Top 6 Revenue Cycle KPI Questions Answered

During a recent MGMA Webinar, Power of the KPI: What Top Performance Indicators Medical Practices Should Monitor, Conifer Health asked attendees about their biggest revenue cycle concerns. This blog tackles those concerns and provides proven, real-world tactics that can be put in place today to help.

Concern 1: Many attendees expressed frustration that they’d been unable to attract qualified candidates for hard-to-fill positions in patient accounts, payments, posting, and other insurance-related positions.

Conifer’s Recommendation: We hear a lot about the shortage of clinicians, but revenue cycle staff are also in high demand. Many revenue cycle positions that went remote during the pandemic have become permanent work-from-home jobs. Because of this, the most experienced candidates can choose from a larger pool of nationwide opportunities. They’re no longer limited by local offerings. This has made the RCM field much more competitive.

The best approach for practices is to do a realistic assessment of what they’re spending on recruiting, hiring, and onboarding. They should also consider the cost in terms of time and training needed to bring inexperienced staff up to speed. For example, mistakes in coding or timely filing issues can lead to denied claims, write-offs, and more work for staff. And asking existing staff to work harder or longer hours could lead to burnout and increased turnover.

A better solution may be to outsource some of these positions. Outsourcers often have greater resources to hire and retain the most experienced revenue cycle experts. When partnering with an outsourcer, practices benefit through increased staff productivity, fewer errors and write-offs, and improved revenue. In this way, outsourcing vital RCM positions can bring a relatively quick return on investment.

Concern 2: Attendees were also frustrated with the significant increase in overpayments and takebacks in the first quarter of 2023 and felt they needed a more streamlined process of tracking and working overpayments.

Conifer’s Recommendation: Takebacks are painful for physician practices, and it’s impractical to set aside contingency funds to cover their likelihood. The best step practices can take is to do all they can to avoid takebacks in the first place. But this requires understanding why takebacks are occurring. Tracking is critical to this effort.

The best way to track takebacks is to create automated overpayment reporting, including where they occur most often and with which payers they are most likely to occur. Since payers are inconsistent in the information they provide regarding takebacks, the provider must perform due diligence to get that information. Once practices identify issues leading to takebacks, they can put proactive measures in place to prevent them in the future. This should include creating a standard appeal process for when takebacks do occur.

Concern 3: Some attendees were concerned about the efforts they were spending on credentialling and the impact on A/R.

Conifer’s Recommendation: Credentialing is a resource-intensive, manual process that must be repeated regularly. But taking shortcuts in this process can lead to headaches down the road, including denied claims, delayed reimbursement, and even financial liability. Even a single mistake on an enrollment form can cause significant issues. This is why, when it comes to credentialing, experience matters.

Outsourcing can be a surefire win for practices with staffing challenges or limited credentialing expertise. Partners with experienced credentialing staff know what to look for and typically have resources the average practice lacks regarding background checks and verification of certifications and licenses. They leave no stone unturned and can find those crucial details that are so easy for practices to overlook.

Concern 4: One topic that several attendees brought up was calculating KPIs for net collections. They knew it was an important metric to track but were unclear about how many months of payments they should assess to determine their net collection rate.

Conifer’s Recommendation: One mistake many practices make is that they use transactional data to calculate their net collections rate instead of reimbursement data. While it can be done with transactional data, the results won’t be as accurate. Transactional data often includes claims that haven’t been fully adjudicated or where contractual adjustments haven’t yet been made.

There are times, however, when practices must use transactional data. In these cases, Conifer recommends going back 120 to 150 days. However, practices must remember that impending payments and adjustments may skew the results.

Concern 5: Attendees were also concerned about what benchmarking data they should be using for measuring their KPIs.

Conifer’s Recommendation: DataDive data from MGMA is a go-to resource for Conifer. We find it a compelling resource because it contains all the information needed to dive into the data and create precise benchmarks.

While DataDive also includes specialty information, there are other resources that specialty practices may also want to consider. These include the American Medical Association (AMA) and the American Academy of Family Practitioners (AAFP).

Concern 6: Attendees who were considering outsourcing were concerned about which “red flags” they should be looking for.

Conifer’s Recommendation: One of the biggest complaints Conifer hears from new clients is that their previous outsourcers could never show actual metrics that indicated the value they brought to the relationship. This is a big red flag. Outsourcers should never expect their clients just to take their word that they’re adding value.

The best outsourcing partners are those that use the practice’s own systems to measure KPIs and then use those results to prove their value to the relationship. Because of this, they should be able to provide typical results a practice can expect to achieve.

Putting it All Together

In these challenging times, provider practices must do all they can to optimize their revenue cycle processes. Increasingly, outsourcing has become an essential part of this effort. Outsourcing can help practices improve practice performance, reduce stress on staff, and set the stage for long-term financial success.

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