Creating medical billing reports can help you diagnose the health of your practice. Reports can show you how your practice is performing on important revenue cycle metrics, whether claims are being paid in a timely fashion and how well insurance carriers are paying you for key procedures, among other things. These reports will provide you with accurate information regarding the health of your practice saving you from lost revenue, keeping your practice financially sound while allowing you to free up your clinical staff and resources to better serve your patients, increasing your reimbursement average, reducing insurance company denials of payment, taking care of unpaid accounts, and decreasing denied claims. Following are 07 of the most important medical billing reports that your practice should check frequently:
The Accounts Receivable Aging Report/ AR Report
This report serves as a gauge for the health of the practice and indicates if the billing department is doing its job properly. One could generate this report by hand but too much time would be involved in doing so rendering the notion of hand-generated accounts receivable aging reports impractical. To get more deep insights, you can divide the Account Receivable Aging Report based on insurance and CPT codes.
When looking at the accounts receivable aging report, one hopes to find that the claims are paid before 45 days. If it is taking longer than 45 days for a claim, one needs to check to see if the claim has been rejected or is unpaid. Urgent attention is required if a claim has not been paid for 90 days. However, it is also important not to panic if you see many unpaid claims when you check your Accounts Receivable Aging Report. Many things can affect the numbers on this report such as the number of patients you have, and whether you use paper or electronic claims. Additionally, aspects of the claim itself may affect the speed. Workers’ compensation and car accident claims generally take longer. Out-of-state claims will also most likely take longer to be paid.
Payment Trend and Collection Reports
If you see red flags in your Accounts Receivable Aging Report, Payment Trend and Collection Reports can help you get more information about what may be going on. They show information about how much you have billed and collected. The Insurance Payment Trend Report shows this number in comparison to what the insurance allows. This report tells you how much you should collect from your patients to pay their claims.
To see how much one has billed out and collected and how it compares to what insurances allow, one needs to look at the Insurance Payment Trend report. By looking at the report one can judge how much is to be collected from patients to pay their claims. Claims that are over a specified number of days and have not been paid can be seen in the Insurance Collection Report. One can use the Insurance Payment Trend and Collection reports to further analyze the problem, in more detail, when one sees an issue in the accounts receivable aging report. You can pull up a report your claims and payment trends summary against DOS (date of service). This would help you know the claims value and how much the insurance paid.
The Key Performance Indicators Report
This is one of the most valuable reports. Using it one can pinpoint the encounters and CPT codes providing most profit. The KPIs Report keeps track of total encounters, the total number of procedures, total charges, total collections, outstanding A/R, and total adjustments. It provides indicators which billers use to judge trends which are negative and positive, thus enabling practices to change what does not seem to be working and continue to do what is working.
You should run this report every week. Compare the results to the previous week so that you can have a more exact idea about the problem as soon as it appears. If you see sudden changes in the collections, you may have a problem and should look deeper into that specific issue to determine what is wrong and how you can fix it. Analyzing other reports can be an effective way to identify the problem.
Insurance Analysis Report
The report can show the top 10 payers and insurance companies which contribute to the major portion of the business of practice. The report also helps to keep track of payments, collections, and CPT codes and units. It also provides information about how a practice is getting paid for certain procedures and how its revenue cycle is proceeding. Using this insurance analysis report a practice can highlight the carrier which is paying less than other commercial carriers. Instead of dropping the carrier, the practice could renegotiate a better deal. While the option a practice chooses varies, the important thing is that the report allows practices to make informed decisions.
We recommend that you run the Insurance Analysis report at least two times a week. The sooner you can catch a discrepancy among your insurers, the sooner you can make a change that could save you a significant amount of money.
Another vital set of reports that your practice needs to consistently analyze are patient payments. Tracking patient payments is a necessary part of ensuring that your practice is profitable. According to Mckinsey & Co. in some hospitals, the rate of bad debt for insured patients is on a high at well over 30% per year. Medical bills are the leading cause of bankruptcy in the United States and lead many people to fall into debt, so the chances of someone delaying or trying to skip a payment are high.
It’s challenging for the front office to convince patients who don’t know their benefits. Getting the payment, once they step out of the office is the most challenging task. Due to the Affordable Care Act and employers plan enrollment, an out-of-pocket expense is on a high and keeping a track of patient’s collection has become the need of the hour.
Clearing House Rejections
Rejected claims waste precious time and damage your profitability. If you track clearinghouse rejections, you can identify common issues and work to reduce those problems on future claims. In the early stages, some payers implemented the ICD-10 code set-specific in their front-end translators and entire batches are rejected with an acknowledgment of 999 which usually happens at claim acknowledgment level (277CA). Some providers used ICD-10 codes on the same claim which caused clearinghouse rejections. Clearinghouses have reported seeing claims for ICD-10 with wrong qualifiers. The reason could be incorrect settings in the vendor’s application. Some organizations reported unpredicted issues with small payers. It points out that payers who made changes to their applications after ICD-10 caused rejections which were not related to ICD-10.
No matter how hard you try to make everything perfect, denials still happen. But you have to recognize that the insurance companies have an economic incentive to deny claims, so you’re never going to get it down to zero. Denials by commercial payers have now risen to 26% of the total claims denied. A 100% increase in Demographic or technical denials which results in write-offs. For appeal on all denied claims, the success rate is 50-56%.
As per our observation, if office procedures are good in gathering the correct information and submitting clean claims, you can still expect to see at least 5% of denials for claims. If a staff responsible for reading the explanation of benefits (EOB) misses the errors, then there is a high chance of losing revenue on this. Reports can be pulled up based on top 10 CPTs for which claims were denied and Top 10 payers who denied the claim.
Medical Billers and Coders (MBC) provides the medical billing reports needed to save money and time. We provide collection reports, revenue analytics, and key indicators so that a practice can free resources and clinical staff to better serve patients. MBC empowers practices to reduce insurance company denials, increase reimbursement average, and remain financially sound. To know in-depth about our reporting services, call us at 888-357-3226 or write to us at email@example.com