10 Medical Billing reports that will make Medical Practices Profitable!

As a physician, you need a reliable and efficient business intelligence system that provides automated revenue reports of your practice. These reports will provide you with accurate information regarding the health of your practice saving you from lost revenue, keeping your practice financially sound while allowing you to free up your clinical staff and resources to better serve your patients, increasing your reimbursement average, reducing insurance company denials of payment, taking care of unpaid accounts, and decreasing denied claims. Use the wrong software for the job, and you will have to bear the burden of opposite results.

Medical billing reports are crucial to saving physicians from suffering the fate of David Fairbrook whose practice lost $30,000 in just one year. The reason for the loss was poor billing. Unless a physician is ready to lose large sums of money, understanding medical billing reports and using the right software to provide automated revenue reports is a must

Download the resources on 7 practice management templates which need zero technical skills

This report serves as a gauge for the health of the practice and indicates if the billing department is doing its job properly. One could generate this report by hand but too much time would be involved in doing so rendering the notion of hand-generated accounts receivable aging reports impractical. A practice that sees 15 to 20 patients needs software to generate this report. If the practice is not using software, it’s losing revenue.

Analytics helped a hospital in the Midwest with less than 200 beds to find out that its claims held were more than 27 percent higher than its peers and the result was $5.24 million in the claims held.

The director of patient financial services at the hospital pulled out a review of the claims held and ordered A/R to help release the claim as

a top priority. In not more than six weeks the hospital was able to reduce held claims A/R days from 3.5 to 1.0 days and how much they were able to cut the stuck revenue? To $1.41 million and yes it’s a great achievement.

To get more deep insights, we can divide the Account Receivable Aging Report based on insurance and CPT codes.

 You can pull up a report for A/R based on insurance 

If you want a report based on CPTs, an account receivable report like the one below, could be a great help.

A/R based on CPTs

What information does this report provide?

 It takes, on average, one month for claims to be paid. The Report shows which claims have not been paid.

When looking at the accounts receivable aging report, one hopes to find that the claims are paid before 45 days. If it is taking longer than 45 days for a claim, one needs to check to see if the claim has been rejected or is unpaid. Urgent attention is required if a claim has not been paid for 90 days.

One must remember that the above are averages, and if a practice sees a large number of patients who are insurance carriers from another state or those involved in automobile accidents, then the averages will be higher.

To be able to effectively examine claim issues, one needs to use efficient software. Anyone using spreadsheets and keeping track of claims, which have not been paid, manually is going to lose revenue. In addition to efficient software, one needs to remember to verify CPT (Current Procedural Terminology) codes at the beginning of each year. If a CPT code has expired, then using it will result in a rejected claim.

To see how much one has billed out and collected and how it compares to what insurances allow, one needs to look at the Insurance Payment Trend report. By looking at the report one can judge how much is to be collected from patients to pay their claims.

Claims that are over a specified number of days and have not been paid can be seen in the Insurance Collection Report. One can use the Insurance Payment Trend and Collection reports to further analyze the problem, in more detail, when one sees an issue in the accounts receivable aging report.

You can pull up a report of your claims and payment trends summary based on the DOS (date of service). This would help you know the value of the claim and how much the insurance paid. A sample payment collection report

should like the one below:

Claims and Payment transaction trends summary

This is one of the most valuable reports. Using it one can pinpoint the encounters and CPT codes providing the most profit. In the past, this report had to be done by hand. It took up to a month to complete. Today, efficient software generates the report in seconds. Practices get data in real-time.

The KPIs Report keeps track of total encounters, the total number of procedures, total charges, total collections, outstanding A/R, and total adjustments. It provides indicators that billers use to judge trends that are negative and positive, thus enabling practices to change what does not seem to be working and continue to do what is working.

 Key Performance Indicators Report

For example, if the KPIs report shows that charges increased one month, but the next month’s collections did not increase, then there is a problem. Similarly, the report will show if, all of a sudden, there is a drop in collections that have been consistent in the past. You can get Key Performance Indicators to report like the one above.

