Remittance Efficiency Index Score

Remittance Efficiency Index (REI) Calculation

The Remittance Efficiency Index (REI) is an online computation designed to assist healthcare providers, RCM companies, clearinghouses and healthcare stakeholders to identify their efficiency index based on existing processes for posting EOBs, ERAs, checks and electronic payments.

The final index score is based on customized weighting and efficiency calculations, ranging from "1" (representing fully manual/highly inefficient) to "100" (fully automated/extremely efficient). The final score correlates well to a grading scale, where 90 - 100 = A, 80 - 89 = B, 70 - 79 = C, 60 - 69 = D, and under 60 equates to more of a failing grade.

The goal of any healthcare organization is to achieve 100% posting automation from electronic payments and remits. However, even when paper exists, organizations can still achieve very high levels of efficiency using artificial intelligence and automation solutions. Please complete the 7 questions below to see your organization’s REI score. Did you make the grade?

Remittance Efficiency Index Score

Claims Submission

Select option which best describes your claims submission process.

All claims are sent directly to payers or to a clearinghouse via 837 files; claims that must be sent on paper are printed by the clearinghouse

Most claims are sent directly to payers or to a clearinghouse via 837 files; claims that must be sent on paper are printed in-house

All claims are printed and mailed in-house

Paper Handling Options

Select option which best describes how your organization manages paper remittances (EOBs) and payments (checks).

Outsourced to commercial lockbox with AI enhanced data lift/conversion

Internal mail room scanning with AI enhanced data lift/conversion

Internal or external lockbox coupled with manual BPO (Business Process Outsourcer) or limited OCR capabilities

Internal or external lockbox scanning coupled with in-house labor for data completion

Key from paper into PMS/HIS with limited digital archive

Remittance Advice

Select the option that best describes the automation levels of your remittance posting processes.

Greater than 95% auto-posting of all remittances (ERA + EOB) with minimal error correction.

70-94% auto-posting of all remittances (ERA + EOB) with moderate error correction.

High concentration of paper remittances posted manually with in-house company resources.

Correspondence Processing

Select the option which best describes how your Correspondence Letters from denied claims are processed.

Outsourced to 3rd party with fully-automated data extraction, full classification and comprehensive worklisting capabilities.

Partially outsourced with fully-automated data extraction, classification and comprehensive worklisting capabilities.

Fully automated data extraction & classification, but no worklist functionality.

Fully automated data extraction but no classification or worklist functionality.

In-house manual processing with no automated posting.

Denial Identification and Prioritization

Select the option which best reflects how denied claims are analyzed and prioritized.

All denials can be grouped according to user-selected criteria as shown below; with the addition of predictive capabilities driven by historical denial data

All denials can be grouped according to user-selected criteria, including $ denied, the frequency of specific denials, payer, provider, and even CPT or Dx codes

Denial tool allows for some flexibility in selecting priorities such as by the denied value or frequency of similar denials

All denials are reviewed in date order; prioritization of appeals/resubmissions is handled manually

Little to no attempt to work appeals/resubmissions

Payment Reassociation

Select the option below which reflects how payment reassociation is accomplished at your organization.

Advanced reporting allows for validation of the funds and remittances both being received by comparing ACH and 835 files

Bank records for payer ACH deposits and 835s/EOBs have to be manually reconciled or reconciled via spreadsheets

Post all payments without reconciling to bank account

Data Management & Searchable Document Archive

Select the option which best reflects the data management and document archive environment for the organization.

Paper Remits, Correspondence, and ERAs are accurately captured and automatically ingested into a system with built in worklisting capabilities, indexing, research, storage/archiving with advanced business intelligence

Paper Remits & Correspondence is accurately captured and automatically ingested into a system with built in worklisting capabilities, indexing, research, storage/archiving

Paper Remits & Correspondence is accurately captured and ingested into a system which allows research, storage/archiving

Images are captured, not uploaded to system with indexing or search capablities

Paper is physically archived, placed in boxes and filing cabinets and forgotten

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