Key Performance Indicators

We believe that Key Performance Indicators (KPIs) are the best way to measure success, reach goals, and develop the next steps for growing your practice financially. We are committed to transparency in all facets of our work, and as such we proudly share our own KPIs that show that we stand head and shoulders above the rest of the industry.

KEY PERFORMANCE INDICATORS THAT MATTER

At Physician Revenue Solutions we look through your Key Performance Indicators with you to ensure each one is being met. Choosing the right KPIs relies upon knowing what’s good for you and your bottom line. Key Performance Indicators for medical practices differ from those in other fields because of the complex nature of medical billing and dealing with patients, collections, and insurance companies.

Some Key Performance Indicators include but are not limited to: 

  • Outstanding Collections
  • Average Days in Accounts Receivable
  • Percentage of Collections in Accounts Receivable over 120 days
  • Denial Rate of Claims 
  • Net Collection Rates 
  • Reimbursement dollars divided by insurance carrier
  • Reimbursement dollars divided by procedure

Average Days in A/R

  • Industry benchmark: 35 days
  • Physician Revenue Solutions: Less than 20 Days 
  • What This Means: 

    • The best single assessment of billing health
    • Quickly posting payments from insurance and patients 
    • Following up thoroughly on denied claims and claims without a response
    • The average will vary by specialty and payer, but typically A/R greater than 50 days should be a red flag.

Days in A/R should be in the range of 40 to 45 days. However, there is a multitude of factors that may cause it to fall beyond this date range.

Average Percent of Days in Accounts Receivable Over 120 Days

  • Industry benchmark: 12%
  • Physician Revenue Solutions: 8%
  • What This Means: 
    • Comparing A/R aged over 120 days to overall A/R is a good assessment of financial health.
    • Percentage of A/R aged 120+ days that is higher than 12% can be indicative of many billing ailments including untimely and/or incomplete posting, untimely follow-up on denied claims or claims for which you have not yet received an adjudication decision from the insurance company. This can also be a sign of an insufficient patient due-balance policy.
    • PRS works to resolve claims quickly, allowing practices to reliably and consistently receive payment and maintain financial peace of mind. 
    • A/R greater than 25% could indicate large claim denial and follow-up issues or a bad patient payment process system.
    • Similar factors to average days in Accounts Receivable can extend claims beyond 120 days.

Denial Rate for Processed Claims

  • Industry Benchmark: 8%
  • Physician Revenue Solutions: 6%
  • What This Means: 
    •  Lower denial rate means more money in your pocket
    • PRS is relentless in our claims work, our knowledge of coding and persistence means we close more claims and make sure you get the money you need for your practice. 
    • Processing clean claims are critical to decreasing the average days in A/R and ensuring a healthy revenue cycle for a practice.
    • A low denial rate is indicative of strong front-end revenue cycle processes, particularly charge review and coding functions.
    • A high denial rate can be indicative of needed improvement in front-end revenue cycle processes, including those managed by front desk staff. It also highlights the need for a professional coding review of encounters.

Net Collection Rate

  • Industry Benchmark: Less Than 98%
  • Physician Revenue Solutions: Greater than 98%
  • What This Means: 
    • Tracking adjusted net collection rate is a good method of assessing billing health and how well a practice collects the dollars “allowed” per insurance contracts.
    • A higher rate means more money in your pocket and fewer contractual adjustments. 
    • A net collection rate below 95%, even after write-offs, can be an indication of poor performance when it comes to claims and proper coding.

HOW TO IMPROVE YOUR KPIs OVERALL

You can improve Days in Accounts Receivable results through: 

  • Timely Insurance verification 
  • clean charges 
  • Strong time-of-service collection (copayments, coinsurance, unreached deductibles and deposits pre-service deposits)
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For all KPIs:

  • Automation: PRS can help you set up automated systems that reduce work for your office and automatically check insurance coverage and benefits eligibility verification, and automate processes such as remote deposit, charge scrubbing, e-remittance, and funds transfer.
  • Be relentless: PRS is relentless in hunting down payments and verifying claims. But there are some steps you can take in-office as well such as verifying insurance before patients present.

USING YOUR KPIs

You won’t always hit your KPIs, and you sometimes may exceed them. Use them as a benchmark for what “good looks like.”  We can help you keep track of your Key Performance Indicators and other goals so you are never caught by surprise. Your KPIs are just one measure of success for your practice. Adhering Coding, credentialing and reports best practices can help your practice grow and maintain financial success.

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