Bill Sample / December 9, 2018 / Ellen Tillman
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.
If you dont include the responsibilities of each party in the contract how does it protect either of you when the relationship starts to fall apart? And if neither party knows their responsibilities how can you expect that the relationship will work? Here is an example. You specify in the contract that it is the obligation of the providers office representative to supply you with all the payment remittances but you are not getting them which is causing you to do a lot of extra work in contacting the insurance carriers to check status on claims that were already paid. It is upsetting to spend three or four hours calling insurance companies to find that the claims were paid but the doctors office missed sending you the eobs.
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.