Since introducing ASC-specific benchmarks in 2017, we have seen centers gain a much better handle on their financial health. Having the tools and intel to gauge performance across all functions of the revenue cycle has been a game-changer for ASC leaders. Because of that, we have reevaluated our previous metrics and established our eight metrics for 2019:
- Days Outstanding
- Percent of A/R Over 90 Days
- Claim Lag/Charge Lag
- Statemen Lag
- Clean Claim Percent
- Claim Denial Percent
- Net Collection Rate
- Latest 2019 Benchmark: A/R Follow-Up
These benchmarks dive deep into the health of your revenue cycle to assess key components that shape and define your revenue cycle.
We also include a case study highlighting how one center increased collections by $125,000 per month, due in part to A/R Follow Up.
2 years ago, we looked at A/R as a combination of gross and net, but have since transitioned to taking contractual write-offs at the time of charge entry; creating a cleaner, more accurate benchmark. Our gold standard is below 25%, and this change has helped get a true metric to drive performance.
With electronic billing, claim lag is nearly instantaneous in most ASCs. The gold standard for charge lag is same day of service – 48 hours. If it goes beyond it is time to look at dictation, coding, or invoicing processes.
Higher deductible plans are pushing more of the payment responsibility to patients. The sooner patients get the statement, the faster payment is received. We run statements once a week, so the gold standard is 5 days or less.
Clean claims mean fewer denials. We constantly strive to get better. Our staff reviews every rejection and makes sure we learn from it. Our gold standard is an aggressive 98%.
2 years ago, we set the gold standard at 10% and now we are cutting that number in half. Once we started tracking and measuring denials, we were able to educate our internal staff as well as center staff. We are now below 5%.
If your team is fighting hard enough for what you are contracted to get paid, you should end up very close to 100%. There will always be some bad debt due to patients unable to pay, or a denial if you didn’t get pre-authorization, but our gold standard is greater than 97%.
We have added a new metric that tracks how many of the cases a center has with an open balance are being followed up on each month. The gold standard for follow up at least 95%. This metric helps us track individual biller performance, and results in improved collections and a decrease in A/R over 90 days.
Our benchmark is less than 30 days. ASCs that are doing well against the other benchmarks, are likely hitting this one as well, since many of the other metrics contribute to reducing Days Outstanding.