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A Key Performance Indicator (KPI) is a set of quantifiable measures used to gauge the long-term performance of an organization. Because KPIs are quantifiable measures, they help you avoid anecdotal discussions like “Jane thinks our denials are trending favorably, however, John does not share the same opinion.”. KPIs spotlight on one single version of the truth and become indispensable for informed decision making and accountability.
However, nailing down the most important KPIs for your provider organization can be confusing. Not knowing which KPIs to track or even tracking the wrong KPIs, can waste valuable management bandwidth and demarcate the organization away from the long-term goals.
| Revenue Cycle Area or Function | Key Performance Indicator (KPI) | KPI Impact |
|---|---|---|
| Scheduling / Orders | Appointment No Shows & Cancellation % | No-shows and cancellations can have a deeper negative impact than you might think. The scheduling team must now spend additional time rescheduling patients. It negatively impacts revenues as your practice may lose out on billable time. |
| Pre and Time of Service | Time of Service Collections | An efficient upfront or time of service collection process positively impacts your cash flow and offers an opportunity to educate the patient on their overall financial picture. When this KPI is high or increasing, it means you are clearly communicating to patients, building trust, and collecting revenue early in the RCM process, decreasing the risk of aging AR. |
| Billing | Denial Rate % | From the moment patients begin providing information to your practice to the end of the care encounter, the risk of a denied claim increases every step of the way. This KPI should be a north star for your practice to sense for potential issues leading to denied claims. |
| Payment | Net Collection Rate | Collecting everything owed to your practice is critical so you aren't leaving money on the table. This KPI allows you to measure your collection rate based on contractual agreements with payers. Net Collection Rate also monitors how well your team is collecting “collectable dollars”. |
| Payment | Days in AR | Timely payments and revenue are the lifeblood to keeping your practice running. This KPI helps you sense for delays in patient or insurance reimbursement so your revenue cycle team can focus their energy in the right place. |
Imagine a pilot having to fly a jumbo jet without her dashboard, gauges, and dials or with faulty instrumentation. First, it would be highly dangerous and second, she would have to rely completely on her instincts. Running your provider practice without the right Key Performance Indicators is the same. Establishing and monitoring appropriate KPIs helps provider practices track their performance, drive accountability, broadcast a vision of excellence to arrive at a financially healthy operation. A meaningful and adequate set of Indicators will tell your provider practice if it is headed in the right direction.
Casey Peters brings over 16 years of experience in the health care industry as an operational leader, project manager, and financial transformation consultant. From start-ups to complex health systems, Casey leads teams that solve complex challenges with technology, thoughtful organization and innovative business strategy. As the Senior Director of Consulting and Transformation, he is responsible for positioning organizations to reach their strategic, operational, and financial goals through transformational revenue cycle management initiatives.
Founded in 2011, SYNERGEN Health is a pioneer in the technology and data-driven revenue cycle
transformation for the U.S.
health care industry. SYNERGEN Health provides complete revenue cycle services, advanced
analytics, payment solutions,
machine learning, robotic process automation, consulting services and other software
solutions.
For more information, visit: www.SYNERGENhealth.com.
