Billing Score Card

1
Billing Score Card

• Owen B. Evans, M.D.
• Professor and Chair
• University of Mississippi Medical Center
• Jackson, Mississippi

2
Billing Score Card

• Purpose to measure standard business indicators
  of billing performance
• Methods
• Standard Signature Reports
• Microsoft Excel
• Benchmarks
• Dashboards
• Usage

3
Standard Business Indicators

• Days in Receivables (DIR)
• Net Collection Rate
• Lag days
• Account Receivables (A/R) gt120 days

4
Days in Receivables (DIR)

• DIR standard measure of the revenue cycle. DIR
  is basically the number days of charges that are
  in the Account Receivables (A/R)
• A/R/(YTD Charges/Months)30 days
• Example
• Period Ending A/R 100,000
• YTD Charges 150,000
• Month March (3)
• DIR 100,000/ (150,000/3)30 60 days

5
Net Collection Rate

• Gross Collection Rate Payments/Charges
• Net Collection Rate percentage of collectable
  charges
• Net Rate Payments/ (Charges-allowances-courtesi
  es-transfers)
• Example
• Payments 40,000
• Charges 100,000
• Allowances 50,000
• Courtesies1,000
• Transfers 0
• Net Collection Rate 40,000/ (100,000-50,000-5,000
  -1,000-0)
• 40,000/44,000 .909 or 90.9

6
Lag Days

• The number of days from the day of service to
  charge entry
• Affects revenue cycle and cash flow
• Delay in charge entry increases lost fee tickets

7
Account Receivables gt120 days

• A/R gt120 days is a major back office indicator.
• Excessive aged accounts indicates either
  excessive errors in charge entry or inattention
  to denials
• A/Rgt120 days/ total A/R
• Example
• A/Rgt120 days 20,000
• Total A/R 100,000
• 20,000/100,00020

8
Account Receivables gt120 days

• A/R gt120 days needs to be interpreted in
  relation to Days in Receivables
• Example YTD Charges 150,000
• Period Ending A/R 25,000 Month March
  (3)
• DIR 25,000/ (150,000/3)30 15 days
• A/R gt120 d 5,000 / 25,000 20 A/Rgt120
  days
• Example YTD Charges 150,000
• Period Ending A/R 100,000
• Month March (3)
• DIR 100,000/ (150,000/3)30 60 days
• A/R gt 120 d 20,000 20 A/Rgt120 days

9
Signature Reports

• SG-AG150 Service Group Within Tx Class Within
  Provider Days in Recievables and Net Collection
  Rate
• SG-LAG33 Lag Report Days from date of service
  to date of entry
• SG-ATB03 Aged Trial Balance Summary A/R gt120
  days

10
SG-AG150 Service Group Within Tx Class Within
Provider

• A0A8 ACTIVITY BY REVENUE
  PLAN GROUP SUMMARY SG-AG150
  PERIOD 02 DATE 03/07/06
• XXXXXXXXX SERVICE
  GROUP WITHIN TX CLASS WITHIN PROVIDER
  AS OF 03/06/06 TIME
  03.27.58
• 
  ACCOUNTS RECEIVABLE
  LEVEL X
  PAGE 1
• 
  
  
  INDEXGRA ND TOTAL SUMMARY
• GUARANTOR RE CHAMPUS REVE
  MEDICARE REV MEDICAID REV BLUE SHIELD
  COMMERCIAL R WORKMANS COM OTHER REVENU
  TOTAL
• ------------- -------------
  ------------- ----------- -- -------------
  ------ ------- ------------- -
  ------------ -------- ----------------------
  --------------------------
  ------------------------- ---------------
• LAST PER ENDING A/R -----
  -----
  ----- -----
  ----- -----
  -----
  65123,364.82
• CUR 4808,098.93 113,930.20
  5147,757.25 6950,202.55
  3957,254.65 1834,650.29
  322,838.25 247,083.00
  23381,815.12
• YTD 9784,917.31
  241,228.70 11051,054.71
  13763,704.45 8163,604.15
  4366,773.81 773,352.00
  471,503.25 48616,138.38
• CUR 27,058
  967 37,572
  39,914 25,579
  10,746 1,329
  632 143,797
• YTD 52,829
  ,823 75,493
  80,874 52,794
  22,462 3,120
  1,229 290,624
• PAYMENTS
• CUR 555,983.08-
  34,420.10- 1299,744.57-
  2288,412.78- 1743,344.81-
  1013,297.65- 252,372.79-
  181,001.05- 7368,576.83-
• YTD 1262,674.84-
  87,554.34- 2306,370.93-
  4575,846.99- 3175,419.35-
  2199,781.53- 487,553.25-
  231,569.87- 14326,771.10-
• CUR 16,130
  693 16,749
  30,890 13,164
  8,317 1,163
  903 88,009
• YTD 34,554
  1,679 32,982
  63,070 26,111
  19,219 2,365
  1,219 181,199
• CONTR ALLW

