ASC Revenue Cycle Benchmarks to Know and How to Improve ... · ASC Revenue Cycle Benchmarks to Know...

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ASC Revenue Cycle Benchmarks to Know and How to Improve Each of Them September 30, 2016 Becker’s 23 rd Annual Meeting The Business and Operations of ASC’s

Transcript of ASC Revenue Cycle Benchmarks to Know and How to Improve ... · ASC Revenue Cycle Benchmarks to Know...

Page 1: ASC Revenue Cycle Benchmarks to Know and How to Improve ... · ASC Revenue Cycle Benchmarks to Know and How to Improve Each of Them September 30, 2016 ecker’s 23rd Annual Meeting

ASC Revenue Cycle Benchmarks to Know and How to Improve Each of Them

September 30, 2016

Becker’s 23rd Annual MeetingThe Business and Operations of ASC’s

Page 2: ASC Revenue Cycle Benchmarks to Know and How to Improve ... · ASC Revenue Cycle Benchmarks to Know and How to Improve Each of Them September 30, 2016 ecker’s 23rd Annual Meeting

Agenda

• Core ASC Revenue Cycle Benchmarks

• Appendix A – Speaker Biography

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“The Benchmarks”

• Days Outstanding / Days in A/R

• Claim Lag / Charge Lag

• % of A/R Greater than 90 Days

• Net Collection Rate

• Denial % / Clean Claim %

• Business Office Staff per 1,000 Cases

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Days Outstanding / Days in AR

• Definition: In its most basic form, Days Outstanding is essentially

the time it takes to get a claim paid

• Calculation: Total AR / (total charges from last 3 months/90)

• Regent Standard: Less than 30 Days

• Uses: Determines the health of your AR. Wild swings from

month-to-month may highlight a billing or collection problem

Page 5: ASC Revenue Cycle Benchmarks to Know and How to Improve ... · ASC Revenue Cycle Benchmarks to Know and How to Improve Each of Them September 30, 2016 ecker’s 23rd Annual Meeting

Claim Lag / Charge Lag

• Definition: The time it takes to get a claim entered and sent

• Calculation: Number of days from DOS to charge entry /

submission

• Regent Standard: Less than 3 Days

• Uses: Determines how quickly charges are being sent. A

high Claim/ Charge Lag has a negative impact on Days

Outstanding

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% of A/R Greater than 90 Days

• Definition: The amount of $$ as it relates to total AR

greater than 90 days outstanding

• Calculation: Total AR greater than 90 days / Total AR

• Regent Standard: Less than 15%

• Uses: High % of AR greater than 90 days may emphasize an

issue with patient collections or insurance denials

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Net Collection Rate

• Definition: The % of eligible $$ the facility actually collected

• Calculation: Total payments / (total charge – contractual –

bad debt + refunds)

• Regent Standard: Greater than 97%

• Uses: Determines how well business office staff are

collecting on contracted accounts

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Denial % and Clean Claim %

• Definition: % of claims that are rejected by payer and % of

claims sent out without edits

• Calculation: Total claims / denied or clean claims

• Regent Standard: 98% Clean, Less than 5% Denial Rate

• Uses: A high denial rate could highlight issues with certain

payers. A low clean claim % may pinpoint some issues with

either your biller or front office

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1.14

1.40 1.44 1.53 1.56 1.621.79 1.87 1.92

2.05

2.94

3.02

3.25

5.66

0.00

1.00

2.00

3.00

4.00

5.00

6.00

0

1000

2000

3000

4000

5000

6000

Total Cases (June '09 - May '10) FTE's per 1,000 Cases

2010 Business Office FTEs per 1,000 Cases

Regent Average = 1.85

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0.92

1.121.25 1.27

1.36

1.56 1.61

1.70

1.93

2.11

2.22 2.25

2.29

2.39

2.57

2.84

2.99 3.02

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

0

1000

2000

3000

4000

5000

6000

Total Cases (August '12 - July '13) FTE's per 1,000 Cases

2013 Business Office FTEs per 1,000 Cases

Regent Average = 1.76

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0.90

1.071.12

1.281.33

1.461.53

1.53 1.551.60

1.69

1.711.79

1.83 1.84

2.23

2.33

2.77

0.00

0.50

1.00

1.50

2.00

2.50

3.00

0

1000

2000

3000

4000

5000

6000

Total Cases 2014 FTE's per 1,000 Cases

2014 Business Office FTEs per 1,000 Cases

Regent Average = 1.52

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Regent Average = 1.51

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The KPI

In the list of hypothetical ASC’s below, assuming charge masters are the

same, which one is in the best financial position and why?

a) Days in A/R – 35.0; Net Collection Rate – 97%; Percent A/R > 90 –11%; Gross Collection Rate – 69%

b) Days in A/R – 23.0; Net Collection Rate – 99%; Percent A/R > 90 –6%; Gross Collection Rate – 63%

c) Days in A/R – 40.0; Net Collection Rate – 92%; Percent A/R > 90 –16%; Gross Collection Rate – 74%

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Thank You!

“We wanted a company with a proven record of success that focused specifically on the ASC community”

Terri Gatton RN, CNOR, CASC

Administrator, Andrews Institute ASC

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Appendix A

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Michael Orseno

Michael Orseno brings nearly 21 years experience transforming revenue cycle processes and outcomes for healthcarefacilities and Regent Revenue Cycle Management. At Regent RCM, he is responsible for developing and deploying aunique service model that consistently improves financial outcomes while delivering increased efficiency and control.He leads a team of revenue cycle specialists, supervisors, and directors to ensure adherence and accuracy whiledefining protocols and best practices for the industry.

Prior to joining Regent, Orseno served as Revenue Cycle Administrator for the Chicago Institute of Neurosurgery andNeuroresearch. He received a Master of Science Degree in Health Systems Management from Rush University MedicalCenter and a Bachelor of Arts Degree in Public Administration from Augustana College.

[email protected]