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Medical Billing Reports help attain efficiency and profitability

October 12, 2012

High Performance Practice

Now more than ever before, a private medical practice requires meaningful data in order to track revenue, expenses, over heads to attain maximum efficiency and profitablity.  In today’s high tech healthcare market, with its shifting regulations, its reduced payments, and its increased competition, being able to manage the business side of a practice requires constant attention.  The fundamentals of practicing medicine are essentially unchanged.  What has changed is the pace at which business decisions affect the bottom line and a practice’s viability.  Business decisions need to be based on hard data.

By utilizing the full range of reports in practice management software, physicians and practice managers can act with confidence to determine if their operations are profitable.  They can determine where there is room to grow, and they can locate areas that need improvement.  By being able to focus not only on details, but also on trends, waste is eliminated and profits increase.

Harnessing all the data entered into billing and practice management software is accomplished easily and in a readily understandable format.  Every patient encounter is translated into bytes that can shed light on every aspect of an operation.  All one needs to do is know where and how to look for the information.

State-of-the-art billing software forgets nothing.  Running reports on charges and income from past years or past quarters provides an accurate and reliable benchmark which can be compared to present figures.  Is income up or down?  Is it flat?  How did past income reflect gross charges?  Does current charge methodology and medical practice generate the same percentage of payments versus adjustments?

Running a summary report gives an indication of overall patterns.  The power of computer-generated reports is that they can instantly provide granularity of data.  The ICD-9 coding system is being converted to ICD-10 because the research community demands greater granularity of statistics regarding medical conditions.  Medical scientists are not the only people who study statistics.  Medical practice owners and managers also study the data available to them to model their response to market conditions.  With the right software in place, broad trends can be recognized and then managers can drill down into their database to determine the causes.

Reports can identify shifting payer bases, changes in payer fee schedules, changes in procedure frequency based on CPT codes, changes in conditions being treated based on ICD-9-CM codes, changes in incoming referral sources, and changes in reimbursement frequency.  Aged accounts receivable from any point in time can be compared to current aged A/R to make accurate predictions and to identify deficiencies.

The same data can be reported with different focus depending on the report being run.  How many Medicare patients were seen this time last year, and does it match how many are being seen now?  What amount was received from United Healthcare in 2010, 2011, and now?  Is there an explanation for the difference?  One provider bills more 99214 encounters compared to the other providers in the practice.  Are these higher level charges justified?  If so, should other providers be doing the same?

Whether the information in reports are positive or negative, they should be run and monitored regularly in order to predict and channel the future of current operations.  The granularity of data that reports provides allows for maximizing potential revenue and directing care.  Medical services are provided to patients in order to alleviate or cure disease, but medicine is a business.  With accurate data delivered in automated reports, private practices can improve the standard of care they deliver while increasing income.  By identifying overall payment trends. and by identifying specific payers and practices that add value to a practice, constant and consistent monitoring of data is the backbone of a of a successful medical practice.


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