Revenue Cycle Reports: Key Intelligence to Optimize RCM

After attending conferences or reading healthcare revenue cycle articles, proactive CFOs and revenue cycle leaders return to work excited to:

• pursue underpayments
• accurately and consistently update chargemasters 
• conduct net revenue forecasting based on real-time data
• optimize upfront collections

As described in RCM for MSOs: Driving Value Creation with Revenue Cycle Optimization, these pursuits all pull in more revenue. Better, with these often-overlooked RCM tasks established or improved, healthcare organizations can reap the rewards for years to come.

As enticing as these opportunities are, RCM executives can’t quit at implementation. They must measure their success to confirm the efforts are paying off. For that they need revenue cycle reports. After all, “what gets measured gets managed,” as business management guru Peter Drucker told us long ago. For RCM executives, having reliable control of the revenue cycle can be almost as critical as wringing more cash from it. 

You can examine and improve your revenue cycle when you run key revenue cycle reports based on your data. While many healthcare organizations still run reports via “brute force” with spreadsheets and (much) manual labor, others have invested in AI-driven, automated solutions that spin up these reports based on access to data from many of the systems already in place. 

Review the revenue cycle reports below not only to check and refine your own decision-making but also to demonstrate what’s working at your organization to peers and superiors in a straightforward, data-supported manner. After all, in the digital era, most of your colleagues have adopted an “In God we trust. All others must bring data.” mentality. Select from this list of reports to provide the clarity you and your team need to guide your organization toward improved revenue cycle optimization. 

What are revenue cycle reports? 

Revenue cycle reports are comprehensive analytical tools healthcare organizations use to monitor, evaluate, and optimize their financial performance. These reports provide detailed insights into various aspects of the revenue cycle, from patient registration and insurance verification to claims processing and payment collection.  

Staff, outsourced partners, and software then analyze this data to identify trends, assess performance, optimize processes, and make data-driven decisions to improve financial outcomes. These reports typically include key performance indicators (KPIs) such as denial rates, days in accounts receivable, clean claims rates, and collection ratios. Metrics help healthcare leaders track progress, benchmark against industry standards, and implement targeted strategies to refine and improve their revenue cycle management processes.

Reports are built on data

To generate healthcare revenue cycle reports, staff and software access data from various sources within the healthcare organization. The primary data sources include:

• electronic medical records (EMR) systems 
• practice management software (PMS)
• billing systems 
• claims data 
• financial systems 
• patient demographics 
• clinical data, including medical images and lab results 
• treatment data 
• accounts receivable information 
• reimbursement data
• patient billing and collections data

Manual data compilation and analysis require a staff member or a team to cross-check these sources and derive insights. The best revenue cycle analytics software solutions standardize their data sets and integrate these data sources to provide a unified view of the organization's financial health. Read how, with the government’s insistence, healthcare organizations are achieving data integration.

Data analytics software typically uses ETL (Extract, Transform, Load) or ELT (Extract, Load, Transform) processes to gather data from these diverse sources, integrate it, and prepare it for analysis. The software then applies various analytical techniques to derive insights and generate reports that help organizations make data-driven decisions.

Revenue Leakage Revenue Cycle Reports

Revenue leakage reports pinpoint areas where income is being lost due to errors, inefficiencies, or missed opportunities in the billing and coding processes.

Revenue Leakage Report

This report identifies instances of under-coding, missed charges, or incorrect pricing that lead to significant revenue loss. By highlighting these issues, healthcare providers can take corrective action to ensure they are capturing all billable services and applying appropriate charges.

Revenue leakage data comes from: billing systems, claims data, financial systems, practice management software, electronic medical records, accounts receivable information, and reimbursement data

Charge Integrity Report

The charge integrity report detects incorrect and under-coded claims as well as missing charges. This comprehensive analysis helps healthcare organizations maintain accuracy in their billing processes and maximize revenue by ensuring all services provided are properly documented and charged.

Charge integrity data comes from: billing systems, claims data, electronic medical records (EMR), practice management software, financial systems, and charge capture systems

Denial Analysis Report

This report analyzes claim denials to identify patterns and root causes of rejections. By understanding the reasons behind denied claims, healthcare providers can implement targeted improvements to their billing processes, reduce denial rates, and accelerate revenue collection.

Denial analysis report data comes from: claims systems, billing systems, electronic medical records, practice management software, financial systems, and payer information databases.