11
SG-LAG33 Lag Report Days from date of service
to date of entry

• 00000 XXXXXXXXXX A0A8
  LAG REPORT
  SG-LAG33 PERIOD 12 DATE 01/06/06
• 
  
  AS OF 01/05/06
  TIME 05.15.01
• 
  
  
  PAGE 1
• 
  
  INDEXXXXXXXXXXXX
• PROVIDER XXXXXXXXXXXX
  LEVEL- 2
• --------------------------------------------------
  --------------------------------------------------
  --------------------------------------------------
  ------------- ------------------------------------
  -
• TOTAL DATE OF SERVICE TO DATE OF
  ENTRY DATE OF SERVICE TO INS BILL DATE
  DATE OF SERVICE TO GUAR BILL DATE
• ACT CHARGE
  OVER AVG.
  OVER AVG.
  OVER AVG.
• PER DOLLARS 0- 30 31- 60 61- 90
  91 DAYS 0- 30 31- 60 61-
  90 91 DAYS 0- 30 31- 60
  61- 90 91 DAYS
• --------------------------------------------------
  --------------------------------------------------
  --------------------------------------------------
  --------------------------------------------------
  
• --------------------------------------------------
  --------------------------------------------------
  --------------------------------------------------
  --------------------------------------------------
  
• 1 1,749,684.46 2618 1
  9 17 11.0 1882
  63 54 71 17.4
  713 311 91 117 40.5
• 2 1,880,433.16 2871 8
  4 27 12.5 2176
  11 59 75 17.1
  713 391 94 80 36.6
• 3 2,111,539.25 3175 27
  10 27 11.3 2365
  52 64 96 16.4
  771 376 76 114 37.6
• 4 1,988,648.25 3106 21
  7 7 10.4 2354
  66 71 71 16.0
  706 354 84 141 39.3
• 5 2,066,202.00 3240 25
  11 15 12.2 2408
  67 78 36 15.9
  761 408 108 97 37.0
• 6 2,154,299.00 3322 15
  15 10 10.3 2513
  48 67 59 14.1
  800 439 94 71 34.2
• 7 2,275,338.00 3118 12
  9 25 10.0 2294
  53 90 140 1 8.8
  692 308 101 79 34.3
• 8 2,023,252.00 2803 15
  9 13 11.2 2011
  81 53 101 18.0
  624 337 76 40 31.4

12
SG-ATB03 Aged Trial Balance Summary

• 00000 XXXXXXXXXXXXXXXXXXX A0A8
  AGED TRIAL BALANCE SUMMARY
  SG-ATB03
  PERIOD 12 DATE X/XX/XX
• 
  PATIENT NAME WITHIN
  GUARANTOR NAME WITHIN PROVIDER
  AS OF 01/05/06 TIME 04.37.31
• 
  
  AGING BY DATE OF ENTRY
  PAGE 1
• 
  SEQ 13
  INDEXSUMMARY
• PROVIDER XXXXXXXXXXXXXXXXXXXXXXC
  LEVEL-2
• AR PLAN GROUP 000- 030 031-
  060 061- 090 091- 120
  121- 150 151- 180 181- 210
  211- OVER TOTAL
• 
  ----------- -----------
  ----------- -----------
  ----------- -----------
  ----------- -----------
  -----------
• GUARANTOR REC 449,575.71 535,311.82
  453,191.22 642,010.96 290,506.36
  149,442.53 64,874.40
  515,567.95 3100,480.95
• COMMERCIAL RE 198,099.26 96,595.33
  67,200.88 47,101.67
  18,946.08 23,509.33 18,606.44
  34,979.88 505,038.87
• MEDICAID RECE 320,901.79 80,929.58
  70,956.02 78,794.79
  34,097.49 26,742.49 25,194.22
  150,337.57 787,953.95
• BLUE SHIELD R 305,385.27
  85,635.92 50,901.61 51,070.04
  10,424.67 24,923.41
  8,340.10 33,454.24 570,135.26
• MEDICARE RECE 378,241.00 39,215.38
  22,659.80 26,029.46
  2,763.30 12,656.85 5,521.00
  53,892.88 540,979.67
• WORKMANS COMP 40,624.00 13,909.00
  10,235.70 13,914.00
  2,232.00 6,094.50 911.00
  9,589.00 97,509.20
• CHAMPUS RECEI 13,104.66 11,022.81
  2,289.00 4,721.40
  8,453.40 1,009.87 770.00
  14,531.36 55,902.50
• OTHER RECEIVA 18,743.00
  7,219.63 12,615.00 23,817.77
  10,836.75 6,209.96
  1,320.00 39,188.67 119,950.78
• UNAGED
  
  
  
