Reports are invaluable to the operation of an outpatient medical practice. With the right tools in place, practice managers and physician owners can gauge performance of the practice as a whole and of individual providers. By benchmarking past performance and future expectations, the use of reliable data measures efficiency and profitability.
Being able to fine tune day-to-day operations is essential in today’s competitive healthcare environment and sound business decisions require accurate information. Practice Management (PM) software records every procedure performed during a patient encounter. Using this detailed and deep database, reports are generated that monitor payer relations and practice productivity. These reports can be used for internal comparisons as well as for comparing the practice’s operations to national industry trends.
The first report of obvious value is the ability to track the frequency of CPT usage. Each CPT code is matched to a corresponding charge. The inappropriate assignment of medical codes to medical procedures can lead to charges of fraud or abuse against a medical practice. By tracking CPT usage, this report can identify possible over-reliance on some codes to the neglect of other, more accurate ones. If a practice regularly charges for codes from another specialty, it may be cause for investigation and possible revision of the practice’s super bill.
Not only can efficient PM software summarize a practice’s total CPT charges, it can break this information down by provider. Does one provider in the group charge higher level E/M services than the others? If so, are those charges justified? If they are, and the provider sees a similar patient population as the other providers, it may be time to educate the practice as a whole on proper documentation. Routine undercoding is as serious as routine overcoding. RAC audits were instituted to ensure accurate reimbursement for provided services, not only to pursue overcharges.
The Comparative Daily Patient Visits Report details how many patient encounters a provider completes during the workday. This report can be used to detect possible weak points in the scheduling process. Coupling this report with the CPT Frequency Report, practice managers can accurately monitor provider productivity. A provider who performs a majority of time-intensive, highly reimbursed procedures is justified in seeing less patients over the course of the day. Using these two reports together measures how providers and their staff can more effectively utilize their time to see more patients and produce more revenue.
Many PM programs cannot measure the Relative Value Units (RVUs) produced by individual providers. m-scribe’s software can. While the Revenue Based Relative Value Scale (RBRVS) may not be on many practice’s radar, it is the system used by Medicare and private insurers to determine usual and customary reimbursement rates based on physician work, practice expense, and malpractice expense. By tracking practice RVUs, a practice manager can compare that to national and geographic standards to determine if his or her practice is within expected averages.
Knowing what happens to charges after they are generated is just as important as knowing how they are generated. The most powerful versions of PM software compare charges to collections and adjustments. This can be done annually, quarterly, or monthly, and it can be a summary by the practice or the report can be detailed down to individual providers. Tracking payments and adjustments provides a wealth of information on how the practice’s fee schedule is set. A practice that sees an average of five or ten percent adjustment to their charges probably has its charges set too low and may be losing potential revenue. When adjustments are a high percentage of charges, above 70 or 80 percent, the practice may be losing hidden revenue. When a large claim is written off in error, it won’t attract attention if the practice regularly writes off 80 percent of its A/R.
By monitoring payer actions after claims are submitted, practice managers can identify their top managed care payers and determine if their reimbursement rates are equitable for the amount of professional service the practice is providing to the plans’ beneficiaries.
By having all this information available on a regular basis, physician practice owners and their managers can evaluate how the practice operates, andhow it interacts with both patients and payers to produce maximum profit through the most efficient use of provider time and expertise.