NextGen Healthcare recently conducted a survey among practices across the nation to gain deeper insight into the current state of revenue cycle management (RCM) across various medical practices. Participating practices included both NextGen Healthcare clients and non-NextGen Healthcare clients, spanning varying specialties, staff size, and locations. The survey results reflect the operational and financial metrics provided by each of them. .
The RCM Survey Report: What’s Happening Behind the Billing Office Door evaluated several high-level metrics including: net collection percentages; first-pass clean-claim rate; average days in A/R; and, outstanding collections for 120+ days. The survey revealed that many medical practices fell short of best practice benchmarks and are potentially missing opportunities to optimize revenue.
Here are 27 revealing practice management revenue cycle management trends from the survey:
Billing Office Profiles
1.Though most practices—77 percent—reported having between one and 10 people working in their billing offices, 7 percent said they employed 25 or more across billing functions.
2. On average, practices with 1-10 providers had 1:1 provider/biller ratios. Those with 11- 20 providers had 3:1 provider/biller ratios. And those with 21-30 providers had 5:1 provider/biller ratios.
3. Just over three-quarters of surveyed practices said they did not outsource any of their billing.
4. Across both the practices that handled billing in-house and those that outsourced, the use of automation in the revenue management process was popular.
5. Nearly half of practices reported having one person handling the process.
6. 45% of practices reported having 2-5 people working on denial resolution.
7. Among practices that outsource their billing, 31 percent said they still handled denial resolution internally; 59 percent have their billing provider handle denial resolution for them.
8. When asked to evaluate and rate the effectiveness of their denial follow-ups and resolution on a scale of 1-10, only 15 percent of those surveyed rated their practices’ denial follow-up and resolution abilities as a “10” or “Excellent.” Thirty-one percent of practices rated their abilities between 1-5.
Staff capabilities and performance
9. On average, practices reported that their billing professionals could post 137 payments and adjustments each day. Of those payments, about 17 percent of practices said the electronic to paper payment ratio was 75:25—which is consistent with the estimated best practice ratio practices should try to achieve.
10. just 4 percent of practices would give a “10” or “Excellent” rating to their ability to ensure all electronically submitted claims make it to the carrier.
11. The majority—49 percent—rated their e-submission abilities between 7-9, and 22 percent considered their abilities only worthy of the 1-5 rating.
12. Twenty-one percent of practices said they were “Very Confident” in their ICD-10 preparation, 50 percent were “Somewhat Confident” and 23 percent of practices were “Not At All Confident.”
13. Billing issues or challenges accounted for anywhere between one and 40+ percent of practices’ incoming phone calls from patients.
14. On average, surveyed practices said 35 percent of incoming patient calls had to do with billing questions or problems.
15. Although maintaining a credit card on file program has proven to be very effective for ensuring patient payment collection, only 35 percent of surveyed practices have implemented a credit card program. Sixty-five percent do not have a system for keeping patient credit cards on file.
16. For a little over one-third of practices, charges are entered into the system within one day of patients’ visits. Eleven percent of practices said they were able to get charges entered into the system within hours of the time of service.
17. To ensure that services rendered are billed, 15 percent of practices reported keeping safeguards in place that they rated as 10 or “Excellent.” Fifty-five percent rated their billing safeguards between 7-9, and 23 percent rated them between just 1-5.
18. To ensure payment for all services according to payer-contracted rates, 10 percent of respondents reported having “Excellent” measures in place. Forty-two percent gave their payment-ensuring measures ratings between 7-9, and 37 percent believed their measures only deserved ratings between 1-5.
19. When asked to assign ratings to their processes for checking every EOB and every CPT code, 10 percent of practices rated their methods “Excellent.” Thirty-five percent gave their processes ratings between 7-9, and 46 percent said their processes only deserved ratings between 1-5—leaving quite a bit of room for improvement in their procedures.
Financial performance indicators
20. For Net Collection Percentages, 46 percent of practices selected estimates in the 70-80 percent range. Twenty-four percent selected estimates in the 81-90 percent range, and 30 percent selected estimates in the 91-100 percent range.
21. The overall average number for Average Days in A/R was 35. For practices with 1-5 people in their billing department, the average number of days was 36.5, while practices with 5 or more people saw a slight uptick of 36.9.
22. Five percent of all participating practices reported that their Average Days in A/R was 60 days.
23. Among practices that said they handled billing internally, nearly 7 percent reported Average Days in A/R as 60. And of those practices that outsourced billing, only 2 percent reported 60 as their number of Average Days in A/R.
To download the RCM Survey Report: ‘What’s Happening Behind the Billing Office Door,’ click here.