Still not finding what you’re looking for? Our unique combination of deep industry expertise, robust operational capability and client-focused service significantly improves the efficiency and profitability of healthcare organizations. 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. A healthcare KPI, or metric, is a type of performance measurement that helps you understand how your healthcare organization or department is performing. 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. Improper submission of a claim can still be paid, but there is a chance that it will be underpaid. Worse, it will give you an inaccurate snapshot of the health of your operations. They set those drivers (or goals) through benchmarking – against company historical data and compared to other groups in your specialty. Build a customized solution for your practice. Look out for blog posts and resources from Kareo in your inbox. 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. By tracking and comparing 10 Example Medical Marketing Key Performance Indicators (KPI's) Don't Confuse Medical Practices Goals with KPIs. 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. Although it’s nice to measure your collections as a percent of gross charges (commonly referred to as the gross collection rate), you can’t use the result to judge the performance of your operation. Ultimately, that’s the goal of the key performance indicators – not to judge, but to improve. In today’s challenging reimbursement era, there seems to be no end in sight to the complexities of medical billing. Choosing an EHR for your small practice is a big decision. Click to see full answer. You can improve DRO results through robust time-of-service collections, including collection of copayments, coinsurance, unmet deductibles and pre-service deposits. 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? Although you can determine the average daily charge based on 365 days, using 90 days accounts for seasonality, growth and other fluctuations in business. But according to Becker’s Healthcare, too many healthcare professionals only track what they bill. This is the actual scorecard with Medical Dashboard and performance indicators. One way to start thinking about goal setting for your business is by making sure you're tracking the right metrics. •Examine reasons for insurance denials. Billing best practices dashboard: 11 metrics to know Ellie Rizzo - Wednesday, August 6th, 2014 Print | Email Here are the most important best-practice benchmarks that every ASC should keep in mind , says by Ann Geier, vice president of clinical informatics at SourceMedical's National Client Meeting in Oak Brook, Ill., on July 24: Overview; ... Track These Metrics to Improve EMS Billing Efficiency. 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. 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. 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. That’s why identifying and monitoring key performance indicators for medical billing is critical. Revenue cycle KPIs are essential for understanding the health of your practice. MAP Keys are industry-standard metrics or KPIs used to track your organization’s revenue cycle performance using objective, consistent calculations. As a result, the net collection rate reflects your ability to collect the contracted allowable rate, which is a combination of payments made from both the payer and the guarantor. Elizabeth Woodcock, MBA, FACMPE, CPC is a professional speaker, trainer and author specializing in medical practice management. A significant sum of money over 60 days can signify charge lag issues, increase in rejections from the claim scrubber and first pass denials from the payer, bad write-offs/adjustment protocols or poor collections processes in general. Build a custom tailored solution that fits your practice’s needs. With Kareo, you get simple solutions for every part of your practice—from scheduling and charting to billing and collections. Here's a quick overview of changes in CMS programs, insurance plans and patient payments. In this manner, what is KPI in healthcare? This metric can be used to compare with practices with similar: specialty, location, and clinical personnel. There are a couple ways to measure what you’re taking in. Percentage of A/R Over 60 Days = Total Balance Aged Greater Than 60 Days / Total A/R Balance for All Ages, Days in AR = Total AR / Average Daily Charges (90-day average), Collections Per Visit = Total Reimbursements / Total Visits (for a specific time period), FPRR = # of Claims Paid on First Pass / Total # of Claims Submitted (for a specific time period), GCR = Total Payments / Charges *100% (for a specific time period), NCR = (Payments / (Charges – Contractual Adjustments)) * 100%, Contractual Variance = Contracted Rate (based on your fee schedule) Minus the ERA Allowed Amount. When it comes to medical billing, you may not need to fully understand CPT code assignment, diagnosis code nuances or clean claim filing parameters. Monitor the aged receivables sitting in your aged trial balance to determine if your efforts are paying off. Whether it’s a hospital, a private healthcare provider, a pharmaceutical company or an insurer, a business dashboard can help any organization in the healthcare industry stay on a forward-moving trajectory. Your first pass resolution rate (FPRR) is the percentage of claims that are paid after being submitted a single time. Although cash can’t be benchmarked, you can ensure that its flow is the same as – or better than – the previous time period. Practices calculate their NCR to see how much revenue is lost due to factors such as uncollectible debt, or other non-contractual adjustments. Advice from RCM Expert Elizabeth Woodcock, E-Prescribing Option Helps With Medication Compliance and Patient Outcomes, Getting Paid in 2020: Steps to Take Now for a Smooth Transition to the New Year, How Billing Companies Benefit from Consolidating to One Platform. Single data points without comparison don’t tell much of a story! 