Bill Sample / December 10, 2018 / Corrine Carney
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.
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.
You want to imagine a symbiotic relationship with your providers and then list the reasons this relationship works and put those actions in your contract as responsibilities of yourself or the provider. You need a list of everything that you have ever heard of going wrong in a medical billing business between the provider and the biller. You need to decide how you would avoid those situations if possible and cover how it would best be handled in your contract if unavoidable. What you are charging your provider and how you will get paid is a fairly important part of your contract. Are you charging a percentage a flat rate or a per claim fee? Is it clearly defined how you are charging? Is the percentage on what is billed out or what is received? Are patient payments included? If charging per claim what constitutes a claim? Is it a line on a claim form or is it per page? You also need to take into account what will happen when the relationship ends.