Divide that figure by your average daily charge. KPI                            Industry norm                                   OMG (‘Oh, my gosh!’) There are a couple of important factors to recognize: the two to four percent left on the table is bad debt, including monies you’ve written off to a collection agency and other uncollectables. Healthcare KPIs & Metrics (650) 469-1313 The “Gross Collections Rate” tells you the percentage you collected of what you billed. This metric should be reviewed every month to make sure you aren’t experiencing blockage in money being paid. Despite the obstacles, you have to be on top of your game to ensure that collections are optimized. TIP ICD-10 ICD-10 KPIs at a Glance Now that you’ve made the switch to ICD-10, you can look for opportunities to analyze your progress. Revenue cycle KPIs are essential for understanding the health of your practice. Our solutions enable fantastic financial outcomes for medical and dental organizations nationwide. Telehealth and Telemedicine Billing Service, Dental Insurance Eligibility Verification, Medusind is the Leading Technology Enabled RCM Provider. Net Collection Rate – This metric is a measure of a practice’s effectiveness in collecting all legitimate reimbursement. Such a trend should be examined further to determine the cause (s). Get the latest guidance on telehealth, coding and billing for COVID-19. The math required to calculate your medical billing metrics isn’t too complicated but you may need to drop your data to Excel if you don’t have Medusind as your medical billing company or you’re not using our powerful Medclarity platform. There’s always plenty of work to do, but how do you know if your operation – and the staff you employ to carry out your game plan – is performing at full speed? KPI Library is a community for performance management professionals. With the advent of practice management software, there is no limit to the data your practice can measure. Falling within the industry norms on key measures should certainly be your goal, but it’s easy to be distracted by the multitude of external challenges that influence your performance. MAP Keys are industry-standard metrics or KPIs used to track your organization’s revenue cycle performance using objective, consistent calculations. The last, but certainly not least, key performance indicator is measuring collections on a weekly, if not daily, basis. KPI #1 - Clean Claim Rate. You can calculate your average daily charge by taking the previous three months’ worth of charges, and dividing by 90. However, once initiating the measurement process for KPIs, I feel confident you will gain information to modify the KPI … If uncollectables are all written off as contractual adjustments, you’ll appear to be collecting 100 percent of the dollar – even when you’re really not. Although you can determine the average daily charge based on 365 days, using 90 days accounts for seasonality, growth and other fluctuations in business. What are Your Rejections and Denials Trying to Tell You? Monthly Metrics * Review outstanding A/R (billed, value and days) * Review monthly production by doctor * Review denial activity during month * Review reverse aging of payments (track which billing month received payments pertain to) It is possible to run a thriving, financially strong medical practice. If your staff incorrectly categorizes the adjustment as a contractual adjustment, then neither the payment nor the allowable are included in the rate. One way to start thinking about goal setting for your business is by making sure you're tracking the right metrics. You can and should use the same calculation for percentage over 90 and 120 days for total view of your A/R. Medical Devices; Medical Devices; For Fire . Net collection rate. Here are eight key performance indicators (KPIs) you can look at as you step up your game in 2020, and two ways to calculate them: by hand and with the TIMS Software reports you can run to even more quickly identify where your business stands. A/R over 120:             <12 percent                                                 20% A high gross collection rate (GCR) indicates your fees are close to the payer’s rates, and how well your practice is doing at collections. Build a customized solution for your practice. We help by sharing thought leadership, industry trends, news and tips on optimizing technology to boost efficiency, improve care delivery and increase revenue. Verify insurance before patients present, and don’t forget to check coverage on hospital and other non-office services. © Copyright 2020 Kareo, Inc. All rights reserved. Since each medical practice’s fee schedules, payer mix, and contracts vary, your gross collection rate also will be different. Although payment plans may be a necessity of your patient collections process, categorize them with a different payer class. Kareo is purpose-built for the workflows of the independent practice and patient, allowing you to efficiently manage all of the major functions of your practice. Knowing the amount you collect on an average visit is a good way to measure your practice against the industry standard and other same-specialty practices in your area. While some percentage of the complaints that patients bring to your office will inevitably get better with the passage of time, the same cannot be said for medical billing financial performance. A healthcare KPI, or metric, is a type of performance measurement that helps you understand how your healthcare organization or department is performing. By routinely monitoring your medical billing metrics you can ensure that the practice is collecting what it’s owed. Improve your cash flow by automating insurance coverage and benefits eligibility verification, charge scrubbing, electronic remittance, funds transfer, remote deposit and the many other technological tools available to the medical billing industry. 