The healthcare industry cannot have a universal solution when it comes to managing their revenue cycles. There are specific types of process flow, patient mix, and billing problems for every medical speciality, so a one-size-fits-all set of Key Performance Indicators (KPIs) isn’t workable. Individualisation of KPIs on a speciality-by-speciality basis must occur to provide credible information, enhance performance, and enhance revenue.
What is Revenue Cycle Management?
Revenue Cycle Management, or RCM in a healthcare organisation, is the management of the revenue cycle. The entire patient treatment process of every patient, from registration and scheduling to payment in full, is tracked. This includes collection, posting of payment, verification of insurance, billing the patient, and submission of a claim. With proper RCM, healthcare practices can have a proper stream of income.
KPIs of the Revenue Cycle
Key Performance Indicators (KPIs) of the revenue cycle are the indicators of the effectiveness and efficiency of the process. The revenue cycle KPIs provide feedback on various aspects of financial performance. This includes billing integrity, percent denied claims, timely payment, and revenue collected. Tracking the indicators enables healthcare practices to identify areas to correct to improve their revenue cycle.
Why Speciality-Specific KPIs Matter
Each of the healthcare specialities are unique. Primary care units experience a volume of patients and their goal is preventitive medicine. One the other hand surgical centers will focus on the number of procedures that were performed and their outcomes. Each of the revenue cycle KPI must be in concert with all these varied behaviors so practices can report according to them.
Speciality-specific KPIS are more specific, enable quicker diagnosis of issues, and enable more specific targeting.
Key KPIs for Various Specialties
Primary Care
- Visit Volume: This measures the volume of patient visits within a particular time frame. If it is seen that the volume increases, it means that there is demand.
- Preventive Services: This KPI observes the number of people doing the recommended screenings and tests. If preventative tests are higher, it means that the patient management is proactive by the clinic, which is good for patients’ health in the long run.
- Average Reimbursement: This measures of cost-effectiveness of the clinic but measuring the average payment of each patient visit.
Surgical Care
- Procedures: This counts the number and types of surgical procedures being carried out. Larger and more complicated procedures mean greater revenues and vice versa.
- Cancellation Percentage: If procedures are cancelled, it affects revenue and scheduling efficiency of the institution. Having a general analysis of cancellation percentages helps keep the finances of the place in check.
- Average Charge Per Case: This is a measurement of how much an average case costs. By adding the total charges of all surgeries and dividing them by the total number of surgeries, this can be found. This can help understand the average costs of the place and compare it with similar places, which can be helpful for patients seeking treatments.
Pediatrics
- Vaccination Compliance Rate: This is a measurement of how many children are getting their prescribed vaccines on time. This is important information for the health and safety of the individual as well a the society around the child.
- Rate of No-shows: If more peple cancel appointments are don’t show up its affects revenues.
- Average Time to Reimbursement: Average number of days from the date reimbursement is received after the billing patient or insurance is submitted.
How to Customize KPIs to Your Specialty
- Define Core Revenue Streams: Where your revenues are coming primarily coming from, for e.g., consults, procedures, diagnostic tests,etc.
- Classify Billing Issues: List usual billing issues such as denials, lost authorisations, or coding errors.
- Align KPIs with Clinical Goals: Align financial KPIs with quality patient care goals as well.
- Make Use of Computer Packages: Track KPIs on a full-automatic basis using the use of computer packages and keep up to date with trends as a team.
- Check and Calibrate Periodically: Check KPIs from time to time to make sure that they are practiced in line with practice objectives as well as market trends.
Revenue cycle management is not “one-size-fits-all.” KPIs when customised to speciality gives you more precision and specific sollutions. This is very important for the healthcare industry so that they can be efficient in providing care to their patients.
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