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Managing day to day rcm performance with data


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Revenue Cycle Management: What Matters Now, Part 2 of a 6-part series. View podcast and key topics at

Published in: Health & Medicine
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Managing day to day rcm performance with data

  1. 1. Revenue Cycle Management: What Matters Now Managing Day to Day RCM Performance with Data Guest Host Julie Huffman, Tim Coan, VP, Operations CEO ALN Medical Management ALN Medical Management
  2. 2. Common Billing Metrics Measurement Definition Dollars Collected Total cash received Total Accounts The total amount of money the practice is owed Receivable for services rendered Days in Accounts The average number of days from when a claim Receivable (DAR) is entered into the system until it is paid A/R Aging The amount of A/R outstanding, classified by time periods since the date of service Number of Open Completed patient visits for which a claim has not Appointments yet been submitted Gross Collection Net Revenue Ratio Gross Charges
  3. 3. Collection Ratio Net Revenue  Gross Collection Ratio: = Gross Charges Net Revenue  Net Collection Ratio Gross Charges – All non-collectible adjustments Collectible Adjustments Non-Collectible Adjustments • NSF fees • Contractual adjustments • Bad debts • Charity Care • Small balance • Courtesy, inclusive, and prompt • Administrative and timely filing pay discounts
  4. 4. Front End Billing Metrics Front End Billing Metrics The time interval between the date a service Claim Lag is rendered or an item is supplied and the date a service or item is processed and paid. The percentage of claims that are rejected at Claim Submission submission (software, clearing house, payer) Patient information, guarantor information, Demographic Quality and insurance information Conditions an employee must meet in order to qualify for coverage under a plan, such as Eligibility length of service, employment status, or attainment of a certain minimum age
  5. 5. Back End Billing Metrics Back End Billing Metrics Denial Rate Compare to industry standards by specialty Shows quality at the transaction level, recurring Denials, by Type themes – coding or payer specific The percentage of claims successfully resolved (paid First-Pass Pay Rate or adjudicated to patient responsibility) on the initial submission. Measures of ERAs, EFTs, payment posting, secondary claim filing, Automated Tasks reconciliation of cash deposited to payments posted The ratio of patient responsibility to total billed Percent of Patient Liability charges. The ratio reflects patient deductibles and is important in measuring front office function.
  6. 6. Claim Denials
  7. 7. Patient A/R Statement Cycles Automated every 28 days Standard processes, automated Collection Letters calls, collection agency write-offs Soft Collections Phone calls, specialized agencies Hard Collections Collection agency
  8. 8. Real Time Data
  9. 9. Staff Productivity
  10. 10. RCM: What Matters Now Why RCM Performance is More Important Than Ever Interoperability: Managing Day The Coming to Day RCM Merger of Performance Clinical and with Data Financial Data Revenue Cycle Management RCM Reporting: Technology What to Watch, Enhanced RCM When to Watch The Future of Coding and Compliance