Improving ASC KPIs: Clean claim percentage, denial rate, and denial reason trending
Written by Angela Mattioda, Vice President of Revenue Cycle Management Services, Surgical Notes
When ASCs proactively monitor and analyze key performance indicators (KPIs), they can effectively influence their facility's revenue cycle performance by catching problems that decrease revenue, profits, and staff productivity and performance. Once identified, surgery centers can apply data-driven improvements that reverse these trends.
This fourth article in an ongoing series about improving ASC KPIs focuses on three related metrics: clean claim percentage, denial rate, and denial reason trending. Note: Access the previous article on days in accounts receivable (AR) and AR greater than 90.
Why you should monitor these KPIs
Tracking clean claim percentage — which is calculated by measuring the percentage of payers' rejections of claims — is critical as the submission of clean claims helps reduce the denial rate and better ensures timely payment.
Tracking the denial rate is important because when ASCs fail to address denials in a timely fashion, this will negatively affect the majority of a center's KPIs. It can also cause an ASC to lose money, such as in the form of lost interest or completely lost payments when claims are permanently denied.
Just as significant as monitoring denial rate, tracking denial reasons helps an ASC identify whether it is experiencing an issue with a single claim or facing a possible trend that can contribute to growing and ongoing denials.