Jun 11, 2024
Apr 15, 2025
Written By Elizabeth Cifers
If you’re dipping your toes into revenue cycle management at your retina practice, you may be overwhelmed by the many steps and stages of the revenue cycle and wonder where to start. Many practice management systems offer dashboards and reporting on revenue cycle analytics, which can reveal areas to focus on. Still, it could prove challenging to interpret what you’re looking at and decide which to tackle first—plus, these dashboards aren’t foolproof.
Over Elizabeth’s decades of experience in ophthalmology and, more specifically, retina, she’s found the most “easy wins” for efficiency and revenue with the four metrics below. Other analyses can take longer to produce improvement but are equally important—we’ll touch on this a bit at the end of the article. Keep reading to learn how to create efficiencies and boost revenue at your retina practice.
The following four revenue cycle analytics will help you identify inefficiencies in your retina practice's charge entry, billing, and insurance claims process. Most of these inefficiencies can be fixed relatively quickly with minimal effort, and most importantly, they are 100% under your control to change.
1. Charge Entry Lag – The days between the service and charge entry dates.
2. Billed Charge Lag – The days between the service and claim submission dates.
The benchmark for Charge Entry Lag and Billed Charge Lag is 1-3 days each. If the lags are longer at your retina practice, it may be a simple process change. Ideally, the physician or scribe should enter the charge at the service time, which should then be billed as soon as possible. If this isn’t possible, the biller should key in the charges the same day or the following day.
In general, seek to reduce the time it takes for the biller to receive and enter the charge. Each additional day adds to Days in Accounts Receivable (A/R)—in other words, an inefficiency in your revenue cycle.
3. Clean Claim Rate – The percentage of claims the payer accepts on the first submission for a specified period.
4. Claim Denial Rate – The percentage of claims denied by the payer for a specific period.
Inefficiencies in the insurance claims process can hamper the revenue cycle at your retina practice. Your Clean Claim Rate should be at least 95%, and your Claim Denial Rate should be 5%, but not more than 5-10%. If your claims are being denied at a greater rate, investigate for simple errors preventing them from making it past the edits, like improper modifiers, too many units of a drug for one day, or multiple of the same diagnostic test billed.
For a more detailed discussion of these four revenue cycle analytics, see Elizabeth’s article: Often Overlooked Key Performance Indicators (KPIs) for Retina Practices.
Claim denial analysis may start at a high level, such as identifying specific payers, CPT1, or HCPCS codes associated with lagging accounts receivable. Once a pattern has been identified, drill down to the patient level. The Remittance Advice (RA) will provide a reason. If there is a recurrent error, educate your team on properly coding, documenting, or billing.
While the first four metrics discussed may be low-hanging fruit, these next few analytics are just as valuable for your retina practice's revenue cycle.
New patient referrals keep the revenue cycle flowing. The benchmark for the New Patient Ratio is 5-10%. If your retina practice isn’t attracting a steady stream of new patients, do you know why? As a best practice, new physicians should schedule meet-and-greets with referring physicians and optometrists to establish relationships.
Net Collections Per FTE Staff is a measurement of the efficiency of your staff, which significantly impacts revenue. Full-time equivalent (FTE) staff is the number of hours your staff works over a period divided by the number of full-time hours in that same period. When you divide your net collections by your FTE staff, you should land in the ballpark of $165,000-$230,000 for the year. If you don’t, consider how your staff may need to be trained or reallocated.
Overall, the revenue cycle analytics at your retina practice should improve over time and stabilize. When they’re outside industry benchmarks or moving in the opposite direction, it’s time to investigate. Sometimes, a minor adjustment to a procedure is all that’s required. Other improvements may take more time and effort, but they’re worth it in the long run.
For an expert analysis of the revenue cycle at your practice, hire retina practice consultant Elizabeth Cifers. Elizabeth has decades of experience in medical administration. She’s witnessed the revenue cycle challenges unique to retina and has abundant solutions ready to help you make a difference in your efficiency. Schedule a free consultation with Elizabeth here.
Sources:
1CPT is a registered trademark of the American Medical Association. CPT copyright American Medical Association. All rights reserved.
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