18 KPI #3 - Denials by Procedure Code •HIPAA EDI ANSI Standard Codes. Let us show you how easy it is to write notes and prescriptions, code encounters, and manage patients in our fully integrated, cloud-based EHR. Don’t allow too many excuses. This KPI is purely meant to evaluate whether the payer you are working with makes accurate reimbursements apart from adhering to the contract signed between you two. Monitoring all of the key performance indicators together – and doing so weekly, or even daily – means there is nowhere for poor financial performance to hide. Days in receivables outstanding (DRO). Here’s what to do with the knowledge you gain by monitoring key performance indicators: Kareo’s integrated care delivery workflow optimizes the providers time and is surprisingly easy to use, Realize opportunities to maximize insurance reimbursements at each stage of the revenue cycle, End-to-end patient collections to increase revenue while maintaining positive patient relationships, Improve patient care and increase practice revenue with comprehensive patient experience, Kareo’s intuitive platform puts billing companies in control of their business and the practices they serve, Kareo has the tools and resources necessary to help you simplify the complexities of your practice, Kareo has refined our platform to help meet the needs of your Mental Health or Physical Therapy practice, Grow your practice and engage with patients, Designed for billers, trusted by practices, Billing experts help you collect more, faster, Care for patients using HIPAA-Compliant video, Clearly communicate patient responsibility, Transform data into revenue opportunities, Improve productivity with mobile simplicity, Applications and services from our partners. Writing off a bunch of uncollected money will certainly bring your DRO and percentage of receivables over 120 days into alignment with industry standards, but it won’t tell the whole story of your financial performance. Monitoring your practice’s financial performance while providing exceptional patient care is vital to your medical group’s success. Click to see full answer. Overview; ... Track These Metrics to Improve EMS Billing Efficiency. Classify these accounts separately, and report your DRO and receivables over 120 percent with – and without – payment plans. Cash. For the latter, even if the services have already been performed, you are better off identifying insurance problems before the claim is transmitted instead of 30 or 60 days later when the claim finally bounces back to you. Think of the practice evaluation as … Your first pass resolution rate (FPRR) is the percentage of claims that are paid after being submitted a single time. Use your KPI data. 7 KPI #1 - Clean Claim Rate ... • Medical Necessity ... 04/20/15 Billing Summit 2015. Worse, it will give you an inaccurate snapshot of the health of your operations. Many of these metrics are actually specific key performance indicators for hospitals.. Secondly, what is GCR in medical billing? Deciding exactly what reports and statistics are the most meaningful is important. You can improve DRO results through robust time-of-service collections, including collection of copayments, coinsurance, unmet deductibles and pre-service deposits. This case study is a process definition for a Billing Process, adapted from a real freight business. Our unique combination of deep industry expertise, robust operational capability and client-focused service significantly improves the efficiency and profitability of healthcare organizations. For more information and ideas about how metrics, dashboards and appointments have changed, join Nate Moore’s session, “Rethinking Metrics, Dashboards and Appointments After COVID-19,” at the Medical Practice Excellence Conference , Oct. … Your guide to exceeding a 95% clean claims rate and speeding up insurance payments. This can be affected by how your biller submits the claim among other reasons. A healthcare KPI or metric is a well-defined performance measurement that is used to monitor, analyze and optimize all relevant healthcare processes to increase patient satisfaction. Receivables outstanding over 120 days. The same factors cited above for DRO may positively – or negatively – impact your ability to beat or fall short of the 12 percent range. Consider these key performance indicators to establish the framework for your dashboard. Every practice will have a different GCR because each sets a unique fee schedule, therefore this metric is best monitored internally rather than compared with industry benchmarks or other practices. If your NCR is lower than 90-100% after write-offs, you should consider an audit of billing practices. In today’s challenging reimbursement era, there seems to be no end in sight to the complexities of medical billing. Here's a quick overview of changes in CMS programs, insurance plans and patient payments. •Examine reasons for insurance denials. Instead, focus on the net – also known as ‘adjusted’ – collection rate. There are many ways to analyze medical billing and collections data but the following 7 KPIs are most closely correlated with your financial performance: A proactive approach to monitoring these metrics is to review them at month’s end and compare them to previous periods. Although focusing on the ‘over 120 day’ category is recommended, you can certainly measure your success by evaluating the percent over (or under) any of the aging categories. PE for healthcare’s complementary practice evaluation will give you access to accurate metrics using KPI’s. They set those drivers (or goals) through benchmarking – against company historical data and compared to other groups in your specialty. Enter your email address to receive "Go Practice" as an email newsletter. Practices calculate their NCR to see how much revenue is lost due to factors such as uncollectible debt, or other non-contractual adjustments. There are a couple ways to measure what you’re taking in. The key is to choose a category – and stick to it. The last thing a medical practice needs is for patient visits to decrease and then have the billing office slow the revenue cycle down even further. Don’t be misled. 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