Top 5 revenue performance KPIs every orthopedic group should track

Orthopedic group practices are continually looking to cut costs and improve throughput. Access to vital financial data will help in eliminating revenue cycle inefficiencies and increase revenue management ROIs. According to a 2016 survey by Black Book, 9 out of 10 medical practices cited that they’re not financially and technologically equipped to offer value-based care.

Labyrinthine and confusing financial reports and a deluge of information generated every month make tracking key metrics arduous. Tracking the data that matters will help group practices stay financially stable in today’s volatile healthcare space.

Here are 5 metrics you should track to identify incremental revenue opportunities, monitor the productivity of physicians, and reduce compliance risks.

Why it is important: Denials are expensive. Following up on denials is becoming increasingly complex and costly. According to a recent study, the percentage of revenue written off by medical practices has increased by 5.9% over the last year. Monitoring and categorizing denials will help your group practice to identify and work on preventable denials, reduce hard denials and monitor key denial management metrics.

Benefits: Ortho group practices can spot denial patterns and trends. Identifying the root cause of denials helps in zeroing down on denied claims and working out an effective denial prevention strategy.

Your report should consist of:

✶ Denial type

✶ Value of claim

✶ Insurer details

✶ Reason code

✶ Description of the denial code

✶ Claim resubmission date

✶ Result

Why it is important: Are you waiting for months on end to get paid? Don’t blame your insurer. Blame it on a slow claims cycle. The number of days it takes for your claims to get reimbursed indicates the accuracy of your claims, the average payment TAT of insurers, and monitors claim submission delays.

Benefits: By tracking the reimbursement TAT of medical claims orthopedic group practices can correct claims cycle inefficiencies, accelerate their claims cycle, submit cleaner claims, and communicate with slow-paying insurance companies to request quicker reimbursement.

Your report should consist of:

✶ Insurer details

✶ Claim submission date

✶ Claim payment date

✶ Number of days to payment

✶ Average reimbursement TAT

Why it is important: The biggest bottleneck orthopedic group practices face today is apportioning payments to physicians. The growing popularity of bundled payment programs makes the tracking of physician productivity scores essential. A report that tracks and details the productivity metrics of physicians can prove to be indispensable.

Benefits: Having a solid understanding of how each physician performs at an individual level will help group practices to take proactive business decisions, based on data and not guesses. Physicians can benefit by setting goals, check how he/she compares with other physicians and determine estimated compensation.

Data points to be tracked:

✶ Number of patient visits

✶ Total number of appointments

✶ Number of new visits

✶ Charges

✶ Collections

✶ Revenue per provider

✶ Productivity ratio

Why it is important: Developing a baseline assessment of your AR will enable you to ascertain the health of your underlying cash flows. Generating AR analysis and aging reports is important because the older the AR gets the more difficult it is to collect. High-deductible health plans in the consumer-driven healthcare marketplace of today have further compounded this problem. Analyzing AR reports will result in lesser money left on the table.

Benefits: Breaking down patient AR from insurer AR equips orthopedic group practices to understand what’s driving each of them. An AR analysis report will enable group practices to prioritize accounts and improve revenue. A detailed accounts receivable report will help you to optimize payer performance and identify patient’s propensity to pay.

What, needs to be tracked:

✶ Claim number

✶ Patient details

✶ Insurer information

✶ DOS

✶ CPT

✶ Billed amount

✶ Balance

✶ AR calling details

✶ Result

Why it is important: Orthopedic coding is complex. It requires in-depth knowledge of key anatomy parts and LCD guidelines. So it is little wonder that the most common denials encountered by orthopedic group practices are coding-related denials. A thorough coding review report is important to reduce coding errors and compliance risks.

Benefits: A concise orthopedic coding report can help you conduct internal coding audits. Knowing what the commonly miscoded procedures are will enable ortho medical practices to make course corrections. It will reduce DNFB, increase coding throughput and ensure accuracy.

Your report should detail:

✶ Insurer details

✶ Top-paying CPT codes

✶ Commonly rejected codes

✶ Top value CPT codes

✶ Compliance of codes with NCCI regulations

Claims data forms the backbone of your revenue cycle. Monitoring, analyzing, and interpreting it will light the way for consistently productive and profitable healthcare organizations.

Utilizing dashboards and scorecards to view pertinent productivity and revenue performance metrics is essential to stay financially successful in the current volatile healthcare space