This month we are providing organizations with various KPIs that will assist your organization with monitoring the financial health of your business. We are discussing average revenue per visit, front desk collection average, ancillary revenue per visit, and E/M code distribution as well as how all of these affect your practice.
Average Revenue Per Visit – This is the total amount received from both the patient and payor on a single date of service. Shows you the cash that you put in the bank and is used to help forecast upcoming cash flow.
- It is usually best to calculate this over a specific time. Most financial folks use either a six month or one-year rolling average. Make sure that you remove any visits that were turned over to Bad Debt and any LWBS visits from the count. You are looking for as pure of a number as you can get to.
- Take your Employer Paid Services (Occ Med/Workers Comp) and perform this analysis on those separately.
- To calculate this number, take your collections less your refunds and divide this by your total visits for the segment of services being analyzed. (Urgent Care / Worker’s Compensation / Occupational Medicine)
Front Desk Collection Average – This is the cash that you receive across the front desk at the time of service. This includes cash pay visits, copayments, and deductibles.
- Organizations want to watch your refunds to make sure that the front desk team members do not over-collect on the account. An often-identified mistake is taking the wrong copayment on a specialty provider versus a primary care provider. The front desk team members should always have a list of providers who are credentialed with a payor that informs them of how they are credentialed. This is called a Payor Credentialing Matrix.
- Front desk team members must always verify benefits. Most practice management systems have an automated process to do this that easily identifies a patient’s copayment, coinsurance, and deductible. Teaching front desk team members where to identify this and how to calculate the out of pocket should be stressed in their onboarding process.
- To calculate this number, take your Front Desk Collected dollar amount for the month and divide this by your total visit count for the month less the LWBS, OccMed and Worker’s Compensation visits.
Ancillary Revenue Per Visit – This KPI assists you with ensuring that you are covering the costs for providing a specific service as well as helping identify your money makers and loss leaders when it comes to Managed Care payor negotiations.  Ancillary services are those services performed in addition to the E/M service and include labs, x-rays, injections, medical equipment, etc.
- Poor documentation is one of the main issues related to failing to capture all ancillary service revenue. For example, A rapid strep can be charged in addition to processing the lab result. On average if a provider fails to properly document their procedures, they lost $28.00 in reimbursement based on the industry average.
- When extracting this data for analysis, make sure that you are posting payments at the line level and that you review claims that have both an E/M level and an ancillary service.
- To calculate this number, take the totals collections by CPT code range and divide this by the total visits with this CPT.
E/M Code Distribution – One of your key metrics to review when your Average Revenue per visit has changed. This metric shows you the codes that are being billed by providers, how often they are selecting these codes, and the effect this has on your reimbursement. As we all know, the higher the coding level the higher the reimbursement.
- It is imperative that providers fully document the services rendered. Make sure your providers actually understand how to code a chart using the main three key components of history, exam, and medical decision making.
- Separate out new patient visits versus established patients and create two different code distribution charts. By doing this you will be able to identify if you have a repeating customer base, the average level of service a provider is performing at, etc.
If you have a question related to various KPI’s that you should be monitoring daily or to discuss where your organization is with your KPI’s please contact Stacy Calvaruso at [email protected].
Medical Practice Success, LLC is a premier full-service Revenue Cycle optimization organization that assists Hospitals, Multi-Specialty, Surgical Centers, Specialty, and Urgent Care organizations with services that include coding and documentation training, medical practice analytics, managed care contracting analysis, credentialing, billing, practice enhancement initiatives, and so much more.
