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As the saying goes, “what gets measured gets managed.” For healthcare providers, this is a reminder that optimizing the revenue cycle relies on monitoring and reporting on the right metrics. Claims, billing and collections teams will struggle to know which of their activities lead to improvements if they don't track key performance indicators (KPIs). The question, then, is how to choose the right KPIs. How can providers gain more visibility into their financial performance? Where are the pitfalls that limit the usefulness of the data? This article looks at how revenue cycle managers may find more opportunities to prevent revenue leakage by building a healthcare revenue cycle KPI dashboard populated with the right medical billing metrics. What is a revenue cycle KPI dashboard? A revenue cycle or medical billing KPI dashboard is part of a revenue cycle management (RCM) platform. It enables real-time visibility into metrics regarding billing and revenue and is customizable based on the KPIs that matter to each healthcare organization. It centralizes critical information related to patient access, healthcare collections, claims management and payer contract management. Challenges and pain points in revenue cycle management The first step in selecting the most relevant KPIs for a revenue cycle dashboard is to identify and understand the thorniest RCM challenges that could be causing dollars to slip through the net. Here is a run-down of some of the biggest obstacles to effective RCM and possible performance measures that may help track improvements: 1. Inefficient patient access for scheduling and registration Revenue cycle management begins in patient access. Unfortunately, so do many of the errors and inefficiencies that lead to claim denials and missed payment opportunities. Confusing and disjointed scheduling systems can lead to underutilization of services and no-shows, as well as falling short of consumer expectations for online booking methods.Online self-scheduling tools make it easier for patients to book appointments so they can start their healthcare journey quickly and conveniently. Cancelled appointment slots can be offered to other patients, to maximize clinician time. Here, it would be useful to track the percentage of unfilled appointments: an increase over time would suggest that patients are finding it easier to book appointments, and confirm better use of doctors' hours.Similarly, digital registration options can quell the frustrations that many patients feel when trying to fill out forms ahead of treatment. No-show rates, percentage of patients using online tools, registration error rates and patient satisfaction scores would all be relevant KPIs. 2. Claims and denial management processes that rely too heavily on manual work From checking payer updates to poring over billing codes, claims management workflows often involve manual tasks that put unwelcome pressure on already-overwhelmed staff. There are many opportunities for errors, which drive up denials and put the brakes on the organization's cash flow. An increase in clean claim rate and a reduction in the rate of denials would be KPIs to look for on the revenue cycle dashboard. An end-to-end claims management solution that uses automation and artificial intelligence (AI) to improve accuracy and lift the load on staff can alleviate these challenges. For example, AI Advantage™, leverages AI to predict and prevent denials using the organization's own historical claims data. 3. Patient collections practices are often inconsistent Patient responsibility for healthcare costs is higher than ever, so the consequences of poor billing practices are severe. Experian Health's State of Patient Access 2023 report found that 63% of providers believe patients frequently postpone care because they're worried about costs. If patients are unsure about what they owe, unable to find financial assistance, or unclear about how and when to pay, the provider is likely to see their accounts receivable metrics and collection rates heading in the wrong direction. Clear bills and convenient ways to pay are key to optimizing patient collections. Collections Optimization Manager supports better financial decision-making for both patients and providers by screening, segmenting and routing accounts based on payment probability. Users get tailored support from an experienced optimization consultant to select the right KPIs and turn insights into effective action. 4. Actionable insights are often out of reach RCM analysts may have a wealth of information to interrogate, but they are often tripped up by disparate systems and legacy processes. Critical information in patient access, collections, claims management and payer contract management may be held in different systems and formats, which makes it much harder to see connections. With revenue cycle analytics tools, providers can make sense of the information they hold, rather than drowning in data. A revenue cycle or medical billing dashboard can enable real-time visibility into the KPIs that matter most while tracking changes over time. What are KPIs for RCM?  