"There are two possible outcomes: if the result confirms the hypothesis, then you've made a measurement. If the result is contrary to the hypothesis, then you've made a discovery."
- Enrico Fermi
In Measuring Staff Performance - Part I, we reviewed the importance of metrics in staff development efforts. We stated five categories of staff measurement:
- Clean Claim Rates
- Denials
- Claim Velocity
- Payment Velocity
- Follow-up Success
In Part II, we looked more closely at Clean Claim Rates by User, Denials, and Claim Velocity. In Part III, we will examine Payment Velocity and Follow-up Success rates.
Payment Velocity. Payment Velocity is a little outside the purview of staff performance, but because it's so important, I have included it here. Claim velocity measures the processes through which charges become filed claims. Payment Velocity gauges your payors' adjudication speed.
- Filing to payment. This is an aggregate measure of your combined payors' claim processing speed.
- Service type payment speed. You've always suspected that some services are paid more quickly (or more slowly) than others. Now is the time to find out.
- Denial rates. This one is really important. You may find that the payor quickest to process your claims also has the highest denial rate. And, it may be that your slowest payor has the fewest denials. Speed isn't everything.
Follow-up Success. This critical task is one of the most difficult to measure. Often, the difference between keeping the doors open and real profitability lies in the success of follow-up efforts. Unfortunately, for your staff, the temptation will always be to shake the trees of new claims and get the easy money, and put off follow-up of denials for tomorrow. Even those practices that assign staff to follow-up-only need to assess the effectiveness of their efforts.
- Claims touched. There is no aspect of billing that requires human intervention more than follow-up. Start your assessment by knowing the raw count of claims touched by your follow-up staff.
- Rate of claims successfully resolved. Of the total denials being worked, what percentage are successful decided in our favor?
- Change in collection percentage. Your collection percentage is the ratio of net charges (charges after contractual discounts) to actual monies received. Specialties differ, but we typically shoot for a number in the high 90s. Your follow-up staff will benefit from knowing this number and any changes month to month. A small increase in your collection percentage can mean significant dollars for your practice. Set goals with your staff for modest increases.
Communicate your goals to everyone on your team, and above all, follow up with your staff and develop coaching and improvement plans.
