Each year, PNC surveys its Healthcare Advisory Board (HAB) members regarding their cash posting processes. The purpose of this survey is to track trends in cash posting automation, associated cost reduction, with two new questions specific to claim denials being added in recent years. The PNC HAB is currently composed of 19 large health systems across the United States. The 2019 survey results, based on 11 survey respondents, provide excellent benchmarks for other health systems seeking efficiency and cost reduction through posting automation, in addition to helping HAB members track their own progress against their peer group.


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Question 1: If you utilize PNC for patient lockbox services with data transmission (i.e. with an OCR line on the patient statement coupon), what is your average automated posting success rate for patient payments?

For 2019, most respondents reported an automated posting success rate greater than 95%, with the average being 97.7%.  Considering that the average has hovered in the 93%-94% range since 2015, a 3-4+ percentage point increase is a notable change, reflecting the goal of successful electronic posting of patient lockbox payments.

Question 2: What percentage of your total insurance payments are currently posted via Direct 835 (ERA)?

The majority of responses fell between 90% and 97% for 2019.  In recent years, as HAB members have increased ERA enrollment efforts and some have undergone system upgrades, average electronic posting rates have increased year over year.  This year's average was 93.7%, compared to an average of 89.8% from 2015-2018. 

Question 3: If you use PNC’s IOCR service (or another similar service) to convert lockbox images to “manufactured” 835s, what percentage of your total insurance payments are currently posted via Direct 835?

For those HAB members that use IOCR to create “manufactured” 835s from paper EOBs, additional electronic posting is proving to be a notable benefit.  On average, respondents saw a 3.6 percentage point increase in electronic posting, bringing the group average to 97.3%.  Two respondents even reported a 100% electronic posting rate between direct and “manufactured” 835s.

Question 4: What is your overall payment posting error rate?

This question showed a few variations among respondents, with reported error rates ranging from a high of 13.2% to a low of 0.01%.  The majority of respondents, however, did report error rates below 2%.  The average response of 1.7% shows a significant drop in error rates over the years.  In 2016, the average payment posting error rate was as high as 9.3%, but has steadily decreased since then.

Question 5: What is your Revenue Cycle Cost to Collect?

Although responses ranged from a low of $0.018 to a high of $0.039, the majority of respondents reported their cost to collect to be between $0.02 and $0.03.  The average response of $0.027 has been relatively stable over the last number of years.

Question 6: What is your Payment Posting Cost to Post?

Payment posting costs divided by total payment volume posted) below $0.50, with a couple of respondents reporting to be below $0.10.  The explanation for these especially low figures includes significant levels of automation and system accuracy, creating a low need for human intervention.  The average cost to post among respondents was $0.224, a figure that had risen to a high of $0.320 in 2018, from the previous low of $0.237 in 2015.

Question 7: What is your average days in un-posted cash?

Most respondents reported days in un-posted cash to be below one full day, averaging about 0.80 days. On the higher end, a few participants reported 2 days in un-posted cash, signaling potential efficiency challenges with cash posting processes, or possibly more relaxed standards in un-posted cash.

Question 8: What is your remittance denial rate?

Responses for this question are closer to the higher end of industry norms.  Industry sources vary in their reported average rates, but collectively indicate an average range of 5%-10%.  A majority of HAB survey respondents reported a remittance denial rate between 6%-11%, with an average of 9.8%.

Question 9: What is your fatal denial rate?

Responses for this question remained in line with industry sources which report average denial write-off rates to be between 1%-5%.  A majority of HAB survey respondents reported their fatal denial rate to be below 2%, with an overall average of 1.8%.


PNC has conducted the annual HAB survey since 2012* and, although the composition of the Board and participation in the survey vary from year to year, there are several member organizations who have been consistent respondents. The two graphs below display yearly responses from these select organizations and highlight the progress that has been made over the last several years, particularly as it relates to posting automation and posting error rates.


  • Overall, HAB member organizations are experiencing a strong year over year increase in automated posting rates.
  • The goal is to get as close to 100% automated posting as possible.

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  • Overall, HAB member organizations are moving steadily in the right direction for posting error rates.
  • The goal is to get as close to 0% posting errors as possible.

View accessible version of this chart.

Results and Overall Comments

As PNC conducts the Healthcare Advisory Board Survey from year to year, results continue to show overall progress in cash posting processes and offer benchmarks to show what is achievable in the areas of automated remittance posting, associated process costs, and management of claim denials.

As adoption of automated processes continue to improve process accuracy and efficiency, healthcare providers have the opportunity to re-deploy valuable staff and resources to other areas of the healthcare revenue cycle to improve key outcomes, including:

  • Improving revenue capture
  • Proactively managing denials and predicting denial trends
  • Creating a more consumer-centric patient experience

*the survey was not conducted in 2014.

A Note About the Survey

The composition of PNC’s Healthcare Advisory Board membership changes from year to year.  Additionally, because survey participation is voluntary and data is self-reported, the survey sample size varies from year to year and question averages may be influenced by the variance in participation. PNC makes every effort to follow-up with participants to validate responses but relies on the integrity of survey participants’ self-reported data.

Accessible Version of Charts

Comparison of Select Yearly Survey Averages

  Question 1
Posting Automation Success Rate
(Patient Pay Lockbox)
Question 2
Electronic posting percentage
(Direct 835 / ERA)
Question 3
Electronic posting percentage
(Direct 835 / ERA + IOCR)
  Question 4
Payment Posting Error Rate  
2016 93.0% 90.1% 92.6% 9.3%
2017 94.7% 87.1% 90.4% 8.0%
2018 93.6% 92.7% 96.9% 3.2%
2019 97.7%
93.7% 97.3% 1.7%

 

Question 2: What percentage of your total insurance payments are currently posted via Direct 835 (ERA)?

 
  2012
2013
2015
2016 2017
2018
2019
Client A
  75.0% 94.5%
95.0%
98.0%
94.0%
94.0%
Client B 93.0%
94.0%
98.0%
96.2%
96.0% 96.0%
97.0%
Client C   66.0% 80.0% 85.0% 85.0% 90.0% 91.0%
Client D 75.0% 80.0% 83.0% 79.6% 92.8% 96.0% 96.0%
Average
84.0% 78.8% 88.9% 89.0% 93.0% 94.0% 94.5%
Median
84.0% 77.5% 88.8% 90.0% 94.4% 95.0% 95.0%

 

Question 4: What is your overall payment posting error rate?

  2015 2016
2017 2018 2019
Client A 16.3% 14.5% 9.0% 5.0% 9.0%
Client B 9.0% 7.0% 3.5% 3.8% 3.2%
Client C 5.0% 1.0% 1.0% 1.0% 0.0%
Average 10.1% 7.5% 4.5% 3.3% 4.1%
Median 9.0% 7.0% 3.5% 3.8% 3.2%