ASC RCM Quick Tips: 5 Key ASC Revenue Cycle KPIs and Their Benchmarks
By Angela Mattioda, Sr. Vice President of RCM Solutions & Client Experience
To identify revenue cycle shortcomings, monitor key performance indicators (KPIs) and compare your performance against benchmarks. Here is a selection of five ASC revenue cycle KPIs worth tracking and their corresponding benchmarks.
Days to bill/charge lag. Monitoring the average days to bill helps ensure cases are billed promptly and payments are received in a timely manner. The standard benchmark for days to bill/charge lag is less than two days.
Days to pay. This KPI indicates the time it takes for an ASC to receive primary insurance payments. Days to pay varies by payer, so benchmarks will vary by ASC. "Sweet spots" to target is 35 days overall, 18 days for Medicare, and up to 55 days for workers' compensation cases.
AR greater than 90. ASCs should strive to collect payments within 90 days. The total AR percentage over 90 days should be below 15% of AR. When an ASC's AR percentage over 90 days exceeds 15%, this indicates the likelihood of revenue cycle problems, especially when the percentage greatly exceeds a center's norm. Analyzing this metric by financial class will help narrow down issues.
Collection rate. This metric can provide valuable statistical analysis on the timeframe of collected revenue. The collection rate is the percentage of expected revenue collected within aging buckets. A 98% collection ratio is industry standard, and the goal is to achieve this ratio within 90 days of claim submission. To take the value of this metric further, monitor your profit and loss rates.
Denial rate. This KPI tells you the percentage of claims being denied by payers. The standard benchmark is less than 5%, although a rate as low as 1% is achievable.