Objective:

The article examines the objective, findings, and clinical context described in Key Metrics for Ophthalmology Revenue Cycle Success.

Approach:

• Data sources: The presenters identified practice-management A/R aging reports, clearinghouse claim dashboards, and financial statements with bank-deposit reconciliation as sources for KPI data.
• Monthly charges and collections: Calculate average monthly gross charges and cash collections by dividing each trailing 12-month total by 12. Compare daily activity with the monthly averages and investigate shortfalls.
• Days in A/R: Calculate days in A/R as total A/R ÷ (total charges ÷ 365). Review aging buckets and investigate delayed chart closure or claims held for missing information.
• Denials and credit balances: Calculate the denied-claim rate as denied claims ÷ claims submitted for the same period. Track credit balances as a share of total A/R and review unresolved balances and refunds.

Key Findings:

• The presenters recommended monitoring average monthly charges and collections to identify revenue-stream changes early; they also advised benchmarking against similar practices and using a practice’s own trailing baseline.
• Heather Hambrick Dunn recommended aiming for fewer than 25 days in A/R, while noting that the target varies by payer mix. She said healthy practices keep roughly 70% of A/R in the 0–30-day bucket and that a growing 91+-day balance can signal collection problem…
• Dunn cited a denied-claim benchmark below 5% of submitted claims and advised promptly correcting and rebilling rejected or denied claims while investigating causes.
• Rahul Bhola recommended credit balances of 2%–3% of total A/R and regular review of balances and refunds.

Interpretation:

The presenters described revenue cycle management as a team responsibility and said KPI monitoring can help practices identify issues, address root causes, and improve processes.

Limitations:

• The context does not provide study methods, measured practice outcomes, or evidence validating the suggested benchmarks.
• The presenters noted that the days-in-A/R target varies by payer mix.

Conclusion:

The presenters said ongoing monitoring and preventive measures are important for identifying potential revenue cycle issues and maintaining long-term financial stability.

Sources:

• Article context: Key Metrics for Ophthalmology Revenue Cycle Success (source URL not provided)