A/R Aging > 90 Days:
Is your total A/R Aging > 90 Days greater than 15%? of that A/R Aging > 90, is more than 50% concentrated to 1 or 2 single payers? If so, within those payers is it a few major modalities that are the culprit? Within those modalities what procedures specifically make up the majority of your aging? Whatever is broken can be fixed.
DNFB and Charge Lag:
Is your DNFB (Discharged Not Final Billed) or Charge Lag greater than 2-3 days? If so, where is the bottleneck? Is it in coding, failed claims, documentation, patient access, revenue integrity/auditing, charge capture or billing? If it is limited to one main area, are their staffing levels appropriate for the volumes of work they are encountering? If those volumes are seasonal, do you need a vendor to help you take on some of that work temporarily?
Cash Collections as a % Of Net Revenue:
On a rolling 12-month basis, are you collecting at least 98-100% of your net revenue? If not, is it due to high aging >90, high denials, payment posting backlog, insurance follow-up backlog, billing backlog, or poor patient collections?
Bad Debt Write-Offs:
Do your Bad Debt Write-Offs exceed 3% of Gross Patient Revenue (GPR)? If so, is it concentrated to certain levels of balances (i.e. balances > $500), certain modalities (i.e. Surgery, or Radiology), or a lack of an Early Out (Pre-Collection) vendor? Is your Time of Service Collection process yielding a collection rate of at least 25% of patient expected? Are you collecting at least 50% all Balance After Insurance (BAI)? Do you have sufficient payment options to help patients pay their bills (i.e. patient financing or upfront discounts)?
Are your independent coding audits showing an accuracy rate of > 95%? Are you missing MCC's and CC's that could yield higher reimbursement? How do your severity classifications look on inpatient? Does your documentation support Inpatient status vs. Obs. Do you have a high rate of coding denials? Do audits show that you are missing procedures or incorrectly prioritizing ICD1O diagnoses? Time to take a look under the hood. This area not only yields dollars, it is what reflects the quality scores for your company.