5 Reimbursement Metrics You Should Track Right Now

Get your infusion pharmacy on the right track with these metrics. 

Are you tracking the right metrics? If your answer is "no" or "I don't know," you're not alone. We often meet infusion pharmacies, specialty pharmacies, and ambulatory infusion centers whose metrics are heading in the wrong direction. That's why we recently teamed up with MedEdge Solutions, a company using technology to maximize pharmacies' ROI, for a conversation tackling this very issue. Let's dive right into it: Here are the reimbursement metrics you should track right now.

1. Unconfirmed Aging

How long does it take your home infusion billers to confirm delivery tickets? We recommend setting your goal to 2-3 business days. Of course, you can encounter longer times due to UPS, FedEx, USPS, or third-party couriers. Paper signatures are also a problem. In-house and nurse deliveries often involve these signatures.

2. Unbilled Aging

Unconfirmed aging isn't the only reimbursement issue. Home infusion billers also struggle with unbilled aging. How long does it take your team to review and bill a claim? What are the reasons you're seeing for holds and aging claims? By keeping a close eye on this metric, your pharmacy can identify any issues, resolve them, and process claims quickly. 

3. Denials

Denials are never ideal for infusion pharmacies. Still, there are expected denials and unexpected denials. Reasons include the following:

  • Incorrect or missing modifers
  • Invalid HCPCs due to contract setup errors

4. Cash to Revenue

How good are your collection efforts? In our experience, most providers perform < 90%, which causes A/R to balloon. Focus on this metric to boost performance and get A/R under control. 

5. A/R Aging

We also recommend focusing on aging A/R. Specifically, your team needs to look at the percentage of A/R > 180 days and the percentage of patient balances. 

Still have questions about your company's metrics? Contact us today to speak with one of our infusion experts.