This is a question not often asked by physicians and it is not uncommon that practices do not measure their trends using nationally published benchmarks or metrics that will allow them to monitor their monthly activities.
In today’s challenging reimbursement environments there seems to be no end to the complexities of medical coding & billing. With the ever changing “rules” from third party payers, to limitations on coverage, increased patient liabilities and increased NCCI (national correct coding initiative) edits that prevent improper payment when incorrect code combinations are reported.
Implementing these “best practice” measures into a monthly evaluation of your billing department or outsourced billing service will give you a better understanding of the performance of these individuals or entity.
MEASURE YOUR OWN PRACTICE
Patient insurance verification pre-visit
Total patient visits divided by total patients verified pre-visit
Charge lag days
Your PMIS should be able to calculate the days from the date of service to entry into the management system
Days in Accounts Receivable (A/R)
Total accounts receivable
divided by Gross charges.
That sum x 30 (average days in a month)
A/R > 120-days in age
Total A/R >120-days divided by
the total accounts receivable
Claim denial rate
Total claims filed to a payer divided by the total denied claims in a given month
Net Collection Rate
Total payments divided by
Gross charges – write offs & adjustments
The most over-looked area in practice management is in the area of denial management. As demonstrated by national statistics below. Denials are an area that can affect A/R levels and cause payment delays when the practice is poorly managed. Further, when posting denial reason codes you should be able to dive deeper and quickly find out where the denials are coming from and take corrective actions. Once these are identified you can build “rules” into your PMIS that will prevent claims submission until the known errors are fixed prior to the first pass claim.
INDUSTRY AVERAGES (based on 2011 data)
Healthcare Revenue Logic, LLC not only has experienced staff in place we, additionally, have the denial management workflow process perfected, which has proven to capture thousands of dollars for practices that would have lost revenue.
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