How to Analyze Revenue Cycle Performance of Medical Practice Using Vericle Reporting

Practice owner must analyze financials and revenue cycle frequently to manage the practice and improve its profitability. Such analysis is difficult because of data complexity and lack of easy access to data.

Steps

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    Collect claim submission and payment data in real time, including provider, CPT code, payer, facility, and referral.
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    Examine **Operational Report**, which shows total claims and $ amounts submitted, paid, adjusted, written off, and failed and allows breakdown by cpt, payer, referral, or a combination of such dimensions. Examples:
    • Billed, paid, balance, AR (30, 60, 120 days) 2005 and for each month by facility, doctor, CPT code, and payer.
    • Which CPT code was the best (worst) in terms of revenue (% paid) in 2005?
    • Which office and which doctor was the most productive in 2005 ($ paid/visit) by CPT code and in total?
    • Which payer underpaid the most in 2005 across all offices and individually within each office?
    • Which payer underpaid the most on the best revenue-generating CPT code?
    • Which referring physician referred most business in 2005 across all offices and individually within each office?
    • What was the distribution of CPT codes for the best referring physician?
    • Which office had most no-shows in 2005 across all offices and individually within each office?
    • Which doctor had most violations of coding audit guidelines in 2005? Who is the worst offender right now?
    • Of the total number of patient visits in January 2006, how many were paid, are still held by payers, waiting for doctor's response, not charged? Same question for July 2005.
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    Examine Denials Report, which shows a list of denied claims and a log of followup actions.
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    Sort Denials Report by amount paid, to tell the smallest payment the billing service is willing fight for. Examples of questions to answer:
    • How many claims were underpaid in 2005?
    • Which claims were underpaid during 2005 according to contract and what was done to recover the differences?
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    Understand Reporting Frequency.
    • What is the turnaround time for new reports?
    • How frequently can you receive the reports?
    • What is the method to access them?
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    Re-examine Data Aggregation and Analysis capabilities:
    • If web-based access is available, do the reports allow drill-into more detail?
    • Is it possible to refine and sort reports on-line and along multiple criteria?
    • Is it possible to export to Excel spreadsheets for further analysis?

Article Info

Categories: Accounting and Regulations