With what feels like an infinite number of healthcare revenue cycle management (RCM) metrics available, it can be overwhelming to identify which metrics you should be tracking. That's why Prochant, the leading technology-driven reimbursement firm, has consolidated a collection of key performance indicator (KPI) guides for home-based care providers to use. Learn what these KPIs are, why they are important, how to calculate them, and more. Set your team up for revenue cycle success by keeping track of these crucial metrics.
90+ Accounts Receivable (A/R)
Your 90+ A/R is the percentage of open outstanding accounts receivable balance that has aged 90 days or more past the date it became billable. It's important to track the age of A/R, because the longer a claim is outstanding, the higher the risk of non-reimbursement. Review more about 90+ A/R here or 4 tips to reduce your A/R Percentage over 90 days for our full breakdown.
A Denial Rate shows the percentage of claims denied by payers during a specified period. This metric quantifies the effectiveness of your RCM processes. A low denial rate demonstrates cash flow is healthy and fewer staff members are needed. Check out everything to know about Denial Rate to learn more.
A write-off or bad debt represents revenue that is recognized but isn't collected. Your Write-Off Rate is the percentage of allowable billing that is adjusted off of your A/R each month as bad debt. A high Write-Off Rate indicates that products/services are being provided to patients free of charge. Check out a more in-depth look at Write-Off Rate here.
Held A/R is A/R that has not been released for billing due to missing or expired CMNs/Prescriptions, prior authorizations, complex data, or other supporting medical documentation. Your Hold Days metric is the number of days worth of revenue tied up in held A/R or unbilled A/R. Review how to calculate Hold Days and questions to ask.
Open Order Days
An Open Order is any order in your system that has not been confirmed or voided. Your Open Order Days metric is the number of days worth of orders currently tied up in open (non-confirmed) orders. A high Open Order Days metric indicates there are problems or backlogs in order confirmations. It could also be a potential indicator of missing documentation, orders piling up, or inefficient external processes. Check out our full guide to Open Order Days.
Credit Adjustment Rate
A credit adjustment is an adjustment applied to an invoice as the result of a billing error. These particular allowed amounts should never have been billed to begin with. Billing errors inflate A/R and revenue, which provides an inaccurate depiction of a company's earnings. A Credit Adjustment Rate constitutes the percent of documented billing adjusted as an error. Get brought all the way up to speed by reading about Credit Adjustment Rate here.
Adjust Allowable Rate
An allowable adjustment is a modified invoice balance based on the "real allowable." This is carried out through either an Explanation of Benefits (EOB) or Electronic Remittance Notice (ERN) during payment posting or invoice follow-up instead of at invoice creation. Adjust Allowable Rate is imperative because it's a gauge for price table or fee schedule accuracy. Incorrect price tables can cause unnecessary follow-ups credited to unresolved balances on invoices. See what else there is to know about Adjust Allowable Rate in our guide.
Tools to Help Track
It's important to calculate and analyze your key performance indicators (KPIs). However, managing spreadsheets and monitoring metrics on your own can result in errors. Prochant recommends utilizing a platform such as Prochant Analytics to track your KPIs and swiftly manage your processes. With a HITRUST CSF Certified RCM partner like Prochant, your patient information is secure and Prochant Analytics comes fully equipped with an expert client support team. Want to learn more? Read about Prochant Analytics or schedule a free demo.
Prochant has a proven track record of helping pharmacy and HME providers meet their financial goals. Our scalable solutions, years of experience, and advanced technology provide best-in-class results to the healthcare community. Headquartered in Charlotte, North Carolina, our client base includes national pharmacy and HME providers and health systems.