Take a revealing look behind billing office doors – view our Healthcare Revenue Cycle Management Survey results.

The results are in! For the second time, NextGen RCM Services set out to measure revenue cycle management performance in the healthcare industry. We were able to get a clearer picture of the RCM landscape and identify areas where practices can make improvements by surveying hundreds of practices across the country on topics that included billing and collections processes, A/R efficiency, and denial resolution.

The 2016 installment of this annual revenue cycle management survey provides eye-opening insights into RCM trends. Industry best practice for first pass clean claim rates for practices is 90% or above.

The good news: Almost one-third of our second annual RCM survey respondents say they achieve first pass clean claim rates between 91 and 100 percent of the time. The not-so-good news: More than 10 percent of survey respondents report rates between 71 and 80 percent – well below the industry’s target rate for first pass clean claims.

How did some of the top specialties compare?

  • 13% of family practices report first pass clean claim rates between 71 and 80%; 18% claimed rates of 91% or higher.
  • 13% of internal medicine practices report first pass clean claim rates between 71 and 80%; 19% claimed rates of 91% or higher.
  • 14% of OB/GYN practices report first pass clean claim rates between 71 and 80%; 20% claimed rates of 91% or higher.
  • 10% of pediatric practices report first pass clean claim rates between 71 and 80%; 17% claimed rates of 91% or higher.

Areas we identified that can help practices make improvements and drive more revenue:

  • Put automation tools to use 100% of the time — many practices don’t leverage the automation resources available to them and especially as we move to value-based reimbursement, automated reporting and analytics must be used to drive better outcomes and avoid penalties.
  • Incorporate denial resolution into your regular workflows or use an RCM services provider who can do them — expediting denial resolution is key to improving cash flow and revenue streams.
  • Create workflows and use tasking to correct the root causes of denials — organize denials by category, analyze patterns, and consider bulk eligibility verification to help mitigate denials.
  • Regularly monitor your practice’s key performance indicators — Net Collections, Average Days in A/R, Outstanding Collections for Dates of Service Over 120 Days, First Pass Clean Claim Rate—and work to get these metrics in line with the industry standards.

Check out the full report to see the eye-opening survey results:

what's happening behind the billing office door
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