Revenue is the backbone of a medical facility. To maintain the survival of your healthcare business, it is integral to streamline the lab revenue cycle management. Many facilities are striving hard to achieve the highest reimbursements because now, due to claims that are either rejected or delayed, has made the RCM process all the more vital.
On the off chance that you deal with your revenue cycle yourself or recruit in-house office staff for the work, you realize how tedious and tiresome it is to make a methodology that runs easily and proficiently. Also, that having a powerless cycle set up almost leads to redundancies, prompting high paces of avoidable rejections & denials.
Thereby, due to enormous issues healthcare organizations can miss out 30% of their revenues. But by the aid of healthy RCM practices, practitioners can overcome these problems.
A proactive RCM strategy should follow certain central KPIs to optimize processes and understand patterns. Consider the accompanying KPIs as the vitals you need to track to guarantee your revenue cycle is optimized:
Denial Rate:
Forgetting about denied claims is a significant issue and it brings about pilling up claims over the long haul. The absence of a coordinated framework makes it hard to have a track of denied claims.
An approach should be carried out to keep rejections at the very least. Practices should know why rejections occur. They should ensure all claims get routinely confirmed and, when denials and underpayments come up, affirmative and quick actions should be taken to optimize lab revenue cycle management.
If you have a high rate of denials, you’ll need to put certain tactics in place to prevent future rejections, especially since our research shows that up to 90% of denials are avoidable. Document the reasons for denials and then put an action plan in place.
Take corrective action.
Perform a thorough root-cause analysis.
Submit the claim for payment.
Decide on the right solution for fixing the particular issue.
An efficient denial management strategy helps you to track the top KPIs to identify denials. It helps you to check documents and past claims and reduces the chances of coding errors that lead to rejections. Moreover, it helps you to minimize the denial rate by implementing quality assessment checks.
Also, the cutting-edge lab billing solutions and new tools help lab experts to watch out for rejections that need consideration. It can help you keep claims from getting denied, augments your payment collection, and smoothes out your lab revenue cycle management.
Clean Claims Rate:
A disturbance in your lab billing & coding can cause bad impacts on your laboratory practice. A payer will often run into issues with patient information while a claim is being handled. It could be the reason that there is some wrong data on the initial form of the patient which causes an issue while preparing the claim. Consequently, it causes revenue losses.
Therefore, regardless of the kind of claim, it’s significant for clean claim submission to provide reliable, accurate, and verified information to payers.
However, having an increased error-free medical claim rate fills your training’s income, so it’s basic to submit them at the very first run-through around. This KPI will disclose to you whether the first touchpoints managing insurance eligibility and patient enrollment in your lab revenue cycle management is working precisely and productively.
Indeed, even a little error in insurance or demographics information data can bring about a denial. so, it is necessary to quality check data prior to claim submission.
Days in Accounts Receivable:
Following the days in A/R will uncover how long it requires for you to get paid for your rendered services. This data is basic in deciding the productivity at this specific point in your RCM work process, as you’ll find how long it requires for your office to get complete reimbursements for provided services.
The most effective method to Find this KPI: Divide the complete A/R by the normal everyday net revenue of patient services. (Divide total annual sales by 365 to get the average everyday net patient service revenue.)
Pending Claim Rate:
As an intermediate state, payers assign a claim to the Pending status. This shows that they will soon update the claim status and doesn’t demonstrate that there’s an issue with the case.
So, check your present rate against a year ago’s rate. Has it expanded, diminished, or continued as before? Your optimal rate is either low or consistently diminishing until you hit your objective. This KPI can give you data on your documentation, authorization, affirmation, and billing groups.
Reimbursement Rate:
Is your revenue rate improving quite a long time after a month? Assuming this is the case, it implies you’re ensuring that your staff is properly trained to enter orders accurately the first time and your patients aren’t paying exactly the contracted rates. If not, you’ll need to investigate these two touchpoints in your lab revenue cycle management and improve them.
Keep in mind, it’s insufficient to just track the information key points. It is significant that you analyze the information after gathering the information. Thereby, you discover approaches to reinforce weak spots in your procedure and upgrade it however much as could reasonably be expected.
Final Words:
The quickest, least demanding, and most expense proficient approach to follow these KPIs and advance your lab revenue cycle management is by joining forces with a professional lab billing solutions agency like Laboratory Billings.
Not exclusively do our RCM specialists make upgraded work processes for practices and claim to fame labs, however we do it utilizing advanced technology and innovative solutions.
Our automation solution and robust intelligence offered as an assistance. Appreciate more opportunity to generate more revenue and focus entirely on your patients. When you save money on overhead expenses by permitting us to make a start to finish RCM methodology that will follow these 5 imperative KPIs to boost the efficiency of your lab revenue cycle management.
Connect with our representative today to learn how our lab billing solutions can help your medical facility to save costs, eliminate human errors, decrease overheads, and accelerate revenue!