Revenue cycle KPIs are quantifiable measures that illustrate the financial viability of an organization's revenue cycle. These metrics indicate if healthcare organizations are achieving their financial goals and are effectively managing revenue inflows and outflows. Specific KPIs will be tailored to the organization's particular goals, challenges and processes. The quality and availability of relevant data will also play into the selection process, to maximize visibility and insights into the revenue cycle. In addition to the suggested metrics discussed above, other common KPIs to feature in a revenue cycle dashboard include: Days in account receivable Aged accounts receivable rate Adjusted collection rate Clean claim rate Claim denial rate Claim appeal rate Bad debt rate Gross collection rate Net collection rate Importance of healthcare revenue cycle KPI dashboards A  revenue cycle KPI dashboard is more than just a handy way to present data. Monitoring an organization's financial health is critical to its ability to serve patients and attract and retain high-performing employees. A healthcare revenue cycle dashboard can enable providers to: Identify if revenue levels are sufficient to keep the organization afloat and know in advance if new strategies are needed to maintain cash flow Locate glaring operational efficiencies in RCM that are costing the organization time and money Forecast future revenue projections to determine the organization's ability to expand and invest Improve all financial decision-making through better use of data that is already being collected Boost patient satisfaction by highlighting opportunities to create a more convenient and transparent financial experience. Driving efficiency and success through RCM solutions Once the revenue cycle KPI dashboard is built, RCM teams can get to work on implementing the specific actions needed to tackle those thorny issues discussed above. With Experian Health's integrated RCM solutions, providers can bring together metrics such as financial performance, billing efficiency and collections rates into one place, to allocate resources more strategically, drive targeted improvements, and accelerate reimbursement. And with these insights, providers are not just managing revenue – they are optimizing for future financial stability. See how Experian Health's revenue cycle management solutions, dashboards and drill-down reports can uncover opportunities to prevent revenue loss and boost profitability.

The relationship between hospitals and payers has often carried an undercurrent of tension. Stacks of paperwork, complex claims rules and manual adjustments are a recipe for disrupted cash flow and time-consuming rework. With profit margins hanging in the balance, providers need the reimbursement process to move forward without a hitch. To the relief of revenue cycle managers, recent developments in digital technology are paving the way for more effective claims management. Case in point: Experian Health's recent acquisition of Wave HDC, which brings together a suite of advanced patient registration solutions for faster and more accurate claims management at the front end of the process. Shifting sands in the hospital-payer relationship could increase denials For healthcare organizations, getting paid in full- and on-time hinges on seamless communications with payers. Any missteps can lead to revenue losses, with denied claims and delayed payments being the outcomes providers most want to avoid. Payers will automatically deny claims that have errors or missing information, while disputes and slow processing times can seriously hamper a hospital's cash flow. The sources of potential conflict have been pretty steady over time, stemming from complex billing processes, frequent changes to payers' requirements, and a lack of standardization between payers.  Tension created by the cost of services and the need to control healthcare costs is a constant in the revenue cycle. Recently, a major shift in dynamics has occurred with the widespread adoption of artificial intelligence by payers. This enables them to process – and deny – claims with unprecedented speed and scale, leaving providers struggling to catch up. On a recent webinar, Makenzie Smith, Experian Health Product Manager for AI AdvantageTM, explained how this change was reshaping the relationship between payers and providers: “So many payer decisions are now being driven by artificial intelligence. Insurers are reviewing and denying at scale using intelligent logic, leaving providers fighting harder for every dollar… Many revenue cycle managers will stick in their comfort zone because operating margins are tight and changing course seems risky. But given this change in payer behavior, the cost of staying the course could put organizations at risk.” How AI-powered revenue cycle management solutions help close the gap between payers and providers Providers are increasingly leveraging digital technology to level the playing field with payers. Integrated software and automation give revenue cycle management teams the right data in the right format and at the right time to respond to queries promptly and accurately. These solutions enable teams to work more efficiently, so they can process more claims in less time. Experian Health's flagship AI-based claims management solution, AI AdvantageTM, is a prime example. This tool predicts