3 Simple CHC Billing Metrics Every Exec Should be Tracking in 2019

Categories: PMG Insights Blog

January 4, 2019

Billing and Revenue Cycle Metrics for CHC Executives As a CHC Executive, what are your most pressing goals for 2019? Would you like to open a new location or add more providers? Perhaps you would like to add a new services line and offer optometry or pharmacy services. No matter what your goals are for 2019, sufficient revenue is needed to make them happen. You will need to keep a close eye on billing related revenue in order to maximize your opportunity and the best way to do that is through oversight of Key Performance Indicators (KPI). PMG tracks a variety of KPI’s for all of our revenue cycle clients. While each KPI offers valuable insight we all know that the average CHC Exec does not have time to drill down to a granular level on each one and must rely on key stakeholders.

Today we will share three critical KPI’s that you should closely monitor this year. Monthly measurement and dialogue with your billing leadership are essential to diagnose root causes that impede optimal performance and to develop strategies to resolve.  Create a game plan to address these issues and watch these KPI improve over time. Stick to this method for all of 2019 and watch your revenue improve in 2020 and beyond.

How much are you paid per visit? How about other FQHCs in your state?
Blended Encounter Rate

The Blended Encounter Rate (BER) is an average payment per encounter (visit) based on total visits and total payments. How does your center’s BER compare to other FQHCs in your state?

How to calculate BER:
Total Annual Payments ÷ Total Annual Visits = BER

To calculate the average BER for FQHCs in your state go to the most recent UDS data and select your state from the map. Select the ‘State Program Grantee Data’. Total Payments can be found on Table 9D, line 14. Total Visits can be found on Table 5, line 34b

If you find your FQHC is below the state average you can calculate the potential lost revenue:
Step #1 – State average BER – Your FQHC BER = Lost revenue per visit
Step #2 – Lost revenue per visit X Total Annual Visits = Potential lost annual revenue

How long is taking you to get paid?
Days in Accounts Receivable

Days in AR (DAR) measures the average number of days it takes a center to collect or fully adjudicate a claim. PMG’s benchmark is 30 days but this may vary by region and payer contract. There is a definite red flag at 50 days in AR due to payer filing timelines.

How to calculate DAR:
Total AR ÷ (Total Charges ÷ number of days in charge period) = Days in AR

Do you have enough Billing staff?
Staffing Levels

How many billers do you need to run your billing offices? HBMA and MGMA benchmarks encounters/ visits managed per staff person (all aspects) as 20,000 visits per year for Electronic Charge Capture and Payment Posting and 15,000 per year for Manual Charge Capture and Payment Posting.

How to Calculate Staffing Levels:
Total Number of Visits ÷20,000 or 15,000 (as applicable).

Make Your Revenue Cycle Goals a Reality

Be diligent in tracking these metrics month over month. Note where you are today and decide where you would like to be. Use the KPIs to start meaningful conversations with your billing staff and work together to set attainable quarterly goals. Task your billing management with creating an action plan detailed down to payor category and denial reason to meet those goals and measure progress to plan. If you commit to this process and follow it diligently throughout the year, you will see the increased revenue that will make your goals a reality.

 

Conquer your Revenue Cycle: 3 KPIs Every CHC Should be Watching  (PDF)