At Smrtdo Medical Billing, our primary purpose is to help healthcare providers optimize their reimbursements and maximize their revenue. We have spent 13 years working with a wide range of practices, specialties and hospitals and we have gathered important data along the way.
Here are the top 5 metrics we found you should watch to maximize your revenue cycle process:
1. Verification of Benefits should be 100%
The whole billing process starts at your front desk. It is highly important that your staff is using up‐to-date, Practice Management System (PMS) to verify eligibility or any system to verify insurance coverage while scheduling the appointment.
Succeeding in this step is key to prevent lost or delayed revenue from billing the wrong insurance.
2. Coding review and claim scrubbing should be 100%
After making sure that we are billing the right insurance and we have checked that the coverage is active, all procedures and diagnosis coding has to be reviewed and scrubbed. We have to be 100% sure that the ICD-10-CM, CPT, HCPCS codes and appropriate modifiers are billed. This will reduce the percentage of claims that are denied, delayed, or partially paid, and thus prevent lost revenue for the practice while optimizing time and effort.
During this process, the coding review and scrubbing is performed by a combination of experienced and certified coders and highly sophisticated coding and claims scrubber software.
3. Clean claim submission rate should be greater than 95%
When you are ready to submit the claim without errors, we are aware that all the steps taken
before submitting the claim are essential to increase the cash flow, minimize days in accounts
receivable, and prevent lost revenue from denied, delayed, or partially paid claims.
Also a highly experienced billing partner like Smrtdo Medical Billing can be on top of details that
can be corrected prior to the final submission of a claim, this will reduce the number of times that
the billing staff intervenes with the claim and will help to have a healthy Accounts Receivable.
4. A/R over 120 days should be less than 3%
For some reason many practices are beginning to consider A/R over 120 days to be “write offs”.
But claims that may fall in this bucket are most of the time insurances that do not accept
electronic claims. Since we know that mailing claims can take a long time before the insurance
receives and process the claim, we need to keep track of it to make sure that even though the
claim is in this bucket can still be collected and not be a write off for timely filing, but it is
important to base your calculations on the actual age of the claim based on the date of service.
5. The Denial rate should be less than 5%.
Most of the cases the claims can fall into the denials bucket for situations that can be avoided,
such as getting the patient´s name misspelled, a wrong date of birth, a mistyped or expired policy
ID number or because some patients depending on their policy may require an authorization.
Not paying attention to the denial rate can lower your revenue and create more delays before you
can actually collect the money for the services rendered. Smrtdo Medical Billing works hard to
improve your collection rate while correcting this errors enhancing your cash flow reducing billing
and coding errors.
There are also many factors that you have to be on top at the same time while taking care of your
patients. Partnering with Smrtdo Medical billing is great asset to your billing department process
so you can continue to deliver the medical attention your patients require while we focus on all
your billing process to keep your healthcare organization running.
Editor’s note: Ilka Cruz, Operations Manager at Smrtdo Medical Billing, wrote this article.