[Free] RCM Calculator - Stop Guessing and Start Optimizing

Could hidden gaps in your RCM workflows be draining your healthcare organization without you realizing it?

Feed your billing data into our free RCM calculator to instantly estimate revenue recovery and get clear insights to maximize billing efficiency.

How Do Revenue Cycle Management Calculators Work?

RCM calculators work by taking your raw financial data and using industry benchmarks to calculate RCM efficiency or revenue recovery estimate.

The popular industry benchmarking data sources are the Healthcare Financial Management Association (HFMA) MAP Keys and the Medical Group Management Association (MGMA) DataDive.

Once the calculator completes the benchmarking and variance analysis, you’ll get your performance score and targeted insights to close identified gaps and improve revenue.

What Can You Measure? Key Metrics the Calculator Covers

Our calculator can help you measure your revenue cycle performance and operational efficiency.

The revenue cycle performance measurements benchmark your monthly gross charges, claim denial rate, and net collection rate against those of your peers in the healthcare industry.

• Monthly Gross Charges: The total amount billed for healthcare services in a month before discounts or deductions.

• Claim Denial Rate: The percentage of claims that get rejected by payors on the first try.

• Net Collection Rate (NCR): The percentage of collectible revenue your organization actually secures after accounting for denials and contractual adjustments.

In benchmarking your operational efficiency, we evaluate the following key metrics:

• First-Pass Resolution Rate (FPRR): Also known as the Clean Claim rate, FPRR is the percentage of insurance claims that are paid on the first try without corrections.

• Days in Accounts Receivable (AR): The number of days it takes to get paid after submitting a claim.

• Average Documentation Time per Encounter: The average time clinicians spend completing documentation for each patient visit.

• Patient Encounters per Provider: The number of patients a provider handles in a given period.

• Monthly RCM Operating Costs: The total expenses incurred monthly in managing RCM activities like documentation, coding, billing, and denial management.

How to Read RCM Calculator Results

Based on the data you’ve provided, our calculator will reveal your RCM Score, Monthly Leakage, and Annual Revenue Opportunity.

Here’s what they mean:

• RCM Score: It is out of 100, and reflects how your revenue cycle is performing against HFMA and MGMA benchmarks across denial rate, net collection, A/R days, FPRR, and cost to collect. The lower the score, the more money your health organization is leaving on the table.

• Monthly Leakage: It is the uncollected net revenue per month. You may be leaving revenue on the table due to a high denial rate and a low net collection rate.

• Annual Revenue Opportunity: It is our conservative estimate of what you can realistically recover in a year if you optimize your revenue cycle. We’ve modeled it at roughly 60% first-year capture across all recovery levers.

Common Errors That Skew RCM Results

The calculator can only be as accurate as the data you feed it. Therefore, you want to avoid the following errors:

• Using outdated data: It’s best to use the latest RCM data you have. Using past data can hide current performance issues and distort benchmarks as the operating conditions change.

• Misreporting clean claim rates: Ensure to only include claims that were paid on the first try (without corrections) when computing FPRR. Misreporting the clean claim rate can give a false sense of efficiency by underestimating errors, payment timelines, and the amount of rework done.

• Inputting an incorrect payor mix: Our calculator gives you pointers (based on percentages) on what we consider to be a government-heavy, balanced mix, high self-pay, or mostly commercial payor mix. It’s vital to get the mix right, as errors here can skew results by masking how different reimbursement rates, denial patterns, and payment timelines affect revenue cycle performance.

How to Improve Your RCM Score After Running the Calculator

Generally, you can improve your RCM Score by:

• Closing the Net Collection Rate gap

• Increasing first-pass resolution

• Increasing denial recovery

• Reducing the cost to collect

• Reducing A/R days

Our calculator’s detailed breakdown at the KPI-level will tell you exactly where revenue is slipping through the cracks.

We also quantify the recovery opportunities in dollar terms, allowing you to improve your RCM Score while prioritizing areas that will deliver the biggest financial impact to your healthcare organization.

That said, you can achieve superior results by closing all mid-revenue-cycle gaps through an end-to-end workflow. That’s why we built DeliverHealth using 2 integrated solutions as follows:

• InstaNote: It is our AI-powered documentation solution that instantly turns your patient conversations into structured clinical notes. It includes coding suggestions.

• InstaCode: It is our AI-driven coding solution that’s designed to improve accuracy and productivity. It supports autonomous coding and integrates with InstaNote for seamless documentation-to-coding workflows.

Ready to uncover exactly where you’re losing revenue and how much you can recover by closing the revenue cycle gaps?

Frequently Asked Questions (FAQs)

Let’s now answer some of the commonly asked questions about using an RCM calculator:

What Data Do You Need to Use an RCM Calculator?

You need the following data to use the calculator:

• Gross Charges

• Denial Rate

• Net Collection Rate

• Clean Claim Rate

• Days in Accounts Receivable

When Should a Healthcare Team Use an RCM Calculator?

Many healthcare teams seek an RCM calculator when collections are lower than expected, and they want to troubleshoot the cause.

It is a valid reason to use a calculator, but you should also consider the exercise when you want to:

• Reduce denials and lower days in AR.

• Benchmark performance with peers in the industry.

• Undertake budgeting and forecasting to estimate revenues realistically.

• Implement new medical billing and insurance coding workflows or Clinical Documentation Improvement software (post-implementation analysis).

How Accurate Can an RCM Calculator Be?

When you provide accurate, up-to-date data, the RCM calculator can deliver highly reliable insights.

However, results are based on industry benchmarks, and you should view them as educated estimates (not exact forecasts).

How Does an RCM Calculator Support Better Cash Flow Decisions?

The calculator gives you the data to prioritize high-impact areas that can improve revenue recovery.

Specifically, you’ll have the following insights to support cash flow decisions:

• Where is cash being lost?

• Where is cash being delayed?

• How much revenue is recoverable if you fix a specific gap?

• Which actions will have the greatest impact on cash flow management?

What Metrics Can an RCM Calculator Show?

Generally, an RCM calculator will tell you how you compare to peers based on the following KPIs:

• Net Collection Rate

• Claim Denial Rate

• Days in AR

• Clean Claim Rate

• Cost to Collect

• Effective Contractual Adjustment

Our calculator covers the above and includes an RCM Score, as well as Monthly Leakage and Annual Revenue Opportunity in dollar terms.

Can an RCM Calculator Work for Multi-Location Healthcare Groups?

Yes, there are benchmarks for multi-location healthcare groups.

All you have to do is provide the aggregated data for the entire system or for a single location.