A Medical Practice is a unique business in many ways, but it
is still a business and must be treated as such. Checking the health of your practice is
similar to checking the health of your patients. In this three part series, we will look at
these Vital Signs, pulse, blood pressure and temperature, to help you assess
the financial well-being of your medical practice.
In Part 1, we addressed the pulse of your practice: trends
in new patient statistics and physician referrals. If you missed Part 1, please select this
link: Check the Vital Signs of Your Medical Practice-Part 1
For Part 2, let’s check that Blood Pressure- 
Are the numbers of services you
bill increasing, decreasing, or staying the same?
Depending on your type of medical
practice, you could expect to see one or two procedure codes billed per patient
visit or for some specialties like Radiation Oncology, you may bill 10
procedure codes per visit. In either
case, reviewing reports that show month-to-month statistics can allow you to
recognize anomalies in your billing patterns.
Sharp declines in a certain procedure may indicate forgotten or missed
coding opportunities and therefore missed revenue. Many payers have time filing limits from the
date of service. They can range from 60
days to one year. A regular review for
missed charges will enable to meet those filing limits and collect on all of
your rendered services. If your report
showed an unexpected procedure or an unusually high number of a certain
procedure was billed, you will be able to audit the medical record(s) for
appropriate documentation. If billing
errors are discovered, you can get ahead of an insurance audit by quickly
refunding any payments received for these non-provided services. Keeping yourself in the good graces of your
payers is always important.
Is your claim reimbursement in line
with your contracted fees?
This type of analysis is
invaluable to any medical practice. Once
you have signed on that dotted line with the payer, you are wise to ensure that
you are receiving the proper reimbursement based on the agreed upon contractual
rates. In the daily whirlwind of
activity in the medical office, office staff seldom has the time to comb over
the detail of every paid line item. A
monthly report that compares the payments received to the payer’s fee schedule
will indicate payments that are below (as well as above) the payers contracted
fees. Payments that are below should
immediately prompt a call the Provider Relations Department. For payments above the contracted fees,
research has to be done on the accuracy of the fee schedule you are using, for
instance, perhaps the payer has updated its schedule and you have not. This type of report could also make you aware
of overpayments. If those are pre-emptively refunded to the payer, it will show
your practice to be following proper procedures in the eyes of the payer.
These two reports are just a small
sampling of the extensive selection of practice
management reporting options built into the Report Center module of Iridium Suite Medical Billing Software.
Be sure to watch for the upcoming
publication of Part 3: Temperature.