  334,018.84-

13
SG-ATB03 Aged Trial Balance Summary

• 00000 XXXXXXXXXX A0A8
  AGED TRIAL BALANCE
  SUMMARY SG-ATB03
  PERIOD 12 DATE XX/XX/XX
• 
  PATIENT NAME WITHIN GUARANTOR
  NAME WITHIN PROVIDER AS OF 01/05/06
  TIME 04.37.31
• 
  
  AGING BY DATE OF ENTRY
  
  PAGE 2
• 
  
  
  SEQ 13 INDEXSUMMARY
• PROVIDER ANE XXXXXXXXXXXXXXXXXXXXXX
  
  LEVEL-2
• 
  
  C O N T R O L T O T A L S
• 
  
  
• 
  INSURANCE
  BALANCE 2,677,470.23
• 
  GUARANTOR BALANCE 2,766,462.11
• 
  -------------------

14
Score Card

• XXXXXXXXXXX XX/XX/XX Department Code A
• Practice Evaluation (1)
• Data from Month End Report(2)
• Total Guarantor Non-Guara
  ntor
• Fiscal Period (from AG150 or AF053)
  12 12
  12
• YTD Charges (from AG150 or AF053)
  19,268,825 5,705,948
  13,562,878
• YTD Payments (from AG150 or AF053) 6,414,408
  1,033,148 5,381,260
• YTD Adjustments (from AG150 or AF053) 1,329,055
  103,313
  106,574
• YTD Contr Allow (from AG150 or AF053) 7,496,945
  497,006
  8,119,107
• YTD A/R Balance (from AG150 or AF053) 3,451,656
  2,376,026 1,075,631
  
• YTD Courtisies (from AG150 or AF053) 30,822
  30,822
  -

15
Score Card

• Notes
• (1) Reports that are needed for this evaluation
  are the month end AG 150, SG-ATB 03 ("ATS"), LAG
  33.
• (2) Negative numbers from AG 150 are converted to
  positive numbers in this column for these
  calculations.
• (3) DIR calculation YTD A/R Balance/(YTD
  Charges/Fiscal period Month)30days.
• (4) A/Rgt120 days calculation A/R balance gt120
  days/Total A/R balance.
• (5) Net collection calculation YTD Payments/(YTD
  Charges-Allowances-Courtesies- Transfers).
• (6) Lag time is the time from service date to
  time of charge entry.

16
Score Card

• (7) Points are calculated from on a scale of
  0-25. Point Calculations
• A/R Days in Receivables 0 points gt80 days, 5
  points gt70, 10 points gt60, 15 points gt50, 20
  points gt40, 25 points lt40
• A/R Over 120 Days 0 points gt 50, 5 pointsgt
  40, 10 points gt 30, 15 pointsgt 20, 20 points gt
  15, 25 pointslt15
• Net Collections 0 pointslt85, 5 pointslt87.5,
  10 pointslt 90, 15 pointslt 92.5, 20 pointslt95,
  25 pointsgt95
• Lag Time average 0 points gt35 days, 5 points
  gt30, 10 points gt25, 15 points gt20, 20 points
  gt15, 25 points lt15
• (8) Score calculation 50 1/2 of the points
  awarded.

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Benchmarks

• UP MGMA
• A/R Days in Receivables lt40 47.7
• A/R Over 120 Days lt15 19.74
• Net Collections gt95 97.78
• Lag Time average lt15 6.0
• MGMA average for multi-specialty group

18
Dashboard

• XXXXXXX September 2005 B
• Total Guarantor Non Guarantor
• A/R Days in Receivables 50
  149 33
• Group Average 74 180 47
• Median 84 187 55
• Range 43-141 135-284 27-122
• A/R Over 120 Days 17.9 26.4 11.2
• Group Average 29.1 35.8 22.0
• Median 26.5 35.0 16.7
• Range 17.3-39.6 24.9-51.7 5.3-56
• Net Collections 71.2 14.1 89.5
• Group Average 67.6 11.0 104.0
• Median 64.0 12.0 100.0
• Range 27-111 3-111 84-gt100
• Lag Time 19.7 19.7 19.7
• Group Average 30.1 30.1 30.1
• Median 21.9 21.9 21.9
• Range 6.9-56.4 6.9-56.4 6.9-56.4
• Practice Score 77.5 67.5 90.0

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Appendix Macro to convert 12345- to -12,345

• Module 3 1
• Sub Macro3 ()
• Macro3 Macro
• Macro recorded 3/29/00 by USER
• Converts string- to a negative number
• Keyboard Shortcut Ctrlm
• Worksheets(1) .Activate
• For Each c In Range (myrange)
• c.Font.Size 6
• SS c.Value
• If Right (SS, 1) - Then
• L Len(SS)
• SS - Left (SS, (L 1))
• c.Value SS
• c.Style Comma
• If Right (SS, 2) - - Then