rcm glossary

Total performance score (TPS)

Total performance score (TPS) is a metric that quantifies the overall performance of a healthcare revenue cycle management system, providing a comprehensive assessment of its efficiency and effectiveness.

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What is Total Performance Score (TPS)?

Total Performance Score (TPS) is a metric used in healthcare revenue cycle management (RCM) to evaluate the overall performance of a healthcare organization or provider. It is a comprehensive measure that takes into account various key performance indicators (KPIs) and provides a holistic view of the organization's financial and operational efficiency.

The TPS is typically calculated based on a combination of quantitative and qualitative factors, including revenue cycle metrics, patient satisfaction scores, compliance with regulatory requirements, and other performance indicators. It helps healthcare organizations assess their strengths and weaknesses, identify areas for improvement, and benchmark their performance against industry standards.

Difference between Total Performance Score (TPS) and Key Performance Indicators (KPIs)

Key Performance Indicators (KPIs) and Total Performance Score (TPS) are closely related terms in healthcare revenue cycle management, but they have distinct differences. KPIs are individual metrics or indicators that measure specific aspects of an organization's performance, such as days in accounts receivable (AR), denial rate, or clean claim rate.

On the other hand, TPS is a composite score that combines multiple KPIs to provide an overall assessment of an organization's performance. While KPIs focus on specific areas, TPS takes a more comprehensive approach by considering various factors that contribute to the organization's financial and operational efficiency.

In essence, KPIs are the building blocks of TPS. By tracking and analyzing KPIs, organizations can identify areas of improvement and work towards achieving a higher TPS.

How is Total Performance Score (TPS) Calculated?

The calculation of Total Performance Score (TPS) may vary depending on the specific methodology adopted by an organization or industry standards. However, the following are some common components that are often considered when calculating TPS:

1. Revenue Cycle Metrics: TPS incorporates various revenue cycle metrics, such as days in AR, denial rate, clean claim rate, first-pass resolution rate, and collection rate. These metrics provide insights into the organization's financial performance, efficiency, and effectiveness in managing the revenue cycle.

2. Patient Satisfaction Scores: Patient satisfaction is an essential aspect of healthcare quality. TPS may include patient satisfaction scores obtained through surveys or other feedback mechanisms. These scores reflect the organization's ability to provide a positive patient experience and meet patient expectations.

3. Compliance with Regulatory Requirements: Healthcare organizations must comply with numerous regulatory requirements, such as HIPAA, EHR meaningful use, and billing and coding guidelines. TPS may consider the organization's compliance with these regulations as a factor in assessing overall performance.

4. Financial Performance: TPS often incorporates financial performance indicators, such as net revenue, operating margin, and accounts receivable turnover. These indicators provide insights into the organization's financial stability and profitability.5. Benchmarking: TPS may also involve benchmarking the organization's performance against industry standards or peer organizations. This allows for a comparison of performance and identification of areas where improvements can be made.

Once the relevant metrics and indicators are identified, each component is assigned a weightage based on its importance and contribution to the overall performance. These weights are then used to calculate the TPS by aggregating the scores of individual components.

Examples of Total Performance Score (TPS) in Healthcare RCM

Example 1:

A hospital calculates its Total Performance Score (TPS) by considering the following metrics: days in AR, denial rate, clean claim rate, patient satisfaction scores, compliance with regulatory requirements, and financial performance indicators. Each metric is assigned a weightage based on its significance. After aggregating the scores, the hospital obtains a TPS of 85 out of 100, indicating a relatively good overall performance.

Example 2:

A medical billing company calculates TPS for its clients by focusing on revenue cycle metrics, such as first-pass resolution rate, collection rate, and accounts receivable turnover. The company also considers client satisfaction scores and compliance with billing and coding guidelines. By calculating TPS for each client, the company can identify high-performing clients and those who may require additional support or improvement.

In both examples, TPS serves as a valuable tool for healthcare organizations to assess their performance, identify areas for improvement, and track progress over time. It provides a comprehensive view of the organization's financial and operational efficiency, enabling informed decision-making and strategic planning.

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