First Pass Resolution Rate (FPRR) is a key performance indicator (KPI) used in healthcare revenue cycle management to measure the efficiency of the billing process. It refers to the percentage of claims that are processed and paid on the first submission without any need for rework or resubmission. A high FPRR indicates that the billing process is streamlined and effective, resulting in fewer denials and rejections. This translates to faster payment and improved cash flow for healthcare providers. On the other hand, a low FPRR suggests that there are issues in the billing process that need to be addressed, such as incorrect coding or incomplete documentation. FPRR is calculated by dividing the number of claims that are paid on the first submission by the total number of claims submitted, and multiplying the result by 100. It is important for healthcare providers to track FPRR regularly and strive to improve it over time to optimize their revenue cycle management.
First Pass Resolution Rate (FPRR) is calculated by dividing the total number of claims that are processed and paid on the first submission by the total number of claims submitted. This metric is used to measure the efficiency of the revenue cycle management process, as a higher FPRR indicates that claims are being processed accurately and quickly, resulting in fewer denials and rejections.
To calculate FPRR, the following formula can be used: FPRR = (Total number of claims processed and paid on first submission / Total number of claims submitted) x 100
For example, if a healthcare organization submitted 1,000 claims and 800 of those claims were processed and paid on the first submission, the FPRR would be: FPRR = (800 / 1,000) x 100 = 80%
This means that 80% of the claims submitted were processed and paid on the first submission, indicating a high level of efficiency in the revenue cycle management process.
Best practices to improve First Pass Resolution Rate (FPRR) are:
1. Accurate Patient Registration: Ensure that patient registration information is accurate and complete. This includes verifying patient demographics, insurance information, and eligibility.
2. Timely Charge Capture: Charge capture should be done in a timely manner to avoid any delays in the billing process. This includes capturing all charges for services rendered, including any ancillary services.
3. Proper Coding: Accurate coding is essential for FPRR. Ensure that the correct codes are used for all services rendered, and that they are supported by proper documentation.
4. Effective Claims Management: Claims should be submitted in a timely manner, and any errors or rejections should be addressed promptly. This includes monitoring claims status and following up on any unpaid or denied claims.
5. Ongoing Staff Training: Staff should be trained on the importance of FPRR and how to achieve it. This includes training on proper patient registration, charge capture, coding, and claims management.
6. Utilize Technology: Technology can help improve FPRR by automating processes, reducing errors, and improving efficiency. This includes using electronic health records (EHRs), revenue cycle management (RCM) software, and other tools.
7. Monitor and Analyze Metrics: Regularly monitor and analyze FPRR metrics to identify areas for improvement. This includes tracking FPRR by payer, service line, and provider.By implementing these best practices, healthcare organizations can improve their FPRR and optimize their revenue cycle management processes.
The industry standard benchmark for FPRR is typically set at 90%. This means that healthcare organizations should aim to achieve a FPRR of at least 90% for their claims processing. Achieving this benchmark indicates that the organization's revenue cycle management processes are efficient and effective, resulting in timely and accurate payment for services rendered. A high FPRR is important for several reasons. First, it reduces the need for rework and resubmission of claims, which can be time-consuming and costly for healthcare organizations. Second, it improves cash flow by ensuring that claims are paid in a timely manner. Finally, it enhances patient satisfaction by reducing the likelihood of billing errors and delays in payment. To achieve a high FPRR, healthcare organizations should focus on improving their claims processing workflows, including verifying patient eligibility, ensuring accurate coding and documentation, and submitting claims in a timely manner. Regular monitoring and analysis of FPRR can also help organizations identify areas for improvement and implement strategies to optimize their revenue cycle management processes.
Revenue cycle software can greatly improve the First Pass Resolution Rate (FPRR) metric by streamlining the entire revenue cycle process. With the help of advanced technology and automation, revenue cycle software can identify and correct errors in real-time, reducing the number of claims that are denied or rejected. This, in turn, improves the FPRR metric by increasing the number of claims that are processed correctly on the first attempt. Revenue cycle software can also help healthcare organizations to identify trends and patterns in their revenue cycle process, allowing them to make data-driven decisions to improve their FPRR metric. By analyzing data on claim denials and rejections, revenue cycle software can help organizations to identify the root causes of these issues and take corrective action to prevent them from happening in the future. If you're interested in improving your healthcare organization's FPRR metric, consider booking a demo with MD Clarity's revenue cycle software. Our software is designed to streamline the entire revenue cycle process, from patient registration to claim submission and payment posting. With our advanced technology and automation, we can help you to improve your FPRR metric and increase your revenue. Contact us today to learn more!