12 KPIs for RCM: How to Monitor and Improve Performance
How well is your medical practice’s revenue cycle going? No matter where you are currently, there’s always room for improvement and eliminating inefficiencies. But which KPIs should you pay attention to? In this article, we’ll look at 12 key metrics that can help you achieve a strong financial position. Why are revenue cycle KPIs important? Running a successful medical practice or healthcare business requires tracking a variety of metrics. Revenue cycle KPIs are especially important because they help you track essential financial indicators and assess the overall health of your operations. They also reveal areas where you can improve your processes. A strong revenue cycle keeps your business stable and maintains a steady cash flow. This stability allows you to allocate resources more effectively and strategically scale your team, so you can care for more patients or expand your scope of practice. Revenue Cycle Management Challenges and Pain Points Inefficient patient access for appointments and registrations The revenue cycle starts with patient access, and this is where many problems begin.Inefficient or confusing scheduling systems can lead to missed appointments and low utilization of services, and often fail to meet today’s expectations for easy online booking. Implementing online self-scheduling empowers patients to book their appointments, reducing no-shows and making better use of physician time.Key metrics to look at include missed appointment rate, which indicates ease of appointment availability and better use of physician time; and tracking online registration usage, registration errors, and patient satisfaction. Manual management of claims and denials Processing claims often requires a lot of manual work, from checking payer updates to classifying billing codes. Not only is this stressful for staff, but it also increases the chance of errors and denials, which can slow down cash flow. To improve this, focus on good claim rates and frequency of denials. Automating the claims process with a cloud-based EHR can help reduce denials by predicting and preventing issues, making your team’s work easier. Inconsistent Patient Intake As patients are expected to pay more of their medical costs, a clear and effective billing approach is important. Simplifying billing and offering convenient payment options is key to improving collection rates. Here’s what you can do: Use data analytics to identify trends and patterns in billing and collections to better understand and solve problems. Provide patients with out-of-pocket estimates before their visit. This helps set expectations and avoid surprises. Accept a variety of payment methods, including credit/debit cards, online payments, and mobile wallets. Send reminders about upcoming payments and past due amounts via multiple channels (email, SMS, phone). Get actionable insights This complexity makes it difficult to understand the connections between different areas like patient access, collections, claims management, and payer contracts.To make sense of the data, use revenue cycle analytics tools that consolidate information and provide real-time insights.A well-designed dashboard can help you track important KPIs and identify trends over time, turning complex data into actionable information. What is a KPI Dashboard? Revenue cycle KPI dashboards are valuable tools for healthcare organizations that provide real-time insight into billing and revenue metrics.Because it is integrated into your Revenue Cycle Management (RCM) platform, it can be customized to highlight the key performance indicators that matter most to your business.This dashboard allows practice managers to closely monitor important financial transactions, which in turn allows for more informed decisions and improved overall performance. Revenue Cycle KPI Dashboard helps to: Improve cash flow Reduce bad debt ⢠Improve overall financial performance Identify operational inefficiencies Predict the future Improve patient satisfaction Days Receivable Ideally, this number should be low, as it means your cash flow is in good shape.If you wait more than 50 days, it could be an indication that you have issues with cash flow and covering expenses.To reduce this time, consider tightening your payment policies or offering early payment incentives. To determine your days receivable, use this formula: Days receivable = (Total accounts receivable / Average daily sales) Accounts receivable past due rate This metric helps you understand how long your unpaid invoices have been past due.Split your accounts receivable into time categories such as 0-30 days, 31-60 days, 61-90 days, and over 90 days.If many of your accounts receivable are over 90 days past due, it’s time to rethink your collection strategy to get paid in the first category (0-30 days). This can be calculated using the following formula: Receivables by Due Date Ratio = (Number of Open Receivables in Time / Total Number of Open Receivables) * 100% Perfect Claims Allocation This tracks the percentage of claims that were processed without issues, such as rejections, missing information, and errors.A higher ratio means that your billing and management processes are up to date.A lower rate can mean you have to work harder to avoid payment issues. To improve your clean claims set, try these tips: Train your team thoroughly in medical billing practices Establish and follow clear procedures to ensure consistency Use the following formula to calculate your clean claims rate: Unconfirmed claims rate = (Unconfirmed claims / Total claims) * 100% Claim denial rate This metric indicates the percentage of claims that are denied by the insurance company or the patient.A high denial rate can wreak havoc on your revenue cycle and overall operations.Common reasons for denials include coding errors and incomplete information.Keeping an eye on this rate can help you address issues before they escalate. Denial rate = (number of claims denied / total number of claims) * 100% Appeal rate Your appeal rate indicates the percentage of denied claims that you appeal.The decision to appeal all claims or only high-value claims depends on your practice’s approach. To calculate your appeal rate, use: Appeal rate = (number of claims disputed / total number of claims denied) * 100% Bad Debt Ratio This key figure tells you the percentage of accounts receivable that are uncollectible and need to be written off.A high bad debt ratio indicates that you need to improve your debt collection process.Some bad debts are inevitable, but you can
Physician Billing vs. Hospital Billing: What’s the Real Difference?
