The Most Important Billing Reports in Revenue Cycle Management (Part 1)

 

RCM (Revenue Cycle Management) involves tracking claims, confirming payment is received, and following up on denied or unpaid claims to maximize your office revenue. Generating medical billing reports can help you recognize the health of your practice. The first report we are covering this week is your Accounts Receivable or A/R report. Understanding your A/R report is crucial to ensuring your RCM procedures are efficient and effective. Lets take a look at the most important billing reports in Revenue Cycle Management.

Accounts Receivable Aging Report

What does this report tell me?

The A/R aging report will give you a breakdown of insurance and patient balance claims based on the number of days they have been unpaid or in receivables. Most insurances, aside from government insurances, take approximately a month to pay. This report gives you a generalized look at where payment issues might be coming from. This report should give you a look in both dollar amount and by percentage. With just a brief look at the 150 days plus column on this report, a knowledgeable manager or billing company can tell whether a practice’s billing department is doing well.

They should question:

Is there a large dollar amount there?

Is there double-digit percentage outstanding?

A Closer Look

Every AR report could be formatted differently, and appearance may vary depending on which system you are using. The aging buckets may vary, some can carry out between 180-360 days, but will still provide the same information.

Our example below provides a breakdown of claims from: 0-30 days, 31-60 days, 61-90 days, 91-120 days, and greater than 120 days. As you can see our report is broken down by insurances and “Self-pay” or patient balances.

A common question I receive is: How do I know what my percentages should look like?

Answer: It is a great idea to purchase the annual average benchmarking report from the Medical Group Management Association (MGMA). They publish an annual report benchmarking the AR for different medical specialties. Medicare (CMS) also puts out a similar report that is free that can be used as a overall benchmarking tool.

Report: Aging as of 09/05/2018
Local Reporting Category # of Charges <31 31-60 61-90 91-120 >120 Total
AETNA 22  2,650.00
(37.01%)
 500.00
(6.98%)
 4,000.00
(55.87%)
 0.00
(0%)
 10.00
(0.14%)
 7160.00
(100.00%)
BCBS 152  30,817.20
(79.46%)
 5,925.00
(15.28%)
 1,792.75
(4.62%)
 150.00
(0.39%)
 100.00
(0.26%)
 38784.95
(100.00%)
CIGNA 34  7,080.00
(88.06%)
 120.00
(1.49%)
 530.00
(6.59$)
 0.00
(0.00%)
 310.00
(3.86%)
 $8,040.00
(100.00%)
HUMANA 4  0.00
(0.00%)
 0.00
(0.00%)
 0.00
(0.00%)
 0.00
(0.00%)
 3,826.81
(100.00%)
 $3826.81
(100.00%)
MEDCOST 11  550.00
(9.37%)
 5,070.00
(86.37%)
 150.00
(2.56%)
 0.00
(0.00%)
 100.00
(1.70%)
 $5,870.00
(100.00%)
MEDICAID 345  73,242.71
(73.20%)
 7,072.38
(7.07%)
 6,435.00
(6.43%)
 2,781.13
(2.78%)
 10,524.93
(10.52%)
 $100,056.15
(100.00%)
SELF PAY 40  6,974.06
(9.35%)
 9,914.89
(13.29%)
 6,977.37
(9.35%)
 7,217.62
(9.67%)
 43,530.89
(58.34%)
 $74,614.83
(100.00%)
TRICARE 43  11,325.95
(58.97%)
 645.66
(3.36%)
 5,052.30
(26.30%)
 474.44
(2.47%)
 1,708.69
(8.90%)
 $19,207.04
(100.00%)
UHC 79  33,983.00
(59.85%)
 14,100.00
(24.83%)
 0.00
(0.00%)
 5,450.00
(9.60%)
 3,250.54
(5.72%)
 $56,783.54
(100.00%)
TOTAL 730  $      166,622.90  $    43,347.93  $ 24,937.42  $    16,073.19  $      63,361.86  $         314,343.30

 

What are all these numbers?

  • The 0-30-day bucket for both the patient and insurance should be your highest totals. They’re the most current – we just submitted the claims and we are waiting for those claims to process to receive payment.
  • Your next highest will be the 31-60-day bucket. Typically, most of the claims due will fall in the 0-60-day period. This depends on the speed of the insurance company and how quickly they process payment. Submitting a claim to a secondary payor could also affect this bucket.
  • The money in the 61-90 bucket should drop off dramatically, especially with your insurance balances. You can see in the example given above, this office needs some work on their buckets. Some insurances show less than 7% while insurances like Aetna and Tricare are showing some red flags. These red flags can be anywhere from appeals, billing workflow problems, to reprocessing claims.
  • The 91-120-day bucket totals should drop as we work claims, bill patients, do our follow-up and pursue collection efforts, by running this report once a month, you can watch your billing staff or billing company’s progress.
  • Keep your percentage of 121 days or more to a minimum. Make it your goal to work these old claims hard. The older the claim the more difficult it is to collect on. The aim is to keep it in the single digit percentages for over 120 days.

There’s always going to be some money in each of these older buckets. But the key is to be sure the buckets in the 91 day and higher range are as low as possible. Keep working those claims, if you notice no improvement it is time to reevaluate your billing team.

KEEP IN MIND: The AR report is one essential tool but should not be the only report ran to monitor your billing. There are many other factors affecting these totals.

IMPORTANT TIPS

  • In the 0-30-day bucket, one factor that could affect the totals could be provider vacations or slow claim submission. Having a few providers out of the office would account for a lower total in this bucket. But if that number is lower and your older AR stays the same, your days over 120 as a percentage will increase. In balancing these reports, you must take that into account.
  • Uncertain technical issues with Insurance – Your practice could have issues with a certain insurance company that hasn’t paid for any given reason.  This may leave claims to take months to process due to some technical issue that hasn’t been resolved.
  • Appeals – which could take months to resolve – There could be multiple appeals, leading to a lot of insurance balances in the 120-plus bucket. You’re still constantly working those claims, but they show up as outstanding. So, your percentage and amount due may continue to increase but that may be OK.

ATTENTIVENESS MANAGERS!

One way some billers run the report to make the insurance AR “look better” is to run the report based on date-of-last insurance submission. Practice management systems can re-bill all or some of the old claims in bulk by setting the report parameters to last submission date instead of date of service. This, however, starts the clock over again, putting the old claims in the current 0-30-day bucket, making your AR reports look good.

Make sure your reports are NOT being done this way. Always compare your current month to your previous month to ensure there are no drastic changes in your numbers. If so, INVESTIGATE!

Calculating Days in A/R

  1. First, calculate the practice’s average daily charges:
  2. Add all charges posted for a given period (e.g., 3 months, 6 months, 12 months).
  3. Subtract all credits received from the total number of charges.
  4. Divide the total charges, less credits received, by the total number of days in the selected period (e.g., 30 days, 90 days, 120 days, etc.).
  5. Next, calculate the days in A/R by dividing the total receivables by the average daily charges.

As part of our medical billing services, RelianceMM offers a variety of customized and tailored reports for your practice. All of our reports are prepared monthly, and a copy is given to each physician owner and manager.

If you need help with your analysis, give us a call.  Have that peace of mind you deserve by knowing your medical billing is being handled by professionals who get the job done correctly.

 

For more on Medical Billing & Coding, Healthcare Administration, and Insurance News and Updates, you’re already at the right place. Be sure to stay on top of everything by subscribing to the Rx for Success Medical Billing Blog here!

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