for High Performance in Revenue Cycle
HFMA MAP KEYS℠ TABLE OF CONTENTS: DEFINITIONS AND DETAILS
NET DAYS IN ACCOUNTS RECEIVABLE (A/R)
Numerator: Net A/R
Denominator: Net Patient Service Revenue
AGED A/R AS A PERCENTAGE OF TOTAL BILLED A/R >90 DAYS
Numerator: Billed A/R >90days
Denominator: Total Billed A/R
POINT-OF-SERVICE (POS) CASH COLLECTIONS
Numerator: Patient Point-of-Service (POS) Payments
Denominator: Total Self Pay Cash Collected
COST-TO-COLLECT
Numerator: Total Revenue Cycle Cost
Denominator: Total Patient Service Cash Collected
CASH COLLECTIONS AS A PERCENTAGE OF NET PATIENT SERVICE REVENUE
Numerator: Total Patient Service Cash Collected
Denominator: Net Patient Service Revenue
BAD DEBT
Numerator: Bad Debt
Denominator: Gross Patient Service Revenue
CHARITY CARE
Numerator: Charity Care
Denominator: Gross Patient Service Revenue
DAYS IN DISCHARGED NOT FINAL BILLED (DNFB)
Numerator: Gross dollars in DNFB
Denominator: Gross Patient Service Revenue
DAYS IN FINAL BILLED NOT SUBMITTED TO PAYER (FBNS)
Numerator: Gross dollars in FBNS
Denominator: Gross Patient Service Revenue
DAYS IN TOTAL DISCHARGED NOT SUBMITTED TO PAYER (DNSP)
Numerator: Gross dollars in DNFB + gross dollars in FBNS
Denominator: Gross Patient Service Revenue
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Net Days in Accounts Receivable (A/R)
Equation and Data Source:
Net A/R
Balance Sheet
=
Average Daily Net Patient Service Revenue Income Statement
Points of Clarification
Net A/R
Net A/R is the net patient receivable on the balance sheet. It is net of credit balances, allowances for
uncollectible accounts, discounts for charity care, and contractual allowances for third-party payers.
Includes
1. A/R receivables outsourced to third-party company but not classified as bad debt
2. Medicare Disproportionate Share Hospital (DSH) payments
3. A/R related to patient specific third-party settlements; a “patient specific settlement” is a payment applied to
an individual patient account.
4. Capitation A/R
Excludes
1. A/R related to non-patient specific third-party settlements; a “non-patient specific settlement” is payment
that is not applied directly to a patient account; it may appear as a separate, lump sum payment unrelated to
a specific account. Examples include Medicaid Disproportionate Share Hospital (DSH), CRNA, IME, and GME
payments.
2. Non-patient A/R
Net Patient Service Revenue
Total Net Patient Service Revenue is Gross Patient Service Revenue net of allowances for uncollectible
accounts, discounts for charity care, and contractual allowances for third-party payers.
Includes
1. Medicare Disproportionate Share Hospital (DSH)
2. Capitation or Premium Revenue
Excludes
1.
Medicaid Disproportionate Share Hospital (DSH)
2. 340B drug purchasing program revenue if NOT recognized as a patient receivable/in the patient accounting
system
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Aged A/R as a Percentage of Total Billed A/R >90 days
>90 days
Aged Trial Balance
Equation and Data Source: Total Billed A/R = Aged Trial Balance
Points of Clarification
Billed A/R >90days
Total billed A/R amount >90 days for all payers, aged from discharge date.
Includes:
1. Only active billed debit balance accounts; “active billed accounts” are only those accounts that are open
2. Series accounts/recurring accounts
Excludes:
1. Active billed credit balance accounts; these should be removed from the data
2. Discharged Not Final Billed (DNFB) accounts
3. in-house accounts
4. In-house interim-billed accounts
Total Billed A/R
Total billed A/R amount for all payers in reporting month, aged from discharge date
Includes:
1. Only active billed debit balance accounts; “active billed accounts” are only those accounts that are open
2. Series accounts/recurring accounts
Excludes:
1. Active billed credit balance accounts; these should be removed from the data
2. Discharged Not Final Billed (DNFB) accounts
3. in-house accounts
4. In-house, interim-billed accounts
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Point-of-Service (POS) Cash Collections
Patient POS Payments
Accounts Receivable
Equation and Data Source: Total Self Pay Cash Collected = Accounts Receivable
Points of Clarification
Patient Point-of-Service (POS) Payments
Point-of service payments are defined as cash collected prior to or at time of encounter and up to seven
days after discharge.
Includes:
1. All posted POS payments, including undistributed payments
2. Cash collected on prior encounters, including cash collected on bad debt accounts, at the current pre-service
or time-of-service visit
3. Pre-admit dollars captured in the month payment is posted rather than received
4. Bundled payments, if included in denominator
Excludes:
1. Refunds; cash refunded to the patient should not be considered
Total Self Pay Cash Collected
Total cash collected for patient responsibility for the reporting year
Includes:
1. All patient cash collected for the month reported from patient cash account
2. All posted Self Pay payments, including undistributed payments
3. Bad debt recoveries
Excludes
1. Refunds; cash refunded to the patient should not be considered
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Cost-to-Collect
Total Revenue Cycle Cost
Income Statement
Equation and Data Source: Total Patient Service Cash Collected = Income Statement
Points of Clarification
Total Revenue Cycle Cost
The following Revenue Cycle Costs should be reported with their respective functional area’s costs as
applicable: salaries and fringe benefits, subscription fees, outsourced arrangements, purchased services,
software maintenance fees, bolt-on application costs and their associated support staff, IT operational
expenses related to the revenue cycle, record storage, contingency fees, and transaction fees.
