ASC Revenue Cycle Benchmarks to Know and How to Improve ... · ASC Revenue Cycle Benchmarks to Know...
Transcript of ASC Revenue Cycle Benchmarks to Know and How to Improve ... · ASC Revenue Cycle Benchmarks to Know...
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
Agenda
• Core ASC Revenue Cycle Benchmarks
• Appendix A – Speaker Biography
“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
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
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
% of A/R Greater than 90 Days
• Definition: The amount of $$ as it relates to total AR
greater than 90 days outstanding
• Calculation: Total AR greater than 90 days / Total AR
• Regent Standard: Less than 15%
• Uses: High % of AR greater than 90 days may emphasize an
issue with patient collections or insurance denials
Net Collection Rate
• Definition: The % of eligible $$ 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
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
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
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
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
Regent Average = 1.51
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%
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
Appendix A
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.