Billing best practices dashboard: 11 metrics to know

Best practices demonstrate industry standards, allow comparison among ASCs and help centers commit to improvements. Here are the most important best-practice benchmarks that every ASC should keep in mind , says by Ann Geier, vice president of clinical informatics at SourceMedical's National Client Meeting in Oak Brook, Ill., on July 24:

1. A/R
Best practice: 32 days
Problem: Defining A/R is difficult, given out-of-network reimbursement, calculation method and other circumstances. The higher A/R is, the less probability a center has of collecting what it is owed.
Solution: Cleaning up A/R days by implementing regular, actionable account status checks can pay for itself between 10 and 20 times over.

2. A/R percentage current
Best practice: 72 percent
Problem: More than 90 days out from billing, it is very difficult to collect.
Solution: Have a system to show which accounts are resolved, and pay attention to it!

3. Percentage of cases projected
Best practice: 93 percent
Problem: Revenues and expenses are based upon this projection, made before opening an ASC. Reasons for low yield of cases projected can be anything from scheduling to an incorrect market analysis.
Solution: Dig in to the "why." Why is the projection falling short? Then take steps to address those reasons.

4. Cases per day
Best practice: 10 cases per OR per day
Problem: Too few cases means higher overhead costs per day. Wage costs per day are also relatively fixed.
Solution: Bringing as many cases as possible lowers overhead and spreads wage cost in a manageable way.

5. EBITDA
Best practice: Less than $3 million net revenue: 12.8 percent, more than $9 million net revenue: 37.3 percent
Problem: Operational inefficiencies eat at profits.
Solution: Improve by conducting case-costing and assessing variable costs, as fixed costs are much harder to impact. Note: 40 percent is good, between 30 percent and 39 percent is typical and less than 30 percent is poor.

6. Man-hours per case
Best practice: Total man-hours: 10.4 per case, clinical man-hours only: 6.3 per case (for a 3-4 OR center).
Problem: Staffing is often inefficient        
Solution: Consider more efficient scheduling and staffing practices to achieve optimal man-hours per case. Note: this is a newer measure that replaces average staffing costs per case. It will vary by case mix, between 8 hours total (5 hours clinical) and 12 hours total (8 hours clinical) per case, depending on the specialty in question.

7. Collections per day
Best practice: Depends on case and payer mixes
Problem: Low collections are a dangerous problem to have, especially as the longer it takes to collect, the less likely a center is to see that revenue.
Solution: Track trends in collections for internal benchmarking purposes. Watch for steep or unexpected drops, increases in denials and falling patient collections on the date of service.

8. Turnover time
Best practice: Routine cases: 7 minutes, complicated cases: 10 minutes
Problem: Slow turnover delays all center processes and affects patient satisfaction.
Solution: Track turnover time using a software system to consolidate OR scheduling and eliminate scheduling gaps.

9. Denial Rate
Best practice: Low
Problem: Denials mean the center will be absorbing the costs of the case.
Solution: Don't accept routine excuses, and appeal denials immediately. Document meticulously to figure out denials as quickly as possible.

10. Supply costs
Best practice: Supply costs per case (average): $374.22, or 21.6 percent of collections
Problem: Climbing rates can wreck havoc, as supply costs are one of the two largest ASC expenses.
Solution: Use an inventory system and track order, back-orders and supply purchasing and use in real time.

11. Staffing costs
Best practice: Costs per case: $426.02, or 23.5 percent of collections.
Problem: Staffing is one of two largest ASC expenses and can create unnecessary cost.
Solution: Review scheduling and staffing daily. Flexible staffing is crucial.

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