What are the key metrics to measure RCM performance and patient satisfaction?

1 Days in accounts receivable

Days in accounts receivable (DAR) is the average number of days it takes to collect payment from insurance companies and patients. A lower DAR indicates a faster and smoother RCM process, which reduces the risk of bad debt, cash flow issues, and patient dissatisfaction. To lower DAR, healthcare providers need to implement strategies such as verifying insurance eligibility, submitting clean claims, following up on denials, and offering flexible payment options.

2 Claim denial rate

Claim denial rate is the percentage of claims that are rejected or denied by insurance companies for various reasons, such as coding errors, missing information, or policy issues. A high claim denial rate indicates a poor RCM process, which increases the cost of rework, delays payment, and frustrates patients. To reduce claim denial rate, healthcare providers need to implement strategies such as using automated coding tools, checking claim accuracy, and appealing denials promptly.

3 Net collection rate

Net collection rate is the percentage of total charges that are collected after deducting contractual adjustments, write-offs, and bad debt. A higher net collection rate indicates a more effective RCM process, which maximizes the revenue and profitability of healthcare providers. To increase net collection rate, healthcare providers need to implement strategies such as negotiating favorable contracts, reviewing charge capture, and enhancing patient collections.

4 Patient satisfaction score

Patient satisfaction score is a measure of how satisfied patients are with their overall experience of receiving healthcare services, including the quality of care, the communication, and the billing. A higher patient satisfaction score indicates a more positive RCM process, which builds trust, loyalty, and referrals among patients. To improve patient satisfaction score, healthcare providers need to implement strategies such as providing clear and timely billing statements, offering convenient payment methods, and soliciting feedback.

5 First-pass resolution rate

First-pass resolution rate is the percentage of patient inquiries or complaints that are resolved on the first contact, without the need for escalation or follow-up. A higher first-pass resolution rate indicates a more efficient and responsive RCM process, which reduces the workload and cost of customer service, and improves patient satisfaction. To improve first-pass resolution rate, healthcare providers need to implement strategies such as training staff, using automation, and providing self-service options.

6 Patient access rate

Patient access rate is the percentage of patients who are able to access the healthcare services they need, when they need them, without facing barriers such as long wait times, limited availability, or high costs. A higher patient access rate indicates a more accessible and affordable RCM process, which increases the volume and quality of care, and enhances patient satisfaction. To improve patient access rate, healthcare providers need to implement strategies such as optimizing scheduling, expanding telehealth, and offering financial assistance.