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Evaluating practice performance – start with the numbers

January 15, 2020

Bench-marking is a great way to evaluate how your practice is performing. Various methodologies range from singular internal practice bench-marking (such as one physician to another’s collections year over year) to external bench-marking (comparing one practice to the best performing practices in a specific region).

The key to actionable, effective bench-marking is to ask the right questions of your practice in the bench-marking process. It is a bit more challenging than it might seem and requires an astute understanding of the care-providing business (not simply care providing!).

To start you‘ll need to understand a few of the integral categories for consideration (as outlined by MGMA) including Leadership, governance and equity, Productivity, Compensation, Clinic/Practice operations, Facilities and capital improvement, Staffing, Accounts receivable management, Coding and compliance, Information systems, and Utilization management. This is the basis for a holistic perspective that will shed insights on opportunities for practice improvement.

While all of the categories named above play a role in the vitality of your practice, we will focus on two primary areas that seem to give practices the most challenges:

1 – Accounts receivable management

2 – Coding and compliance

Analysis of these two areas will clearly indicate the practice’s financial health and help you forecast the impact of patient A/R and coding variables in the future.

Accounts Receivable Management

These days we are seeing a trend of practices gravitating to affiliations with hospitals to help ensure stability. While this may seem like a great alternative to the current business climate and its challenges, it does have some underlying drawbacks. When independent practices are immersed in a new health system, there are generally a number of billing and collection systems performing at a range of different levels, all required to interface and coexist with the larger health systems’ infrastructures. It can be a laborious and costly transition. The tedious nature of the transition is impacted even more substantially by virtue of payers’ increasingly rigid claims management.

Here are a few questions to ask yourself that will provide a strong basis for actionable learning:

• Have sufficient staff and a realistic timeline been dedicated to standardizing billing practices and minimizing operational redundancy?

• Have systems been implemented to minimize patient A/R delinquencies (days and amount owed)?

• Has one person been designated to provide insights and guidance on individual payer requirements for co-pays, deductibles, pre-authorizations and referrals?

• Is there a system in place to deal effectively with delinquent accounts after they have been written off by the hospital or health system?

These astute questions will help you become keenly aware of your practice’s financial potential. These are also questions you may not know the answers to. That’s where CRT Medical Systems’ medical billing specialists can help get you on the right track. We can answer these questions because we have over 30 years of aggregated data from practices of all sizes. We know the best processes to improve practice performance at any size.

Coding and Compliance

A famous architect once said, “God is in the details.” When it comes to coding and compliance he was wise beyond his drawing board. Consider coding and compliance the superhighway infrastructure of the healthcare system. Now think of that superhighway being regulated by signals that change at random intervals at new locations on a daily basis. It requires a sharp and nimble intellect that can identify change, react to it quickly and implement new information seamlessly in order to be reimbursed in a timely manner and to maintain compliance. Detailed documentation is critical to reimbursement and to maintaining compliance.

Is your head spinning yet?

We know that physicians generally make minimal investments in practice management systems, typically only to handle billing. As government scrutiny of integrated systems and compliance increases, it’s paramount that a practice understand changes in regulation (such as meaningful use and transition to 5010). Physicians and staff are solely responsible for optimizing reimbursement and minimizing denials and compliance risks. As payers pay less and patients pay more, practices are moving to a threshold of greater risk.

Is your practice prepared for this increased risk?

Here are some questions to help you determine how well prepared you are:

• Does your practice maintain up-to-date and proper coding procedures?

• Does this training account for individual specialties within your practice?

• Have all of your practice’s providers been audited annually?

• Is your practice (organization and process) in compliance with relevant rules and regulations?

• Does your practice perpetually implement and observe compliance throughout the system?

While these questions will give you a solid foundation to begin implementing the best processes for your practice, we humbly believe the best question is “Have you called CRT Medical Systems yet?”

If the answer to this question is yes, then an affirmative domino effect is in place for any remaining questions. CRT handles it all.

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