Blue Cross Blue Shield Michigan Heads April's Chiropractic Office Billing Software Precision Index

Chiropractic Office Billing Software Performance Index (BPI) in April 2007 outperformed its March value by 4.3%, bringing the index from 18.9 up to 14.6, ahead of the national average of 17.7%, while replacing four of BPI participants in March on the list of top ten performers. BPI guides chiropractic office managers and helps the development of both chiropractic billing software and billing performance standards. This article describes a rule-based chiropractic billing index, including its coverage definition, update cycle, volume weighting, and provided information.

BPI = 14.6 means that the average of ten top performing payers working with Billing Precision clients have 14.6% of Accounts Receivable beyond 120 days. BPI is a key billing performance characteristic, as it is a proxy of the claims that are never paid. Obviously, the lower is the index the better is billing performance. The table below also lists the top ten performing payers and their relative index as recorded in the Billing Precision's system.

 

• Billing Precision Index 14.6
• Blue Cross Blue Shield Michigan 3.2
• Blue Cross Blue Shield Colorado 6.8
• Humana 7.9
• Blue Cross Blue Shield Illinois 11.1 (down from 11.2 in March)
• United Health Care 13.9 (up from 23.2 in March)
• Cigna 15 (down from 12.9 in March)
• Medicare New Jersey 16.4 (up from 20.5 in March)
• Blue Cross Blue Shield Texas 20 (down from 15.2 in March)
• Great West 22
• Aetna 22.1 (down from 20.9 in March)

April BPI dropped four participants since March:

• Blue Cross Blue Shield Pennsylvania
• Blue Cross Blue Shield Alabama
• Medicare Pennsylvania
• Blue Cross Blue Shield New Jersey

Three payers improved their index since March:

• Blue Cross Blue Shield Illinois 11.1 (down from 11.2 in March)
• United Health Care 13.9 (up from 23.2 in March)
• Medicare New Jersey 16.4 (up from 20.5 in March)

Three participants lowered their indexes with respect to March BPI:

• Cigna 15 (down from 12.9 in March)
• Blue Cross Blue Shield Texas 20 (down from 15.2 in March)
• Aetna 22.1 (down from 20.9 in March)

April BPI added four new participants since March:

• Blue Cross Blue Shield Michigan 3.2
• Blue Cross Blue Shield Colorado 6.8
• Humana 7.9
• Great West 22

Coverage

BPI is rule-based, i.e., payer participation in the index is defined by dynamically rules at the time of computation and not by a static listing of specific payers. Therefore, any specific payer may start or discontinue participation in the index, dependent on satisfaction of rule's conditions.

Current selection of payers for participation in the BPI is based on fifty top-volume providers across all United States that have received Billing Precision services for more than six months and have more than two hundred claims in their current Accounts Receivable.

Update Cycle

BillingPrecision.com updates BPI on a monthly basis.

Volume Weighting

BPI is volume weighted, which is important to accommodate future growth of provided information, index combinations, and sensitivity across multiple indices.

Information Provided

BPI computes the percent of Accounts Receivable beyond 120 days. Note that national average across all medical specialties of percent of accounts receivable beyond 120 days is 17.7%.

Summary

Chiropractic Office Billing Software Performance Index helps the development of both chiropractic office billing software and billing performance standards. Chiropractic office managers can use the index to benchmark their billing performance and guide its improvement over time. Rule-based index definition allows for automated inclusion and exclusion of payers in the index based on payer attributes, such as numbers of processed claims, accounts receivable distribution, certain mix of CPT codes, or patient demographics.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

Top 4 Transparency and Accountability Attributes for Electronic Medical Billing Software and Service

Medical billing industry has volumes of arcane terminology and payer- and time-dependent claim validity and pricing interpretation rules, facilitating massive payments of invalid or ineligible claims and denials of error-free claims. Process transparency provides its participants greater visibility of internal process activities. An increased level of access promotes teamwork, increases client satisfaction, and assists in process streamlining.

Billing process is the interaction between the participants (i.e., insurance company (payer), healthcare service provider (provider or doctor), patient, and billing service provider (biller)) designed to pay or deny a payment request (claim) submitted by the biller to the payer and to the patient on behalf of the provider. The amount and complexity of billing information make it very difficult for the doctor to maintain compliance and identify and resolve errors and underpayments.

Billing service transparency allows participants of the billing process to expedite error identification and resolution, resulting in reduced over- and under-payments and improved regulatory compliance.

Attributes of Billing Transparency

Billing transparency has four key attributes, including universality, continuity, ubiquity, and scalability.

