#222 - The $150,000 a Year Nobody Bills You For: Score Your Practice in 20 Minutes
Claims and charges: the raw material. Claims are the denominator under almost every rate. Divide charges by claims and watch that average for silent charge-capture drops.
Adjustments: where good numbers go to hide. Split contractual from everything else. If timely filing write-offs are coded as contractual, a 94 percent collection rate can look like 100.
Net collection rate: receipts divided by charges minus contractual adjustments. About 95 percent is the common comparison point. A green you cannot verify is not a green yet.
Denial rate: the front desk number everyone blames on billing. Use first-submission denials and keep rejections and prior auth denials out of it.
Insurance A/R over 90: the money quietly becoming a write-off. Break it out by payer. One payer owning most of the old money is a payer problem, not a billing problem.
Patient A/R over 90: scored on trend. The biggest factor is when you first tell the patient what they owe.
Three actions this week:
• Finish your scorecard with a three-month average. Write unknown where you cannot get a number.
• Give your lowest vital one owner and one 30-day question.
• Put the seven numbers on your monthly meeting agenda, same order, every month.
Episode breakdown: The $150,000 nobody bills you for | Your practice's vitals | How the test works | Claims, charges, adjustments | Net collection rate | Denial rate | Insurance A/R over 90 | Patient A/R over 90 | Add it up | Your plan this week