Your Revenue Cycle Management Data Template

This attribute describes the individual activities that make up the end-to-end revenue cycle process. Each value represents a distinct step, milestone, or task performed on a billing event, like creating a claim, receiving a denial, or posting a payment.

Analyzing the sequence and frequency of these activities is the foundation of process mining. It allows for the visualization of the process map, identification of rework loops (e.g., 'Claim Denied' followed by 'Claim Corrected'), and measurement of transition times between steps. This is critical for understanding process efficiency and compliance.

This attribute defines the steps in the process map, which is fundamental for visualizing and analyzing the revenue cycle workflow.

Generated from event logs, status change records, or transaction types within Waystar's claims and billing modules.

The Billing Event acts as the primary case identifier, linking all activities from charge capture to account closure for a specific billable service. It represents the entire lifecycle of a single claim or patient invoice.

In process mining, analyzing the journey of each Billing Event allows for a comprehensive view of the revenue cycle. It helps identify common process paths, deviations, and bottlenecks affecting individual claims. This level of granularity is essential for understanding process performance and pinpointing specific areas for improvement, such as delays in claim submission or payment posting.

This is the essential Case ID that connects all related revenue cycle activities, making it possible to trace the end-to-end process for each billable item.

This is typically the primary key from the main billing or claims transaction table within Waystar. Consult Waystar documentation for the specific table and field name.

The Event Timestamp records the exact moment an activity took place. This timestamp is crucial for ordering events chronologically and calculating durations between different steps in the process.

In process analysis, timestamps are used to calculate key performance indicators such as cycle times, wait times, and processing times. For example, the difference between the 'Claim Submitted' timestamp and the 'Payment Posted' timestamp determines the overall payment cycle time. Accurate timestamps are essential for bottleneck analysis and performance monitoring.

Timestamps are required to order events, calculate cycle times, and analyze process performance, forming the temporal backbone of the analysis.

This is a standard field associated with almost every transaction or status change record in Waystar, often named 'Creation Date', 'Transaction Date', or similar.

This attribute provides a timestamp for when the data was last extracted from the source system. It is not the time the business event happened, but rather the time the record was pulled for analysis.

This information is critical for data governance and for understanding the freshness of the data in the process mining analysis. It helps users know if they are looking at up-to-date information and is essential for managing incremental data loads.

Ensures data transparency by indicating the freshness of the dataset, which is vital for accurate and timely reporting and analysis.

This timestamp is typically generated and added to each row by the ETL (Extract, Transform, Load) process during data ingestion.

This attribute identifies the source system that generated the event data. In a complex IT landscape, revenue cycle events might originate from different modules within Waystar or even from integrated external systems like an Electronic Health Record (EHR).

Understanding the source system is important for data validation, troubleshooting, and understanding process variations that may be driven by different system behaviors. It helps in attributing process issues to the correct application or interface.

Identifies the origin of the data, which is crucial for data governance, quality assurance, and understanding process variations across different systems.

This is often a static value ('Waystar') added during data extraction or can be derived from specific modules or tables within the system.

The Billed Amount represents the gross charge for the services provided to the patient before any adjustments, contractual allowances, or payments are applied. It is the initial value of the claim submitted to the payer.

This attribute is crucial for financial analysis and understanding the monetary value flowing through the process. It can be used to segment analysis by claim value, identify trends in charges for different services, and calculate the overall financial impact of process inefficiencies like denials or payment delays. It's a foundational metric for most financial dashboards.

Represents the total value of a claim, allowing for financial impact analysis of process delays, denials, and adjustments.

A standard financial field on the claim or charge entry screen in Waystar.

Claim Status provides a snapshot of where a specific billing event is in the revenue cycle at any given time. It indicates the latest milestone reached, such as whether a claim has been sent, is under review by the payer, has been paid, or was rejected.

This attribute is crucial for financial reporting and operational management. In process mining, it helps to understand the current state of all open cases and can be used to analyze how long cases spend in certain statuses, like 'Pending Payer Adjudication'. This directly supports the 'Outstanding Balances and Aging' dashboard.

Provides a current-state view of all in-flight claims, enabling analysis of bottlenecks and prioritization of work.

A standard field on the claim or billing record in Waystar, updated as the claim progresses through the cycle.

When a payer denies a claim, they provide a reason code explaining the rejection. These codes can indicate issues like missing information, non-covered services, or coding errors. This attribute captures that specific code.

Analyzing Denial Reason Codes is fundamental to improving the revenue cycle. It allows the organization to identify the root causes of denials, such as frequent errors from a specific department or issues with a particular payer's requirements. This data directly powers the 'Claim Denial Rate and Reasons' dashboard and is key to developing strategies to prevent future denials and improve first-pass payment rates.