Physician billing and hospital billing are often confused, but there are some key differences. Both present their challenges and necessitate expertise to navigate their complexities. A clear understanding of these billing processes is critical for financial management, improving patient care, and streamlining revenue cycle operations. Physician Billing Requirements: Physician billing necessitates meticulous attention during the treatment process. This includes: Carefully recording patient visits classifying services provided It is important to take note of any necessary subcodes/modifiers to ensure complete reimbursement. Healthcare providers maintain comprehensive documentation for each patient visit, which includes demographic information, medical history, symptoms, diagnosis, treatment plans, and other pertinent data. The utilization of alphanumeric medical codes alongside any required supplementary information facilitates the accurate assessment of physician reimbursement. Hospital Billing Requirements: Hospital billing employs a standardized set of codes; however, it is more intricate due to the diverse array of services offered within hospitals.Hospital billing begins when a patient is admitted to a facility and continues until they are finally discharged. Hospital billing necessitates the use of a chargemaster, a comprehensive database that catalogs all the services for which a facility can issue charges. Healthcare professionals thoroughly document every aspect of the patient’s care during the stay, including diagnosis, treatment, procedures, medications, and any additional services provided. Key differences between medical billing and hospital billing Scope and extent of services Physician billing focuses primarily on individual patient visits in clinics and private practices, and billing staff must use only a small portion of the codes. However, hospital billing employs nearly all sections except for the most specialized ones, and larger hospitals might utilize the complete code set, necessitating more skilled coders and billing staff. Documentation and coding practices Effective hospital billing depends on a collaborative effort in documentation and coding. Many health care professionals work together to fully and accurately document patient interactions and services provided. Physicians and staff can do this at the point of care, making it more targeted. Revenue Streams and Reimbursement Models In this system, healthcare providers are compensated for each service provided based on a pre-determined fee structure. This structure incentivizes healthcare providers to deliver a broader range of services, as their compensation is linked to the volume and complexity of patient visits. Hospital billing, on the other hand, employs various reimbursement methods, including prospective payment systems (PPS), diagnosis-related groups (DRGs), and value-based reimbursement contracts. These systems determine payment based on the patient’s diagnosis, length of stay, and case complexity. Administrative Workflow and Responsibilities The administrative workflow associated with physician and hospital billing varies greatly depending on the scope of each.Medical billing may occur within an individual practice or a medical group. Hospital revenue cycle management and billing operations require a dedicated billing department or an experienced medical billing expert service. Optimize Hospital and Physician Billing If you are dealing with medical or hospital billing, it is essential to have an effective process in place along with a skilled billing team.With the right support, providers can receive maximum reimbursement and minimize the burden of revenue management. Medical groups looking to improve their revenue cycle management and billing can benefit from partnering with a MedEx MBS. MedEx MBS has a proven track record in revenue cycle management, giving our clients the confidence to outsource their administrative billing processes to us so they can focus on providing excellent patient care. Our RCM solutions increase efficiency and revenue potential, enabling our clients to succeed in today’s challenging healthcare environment.