Includes
1. Patient Access Expense: eligibility and insurance verification, cashiers, pre-registration,
admissions/registration, authorization/pre-certification, financial clearance, Medicaid eligibility, and financial
counseling
2. Patient Accounting Expense – billing, collection denials, customer service, subscription fees, collection agency
fees, CDM/revenue integrity, cash application, payment variances, and all related expenses associated with
these functions
3. HIM Expense – transcription, coding, ROI, chart completion (PRCA), imaging, and all related expenses
associated with these functions regardless of reporting structure. Coding cost includes all facility coding costs
and only those professional coding costs associated with provider-based clinics.
Excludes
1. IT “Hard” costs: capitalized costs such as hardware, licensing fees, core HIS and PAS, servers, and any FTE that
supports these
2. Lease/Rent expenses
3. Physical space costs: utilities, maintenance, depreciation
Total Patient Service Cash Collected
Total patient service cash collected for the reporting year, net of refunds
Includes
1. All Patient Service payments posted to patient accounts, including undistributed payments
2. Bad debt recoveries
3. Medicare Disproportionate Share Hospital (DSH) payments
4. Indirect Medical Education (IME) payments
5. Capitation or Premium cash
Excludes
1. Patient-related settlements/payments; examples include Safety Net, DME, Medicare Pass-Through, Medicaid
DSH
2. Non-patient Cash; examples: pharmacy, gift store, cafeteria
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Cash Collections as a Percentage of Net Patient Service Revenue
Total Patient Service Cash Collected
Income Statement
Equation and Data Source: Average Monthly Net Patient Service Revenue = Income Statement
Points of Clarification
Total Patient Service Cash Collected
Total patient service cash collected for the reporting year, net of refunds
Includes
1. All Patient Service payments posted to patient accounts, including undistributed payments
2. Bad debt recoveries
3. Medicare Disproportionate Share Hospital (DSH) payments
4. Indirect Medical Education (IME) payments
5. Capitation or Premium cash
Excludes
1. Patient-related settlements/payments; examples include Safety Net, DME, Medicare Pass-Through, Medicaid
DSH
2. Non-patient Cash; examples: pharmacy, gift store, cafeteria
Net Patient Service Revenue
Total Net Patient Service Revenue is Gross Patient Service Revenue net of allowances for uncollectible
accounts, discounts for charity care, and contractual allowances for third-party payers.
Includes
1. Medicare Disproportionate Share Hospital (DSH) payments
2. Capitation or Premium Revenue
Excludes
1. Medicaid Disproportionate Share Hospital (DSH) payments
2. 340B drug purchasing program revenue if NOT recognized as a patient receivable/in the patient accounting
system
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Bad Debt
Bad Debt
Income Statement
Equation and Data Source: Gross Patient Service Revenue = Income Statement
Points of Clarification
Bad Debt
Total bad debt deduction for the reporting year as shown on the income statement; not the amount
written off from A/R. Also called "Provision for Uncollectible Accounts", or "Provision for Bad Debt", or
"Bad Debt Expense".
Gross Patient Service Revenue
Total Gross Patient Service Revenue for the reporting year
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Charity Care
Charity Care
Income Statement
Equation and Data Source: Gross Patient Service Revenue = Income Statement
Points of Clarification
Charity Care
Total Charity Care for the reporting year as shown on the income statement; not the amount written off
from A/R
Gross Patient Service Revenue
Total Gross Patient Service Revenue for the reporting year
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Days in Total Discharged Not Final Billed (DNFB)
Equation and Data Source:
Gross dollars in Discharged Not Final Billed (DNFB)
Unbilled A/R
= Income Statement
Average Daily Gross Patient Service Revenue
Points of Clarification
Gross dollars in Discharged Not Final Billed (DNFB)
Gross dollars in A/R for inpatient and outpatient accounts not final billed. Refers to accounts in suspense
(within bill hold days) and pending final billed status in patient accounting system. This is a snapshot at
the end of the reporting year.
Includes
1. Recurring accounts (i.e. interim bills) as long as they have been discharged but not final billed
Excludes
1. In-house accounts
2. Accounts in FBNS
Gross Patient Service Revenue
Total Gross Patient Service Revenue for the reporting year
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Days in Final Billed Not Submitted to Payer (FBNS)
Equation and Data Source:
Gross dollars in Final Billed Not Submitted to Payer (FBNS) Claims Processing Tool
= Income Statement
Average Daily Gross Patient Service Revenue
Points of Clarification
Gross dollars in Final Bill Not Submitted to Payer (FBNS)
Gross dollars from initial 837 inpatient and outpatient claims held by edits in claims processing tool that
have not been sent to payer. This is a snapshot at the end of the reporting year.
Includes
1. Initial claims only
2. Professional fees, if included on the 837 claim
Excludes:
1. In-house accounts
2. Accounts in DNFB
3. Rebills and late charge bills
Gross Patient Service Revenue
Total Gross Patient Service Revenue for the reporting year
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Days in Total Discharged Not Submitted to Payer (DNSP)
Gross dollars in DNFB + gross dollars in FBNS
DNFB + FBNS
Equation and Data Source: Average Daily Gross Patient Service Revenue = Income Statement
Points of Clarification
Gross dollars in DNFB + gross dollars in FBNS
Combines DNFB dollars and FBNS dollars
Gross Patient Service Revenue
Total Gross Patient Service Revenue for the reporting year
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