Financial Performance Revenue Cycle Reports

Revenue Forecast Report

This report utilizes historical data and predictive analytics to generate accurate revenue projections. By analyzing past trends and incorporating current market conditions, hospitals can better anticipate future cash flows and plan accordingly.

RCM managers create revenue forecast reports using data from billing systems, financial systems, claims data, practice management software, electronic health records, historical revenue data, and patient demographics.

Payer Performance Scorecard

The Payer Performance Scorecard evaluates key metrics related to different payers, including reimbursement rates, payment turnaround times, and underpayments. This comprehensive assessment helps hospitals identify which payers are most efficient and profitable, allowing for strategic decision-making in contract negotiations and resource allocation.

RCM managers create payer performance reports using data from claims systems, billing systems, financial systems, practice management software, payer contract information, reimbursement data, and denial data.

A/R Aging Analysis

This report categorizes accounts receivable by age, providing a clear picture of outstanding payments and potential collection issues. By identifying accounts that are aging beyond acceptable thresholds, hospitals can prioritize follow-up actions and implement targeted strategies to accelerate cash flow.

RCM managers create A/R Aging reports using data from billing systems, financial systems, practice management software, accounts receivable information, patient demographics, and claims data.

Operating Margin Report

The Operating Margin Report calculates the percentage of revenue remaining after covering operating expenses. This crucial metric helps hospitals assess their operational efficiency and profitability, allowing them to identify areas for cost reduction or revenue enhancement.

RCM managers create operating margin reports using data from financial systems, billing systems, claims data, practice management software, cost accounting systems, and revenue data.

Total Margin Report

This report provides a comprehensive view of a hospital's financial performance by including both operating and non-operating income sources. By analyzing the total margin, healthcare organizations can evaluate their overall financial health and make informed decisions about resource allocation and investment strategies.

RCM managers create total margin reports using data from financial systems, billing systems, claims data, cost accounting systems, revenue data, expense data, and operational performance metrics.

Payer Mix Analysis

The Payer Mix Analysis breaks down the hospital's revenue sources by payer type, including commercial insurance, Medicare, Medicaid, and self-pay patients. This report helps hospitals understand their revenue distribution and identify potential risks or opportunities associated with changes in the payer mix.

RCM managers create payer mix analysis reports using data from billing systems, claims data, financial systems, practice management software, electronic health records, patient demographics, and reimbursement data.

Bad Debt and Charity Care Report

This report tracks the amount of uncompensated care provided by the hospital, including both bad debt and charity care. By monitoring these metrics, hospitals can assess the impact of their financial assistance policies and identify trends in uncompensated care that may affect their overall financial performance.

RCM managers create bad debt and charity analysis reports using data from financial systems, billing systems, patient accounts receivable, claims data, charity care documentation, patient demographics, and collection agency records.

Operational Efficiency Revenue Cycle Reports

Operational efficiency reports explore the performance and effectiveness of various aspects of the revenue cycle management process. These reports help healthcare organizations identify areas for improvement and optimize their workflows.

Workflow Analysis Report

This report identifies inefficiencies and bottlenecks in the revenue cycle. By analyzing each step of the revenue cycle, organizations can pinpoint areas where delays or errors occur frequently, enabling them to implement targeted improvements.

RCM managers create workflow analysis reports using data from electronic health records (EHR) systems, practice management software, billing systems, claims data, operational data, staff productivity metrics, and time tracking systems.

Clean Claims Rate Report

 This report tracks the percentage of claims submitted without errors, providing a crucial metric for assessing the accuracy of the billing process. A high clean claims rate indicates that the organization is submitting accurate and complete claims, which can lead to faster reimbursements and improved cash flow.

RCM managers create clean claims reports using data from billing systems, claims data, electronic health records, practice management software, coding systems, and payer-specific rules and guidelines.

First Pass Yield Report

This report measures the percentage of claims paid on first submission, offering a more revenue-centric indicator than the clean claims rate. By focusing on actual payments received without additional effort, the first pass yield report provides a clearer picture of the organization's revenue cycle efficiency and effectiveness.

RCM managers create first pass yield reports using data from billing systems, claims data, electronic health records, practice management software, payer remittance information, and denial tracking systems.

Patient Financial Experience Revenue Cycle Reports

These metrics provide valuable insights into how patients interact with the financial aspects of their healthcare experience, helping providers improve patient satisfaction and optimize revenue collection.

Point-of-Service Collection Rate Report

This report tracks the percentage of patient payments collected at the time of service. It helps healthcare providers assess the effectiveness of their upfront collection strategies and identify opportunities to improve cash flow.

