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Benchmarking Accounts Receivables: A Whole New Way To Think
by Adam Gobin & Adam Townsend
Benchmarking What’s the goal?
Status Quo: Track DAR by historical and/or average across 12 months
After today: Track DAR by analyzing days to pay + denial turnaround time
Average DAR Targeted Goal/Benchmark DAR
Chapter 1: Categorization of Denials Chapter 2: Categorization of Claims/Remits Chapter 3: Key Take-Aways
Today’s Agenda Changing the definition of benchmarking
Payor
Provider/ Health System
Employer Groups
Healthcare Reform
ICD-10
Medicare Hedis
Days in Accounts Receivables (DAR) Impacts Wow.
Chapter 1: Categorization of Denials
Too Much Data to Develop True Understanding Big Data can be overwhelming
It’s an incredibly complex process to create a simple one.
Denial Centralization
Denial grouping and accurate routing for efficient follow up
Denial Centralization Hyper-specialization At Its Best
Medical Documentation Pre-cert/Auth
Registration/ Insurance
Non-Covered Services
Duplicate Denials
Provider Related
Denial Centralization Hyper-specialization At Its Best
Denial Centralization Hyper-specialization At Its Best
Emory is using CORE standards to be able to effectively redefine centralize groups on a recurring basis.
Chapter 2: Categorization of
Claims/Remits
Denial Turnaround Time Days to Pay
Denial Centralization
Effective Benchmarking Toolbox 3 Focus Areas
Average number of days it takes for denied claims to get paid
The number of days it takes for claims to get paid
Denial grouping and accurate routing for efficient follow up
Department of Orthopaedics Case Study
Look at data that shows payment after working denied claims
This data tells us how long it takes to get paid after internal processes and insurance processing of denied claims
Denial Centralization
Denial grouping and accurate routing for efficient follow up
Department of Orthopaedics Case Study
A B C D E 27130 18 13 12 11 12
27447 16 14 11 11 13
20610 14 12 12 15 14
29888 15 15 13 13 11
29881 17 15 13 15 16
Top Cash CPTs Resubmitted Claims
Denial TAT
Average number of days it takes for denied claims to get paid
A B C D E 27130 26 21 39 29 32
27447 36 32 27 31 28
20610 31 28 26 33 33
29888 29 31 31 33 32
29881 33 29 32 32 34
Recommendations: 1. Compare paid claims vs denied claims - what’s the difference - focus in on the issues! 2. Calculate the Denial TAT by subtracting the claim resubmission date and the reject date
Goal: Decrease days to pay, increase cash flow
Avg: 13 days
Avg: 30 days
Scientific Benchmarking Formula.
By digging into this bucket, we can figure out root causes to reduce denial TAT. Example, diagnoses 844.2 and 840.4 were used and these indicate sprains - the insurance company needed more specification.
Avg: 7 days
Incredible Products Deliverables that make your CFO Smile.
Scorecard Meaningful Target
A B C D E 27130 18 13 12 11 12
27447 16 14 11 11 13
20610 14 12 12 15 14
29888 15 15 13 13 11
29881 17 15 13 15 16
Market your days to pay scorecard at your managed care meetings to encourage payor to pay sooner!
50 32
Accomplished an 18 day turnaround by focusing on the top 2 CPT AR drivers - addressing coding
The average or historical DAR becomes a more real number - a more effective and aggressive target
And One More You’d Really Love A Brilliant one.
Predictive Analytics
A B C D E 27130 18 13 12 11 12
27447 16 14 11 11 13
20610 14 12 12 15 14
29888 15 15 13 13 11
29881 17 15 13 15 16
Predictive payment schedule
Predictive claims submission
Chapter 3: Key Takeaways
Although DAR is a great metric…what drives the below formula…is truly…
Days to pay.