Challenges in Dermatology Medical Billing and Coding
Coders play a key role in setting these codes, and billers prepare claims based on these codes. These claims are submitted to government agencies and commercial payers to pay for services provided by a dermatologist. This includes government payments such as Medicare and Medicaid, as well as private insurance providers. Given the diversity of medical practices, including cosmetic, medical, and surgical procedures, billing can be difficult. In this process, accurate diagnosis of skin and wound types is essential, including details of procedures such as excision, scar removal, and biopsy. The world of dermatology billing and coding is fraught with challenges due to constantly changing insurance reimbursement policies. Addressing these complex issues requires a thorough understanding of healthcare regulations, proficiency in implementing changes, and ongoing compliance with ever-changing billing guidelines. The Role of Dermatology Billing and Coders The role of medical billers and coders is essential. They manage patient data, including treatment and insurance information. The financial health of a medical practice or facility depends on the strength of its billing team. However, the complexity of dermatology billing stems from the combination of medical and surgical specialties. This requires a thorough understanding of the various uses of the current and revised Comprehensive Terminology Codes (CPT). Dermatology Medical Billing Process In the initial stage of dermatology medical billing, bills are sent to patients “just in time” to avoid confusion and ensure transparency of financial transactions. This initial communication is not only clear but also effective to follow. However, denials can occur for a variety of reasons, including incorrect medical codes or information about missing patients. Therefore, maintaining the accuracy and traceability of patient records is essential to effective prevention management. The final stage of dermatology medical billing is billing, which has two functions: pre-billing and payment processing. Pre-payments are intended to provide patients with information about outstanding balances as a means of managing costs. Dermatology Medical Coding System Dermatology medical coding relies on two main systems: the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT). CPT, on the other hand, includes a comprehensive set of codes for inpatient and outpatient procedures and services. Medical coding systems use CPT codes to accurately bill a variety of treatments, including extractions, scrapings, surgeries, and skin biopsies. They must include a detailed patient history, laboratory findings, and management decisions. General Medical Billing Codes Related to Dermatology Dermatology procedures and treatments are often assigned specific medical billing codes to facilitate accurate billing and recordkeeping. Below are the CPT codes found on medical billing statements for a variety of skin-related problems. CPT Codes Lesion Removal The different types of lesions include: precancerous lesions, malignant lesions, and malignant lesions, which can be removed using a variety of methods including cryotherapy, chemotherapy, laser therapy, and electrosurgery. When multiple lesions are removed in a single surgical procedure, multiple CPT codes are used to describe each lesion. Some of these codes include: 17000: This code is used for the removal of cancerous lesions; primary lesion (such as actinic keratosis) 17003: This code is used for the removal of cancerous lesions; 2-14 lesions (e.g., actinic keratosis) 17110: This code is used for the removal of malignant lesions other than hemorrhagic lesions up to 14 lesions. 11403: This code is used for the removal of malignant tumors, including the extremities, legs, arms, or trunk 11603: This code is used for the removal of malignant tumors, including the extremities, legs, arms, or trunk CPT Codes for Mohs Micrographic Surgery Mohs micrographic surgery is used to remove skin cancer. It usually occurs in multiple stages. The procedure involves removing tissue in stages and examining it under a microscope to ensure complete removal. The appropriate CPT codes are: 17311: This code is used for Mohs microsurgery with the cranial technique 1; 17312: This code is used for each additional section after the first section of Mohs microsurgery: hand, neck, foot 17313: This code is used for Mohs microsurgery of the hand, neck, and trunk using the cranial technique. 17314: This code is used for each additional section after the first section of Mohs microsurgery: hand, neck, and foot Pathology CPT Codes Pathology procedures are the examination of tissue and skin samples at the cellular level. Common pathology CPT codes are: 88304: Level III – This code is used for invasive disease, gross and microscopic examination. 88305: Level IV – This code is used for invasive diseases, microscopic and microscopic examination. 88312: This code is used for special annihilation procedures, including interpretation and reporting 88341: This code is used for immunohistochemistry or immunocytochemistry diagnostic procedures Phototherapy and Laser Therapy CPT Codes Phototherapy and laser therapy are used to treat a variety of skin conditions. The relevant CPT codes are: 96920 and 96921: These codes are used for laser treatment of inflammatory skin conditions. 