Medical Billing Performance Index

By: Yuval Lirov
Submitted: 2007-01-17 12:20:20
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Benchmark-driven performance management helps establish objective industry standards. Medical service providers can use benchmarking to evaluate performance of their billing service and measure their improvement over time. This article presents a prototype for a rule-based chiropractic index, including its coverage definition, update cycle, volume weighting, and provided information.

Current (June 2006) Billing Precision Index (BPI) stands at 18, which means that the average of ten top performing payers working with BPI clients have 18% of Accounts Receivable beyond 120 days. This is a key billing performance characteristic, as it is a proxy of the claims that are never paid. Obviously, the lower is the index the better is billing performance. The table below also lists the top ten performing payers and their relative index as recorded in Billing Precision's system ( BillingPrecision.com ).

• Billing Precision Index 18
• Benesight 5
• Blue Cross Blue Shield Florida 5
• Medicare Florida 7
• United Health Care 8
• Oxford 11
• Cigna 13
• Medicare New Jersey 17
• Horizon 18
• Aetna 21
• Blue Cross Blue Shield Texas 33

Coverage

BPI is rule-based, i.e., payer participation in the index is defined by dynamically rules at the time of computation and not by a static listing of specific payers. Therefore, any specific payer may start or discontinue participation in the index, dependent on satisfaction of rule's conditions.

Current selection of payers for participation in the BPI is based on fifty top-volume providers across all United States that have received Billing Precision services for more than six months and have more than two hundred claims in their current Accounts Receivable.

Update Cycle

Billing Precision updates its index on a monthly basis.

Volume Weighting

BPI is volume weighted, which is important to accomodate future growth of provided information, index combinations, and sensitivity across multiple indices.

Information Provided

BPI computes the percent of Accounts Receivable beyond 120 days. Note that national average across all medical specialties of percent of accounts receivable beyond 120 days is 17.7%.

Summary

Medical Billing Performance Index helps the development of billing industry standards. Medical service providers can use the index to benchmark their billing performance and to guide its improvement over time. Rule-based index definition allows for automated inclusion and exclusion of payers in the index based on payer attributes, such as numbers of processed claims, accounts receivable distribution, certain mix of CPT codes, or patient demographics. Relative payer index provides billing process improvement direction.

Yuval Lirov, PhD, author of "Mission Critical Systems Management" (Prentice Hall, 1997), inventor of multiple patents in artificial intelligence and computer security, and CEO of Vericle.com Billing Technologies. Vericle delivers comprehensive practice workflow engine that integrates patient scheduling, electronic medical records (EMR), billing, transcription, and compliance management. It improves billing performance and reduces audit risk. Yuval invites you to post questions about and share your knowledge of medical billing and compliance at BillingWiki.com.

Article source: Expert Articles