and prevents denials by identifying patterns in payer behavior and flagging claims with a high probability of denial so specialists can intervene before the claim is sent to the payer. This works alongside ClaimSource®, which automates clean claim submissions at scale. Using a single application, all claims are prepared and submitted with all necessary documentation, reducing the risk of denial due to missing or inaccurate information. Integrating Wave HDC's data capture technology for comprehensive claims management In November 2023, Experian Health acquired Wave HDC, which specializes in using AI-guided solutions to capture and process patient insurance data at registration with unrivalled speed and accuracy. This gives Experian Health clients access to a single denial management solution, known as Patient Access Curator. This new technology is a single click solution that spans eligibility verification, coordination of benefits, coverage and financial status checks with near-100% accuracy in less than 30 seconds. Crucial registration data can be captured in real time as soon as the patient checks in for an appointment, with no need to chase and update data post-registration. A single inquiry can search for all the essential insurance and patient demographics instantly, enabling better use of staff resources and smoother communications with payers. Tom Cox, President of Experian Health, says the move “allows us to quickly scale our portfolio with advanced logic and AI-powered technology to help solve one of the biggest administrative problems providers face today, which is claim denials.” Accurate patient data from the outset is key to preventing downstream denials, many of which originate in patient access. By reducing errors and enabling faster processing times, this comprehensive approach to denial management will help strengthen the relationship between providers and payers, ensuring timely payments and clean claims. Contact Experian Health today to find out how AI and automation can help build a successful relationship between providers and payers – and drive down denials.

Contracts govern the revenue cycle, but negotiating contracts and ensuring compliance can feel increasingly unmanageable as mergers and acquisitions, ongoing staffing challenges, and the sheer volume of contracts, plans, and provisions make contract management a massive project for healthcare providers. Tricia Ibrahim, Director of Product Management at Experian Health, shares her insights on a challenging environment heading into 2024. Providers are grappling with mounting complexity, an explosion of data, and continuing pressure to maximize efficiency and revenue. But, according to Ibrahim, healthcare contract management software is evolving to meet these challenges—and helping providers find clarity amid the complication. Q1: What are the major challenges with healthcare contract management as we move into 2024? “I think what clients are most concerned with, especially leading into 2024, is the complexity of payer contracts,” says Ibrahim. A typical provider may manage hundreds or thousands of contracts, each one with a range of plans and provisions that affect the bottom line. “Being able to negotiate better contracts is a key concern,” says Ibrahim, “but clients increasingly feel outgunned and overwhelmed by the amount of information involved.” Accessing and analyzing data effectively is more critical than ever. “When providers come together with payers to negotiate contracts, it can be difficult for them to evaluate the contract that the payer is putting in front of them,” in part because it's hard to know how their current contract is performing or how contract provisions will play out in dollars and cents, Ibrahim explains. “Underpayments and denials are a constant struggle. Also, providers need to understand how volume and patient mix will factor in.” Contract management has a direct effect on revenue and the bottom line. Negotiated terms may or may not cover actual costs. A small change in terms might have an outsized effect due to high volume. Denied claims, underpayments, downcoding and late payments can slow the revenue cycle and reduce the amount of revenue providers receive. “At the same time, we're also starting to see a greater interest in collaboration between providers and payers,” says Ibrahim. “Having additional visibility allows both parties to have more meaningful discussions and move toward solutions that work for everyone.” Q2: What are providers doing to take on these challenges? “Many providers are investing in technology,” says Ibrahim. “A 2023 analysis by Bain & Company found that 80% of healthcare executives had accelerated software and IT investment over the past year in response to mergers and acquisitions, staffing shortfalls, and an increasing need for efficiency.” As contract management becomes more complex, providers are also reaching for more powerful healthcare contract management software tools to manage data—and leverage it to negotiate contracts effectively and monitor contract compliance over time. Q3: How can healthcare contract management software like Experian Health's Contract Manager and Contract Analysis help providers negotiate better contracts? “Having meaningful information backed by