This attribute is essential for root cause analysis of claim denials, enabling targeted actions to reduce revenue loss and rework.

Populated in the claim record when a denial event occurs. This information is received from the payer in the remittance advice.

The Outstanding Balance represents the current accounts receivable amount for a given billing event. It is calculated as the billed amount minus any payments and adjustments applied to date.

This is a critical financial metric for managing cash flow and accounts receivable. It is the primary attribute for the 'Outstanding Balances and Aging' dashboard, allowing the organization to track total receivables, identify high-balance accounts, and prioritize collection efforts. Monitoring this value over time shows the effectiveness of the collection process.

Directly measures accounts receivable, which is essential for managing cash flow, prioritizing collections, and assessing financial health.

This is typically a calculated field in Waystar's reporting modules (Billed Amount - Paid Amount - Adjustments). It might need to be calculated during data extraction if a direct field isn't available.

This attribute identifies the specific payer, such as an insurance company, government program like Medicare, or another entity, responsible for adjudicating and paying the claim. Each payer may have different submission requirements, payment schedules, and denial patterns.

Analyzing the process by Payer Name is essential for identifying which payers have the longest payment cycles, highest denial rates, or most complex processes. This allows organizations to tailor their strategies, prioritize follow-ups with problematic payers, and negotiate better contracts.

Segmenting the process by payer is critical for identifying payer-specific bottlenecks, denial reasons, and payment delays.

Found in the claim or billing information, linked to the patient's insurance details within Waystar.

Service Type classifies the nature of the billable service rendered to the patient. Different types of services often have distinct billing codes, reimbursement rates, and process complexities.

This attribute allows for a granular analysis of the revenue cycle based on the clinical department or service line. It helps answer questions like, 'Which service lines experience the most billing delays?' or 'Are denial rates higher for surgical procedures compared to consultations?'. This is key for departmental performance analysis and targeted process improvement.

Allows for analysis of process performance by clinical department or service line, revealing variations in efficiency and profitability.

Typically derived from procedure codes (CPT/HCPCS) or linked to the department that provided the service within Waystar.

The Adjusted Amount represents the sum of all financial adjustments made to a billing event's balance. This includes contractual allowances dictated by payer agreements, as well as other write-offs or corrections.

This is a key metric for the 'Account Adjustment Rate and Impact' dashboard. Summing this amount across different reason codes or payers reveals the financial impact of revenue leakage. It helps quantify losses and provides a business case for addressing the root causes of adjustments.

Quantifies the amount of revenue lost due to write-offs and adjustments, highlighting the financial impact of billing issues and contract terms.

Sourced from financial adjustment transactions within Waystar. It may require summing multiple adjustment entries for a single billing event.

When the balance of an account is changed for reasons other than a payment, such as a contractual allowance or a write-off, an Adjustment Reason Code is used to document why. This attribute captures that code.

Analyzing these codes is essential for the 'Account Adjustment Rate and Impact' dashboard. It helps identify the root causes of revenue leakage, such as frequent contractual adjustments with specific payers or write-offs due to billing errors. Understanding these reasons is the first step toward minimizing avoidable revenue loss.

Explains why revenue was adjusted or written off, providing critical insights into revenue leakage and payer contract performance.

Associated with adjustment transactions in the payment posting or accounts receivable module of Waystar.

This calculated boolean attribute indicates whether a claim was paid without any intervening negative events like a denial, rejection, or request for more information. A 'true' value signifies a clean, efficient process for that claim.

This attribute directly supports the 'First Pass Payment Rate' KPI, which is a critical measure of overall revenue cycle efficiency. Analyzing the characteristics of claims that are not paid on the first pass (e.g., by payer, service type) helps to identify the primary drivers of rework and payment delays. Improving this rate leads to faster cash flow and lower operational costs.

Directly measures billing and claims processing quality. A high first pass payment rate indicates an efficient process with minimal rework.

This is a derived attribute calculated during data transformation. The logic checks if a 'Payment Posted' event occurs without being preceded by events like 'Claim Denied' or 'Account Adjusted'.

This attribute records the cumulative amount of money that has been successfully collected for a billing event. This includes payments from primary and secondary insurance payers as well as payments from the patient.

Paid Amount is a key outcome metric for the revenue cycle. It is used to calculate the final yield on billed charges and to measure the effectiveness of the entire process. Comparing Billed Amount to Paid Amount reveals financial performance and highlights areas of revenue leakage. It is essential for dashboards related to collection effectiveness and overall financial health.

