KPI & SLA Management Overview

A measurable metric used to track and improve performance over time for a specific objective. KPIs help gauge progress, provide targets, and inform decision-making.

A contractual agreement defining the expected service standards between a supplier and a customer. SLAs outline metrics, service level expectations and potential consequences for failing to meet expectations.

KPIs are used internally to drive performance improvement, while SLAs are focused on meeting external customer expectations.

KPIs provide targets to aim for, milestones to track progress, and insights for informed decision-making. They help teams stay on track and optimize performance.

KPIs and SLAs work together to ensure both internal performance improvement and external customer satisfaction.

KPIs and SLAs can be adapted to align with specific organizational goals and cater to different departments or teams. This allows for flexible and targeted performance management.

A measurable value that indicates a team's performance. In this case, 200 claims processed per day.

A contractual agreement outlining service standards and deadlines. In this case, any escalated claims must be resolved within 48 hours.

Medical claims are the documents submitted to insurance companies for reimbursement of medical expenses. Processing these claims involves verifying accuracy and completing necessary paperwork.

The process of managing the financial aspects of healthcare, focusing on billing, coding, and collecting revenue. This often involves claims processing.

These are claims that require special attention due to issues like missing information or rejection by the payer. They need to be resolved quickly to avoid delays and penalties.

A hierarchical framework for organizing KPIs based on their scope and focus: Strategic KPIs highlight overall business impact, Tactical KPIs focus on departmental efficiency, and Operational KPIs measure employee performance.

A plan for managing and optimizing an SLA throughout its lifecycle, including establishing, implementing, monitoring, reviewing, and analyzing its performance.

The way in which KPIs contribute to ensuring SLA commitments are met by providing data on internal performance and measuring progress towards service targets.

The practice of using KPIs to align individual and team goals with overall business objectives, fostering a shared understanding of performance targets and driving collaborative effort.

A specific example of a KPI used in US healthcare revenue cycle management (RCM) to track the speed and efficiency of medical claim processing.

The consequences of failing to meet KPI targets, potentially resulting in breaches of SLA commitments, penalties, or service credits.