With the new consolidated revenue cycle, UVA Physicians Group has established minimum service standards across six performance indicators that demonstrate the health of our business operations. This will ensure we have adequate cash flow and enable us to achieve our clinical growth strategies.
The revenue cycle process happens both before and after a patient receives services. There are six Key Performance Indicators (KPIs) that help us measure the efficiency and success of the revenue cycle enterprise. The organizational KPIs can be found at the following link: UVA Health Data Portal (log-in required)
- Accounts Receivable (A/R Days) This metric reflects how quickly patient revenue is resolved, with lower numbers reflecting a better score. The metric is calculated by taking the total accounts receivable and dividing by the average daily revenue for the last 91 days. This is improved by getting claims submitted on time, making sure the claims do not have errors, following up with payors if they have not provided payment and collecting money at the point of service.
- Clean Paid Claims % This metric tracks if a processed claim does not have warnings or errors in the charge review or claim edits, and was not denied. The claim must have valid supporting diagnoses for each charge. It also measures whether the claim went out with the correct insurance coverage for the date of service billed within the filing deadlines for the payor. This is improved through root cause analysis and enhancing our charge router software to look for potential errors before claims are sent out.
- Pre-A/R Days This is a measure of the number of days that charges have not been posted to accounts when the services have already been provided. It is calculated by taking the unposted charges in the work queues and dividing by the last 91 days of average daily revenue. This is improved by making sure that we have timely closing and coding of each patient encounter.
- Primary Denial Rate This is a refusal of a payor to make payment on a claim for a defined list of reasons such as no referral, no prior authorization, not medically necessary services, patient not covered on the date of service. The metric is calculated by dividing the number of denials received from primary payors by the payments posted for primary payers. This is improved by continuously enhancing our scheduling and registration operation to have accurate data at the point of care. Working on logic to check for these issues before the claim is reduced is another area that can improve this function.
- Insurance More Than 90 Days This is a measure of aging of claims owed by insurance companies past the date of service. The calculation is based on the percentage of insurance accounts receivable older than 90 days from service date divided by total outstanding insurance accounts receivable. This is important for us to track as the longer claims sit in accounts receivable, the less likely it is that we will be paid or will be paid less. This is improved by ensuring we get claims and coding done as quickly as possible after we deliver patient services.
- Net Collection Ratio This metric tracks our success at getting paid what we are supposed to be paid according to our managed care contracts. It is a percentage representing what we are receiving against what we are supposed to receive. Perfect score would be 100%; we are striving for the 90’s. This is improved by accurate modeling of contracts and loading into the system, minimizing avoidable denials, and holding the insurance companies accountable paying us what we are owed.
For additional information talk to your department chair and/or administrator who can provide details and reports.
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