• MAP Keys for Hospitals and Health Systems

    Pre-Registration Rate

    Purpose:
    Trending indicator that patient access processes are timely, accurate, and efficient

    Value:
    Indicates revenue cycle efficiency and effectiveness

    Equation:
    N: Number of patient encounters pre-registered
    D: Number of scheduled patient encounters 

    Insurance Verification Rate

    Purpose:
    Trending indicator that patient access functions are timely, accurate, and efficient

    Value:
    Indicates revenue cycle process efficiency and effectiveness

    Equation:
    N: Total number of verified encounters
    D: Total number of registered encounters

    Service Authorization Rate

    Purpose:
    Trending indicator that patient access functions are timely, accurate, and efficient

    Value:
    Indicates revenue cycle process efficiency and effectiveness

    Equation:
    N: Number of encounters authorized
    D: Number of encounters requiring authorization 

    Point-of-Service (POS) Cash Collections

    Purpose:
    Trending indicator of point-of-service collection efforts

    Value:
    Indicates potential exposure to bad debt, accelerates cash collections, and can reduce collection costs

    Equation:
    N: POS payments
    D: Total patient cash collected

    Conversion Rate of Uninsured Patient to Payer Source

    Purpose:
    Trending indicator of qualifying uninsured patients for a funding source

    Value:
    Indicates organization's ability to successfully secure funding for uninsured patients and improve customer satisfaction

    Equation:
    N: Total uninsured patients converted to insurance
    D: Total uninsured discharges and visit

    Days in Total Discharged Not Final Billed (DNFB)

    Purpose:
    Trending indicator of claims generation process

    Value:
    Indicates revenue cycle performance and can identify performance issues impacting cash flow

    Equation:
    N: Gross dollars in A/R (not final billed)
    D: Average daily gross revenue 

    Days in Total Discharged Not Submitted to Payer (DNSP)

    Purpose:
    Trending indicator of total claims generation and submission process

    Value:
    Indicates revenue cycle performance and can identify performance issues impacting cash flow

    Equation:
    N: Gross dollars in DNFB + Gross dollars in FBNS
    D: Average daily gross revenue

    Late Charges as a Percentage of Total Charges 

    Purpose:
    Measure of revenue capture efficiency

    Value:
    Identify opportunities to improve revenue capture, reduce unnecessary cost, enhance compliance, and accelerate cash flow

    Equation:
    N: Charges with post date greater than three days from service date
    D: Total gross charges

    Net Days in Credit Balance

    Purpose:
    Trending indicator to accurately report account values, ensure compliance with regulatory requirements, and monitor overall payment system effectiveness

    Value:
    Indicates whether credit balances are being managed to appropriate levels and are compliant to regulatory requirements

    Equation:
    N: Dollars in credit balance
    D: Average daily net patient service revenue

    Days in Final Billed Not Submitted to Payer (FBNS)

    Purpose:
    Trending indicator of claims impacted by payer/regulatory edits within claims processing system

    Value:
    Track the impact of internal/external requirements to clean claim production, which impacts positive cash flow

    Equation:
    N: Gross dollars in FBNS
    D: Average daily gross revenue 

    UB04 (8371) Clean Claim Rate

    Purpose:
    Trending indicator of claims data as it impacts revenue cycle performance

    Value:
    Indicates quality of data collected and reported

    Equation:
    N: Number of claims that pass edits requiring no manual intervention
    D: Total claims accepted into claims scrubber tool for billing prior to submission 

    Denial Rate – Zero Pay

    Purpose:
    Trending indicator of % claims not paid

    Value:
    Indicates provider's ability to comply with payer requirements and payer's ability to accurately pay the claim

    Equation:
    N: Number of zero paid claims denied
    D: Number of total claims remitted 

    Denial Rate–Partial Pay

    Purpose:
    Trending indicator of % claims partially paid

    Value:
    Indicates provider's ability to comply with payer requirements and payer's ability to accurately pay the claim

    Equation:
    N: Number of partially paid claims denied
    D: Number of total claims remitted 

    Denials Overturned by Appeal

    Purpose:
    Trending indicator of hospital's success in managing the appeal process

    Value:
    Indicates opportunities for payer and provider process improvement and improves cash flow

    Equation:
    N: Number of appealed claims paid
    D: Total number of claims appealed and finalized or closed 

    Denial Write-Offs as a Percent of Net Revenue

    Purpose:
    Trending indicator of final disposition of lost reimbursement, where all efforts of appeal have been exhausted or provider chooses to write off expected payment amount

