Medical Billing And Coding

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December Billing Performance Index (BPI) outperformed November value by 4%, replacing two participants in the list of top ten performers and raising the index from 13.7 up to 13.1. This article describes a 7-th iteration of a prototype for a rule-based chiropractic billing index, including its coverage definition, update cycle, volume weighting, and provided information.

BPI = 13.1 means that the average of ten top performing payers working with BillingPrecision.com clients have 13.1% of Accounts Receivable beyond 120 days. BPI is a key billing performance characteristic, as it is a proxy of the claims that are never paid. Obviously, the lower is the index the better is billing performance. The table below also lists the top ten performing payers and their relative index as recorded in Billing Precision’s system.

• Billing Precision Index 13.1
• Triad 3.5
• Blue Cross Blue Shield Wisconsin 4.4 (down from 2.9 in November)
• Medicare Florida 5.6
• United Health Care 7.1 (up from 12.1 in November)
• Blue Cross Blue Shield Illinois 10.6 (down from 5.4 in November)
• Health EOS 11.9 (up from 19.5 in November)
• Cigna 12 (same as November )
• Medicare New Jersey 16.3 (down from 12.1 in November)
• Blue Cross Blue Shield New Jersey 18.5 (up from 20.2 in November)
• Medicare Wisconsin 18.5 (down from 16.1 in November)

Dropped participants from November BPI:

• Horizon 6.5
• Aetna 17.2

Improved participants with respect to November BPI:

• United Health Care 7.1 (up from 12.1 in November)
• Health EOS 11.9 (up from 19.5 in November)
• Blue Cross Blue Shield New Jersey 18.5 (up from 20.2 in November)

Underperforming participants with respect to November BPI:

• Blue Cross Blue Shield Wisconsin 4.4 (down from 2.9 in November)
• Blue Cross Blue Shield Illinois 10.6 (down from 5.4 in November)
• Medicare New Jersey 16.3 (down from 12.1 in November)
• Medicare Wisconsin 18.5 (down from 16.1 in November)

New participants with respect to November BPI:

• Triad 3.5
• Medicare Florida 5.6

Coverage

BPI is rule-based, i.e., payer participation in the index is defined by dynamically rules at the time of computation and not by a static listing of specific payers. Therefore, any specific payer may start or discontinue participation in the index, dependent on satisfaction of rule’s conditions.

Current selection of payers for participation in the BPI is based on fifty top-volume providers across all United States that have received Billing Precision services for more than six months and have more than two hundred claims in their current Accounts Receivable.

Update Cycle

BillingPrecision.com updates BPI on a monthly basis.

Volume Weighting

BPI is volume weighted, which is important to accommodate future growth of provided information, index combinations, and sensitivity across multiple indices.

Information Provided

BPI computes the percent of Accounts Receivable beyond 120 days. Note that national average across all medical specialties of percent of accounts receivable beyond 120 days is 17.7%.

Summary

Medical Billing Performance Index helps the development of billing industry standards. Medical service providers can use the index to benchmark their billing performance and to guide its improvement over time. Rule-based index definition allows for automated inclusion and exclusion of payers in the index based on payer attributes, such as numbers of processed claims, accounts receivable distribution, certain mix of CPT codes, or patient demographics. Relative payer index provides billing process improvement direction.

Yuval Lirov, PhD, author of “Mission Critical Systems Management” (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net Billing Technologies and Services. Vericle? unites hundreds of billing services across the nation. Its electronic medical billing software tracks payer performance from a single point of control and shares compliance rules globally. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

WASHINGTON — Don’t assume that your complicated medical bill is correct.

This entry was posted on Tuesday, November 13th, 2007 at 5:45 am and is filed under Medical Billing And Coding. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.