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. Obviously, you’d prefer to see that 100 percent of your receivables are under 120 days, but that’s unrealistic. Insurance verification and timely, clean charges contribute to success as well. Factors outside of your control, such as dealing with challenging payers like Workers’ Compensation and having a bevy of patients on payment plans, may lead to above-range DRO results, even if your operations are in order. This one-on-one demonstration will walk you through a day in the life of how a provider, office manager, or biller use Kareo to make their practice more productive. Let’s say you contract with USA Insurance for $56.40 for a 99212. In honor of National Pharmacist Day, which fell on Sunday, January 12... Before we know it, January will be here and with that comes a few of... A medical billing company’s activity consists of much more than... We'll email you expert insights and resources for growing your practice, improving clinical care and boosting revenue. Deciding exactly what reports and statistics are the most meaningful is important. This case study is a process definition for a Billing Process, adapted from a real freight business. Telehealth and Telemedicine Billing Service, Dental Insurance Eligibility Verification, Medusind is the Leading Technology Enabled RCM Provider. Monitoring your practice’s financial performance while providing exceptional patient care is vital to your medical group’s success. Verify insurance before patients present, and don’t forget to check coverage on hospital and other non-office services. Receivables outstanding over 120 days. Once the car’s wheels go off the paved highway, it’s not too long before you are in a ditch, financially speaking. Tracking KPIs separately for each payer will assist in isolating the root cause of issues. (As noted above, be sure to exclude the credits when analyzing the amount of accounts receivables over 120 days.) Medical Billing Metrics, or Key Performance Indicators (KPIs) help practices understand their revenue cycle and provide insights to increase collections. KPI Library is a community for performance management professionals. Healthcare KPIs & Metrics (650) 469-1313 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. (Adjusting for credits is important, as credits offset receivables, thus masking performance.) Indeed, if you’re reporting 100 percent (or more), month after month, it may be a result of wide variability in productivity or revenue (and thus signal a potential need to redesign billing processes) - or it may be a function of how your staff is treating adjustments. Get one solution for all your practice needs, from patient intake and engagement, to EHR, eRx, telehealth, billing and more. KPI Industry norm OMG (‘Oh, my gosh!’) DRO: 40 to 45 65 A/R over 120: <12 percent 20% Your DRO should be in the range of 40 to 45 days, although there are several factors that may cause it to fall outside of this target. You simply need a set of comparative metrics that allow you to monitor your performance and alert you to trends to help you adjust or respond to change in a … 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. 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. 18 KPI #3 - Denials by Procedure Code •HIPAA EDI ANSI Standard Codes. Tell us about yourself and a Kareo Solutions Consultant will contact you shortly. 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. ©Copyright 2021 Kareo, Inc. All rights reserved. However, once initiating the measurement process for KPIs, I feel confident you will gain information to modify the KPI … Shoot for less than 12 percent being over 120 days. You can and should use the same calculation for percentage over 90 and 120 days for total view of your A/R. •Denial Reasons give you an explanation for It’s often used to see how much revenue is lost due to factors like uncollectible debt, untimely filing, and other non-contractual adjustments. This metric tells you how effective your revenue cycle management (RCM) process is. Furthermore, if your rate is too good to be true, it probably is. A/R over 120: <12 percent 20% Warning signs: An increase in this KPI compared to the benchmark means an ASC is likely dealing with payer delays, billing issues, and/or denials. COVID-19 Telehealth Coding & Billing Guide. 7 KPI #1 - Clean Claim Rate ... • Medical Necessity ... 