Frequently Asked Questions

What benchmarks should I be looking for from a billing service?

The Healthcare Billing and Management Association, the only professional association for billing services, has established the following benchmarks of excellence.

Turnaround time from date of service to date of posting should be no longer than 45 days.  This assumes a clean claim.  With the increase of electronic remittance, the turn around time for many of the larger carriers, including Medicare, has been reduced to 2 to 3 weeks, or less, in some cases.  Obviously, there will always be denials by carriers so if there is a problem with a claim, reviews, redeterminations and hearings can add 30 to 90 or more days to the cycle.   

This 45 day turnaround time also equates to having no more that 1.5 months of gross charges in your insurance aging.  For example, if your practice averages $100,000.00 in gross charges every month, then the total insurance Accounts Receivables (A.R.) should not be more that 1.5 times that (or $150,000.00).

Over 90-day outstanding insurance claims should not regularly exceed 10% of the entire gross charges.  In the above example, if your total insurance A.R. is $150,000.00, the over 90-day outstanding revenues should not exceed $15,000.00.  And, those that fall into the over 90-day category, should be in some review, refile, or redetermination status.

 

Inga's answer...