96900: This code is used for radiation therapy (ultraviolet radiation) 96910: This code is used for photochemotherapy; tar and UVB, or petroleum jelly and UVB 96567: This statement focuses on phototherapy using external light to destroy cancerous or malignant lesions. J7308: This code is used to administer aminoacetyl propionate hydrochloride in phototherapy. What Modifier 25 Means Modifier 25 is a very popular term in the dermatology billing field. It is widely used, but it is often misused. This modifier represents evaluation and management (E/M) services provided by a single physician on the same day of surgery. Failure to do so can result in audit risk. The E/M designation is a significant component of medical billing, allowing healthcare providers, including dermatologists, to receive reimbursement from government payers (Medicare and Medicaid) and insurance providers. It is important to note that the (25) change should only be associated with E/M codes, not procedural codes. Key Challenges in Dermatology Medical Billing and Coding Dermatology medical billing and coding is challenging due to the complexity and ever-changing procedures, policies, and regulations. It is very difficult to document and understand the accuracy of changes. It takes a long time to obtain insurance
CPT MODIFIERS IN BILLING AND CODING
The CPT modifier (Current Procedural Terminology) consists of a two-digit code predominantly utilized in medical billing and coding practices. It serves to convey details about the medical procedures or services that healthcare providers offer to their patients. The two-digit CPT code elucidates specific treatments, variations, or circumstances involved in the care provided. CPT modifiers enhance the clarity by offering additional insights or descriptions related to the physician’s services. These modifiers distinctly articulate the medical procedure by altering its definition. This article will illuminate some of the frequently utilized CPT modifiers in medical billing, along with their interpretations. CPT Modifier 25: This modifier applies to the evaluation and management of services or procedures that the same healthcare provider provides to the patient on the same day as another professional introduces a new service or procedure. The patient can receive the services and procedures outlined by this code, necessitating further evaluation and management beyond the usual preoperative or postoperative care. This evaluation and management are driven by the patient’s condition, and it mandates reimbursement for both the procedure and the evaluation and management (E/M) components. CPT Modifier 50: This modifier signals the execution of additional procedures on both sides of the body during the same operative session. It is relevant for procedures performed symmetrically on body parts such as the eyes and knees. CPT Modifier 51: Modifier 51 indicates that two or more procedures are performed simultaneously in the same operative session. It signifies that the payer is required to provide additional reimbursement for the new procedure in the medical billing process. CPT Modifier 58: This modifier is employed for pre-arranged and documented therapy received by a patient following a major surgery. The surgical modifier 58 within medical billing is recognized as a new procedure, necessitating reimbursement for subsequent medical procedures during the postoperative period. CPT Modifier 59: Modifier 59 is used when multiple procedures are performed on the same patient on the same day, but they are not bundled together. It indicates that separate reimbursement should be provided for additional procedures in medical billing. These procedures are unrelated and may require different physicians to execute them in conjunction with the same organ or system on the same or different days. Consequently, reimbursement in medical billing is contingent on the sub-surgical CPT modifier. CPT Modifier 76: This modifier is relevant for the repetition of medical procedures on the same day due to specific medical conditions. It signifies that services or medical procedures should be repeated on the same day after the original procedure. Modifier 76 clearly distinguishes between repeated and duplicate services. CPT Modifier 78: This modifier indicates unplanned postoperative procedures, signifying the unexpected return of a patient to the operating room or procedural space immediately following the original treatment. It reflects unforeseen outcomes of earlier surgery, such as infections, hemorrhage, or debridement, which necessitate the urgent return of the patient. Importantly, the second procedure must be directly related to the initial medical procedure. Moreover, surgical modifier 78 is not exclusively for addressing complications, but also for managing all aspects of postoperative care. CPT Modifier 79: This modifier is applied when patients return to the same healthcare provider during the postoperative period to receive unrelated medical services. It involves performing different procedures or services on the same anatomical location by the healthcare provider during this time. Conclusion The article has touched on several examples of CPT modifiers. A variety of CPT modifiers exist to communicate specific information relevant to the service period. It is essential to refer to the official guidelines of CPT coding to ensure that payers can adequately compensate for the precise services coded for billing purposes. Accurate medical billing with the correct modifiers results in fewer claim denials and ultimately enhances reimbursement rates. This assists healthcare professionals in conserving funds for medical establishments.
What Makes a Laboratory Billing System Successful?