This top-paying insurance analysis report helps save both money and time. It gives practices an overview of how they are doing. The report does this by tracking revenue cycle metrics. The report shows the top 10 payers and insurance companies which contribute to the major portion of the business of practice.

In addition to showing the top 10 carriers, the report also keeps track of payments, collections, and CPT codes and units. Using this information practice can narrow down to the specifics regarding the collections, charges, and payments of a given CPT code.

Healthcare CFOs about RCM and compliance auditing

The Top Carrier/Insurance Analysis Report allows practices to track Collection per Total Relative Value Unit (RVU). This gives practices information regarding how good their rates are. It also provides information about how a practice is getting paid for certain procedures and how its revenue cycle is proceeding.

Insurance Analysis Report

Using this insurance analysis report a practice can highlight the carrier which is paying less than other commercial carriers allowing it to drop that carrier and save up to $50,000 a year. Instead of dropping the carrier, the practice could renegotiate a better deal. While the option a practice chooses varies, the important thing is that the report allows practices to make informed decisions.

It’s challenging for the front office to convince a patient who doesn’t know his benefits and to get the patient to pay, once they step out of the office is the most challenging task. Due to the Affordable Care Act and employers’ plan enrollment, out-of-pocket expenses are on high, and keeping a track of patient collection has become the need of the hour.

A survey by Mckinsey & Co. on patients’ payment as a percentage of doctors’ total revenue

According to Mckinsey & Co. in some hospitals, the rate of bad debt for insured patients is high at well over 30% per year

As a result, it is the need for an organization to keep a track of the payments collected from patients. A business intelligence tool that integrates with your EMR could be of great help. You can get a patient payment collection report below.

These patient payment reports can be pulled up with the help of a reporting tool or by using an App that integrates with your EMR and delivers the above reports straight to your phone.

Payments Collected from Patients

In the early stages, some payers implemented the ICD-10 code set-specific in their front-end translators and entire batches are rejected with an acknowledgment of 999 which usually happens at the claim acknowledgment level (277CA).

Some providers used ICD-10 and ICD-9 codes on the same claim which caused clearinghouse rejections.

Clearinghouses have reported seeing claims for ICD-10 with wrong qualifiers. The reason could be incorrect settings in the vendor’s application. Some organizations reported unpredicted issues with small payers. It points out that payers who made changes to their applications after ICD-10 caused rejections that were not related to ICD-10.

Recommended ICD-10 Provider Benchmark Metrics

• ICD-10 Benchmark metrics every provider must follow.
• What are your Front-end rejection error rates?
• What is the percentage of 277 CA front-end rejections (by status code) which is measured over a unit of time(generally two-week intervals)
• What are the average days from claim submission to payment
• What is the denial rate variance metrics (payor/provider benchmark)
• Dollars submit on claims, dollars denied
• Calculate the percentage of ASCX12 835 payment denials by the type of denial code say CARC or RARC.

It is important to keep up with the above benchmarks and to achieve it, tracking the clearinghouse rejections and automating the process with a business intelligence App is one solution every health IT expert recommends. An example of a clearinghouse rejection, every medical practice must have.

 Clearing House Rejection Reports

It is important for organizations to know what metrics are important to track. What are the average days in AR or the percentage of a first past resolve rate by the large and a small payer?  PayerView Data did a survey to find out the performance of large payers based on metrics. Along with that is a comparison of small-payer Maryland MCO.

The idea is not only to compare the performance of small payers with the giants. It also gives you a measure of the average days in AR, First pass resolve rate, provider collection burden, denial rate, enrollment efficiency, enrollment TAT, etc…

Tracking the reimbursement metrics can help you better the above metrics. Yes, using a reporting tool is a great help but if you are not someone who can drag a customized report, it can be challenging and frustrating. So automating the reporting tasks and using a revenue analytics App will help you smoothen the reporting and tracking process.

Keep a track of your average claims reimbursement TAT to see if it is consistent. For example, your TAT for three months shows 22 days, for the last six months shows 29 days and for the last twelve years shows 38 days. This could help you review your claims held and hence reduce the days in A/R. A claims TAT report shows how practices are pulling up reports to find out their TAT.

