The Four Metrics Optometry Billing Managers Need To Focus On

Tracking and reviewing key performance indicators and metrics for your practice can seem a bit daunting. The typical practice owner is so busy working IN the practice that there isn’t a lot of time left to work ON the practice.

Taking a little time to analyze your data is essential, but it’s easier said than done. You can “get by” without reviewing metrics, but having a solid list of them can open your eyes to the direction your practice is heading. Here are a few that should be easy to obtain and will help you move forward in the right direction.

How to Avoid Being Overwhelmed By Cash Flow Problems

Don't get overwhelmed, these four metrics will help you take control of your cash flow and feel confident managing your optometry billing.

Cash Month-Over-Month—Total dollars collected compared to the same month in the previous year

• If time permits, obtain the numbers for managed vision care plans, medical plans and patient responsibility. Do you know who your most profitable payers are? Simply take the gross revenue by payer and divide it by the number of patients you saw.

Encounter Volume—The number of patients seen compared to the number of claims filed, for a given period

• Many times, we find that new clients have a problem with initial submission of their insurance claims. It’s difficult to get paid when the claim was never submitted.

Number of Rejections—Number of claims submitted but rejected by the clearinghouse or payer

• Overturning a rejection could be as easy as making sure the patient’s middle initial is on the claim form. However, many times these things go unworked, leaving valuable cash on the table. Verifying that your team is working your rejections actively is crucial.
• Once reviewed, this information should help find the root issue(s). Eliminating rejections, rather than waiting to fix them on the back end is imperative in making your cashflow more consistent.

Denial Percentages—Various stats surrounding your denials

• You should know the practice’s average denial percentage to have a baseline for indicating if there is an atypical increase one month. Is it a problem with your submission or a problem with the payer? Being able to compare your denial rate with that of the industry will help you answer that question.
• Do you know your denial percentages by line item rather than claim level? Tracking which CPT codes are denying can help in correcting the systemic issue causing the denials in the first place.

The four metrics mentioned above are a great start to analyzing your practice. Challenge yourself to nail those metrics, and then each month add a new one to measure. Before you know it, people may start asking you how to track and review their practice’s metrics.