First Pass Resolution Rate: Cash Flow Predictor

First pass resolution rate has a direct impact on a practice's cash flow. When claims are paid on the first submission, the practice receives payment faster, reducing the amount of time claims spend in accounts receivable. For example, if a practice has a high FPRR, they may see payment on a claim within 14 days, whereas a practice with a low FPRR may see payment in 30 days or more. This delay in payment can cause cash flow problems, particularly for small practices with limited reserves. In our experience, a 10% increase in FPRR can result in a 5% reduction in days in accounts receivable.

To illustrate the impact of FPRR on cash flow, consider a practice with 100 claims submitted per month, with an average revenue per claim of $100. If the practice has a FPRR of 80%, they will receive payment on 80 claims within 14 days, resulting in $8,000 in revenue. However, if the practice has a FPRR of 60%, they will only receive payment on 60 claims within 14 days, resulting in $6,000 in revenue. This $2,000 difference in revenue can have a significant impact on the practice's cash flow.

In addition to the direct impact on cash flow, a low FPRR can also indicate underlying issues with the practice's revenue cycle management. For example, a high number of claims requiring additional information or resubmission may indicate a problem with the practice's charge capture or coding processes. By analyzing the reasons for denied or rejected claims, practices can identify areas for improvement and implement changes to increase their FPRR.

There are several common causes of low first pass resolution rate, including incorrect or incomplete patient demographic information, missing or incorrect insurance information, and coding errors. For example, if a practice submits a claim with an incorrect patient date of birth, the claim will likely be rejected, reducing the practice's FPRR. Similarly, if a practice fails to obtain prior authorization for a service, the claim may be denied, also reducing the FPRR.

To improve FPRR, practices should focus on ensuring accurate and complete patient and insurance information, as well as accurate coding and billing. This can be achieved through regular audits and training of staff, as well as the implementation of electronic health records and practice management systems. For example, our company has seen significant improvements in FPRR by implementing a system that automatically checks patient demographic information and insurance eligibility before claims are submitted.

In addition to these strategies, practices can also improve their FPRR by monitoring and analyzing their claims data. By tracking the reasons for denied or rejected claims, practices can identify areas for improvement and implement changes to increase their FPRR. For example, if a practice notices that a high number of claims are being rejected due to missing prior authorization, they can implement a process to ensure that prior authorization is obtained for all services that require it.

Practices can improve their first pass resolution rate by implementing several strategies, including regular audits and training of staff, implementation of electronic health records and practice management systems, and monitoring and analysis of claims data. For example, our company has seen significant improvements in FPRR by implementing a system that automatically checks patient demographic information and insurance eligibility before claims are submitted. We have also seen improvements by providing regular training to staff on coding and billing procedures, as well as by conducting regular audits to ensure that claims are being submitted accurately and completely.

In addition to these strategies, practices can also improve their FPRR by working closely with their payers. By establishing relationships with payer representatives and staying up-to-date on payer policies and procedures, practices can ensure that they are submitting claims that meet payer requirements, reducing the likelihood of denied or rejected claims. For example, we have worked with several payers to establish electronic submission processes, which have reduced the number of claims that are rejected due to missing or incomplete information.