• Universality: every participant in the billing process, including patient, provider, payer, and biller, has access to every aspect of the billing process.
• Continuity: process detail is available continuously on a 24 x 7 basis.
• Ubiquity: access to billing process is provided over secure standard Internet browser that requires no special hardware or software and is available everywhere.
• Scalability: both the big picture and minute detail are available for scrutiny universally and continuously. The big picture consists of total cash flow in a given time period, current submitted and failed claims, and billing quality metric. It must contain comprehensive summary of patient visits and unpaid balances. The minute detail pertains to individual claims making up the big picture, including complete history from the moment of creating the claim, testing its validity and eligibility, making corrections, performing submissions, reconciling payer messages and explanations of benefits (EOB) with original claims, until payment. Both perspectives must allow arbitrary aggregation of claims and drill in for detail to enable effective followup.

How to Build Transparency Into Your Billing Service?

A transparent billing service leverages technology to enable competent personnel to execute disciplined billing process. Therefore, to implement a transparent billing process, you must

[ ] Get access to adequate technology to support universality, continuity, ubiquity, and scalability.

[ ] Develop and thoroughly document claim processing procedures, including compliance and integration with practice workflow.

[ ] Train personnel in following the procedures and using the technology

[ ] Review personally and continuously billing quality, technology capabilities, adequacy of procedures, discipline, and training.

Note that Vericle-like technologies based on Straight Through Billing (STB) methodology implement billing transparency by design because billing transparency is an integral attribute of every component of STB process.

Yuval Lirov, PhD, author of Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk (Affinity Billing) and Mission Critical Systems Management (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

Count the Ways Medical Billing Software Helps You Save

Wouldn’t you want the newest billing software that meets all the needs of your business? Your clients will be more satisfied with the service you give them. Your staff will stay on top of details and be more efficient. You will be able to manage your practices with less worries and stress. Medical billing software is the easy, simple solution that will help you treat your patients right, make life on your staff less complicated, and help you stay in control of your business.

Now let’s count the ways medical billing software can help save you time and money.

1. Easy-to-use and maintain

2. Efficient and accurate in data entry process

3. Customizable to your office

4. Can work efficiently and effectively with multiple clinics

5. Doctors can schedule and manage patients from their office

6. Entry screens are easy to handle

7. Save on data entry time

8. Costs less than old software

9. User friendly

10. New employees will learn how to use it quickly

11. Tracking reports are ever changing to fit practices needs

12. Stay connected and updated with all your offices

13. Work anywhere with an Internet connection

14. It’s secure—HIPPA-compliant servers back it up 24x7

15. Technical Remote Service always available for your needs

16. Tier 1 data center facility ensures system upkeep

17. Reduce IT costs across the board—no extra servers, log-ins, or installations needed

18. Synchronize data

19. Pay-as-you-go—upgrade or keep it simple depending on your practice needs

20. Updates installed often (usually weekly) and major upgrades as you go along

21. Guided setup makes it easy on staff and you for use

22. Professionals train staff and offer continuous help

23. Organize and retrieve client folders without hassle

24. Multiple locations can work on the same real-time data all day

25. Reports are always up-to-date no matter where you are

26. Can archive, download and run reports day or night

27. System speed is quick

28. Pre-configured defaults

29. Have option for patient and appointment data imports

30. It’s web-based and easier to handle for your office than the old software

What do all of these mean for you? They mean better accuracy, more efficiency, and greater benefits for all involved. Not only will you save in time and money, but you will also reduce the amount of stress dealing with outdated software that doesn’t meet your needs. Medical billing software meets and takes care of your clients’ needs, your staff needs, and your needs. It will change the way you manage and keep up on all your office affairs for the greater good.

Jordan Bartlett is a client account specialist with 10x Marketing – More Visitors. More Buyers. More Revenue. For more information about medical billing software please visit AdvancedMD.

Electronic Medical Billing Software and Service Performance Metrics

Billing performance measurement is an integral part of medical practice billing process and a prerequisite to effective practice management. Systematic measurement becomes mission-critical with growth of billing complexity or outsourcing of the billing function. Traditional billing metrics are limited in scope and focus on claim submission process, ignoring process imperfections on the insurance (payer) side. Modern computer technologies allow both productive measurement and effective action by the disciplined billing office to improve claim submission and payment processes.

