Lost Revenue Calculator for Medical Billing

Lost Revenue Calculator for Medical Billing

Your medical practice probably missed revenue this year that you could have collected. But how much have you been leaving on the table? We built a quick calculator to help you find out.

Of course, some non-payment is to be expected. But there are steps you can take to keep that number as low as possible. Two metrics that help you identify missing revenue that could have been yours: net collections and risky A/R. 

Just enter some basic collections and A/R details, and we’ll let you know how much you may be leaving on the table.

Net Collections Rate

Net collections is the gap between the reimbursement you expected to receive from payers and what they actually paid. Practices lose out on revenue for all sorts of reasons. Insurance companies may deny claims and appeals efforts may not yield payment. Or, insurance may pay based on outdated fee schedules and the resulting variances are not identified. Sometimes, patients also neglect to pay their out of pocket costs. 

To determine your net collections rate, you’ll need to know the total collections, charges and adjustments for your practice. First, subtract any adjustments from your total charges. What’s left is the revenue owed by payers. Next, take your actual collections to date and divide by the expected number from your first calculation. That’s your net collections rate.

At Gentem, our net collections benchmark is 95%. If you are recuperating less than that, review your process to understand why.

High Risk A/R

Over time, missed collections add up. Accounts receivable that were not paid on time, often known as aging A/R, are at a high risk of never being paid. Of course, not every claim will yield full reimbursement. But if you have lots of aging A/R, you may have opportunities to collect more.

Ideally, most of your outstanding accounts receivable should be in the 0 to 30 day bracket, since they are most likely to get paid. If you work with payers that are consistent but slow to process and pay claims, you may also expect to see A/R sitting in the 31-60 day bracket. A/R still outstanding after 90 or 120 days is at the highest risk of never being paid.

Our benchmark at Gentem is for no more than 8% of total A/R to be unpaid after 90 days, and no more than 5% after 120 days. Anything above those percentages may be unnecessarily at risk: outstanding claims in these buckets may need more follow up for resolution. In addition, after 90 days, timely filing or appeal/adjustment limits may be exceeded.

You can use our calculator to compare your own percentages and see how that gap translates to a dollar amount. A more streamlined collections process can help you get that number down.

5 Must-Know Metrics To Build A Thriving Medical Practice

With this free guide, you’ll learn the key metrics that inform your practice’s financial performance and how best to optimize them to support practice growth.

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