Certified Revenue Cycle Representative (CRCR) Practice Exam

What are the two KPIs used to monitor performance related to the production and submission of claims to third party payers and patients?

1. Days from claim initiation to approval and days from discharge to payment

2. Elapsed days from discharge to final bill and elapsed days from final bill to claim/bill submission

3. Total claims submitted and claims denied rates

4. Days to service completion and days to payment resolution

The correct answer is: Elapsed days from discharge to final bill and elapsed days from final bill to claim/bill submission

The correct choice focuses on key performance indicators (KPIs) that are essential for monitoring the efficiency and effectiveness of the claims process within the revenue cycle. These specific KPIs provide valuable insight into the timeliness of billing and the overall claim submission workflow. The first KPI in the correct option, "elapsed days from discharge to final bill," measures the time taken to generate the final bill after a patient’s discharge. This metric is crucial because it reflects how quickly a healthcare organization can prepare billing information for submission, ultimately affecting cash flow and financial stability. The second KPI, "elapsed days from final bill to claim/bill submission," is significant as it indicates how long it takes to submit the claim to payers after the bill has been finalized. Timely submission is critical to ensuring that payments are received as soon as possible, which directly impacts the organization's revenue cycle efficiency. By monitoring these KPIs, healthcare organizations can identify bottlenecks in their billing processes, leading to improved practices in the production and submission of claims. Efficient management of these timelines supports better overall financial performance and enhances the cash collection process.