7 Top RCM KPIs To Track For Oncology Billing Success
Oncology billing and RCM is not like other specialties. It involves a certain high-level intricacy in creating medical claims that leads to a considerable delay in payments.
But that’s not all.
The risk of billing errors is always high in oncology. These errors cause further payment delays that not only affect your finances but also pause patient care. And so the vicious cycle begins that ends with your practice in the doldrums.
This entire scenario is avoidable if you keep track of certain RCM KPIs. Sure, you must have already been keeping an eye on metrics like denial rates and AR days. But these couple of parameters alone won’t help you cover a complex domain like cancer care. For effective oncology billing, you will need to track multiple metrics, which we are going to discuss below.
KPI#1: Claim Submission And Clean Claim Rate
The rate of clean claims in response to total claim submissions reveals a lot about your oncology practice’s financial health. A high rate indicates that your billing process is more accurate and up-to-the-mark. It is a sign that you get fewer claims to re-work, which translates into a steadier revenue stream.
Clean claim rate helps you identify and rectify the following fundamental issues:
- Patient information inaccuracies
- Incomplete or erroneous documentation
- Charge capture mistakes
Remember, the industry benchmark for high-quality clean claim rate is 97%. For oncology practices, it is a difficult but possible goal to achieve. To stay on top of it, it is better if you deploy a well-trained RCM staff and sophisticated, specialized billing tech.
KPI#2: Account Receivable (A/R) Days
Aside from getting your claims approved on the first attempt, you should also be looking into how long your average claim approval time is. The established metric used to calculate this is “Days in A/R.” Knowing the time a claim takes to get approved helps determine the effectiveness of your current processes. You get a better picture of your financial efficiency. In general, you should have a shorter average A/R cycle to maintain a strong cash flow.
Tracking A/Rs is more important for oncology practices than for other specialties. The reason is obvious. Oncology and cancer care involve expensive drugs and therapies. Payers take a long time to process claims for these services. Any further payment delay can put additional strain on your practice.
Industry standards recommend keeping the oncology A/R under 40 days. With A/R management, you can ensure you do not cross this threshold. This is because it helps you:
- Maintain claim accuracy
- Streamline the billing process
- Stay updated on all your outstanding receivables
KPI#3: Average Length Of Revenue Cycle
Another crucial metric that helps assess your financial stability is the length of your revenue cycle. This KPI calculates the duration from service provision to payment collection. Hence, it has a much broader scope than A/R assessment.
The assessment of revenue cycle length usually involves tracking the following factors:
- Billing errors
- Claim denials
- Average delay in the payer response
The data from the AR days assessment also helps calculate the length of your revenue cycle.
Tracking revenue cycle length can help you rectify major issues that have been burdening your practice. It helps improve claim accuracy, follow up on your accounts receivable proactively, and streamline your entire financial streams.
KPI#4: The Rate Of Claim Denials And Rejections
Having a higher rate of claim denials and rejections means there is something seriously wrong with your oncology RCM strategy. The top problem areas include:
- Problems in claim processing
- Wrong coding
- Documentation inaccuracies
Each of these issues can result in a denial or rejection. And the ultimate victim is the revenue.
The good news is that there are ways to decrease your denials and rejections. They mainly include:
- Reviewing your claim thoroughly
- Training your staff regularly
- Working on the detailed reports of denials/rejections to fix issues
Not only do these steps help rectify problematic claims, but they also help avoid root causes in the future. Remember, the accepted range for denials in the industry is below 10%. And the ideal range is below 5%. Make sure that you aim for the optimal range when strategizing your revenue cycle.
KPI#5: Charge Lag Duration
Oncology care involves multiple services, like chemo, immunotherapy, and radiation. The complete treatment can take several weeks or months. And every phase of this course can generate certain charges that require proper coding, documentation, and submission. Sometimes, covering these charges takes longer than the treatment itself. This creates a time gap between the service completion and claim submission.
Sometimes, this lag time occurs no matter how immaculate your RCM strategy is. Therefore, it is essential to track this gap properly. Having a large gap means you have a problem that needs immediate attention.
Some effective measures to reduce charge lag include:
- Implementation of efficient coding processes
- Staff training on documentation and its intricacies
- Technology adoption to accelerate claim preparation
- Deployment of expert staff on denials and appeals
KPI#6: NCR Adjustment for Oncology Drugs
Oncology drugs are among the most expensive healthcare medications. But that’s not the problem. The problem is that administering these drugs must often require pre-approvals and certain adjustments in the billing process. Failing to fulfill these prerequisites can lead to significantly reduced reimbursements.
KPI#7: Success Rate Of Prior Authorizations
Oncology is among the top specialties that depend heavily on prior authorizations. That’s because many of its services (like imaging scans, infusion, and certain drugs and therapies) require approval from the payer. Non-approvals can lead to treatment delays, which can be life-threatening.
Having a denial or two once in a while shouldn’t be a cause of concern. But a chronic occurrence would mean you have a problem to rectify. The first thing you are going to have to check is the percentage of prior auth approvals. A lower percentage would indicate any of the following issues:
- Your documentation is incomplete.
- You are not following the payer guidelines properly.
Fixing these issues will improve your PA approval percentage instantly. And you will be able to ensure full reimbursements for your services.
Wrapping Up
Tracking RCM KPIs is a vital part of oncology practice management. Not only does it help improve collections, but it also unburdens physicians of financial worries that disrupt patient care.
Nevertheless, even KPI tracking can be hectic for oncology practices as it makes already stressful RCM more difficult. This is why outsourcing this process is often the safest bet.
Speaking of outsourcing, AltuMED is your top choice for end-to-end oncology billing. Our RCM package offers everything, including KPI tracking, which gets further support from our proprietary billing AI and predictive analytics algos. For details, contact us.
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