Host

Tim Coan, CEO ALN Medical Management

Guest

Julie Huffman, VP, OperationsALN Medical Management

Revenue Cycle Management: What Matters NowManaging Day to Day RCM Performance with Data

Common Billing MetricsMeasurement DefinitionDollars Collected Total cash received

Total Accounts Receivable

The total amount of money the practice is owed for services rendered

Days in Accounts Receivable (DAR)

The average number of days from when a claim is entered into the system until it is paid

A/R Aging The amount of A/R outstanding, classified by timeperiods since the date of service

Number of OpenAppointments

Completed patient visits for which a claim has not yet been submitted

Gross CollectionRatio

Net RevenueGross Charges

Collection Ratio

Gross Collection Ratio: =

Net Collection Ratio

Net RevenueGross Charges

Net RevenueGross Charges – All non-collectible adjustments

Collectible Adjustments Non-Collectible Adjustments• NSF fees• Bad debts• Small balance• Administrative and timely filing

• Contractual adjustments• Charity Care• Courtesy, inclusive, and prompt pay discounts

Front End Billing Metrics

Front End Billing Metrics

Claim LagThe time interval between the date a service is rendered or an item is supplied and the date a service or item is processed and paid.

Claim Submission The percentage of claims that are rejected at submission (software, clearing house, payer)

Demographic Quality Patient information, guarantor information,and insurance information

Eligibility

Conditions an employee must meet in order to qualify for coverage under a plan, such as length of service, employment status, or attainment of a certain minimum age

Back End Billing Metrics

Back End Billing MetricsDenial Rate Compare to industry standards by specialty

Denials, by Type Shows quality at the transaction level, recurring themes – coding or payer specific

First-Pass Pay RateThe percentage of claims successfully resolved (paid or adjudicated to patient responsibility) on the initial submission.

Measures of Automated Tasks

ERAs, EFTs, payment posting, secondary claim filing, reconciliation of cash deposited to payments posted

Percent of Patient LiabilityThe ratio of patient responsibility to total billed charges. The ratio reflects patient deductibles and is important in measuring front office function.

Claim Denials

Patient A/R

Statement Cycles Automated every 28 days

Collection Letters Standard processes, automated calls, collection agency write-offs

Soft Collections Phone calls, specialized agencies

Hard Collections Collection agency

Real Time Data

Staff Productivity

RCM: What Matters Now

Revenue Cycle

Management

Why RCM Performance is More Important

Than Ever

Managing Day to Day RCM Performance

with Data

Technology Enhanced RCM

The Future of Coding and Compliance

RCM Reporting:

What to Watch, When to Watch

Interoperability: The Coming

Merger of Clinical and

Financial Data