The pandemic created countless challenges in the healthcare industry—including in terms of the revenue cycle. While cash flow has always been hard to predict, experts believe that the operating margins of some health delivery organizations may still end the year below their pre-pandemic levels. Other reports predict a slower return to normal in healthcare due to a worsening labor market. These forecasts make careful revenue cycle management especially critical right now.
Previously, we've covered the revenue cycle management (RCM) process in behavioral health. This article will build on that discussion, starting with the importance of measuring key performance indicators to understand your organization’s revenue cycle. Then we’ll delve into the advantages provided by revenue cycle management healthcare technology for behavioral healthcare.
What Is Revenue Cycle Management Software?
A healthcare organization's financial viability depends on an effective revenue cycle management strategy. RCM software connects the financial and clinical aspects of care, ensuring that providers are properly reimbursed for their services through accurate and efficient billing and claims management processes.
But RCM isn’t just about the money. Today’s revenue cycle management technology can also improve patient access to a high-quality healthcare system.
ContinuumCloud’s electronic health record (EHR) software incorporates RCM functionality. Through a secure portal, patients can schedule appointments, fill out paperwork, and update their insurance and billing information. This helps decrease wait time in the office and leads to a better patient experience overall. Additionally, because RCM emphasizes comprehensive insurance verification upfront, patients are better informed about what their coverage provides, as well as their own financial responsibilities.
Revenue Cycle Management Healthcare KPIs
ContinuumCloud provides a robust end-to-end RCM solution that captures, stores, and analyzes specific data points. Through data analytics, the software helps organizations establish a set of key performance indicators (KPIs) for monitoring.
Monitoring KPIs is an important part of optimizing and transforming revenue cycle processes in healthcare. Benchmarking is the technique used to compare two sets of data. The comparison helps anyone evaluating the healthcare revenue cycle management process to gauge the health system’s financial performance and discover opportunities for improvement in areas like claims denial management and accounts receivable.
Below is a list of some of the most common KPIs that health organizations look at to better understand their revenue cycle:
Claims Denial Rate
In most cases, healthcare costs are paid by insurance companies. Sometimes, insurance providers refuse to pay, but it’s important to keep the claims denial rate low. It’s generally recommended that institutions aim for a claims denial rate below 5%. A low claims denial rate can indicate that the organization regularly meets the administrative criteria that insurance companies set.
This KPI can signal that you may be able to add more clinical positions. If you have a low claims denial rate, this means that your cash flow is healthy — therefore, fewer staff members are needed to maintain cash flow processes.
Days Cash on Hand
This metric denotes how many days your organization could cover its operating expenses using your cash resources. Generally speaking, organizations should aim for 60–90 days of cash on hand.
Days in AR
Days in accounts receivable (AR) is a KPI that figures out the length of time it takes for a claim to be paid. The longer that behavioral health organizations wait for payment for services, the less cash they have to invest and earn interest.
Keeping this metric under the industry standard ensures your practice’s financial viability. When your days in AR rise, you may also see a rise in claims denials. This is because insurance carriers impose filing limits — typically within 90 days after service. Providers may have difficulty receiving payment for services once these deadlines pass.
Clean Claims Rate
This KPI measures the proportion of your insurance claims that have been processed and reimbursed the first time you submit them — in other words, there were no errors, rejections, or manual inputs needed. If you have a low amount of clean claims, this may lead to higher administrative costs and signal inefficient RCM processes.
Behavioral Health KPIs: Report and Optimize
You’ve gathered data, crunched the numbers, and now it’s time to create a report. This is undoubtedly one of the most disliked steps in revenue cycle management. However, you don’t need to stress — creating detailed reports can be easy. ContinuumCloud's EHR platform with an RCM reporting dashboard includes access to over 1,200 types of report templates so you can interact with all types of information, such as schedules, behaviors, cycle summaries, treatment plans, claims, and billing. You can create revenue reports, billing and reimbursement reports, staff efficiency reports, and stakeholder reports on everything related to your practice.
The RCM reporting dashboard allows you to filter data and display specific revenue cycle information to optimize your results. Do you need benchmarking data for a big picture analysis? ContinuumCloud has it covered with comparative data from trusted industry sources.
The RCM Process
The behavioral healthcare industry comprises dozens of specialties and subspecialties. While each behavioral healthcare specialty is unique, the RCM process will follow a similar workflow:
- The patient registers.
- Staff verifies the patient’s insurance eligibility.
- The patient schedules an appointment.
- The patient pays the copay or other prepayment fees.
- The patient receives care.
- Clinicians submit charge capture.
- Back office processes begin: coding, billing, claim submission/filing, patient billing for underpayment, patient credit for overpayment.
Each step in revenue cycle management should flow seamlessly into the next.
ContinuumCloud has built their RCM platform to streamline and optimize your internal business processes. Workflow automations improve efficiency by scheduling and sending appointment reminders, payment policy updates, and privacy notifications.
Revenue Cycle Management Use Case: Behavioral Healthcare and HDHPs
Mental health services are in high demand. Even so, a growing number of behavioral health patients do not have adequate health insurance coverage, which can lead to substantial out-of-pocket expenses. Therefore, it may be difficult for these patients to get the care they need.
The Employee Benefit Research Institute recently reported on a major shift in the way Americans utilize behavioral health services due to the popularity of high-deductible health plans (HDHPs). According to the report:
- Almost 60% of adult workers have a high-deductible health plan.
- For single employee coverage, the average annual deductible was $446 in 2002. By 2020, that average annual deductible was $1,945.
- For family coverage, the average annual deductible was $958 in 2002. By 2020, that average annual deductible was $3,722.
The Employee Benefit Research Institute found that healthcare usage among patients with conditions such as major depressive disorder, anxiety, and ADHD decreased after adopting a HDHP. This could be one factor driving the increased usage of mental health and well-being apps. But while it’s true that mobile apps are easily accessible, should they take the place of therapy?
RCM tools and electronic health record technology can help you retain your patients. Offer telehealth visits and encourage communication through safe, direct channel messaging. ContinuumCloud’s mobile patient engagement app helps patients connect with peers in a safe environment between visits.
Partner with the Leader in Behavioral Health Revenue Cycle Management
Managing the revenue cycle can be challenging on your own. You need a partner that can provide guidance and support throughout the entire revenue cycle. The behavioral health IT experts at ContinuumCloud want to help you improve your organization’s financial performance and boost efficiency.
As a leader in the behavioral health technology industry, ContinuumCloud provides breakthrough solutions to a variety of behavioral health industries, including mental health, substance use treatment, intellectual or developmental disability, autism, foster care, human services, and public health. Our revenue cycle management healthcare technology is just one part of a larger platform that integrates cloud-based EHR, a patient portal, secure communication modules, and a mobile patient engagement app.
When you collaborate with ContinuumCloud, you get much more than medical billing and insurance reimbursement software. Revenue cycle management healthcare software can streamline your interactions with patients and generate reports that can help you improve your processes. To learn about partnering with ContinuumCloud, contact an expert today.