With our industry in turmoil and practices in the throws of the COVID-19 Novel Coronavirus crisis, practices are forced to cut back operations and shift employees to either work-from-home, furloughed, or laid-off altogether. It is more imperative now, more than ever, to monitor the vital lifelines of the revenue cycle and your practice. Below are critical areas of your revenue cycle you should be looking at on a regular basis to maintain proper cash flow and an efficient and effective revenue cycle.
- This report tracks the claim volume by payer category and original billing media (paper, electronic, statements/other invoicing) by original billing date.
- The billing media charge volume ratio should remain relatively consistent over time. The billing media should remain in line with expectations for the carrier category; WC and MVA will likely be set to drop to paper, major payers should file electronically, etc. The report helps to alert you if there is a notable fluctuation in charge volume, shift in original billing media that might suggest a payer mix shift, or incorrect setup of a carrier in the master file.
Payment Posting Lag
- This report will show you TAT from receipt/deposit to posting for payments and denials.
- Review the report to ensure posting TAT is consistent and within expectations. If lags are outside expectations, investigation may be required to identify bottlenecks or inefficiencies in the process.
Charge Posting Lag
- This report measures TAT from DOS to charge posting
- Review the report to ensure charge posting TAT is consistent and within expectations. Results should be trended by provider/location/service line. If lags are outside expectations, investigation may be required to identify bottlenecks or inefficiencies in the process.
- This report provides denial trending by insurance carrier category and denial category.
- Review denial trending to identify any unexpected increases in denial volume by denial category or carrier for further investigation. Review controllable denial categories (authorization, eligibility, coding, non-covered) to identify opportunities for process improvement and denial minimization.
AR Follow Up Analysis
- This report helps monitor that open claims out to insurance are being worked promptly.
- [40+ Days Since Follow Up Table Can Be Found In “AR Follow Up Analysis”]
This report show # of vouchers and AR by aging for vouchers that have had claim notes applied during previous work efforts, but have not had a claim note applied in 40+ days. These claims should be isolated for collectors to work, re-status, and push the payer for resolution.
- [60+ Days No Follow Up Table Can Be Found In “AR Follow Up Analysis”]
This report show # of vouchers and AR by aging for vouchers that have had no payment or adjustment that were last billed 60+ days ago, and have had no claim notes applied. These claims should be statused to confirm the payer has the claim on file and adjudication is forthcoming.
Appointment Eligibility Status
- This report trends the results of eligibility verification efforts as logged in the PM system.
- This report shows the % of kept non-self-pay appointments that fall into each of the eligibility statuses. This can help illustrate registration errors that prevent the payer from finding the patient (Exceptions) and instances where the patient has new insurance that has not yet been obtained (Inactive). Trends can be used to help educate staff to reduce registration errors and ensure updated insurance information is being captured.
- This report trends a series of metrics over time to understand cash flow, identify bottlenecks with charge submission, understand progress toward working AR, denial volume, and appointment trends
- This report trends front desk success rate in copay collection to monitor up front collection efforts
- This report trends practice E&M level utilization against national trends to identify if practice is being too aggressive on E&M level and risks audit, or too conservative on E&M level and risks lost revenue
Outstanding AR Percentage by Month
- This report tracks AR satisfaction by service month over time to monitor that claims are being resolved as expected and no unexpected pockets of AR are accruing
Days in A/R by Payer
- This report illustrates how quickly insurance companies process and pay claims. It’s crucial to understand payer processing time norms and identify if payment goals are not being met based on experience with your practice’s major payers. Quickly focusing on payers that begin to process outside of identified norms can ensure there are no bottlenecks caused by practice or payer behavior that are negatively impacting cash flow.
Having the proper protocols in place to monitor your revenue cycle is critical to truly understanding the health of your revenue cycle and practice’s profitability. If you have any questions on how to deploy these analytical metrics in your practice or interested in entrusting HIS team of revenue cycle experts to manage it for you please contact us.