Most practices have goals and targets set for each year when it comes to their revenue collection. Structured plans are devised to ensure this goal is met. With all the steps involved in making a practice a successful one, it becomes extremely important to track the viability of these goals and any need to reform them. What better way to do this than tracking your Key Performance Indicators(KPI)? KPIs don’t just enable you to identify areas of improvement, they also provide insight into possible future trends if you maintain the strategy already in place.
KPIs are facts, numbers, and metrics that provide insight into the efficiency of the dental RCM. They let the practice have an in-depth understanding of the various aspects related to their RCM. A practice that fails to assess their KPIs in RCM is operating blindly, as they have no early signs or warnings of any decline in the performance of the revenue cycle. Ignoring your KPIs is one of the most frequent causes of a lackluster revenue cycle.
Here are some of the important KPIs to make sure that your RCM is running effectively:
Days in AR
The days spent in AR show how long it usually takes your practice to get payment for services provided. This number aids in determining how successfully the practice is collecting payments and how efficiently it handles account receivables, thus shedding light on the flow of revenue at your practice. Ideally, it’s always better to keep your AR days within a 30-day benchmark, but never let them exceed 60 days. To measure the days in AR, you need to first consider a certain time period you would like to check. This could be the past month, past quarter or even the past year. Simply add the daily charges within this time period and divide it by the total number of days in the chosen time period.
Net collection Rate
The net collection rate indicates what percentage out of the total payments due, is actually received by the practice. It shows how successful your practice is at collecting the payment owed to them. The net collection rate could reveal a great deal about your practice’s collection tactics and how you can modify them. A consistent low net collection rate indicates a deeper problem like internal ineptitude. As with Days in AR, the first step to calculating the Net Collection Rate is to decide on a timeframe. You then need to divide the total payments that you received within this timeframe by the payments that were expected or agreed upon. The Net Collection Rate is determined once this number is divided by 100.
Bad debt is a common occurrence and is a part of having your own business or practice. Collecting patient payments on time may not always be easy but not all failure to collect instances need to be written-off as bad debt. A high percentage of bad debt is never good for your practice. Calculating the bad debt ratio will help your practice determine if there is a need to change the collection process or even if there is a need to change your approach in patient communication. To calculate your bad debt ratio, divide the bad debt written off by the total sales of your practice.
Clean claim rate
Clean claim rate is the percentage of insurance claims that are submitted and successfully reimbursed at the first instance of submission. A high clean claim rate means faster payments. It indicates that the claims being submitted have a high quality of data. Measuring the clean claim rate helps practices monitor the effectiveness of the data collection process prior to claim submission. Rejected claims need a lot of time to resolve and involve additional work and cost to both the provider and the payor.
While denied claims can result in underpaid claims or no payments, they can also be remedied and sent back. However, making many appeals for rejections may result in additional fees and may reduce the effectiveness of the revenue flow. The denial rate can be calculated by dividing the total amount denied by the total amount submitted as claims. If the percentage is above 10, you may need to re-examine your eligibility and verifications and coding processes.
There are several other KPIs that you can use to measure the effectiveness of your RCM like Point of Service Cash Collection, Revenue Per Patient Visit and Late charge rates. Understanding what your practice needs and ensuring the use of the right KPIs can go a long way towards maintaining a healthy RCM.