8 Key Performance Indicators (KPIs) Every Cardiology Practice Should Track for RCM Success
Cardiology billing has gotten more complex over time. The reason is the inclusion of too many services and procedures. Billing regulations are also more intricate than ever. One of the ways to set foot in the right direction is to track the right Key Performance Indicators (KPIs) in cardiology RCM.
In this blog, we will discuss vital KPIs that help improve the revenue cycle and ensure overall better financial health of your cardiology practice.
Importance of KPIs in Cardiology RCM
Key performance indicators can support your practice in numerous ways. Their primary function is to help you track your practice’s financial health. But this very function eases the way to streamlining reimbursements and reducing denials. Some KPIs even provide industry insights and competitor analysis. So using them can help you adjust your practice operations for growth. RCM KPIs also help you make intelligent decisions regarding billing efficiency, collections, and all other revenue-related matters.
Important KPIs in Cardiology Billing
Productivity-Related KPIs
1. Claim Submission Timeliness
One of the most crucial metrics for measuring the success of any revenue cycle is the timeliness of claim submission. This KPI looks at the duration between the date of service (DOS) and claim submission. The shorter this duration, the quicker the reimbursement.
2. Denial Rate
It refers to the rate at which insurance companies reject claims. Cardiology billing often involves intricate scenarios, e.g., coding challenges with myocardial perfusion imaging or stent placements. These challenges increase the risk of denials. What’s important here is to keep an eye on the denial rate to stay informed about your standing.
3. First-Pass Resolution Rate (FFPR)
One of the significant indicators of your cardiology practice’s success is that you get a higher number of claims approved in the first pass. The particular metric to measure the percentage of such successful claims is called FFPR. A higher FFPR means that you get quick reimbursement for most of your claims. And since cardiology claims face unique hurdles, tracking FFPR becomes critical.
Accounts Receivable Tracking KPIs
4. A/R Aging
This metric helps a cardiology practice determine the time it usually takes to receive payments from patients or payers. It categorizes unpaid payments based on the number of days since they became outstanding. This allows you to identify bottlenecks in collection cycles and fix them on time.
5. A/R Days
Commonly referred to as Days in A/R, this metric allows cardiology practices to measure the average number of days it takes to receive payments after claim submission. A lower number of A/R days means you are getting payments rather quickly.
6. Net Collection Rate
NCR compares the payment received against the payment billed. It doesn’t include the amount adjustment based on payers’ rates. It only considers the billed amount. A higher net collection rate means you are getting a large portion of the bill. And it’s great for your revenue.
Financial Health-Related KPIs
7. Gross Collection Rate (GCR)
This KPI calculates the rate of gross collections by dividing the total amount of payments by the total billed amount. The calculation may involve data from a month or a year. Using this metric, you can determine whether your cardiology practice is collecting revenue in the way it should. Like the net collection rate, A high CGR means that you are collecting payments from patients and payers effectively. It just gives a broader view of your collections.
8. Revenue Per Encounter
This metric provides revenue insight by dividing net collections by the total number of patient visits in a month. By this, you get a quick overview of your revenue cycle health in that month. This KPI holds a particular value for cardiology practices. This is because of the high cost of procedures and the possibility of financial blowback in case of underpayments or denials. Revenue per encounter helps you determine whether you are getting reimbursed adequately on average.
How To Improve Cardiology Revenue Cycle KPIs For Maximum Profitability?
Improving Coding Accuracy For Reducing Denials
Coding accuracy is vital for reducing denials and resubmissions. An important step for achieving this is to use advanced RCM solutions for claim processing and report generation. Modern-day tools are based on sophisticated algorithms. Some of them even use AI and machine learning. Many of these tools provide real-time insights based on your preferred KPIs. You can use these insights to stay up-to-date about your claims’ performance and ultimately prevent denials.
Training And Empowering Your Team
It is important to train your staff members to use KPIs during billing and RCM operations. This will allow them to keep track of their performance. An important measure is to arrange workshops where RCM specialists would educate them about the latest practice management tools and techniques. These workshops must include sessions where team members will be taught about tracking KPIs and adjusting performance accordingly.
Conclusion
Your cardiology revenue cycle will flourish if you track the right KPIs. You’ll see fewer rejections, and your collections will increase. However, it is easier said than done for most practices. Revenue cycle management in general is a significant administrative task. Add KPI tracking, and you will find yourself entangled with things other than patient care.
If you are one of such practices that struggle, you can consider outsourcing your cardiology RCM to AltuMED. We have a dedicated team of billing and revenue experts who take care of everything in your cardiology RCM, including billing, coding, credentialing, and KPI-based performance adjustment.
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