Medical billing metrics are those critical performance indicators that enable an effective revenue cycle that work towards continuous improvement and realizes practice goals. Metrics are a crucial element to gaining control over profitability and operations. However, every practice needs context and benchmarks to make their internal measures meaningful. Benchmarks must span across time, against established goals, and the competition. Without clearly defined performance indicators it will be difficult at best to measure the performance of a clinics revenue cycle in the short and long-term.
One important measure of success is the first-pass resolution rate, or the share of claims that are paid on the first round of submissions. To calculate your first-pass resolution rate you take the total number of claims paid divided by the total number of claims submitted during a specified period of time. The result should be 90% or greater and is a measure of the effectiveness of the billing process from start to finish. This includes the pre-visit and verification all the way through to coding and billing. The tighter the process, the less chance for rejections on the first pass. As a matter of fact, ORI averages 95% across all accounts in this area!
A means to achieve higher first past resolution is by measuring clearinghouse submission first-pass clean claim rates. Having a rigorous process of rules established at the clearinghouse level will ensure fewer claims are rejected at the payer. ORI prides itself in working to meet and exceed internal and external benchmarks and strong client relationships enable a fine tuning that can produce real results.
In fact, Specialists in General Surgery and Outsource Receivables were recognized by Gateway in October for the collaborative efforts and attention to detail which resulted in a 99% clean-pass rate; granting access to the Gateway 99% club! The team’s effort was recognized at the eClinicalWorks National Conference in Texas this past month. Darla Morris-Preble of SGS and Duane Horn of ORI accepted the recognition on behalf of the team. Keep up the great work!
Check-out the video from Gateway which lays out the steps needed to achieve success: