Turn Your Healthcare RCM Metrics into Action & Drive Significant Financial Change

Delivering standard medical aid to the patients while maintaining profitability is the primary objective of every health care provider. Achieving this balance is no doubt the key to a successful health care business. Moreover, physicians seem more interested in keeping their finances stabilized than ever before. 

Achieving these financial goals are only possible through the effective management of the entire revenue cycle. Such as; patients’ scheduling, registration, charge entry, medical coding, claims submission, follow up, denial management, AR recovery and payment posting. However, we’ve been talking a lot about determining the key performance indicators to measure the effectiveness of the revenue cycle. No doubt, determining the RCM KPIs is the key to know where your business stands in terms of profitability & productivity. So, once you determine the key metrics, then what’s next? 

Your financial success doesn’t just revolve around knowing the key performance indicators. But it’s all about taking steps to create and develop a strategic plan to accelerate your revenue cycle management. Turning the key RCM metrics into action can actually take your practice’s financial goals to another level. Do you want to create a strong financial plan but don’t know where to get started? 

In this article, I have come up with proven strategies to help you in deploying a solid plan to take your health care business to the highest levels of profitability. 


First of all, decide the key performance indicators to track the performance of your physician billing system. KPIs can help medical care providers to increase the accuracy and the financial viability of their practice. However, the most common RCM metrics are as follow; 

➔ Days in Accounts Receivable

➔ Clean claims ratio (CCR)

➔ Denial rate

➔ Bad debt rate

➔ Net collections ratio

➔ Gross collection rate

➔ Referral Rates

So, decide the key performance indicators, then figure out how to track them effectively, collect data and analyze it. No doubt doing so takes a lot of investment in terms of both, time as well as money. Successful execution of these tasks doesn’t mean you have done it yet. Your goal must be to collect 100 percent of net revenue. Just make it more comprehensive, for example, the data shows that your net collections are only at 90%.  Which means that you are lagging behind your revenue goals. Now the next step is digging deeper into your medical billing systems to know the major causes. Which are holding you back from catching up with the billing collection targets. For instance, if you find that missing 5% revenue is due to the failure to collect the patient’s copays. And the remaining 5 percent is stuck in excessive claim denials due to certain reasons. It may seem like a small percentage. But it can cost millions of dollars in terms of lost revenue. The most common reasons behind insurance claims denials are: 

Insufficient or lack of documentation that supports medical necessity.

Incorrect charge capture. 

Missing/ incorrect patients’ demographic as well as insurance information. 

Lack of prior authorization. 

Invalid medical codes.

Duplicate billing. 

Do you find the reasons behind revenue leakage? If so, then Good Job! Now you have a complete understanding of how much money you are losing & why you’re missing it. It will pave the way to take further action to improve your billing collections.


Now you get to know how many dollars you are leaving at the table. And performed the detailed root cause analysis to get to the major causes of the problem. Now it’s time to make a proper plan to eliminate those issues. For instance, if the above-mentioned factors are leading to the claim denials and eventually revenue loss. Then move ahead.  Now get your entire revenue cycle team onboard including front desk and back-end teams to discuss what is going wrong and which action you can take to eliminate the red flags in the revenue cycle management. 

Furthermore, make sure that each person in the chain understands his/her role and is working diligently to execute their tasks in an efficient manner. More importantly, physicians should make sure that the rules are being assigned to the staff according to their skills as well as capabilities. Along with the assistance of the revenue leaders and your RCM staff, develop a method to correct the problem. Let’s take another example. If the incorrect medical documentation or the manual process of data collection, processing and medical billing is the reason behind declined reimbursements.

Then invest in the staff training and more importantly automation of the entire urology medical billing _ from patients scheduling to payment posting and all in between. Along with planning to transition from manual to advanced billing technology, also pay attention to the training of the administrative staff. At this stage, health care professionals should set quantifiable goals. That may include the desired percentage of clean medical claims i.e., 99%, and a timeline to achieve it. The best thing you can do is convert your plan into a precise and accurate document. 


With a plan and goals in place, it’s the right time to implement the plan that you’ve made so far. As we have earlier taken the example of manual billing methods and automation. So, you have decided to invest in automation. Make a budget for the purchase and maintenance of the cutting-edge practice management solutions i.e. EHR systems. Purchase the software and ensure its successful deployment within your physician practice. 

After the implementation of the Electronic Health Records (EHR), the next step is staff training. Because the utilization of EHR isn’t beneficial until your administrative staff have a complete know-how of its effective use. Providers need to understand that embracing innovation isn’t easy for their staff. So, give them time to understand the things, set a positive tone and help your team understand their tasks. 

Concluding Remarks 

Know, plan and implement solutions according to your financial needs and areas that need improvements. Once you implement the plans you need to track results and continue to review data and analytics to make sure the plan is working. Compare the outcomes before and after the implementation. Remember! Don’t forget to celebrate victories and give credits to keep your team motivated as well as onboard. 

Thus, this three-step approach can be applied to each key performance indicator you use to measure the success of your revenue cycle management. No doubt, it’s a daunting task. But you can simplify it by outsourcing your medical billing services to a professional billing collection agency. Outsourced RCM experts not only streamline your reimbursements. But also help you to determine, track and improve the key performance indicators, to ensure the continued financial stability as well as the sustainability of your practice.  


