Comprehensive KPI Checklist for Revenue Cycle Management in Large Health Systems

In today’s healthcare landscape, successful Revenue Cycle Management (RCM) is essential to maintaining a healthy bottom line and supporting the mission of delivering quality patient care. The complexity of RCM in large health systems demands a robust set of Key Performance Indicators (KPIs) that offer insight into performance at every step of the revenue cycle. Here’s an extensive list of KPIs that RCM teams should consider to drive data-informed decisions and improve financial health. Tracking these metrics in real-time enables us to spot trends, optimize processes, and ultimately ensure sustainability for the health system.

Front-End Metrics

• Patient Registration Accuracy Rate: Measures the accuracy of patient demographic and insurance data collected during registration.

• Eligibility Verification Rate: Percentage of patients whose insurance is verified before service.

• Prior Authorization Rate: Tracks the percentage of services that received prior authorization when required.

• Point-of-Service Collection Rate: Measures the percentage of payments collected at the time of service.

• Patient Financial Clearance Rate: Percentage of patients fully financially cleared before service.

• Scheduling to Registration Lag Time: Measures the time between scheduling and registration, identifying potential workflow bottlenecks.

Claims Metrics

• Clean Claim Rate: Percentage of claims submitted without errors or need for follow-up.

• First Pass Resolution Rate: Measures the percentage of claims paid on the first submission.

• Claim Submission Lag Time: Time between patient encounter and claim submission.

• Denial Rate by Type: Percentage of claims denied categorized by type (authorization, medical necessity, coding).

• Days to Final Bill (DNFB): Time taken from the end of service to billing finalization.

• Underpayment Rate: Measures the percentage of claims underpaid by payers against the contracted amount.

• Top Payer Denials by Volume and Value: Identifies specific payers and denial types driving the highest volumes and financial impacts.