Revenue Cycle Management (RCM) metrics provide key performance indicators to monitor cash flow and billing operations. Common metrics include dollars collected, days in accounts receivable, claim denial rates, and first-pass pay rates. Collecting real-time data on these metrics allows practices to identify issues, improve processes, and ensure compliance. As clinical and financial data become more integrated through technologies like interoperability, ongoing RCM performance monitoring will be crucial for healthcare organizations.

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. 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. 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

5. 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

6. 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.

7. Claim Denials

8. 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

9. Real Time Data

10. Staff Productivity

11. 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