Revenue Cycle Measurement and Effectiveness–RCM Key Performance Indicators

Learning Objectives

• Level set on key health care industry trends such as denials, underpayments, administrative burden, workforce, revenue leakage, and uncompensated care.
• Identify, Develop, Monitor, and Adapt KPIs for and effective RCM.
• Analyze the process improvement steps identified to achieve benchmarked best-in-class performance.

Key performance indicators have become critically important as providers face patients as payers, revenue leakage, and increasing denials. Budgetary and operational constraints also can create staffing challenges, and RCM departments must demonstrate successes and justify the need for resources. Identifying, tracking, and reporting on key datasets affords an RCM to convert their role from cost center to revenue integrity centers.

Optimization of intake, staffing, accuracy, yield, and patient throughput, can all be leveraged by consistently reporting KPIs. A process that objectively measures performance, celebrating successes and identifying opportunities, can help establish staff accountability and achieve alignment towards strategic goals. Benchmarking to internal operations, as well as to industry-recognized KPIs, can help ensure RCM is on course.