2. Benchmarking
What’s the goal?
Status Quo: Track DAR by historical and/or average across 12 months
After today: Track DAR by analyzing days to pay + denial turnaround time
Average DAR Targeted Goal/Benchmark DAR
3. Chapter 1: Categorization of Denials
Chapter 2: Categorization of Claims/Remits
Chapter 3: Key Take-Aways
Today’s Agenda
Changing the definition of benchmarking
6. Too Much Data to Develop True Understanding
Big Data can be overwhelming
It’s an incredibly complex process to create a simple one.
7. Denial
Centralization
Denial grouping and accurate
routing for efficient follow up
Denial Centralization
Hyper-specialization At Its Best
Medical
Documentation
Pre-cert/Auth
Registration/
Insurance
Non-Covered
Services
Duplicate
Denials
Provider
Related
11. Denial Turnaround
Time Days to Pay
Denial
Centralization
Effective Benchmarking Toolbox
3 Focus Areas
Average number of days
it takes for denied claims to
get paid
The number of days it takes
for claims to get paid
Denial grouping and accurate
routing for efficient follow up
12. Department of Orthopaedics
Case Study
Look at data
that shows payment
after working denied
claims
This data tells us
how long it takes to
get paid after
internal processes
and insurance
processing of denied
claims
Denial
Centralization
Denial grouping and accurate
routing for efficient follow up
13. Department of Orthopaedics
Case Study
A B C D E
27130 18 13 12 11 12
27447 16 14 11 11 13
20610 14 12 12 15 14
29888 15 15 13 13 11
29881 17 15 13 15 16
Top Cash CPTs Resubmitted Claims
Denial
TAT
Average number of days
it takes for denied claims to
get paid
A B C D E
27130 26 21 39 29 32
27447 36 32 27 31 28
20610 31 28 26 33 33
29888 29 31 31 33 32
29881 33 29 32 32 34
Recommendations:
1. Compare paid claims vs denied claims - what’s the difference - focus in on the issues!
2. Calculate the Denial TAT by subtracting the claim resubmission date and the reject date
Goal: Decrease days to pay, increase cash flow
Avg:
13 days
Avg:
30 days
14. Scientific Benchmarking
Formula.
By digging into this bucket, we can figure out root
causes to reduce denial TAT. Example, diagnoses
844.2 and 840.4 were used and these indicate
sprains - the insurance company needed more
specification.
Avg:
7 days
15. Incredible Products
Deliverables that make your CFO Smile.
Scorecard Meaningful Target
A B C D E
27130 18 13 12 11 12
27447 16 14 11 11 13
20610 14 12 12 15 14
29888 15 15 13 13 11
29881 17 15 13 15 16
Market your days to pay scorecard at your managed
care meetings to encourage payor to pay sooner!
50 32
Accomplished an 18 day turnaround by focusing on the
top 2 CPT AR drivers - addressing coding
The average or historical DAR becomes a more real
number - a more effective and aggressive target
16. And One More You’d Really Love
A Brilliant one.
Predictive Analytics
A B C D E
27130 18 13 12 11 12
27447 16 14 11 11 13
20610 14 12 12 15 14
29888 15 15 13 13 11
29881 17 15 13 15 16
Predictive payment schedule
Predictive claims submission