Using appropriate metrics helps improve policies and procedures, shorten revenue cycle, reduce patient complaints, improve financial performance and compliance, increase cash flow, reduce bad debt, identify areas of potential growth, improve employee morale, increase productivity, and reduce costs. Useful metrics must be comprehensive and simple. They must combine both complete end-to-end processes and their individual components. Metrics must be used consistently over time and compared to standards. Obviously, different standards apply to different medical specialties, patient demographics, payers, and samples of CPT codes.

Medical billing metrics typically include compliance, cash balances, charges, accounts receivable, and collection ratios to help monitor cash flow. This article focuses on performance metrics. For discussion of compliance program, see companion article on Medical Billing Compliance.

Collection Ratios

Traditional metrics include gross and net collection ratios. Both metrics are subjective to individual practice because they compare (often arbitrary) charges to (allowed) payments. (Net collection rate is defined as a ratio of Total Collections and Total Charges less Adjustments. Gross collection rate is defined as a ratio of Total Collections to Total Charges only.) According to Medical Group Management Association (MGMA) 1998 Cost Survey, adjusted fee-for-service collections (net collections) for family practices in 1997 averaged 98.65 percent. A declining net collection ratio may be symptomatic of increased contractual write-offs or insufficient number of denial appeals. This metric is especially useful in the absence of modern computer technology, when comparison of every payment to allowed amount is impossible, or when appeal process of denials is too expensive. Otherwise, the use of charges in defining gross and net collection metrics precludes them from productive discovery of process improvement opportunities.

Days in Accounts Receivable (DAR)

A growing number of days in accounts receivable are symptomatic of a faulty billing process. One way to determine DAR is to count days from the date of service to the date of payment for every claim and then average across all claims. A simpler way to compute average number of days in accounts receivable by taking a ratio of accounts receivable to average daily charges, or

Number of days in accounts receivable = (Accounts Receivable / Average Charge) x 365

This metric too depends on medical specialty, patient demographics, payer mix, and CPT sample. Another downside is that this metric is sensitive to provider as it counts the lag time of unsubmitted claims for services already delivered. This lag time roughly averages across all payers making DAR an effective comparison metric between payers for individual provider but invalidating it across multiple providers.

One obvious advantage of DAR metric is its independence of charges. The averaging feature of this metric eliminates sensitivity to specific day or CPT but also hides the behavior shape of the accounts receivable curve.

First-Pass Pay (FPP Rate) and Denial Rate

FPP is the percentage of claims paid in full the first time upon submission (subject to federal or state timely payment regulations: 15 days for electronic submission and 30 days - for paper).

Denial rate is the complementary metric to FPP rate. It counts the percent of claims that require followup and therefore cost more to process. Followup may take the form of a phone call to payer to discover a lost claim or to receive interpretation of denial message, correction of earlier submitted data, resubmission of the original claim, consultation with the provider and medical notes, or denial appeal.

Both FPP and Denial rates are very important metrics often used for billing process improvement. The upside of FPP/Denial metric is that it is charge-invariant but its downside is that it hides the differences between process imperfections on the claim submission and claim payment sides. To identify patterns of problem CPT codes or payers, FPP/Denial metric needs to be computed and compared across all pairs of payer-CPT code, which is a standard feature for modern billing technologies.

Patient Liability

Percent of Patient Liability is the ratio of patient responsibility to total billed charges and it roughly reflects patient deductibles. This measure is important in measuring front office function as it has little to do with clean claim submission or effective followup.

Percent of Accounts Receivable Beyond 60, 90, and 120 Days (PARB60, PARB90, and PARB120)

PARBX resolves the sensitivity issue of DAR metric and offers simple and charge-invariant metric of billing process. Its graphic representation has a skewed bell shape. Its steepness represents billing process quality: a steep curve and thin tail means healthy billing process, while a flat bell and a fat tail means billing problems.

According to the MGMA survey, 25.35 percent of the average family practice's accounts receivables were more than 120 days old in 1997. This number has improved down to 17.7% in 2004.

In summary, comprehensive and charge-invariant metrics, such as PARBX, are more informative and objective than collection ratios. However, these metrics alone fall short from identifying specific areas for billing process improvement. Modern technology helps identifying billing bottlenecks as it allows interactive review of multiple metrics along different aggregation dimensions. For instance, PARBX metric is especially helpful to identify patterns of problem claims containing specific payer or CPT code. Further, modern Vericle-like technologies enable comparison of every payment to allowed amount and subsequent appeal on every denial, effectively reducing the average percent of accounts receivable to low single digits.

Yuval Lirov, PhD, author of Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk (Affinity Billing) and Mission Critical Systems Management (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com