Charging strategies for Laboratories are part of the same general coding and charging framework used in various healthcare areas throughout the US, but charging services for research facilities are unique in several ways. One of the key contrasts between laboratory and other sorts of therapeutic workplaces is the number of claims prepared. A laboratory typically benefits numerous more patients each day, resulting in a large number of claims being submitted. Another distinction, and one that makes charging for such healthcare organizations especially challenging, is that laboratory claims are for relatively small sums. This makes it troublesome to give time to taking care of each dissent or dismissal since labor costs can rapidly exceed the value of the claim. The issue with giving up on refusals is that the accumulated sum of unpaid claims can quickly rise to an unsustainable sum, putting the laboratory at risk of coming up short as a commercial entity. The Best Administrations Have a Solid System For research facility administrations to be maintainable, it needs to be based on a framework that includes all angles of the laboratory as a trade and incorporates the points of interest of charging for each understanding from contact through installment. Having a framework in place builds up a rehashed plan, so time isn’t spent on figuring out how to do things that have as of now been done, and scheduling issues with claims don’t result in misplaced revenue. How to Select a Lab Charging Company The framework ought to incorporate training of all workers on the roles they are involved with, from the front office that takes the arrangement to the charging staff who send statements to patients when they have an adjustment due after testing. The framework, moreover, needs to incorporate a strategy for producing reports so that the income cycle administration (RCM) metrics are analyzed and principals are mindful of how successful that angle of the laboratory is. Tips for Fruitful Billing Address any doubts about utilizing the charging program that is always being overhauled. Codes are upgraded yearly, but safeguards and government payers make changes at diverse times. Verify qualification and decide that you have the legitimate authorizations when an arrangement is planned or an understanding arrives as a drop-in. Collect the patient’s portion of the charges when they check in. It’s much less demanding to collect forthright than to get installments for a charge in the future. Code claims ceaselessly. Permitting work to amass some time recently, it is charged lets more gets neglected and perplexities are more troublesome to sort out after more time has passed. Scrub claims day by day. An experienced restorative biller ought to check each claim for errors some time recently it is submitted. These administrations are much more productive when they incorporate a strategy for scouring that is repeated for each claim. Track claims until they are paid. Dismissals and dissents frequently get put aside and not revamped, so they never get paid, but this comes about in up to 25% of income being misplaced, which is more than a therapeutic laboratory can afford to lose. The framework ought to incorporate a way to track claims and a plan for following up on unpaid claims. Review reports, analyze issues, and communicate comes about with staff. It is critical to confirm that the sum you are paid is expanding at a rate of the sum you are charging, and the time it takes to Laboratory charging is challenging, but there are five basic ways to maintain a strategic distance from refusals for expanded collections. When it comes to dissents in research facility charging, there are two particular types of hard and soft claims. Difficult claims cannot be switched since the income has been totally composed off due to the age of the account or other components. Delicate claims; be that as it may, are, as in were, transitory refusals and can be turned around if the claim is rectified within the designated time. The five most common reasons for denied claims in research facility charging are insufficient protection scope, benefit as of now settled, copy claims, lapsed recording time, and lost data. Underneath is a breakdown of each claim denial. Getting paid is diminishing (or at the least sensible time). Dismissals and refusals ought to be surveyed to decide if there are specific payers that are issues, so the related issues can be found and addressed. When issues are found, it is vital to come up with an arrangement and ensure that any doubts, all staff involved are educated, so that no one makes the same mistakes in the future. 5 Ways to Maintain a strategic distance from Refusal of Research facility Charging Claims Laboratory charging is challenging, but there are five straightforward ways to dodge dissents for expanded collections. When it comes to dissents in research facility charging, there are two unmistakable types: hard and soft claims. Difficult claims cannot be switched since the income has been totally composed off due to the age of the account or other components. Delicate claims, in any case, are, as it were, transitory refusals and can be turned around if the claim is rectified within the designated time. The five most common reasons for denied claims in research facility charging are lacking protection scope, benefits as of now settled, copy claims, expired recording time, and lost data. Underneath is a breakdown of each claim denial. Common Causes of Denied Claims Eligibility: When a method, test, or benefit is not secured by a patient’s protection arrangement, and they did not affirm their benefits at the time recently administered services were rendered. Service arbitrated: This is when the administrations are secured by the patient’s protections; be that as it may, a claim has as of now been submitted as part of another service. Duplicate claims are claims submitted multiple times by the same supplier for the same service on the same day. The constraint for recording terminated: This sort of research facility charging dissent