I have a B.S in Human Services from Virginia Tech. I have worked in the medical billing and coding field for over 6 years. Currently, I am converting my passion into my words & writing content for publications regarding RCM. 

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

4 Ways to Improve Medical Back Office Operations

The back office is the beating heart of any healthcare organization. It’s responsible for everything from administrative tasks to financial management, ensuring that the facility runs smoothly and efficiently. Yet, despite its crucial function, the back office can often feel overlooked, underutilized, or improperly managed. This blog post will discuss four effective ways to improve medical back office operations and help your healthcare facility to operate more smoothly.


Standardize Procedures

One of the most important steps in improving back office operations is standardizing procedures. Each staff member should understand their role and follow established guidelines for managing patient paperwork, billing, and more. Establishing clear procedures and protocols can create consistency in your workflow, which leads to improved accuracy and efficiency. This also ensures a standard of care that all patients can expect when visiting your facility. Creating a standard operating procedure manual can help you ensure everyone follows the same procedures, so start by outlining steps for common tasks, including scheduling appointments, patient check-ins, and processing claims.


Automate Processes

Automation is the key to increasing efficiency in the back office. Manual data entry can be time-consuming and prone to errors. Automation of tasks and processes where possible, such as scheduling appointments and processing insurance claims, can free up valuable time for employees to devote to other necessary tasks. Additionally, adopting a patient management system that incorporates automation can increase accuracy and productivity—automating billing and sending reminders to patients for example can result in fewer missed appointments and improved collections.


Integrate Technology

One of the most effective ways to improve back-office efficiency is to integrate technology into your workflow. Software solutions such as medical billing software, EHR software (such as drchrono, or Cerner) can simplify administrative tasks, while automated patient management systems or electronic payments systems can streamline financial management. The healthcare industry now offers web-based systems such as MyMedLeads, which not only has a suite of patient acquisition tools, but also serves as a communication platform for doctors and patients.


Back Office Healthcare Operations Software

The right software solutions can dramatically improve back-office operations. Rather than relying on manual processes that are prone to errors, healthcare facilities should consider implementing back office healthcare operations software. Medical billing software, for example, can help you manage financial information and payments more efficiently, resulting in fewer delays and higher collections. Medical practice management software can streamline scheduling and reduce wait times for patients. In addition to these software solutions there are modern back office healthcare platforms that provide various components (like billing, claims processing, and documentation) within the same platform, unifying workflows to increase efficiency and reduce error rates.


Implementing standardized procedures, automation, as well as technology and software solutions can all aid in boosting the efficiency and productivity of your back office operations. Healthcare facilities that successfully implement these methods will have a streamlined workflow, improved accuracy and precision, and be able to provide better quality care to patients. With the right tools and mindset, medical facilities can achieve a high level of operational success and improve their medical outcomes.

Lizzie Weakley is a freelance writer from Columbus, Ohio. In her free time, she enjoys the outdoors and walks in the park with her husky, Snowball.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

How to Help Explain Billing to Curious Patients

Knowing a few of the specifics about medical billing procedures can go a long way in assuring your patients and providing them better customer service.

by Eileen O’Shanassy

Between providing healthcare and every possible service that you can to patients, medical professionals also have to consider their billing procedures. Few would argue that healthcare billing is straightforward and easy to understand. We all know that the system is complex, but patients may be particularly curious about what they are being billed for, and regardless of your job, knowing a few of the specifics can go a long way in assuring your patients and giving better customer service. 

Detailing Expenses

Each patient is provided with a comprehensive breakdown of what is on their bill when they receive it, but that does not make it any easier to understand. They may even want to dispute certain charges because they are just so certain they are right about something and you are trying to rip them off. They may stick with this incorrect belief no matter how much you explain it to them, but trying to explain it may indeed save you some headaches. Familiarize yourself with common charges and help patients understand why you might need to charge for a certain procedure.

Go Through it with Them

The bills sent out to patients will have information that includes the date they received a certain treatment, the name of that treatment, the doctor or medical professional who administered the treatment, the portion that insurance covers, and more. If a patient has a question about their bill you should start by looking over the bill to see what you can find within the bill regarding the various treatments that they received. It may be the case that they just overlooked something that you can point out to them.

When Legal Action is Necessary

An attorney may be called for in certain situations if an irate patient begins to bring a suit against the hospital or medical facility because of how they were billed. It is often the case that the billing is correct and that the patient just does not understand it. However, it is also true that the medical billing people can in fact be wrong as well and make mistakes. If they make mistakes, then you could be open to a lawsuit coming your way. 

Someone trained in the law is called for in situations like this because they just know what the right moves to make are. They can look over the medical bills themselves and see where the issue is and try to resolve it with the patient out of court. Staying out of court is the number one goal here, and the best way to do that is to hire an experienced lawyer who knows how to defuse situations like this, and that may come up from time to time. You are definitely in the right to do this if you feel the pressure closing in from a patient.

Helping patients to understand their billing can make for a much better experience overall. Keep these things in mind when you have a patient who needs a few things explained.

Eileen O’Shanassy is a freelance writer and blogger based out of Flagstaff, AZ. She writes on a variety of topics and loves to research and write. She enjoys baking, biking, and kayaking. Check out her Twitter, @eileenoshanassy.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.