Quick Tips to Improve 5 Top ASC Revenue Cycle KPIs

One of the most effective ways to strengthen an ASC's revenue cycle performance is by monitoring key performance indicators (KPIs) and then acting when KPIs start moving in the wrong direction.

Here are five of the most important ASC revenue cycle KPIs and tips to improve their performance and address obstacles to success.

1. Days to bill/charge lag

Monitoring average days to bill helps ensure cases are billed promptly and payments are received in a timely manner.

Tips for improvement:

• Establish an efficient process for business office staff to submit requests (e.g., coding queries, report amendments) to providers to receive timely responses.
• Closely track any missing documentation (e.g., pathology report, history and physical, implant log, invoice) to better ensure timely responses to payer requests.
• Do not delay billing for a missing invoice if the invoice is not required by the payer. Also, do not hold up billing for implant pricing if the implant is not covered by the payer.
• Address any billing team deficiencies immediately. Delays in tackling these problems will likely lead to the problems growing. Improve the likelihood of identifying issues by monitoring team productivity, days to bill, clean claim submission percentage, tracking of held cases, and charge entry accuracy.
• Monitor physicians' days to dictate and have a policy in place to address delinquencies.

2. Days to pay

This KPI indicates how long it takes to receive primary insurance payments. As with days to bill, payment delays will negatively affect the bottom line.

Tips for improvement:

• Always review the insurance and insurance identification entered in the demographic screen prior to claim submission. This will help ensure more accurate entry and avoid delays that occur when the claim is submitted to the wrong insurance.
• Perform quality assurance (QA) review of charges prior to claim submission.
• If a payer requires paper claim submission, follow up with the payer within 14 days to confirm the claim was received and is on file. Problems with paper claims submissions can significantly contribute to an increase in this metric.
• Follow up on all claims within 21 days of submission to verify the claim was received and is in processing. Doing so will also help identify denials sooner and empower you to respond faster.

3. AR>90

Tracking accounts receivable (AR) greater than 90 days is a valuable means of achieving early identification of payer issues.

Tips for improvement:

• Work all claims within 21 days of claim submission to ensure they are received and in process. Confirm that the payer requires no additional information to process the claim.
• If a case includes a covered implant(s) and/or biologic but the invoice is not available upon claim submission, track and submit the invoice as soon as it is available.
• Perform QA review of all charges prior to claim submission. This will help you avoid errors that lead to payment delays and age the account.
• Address all denials within 48 hours of receipt.
• Submit appeals within 48 hours of receiving a low or incorrect payment.
• Treat patient balance AR equally to insurance AR. Work patient balances consistently. Implement a process to refer patients to collections when patients are not responsive to outreach efforts and statements.
• Once you are paid by the primary payer, immediately drop the balance to the secondary insurance or patient.

4. Days in AR

Days in AR indicates the time it takes for an ASC to completely resolve the case from its AR, which includes any secondary and patient billing. Tracking days in AR is important for identifying revenue cycle issues.

Tips for improvement:

• Monitor days in AR by financial class. This will enable you to better determine offenders.
• Create reasonable benchmarks for each payer type. If even a slight increase occurs, there are likely recurring issues.
• Review cases under the offending financial class to better understand the reason(s) for an increase.
• Reviewing days in AR by financial class can help isolate the offenders without specific types of cases skewing the numbers.
• Complete an audit of the AR. This should help to further determine reasons why a specific financial class has a higher days in AR. Focus on addressing any common problems first.

5. Denial rate

If denials are not addressed in a timely fashion, they will negatively affect the majority of a center's revenue cycle KPIs.

Tips for improvement:

• Perform QA review on claims prior to submission. This will help you ensure accuracy.
• Make sure your charge entry team knows the specific contracts and payer rules on required documentation for full payment of the claim.
• Coding and billing teams should know when a code will not be payable. If the coding or billing team identify such a code, the business office should be notified immediately. If there is a non-payable code issued, conduct a code review with the history and physical (H&P) to determine whether there is an alternative code that is payable and compliant. If no such code exists, the provider should review the case, along with the local coverage determination (LCD) requirements, to determine whether an amended report is justified.
• Front office issues can inflate an ASC's denial rate. Authorization is commonly associated with denials. Denials related to authorization can occur if the insurance representative does not provide the correct information, the insurance verifier is not asking the correct questions, and/or the scheduled procedure code differs from what was performed. It is important to report the authorization number on the claim to avoid erroneous denials. If the code changed and authorization was required, address it immediately. Some payers will only change an authorization up to 14 days past the date of service. If the change is not completed during this two-week period, the payer will likely issue a permanent denial or apply a penalty.

Improving KPIs Through Outsourced ASC Billing

Underperforming KPIs is just one of the factors motivating ASCs to consider outsourcing their billing. Outsourced ASC billing can deliver significant revenue cycle improvements as well as operational and clinical benefits, many of which are highlighted in our latest e-book, "Overcome Top ASC Challenges With Outsourced Billing." Request your copy today!