Measures the actual cash collected, which is a primary outcome metric for evaluating the overall success of the revenue cycle process.

Derived from payment posting transactions linked to the claim in Waystar. It may require summing multiple payment records.

Patient Class categorizes the type of patient encounter, which often dictates billing rules and reimbursement rates. Common classes include Inpatient, Outpatient, and Emergency.

Analyzing the revenue cycle by Patient Class can reveal significant process differences. For example, inpatient claims are often more complex and have longer payment cycles than outpatient claims. This segmentation is important for setting realistic performance targets and tailoring process improvement initiatives to the specific needs of each class.

Helps segment the process based on encounter complexity (e.g., inpatient vs. outpatient), which often correlates with different billing rules and cycle times.

A standard field in the patient registration or encounter data within Waystar or the source EHR.

This attribute is the unique identifier for the patient associated with the billing event. It links the financial transaction back to the individual who received care.

While the Billing Event is the case, Patient ID allows for patient-centric analysis. It can help identify repeat patients, understand the end-to-end patient financial journey across multiple visits, and analyze if certain patient demographics are associated with payment issues or higher denial rates. It provides a way to aggregate all billing activities for a single person.

Enables patient-centric analysis, allowing for a view of the entire financial journey for an individual across multiple billing events.

A standard field on the claim or patient registration record within Waystar or linked from an EHR.

Payer Type groups individual payers into broader categories based on their nature. This provides a higher-level view than the specific Payer Name.

This attribute is useful for strategic analysis and reporting. It allows leadership to understand performance trends across major payer categories, such as comparing the overall performance of government payers versus commercial insurers. This can inform strategic decisions about payer contracting and resource allocation.

Enables high-level analysis by grouping payers into categories like Commercial or Government, which often have distinct payment behaviors and rules.

Typically derived by mapping the Payer Name to a predefined category list. This logic may exist in Waystar or need to be built during data transformation.

This calculated metric measures the duration of the core payment collection process. It is typically calculated as the time difference between the 'Claim Submitted To Payer' event and the final 'Payment Posted' event for a billing event.

This attribute is the primary measure for the 'Overall Payment Cycle Time Analysis' dashboard and a key performance indicator for cash flow. Analyzing this duration across different payers, service types, or patient classes helps identify the biggest sources of delay in receiving payment. Reducing the average payment cycle time is a primary goal for nearly all revenue cycle management initiatives.

A core KPI that measures the speed of cash collection. Analyzing it helps identify and address the most significant delays in the payment process.

Calculated during data transformation by subtracting the timestamp of the submission event from the timestamp of the payment event.

The Payment Due Date is the date set by the provider or dictated by payer contracts by which the payment should be received. It serves as a benchmark for measuring payment timeliness.

This attribute is essential for the 'Outstanding Balances and Aging' dashboard. It is used to calculate the age of receivables, categorizing them into buckets like '0-30 days', '31-60 days', etc. This aging analysis is a standard financial practice for managing accounts receivable and prioritizing collection efforts on overdue accounts.

Provides the baseline for calculating accounts receivable aging, which is critical for managing collections and understanding cash flow timeliness.

Can be found on the invoice or claim record. It may be calculated based on the invoice date and payment terms.

This attribute identifies the specific employee or system user who executed a given activity in the process. For example, it could show which biller submitted a claim or which collector initiated a follow-up call.

Analyzing the process by user helps in understanding workload distribution, individual performance, and training needs. It can highlight if certain users have higher error rates or are more efficient at resolving denials. This is valuable for team management and quality control within the revenue cycle department.

Assigns accountability for process steps, enabling performance analysis at the individual or team level and identifying training opportunities.

Found in the audit trail or transaction logs for events in Waystar, often as 'UserID', 'ProcessedBy', or similar.

This metric, also known as 'charge lag', measures the efficiency of the front-end billing process. It is calculated as the time difference between the 'Service Provided/Completed' event and the 'Charges Captured' or 'Claim Created' event.

This attribute directly supports the 'Service To Invoice Cycle Time' dashboard. Delays in this part of the process, known as charge lag, directly postpone the start of the payment cycle, delaying cash flow. Monitoring this helps ensure that all services are billed promptly and accurately, preventing lost revenue and accelerating the entire revenue cycle.

Measures front-end billing efficiency. Reducing this 'charge lag' is crucial for accelerating the entire revenue cycle and preventing lost charges.

Calculated during data transformation by subtracting the timestamp of the service event from the timestamp of the charge capture/claim creation event.