Bill Sample / December 9, 2018 / Millicent Walsh
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.
Net collection rate is defined as a ratio of Total Collections and Total Charges less Adjustments. Gross collection rate is defined as a ratio of Total Collections to Total Charges only.) According to Medical Group Management Association (MGMA) 1998 Cost Survey adjusted fee-for-service collections (net collections) for family practices in 1997 averaged 98.65 percent. A declining net collection ratio may be symptomatic of increased contractual write-offs or insufficient number of denial appeals. This metric is especially useful in the absence of modern computer technology when comparison of every payment to allowed amount is impossible or when appeal process of denials is too expensive. Otherwise the use of charges in defining gross and net collection metrics precludes them from productive discovery of process improvement opportunities.
Days in Accounts Receivable (DAR) A growing number of days in accounts receivable are symptomatic of a faulty billing process. One way to determine DAR is to count days from the date of service to the date of payment for every claim and then average across all claims. A simpler way to compute average number of days in accounts receivable by taking a ratio of accounts receivable to average daily charges or Number of days in accounts receivable = (Accounts Receivable / Average Charge) x 365 This metric too depends on medical specialty patient demographics payer mix and CPT sample. Another downside is that this metric is sensitive to provider as it counts the lag time of unsubmitted claims for services already delivered.