How committed is your team to make your acupuncture practice the best it can be? From your medical billing department to your clinical staff to your front desk reps, everyone involved in day-to-day business around your holistic practice should be motivated to help you become a top-of-the-line medical establishment.
In order to understand how well your acupuncture practice is financially operating, you need to understand which metrics to track. Knowing which key performance indicators to monitor will empower your staff to optimize their work and streamline your acupuncture practice’s overall operations.
If your holistic practice’s billing staff isn’t diligent with billing practices, mistakes such as upcoding, downcoding, and inaccurate information can go undetected until it’s too late. This can lead to a high number of rejected claims and ultimately impact your practice’s financial future. Ensuring accurate billing and coding can protect your holistic practice from fines and inefficient billing practices that puts your practice at risk.
Every claim that is not paid on the first submission wastes your holistic practice’s valuable time and money. The Medical Group Management Association (MGMA) estimates that the average cost to re-work a claim that has been rejected or denied is $25 for each claim. If your integrative healthcare practice has to rework 100 claims per month, then it costs your practice an average of $2,500 a month to work on unclean claims; that’s an estimated $30,000 a year! 
Additionally, inaccurately submitted claims can result in legal trouble. If your holistic practice submits too many improperly filled out claims, you can be flagged for potential fraud and abuse. The U.S. Department of Justice (DOJ) enforces laws, such as the False Claims Act and Anti-Kickback Statute, to crack down on coding abuse like improperly used modifiers, overcharged services, and more. In fact, fraudulent claims can cost your holistic practice thousands of dollars in fines!
As the saying goes, knowledge is power. In order to know how well your acupuncture practice is performing, you should investigate the following key performance indicators:
When thinking about your revenue, you may be inclined to focus on gross collection rate - the total of your initial charges before adjustments. But your net collection rate is a better measurement of financial performance and collections effectiveness since it factors in the percentage (after negotiated contract write-offs) of collectible funds that are actually collected by your practice.
A 96% net collection rate is considered ideal across the industry. Anything lower than a 95% clean claims ratio means your holistic practice is losing revenue, which also indicates your holistic practice is wasting further money and time reworking rejected claims. In reality, most holistic practices have a rate that varies between 75% and 85%, which means that somewhere around 15–25% of claims submitted each month have to be worked on twice, at minimum.
Your holistic practice’s clean claim ratio is the average number of claims paid upon the first submission. Every provider would love to reach a percentage above 95, but it’s about more than just reaching that number – it’s about streamlining your practice!
Holistic practice budgets are tight, and your staff’s time is the most precious resource you have. So if your clean claims rate is less than 85%, it means your staff is likely having to spend extra time on identifying denial reasons, coordinating with payers, and re-submitting claims. Overall, the clean claims rate directly affects your holistic practice’s overall revenue cycle.
Holistic practices should strive for a 95% clean claims rate, however, few practices actually reach that target goal. Most practices receive reimbursements the first time a claim is submitted for approximately 75% to 85% of claims they bill, which means about one-quarter of claims are denied or delayed due to errors or incomplete documentation.
Accounts receivable (AR) is the balance of money due to a firm for goods or services delivered or used but not yet paid for by customers. Accounts receivables are listed on the balance sheet as a current asset. AR is any amount of money owed by customers for purchases made on credit.
This is probably one of the most critical pieces of information you need to obtain in order to run your acupuncture practice; this metric helps you budget your inflow and expenses. This is calculated by taking your A/R at the end of the closed month and dividing it by the charges at the end of the same closed month. You then take that number and multiply it by the calendar days in the same month.
As with your entire payer mix, like insurance contracts, there should never be a high accounts receivable balance in any given class or insurance type. It's really a good idea to not carry patient balances on your books for more than 90 days. If you have patient balances over this timeframe, find out why and work to resolve them as soon as possible.
Monitoring this self-explanatory metric also helps you keep track of underperformers at your practice. The average charge per visit and pay per visit are great pieces of information to have to set a standard; then, if you fall below this average on any given visit, it’s a good idea to investigate why.
By using these tips to boost your acupuncture practice’s revenue cycle, you’re sure to make the most of your practice’s revenue in the future. However, these tips definitely require time and effort to do it successfully. If you’re in need of expert medical billing services, let Holistic Billing Services be your go-to source for an error-free billing solution.
With decades of experience dealing with a broad range of medical billing issues for all kinds of holistic practices, the team at HBS has seen just about every kind of medical billing error an organization can make. That’s why our clients trust us to help them manage their insurance claims to ensure they’ll be accepted as clean claims on the first attempt, avoiding lengthy back and forth negotiations with the insurance company. And best of all, you’ll avoid the scrutiny of federal and state auditors.
Contact us today to learn about Holistic Billing Services medical insurance billing services and find out how we can help you increase your clean claims rate!
At Holbie, we offer complete and innovative Holistic Billing Services for acupuncture, massage therapy, and chiropractic providers.
At Holbie, we offer complete and innovative Holistic Billing Services for acupuncture, massage therapy, and chiropractic providers.
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