Bill Sample / December 8, 2018 / Karin Higgins
When we started our Medical Billing Service in 1994 there was very little information available on medical billing services let alone medical billing service contracts. In fact some of the information indicated that you really didnt even need a contract if you didnt want one. That couldnt be further from the truth! Having a contract for your Medical Billing Service is very important to protect both you and the provider. Many new billing services ask us for a sample contract or a copy of our contract. Using a sample contract or somebody elses contract is not a good idea. It would be like taking somebody elses will whiting out their name and writing in yours. The only time it will hurt you is when you die and then your family could be in trouble.
This lag time roughly averages across all payers making DAR an effective comparison metric between payers for individual provider but invalidating it across multiple providers. One obvious advantage of DAR metric is its independence of charges. The averaging feature of this metric eliminates sensitivity to specific day or CPT but also hides the behavior shape of the accounts receivable curve. First-Pass Pay (FPP Rate) and Denial Rate FPP is the percentage of claims paid in full the first time upon submission (subject to federal or state timely payment regulations: 15 days for electronic submission and 30 days - for paper). Denial rate is the complementary metric to FPP rate. It counts the percent of claims that require followup and therefore cost more to process.
Useful metrics must be comprehensive and simple. They must combine both complete end-to-end processes and their individual components. Metrics must be used consistently over time and compared to standards. Obviously different standards apply to different medical specialties patient demographics payers and samples of CPT codes. Medical billing metrics typically include compliance cash balances charges accounts receivable and collection ratios to help monitor cash flow. This article focuses on performance metrics. For discussion of compliance program see companion article on Medical Billing Compliance. Collection Ratios Traditional metrics include gross and net collection ratios. Both metrics are subjective to individual practice because they compare (often arbitrary) charges to (allowed) payments.