04/20/15 Billing Summit 2015. Use KPI Library to search for Key Performance Indicators by process and industry, ask help or advice, and read articles written by independent experts. The “Gross Collections Rate” tells you the percentage you collected of what you billed. NCR: 96 to 98% 90% DRO: 40 to 45 65 It may increase when new physicians and/or services are added or decrease if patients cancel procedures, physicians take time off or resign, or other events that may choke off cash. Claims denial rate is derived as a percentage of claims denied. These changes have spurred healthcare companies to look into new healthcare metrics—or key performance indicators (KPIs)—to decide if they are meeting these new standards. Get the latest guidance on telehealth, coding and billing for COVID-19. They are provided below in some of the examples. Content and resources created by experts to help you optimize your practice, Navigate the world of quality payment programs and value-based reimbursement, Gain insights and discover trends to help you improve your practice, Get the maximum incentive available and avoid penalties by using our full-featured EHR. Cash: $? A billing KPI serves a number of purposes in terms of healthcare organization success: They help recognize key success drivers. Organizations across the entire healthcare spectrum leverage our deep expertise and high-quality solutions to maximize revenue, reduce operating costs and navigate the changing healthcare landscape. However, a higher rate does not necessarily mean your practice makes more money. This metric should be reviewed every month to make sure you aren’t experiencing blockage in money being paid. Don’t bury payment plans in the middle of your patient receivables. Claim denial rate is the percentage of claims denied. Instead, focus on the net – also known as ‘adjusted’ – collection rate. Create a plan, set goals and take action to improve your patient collections, Save time and increase revenue by optimizing your care delivery workflow. Monitoring your practice’s financial performance while providing exceptional patient care is vital to your medical group’s success. Of each dollar you’re allowed to collect, what percentage of it do you actually collect? 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. Calculate DRO by adding your current total receivables outstanding and the sum of your credit balances. Our solutions enable fantastic financial outcomes for medical and dental organizations nationwide. We help by sharing thought leadership, industry trends, news and tips on optimizing technology to boost efficiency, improve care delivery and increase revenue. This can be affected by how your biller submits the claim among other reasons. Divide that figure by your average daily charge. 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. Contractual Variance is the amount you are receiving below the amount you contracted with your payers. Accounts receivable (A/R) measures how long it takes for a service to be paid. This KPI is used to determine the efficiency of your RCM process. How to use KPI's for your Medical Practice's Financial Success Published on September 18, 2017 September 18, 2017 • 50 Likes • 11 Comments Your guide to exceeding a 95% clean claims rate and speeding up insurance payments. Getting Paid in 2020: What Independent Medical Practices Need to Know. You can calculate your average daily charge by taking the previous three months’ worth of charges, and dividing by 90. 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. Key Performance Indicators (KPI) are metrics that quantify the success of one’s performance in comparison to measureable business objectives. 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. … PE for healthcare’s complementary practice evaluation will give you access to accurate metrics using KPI’s. This metric measures the percentage of products in a company’s portfolio that are compliant with regulatory requirements set by the government including requirements such as establishment registration, medical device listing, premarket notification, investigational device exemption for clinical studies, quality system regulation, labeling requirements and medical device reporting. Medical necessity pass rate— rate of acceptance of claims with medical necessity content. Knowing your days in A/R is vital for understanding your budget and determining when you have the funds to pay for operating expenses. You’ll also want to keep in mind that cash may vary from week to week (or day to day). 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. We’ll take care of your business, so you can take care of your patients. The key is to choose a category – and stick to it. Despite the obstacles, you have to be on top of your game to ensure that collections are optimized. Missing a timely filing deadline – and having to adjust off the expected money -- is one of those uncollectables that causes the net collection rate to dip below 100 percent, as it should. Here are the industry benchmarks for medical billing DRO: High Performing Billing Department - 30 days or less Average Performing Billing Department - 40-50 days Below Average Performing Billing Department - 60 days or more If your staff incorrectly categorizes the adjustment as a contractual adjustment, then neither the payment nor the allowable are included in the rate. Such a trend should be examined further to determine the cause (s). 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. Carrying credits masks your true performance, making it look much better than it really is. You may also want to consider outsourcing to a more efficient medical billing service! You simply can’t get better until you know where improvement is needed. 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