First Pass Resolution Rate The first-pass resolution rate (FPRR) is the share of a practice’s claims that get paid upon first submission. Calculation – FPRR = Total Number of Claims Paid ÷ Total Number of Claims in a given time Benchmark – Your practice should aim for a FPRR of 90% or above.
Why It Matters – FPRR is a reflection of the effectiveness of your revenue cycle management processes – from pre-visit processes like verifying insurance eligibility, adding required authorizations, and maintaining accurate patient demographics to post-visit tasks like coding and billing. Submitting claims right the first time is critical to maximizing both efficiency and profitability, so always aspire to have the highest FPRR possible.
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Days in Accounts Receivables (AR) is the average number of days it takes a practice to get paid. The lower the number the sooner claims are getting paid. Days in AR should be below the 30-40 day range. Monitoring your Days in AR will help to identify problems with a certain payer before it becomes unmanageable.
Of your total AR, how much of that is money owed by your patients? What are you doing to collect that money? Sending statements on a regular basis and putting a collections process in place can help collect on money that patients owe. Your practice can also implement a credit card on file policy. With the new Health Insurance Exchanges comes larger than normal deductibles. With so many high-deductible health plans in 2014, collecting patient money is going to be more important now than ever.
It is hard enough to keep up with the changing industry standards. The metrics mentioned here will remain constant moving forward. Use them to measure your practice’s revenue cycle. I talk to many practices that have no idea what is taking place with their accounts. By the time they are aware of what is happening, it is too late, and they have lost too much money. These metrics will help determine the health of your practice and help you decide which areas could use improvement. Continuously weak key performanc indicators could compel your practice to revamp processes, replace staff, or outsource the revenue cycle management to help increase profitability. Read how the right approach and attitude from your medical billing service makes all the difference. Then get a quote based on the highest FPRR in the industry here from the top providers.
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