Daljeet Sidhu

Medical Billing Service - Key Performace Metrics for Effective Management

A good Medical Billing Service has the remarkable potential to increase your collection rates by forty percent or more. However, how do they do it? Good metrics are the key to effectiveness of a medical billing service. Like any high performing business, they measure their performance with dependable metrics. If you plan to hire a medical billing service, look for these metrics to assess their performance.

Collecting medical bills is an onerous task. The billing rules are extremely complex, terminology difficult and the deadlines very strict. There is no single billing procedure that could be applied throughout the billing process. Additionally, the medical insurance companies are notorious for trying to avoid paying the bills. Due to such complexity, reliable metrics become even more important to optimize the medical bill collections

If you are considering hiring a medical billing service provider, carefully evaluate their performance measurement system, and the process used to respond to any payment issues or holdups that may arise for collecting the bills.

Following are some of the most important performance measurement metrics that an effective medical billing service should track and report to you.

* Gross and Net Collection Ratio
Gross collection ratio is the amount paid to the practice divided by the total charges billed. This does not include any write-offs. This ratio depends on the practice and the payer mix. A higher payer mix consisting of Medicaid and Medicare may result in lower gross collection ratio. It is best to compare this ratio to practices that are similar to yours. Net collections is the ratio of payments to charges after the adjustments due to write offs. For a high performing service, this ratio is typically over 90%.

* Days in Accounts Receivable
Time elapsed between billing and collection is an important metric to evaluate efficiency of a billing service. Number of days it takes to collect a bill depends on the medical specialties but a billing service can affect it by timely follow up with the payer and quick rectification of any issues that may arise.

* Percent of Bills Past Due
It is important to track past due bills. Billing service should report this as number and percent of accounts that are 60, 90, 120 days past due. It should have effective analysis process to troubleshoot the reasons for accounts falling in past due status. A good billing service would constantly improve upon its processes to shrink the accounts getting past due.

* Patient Liability
Percent of Patient Liability is the ratio of patient responsibility to total billed charges. This is roughly equal to the patient deductibles. This metric is important to track the effectiveness of the front office function since the co-pay is generally collected by the doctor's office before the service is rendered.

* First pass pay rate
This indicates the percentage of filed claims that are paid without any need of follow up. Obviously, higher the percentage, more efficient is the medical billing service. This metric should steadily show improvement. Any dip in first pass pay rate is a red flag and should be properly investigated.

* Denial Rate
Denial rates tell you about the claims that required a follow up during a given period. Billing service should regularly monitor this metric and troubleshoot the causes of denial to keep the denial rate as low as possible.

Medical billing is just too complex, a convoluted process that makes it almost impossible to measure efficiency unless there are good tracking metrics in place. Additionally, it is important to respond quickly to any inefficiency or deterioration in performance. Therefore, in this digital age a monthly paper statement listing the performance metrics is not an acceptable means of reporting. An efficient medical billing service provides means to track these performance metrics via a web portal and promises continuous improvement in performance. Hire an effective and transparent billing service and you would definitely see an improvement in collections.

Before you hire a vendor, compare price quote from multiple medical claims billing service at a Business Network. For further information, please refer to detailed buying guide to hiring medical billing companies.

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