What are key performance indicators?
Key performance indicators are financial measurements designed to evaluate the performance of revenue cycle management (Stall, Therapy Brands, 2021). Practitioners in the behavioral health industry are enthusiastic about data collection; particularly, behavior analysts. One of the most interesting aspects of behavior modification and data analysis is that ABA practitioners can creatively derive many foundational principles of behavior analysis and apply them to many distinct aspects of life. The below lists provide a high-level overview of the assessment, implementation, and maintenance of treatment goals in ABA:
- Evaluation of current levels to assess baseline
- Implementation of specific strategies outlined to mitigate deficits
- Analysis of data to find potential trends or patterns
- Frequent monitoring and reevaluation of data to promote data-informed decision making
- Repeat this process until optimal levels are reached.
Comparably, the same foundational steps to identify ‘target behaviors’ when working with children with autism, can also be applied to aiding with naming key performance indicators, especially in terms of the individual financial needs across various agencies.
Using Behavior Analysis Tools for Denial Data
Utilizing a similar behavior analytic method as reviewed above could benefit an ABA agency by supplying unambiguous data to evaluate before deciding which KPIs metrics will be most valuable to track for their organization. Revenue cycle management procedures (RCM) combined with key performance indicators (KPIs) pinpoint specific financial measurements. When used consistently, these tools are invaluable to support the ability of an ABA organization to remain open and operational (Stall, 2021).
Examples of RCM KPI identified for behavioral health agencies:
- Cash as a % of the net revenue equaling 95% or higher
- Accounts receivable over 90 days old equaling 20% or less of total AR
- Cost to collect which includes all functions related to RCM equaling 10% or less
- Billing Accuracy by sending clean claims at a rate of 98% or higher
Once the best levels are reached, KPI’s and Fidelity checklists are great measurement tools to ensure these levels are maintained across time. A Fidelity checklist paired with KPIs creates a secondary method of assessing the continued effectiveness and performance maintenance of the key indicators. Implementing such tools aids with promoting consistency of peak performance levels.
RCM KPI Challenges for Behavioral Health Providers
Precise and prompt management of an organization’s RCM KPI is crucial in terms of achieving and sustaining maximized revenue performance while reducing the future probability of mistakes that could result in financial losses. In terms of naming the gold star RCM KPI, this most likely is not feasible, as there does not appear to be just one measurement that will provide an all-encompassing snapshot of the RCM’s current performance (Stall, 2021). Although, there is a combination of RCM KPI which appears to be effective when implemented concurrently. Stall (2021) suggests the following RCM KPI measurements aid in tracking the performance and progress across the RCM:
- Accurate reimbursements are essential, as well as promptly filing appeals for mistakes made by the payers to recoup funds in a timelier fashion and reduce the risk of missing the deadline to file for an appeal.
- Create a system for tracking denials and analyzing trends. This information can then be used to develop guidelines for how to avoid activities that lead to denied claims.
- Know the precursors to RCM performance descent and proactivity plan for such an occurrence to mitigate any significant impact on the organization.
- Cash acceleration is another beneficial activity that can increase RCM KPI. This process consists of “resolving older claims before missing filing and appeals deadlines from payers (Stall 2021).” When conducting this process, providers can also make note of any trends so more appeals can be filed to maximize reimbursement efforts.
- Evaluate and analyze KPIs often to promote optimal RCM performance.
Denial Avoidance vs. Denial Management
It is important to schedule recurring tasks to ensure the RCM KPI data is analyzed at least once per month; however, once per week is recommended (Stall, 2021). Frequent monitoring assists with proactively identifying precursors and making timely modifications to divert potential loss of revenue. The overall goal is not to have denials to manage. In LaPointe’s 2016 online article “How to Access Revenue with Improved Claims Denial Management”, she shared the following:
A 2014 Advisory Board study showed that 90 percent of claim denials are preventable. Some of the most common claim denial reasons can be rectified by correcting claims management workflows, including claims submission and patient registration procedures. (LaPointe, 2016)
Stall (2021) refers to this process as ‘Denial Avoidance’ in comparison to ‘Denial Management’. ABA providers who successfully define, find, track and report denials across a multitude of various aspects will most likely be a valuable resource for analyzing process breakdowns and creating proactive solutions for performance improvement (NRHRC, 2021).
RCM Terms to Know
Whether an ABA agency decides to create an internal RCM KPI team to handle all the front-end and back-end administrative tasks or chooses to outsource the tasks to a reputable practice management agency, one thing is certain and that is the ABA practitioners need to stay up to date on the different revenue cycle management terms, local and state policies, as well as payer guidelines. The list below defines some of the important terms used commonly when working within a healthcare agency.
- Copay: The set amount a member will pay at the time of service.
- Deductible: The amount a member will pay before insurance begins reimbursing services.
- Coinsurance: The percentage of the remaining charge the client will pay after meeting their deductible.
- Out of Pocket: The maximum amount a client will pay during the policy.
- Contractual Obligation: The difference between what you charge and the allowed contract amount.
- CARC Codes: Claim adjustment reason codes which explain what factors caused the payor not to pay the contract did amount.
- CPT/HCPCS Codes: Claim adjustment reason codes explain what factors caused the payor not to pay the contract did amount.
- Taxonomy Code: A 10-character code that designates the providers or facility classification and specialization.
Easily Manage Your Revenue Cycle’s Key Performance Indicators
Taking advantage of RCM KPI and performance management software can provide a sense of financial security and confidence in knowing that the most important part of your business is in the hands of experts. Learn more about how Therapy Brands’ solutions can help manage your RCM KPIs to ensure a more efficient revenue cycle.
• Stall, D., Brinkman, M., & Padula, N. (2021). Billing 101: Credentialing, Contracting and Understanding Eligibility by Therapy Brands. Presentation, webinar. https://vimeo.com/589418548 • LaPointe, J. (2016). How to maximize Revenue with Improved Claims Denials Management. Revenue Intelligence. Retrieved 22 December 2021, from https://revcycleintelligence.com/features/how-to-maximize-revenue-with-improved-claims-denials-management
DateJune 16, 2022