reducing the need for subsequent adjustments.

Leveraging Technology for Superior RCM

The healthcare industry is awash with data. Harnessing this data efficiently is the key to successful RCM. Modern tools, like Prochant Analytics, go beyond traditional data representation, providing actionable insights through intuitive dashboards. As a HITRUST CSF Certified RCM partner, Prochant ensures the pinnacle of data security while providing unparalleled client support.

Future of RCM

With the rapid advancements in AI and machine learning, RCM is poised for another transformation. Predictive analytics will play a more dominant role, providing businesses with foresights rather than insights. As generative AI technology becomes more prevalent, real-time data processing will become the norm, further shrinking the RCM cycle duration.

The future of healthcare is undeniably digital. With RCM becoming more complex, the need for comprehensive, intuitive, and secure solutions like Prochant becomes paramount. By understanding and acting upon the essential RCM metrics, home-based care providers can ensure not just survival but flourishing growth in the coming years.

Connect with us today to learn more about how our reimbursement experts can help optimize your revenue cycle management!