Bill Sample / December 9, 2018 / Inez Nielsen
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.
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.
This number has improved down to 17.7% in 2004. In summary comprehensive and charge-invariant metrics such as PARBX are more informative and objective than collection ratios. However these metrics alone fall short from identifying specific areas for billing process improvement. Modern technology helps identifying billing bottlenecks as it allows interactive review of multiple metrics along different aggregation dimensions. For instance PARBX metric is especially helpful to identify patterns of problem claims containing specific payer or CPT code. Further modern Vericle-like technologies enable comparison of every payment to allowed amount and subsequent appeal on every denial effectively reducing the average percent of accounts receivable to low single digits.