Bill Sample / December 9, 2018 / Heather Patrick
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Billing performance measurement is an integral part of medical practice billing process and a prerequisite to effective practice management. Systematic measurement becomes mission-critical with growth of billing complexity or outsourcing of the billing function. Traditional billing metrics are limited in scope and focus on claim submission process ignoring process imperfections on the insurance (payer) side. Modern computer technologies allow both productive measurement and effective action by the disciplined billing office to improve claim submission and payment processes. Using appropriate metrics helps improve policies and procedures shorten revenue cycle reduce patient complaints improve financial performance and compliance increase cash flow reduce bad debt identify areas of potential growth improve employee morale increase productivity and reduce costs.
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.