Those of us that work in the healthcare revenue cycle know that key performance indicators (KPIs) are a critical part of managing the operation and profitability of our businesses. However, organizations that focus solely on the statistics reported to clients (such as days in A/R and collection rates) may not be optimizing their performance. A change to an inward-facing performance mindset leads to improved management which will reflect in client results.

Internal vs. external KPIs

Put simply, internal KPIs are those goals and benchmarks we maintain on an individual business level. These are the analytics and statistics we use to make sure our internal processes are running smoothly, and we are delivering the best service possible to our clients.

External KPIs are those statistics and data points we share with our clients. There is a natural overlap between internal and external KPIs, and we have found that constant monitoring of our internal KPIs often identifies problems well before they affect our clients and appear in external KPIs.

Here are some internal KPIs we have found useful:

Staff productivity goals

The most successful medical billing providers take constant inventory of their claims workload and have daily confirmation of productivity targets. Some standard metrics to watch are – the number of denial corrections per day, the amount or quantity of payments posted, and claim generation volume. We suggest monthly monitoring of these internal KPIs against client-facing KPIs such as days in A/R, denial statistics and clearinghouse rejections. This process of comparison allows your organization to ‘get ahead’ of issues before they affect your clients’ revenue flow.

Days of data receipt to claims submission

If you do not monitor this metric daily, we highly suggest you begin. Days of data receipt to claims submission is the easiest way to recognize issues with the flow of claims information to your company. Stay in communication with your clients about patient flow and have them alert you if there is any unusual activity – for example, a location closing or extended office hours on certain days. From there, you can keep an eye on claims flow and have a rough idea of how many claims should be generated daily. If there is a sudden drop in claims, or an unexpected increase is recognized, you are only a few days out from the beginning of the problem, which should make locating the issue easier. In many cases, checking-in with the managers of various departments, such as IT for file transfers, coding for claims flow issues, and front-end submission for clearinghouse issues will help pinpoint the problem quickly.

Client documentation

We also suggest you internally track client satisfaction to maintain the service levels which are vital to retaining clients. A useful tool for doing this is the creation of two spreadsheets. The first spreadsheet could be used for tracking internal issues that might involve reimbursement in some way. For example, if there was an issue with file transfers and claims were not generated for a day or two, be sure to note the instance as well as some supporting details – it is amazing how we quickly forget the circumstances of anomalies. This record of operational performance can be periodically reviewed and used to improve processes in the future.

Create another spreadsheet to gather notes from client phone calls and meetings. Many companies forward meeting notes as a matter of course and if your company does not, consider making it standard practice. Organize the sheet into columns for things such as payer issues, concerns voiced about your team during meetings and phone calls, client changes that will reflect reimbursement, and anything else you think is relevant. When meetings and calls are tracked over time (and a spreadsheet makes this easy), recurring client issues can be identified and proactively managed. Conversely, they are also useful in instances where clients have been given advice and failed to follow that advice for whatever reason, resulting in a disruption to cash flow.

Establishing both internal and external benchmarks for performance are the key to successful and ongoing relationships with your clients. Consistent monitoring as described above will keep you ahead of operational issues, putting you in the best position to retain (and attract) clients.

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