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FEATURE


Days to bill—Along with clean claim percentage,


charges and CPTs per


case, the days to bill KPI will help you ensure timely billing, Overton-Geise says. “These KPIs can help identify shifts in case complexity and changes to coding that can occur when you have a change in staff. They are crit- ically important because the major- ity of your monthly cash is going to be dependent on timely, accurate pro- cesses at the point of initial billing.”


Denial rates by payer—For this KPI, Mishler says her ASCs look at overall volume of claims denied by payers. “We try to target denial rates of less than 5 percent. If we see the percent- age increasing, we determine what is causing the change and find solutions to bring it down.”


Days in AR and percent of AR over 90 days—These two KPIs help iden- tify reasons that claims are not being resolved, Overton-Geise says. “This can lead to your identifying issues with payers or within your AR team.”


Cash collections—Brazell recommends tracking this KPI on a daily and weekly basis. For his ASCs, the cash collections goal is established monthly by averaging the prior two months' net revenue. “You want to hit 98 percent of that target,” he says. “If there are 20 business days in a month and you are five days into the month, you should be at least 25 percent of the way toward your cash goal. At 10 days, that figure should be at least 50 percent. If you are ahead of schedule, good. If you are below, dig into how your team is performing concerning money you should be collecting.”


Patient satisfaction—How patients feel about your billing process is often an overlooked measurement, Overton- Geise says. “When staff can effectively explain the billing process and make it easier for patients to follow, this sup- ports efforts to collect money owed.”


If you are not paying attention to your KPIs, you are going to lose revenue simply because you are not getting things turned or identifying problems fast enough.”


— Jenny Mishler Orthopaedic & Spine Center of the Rockies


Credit—Mishler says tracking credit owed to patients and payers is an underrated aspect of AR management. “If you do not know your credits, they can become a financial risk as you may count money as yours that is techni- cally not. Canned AR reports in elec- tronic systems often do not pull cred- its out, which can mask growing AR problems. Always know your credits and get them resolved quickly.”


Bad debt—ASCs will want to ensure they manage this KPI well, Brazell says. Bad debt occurs when a bill remains unpaid for more than 120 days (i.e., AR > 120), he says. “That hits your income statement. Keep bad debt between 1 and 2 percent. Watch- ing that on a monthly basis is impor- tant to understanding team perfor- mance and how they are doing with timely collections.”


Quality—A final must-track KPI that Overton-Geise says is essential to a well-performing revenue cycle is the


quality of staff work. This measure- ment will vary by area of the revenue cycle and efficiency of processes, she says. “Quality measurements change over time depending upon where your team is with their development.” As examples, Overton-Geise says coding quality can include looking at whether coders are capturing all appli- cable codes and coding them correctly. Billing quality could include review of whether claims go out clean and if billers ensure billing aligns with payer expectations. Payment posting qual- ity could look at whether payments are applied to the right accounts, refunds and credit balances are handled timely, and patient statements are sent in a timely manner. “When you marry measurements of work quality with more standard KPIs, you get more than just data,” she says. “You can really tell how you are performing—includ- ing identifying significant errors and trends—and give your revenue cycle and staff a roadmap for success.”


Engaging Staff With KPI Data To maximize the value of your KPI data, do not limit access to manage- ment, Mishler says. “I think that lead- ership often knows revenue cycle goals, but staff do not. My feeling is that there is nothing secret here, which is why our staff receive their monthly performance stats. Many who work in the revenue cycle have type-A per- sonalities and are driven by compe- tition. When you share data, you can better define goals and expectations, which should motivate staff to elevate their performance.”


Overton-Geise adds, “Everyone wants to be successful. When your team knows the goals and can feel suc- cess when those goals are met, they tend to work harder and with more focus on achieving those goals. This can lead to a culture-defining experi- ence for your team.”


ASC FOCUS MAY 2021 | ascfocus.org 15


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