data changes the dynamic,” Ibrahim says. “It allows you to have a more strategic conversation. You can say, 'You're supposed to pay us 45 days from the receipt of the claim, but it's been taking 140 days.'” Data provides objective information and can point the way toward measurable improvements going forward. “Our Contract Analysis module allows for the provider to audit payer contract performance,” says Ibrahim. That's not only helpful for tracking what's happened to date; it's also useful for projecting how a new contract might work going forward. “We're able to use historical claims to create scenarios that show how a new contract would affect payment. Sometimes, payers will keep reimbursement rates the same where you have a lot of volume and give you an increase where you don't. When you use our solution to run these types of analyses, you get a more effective understanding of proposed terms.” Q4: Once contracts are in place, how can healthcare contract management software help providers improve compliance? “Detailed analysis is key, and small discrepancies can have a significant impact,” says Ibrahim. “One of our clients, a large academic provider on the medical group side, spotted a trend where they were being underpaid by 10 cents to 50 cents on their EKGs. These kinds of variances typically go unnoticed, but they found 20 or 30 claims to submit.” The payer acknowledged the underpayment and issued the few dollars' difference. “Then the provider decided to look at their contract to see how far back they could appeal. It turned out they were able to go back a significant amount of time. When they added up the underpayments, it equated to $850,000. They ended up settling for $750,000,” Ibrahim says. OrthoTennessee, a Knoxville-based orthopedic practice with multiple locations and more than 50 physicians, uses Experian Health's Contract Management software for healthcare to find inaccuracies, make appeals, and audit contracts at scale. Using Experian Health's Contract Management platform, OrthoTennessee had an 86% success rate for appeals in 2022. “That's the power of the solution: You can really identify trends,” says Ibrahim. Monitoring compliance is a continuous effort: “We’ve done a lot of work with our clients to understand what their evolving needs are. We’ve been named Best in KLAS [by healthcare IT research firm KLAS] multiple years in a row. That recognition has centered around engagement—being engaged with our clients, so we understand what the trends are, what challenges they’re facing, and how we can help solve problems in the most efficient manner.” Q5: What role do regulations play in shaping contract management solutions? “Regulation drives different reimbursement methodologies, [such as] bundled payments or value-based care,” says Ibrahim. “Part of our challenge is making sure we are always evaluating new regulations and ensuring that our system is agile enough to support these new methodologies. “Because regulation never stops, it actually drives a lot of the innovation we do. The No Surprises Act, which came into effect in 2021, requires providers to provide patients with a good faith estimate of costs. We've been able to help clients establish an estimated median rate, which can be useful for estimates that involve non-contracted payers.” As an additional benefit, healthcare contract management software also helps providers spot opportunities. “One of our clients identified 26 plans with enough volume to support additional contracts,” says Ibrahim.  “Providers can even use these solutions to evaluate whether a market exists for a new piece of technology to deliver state-of-the-art care. Understanding performance is a powerful tool.” Q6: Early in our conversation, you said there was a growing interest in collaboration among providers and payers. What does it mean to take a collaborative approach in this context? “I think it's really important for providers and payers to have collaborative communication, to engage in productive conversations where they can work together instead of against each other,” says Ibrahim. “That's how we're going to deliver more integrative care and reduce costs. It’s how we’re going to arrive at coverage options that work for all parties, by developing good relationships between providers and payers. “For our part, Experian Health is continuing to expand Contract Manager to provide data analytics that clearly show the cost of care and the expected reimbursement for various types of services, so providers can evaluate contract performance, identify potential areas of improvement, and have meaningful conversations with payers. “At the end of the day, we all have a common goal: delivering appropriate care at the right time for patients,” Ibrahim concludes. “To progress toward that goal, payers, providers and partners like Experian Health are going need to work together.” These conversations start with a common set of data, so that everyone at the table understands where the opportunities to collaborate and improve may lie—and where the path forward may begin. Learn more about Experian Health's Healthcare Contract Management software and how it can help your organization negotiate and manage contracts effectively and efficiently, even in an increasingly complex environment.