Key Performance Indicators (KPI) Reports

Analyze your data

Review the productivity trends in the Pre-Biller and Biller report for consistency. It is best to view the productivity trended over a period of time. If there is any inconsistency, evaluate the reason and determine a plan of action.

Use the productivity in conjunction with the average daily trip volumes to determine if their daily output meets or exceeds the average daily trip volume. Staffing was calculated based on productivity so if the team is not producing most likely the billing lag time lines are increasing. If the average daily trip volume is 230 the staff must produce 230 or more trips per day.

Another consideration is when to supplement your existing pool with additional staff or overtime support. If the staff is meeting their productivity guidelines and volume continues to increase, additional effort may be needed.

The report

There are numerous benefits to establishing benchmarks for both the pre-billing and coding staff's productivity such as:

• Consistent billing equals consistent cash flow
• Efficient staffing
• Daily and/or weekly feedback provided to the staff

Productivity is typically higher when consistently measured. Use the report's recommendation as a guideline to start the process, however it is recommended that productivity be evaluated for a period to establish guidelines that are meaningful to your organization. While an employee meeting a quota is the ultimate goal, it can backfire if their quota becomes more important than producing quality results. Areas that potentially impact quality are;

• Paper vs. electronic Patient Care Reports (ePCR)
• The quality and accuracy of the PCR
• Lack of training and feedback to EMT crew members regarding billing requirements
• If the billing department consistently receives face sheets from the facility or if they have system access into a facility, tools available to the staff (i.e. eligibility, address search, etc.)

The more the billing staff has to hunt for or request information the less productive and effective they will be.

Role	Prod/day*	Comment
Pre-Biller	50-70 per day 6-9 per hour	The Pre-Biller is typically responsible for verifying demographic and insurance information. Assuring that the complete information is received.
Coder	80-120 per day 10-15 per hour	The coder is typically responsible for applying the ICD code, completing the billing narrative, completing the ambulance certification requirements, verifying the level of service and modifiers, and verifying patient signature requirements are met.
Biller	30-65 per day   4-8 per hour	The Biller fulfills both pre-billing and coding functions. This role needs a lot of information to check and confirm, therefore the Biller productivity is typically lower to allow for accuracy and thoroughness.

* Whether you use the lower-end range verses the upper-end range is dependent on a multitude of criteria but is ultimately affected by the quality and completeness of information received, automation, and efficiency in the billing department.

Analyze your data

If the Billing Lag report displays a billing lag that is greater than one to two days, determine the reason. Do you have trips that are not billed due to staffing or productivity?  Is there a lack of reconciliation processes leaving a large amount of unaccounted for trips?  Is there a large amount of missing information that holds up the billing for several days?  Is there a logistical reason causing a three to four day delay in getting a patient care report? Comparing the average daily trip volume (based on a five-day workweek) against pre-billing and coding productivity will help you determine if a lag is due to staffing.  If the daily average volume is more than the total productivity expectation for either group, you might want to consider overtime or additional staff.

Keeping the lag down to one to two days allows the billing office to quickly determine what may be missing and for operations to quickly respond. If you find a trip is missing a run report eight days after the transport, the likelihood of getting or recreating a report is less viable. Not meeting the signature requirements at the time of transport requires additional effort and increases the timeliness of billing.

Using the report

The Billing Lag report measures the billing lag, trended over time. Billing Lag is the number of unbilled claims divided by average transports per workday. This measurement takes into consideration the department’s effectiveness in reconciling trips, tracking and resolving problem trips, staff productivity, and process efficiency. Reconciliation of unbilled and problem trips, if not managed well, results in lost revenue.

The billing department may be two days behind in processing run-reports but the system may show a much larger number. A larger organization, with numerous stations, and not utilizing an electronic patient care record (EPCR) system, may take one to two days to receive the paper charts extending the lag time to three to four days.  Regardless, establish a baseline that allows for the timeliest billing. The two key criteria that you need to be aware of are the average numbers of “billable trips per day” and the “total number of trips to be billed”.

Analyze your data

Use the Claim Volume and Staffing report to review your claim volumes both daily and monthly. Knowing the average daily and monthly claim volumes will help keep the billing department staffed appropriately. If you forecast future growth, use the staffing recommendations to staff accordingly. Implementing productivity guidelines within the department will aide in determining the staffing for each function; pre-billing, billing, follow-up, etc.

Claim Volume and Staffing report

The Claim Volume and Staffing report provides an objective approach in identifying the amount of billing staff required. Measuring ongoing claim volume provides a trigger to alert you that you need to modify staffing.  Additionally, reviewing the volumes by the “type” of call; i.e. wheelchair, emergency, etc., can determine the level of effort needed in the billing department. The results of this report should be used as a guideline. Since billing systems, processes, and structures are different, you may need to adjust the recommended staffing ratios.

Analyze your data

Over a period, compare the total number of denial rates for the most recent month to the trend from previous months. Has the denial rate improved, stayed the same, decreased?

Review the denial rate to identify possible billing problem trends. For example, a high incident of duplicate denials might indicate that the claim was sent to the secondary insurance after Medicare crossed over the claim. Look to see if unnecessary claims were sent to the payer.

Look for areas that have a high incidence of denials where improvements can be made to your billing process.

The report

Denials are valuable information because they tell you why the claims are not getting paid. No matter how efficient you billing process is, there will always be a small percentage of denials. However, a high denial incidence means a delay in payment and additional effort. Reviewing claim denial specifics over a set period of time can help identify habitual problems. Once identified, long-term strategies defining ways to avoid these problems can be implemented.

For example, you can avoid the Medicare denial of “Name and ID do not match” by placing insurance verification guidelines in the pre-billing department and holding staff accountable to checking the patient’s information against the payer. Determining how the incidence of denials changes over time provides valuable information and feedback such as an increase in certain denials might indicate a possible pre-payment audit, a decrease with other denials may indicate improvement in billing processes, etc.

Use the Notes Productivity report to calculate and display the number of notes created when the claim was in a follow-up status. The number of notes can help track the productivity of your follow-up specialists. The report displays the names of the users by their log in IDs and workdays by the range you select.

Analyze your data

Look at the trend from one payer class to another. Items worth reviewing include any increase in transports or variances in one payer class over another. With the recent economy challenges, many ambulance providers saw a slight shift in their payer mix from insurance to patient.

Weak front-end processes mean costly departmental and staffing costs. There is a higher cost of time and money affiliated with having to initiate the billing process multiple times.

If the pre-billing processes are strong, the trending of the payer mix volume can be used as a tool for forecasting payments.

The report

This report is a current snapshot of the distribution of trips across the payer classed. Therefore, depending upon the thoroughness and consistency of the billing front-end processes, the payer mix can change for previous months.

KPI's for payer mix are slightly different for each ambulance company. It can be dependent upon the demographic area, the type of business model, and contracts with facilities and payers. Emergency organizations may have a higher Insurance and Medicaid percentage as contracts that typically aren’t applicable.