Revenue Cycle Management Blog | GroupOne Health Source

5 Must Know Medical Billing Measures at Your Medical Practice

Written by Ricki Ransom | April 18, 2014

A successful medical practice needs a variety of reports and metrics to measure performance and make improvements as needed. GroupOne understands that many practices are facing financial challenges due to the changes that continue to take place in the healthcare industry. Monitoring the 5 measures mentioned below will provide insight into your practice’s performance.

1. The Accounts Receivable Aging Report

The A/R Aging Report breaks down claims based on the number of days the claims have gone unpaid.  This report gives an analysis from a high level view. It generally will give your aged claim amounts in a 30/60/90/120 day summary. Ideally, your largest claim summary should appear under your 30 days or less aging group.  Once claims start to age out, they will start flowing over into the other aging groups. The older the claim the more difficult it becomes to collect what is properly owed to your practice. As claims age, ask why the claims were not paid and what your staff is doing to fix them? 

2. Denial and Adjustment Management Report

It is essential to track all denials received that come through from all payers. Tracking your denials helps to identify common errors to keep them from happening on future claims. Reviewing your denial and adjustment reports will also help to determine if claims are being followed up on or swept under the rug. All denials should be worked as soon as they are received. Learn from them. Remember your goal should be for clean claims, first-pass resolution.

3.Net Collection Rate

The net collection rate is the percentage of total potential reimbursement collected out of the total allowed amount. There are varying ways to calculate your net collection rate, but the most common is (Payments-credits) / (Charges – Contractual Adjustments). Tracking the net collection rate helps measure the performance of the billing staff. The net collection rate should be above 95% otherwise collectable money is being left on the table. If the net collection rate is low, then there could be a problem with claims submitted, patient statements and/or denials management.

4. Days in Accounts Receivables

Days in Accounts Receivables (AR) is the average number of days it takes a practice to get paid. The lower the number the sooner claims are getting paid.  Days in AR should be below the 30-40 day range. Monitoring your Days in AR will help to identify problems with a certain payer before it becomes unmanageable.

5. Patient Accounts Receivable

Of your total AR, how much of that is money owed by your patients?  What are you doing to collect that money? Sending statements on a regular basis and putting a collections process in place can help collect on money that patients owe. Your practice can also implement a credit card on file policy. With the new Health Insurance Exchanges comes larger than normal deductibles. With so many high-deductible health plans in 2014, collecting patient money is going to be more important now than ever.

It is hard enough to keep up with the changing industry standards. The metrics mentioned here will remain constant moving forward. Use them to measure your practice’s revenue cycle. I talk to many practices that have no idea what is taking place with their accounts.  By the time they are aware of what is happening, it is too late, and they have lost too much money.  These metrics will help determine the health of your practice and help you decide which areas could use improvement.  Continuously weak key performanc indicators could compel your practice to revamp processes, replace staff, or outsource the revenue cycle management to help increase profitability.