RCM managers create point-of-service collections reports using data from practice management software, billing systems, electronic health records, patient demographics, insurance eligibility verification systems, payment processing systems, and real-time cost estimation tools.

Patient Payment Trend Report

This report analyzes patterns in patient payment behavior over time. It offers insights into factors affecting patient payments, such as seasonal variations or the impact of new payment policies, allowing providers to adjust their financial strategies accordingly.

RCM managers create patient payment trend reports using data from billing systems, practice management software, patient portals, payment processing systems, consumer surveys, InstaMed platform data, and third-party market research sources.

Compliance and Regulatory Revenue Cycle Reports

These reports help healthcare organizations maintain regulatory compliance and prepare for audits, helping to avoid penalties and ensure adherence to industry standards.

Compliance Monitoring Dashboard

This dashboard provides a real-time overview of an organization's compliance status across various regulatory requirements. It helps healthcare providers quickly identify and address any compliance issues, reducing the risk of violations and associated penalties.

RCM managers create compliance monitoring dashboards using data from billing systems, claims data, electronic health records, practice management software, regulatory guidelines, audit logs, staff training records, and compliance documentation systems.

Audit Readiness Report

This report assesses an organization's preparedness for potential audits by regulatory bodies or external auditors. It identifies areas that may require attention before an audit, helping healthcare providers proactively address any gaps in documentation or processes.

RCM managers create audit readiness reports using data from billing systems, electronic health records, practice management software, compliance documentation systems, internal audit logs, staff training records, regulatory guidelines, and previous audit findings.

Steps to generate reports manually and with software

Above, we’ve listed dozens of reports for your reference. Most likely, you won’t need them all.  

The steps you take to generate all of these reports are generally as follows: 

1. Data Collection

Manually: Staff gathers data from the sources relevant to the report named above. This process can be time-consuming and prone to errors.

With Software: Revenue cycle analytics software automatically pulls data from integrated systems, ensuring real-time, accurate information.

2. Data Analysis

Manually: Staff analyze historical data, identify trends, and make projections using spreadsheets. This method is labor-intensive and can miss subtle patterns.

With Software: AI-driven predictive analytics tools analyze large datasets quickly, identifying trends and patterns that humans might overlook.

3. Forecasting Model Selection

Manually: Leaders choose a forecasting method based on their experience, often using simple models like time series analysis or budget-based forecasting.

With Software: Advanced software offers multiple forecasting models, such as rolling forecasts and scenario planning, allowing leaders to select the most appropriate method for their needs.

4. Report Generation

Manually: Staff create reports using spreadsheets, which can be time-consuming and lack visual appeal.

With Software: Revenue cycle analytics software generates customizable, visual reports and dashboards with real-time data.

5. Review and Adjustment

Manually: Leaders review reports and make adjustments based on their expertise, which can be subjective.

With Software: AI-powered tools provide data-driven insights and recommendations, allowing leaders to make more informed decisions quickly.

Reinforce your revenue with MD Clarity’s RCM data analytics and reporting tools

Revenue cycle reports showcase just which levers when pulled improve margins, speed operations, and ensure compliance. By offering unprecedented insights and efficiencies across the healthcare organization revenue cycle, revenue cycle reports reflect the value of RCM leader decisions and reflect their grasp of the revenue cycle. 

MD Clarity’s contract management and modeling tool, RevFind, integrates seamlessly with your EMR, PM system, billing systems, and other software. It is software built from the ground up to surface, analyze, and report underpayments, denials, revenue impact of proposed payer changes, and contract performance. Its bidirectional data exchange stems from a dedication to interoperability.  

MD Clarity's RevFind offers a comprehensive suite of analytics reports to help healthcare providers optimize their revenue cycle management, including: 

• Underpayment Detection Report
• Denial Analysis Report
• Payer Performance Scorecard
• Contract Performance Analysis
• Revenue Forecasting Report
• Charge Integrity Report
• Claims Status Report
• A/R Aging Report
• Patient Payment Trend Report
• Compliance Monitoring Dashboard

RevFind's reporting interface allows for customizable analysis of data across multiple dimensions, including denial codes, procedure codes, facilities, providers, and insurers. This flexibility enables users to create tailored reports based on their specific needs, potentially generating numerous variations of analytics reports.

Get a demo to see how RevFind analyzes your data to bring you the insights to fuel your organization’s success long term. Capture the extent of the revenue you’ve earned. 

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