This Dashboard presents 6 Visuals:

1. RCM Key Performance Indicator (KPI)
2. Top 10 Rejection Reasons by Grouping
3. Count of Claims Sent and the Claim Rate by Grouping
4. The Billing Cycle
5. Top Denials by Status
6. CARC Lookup

Use the Controls header to modify the display criteria on the RCM Dashboard.

RCM Dashboard Visuals

1. RCM KPI

• Displays the Metric Type and examines Charges with a Zero Balance by the Encounter DOS.

• Calculated Allowance Rate: Sum of Charges minus the sum of CO45 Adjustments divided by the total sum of Charges.

• The ratio of Dollars Allowed to Dollars Charged.

• Net Collection Rate: Sum of the Payments divided by the sum of the allowed Amount.

• The ratio of Dollars Paid to the Amount Expected to be Collected.

• Gross Collection Rate: Sum of the Payments divided by the sum of Charges.

• The ratio of Dollars Paid to Dollars Charged.

• Copay Collection Rate: Calculates if a Copay Payment was Posted on the same day the Encounter was Posted and divides by the total number of Encounters that have a Copay determined by the Insurance Adjudication.

• PR3: Patient Copay

2. Top 10 Rejection Reasons by Grouping

• Displays the top 10 Rejection reasons calculated by Clearinghouse, Local Edit, or Payer.

3. Count of Claims Sent and the Claim Rate by Grouping

• Shows the count of Claims sent.

• Bars: Claims sent
• Colored Sections of Bars: Individual groupings
• Line: Claim rate

• The Clean Claim Rate is calculated by dividing the number of Claims sent and rejected (denied, rejected by the clearinghouse, rejected by the payer, and/or local edit error) by the total number of Claims sent.

4. The Billing Cycle

• Reports the Average Days to Add, Days to Bill, and Total Days to Bill for each Encounter.

• Days to Add: Divides the difference in days between the DOS and the date the Encounter was added into the PM System by the total number of Encounters.
• Days to Bill: Divides the difference in days between the day the Encounter was added into the PM System and the first date the Encounter was billed by the total number of Encounters.
• Total Days to Bill: Divides the difference in days between the DOS and the first date the Encounter was billed by the total number of Encounters.

5. Top Denials by Status

• Returns the top 10 Denials grouped by Finalized Denied, Not Finalized, and Finalized Paid based on the most recent denied insurance transaction on an Encounter.

• Finalized Denied: The charge is written off or adjusted by the insurance that sent the denial.
• Not Finalized: The Claim is not paid, transferred, written off, or adjusted from the insurance that sent the denial.
• Finalized Paid: The Claim is either paid by or transferred out from the insurance that sent the denial.

6. CARC Lookup

• Outputs the description of the CARC selected in the dropdown box.