Do you know your payers' average turnaround times? Using analytics to pinpoint payment speed can mean big benefits for your business office. The key metric used here is the average number of days from billed claim to payment. Evaluating these results can impact more than cash flow. Here are a few examples:
Staff follow-up activities are structured most efficiently around expected payment turnaround. If payment is not received by the expected date, get to following up! Avoid grouping payers in the same follow-up queue if the expected payment turnaround time differs. For example, if expected payment is 14 days from claim submission for Payer X, do not wait until day 30 to begin follow-up. If average payment turnaround for Payer Y is 45 days, it's too early to follow up at 30 days. By making adjustments to the follow-up queue based on your average turnaround statistics, staff time is used more effectively.
Frequent review of payer contracts can aid in determining how to set your filing limits and ensure payers are held accountable to their established payment timelines. The ultimate goal is to allow three distinct payment cycles to submit a correct claim. If a payer filing limit is 60 days from the date of service and a denial is received on day 35, there's only one more chance to submit a corrected claim before the filing limit. In this case, negotiating with the payer on the contracted filing limit is beneficial. Sound like a bit of a challenge? If you have historical payment data on hand, you have a stronger argument on extending the filing limit. If possible, negotiate a clause requiring the payer to include interest payments if full payment for services is not received by a stipulated date.
Identifying ICD-10 Issues Early
Benchmarking average turnaround right now means you have the ability to quickly identify payer issues after the ICD-10 transition in October. If you expect payment in 29 days based on your payer analytics and payments start coming in slower, it could mean a processing issue. This method works regardless of contracts being in place - even for Medicare and Medicaid - as you are quickly alerted to payment delays that are outside of the norm.
The easiest ways to track payment turnaround is through use of a tool such as a dashboard. The Claim Statistics dashboard in efficientC highlights payers with the longest payment delays. If your organization or revenue cycle vendor does not offer a similar solution, manual tracking is effective (although more time-consuming). In Microsoft Excel, perform a query of all claims paid for a chosen payer. Calculate number of days from billed date to paid date and then determine the average number of days to pay.
For more information on our Claim Statistics dashboard, contact firstname.lastname@example.org or see a demo at www.efficientC.net.