OP Insights: Claim Turnaround Metrics

Version 14.8

Overview

In this section you will find more information on the Claim Turnaround Metrics section of the Billing Overview Tab.

Why is This Important?

Two key metrics, as defined by MGMA, are 'Lag Days' and 'Days to Paid' . Both metrics are used to compare the efficiency of a practice's billing workflow to other practices.

Average Lag Day (DOS to Primary Payer Submission Date)

  • What is this?
  • Lag days (or claim lag days) are the number of days from date of service to first submission of the claim to the clearinghouse or payer.  OP calculates this average for claims submitted during the last 12 weeks.
  • Keeping it Healthy
  • For lag days, smaller is better. Watch for any increase in your lag days because it means there is an extra delay before you will be paid.

Average Pay Cycle (DOS to Fully Paid Date)

  • What is this?
  • A calculation of the number of days from the date of service to the date when the claim became fully paid for each fully paid claim during the last 12 weeks.
  • Keeping it Healthy
  • For average pay cycle, shorter is better.  Watch for any increase in your average pay cycle.