IHP 630 7-2 project preparation

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Southern New Hampshire University *

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630

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Accounting

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Feb 20, 2024

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docx

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1 Southern New Hampshire University IHP 630 7-2 Project Preparation Belkisa Alic January 28, 2024
2 Key Performance Indicators “Key Performance Indicators” (KPIs) play a vital role in assisting the revenue cycle's strategic planning and financial performance (Hristov & Chirico, 2019). The six KPI’s that hold significance to many organizations are as follows: 1. Patient Registration- this is the initial contact with the patient, obtaining the correct demographics, insurance coverage, patient name, DOB, address, and emergency contacts. Patient registration is especially important because if the information is documented incorrectly this would cause a domino effect throughout the entire process resulting in claims being denied, due to insurance and facility information not matching for the patient. 2. Prior authorization- This is a crucial step in getting procedures approved by the insurance and stating from the clinical standpoint why the procedure is necessary for the patient care. When providers want to perform same-day surgeries or in office procedures it is the responsibility of the back-end revenue cycle to get the prior authorization from the insurance to ensure that the service would be paid for. If an authorization is not granted the physician would not be paid and the patient would be responsible for the bill. 3. The Collection rate- this area measures the percentage of charges that were billed and collected. This area can impact how a patient’s experience is because it would help the organization know how the patient is being educated on their portion of payment
3 for the services provided. When a patient is informed of what their responsibility is, it helps the facility maintain their revenue, and not lose in revenue as well as not having to dip into their budgets. “It helps assess the effectiveness of the revenue collection efforts (Hristov & Chirico, 2019).” 4. Days in Accounts Receivable (DAR)- “ Accounts receivable days is the number of days that a customer invoice is outstanding before it is collected. The point of the measurement is to determine the effectiveness of a company's credit and collection efforts in allowing credit to reputable customers, as well as its ability to collect cash from them in a timely manner (accounting tools, 2023).” 5. Net Collection Rate- this KPI helps see the insight of the revenue cycle management and how the effectiveness of the department is truly working to collect the payments necessary. “ The percentage of revenue collected after deducting contractual adjustments and write-offs (Hristov & Chirico, 2019).” 6. Denial Resolve Rate- The Denial Resolve Rate reflects the effectiveness of your revenue cycle in all areas – from eligibility to coding and billing.   The higher the percentage, the better. A high percentage rate means your staff is working effectively. If your rate is low, analyze your eligibility, coding, authorizations, and credentialing processes (Tropea, 2018).”
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