10 Things to Know About 10 ASC Revenue Cycle KPIs
How can you gain better control over your ASC's revenue cycle performance, catch problems hurting your bottom line, and identify opportunities for improvement that can enhance profitability? By monitoring your revenue cycle key performance indicators (KPIs).
Here are 10 things you should know about 10 of the revenue cycle KPIs your ASC should be monitoring.
1. Days to bill
Higher or inconsistent lag days make it more difficult to ascertain revenue estimation. Lengthy delays could lead to denials, lost payments, and increased days sales outstanding. It’s important to understand the composition of this metric (dictation, pending documents, provider queries, coding, and billing).
2. Days to pay
As with days to bill, payment delays can negatively affect the bottom line. Make sure to trend this metric by payer or financial class. Most practice management systems have the ability to report this metric based on when the primary insurance payment is received.
3. Accounts receivable (AR) > 90
When AR percentage over 90 days hits and exceeds 15%, this may indicate revenue cycle problems. Immediately review the offending financial class for issues. Institute a metric benchmark for your center based on your case mix. Keep in mind a lower case volume in the 0-60 buckets will have an impact on this KPI.
4. Days in AR
An increase in days in AR (i.e., days sales outstanding), barring any major changes to the factors influencing the KPI, points to developing issues. If you are receiving insurance payments but the figure continues to rise, there is likely an internal problem keeping your cases open.
5. Days to dictate
If dictation delays become significant, act immediately. You can risk losing payment due to timely filing deadlines.
6. Denial rate
A high denial rate percentage indicates one or more problems within an ASC. These can include coding issues, billing issues, documentation/dictation issues, and performing cases without proper preauthorization and/or medical necessity approvals. Denial management is a critical component to monitor initial denials and final denials that result in lost revenue.
7. Clean claim percentage
A high volume of claims rejections leading to a drop in the clean claim percentage indicates an ongoing claims or clearinghouse issue. Every rejection must be re-worked which can take substantial resources.
8. Percentage of collections for cases > 90 days
A declining percentage of collections for cases greater than 90 days indicates older AR is not receiving the appropriate attention it deserves. This can translate to significant money left on the table.
9. Revenue per case
Do not just focus on declines in revenue per case. An unexpected increase in revenue may point to a concerning issue such as upcoding or overpaid cases that indicate a contract issue
10. Cases in AR
An increase in this metric, when not accompanied by a corresponding increase in case volume, is an indication that your center is failing to close out its cases and leaving money on the table.
The Key to ASC KPIs
Closely monitoring your revenue cycle KPIs and then taking corrective actions when performance starts to suffer will put your ASC in a position to achieve meaningful improvements that can help your short- and long-term financial stability and profitability. The use of next-generation analytics, which take an even deeper dive into revenue cycle data, can unearth new insights and further support your KPI monitoring and analysis efforts.