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It’s time to do a positive one when it comes to practice management KPIs. I know more often than not, we tend to lambast somebody’s wrong metrics or when somebody doesn’t know what they’re doing when it comes to data. Today, we’re going to do the opposite of that. We’re going to go through one that is pretty good, and we’ll give you a sort of overall review at the end.

This one is CareCloud. They have an article on their website related to practice management KPIs and basically what they suggest tracking. I will say that the list is relatively long, and there are good parts, and there are bad parts. In other words, if you’re trying to track everything, then, of course, you’re not tracking anything. 

However, at the same time, I think their goal was probably to say, “Hey, here’s a bunch of metrics that you can track that all have much value. They’re important.” Overall, we’ve assessed that it’s been quite good. I don’t think they’re trying to say, “Hey, here’s the top couple of things.” A separate article would be, “What are the top couple KPIs that a practice has to look at?” and this one, I think, is more of an exhaustive look.

Running down some of those that they list, we’ll go through the good first.

Track the right things

The gap between date-of-service and date billed. Everybody’s got different names for things. This is the cycle time of getting claims out the door, your submission cycle time. Again, to list that one up at the top in the first two, maybe that’s a little lower priority. Again, I don’t think they’re trying to say, “Hey, in descending order, what is the most important?”

They also have time-of-data-entry per encounter. Again, I might put this one a little bit lower in terms of priority.

Time-of-data-entry per patient. Presumably, the difference here is patient registration versus charge entry. Again, maybe a little bit lower priority but worth tracking, and a real KPI, an accurate metric, instead of what we frequently encounter somewhere else.

Percentage of claims denied due to front-end edits versus due to coding oversights. Great! These are really good things to look at. Interestingly, they dive right into that level of depth without starting at the high level of just how many denials you’re getting because they also list a percentage of claims denied due to authorization/referral, insurance information, eligibility oversights. And they later list by category, looking at denials.

Prioritize your KPIs

The reality is that these are excellent things to look at. So we can’t knock them. It’s more than I think that maybe, the article wasn’t organized as well, or somebody wasn’t packaging this in a, particularly effective way. But the metrics and the KPIs themselves are pretty good.

The percentage of no-response claims overall and by the payer is one of the metrics they suggest tracking. We like this one. It’s a little bit more complex to administer this type of metric. You have to get some data out of the system that people don’t always consider. So you have to get not only denial information, which most organizations should be able to access even if they’re not always doing it, but then you also have to be able to track, “Did you not get any information at a particular point in time?” and sort of look at, “Okay, how long post-claim submission has it been without getting a response?” It can be complex. For instance, even if there is data entered into the system in terms of some work item, some activity associated with the collector, whatever that might be, to distinguish between, “Was that prompted or unprompted?”

How do you manage who processes claims?

In other words, did you get a denial back or something like that, as opposed to somebody proactively working a claim, where there was no response, and then getting that information, and then loading that into the system as a note or activity or whatever it might be? That’s a great one. And that’s something we used to track back when I ran a billing company called Cobalt Health. That’s that non-response rate. They’re the ones that sort of disappear into the void where the payers don’t respond. So that’s a great one.

There are other metrics that they list. They’re also good. There’s a long list of them. We encourage you to check it out. I will throw out just a couple of suggestions or critiques because we can’t just say, “Hey, this is all great!” One of the things that they list was collection KPIs days AR net percentage collected. That seems like a kitchen sink like I just threw everything in it. I’ll repeat that so that you get it: collections KPIs days AR net percentage collected.

I’m hoping somebody just fat-fingered that. Maybe, they meant to list those all out separately or something like that and not just be one metric. It’s not entirely clear. Maybe, just a marketing person didn’t understand the metrics, the person writing the article. Who knows?

Let’s discuss time of charge capture

There’s another one where they listed the billed amount versus value at the time of charge capture. Now, maybe, I’m just slow. Maybe, I’m just not the sharpest tool in the shed. Perhaps, we don’t understand metrics as well as I think we do. Having been in this business for 15 years and run analytics, I’m not sure what that means. Does this mean expected reimbursement at the time of the patient care and comparing that to the billed amount, so you’re essentially looking at an anticipated reimbursement versus a billed amount? Is this trying to track how often charges change when you do charge capture and submission? In other words, are there edits of the coding?

Consider when you bill it, and then you have to rebill sat some later time, you’re doing a resubmission, or you’re changing it because you’ve got a denial back, then perhaps tracking whether the dollar amounts changed? It’s not clear what this means, but it’s not just that I might be thick. I mean, I might be completely incompetent, and I probably don’t understand what they’re saying. But if everybody does not clearly understand it, then it’s not a well-articulated metric or KPI.

Most people understand at least the concept of AR days. Even if there are different ways to calculate it and there might be some variations, at a high level, most people know what days AR days are, but I have no idea what that means.

The last thing is they suggest many reports that should be reviewed, like outstanding AR, should be looked at monthly. This isn’t a metric. That’s more of a process. Of course, they don’t explain what you should do with that information. One of the things I find frustrating with a lot of consultants or articles is that they say, “Oh, a good billing person or a good billing manager will know what to do with that information.” I can’t entirely agree with that. But again, that’s not a metric. We’re now getting into a nitpicky kind of stuff.

In conclusion

At a high level, overall, on a 1-to-10 scale for the practice management KPIs that CareCloud lists, I’d probably give them about 9 out of 10. They did an excellent job. Again, there are some metrics that we might include that they don’t possess. They have some metrics that aren’t as important as others. Overall, I think they do a perfect job of listing the top metrics.