According to a current survey released by The Advisory Board, the top trends in denials are:

• Denials by commercial payers have now risen to 26% of the total claims denied.
• A 100% increase in Demographic or technical denials which results in write-offs.
• For appeal on all denied claims, the success rate is 50-56%.

Denials based on a commercial payer such as Aetna or Anthem vary highly. I would like to share a 2013 National Health Insurer Report Card. This report card proves that there is a high demand for a payer-specific strategy.

No matter how hard you try to make everything perfect, denials still happen. But you have to recognize that the insurance companies have an economic incentive to deny claims, so you’re never going to get it down to zero”, says Elizabeth Woodcock, speaker, trainer, and author at Woodcock and Associates.

Yes, this fact hurts but the good news is that a strategy supported by analytics can help prevent denials. “If office procedures are good in gathering correct information and submitting clean claims, you can still expect to see at least 5% of denials for claims,” says Michele Redmond, V.P. Solutions Medical Billing in Rome, New York. Claims are mostly denied due to errors. If a staff responsible for reading the explanation of benefits (EOB) misses the errors, then there is a high chance of losing revenue on this.

Building a concrete denial handling strategy requires high experience and skill. It demands a pattern to be recognized specifically by an insurer. This is possible with analytics.  It can not only help organizations to develop a pattern but recognize how much money they can recover with the help of a revenue analytics system in place.

Having said that, you can have denial analysis reports for claims denied based on two different categories to get a better approach to creating a strategy.

Reports can be pulled up based on:

• Top 10 CPTs for which claims were denied.
• Top 10 payers who denied the claim.

Automating this process would save you time and prevent clerical errors. Many organizations are now using business intelligence to automate the complicated and tedious process of reporting and analytics. An application that integrates with your EMR to pull up such denial Management reports is the best fit for coming up with a concrete plan to fight denials.

There can be nothing bigger than office visits that contribute to the practice’s revenue. Practices need to recognize how they can make more out-of-office visits. Determining the CPT codes and documentation needs to help you boost revenue is what the billing office needs to find out.  Apart from urgent care, it’s tough for other specialties to make the most out of office visits. This is where a better understanding of documentation and coding plays an important role.

An Ob-gyn doctor billed Medicare for the highest number of office visits. He billed for the most complex and expensive procedures for all his 201 Medicare patients.

The first scale shows the doctor who charged more than his peers in Michigan and the second scale points to an average for family medicine providers in Michigan, according to an analysis by ProPublica.

The doctor found such patients with high levels to bill for, so it could not be an audit, is what Medicare said.

Of course, it is not possible to bill like the MI provider. But following a template for CPT codes and documentation needs would be of great help.

You can use a template to understand the CPT codes and documentation requirements for Established patients:

For New Patient visits, you can use this template:

Since the automation industry has turned the face of practice’s workflow, experts strongly recommend business intelligence to help practices leverage the reports. A utilization report for the Top CPTs for reimbursements.

A report for the Top CPTs for reimbursements

Finally, you want to know how many claims are waiting to be released and who’s responsible. A picture that shows the complete view of how many dollars are pending for a month will help to take quick action and decrease the risk of high A/R aging. To understand where did the error happens and the number of claims, it takes a long time to find out if you don’t have an aggressive team to work on it. So in the first place, you need to know how many claims your practice submits per day/month. This is the first data you need to collect. Having an application that integrates with your EMR could help you show the accurate number of claims submitted. And then starts your mathematics of getting paid.

The claims submissions Report gives you the number of claims submitted for the week, the amount billed for a particular week, and the Total billed amount. Similarly, you can get a report for the number of claims submitted for a particular month or a year.

TheBillingBridge provides the medical billing reports needed to save money and time. It provides collection reports, impacts analysis, revenue analytics, and key indicators so that a practice can free resources and clinical staff to better serve patients. TheBillingBridge empowers practices to reduce insurance company denials, increase reimbursement averages, and remain financially sound.