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ESO Solutions Key Performance Indicators – Part Two

For both provider agencies and billing services, implementing a simple KPI to monitor pre-billing activities involves three important measurements:

1. Are your billers meeting goals for volume and charges that your operation needs to submit daily to meet your expected incoming payments? 

When setting goals for claims volume and total charges billed, look at:

  • Your average daily number of claims in the pre-bill queue
  • The dollar amounts associated with the claims in pre-bill
  • The number of claims being moved from the pre-bill queue to ready-to-bill status

Monitoring claims volume and total charges billed will provide you with critical information relative to the flow of claims: Over time, are the number of claims in prebill growing, staying constant or trending down? Also, if applicable to your operation, assigning charges to the claims in pre-bill can provide for a realistic perspective of the impact a potential pre-bill bottleneck may have on your cash flow.

2. Are claims that lack critical billing information properly assigned for follow-up? 

For incidents that are missing key information needed to complete the billing process, it is vital to establish an organized process to catch the outliers. Work with your billing software vendor to make sure these incidents can be immediately categorized and assigned to a pre-bill workflow for timely follow-up. Categories should include: missing PCS; missing insurance; incomplete PCR; and missing signature.

3. How consistently does the output of your pre-bill process meet your organization’s ongoing productivity needs? 

Looking back at the goals you established in Step 1 above, it’s easy to track the performance of your pre-bill process over time. If performance is trending down, ask why. The same goes for performance that’s improving — or inconsistent: Having this information will allow you to appropriately allocate resources and potentially alert you to ways to ensure more efficient processing. It’s also important to track pre-billing productivity against larger organizational trends, such as call volume. If your call volume has increased but pre-bill productivity has not, you need to take corrective action quickly.

ESO is here to help. 

Have a question about getting the most out of your billing operation? Want to learn how ESO’s industry-leading software is helping organizations like yours improve clinical care, operations, and reimbursement? Visit eso.com/billing or call us today at 866-766-9471 x1029. Or schedule a personal demo.