Infusion & DME Billing: How to Calculate Hold Days

There are nearly one-hundred metrics related to healthcare revenue cycle management (RCM). We know. We’ve counted all of them. That kind of input overload makes it easy for your team to lose sight of metrics that matter. Fortunately, there are ways to streamline those metrics with key performance indicators (KPIs). 

Of the KPIs Prochant has found most helpful for the Infusion and DME industries, your Hold Days metric should be near the top of the list. Some providers may know this metric as Unbilled Days. Hold and Unbilled are used interchangeably in this article as they both represent the same concept: claims that we cannot bill due to underlying issues, such as missing CMNs/Prescriptions and Prior Authorizations.

 

What is Held (or Unbilled) A/R?

Held A/R (Accounts Receivable) is A/R that has not been released for billing due to missing or expired CMNs/Prescriptions, prior authorizations, compliance data, other supporting medical documentation, and a host of additional reasons, such as missing data fields (for example, a physician record is missing the physician’s NPI number).

 

What is Hold Days?

The Hold Days metric is the number of days worth of revenue tied up in held A/R or unbilled A/R.

 

How is Hold Days calculated?

To find out what your Hold Days measurement is, follow these steps:

Step 1: Get the sum of all hold types in your billing system, by dollars

** Depending on your billing system, this can be tricky! In addition to Hold and Unbilled, other names you may find this under include: Validation, Rental Hold, Unselected Claims, and Stops.

Step 2: Determine your average monthly Allowable billing.

** Allowable billing = Charge Billing - Contractual Adjustments

Step 3: To calculate the Hold Days:

Total Holds / Monthly average Allowable billing

 

Why is Hold Days important?

Held A/R is revenue earned and recognized for services rendered that you are unable to bill for. Held revenue is the #1 cause of timely filing issues.

 

What is considered Good, Okay, At Risk?

  • Good: Less than 4 days
  • Okay: Between 4-8 days
  • At Risk: Greater than 8 days

 

Role based questions to ask

Executives are most concerned about the Hold Days metric when it is not in the “Good” category, as stated above, as less than four days. Middle-level managers should dig into Hold Days when it is over four days.

 

Are some concerns surfacing? You should start with these questions:

  • What has the trend been?
  • What are my holds by?:
    •  Reason
    •  Payer
    •  Doctor
    • Branch
A lot of providers have each branch responsible for their own holds. More questions to ask yourself:
  • Do we have proactive hold management processes in place?
  • What are my holds by sales representative?

  

Tips to Reduce Hold Days

  • Proactively work holds by gathering:
    • Documentation prior to delivery
    • Soon to expire CMNs
    • Soon to expire prior authorizations
  • Assign ownership to each Hold Reason & carve out time to work the hold every week. For example:
    • CMNs/Prescriptions = Documentation Team
    • Prior Authorizations = Intake Team
    • Compliance Holds = Clinical Team
    • All Others = Billing Team

 

What can we look for in terms of correlation/causation?

Some providers do not confirm orders until all documentation has been received. This means that Open Order Days would be high and Hold Days may be low. Other providers confirm orders immediately after delivery. This means that Hold Days are high, but Open Order Days are low. The benchmark for Open Order Days is less than 12 days. Therefore, we recommend giving a “16-day” budget across both Open Order Days and Hold Days.

 

Tools to Help Track

Even with these steps in place, managing and updating spreadsheets and databases on your own can still lead to a lot of errors and missed revenue. Seek out a purpose-built platform to help keep track of Hold Days and other KPIs integral to your success. Systems like our new revenue cycle intelligence tool, Prochant Analytics, are designed exactly for quickly managing these processes. With its intuitive interface, HITRUST security certification, and unmatched client support team, Prochant Analytics is guaranteed to supercharge your payment velocity and eliminate fears of lost revenue. Want to see how it works? Read the white paper here.


Prochant is the leading reimbursement firm with a dedicated focus on HME and pharmacy. We have a proven track record of helping HME and pharmacy providers meet their financial goals. Our scalable solutions, years of experience, and advanced technology provide best-in-class results to the healthcare community. Headquartered in Charlotte, North Carolina, our client base includes national HME and pharmacy providers and health systems.