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Better Data, Better Decisions: Key Medical RCM Metrics

Healthcare Professional

When leveraged correctly, big data can provide invaluable insights into virtually every aspect of a healthcare organization’s operations, including its revenue cycle. Once this data is collected, it can be parsed and analyzed — or data mined — to yield profitable results ranging from streamlined workflow to increased profitability to improved patient experience.

But data mining is only as practical as the information being gathered and evaluated. There are particular metrics that deserve attention when optimizing your organization’s revenue cycle management (RCM) processes.

Noteworthy Healthcare RCM Metrics

Fully integrated RCM solutions offer a wealth of information about your revenue cycle. However, some metrics provide more insights and opportunities than others.

When establishing and tracking a healthcare organization’s RCM, consider these benchmarks:

Insurance Eligibility

When performed manually, checking or updating a patient’s insurance eligibility for a specific service can be tedious. This issue is compounded if the staff member cannot obtain an immediate response from the provider, or other delays arise.

Since insurance eligibility verification is a significant pain point for most healthcare organizations, it is vital to closely monitor this metric. When matched with other key performance indicators, this data point can help identify shortcomings in RCM practices that delay the revenue cycle and diminish the patient experience.


Pre-authorization, or prior authorization, is another process that is often time-consuming.

A pre-authorization metric tracks how long it takes a staff member to initiate prior authorization or check the status of a pending request. If pre-authorization metrics approach or exceed approximately 10 minutes, it’s time to re-evaluate the approach.

Physician-to-Patient Ratio

Inadequate staffing to accommodate patients can disrupt a healthcare provider’s income streams and diminish patient care. One way to ensure an appropriate number of staff and sustain efficient operations is to monitor the physician-to-patient ratio.

Tracking the physician-to-patient ratio allows the ability to identify and promptly address staffing imbalances. This helps maintain workflow, preserve staff morale, and enhance the patient experience.

Timeliness of Care

Timeliness of care gauges how quickly care is initiated after a patient is admitted.

Decreases in the timeliness of care may indicate inadequate staffing, a backlog of patient data or other issues. This metric can be used in conjunction with other data points such as pre-authorization delays and/or the physician-to-patient ratio to identify and solve internal shortcomings.

Days to Payment

As a metric, days to payment tracks the duration between the admission date and the time payment is received. Like many notable data standards, it’s fundamentally simple but holds great value.

A days-to-payment analysis can help predict a healthcare organization’s cash flow, pinpoint inefficiencies, and determine opportunities to accelerate the revenue cycle.

Claims Denials

Claims denials, particularly technical denials, are among the biggest disruptors of the healthcare revenue cycle.

End-to-end RCM solutions allow you to track total claims denials and specific types of denials. This data supplies information about patterns within denials, as well as sudden spikes or dips in claims denials.

Appeals Submissions

To gain optimal insights from your claims denials metrics, you should also observe appeals submissions.

In particular, monitor the rate of appeals submissions relative to the number of and types of claim denials. Together, these criteria can help healthcare managers hone in on areas to reduce initial claims denials, refine the appeals process, and enhance profitability.

Using RCM Benchmarks to Improve Productivity

The primary purpose of data mining RCM metrics is to improve overall efficiency in ways that positively impact patient care, the healthcare team, the healthcare organization’s revenue cycle, and ultimately the patient experience.

By itself, each metric provides only a limited view into the effectiveness of your organization’s RCM practices. But viewing these individual KPIs as an interrelated data set gives a true 360-degree view of your RCM strategy.

This comprehensive perspective allows confident, data-driven decisions to improve practices and revenue.

RCM Data and the Patient Experience

Traditionally, many healthcare organizations viewed revenue cycle management and the patient care experience as separate issues. However, that is no longer the case.

It’s now clear that RCM and the patient experience are inextricably linked. And RCM data mining can improve the patient experience in several ways.

For example, end-to-end RCM technology and the data management capabilities it provides make it possible to automate several crucial processes. This automation will free up staff to perform more dynamic tasks, such as interacting with patients during the admissions, care, and follow-up processes.

An RCM solution also improves the efficiency of front-office processes. Proper use of a fully integrated RCM service can increase the timeliness of care, which in turn offers the potential for improved patient outcomes, faster claims approval, and expedited time to payment.

Optimize Healthcare RCM with GeBBS

Accurate claims processing and timely payment are essential to maintaining reliable revenue streams for your healthcare organization. However, managing the individual components of an effective revenue cycle has become increasingly complex.

That’s why it’s critical to partner with an RCM solutions provider who understands the intricacies of the modern healthcare revenue cycle and offers scalable solutions to augment everything from scheduling to medical coding, from accounts-receivable management to claims-denial processing. To learn more, request a consultation with GeBBS Healthcare Solutions today.

GeBBS is a leader in healthcare RCM technology and healthcare information management (HIM) services. GeBBS is ranked as one of Modern Healthcare’s Top 10 Largest RCM Firms, one of Black Book Market Research’s Top 20 RCM Outsourcing Services, and one of Inc. 5000’s Fastest-Growing Private Companies in the United States.

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