Revenue Cycle Management includes the office and clinical tasks that record, handle, and collect payment for patient services. It starts with scheduling patients, checking insurance, documenting care, creating and sending claims to payers, and ends with payment and patient billing.
The goal of RCM is to help healthcare providers get full and timely payment for their work. The process can be hard because many groups, insurance plans, rules, and patient costs are involved. Problems like claim denials, billing mistakes, late payments, and patients paying more can make it harder to manage money.
The Healthcare Financial Management Association (HFMA) made MAP Keys, which are measurements that track and improve the revenue cycle. These numbers are open to the public and give clear benchmarks for hospitals, doctor offices, and healthcare systems.
MAP Keys include 29 standard measurements, also called Key Performance Indicators (KPIs), that show how well a healthcare group’s revenue cycle is doing. These KPIs fall into three main groups:
They cover every part of the revenue cycle, from patient entry and billing steps to claims and account updates.
Some examples are:
By watching these KPIs often and comparing to others, administrators know what parts need fixing and what is working.
It is harder now for healthcare groups in the U.S. to keep good revenue cycle performance. Patients pay more than before, with over 30% of income coming directly from them. Changes in insurance, rules, and not enough staff also make it tough to work well.
HFMA’s MAP Keys help healthcare groups by offering:
For instance, Covenant Health won the HFMA MAP Award by using patient-centered plans and new technology. They saw about 5% more net revenue by using these tools and good practices, showing how MAP Keys can help improve finances.
Out of the 29 MAP Keys, some KPIs are especially important for improving the revenue cycle:
1. Point-of-Service (POS) Cash Collections:
Collecting payment when patients get care helps reduce bad debt and lowers the time money is owed. If POS collections are low, it might mean patients are not informed about costs well, leading to late or missed payments.
2. Clean Claim Rate:
This shows how many claims are sent the first time without errors that cause denials or extra work. Claims must be correct for patient info, diagnosis, payer data, and documents. A clean claim rate over 90% is best to reduce work and get paid faster.
3. Days in Total Discharged Not Final Billed (DNFB):
This measures money from patients who have left but have not been billed yet. High DNFB means delays in paperwork or coding. Sending claims quickly avoids cash flow issues.
4. Bad Debt:
This reflects money that cannot be collected from patients. It can happen when upfront collection is poor or financial help is not enough. Lower bad debt rates show better money management and patient help.
5. Days in Accounts Receivable (A/R):
This is the average time it takes to collect payments after billing. If this number grows, it shows problems with follow-up or payers paying slowly. HFMA advises keeping it under 50 days to keep cash flowing.
6. Cost to Collect:
This shows how much the group pays to collect each dollar. Costs include staff, technology, and admin. Keeping it under 3-4% of revenue is a good financial goal.
7. Resolve Rate:
The share of claims that get paid successfully. Low rates can point to coding mistakes, missing approvals, or payer problems that need fixing.
8. Net Collection Percentage:
This measures how much of the money owed is actually collected. It helps catch posting errors and avoid writing off money too soon.
Besides individual KPIs, healthcare groups use benchmarks, which compare their data to other groups or industry standards. For example, having 95% accurate patient registration or 80-90% verifying insurance can lower denials and improve revenue.
Many medical groups face delayed collections. Data shows 42% of U.S. practices wait 91-120 days before sending accounts to collections, and 32% wait even longer. This delay can hurt cash flow. Groups tracking benchmarks can adjust processes to lower days in A/R and DNFB and get revenue on time.
Collecting 35-50% of patient financial responsibility upfront is also a good aim. This is because patients pay more now due to high-deductible insurance plans.
Tools like HFMA’s MAP Key Connect and other software help administrators and IT managers watch performance regularly.
In recent years, healthcare groups started using artificial intelligence (AI) and automation to make revenue cycle steps better, cut mistakes, and improve productivity.
AI-assisted Front-Office Phone Automation:
Some companies offer AI phone systems that handle patient questions, schedule visits, check insurance, and send payment reminders. This helps front-office staff and improves patient communication.
Automating calls ensures that information is accurate and on time. This helps with collecting payments during service and giving financial help, which are key MAP Keys.
Claim Scrubbing and Denial Prediction:
AI can check claims for errors or missing information before sending them. This reduces denials and raises clean claim rates. Some platforms use prediction tools to spot claims likely to be denied and suggest fixes early. For example, some analytics platforms help find denial causes so groups can fix them.
Workflow Automation in Billing and Collections:
Automated systems make billing easier, flag late payments so staff can follow up fast, and support payment plans based on patient financial needs. This boosts collections, cuts days in A/R, and raises patient satisfaction.
Data Analytics and Reporting:
AI tools combine and study data from many sources fast. They help operators see trends, compare to national data, and find revenue cycle problems to fix.
Integration with Electronic Health Records (EHR):
Linking AI with EHR systems helps keep patient info and insurance checks correct. This is needed for high accuracy in registration and eligibility—two important benchmarks.
Using AI, automation, and MAP Key tracking together gives healthcare groups a way to run finances using technology that helps them work faster and better.
HFMA and award-winning groups like Covenant Health focus on clear and patient-centered talks about money. Explaining costs, payment options, and help programs helps patients understand and pay on time. This leads to:
Since patients pay more of costs now, hospitals and offices need systems and staff trained to give good price estimates and explain account status. AI-powered virtual helpers and automated calls work well here, making sure patients get regular and clear info.
HFMA helps healthcare groups improve their revenue cycle. They offer events, online learning, certifications like Certified Revenue Cycle Representative, and tools like MAP Keys. These help groups meet new challenges.
The HFMA MAP Award honors hospitals and providers that meet or beat national benchmarks and keep a patient-focused approach. Winners share their best methods publicly to support ongoing improvement.
Healthcare administrators, owners, and IT managers in the U.S. can use HFMA’s data and programs to build revenue cycle strategies that follow national rules.
MAP Keys play an important role for healthcare groups in the U.S. They help measure and improve revenue cycle management. Using these measures, with technology like AI and automation, clear financial information, and patient communication, supports steady financial results.
For practice managers, owners, and IT leaders, using MAP Keys and smart workflows can help fix common money cycle problems, improve cash flow, cut waste, and make healthcare organizations financially stronger.
The MAP Award, sponsored by HFMA, recognizes organizations exhibiting high performance in revenue cycle management, adhering to industry-standard benchmarks and best practices for financial management.
Covenant Health has partnered with Ensemble Health Partners as their strategic revenue cycle partner, enhancing their financial performance and patient care.
Covenant Health adopted patient-centered recommendations and best practices from HFMA, achieving outstanding patient satisfaction and meeting revenue cycle standards.
Ensemble combines patented technology with over 1,200 documented best practices to enhance efficiency and effectiveness across the revenue cycle.
Ensemble can drive an average net revenue lift of 5% for clients fully outsourcing their revenue cycle management.
It’s a set of guidelines designed to enhance financial performance in healthcare through effective communication and practices.
The MAP Keys are industry-standard metrics used to evaluate revenue cycle performance and guide improvements.
Clear communication regarding financial issues improves patient understanding and satisfaction, leading to better engagement and quicker payments.
The HFMA President and CEO Joseph J. Fifer presented the award during the HFMA Annual Conference.
The goal is to establish a framework for measuring and improving revenue cycle performance, ultimately enhancing financial results and patient experiences.
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