Improving the physician business office


Most practice management systems are built on relational databases.  This means that almost every field can be pulled into reports and analyzed.  "Data mining" has become a buzz word but is only effective if what we are measuring produces changes in practice behavior.  At the end of the day, cash is still king.  Practices need to analyze those things which most directly affect cash flow.  Most physicians want to do the right thing in the right way, but a business office must communicate how effective a physicians productivity is resulting in positive cash flow.

Lag Days - When a physician understands the direct relationship to when charges get into system and when payment for that charge is posted to system, lights go off.  While we say that charges need to be posted to system as soon as possible, does anyone actually monitor by physician how well that standard is being met?  By physician, how many days "lag" between date of patient encounter and charge posted to system? The practice can then determine why lag days are not consistent or why there is even a significant lag between encounter and posting of charge.

Denial Trending - Categorizing denials by practice and denial type and payer can provide the practice with needed information to change behavior. Payers are constantly  changing the rules, by categorizing by payer, practices can easily adjust to new carrier rules.  Of course, it is also important to have a good relationship with top payers.  Have frequent meetings with them to discuss new rules and how the carrier wants claims to be correctly submitted for proper payment. When a practice can be shown that eligibility denials are most frequent; the front-end staff can make adjustments to check-in procedures to significantly decrease these denials. Coding denials can be addressed with practice coders for review of processes and compliance with carrier rules.  Physicians can be educated on how to comply, via documentation with these rules. Each month, the analysis of each month's denials is invaluable to practice success.  But it must also be communicated, not to point fingers, but to improve cash flow. Perhaps the best use of denial trending is prevention of denials.  This can best be accomplished by targeting claims with frequent denials and making appropriate fixes to claim before sending to carrier.  While some might argue that it holds up the claim; the real argument is do you get paid for a faster claim or an accurate claim?

Credit Balances - Probably the most over-looked report in most business offices is the credit balance report.  Credit balances sit on accounts and claims and are ignored many times preventing claims from being properly adjudicated.  Probably 85% of the time, there are not true credit balances on an account.  There has been a posting error or another problem resulting in a credit balance.  By assigning staff to consistently and methodically work credit balances, problem accounts can be resolved, aging can be addressed and clean-up of accounts can be accomplished.  Many carriers have rules about when credit balances are to be reported to them are refunded. Finding what credit balances are true and what is clean-up will help you meet those guidelines.

Small Balance Write-offs - Does your business office have a small balance write-off policy?  Ever wonder about how much of aging in a balance that could be simply written off and reduce the "appearance" of aging?  Allocating time for staff to work this report can help to clean-up AR and reduce statement costs that will never be turned over to a collection agency.

These reports may seem small and unimportant, but can make a big difference to your bottom line. Take the time to create and analyze these reports to improve your bottom line.

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