How Revenue Cycle Benchmarking Can Help Tribal Health Care Organizations

Revenue cycle benchmarking against outside sources can help tribal health care providers inform best practices, increase reimbursements, and track cash flow.

Many tribes have ventured into the complex, yet potentially lucrative health care industry with mixed results. Tribal health care providers often struggle to benchmark their performance because there’s limited publicly available financial information relevant to them. While financial indicators are available for nontribal hospitals, federally qualified health centers, and other types of providers, it’s difficult for tribal health care organizations to derive meaningful comparisons from these data points because the organizations are often funded differently through both grant and patient service revenue.

That said, tribal health care providers can still benchmark using the revenue cycle, verifying that resources allocated to the third-party revenue process are performing to industry standards. Success in this area, which is arguably one of the most complicated aspects of health care management, can help tribal organizations more effectively allocate their often limited funds to improve health care services.

Key Metrics

Revenue cycle information is available from various sources, including the Healthcare Financial Management Association and the Medical Group Management Association. The metrics that are relevant for an organization vary depending on the type of health care facility it’s operating and can include the following:

  • Discharges that arent billed or coded
  • Visits per day and billed visits per day
  • Charging accuracy and timeliness
  • Coding accuracy and completeness
  • Percentage of visits with verified insurance eligibility
  • Percentage of claims billed electronically
  • Days in accounts receivable

Addressing Challenges

Tribal health care providers using the Resource and Patient Management System may face an added layer of difficulty accessing and measuring information because it’s often unavailable. Revenue is often not recorded until it has been billed, for example, making it difficult to measure discharged-not billed revenue. If this problem arises, tribal health care providers can find workarounds and build custom reports or simple information-tracking models when canned reports aren’t available.

Despite the added difficulties, revenue cycle benchmarking is a valuable—and often the only—approach for tribal organizations to gain insight on their performance relative to others in the industry.

We’re Here to Help

If you’d like insight on what benchmarks you should be using or how to overcome system limitation issues in measuring metrics at your facility, please contact us.