5 Medical Billing Benchmarks to Live By

by Applied Medical Systems

A benchmark is known as a point of reference, or a standard, for which things can be compared or assessed. When it comes to your medical billing running smoothly and efficiently, it is important to compare your efforts to those of industry benchmarks in order to gain an understanding of how your medical billing is measuring up. Below are a few medical billing benchmarks that you may want to use in your assessment.

Medical Billing Benchmarks:

  1. Coding: It is best practice for coding to be complete within 48 hours or less following service. If your organization is taking longer than 48 hours to complete coding, a change may be necessary.
  2. Denial Rate: Denial rates for a medical practice should be less than 2%, and ideally less than 1%. If your practice has a denial rate that is greater than 1% to 2%, research should be done to uncover why claims are being denied.   
  3. Claims Billed: Your practice does not get paid until claims are billed. Therefore, it is important to have claims billed out within 24 to 72 hours following the date of service. Although 72 hours is considered acceptable, especially when dealing with a billing discrepancy, a practice should fall closer to the 24 hour mark.
  4. Claims Follow Up:All unpaid claims should be worked within 14 days. In situations where the patient needs to be contacted to resolve an unpaid claims, all correspondence with the patient should be handled within 28 days to avoid further delay in payment. It is important to continue to reach out to patients every 28 days until the bill is paid.
  5. Accounts Receivable(A/R) Days: If your practice has accounts receivables piling up, it may be time to investigate. The medical billing benchmark for accounts receivable is less than 20 to 35 days for a practice with electronic billing. When reviewing accounts receivable days, there should be less than 25% of your A/R that is 60 days overdue and less than 10% that is 120 days overdue.
If your practice is not stacking up to the industry medical billing benchmarks, it may be time to enlist the help of a medical billing company who are experts in the field.

Learn More about Applied Medical Systems

Applied Medical Systems (AMS) is a United States based medical billing and coding company with a proven track record for helping clients get paid faster and the first time. In fact, for the past quarter century we have been helping countless clients, from private practices, to clinics, to emergency department physician groups to hospitals, exceed medical billing benchmarks that they once felt were unattainable. To learn more about AMS, we invite you to explore our website and request a free quote today.