Billing Quality

Traditional billing quality measures look at write-off percentage and long-term gross and net collection ratio. We do not advocate using them because they depend on charges, which are almost arbitrary for every practice. Instead, we focus on % of AR beyond 120 days. Since the likelihood of payment drops by 0.6% every day, % of AR beyond 120 days reflects the total of money you are not likely to collect ever. Therefore, % of AR beyond 120 days represents a reliable and charge-invariant measure of billing quality. For reference, national average of % of AR beyond 120 days is 17.7%.

Billing Quality is measured in terms of timeliness and completeness of payment. The shape of the distribution curve of Accounts Receivable illustrates billing quality. Specific measures include median and percent of accounts receivable beyond 30 days, 60 days, and 120 days. A good quality billing process has relatively small median, e.g., half of the claims must be paid within 30 days, and a steep drop in terms of percents of accounts receivable, e.g., reaching less than 10% of A/R beyond 120 days. The actual amount of Accounts Receivable beyond 120 days is considered uncollectable and labeled as a provider's loss for write off.

Billing Transparency

Billing Transparency allows every participant in the billing process to see continuously both its big picture and the minute detail:

1. Big picture consists of total cash flow in a given time period, current submitted and failed claims, and Billing Quality.
2. Minute detail pertains to individual claims making up the big picture, including complete history from the moment of creating the claim, testing its validity, corrections, submissions, and reconciliations, until payment..

Straight Through Billing

Straight Through Billing integrates billing process within the practice management workflow, connecting patient scheduling, care delivery, and medical record management. Every participant of the practice management workflow receives a unified and coherent picture of practice workload, patient and provider location, resource availability, and cashflow. Straight Through Billing requires integrated technologies for Electronic Medical Records (EMR) and billing.

Straight Through Billing Technology

Straight Through Billing technology streamlines and expedites billing process by automating claim validation, payer message reconciliation, and billing workflow management:

1. Automated claim validation eliminates errors downstream and reduces processing time because it flags errors before submitting the claim to payer.
2. Automated appointment-claim-message reconciliation eliminates costly search for the original claim and standardizes message communication, further eliminating the need to decipher the (often cryptic) payer's message.
3. Centralized Workflow Management drives the followup discipline required for resolution of claim denial and underpayment incidents and establishes high degree of process transparency for all billing process participants, resulting in full and timely payments.

Outside Resources

Straight Through Billing Technology
Straight Through Billing Service
HIPAA

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