    Value:
    Indicates provider's ability to comply with payer requirement and payers ability to accurately pay the claim

    Equation:
    N: Net dollars written off as denials
    D: Average monthly net revenue

    Aged A/R as a Percent of Billed A/R by Payer Group

    Purpose:
    Trending indicator of receivable collectability by payer group

    Value:
    Indicates revenue cycle's ability to liquidate A/R by payer group

    Equation:
    N: Billed payer group by aging (0-30, >30, >60, >90, >120 days)
    D: Total billed A/R by payer group

     

    Net Days in Accounts Receivable

    Purpose:
    Trending indicator of overall A/R performance

    Value:
    Indicates revenue cycle efficiency

    Equation:
    N: Net A/R
    D: Average daily net patient service revenue

    Aged A/R as a Percentage of Billed A/R

    Purpose:
    Trending indicator of receivable collectability

    Value:
    Indicates revenue cycle's ability to liquidate A/R

    Equation:
    N: 0-30, >30, >60, >90, >120 days
    D: Total billed A/R

    Cash Collection as a Percentage of Adjusted Net Patient Service Revenue

    Purpose:
    Trending indicator of revenue cycle to convert net patient services revenue to cash

    Value:
    Indicates fiscal integrity/financial health of the organization

    Equation:
    N: Total cash collected
    D: Average monthly net revenue

    Bad Debt

    Purpose:
    Trending indicator of the effectiveness of self-pay collection efforts and financial counseling

    Value:
    Indicates organization's ability to collect self-pay accounts and identify payer sources for those who can't meet financial obligations

    Equation:
    N: Bad debt
    D: Gross patient service revenue

    Charity Care

    Purpose:
    Trending indicator of local ability to pay

    Value:
    Indicates services provided to patients deemed unable to pay

    Equation:
    N: Charity care
    D: Gross patient service revenue

    Charity as a Percent of Uncompensated Care

    Purpose:
    Trending indicator that monitors charity care versus bad debt

    Value:
    Reflection of charity care (provided to the community)

    Equation:
    N: Charity care
    D: Total uncompensated care (bad debt + charity care)

    Uninsured Discount (New MAP Key, June 2014)

    Purpose:
    Trending indicator of amounts not expected to be paid by uninsured patients

    Value:
    Indicates the portion of the self pay gross revenue not included in cash, charity or bad debt metrics

    Equation:
    N: Uninsured discounts
    D: Gross patient service revenue

    Total Uncompensated Care (New MAP Key, June 2014)

    Purpose:
    Trending indicator of total amounts not collected from patients related to self pay discounts, charity and bad debt combined

    Value:
    Indicates the total amount of self pay gross revenue that is not collectable or expected to be collected

    Equation:
    N: Uninsured and uncompensated care (bad debt + charity care + uninsured care discount)
    D: Gross patient service revenue

    Cost to Collect

    Purpose:
    Trending indicator of operational performance

    Value:
    Indicates the efficiency and productivity of revenue cycle (RC) process

    Equation:
    N: Total Revenue Cycle (RC) Cost
    D: Total cash collected

    Cost to Collect by Functional Area

    Purpose:
    Trending indicator of operational performance by functional area as reported in Cost to Collect

    Value:
    Indicates the efficiency and productivity of revenue cycle process by functional area

    Equation:
    N: Total x (x = the cost of each functional area) cost*
    D: Total cash collected

    *Sum total of all x's (i.e. sum of the cost of each functional area) should equal total cost of Cost to Collect

    Case Mix Index

    Purpose:
    Trending indicator of patient acuity, clinical documentation, and coding

    Value:
    Supports appropriate reimbursement for services performed and accurate clinical reporting

    Equation:
    N: CMI (average RW/Patient) = sum of relative weights for all inpatients*
    D: Number of inpatients in the month*

    *Excludes normal newborns and Medicare-exempt units

  • MAP Award Winner Statistical Data

    Learn more about HFMA’s standard and recommended benchmarks by reviewing statistical data from the MAP Awards winners.

    See the details.

