Tracking Metrics in Billing Agencies
Earlier this year, ZOLL hosted a webinar on Operationalizing Data. After the webinar, we asked attendees to share what, if anything, their organizations were doing to track KPIs, manage their data, and transform it into actionable insights. Over 300 EMS professionals from across the United States responded, and the results surprised us! Less than half of organizations are tracking billing metrics, and over 35 percent of respondents said that EMS billing was their biggest area of concern. We called in a resident ZOLL expert to give some advice on the topic.
Shedding Some Light on EMS Billing Best Practices
We asked Renee Collier, RescueNet Billing Product Owner at ZOLL Data to shed some light on tips, tricks and best practices when it comes to data and EMS billing. As an A/R and Compliance Consultant and a former Firefighter/EMT-I, Renee has “been there done that” when it comes to trying to sort through and implement data insights in EMS.
Q&A With Renee Collier
Knowing that only 42% of the agencies who responded currently track billing metrics, can you explain why these are some of the most important metrics to track?
It is important to collect billing metrics to set benchmarks for your agency and staff. We have worked with our customers to help them determine their Key Performance Indicators (KPI’s) based on certain criteria such as call volume, call type and job functions. Using these KPI’s as benchmarks, you can determine if you are performing well or if there are areas that need your attention.
What are some best practices for collecting and analyzing data?
It is best to know the problem you are trying to solve before data collection and analysis. Determine the problem that is of highest acuity – such as denials or A/R over 90 by payer type – and determine what data points are needed. Then establish a procedure that ensures your data can be collected easily, repetitively, and efficiently by anyone on your team that might be entering it. Train your team on it, and be consistent.
For example, if the issue is missing information from field crews, claims with missing information should be organized according to what information is missing: missing signatures, missing PCS, missing narrative, etc. You can then build a schedule and add in the corresponding “missing information” events. From there, assign the trips to this schedule and corresponding event. You can then run a report based on schedule and event that will help with communicating to operations where they need to increase training and/or corrective action. These trips can also be associated with a dollar amount to show how “missing information” affects revenue stream.
Most organizations are tracking at least a few categories of EMS metrics. Once you have the data – what do you do with it? How can you measure the strengths and weaknesses of your organization against others?
Use your agency’s billing to see where you need to make adjustments in different areas. Some suggested KPIs in terms of front-end measurements are:
- Billing lag
- Trip volume
- Pre-biller and coder productivity
- Payor mix
When it comes to back-end measurements we suggest you measure:
- Accounts receivable
- Follow-up productivity
Gaining Actionable Insights
Once you have your data and can see where you stand in comparison to the KPIs, you will see if the issue is with the front end (high denials) or the back end (high A/R over 90 days amount). We typically see the need for some software tune-ups and process improvement with the staff. Using this framework makes it much easier to action the insights your billing data gives you.
Adjusting Processes Accordingly
Once you benchmark, tune up software and streamline processes, you will want to review the same metrics every 60 – 90 days to determine if what you are doing is making a difference or if there is a new issue that needs your attention. Like patient care, we reassess after intervention to determine if the patient is better, the same, or worse. So it goes for the health of your billing system and processes.
Asking for Help While Setting Benchmarks
If you feel lost or overwhelmed in trying to set your own KPIs, ask your software vendor to provide them for their billing product. If they are not available, consider your current processes and based on those, set your benchmarks. These could include:
- Claims billed per biller per day
- Payments by payer type (trended over the last twelve months)
- Denials (what are they and can they be mitigated through training?)
Once you set those benchmarks with your current numbers, you will be able to identify where you need to make changes.
Over 30 percent of respondents said staffing resource was their biggest obstacle when it comes to being more data-driven. How can software fill the “staffing resource” gap?
Good software takes all of the manual labor out of the pre-biller's duties. Choosing services that are designed with the user in mind and so very easy and intuitive to use, as well as those that complement best billing practices keeps the biller engaged in revenue generating activities. This all works to make your biller more efficient, as it negates the need for cross-referencing everything and constantly querying the internet.
This will result in an increase of claims going out clean the first time, increase in claim volume going out to payers in a shorter amount of time, all of which means getting paid more, and faster!
No one likes silos, but some organizations are still suffering from them! What are the risks of having siloed software, and how can you avoid them?
If you don’t have integrated ePCR and Billing, you will have to rely on manual data entry for claims. This can, and in many instances does, lead to more errors, increases staffing requirements and costs, delays billing claims going out, and can also cause a delay in payments. We strongly suggest investing in an integrated software system – for all the upfront costs, it will save you time and money in the end!
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