IMPORTANCE OF ANALYTICS IN A SUCCESSFUL RCM PROGRAM

Category: Health

A program is successful if you are able to answer micro level questions with values at each and every step. Many analysts across the globe has proved numerous times that how the use of analytics help administrators make decisions at the micro level with some data backing. Every industry today uses analytical tools for an accurate decision making which in turn increase the revenue. Do RCM program in healthcare industry use analytics? If yes, let’s see to what extent these analytics can help in taking a decision? Healthcare analytics play a pivotal role in understanding and implementing a successful RCM program. Analytics give reasons to all the questions - why’s, what’s, when’s, how’s and help in understanding the key metrics that carry the profitable weights of RCM programs. To check if your RCM is in line and meeting the financial goals, compare your key performance indicators against industry benchmarks to figure out holes that are draining your profits. KEY RCM METRICS Aging accounts receivable: Any A/R crossing 90 days is deemed as an aging A/R. The increased A/R population has in it large percentages of expected cash indicating the opportunities of profits undisclosed. Automate workflow to reduce potential write-offs and faster realization of revenue. Why are the collections declining? Where are the gaps? How to address these gaps? These are much harder questions than what you imagine and they can be answered when the metrics are properly analyzed. A supervisor armed with these insights has all possible solutions to enhance financial performance. These metrics also help in holding your staff and payors accountable. In simple terms ‘Visibility/Transparency can lead to better performance of a facility’. Net revenue: In simple terms ‘Ratio of overall cash collected against the expected cash flow is the net revenue in RCM program’. We suggest every owner to understand cash flow at every case level. Understanding net reimbursement at a case level is an important aspect in RCM so that it can help the responsible administrators in collecting all the revenue they own. This metric helps in determining what percent of money is left on the table. Point of service cash collections: Reduce the potential A/R and improve the cash flow by implementing and collecting patient balances at the point of service. Though there may be some difference in opinion, this still is one of the important ways in analyzing this metric. According to HFMA, Revenue Cycle Management is best defined as “Any administrative and clinical function that contributes to the ‘capture-management-collection’ of patient and payor revenue.” Is the visibility/transparency that you get from pencil work or a spreadsheet enough to understand your processes? Can it define by how much your net revenue is down? Analytics provide data at micro level by giving certain value to metrics you want to study. Understanding why your claims submission speed is ‘X’ and net revenue is ‘Y’ is more beneficial than trying to figure out 'what is my claim submission speed?' Promantra’s Revenue Cycle Management services help clients in making financial and strategical decisions with a set of result oriented analytics. We give a detailed explanation of every step analytically, thus in turn be a partner in decision making and directly influencing your net revenue. Knowing and understanding factors/metrics driving your centre's present performance along with analytics truly makes a difference in the long term success of your organization. The combination of right tools and analytics help to simplify the process and plug in the gaps to get desired results.