New Scorecards Help Laboratories and Diagnostic Providers Track Performance on Key Metrics and Compare Results Against Peers

Laboratories and diagnostic providers are always interested in new and easier ways to leverage objective, market-based assessments of key performance indicators (KPIs), particularly in the context of their peers. To provide this insight, XiFin recently launched a series of new scorecards that leverage XiFin best-in-class performance metrics and segment-specific industry benchmarks. Through a robust business intelligence portfolio, XiFin makes it easier for organizations to compare performance on key metrics to that of others in the same diagnostic specialty. Benchmarking data is derived from thousands of payors and the tens of billions in claims billed through XiFin RPM annually.

This article reviews two of the new scorecards: the Period Metrics Scorecard and the Trending Scorecard.

The Period Metrics Scorecard

• Accession/Encounter count (#)
  Current period compared to previous period, and the directional trend
• Procedure code count (#)
  Current period, compared to previous period, and the directional trend
• Procedure code units (#)
  Current period, compared to previous period, and the directional trend
• Total payments posted ($)
  Current period, compared to previous period, and the directional trend

The next section of the Period Metrics Scorecard illustrates key submission metrics for the current period, previous period, and directional trend, as well as comparisons to the segment average and the segment best-in-class.

Segment best in class identifies the best performing metric among organizations in the same segment (i.e., anatomic pathology, molecular diagnostics, hospital, etc.).

Submission metrics include:

• Clean claim rate (submissions)
  Accessions submitted with no manual intervention
• Clean claim rate (zero balance)
  Accessions obtained zero balance with no manual intervention
• EFT percentage
  Electronic File Transfer
• ERA percentage
  Electronic Remittance Advice

Being able to easily monitor submission metrics, such as clean claims percentage, and see them in the context of the average for all organizations in the same market segment, can shine a light on opportunities to improve revenue cycle management processes and thus turnaround time. Likewise, having visibility into the percentage of filings and remittance advice being performed electronically versus the segment average and segment best-in-class can provide insight into opportunities to reduce labor costs.

The final section of the Period Metrics Scorecard includes error/exception processing metrics. As with the submission metrics, the error processing metrics demonstrate performance for the current period, previous period, directional trend, as well as comparisons to the segment average and the segment best-in-class.

Error processing metrics include:

• Average days to fix errors
  Average days to fix accessions in error status
• Average days in queue (fixed)
  The number of calendar days between the error date and the fixed date, averaged
• Average days in Error
  Average number of days accession has been in error status
• Average days in queue (unfixed)
  The number of calendar days accessions have been in queue, averaged
• Unbillable percentage
  Accessions missing information blocking the claim from submission
• Unpriceable percentage
  Accessions missing information preventing pricing for submission
• Back-end denial percentage
  Accessions with at least one back-end denial error (error date in period) / number of accessions with date of service in period
• Front-end denial percentage
  Accessions with at least one front end denial error (error date in period) / number of accessions with date of service in period
• Front-end rejection percentage
  Accessions with at least one front-end rejection (error date in period) / number of accessions with date of service in period

The Trending Scorecard

• Unbillable errors
• Unpriceable errors
• Fixer errors versus unfixed errors
• Clean claims submissions
• Rejection and denial errors
• ERA versus EFT

These scorecards will be discussed in greater detail in a future post.

Finally, even more detailed scorecards are also available to XiFin customers who use Advanced Analytics. These Advanced Analytics scorecards enable managers to drill down into the details behind each of the individual metrics.

Request a demo now to learn more about XiFin’s business intelligence portfolio and best-in-class performance metrics that come standard with XiFin RPM.