Key Performance Indicators (KPIs) for Revenue Cycle Management

Revenue cycle management (RCM) is a critical aspect of any healthcare organization. It involves managing the financial aspects of patient care, from scheduling appointments to billing and collecting payments. The success of RCM can be measured using Key Performance Indicators (KPIs), which provide insights into how well the revenue cycle is functioning. We’ll explore some of the key KPIs for RCM.

1. Gross Collection Rate (GCR) – The Gross Collection Rate (GCR) measures the percentage of total charges collected compared to the total charges billed. This KPI reflects the organization’s ability to collect payments from patients and payers. A high GCR indicates efficient billing and collection processes and effective patient financial counselling.

2. Net Collection Rate (NCR) – The Net Collection Rate (NCR) measures the percentage of total charges collected after adjustments and contractual allowances are taken into account. This KPI reflects the organization’s ability to negotiate favourable contracts with payers and manage denials and appeals effectively. A high NCR indicates efficient revenue cycle operations and effective contract negotiations.

3. Days in Accounts Receivable (DAR) – Days in Accounts Receivable (DAR) measures the average number of days it takes for an organization to collect payment after billing. This KPI reflects the efficiency of the billing and collection processes and the organization’s ability to manage denials and appeals. A low DAR indicates efficient revenue cycle operations and effective denial and appeal management.

4. Denial Rate – The Denial Rate measures the percentage of claims that are denied by payers. This KPI reflects the organization’s ability to submit accurate and complete claims and manage denials and appeals effectively. A low denial rate indicates efficient revenue cycle operations and effective denial and appeal management.

5. Clean Claims Rate – The Clean Claims Rate measures the percentage of claims that are accepted by payers on the first submission. This KPI reflects the organization’s ability to submit accurate and complete claims and minimize denials and appeals. A high clean claims rate indicates efficient revenue cycle operations and effective claims management.
6. Charge Lag – Charge Lag measures the time between the date of service and the date of billing. This KPI reflects the efficiency of the billing process and the organization’s ability to submit claims in a timely manner. A low charge lag indicates efficient revenue cycle operations and effective billing processes.

7. Payment Lag – Payment Lag measures the time between the date of billing and the date of payment. This KPI reflects the efficiency of the billing and collection processes and the organization’s ability to collect payments in a timely manner. A low payment lag indicates efficient revenue cycle operations and effective payment collection processes.

Key Performance Indicators (KPIs) are critical for measuring the success of Revenue Cycle Management (RCM) operations. These KPIs provide insights into the efficiency of billing and collection processes, the organization’s ability to manage denials and appeals, and the effectiveness of contract negotiations. By monitoring these KPIs regularly, healthcare organizations can identify areas for improvement and optimize their revenue cycle operations.

Atlantic RCM is one of the leading multi-specialty medical billing companies in USA that serves 25+ major medical billing specialties. Our experts work across your practice in billing, collections and account receivables management, to help you succeed.

Get in touch with the leading medical billing outsourcing company to learn more. Call us at (469) 501-1500 or write to us Info@atlanticrcm.com