Did You Audit Your Medical Billing Performance Lately?
Regular billing audit practices show that practices that do not audit, can have their denial rates rocket by 20% within record time. This is not unexpected when it is realized that it is equivalent to the half of all claims meaning that steady audits are very critical if performance in medical billing is to be determined. It has become impossible in today’s complex world to conduct systematic audits and has therefore become a thing of the past. Nevertheless, systematic reviews have become almost unavoidable in supporting such financial and operational characteristics.
This blog post explains why you ought to do medical billing audits and suggests how you could do it on your own, as well as introduces the performance measurement template that can change payment processes in your practice.
The Importance of Systematic Medical Billing Audits
Explanation
Instead, medical billing audits have to be a proactive strategic plan. It’s the same as having regular check-ups with your health care physician in order to avoid health care; you have to do billing audits periodically to avoid revenue cycle problems. In that way, you can be able to prevent situations from propping up and become major disasters.
Impact on Revenue Cycle
Ignoring audits can cause a lot of trouble in your revenue cycle, resulting in a rise in insurance denial rates, delayed receivables, and stuck AR, causing high stress on staff. The good point is that these can be avoided by doing regular audits to find the loopholes & improve performance.
Supporting Points
Recurring Claim Cycle Issues: Organizations may be making persistent claim cycle problems, including slow payments, slow revenues and high denial ratios.
Specific Examples: For some of the practices that were not subjected to the audit, they may face some of the problems for instance coding errors, partial documentation, and failure to adhere to the rules set by those payers.
Benefits of Conducting Systematic Medical Billing Performance Audits
Identifying Loopholes
It will provide audits where performance is low and help the management of the practices to attend to these areas and optimize the efficiency of their billing systems.
Improvement Insights
Claim cycle audits are useful to determine what you might do more effectively in the future and in claim on the whole in your practice. It is evident that practices can look for ways on how to enhance their billing process just like any other aspect of the practice given the right equipment as well as information on how to analyze billing data.
Enhanced Relationships
Audits can foster a closer relationship between the practice and the people who submit claims for your team. In this more detailed feedback and recommendation practices can coordinate with their billing partners to enhance better recognition on how to process the revenue.
Investment Guidance
Audits point the path to somewhere between where one should invest in order to have better billing processes. This will enable practices to locate areas of inefficiency in their billing performance and allocate resources effectively.
How to Conduct a Self-Medical Billing Performance Audit
Tracking KPIs
Practices should monitor revenue cycle management (RCM) and key performance indicators (KPIs) monthly and annually to conduct a self-audit. This is good to see what your issues are and where you stack up against the industry benchmarks.
Key RCM Indicators
Monthly Charges, Payments, and Adjustments
Ensure you also track these, so you can issue the correct invoices and as a result be paid promptly. Actual and payable bills, as well as, changes on the bills made during the monthly period, give a chance to see variations in the bills’ flow. They do this to ensure that they continue to have a healthy cash flow cycle and ensure that the services offered by them are billed in a proper way so that they can be reimbursed.
Charge-Entry Lag Times
This means one should monitor the time taken to complete charge entry in order to check whether billing is done in time. The charge entry lag time is one of the biggest contributing factors to lost revenue and delayed payments in outpatient billing. Tracking this metric helps practices recognize where their billing process is getting hung up and work on ways to speed up charge entry.
Denial Percentage
Measure denied claim percentages to identify opportunities for improvement. Some practices categorize and evaluate denial percentages to identify the common causes of denials, such as coding errors, missing documentation, or payer policy breaches. These are areas of preventable denials for practices and where those operating in such niches can grow their collections.
Clean-Claim-Rate Percentage
The idea is to keep track of the clean claim % in order to be certain to bill appropriately. An open claim means a clean claim free from mistakes in its completion and submission and which does not create a suspicion of fraud in the mind of an insurance analyst. This is because the percentage of clean-claim-rate helps practices identify inefficiencies in the billing processes and more importantly, optimise the payments as well as control administrative costs.
Accounts Receivable (AR) Aging by Date of Service
AR aging has to be closely watched in order to determine which payments are-delayed. First of all, AR aging by DOS helps to identify these open claims and, at the same time, offers your practice a chance to respond to them and avoid write-offs! Filtering AR aging ensures that practices are not caught off-guard that a client has not paid yet and maintain a steady cash flow.
Gross-Collection and Net-Collection Percentages
These percentages will be checked on the correct and on time collection. Depending on what the answer is, you may need to calculate your gross collection percentage of total collected compared to total billed or net collection before taking into consideration the contractual adjustments and write-offs. In this way, practices are able to observe whether the arrangements for collecting are effective or not.
Days in AR and Days in AR Over 120 Days
Monitor these measures to detect and fix delayed payments: Days in AR is a measure of the age of accounts receivable and depicts the average number of days it takes to collect monies out from payers and patients following delivery of services in your practice. AR Days > 120 days This case is for long-time pending AR claims. Monitoring of these types (and possibly more) of key performance metrics will help practices to see any issues applications with respect to dues are addressing as well as minimize potential bad debt.
Through monitoring of these particular RCM measures, such practices as billing performance can be assessed and documented, and areas requiring changes can be instituted to optimize revenue cycle management. These indicators have to be monitored and analyzed frequently in order to restore the financial outlook and guarantee the practice’s sustainability.
Using the Medical Billing Performance Measurement Template
Template Overview
Formula Table of KPI with Acceptable Ranges
This tab contains the acceptable ranges and the formulas of KPIs for the business. This enables tracking of the billing performance in practices and comparing with the set standards easily.
Tables for Data Entry
This tab consists of tables for data entry that help practices enter billing data into the system. This helps in making sure that all information that is to be processed is well captured and processed in the right manner.
Linked Dashboard for Comprehensive Tracking
This tab provides the facility of a billing dashboard where all the practices regarding billing can be checked at any single moment. It will assist the practices to not only understand the trend, progress but in fact provide recommendations given several data points in order to enhance the billing process.
Presentation
It is used to show performance figures on screen to the staff or clients on a monthly or yearly basis or printed and given to the clients. This is useful in monitoring the changes over time and situation analysis so as to know the areas that require changes to be conducted. This is because practices can present the data in an organized and brief manner that would make all the stakeholders understand the goals and objectives of the billing process.
Conclusion
Medical billing audits should therefore not be seen as felony but rather as a way of ensuring that your business is on the right track financially as far as medical practice is concerned. Monitoring of key decisions in the RCM and by using for example Medical Billing Performance Measurement Template will help you to identify existing issues, continue improving your billing processes and thus, in the longer term, impact on the financial performance of your practice.
Therefore, do not wait for those revenues to disappear one day and stop running through your pockets. This should not be allowed to be determined by the performance of your medical billing; act now and take charge.
Have you done all you needed to do in order to enhance the medical billing performance? Check no further than the best medical billing training services that are offered at MedPro Motion. You now have the chance to download the Medical Billing Performance Measurement Template for FREE shown you is the beginning of the journey to better billing performance. Last of all, please ask for a call with our experts to describe the results of the audit and recommendations concerning certain changes to make. It’s really sad if you keep on risking the financial health of your practice – don’t let that happen, act now.
Click here to access Medical Billing Performance Audit template
Track the RCM key performance indicators from month to month and year to year to gauge problematic areas
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