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Medical Practice Should Run Value-based Analytics Reports

April 3, 2018

Value-based Analytics

As we move further into value-based care, the analytics and reporting segments of EHR will play an ever-larger role in collecting and analyzing data. Analysis and correct interpretation of reports gives providers actionable choices for improving quality of care and remaining compliant while boosting revenue as they grow their practices.

However, depending on the level of sophistication of EHR systems, this may not be as easy as it sounds. The switch to value-based analytics reporting increases the challenges and potential headaches. Here are some reporting suggestions that may help your practice save time, money and aggravation while improving your rates of payer reimbursement:

Financial Reports: Information Every Medical Practice Should Acquire

Denied Claims Report

As any physician knows too well, denied claims cost money in lost revenues as well as staff time spent finding the cause of denials, followed by re-billing. Be sure to pay attention to each payer’s EOB to determine not only the reasons but their codes and explanations line up with how you bill claims.

According to a recent survey from The Advisory Board, the following are trends in denied claims:

  • Demographic as well as technical denials have risen over 100 percent since the last survey, resulting in increased write-offs.
  • The success rate of appeals on denials was only between 50-56 percent.
  • Commercial payer denials had risen by over 26 percent of total denied claims.

Having a good revenue analytics program can help practices and other organizations detect denial patterns as well as the amount of recoverable revenue.  A denial analysis report can also be broken down further into two separate denial categories based on:

  • The payers who were the source of most denied claims
  • Top CPT codes over which claims were denied

 Reports identifying CPTs and insurance carriers producing maximum benefits for the practice

Conversely, it could be very helpful to know which CPT codes are making maximum contributions to the practice. Knowing how to get the most of an office visit can pay dividends to your bottom line. Payers can be tracked through revenue cycle metrics showing the 10 highest-paying carriers and other payers as well as track payments, collections, CPT codes and units. Correctly tracking a payer’s reimbursement metrics is one of the key ways to reducing the time claims are spending in A/R.

Profit and Loss statement (P&L)

This report shows how profitable a practice is by tracking income (revenues) and expenses. It can help identify key performance indicators (covered further below) including total patient encounters, procedures, charges as well as any collected monies. Any drop in revenue (collections) is a warning – before taking action. An example could be a decrease in the prior month’s billing would likely result in a drop in this month’s collections.

Key Performance / Provider Productivity Indicators

Your provider productivity and performance report should show how each physician is contributing to how to increase revenue-producing with quality measures while keeping costs under control, making it one of the practice’s most important reports.  In addition, having efficient systems software now enables you to do in a matter of minutes what used to take days: track total charges, collections, procedures, encounters, A/R outstanding and adjustments.

Accounts Receivable (AR) Aging

Whether fee-for-service or value-based, this report is essential to determine which claims are outstanding and why. As with denials, unpaid claims are a drain on revenue, so use your analytics to track any claims over a month old. If still unpaid after 45 days, you need to check to see whether it was paid and possibly posted to the wrong account or whether it was denied or still unpaid.

Clearinghouse Rejections and Benchmark Metrics

Early in the switch to ICD-10, a number of payers added set-specific coding in front-end translations, resulting in entire groups of claims rejected, usually at the claim-acknowledgement stage (277CA) with a 999 designation. Use analytics to determine which denied claims are due to erroneously using both ICD-9 and ICD-10 coding as well as codes with wrong qualifiers.  These may not always be due to provider billing error, but to incorrect vendor application settings, which can be determined via analytics.

Value-based Reporting

This may be one of the most important considerations as you run reports:  moving into value-based reimbursement, the practice’s quality measures should have been captured for the Merit-based Incentive Payment system (MIPS) along with others.  Using clinical registries and other sources, providers should be able to compare physician and practice-quality scores against their peers.  Quality measures can also reveal areas needing improvement along with gaps in care.

Removing Obstacles to Reporting

Issues with interoperability between providers’ systems as well as the quality and quantity of data collected can all make sharing data, analyzing and reporting a logistical nightmare.  The result could be missing key metrics and critical financial information which can lead to bad business decisions that could cost you your practice.

Related Article: Advantages of Data Analytics in Revenue Cycle Management

Older EHR systems may not be capable of generating usable or accurate report information quickly but many smaller practices can’t afford upgrades or replacement systems.  Robert Tennant, of the Medical Group Management Association (MGMA) suggests that providers confer with their EHR vendors for add-ons or special applications availability.

Another option is partnering with a claims-management service, which can provide better access to quality analytics and reporting.

Save time and reduce costs with a medical claims management service

 Using a medical claims billing and practice-management service can help eliminate risks of above-mentioned mis-coded claims as well as identify other areas where you may losing revenue. Specialized services, such as those performed by M-Scribe, can also help to track and identify unpaid claims so your practice is reimbursed in a timely manner. 
Taking advantage of our practice management services and extensive claims experience can improve your A/R, reduce rejections, while meeting performance productivity and other value-based measures. Regardless of size or specialty, M-Scribe can help you grow your organization. Contact M-Scribe at 888-727-4234 or email for a free analysis of your practice’s needs and revenue goals.


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