Prepared for: An actual customer–August xx, 20xx
The purpose of this analysis is to provide feedback on:
Annual volume metrics
Claims level reimbursement metrics
Claims level billing efficiency (timeliness) metrics
Denials analysis with primary root cause identification
Comparison of reimbursement to peer group (National database from MGMA)
Accounts Receivable (A/R) metrics in comparison with Best in Class Practices
Recommendations on Financial Performance Maximization opportunities
- Provider Productivity is high in terms of number of patient encounters per full-time equivalent (FTE) provider. Average encounters are about 769 per month.
- Reimbursement in terms of cash collected per claim (on average) is about $134. This is good but has ample room for improvement with a target of around $164 (22.4% improvement).
- Accounts Receivable management indicates ample opportunity for improvement as it appears that rejections and denials are not being worked consistently and aggressively. This is leaving approximately $350,000 in possible reimbursements at risk of loss (the longer the A/R ages, the lower the probability of collecting at 100% of its allowed value). This also increases the cost of capital due to a cash conversion cycle, which entails utilization of resources which could be utilized elsewhere. Without reviewing the write-off policy and the historical amounts written-off in the last fiscal year, it is not possible to more accurately gauge the performance in this area.
- Labor cost of Revenue Cycle Management was not measured as data on staff-related cost or external billing service fees was not available. For this type of practice, the all-inclusive labor cost of revenue collection should be no more $10 per claim.
- Sypore believes it can help increase net collections by at least 20% and reduce billing related costs for the practice to less than 6% of net cash collections.
(Additional details, data tables, and charts removed for brevity.)