Discover the P-P-T Framework (People, Process, Technology), a coordinated strategy for sustainable denial management. Learn critical KPIs (like Revenue Realization Rate and AR Over 120 Days) to assess staffing sufficiency and get guidance on how to prioritize the highest-impact denial problems by value and frequency, setting the stage for continuous revenue cycle improvement.
Learn to decode denial codes (CARCs vs. RARCs), analyze the most frequent denial reasons, and measure performance using key KPIs like the Initial Denial Rate. Crucially, we provide the formulas to calculate the true administrative cost of working denials and the net financial value of your recovery efforts.
Stop losing revenue to denied claims! Learn what the prefixes (CO, PR, OA, PI) mean and discover the shocking truth: 48% of initial denials stem from eligibility issues—a problem you can fix before the patient is even seen. Master the codes and the data to fix the operational breakdowns that are costing you cash.
Denial of claims by insurance payers has become a widespread and escalating problem in the healthcare industry. These denials are not just administrative nuisances; they represent a significant threat to providers’ financial stability and a detriment to patient care. This article, the first in a five-part series, will examine the alarming statistics behind medical billing denials and their multifaceted impact on healthcare practices.
In this last article of our series on the seven most important RCM metrics, we’re focused on calculating gross and net collections and understanding how much of your earned revenue is truly hitting your bottom line.
When healthcare providers regularly calculate claim denials and interpret this metric, it gives them a clear path to increasing cash flow, optimizing performance, and reducing administrative waste. In this article, we’ll help you learn to calculate your medical claim denial rate, why it’s important, what industry benchmarks to strive for, and how to reduce your denial rates over time.
For any medical practice, understanding how much revenue is generated per patient visit is one of the most revealing key performance indicators of overall financial health. In this article, UnisLink defines Average Revenue per Encounter and how to calculate it for your practice.
Two of the most critical metrics for any healthcare practice to monitor are Days in A/R and A/R Over 120 Days. These key performance indicators (KPIs) serve as early warning signs for underlying billing and collections issues, offering clear targets for improvement. Learn how to calculate these top metrics and how to improve them.