Cashless insurance is a patient-friendly process, where the patient is treated in the hospital. The entire insurance process of the patient is taken care of by their insurance platform. Later the insurance company settles the claims directly with the hospital without the patient getting involved, making the process smoother and faster.
There are specific key performance indicators to be considered when deciding on the cashless insurance process product.
- First Time Right Submission: One of the significant features of FTRS for the cashless insurance process ensures that data enters into the forms at the first instance is correct. Thus, no errors can be introduced at any later stage and improve the turnaround time (TAT). Faster TAT means faster processing, which means more claims can be submitted and processed in lesser time.
- Footfalls: You can see the business volume you have conducted with each third-party administrator (TPA), and the management information system provides a complete footfall report. This enables better resource allocation and planning based on trends of peak days for cases. The footfall report allows hospitals to estimate the expected business volume every month.
- Shortfalls: A key component of any claim process is the shortfall between the claim amount and the settled amount when the settled amount is lesser. The right product will capture deductions, list the disallowance reasons, and enable a consolidated viewing of such cases. Each claim has its real-time reporting and analytics that gives you a 360-degree view of the entire system.
- Claims Ageing Profile: An RCM product requires an MIS, making it easy to view the average settlement turnaround time or TAT per case. With an analytics dashboard, it is easy to check settlements made and outstanding balances on a case by case basis to understand complex cases and solve them.
- Claim Submission TAT: The dashboard also requires to shows the time-around-time for claim submissions, the total time taken in each case, after the discharge is approved.
- Rejection & Not Utilized Case Rates: Case rates on rejections and non-utilized cases must be listed on the dashboard, with a breakup of individual cases. Allowing a healthcare provider to know how much business volume is lost and real-time reports make it pretty easy to understand the reasons for rejection and cancellation.
The cashless insurance process is eco-friendly and perfect for the pandemic’s current situation, where social distancing is the norm. These KPIs are an essential benchmark when looking for the right revenue cycle management product.
ABI Health’s Claimbook is India’s best RCM product, which provides all the above features. The easy integration of ClaimBook is its main USP. Administrators can correlate real-time admission data with the claims’ process to understand individual cases.
If you are looking for the best revenue cycle management software, then contact us for the demo.