Q1 denial rates reached a national average of 16.1 percent
Financial health is critical to every organization. Yet, as patients become responsible for a greater share of their healthcare costs it’s more important than ever for healthcare organizations to maintain effective billing and collections processes to ensure the financial health of their organizations.
While greater pricing transparency and improved patient collections processes may help improve the bottom line, comparing billing and collections data against peers is yet another view that can help healthcare organizations improve billing and collections processes.
Using comparative analytics, billing companies can help clients identify and address billing and collections issues to improve and correct revenue cycle issues before they impact cash flow. Leveraging technology to aggregate data allows organizations to compare clients’ current and historical data with national and state benchmarks based on industry ERA data, creating a 360-degree view in areas such as code utilizations, claim denial rates, and more.
Benchmarking key metrics and comparing the performance of an organization against their peers — by specialty and geography — provides a snapshot of overall business performance to pinpoint where providers compare in relation to a particular standard. For example: If accounts receivable averages more than 50 days, benchmarking can provide a comparison to reveal where they stand in relation to industry peers — determine whether this is a normal range or if there are internal issues impacting a specific provider's ability to get paid in a timely manner.
Insights gleaned through comparative analytics can provide a more complete snapshot to improve billing and collections processes. Billing companies can leverage comparative data to:
- capture revenue-related trends and statistics — whether reimbursement, claim rejections and denials, collections, or payer trends — to reveal the financial health of a provider's practice and determine processes and action items to improve operations
- evaluate gross reimbursement and collections to determine whether you are being paid the same as peers
- evaluate collections and determine whether there are existing systems, techniques, or tools available to help improve collection ratios
- evaluate payment velocity to determine whether payers are paying your peers faster than your organization
- obtain information about practice revenue cycles and leverage that information to more efficiently manage the revenue cycle
Comparative Analytics Uncover Spikes In Denials, Billing Patterns
When spikes in denial rates or billing patterns occur, providers need a way to determine whether the spike is specific to their practice or if their peers are also experiencing spikes, and whether the same spike occurred in previous years. Armed with this information, practices can best understand the reasons for spikes and how to address them.
For example, a provider who is concerned about spikes in denials can leverage comparative analytics to trend service lines billed to a specific payer to ensure that there are no spikes in either the number of lines billed or the number of lines denied, helping identify and reduce future spikes in billing and denials.
Using comparative analytics, practices can analyze and trend:
- The total number of service lines billed for the practice and the percent of denied service lines.
- The total number of service lines returned in the 835 over the last 12 months.
- Against their own data for the previous 12 months for year-over-year analysis.
- The percentage of denied service lines for a given time period. Allowing practices to compare the data to state and national averages to see what the denial rates are for peers in the same specialty.
With these reports, the provider can now monitor and resolve any spikes in the total count of service lines that are occurring, as well as any spikes in the number of denials.
The importance of comparing billing and collections data against peers can go a long way in helping practices understand underlying causes for issues, and correct the issues before errors impact the bottom line. As the industry braces for yet another policy shift, monitoring the bottom line takes on even greater importance than ever before.