  • MAP Keys for Physician Practice Management

    Percent of Patient Schedule Occupied

    Purpose:
    Identifies opportunity to maximize slot utilization and improve practice productivity

    Value:
    Measures available capacity in a patient schedule

    Calculation:
    N: Number of patient hours occupied
    D: Number of patient hours available

    Point-of-Service (POS) Collection Rate

    Purpose:
    Provides opportunity to increase collections, decrease collection costs, and accelerate cash flow

    Value:
    Identifies opportunity for increased POS collections

    Calculation:
    N: Total POS collections
    D: Total patient cash collected - all self-pay 

    Total Charge Lag Days

    Purpose:
    Measures charge capture workflow efficiency and identifies delays in cash

    Value:
    Accelerates cash flow

    Equation:
    N: S days from revenue recognition date (posting date) less date of service date (by CPT code)
    D: S CPT codes billed 

    Professional Services Denial Percentage

    Purpose:
    Tracks payer denials and impact cash flow and trends payment opportunity and process improvement

    Value:
    Drives root cause accountability in the revenue cycle processes

    Equation:
    N: S CPT (units of service) codes denied
    D: S CPT codes billed 

    Aged A/R by Payer Group as a Percentage of Outstanding Total A/R

    Purpose:
    Trending indicator of receivable aging and collectibility by payer group

    Value:
    Indicates payment delays or revenue cycle's ability to liquidate A/R by payer group

    Equation:
    N: Billed payer group by aging (0-30, >30, >60, >90, >120 days)
    D: Outstanding A/R by payer group

    Aged A/R as a Percentage of Outstanding A/R

    Purpose:
    Trending indicator of receivable aging and collectibility

    Value:
    Indicates payment delays or revenue cycle's ability to liquidate A/R

    Calculation:
    N: 0-30, >30, >60, >90, >120 days
    D: Total outstanding A/R 

    Primary Physician Practice Operating Margin Ratio

    Purpose:
    Measures the financial performance of a primary physician entity on an accrual basis

    Value:
    Determines the state of financial health and sustainability of current practice operations

    Calculation:
    N: Net income from primary practice operations
    D: Primary practice operating revenue

    Specialty Physician Practice Operating Margin Ratio

    Purpose:
    Measures the financial performance of a specialty physician entity on an accrual basis

    Value:
    Determines the state of financial health and sustainability of current practice operations

    Calculation:
    N: Net income from specialty operations
    D: Specialty operating revenue 

    Net Income/Loss Per Primary FTE Physician

    Purpose:
    Measures the average profit or loss of Primary FTE physician on an accrual basis

    Value:
    Determines the financial health on a physician FTE level; can be used for tracking and trending the profitability of the entity based on a physician level; supports the need for strategy development to minimize losses

    Calculation:
    N: Net income from operations
    D: Number of FTE physicians 

    Net Income/Loss Per Specialty FTE Physician

    Purpose:
    Measures the average profit or loss of specialty FTE physician on an accrual basis

    Value:
    Determines the financial health on a physician FTE level; can be used for tracking and trending the profitability of the entity based on a physician level; supports the need for strategy development to minimize losses

    Calculation:
    N: Net income from operations
    D: Number of FTE physicians 

    Total Primary Physician Compensation as a Percentage of Net Revenue

    Purpose:
    Demonstrates an ability to afford primary physician compensation in relation to the revenue of the physician enterprise

    Value
    Predicts reasonableness of primary physician compensation relative to revenue (direct contribution of a physician)

    Calculation:
    N: Total primary physician compensation
    D: Total net primary patient service revenue

    Total Specialty Physician Compensation as a Percentage of Net Revenue

    Purpose:
    Demonstrates an ability to afford specialty physician compensation in relation to the revenue of the physician enterprise>

    Value:
    Predicts reasonableness of specialty physician compensation relative to revenue (direct contribution of a physician)

    Calculation:
    N: Total specialty physician compensation
    D: Total net specialty patient service revenue 

    Practice Net Days in A/R

    Purpose:
    Calculates the average number of days it takes to collect payment on services rendered; measures revenue cycle effectiveness and efficiency

    Value:
    Used as a potential proxy for DCOH (“Cash Inventory”); determines the effectiveness of patient care collections and can be used for budgeting and cash flow projections

    Calculation:
    N: Net patient service A/R
    D: Average daily net patient service revenue 

    Practice Cash Collection Percentage

    Purpose:
    Measures revenue cycle efficiency, supports the valuation of current accounts receivable, and predicts income

    Value:
    Provides an opportunity to increase cash flow and forecasts accuracy of expected revenues

    Calculation:
    N: Actual patient service cash collections
    D: Net patient service revenue 

     

  • MAP Keys Compliant Program

    HFMA’s MAP Keys Compliant Program evaluates and designates products with data-capture and data-reporting capabilities that support the use of MAP Keys to track, compare, and improve revenue cycle performance. See the details.