Over the course of several years, the reports that I run have changed. Some I have stopped monitoring, others have morphed into new reports, and others have combined into one single report. Here are the reports that I suggest your practice run:
The types of information you need to be reviewing on a daily basis are as follows:
1. Your rolling AR by days
By looking at 0-30, 30-60, 60-90, 90-120, and 120+ days, you will be able to see when your billing department is/is not posting aged A/R, and if they are following up on denials.
2. Your rolling A/R by clinic/payer/provider
If you have more than one clinic, it's good to keep an eye on that A/R in each specific facility and by each provider. If suddenly Medicare stops paying on a specific provider, you will be able to easily and quickly identify this, and figure out why they have stopped paying. This happens more often than you think.
3. Your Medicare payments
It is critical that you identify the exact date that Medicare stops paying you. You need to know this date when you call Medicare to ensure you are paid for any back amounts. Medicare has often delayed payments to providers over the past several years. By knowing this exact date, you are more likely to receive all payments due to you.
4. Your payments summary
This will allow you to review if your front-office staff are collecting and posting copays and coinsurances, as well as following up with posting insurance payments.
5. Your billed claims
It is imperative that you know if your claims are being billed out. There are always software systems that have issues and if there is no one checking to see if claims are being billed out, some may never be sent.
The types of information you need to be reviewing on a weekly basis are as follows:
1. Any Medicare allowable summary reports
Is your practice and procedures bound by any Medicare caps or specific allowed amounts? It's very important that you are aware of these restrictions so that you do not miss out on being paid.
2. Any missed medical notes
Does your EHR program allow you to run reports that show any provider-missed medical notes and charges? This is critical in the reimbursement process.
The types of information you need to be reviewing on a monthly basis are as follows:
1. Adjustments report
This is where you are going to identify any clinic errors, as explained in my last blog. Also, what types of adjustments are being made and if you agreed to those adjustments.
2. DSO (Days sales outstanding)
You will want to know how many days it takes for you to be paid, from the date the patient was seen to the date the payment was received and posted.
3. Clinic key metrics
• Patient visits
• New Patients
• Percent collections
• Number of statements mailed
• Timed units
• Charge per visit
• Pay per visit
4. Collections and 15-day letters
The type of information you need to be reviewing on a quarterly basis is as follows:
1. Total A/R review
How do you know your billing staff are following up on unpaid claims if you are not reviewing their work? By reviewing your AR, you have the final decision on what adjustments need to be made. Has your billing staff tried following up on an $18.34 secondary payment more than once? If so, you've already lost money on that claim. Consider this cleaning house on those types of claims.
The type of information you need to be reviewing on a annual basis is as follows:
1. Year-end review of all of the reports mentioned above
If you had goals set for the year, its time to look at your office performance versus your set of goals. Did you outperform over last year, or the year prior? By looking at years prior, you can review if your goals were on track.
Keep in mind that looking at your performance data is truly key in your overall success; even if you are just starting out. While it can seem a little overwhelming, don't give up and remain consistent with the monitoring process. It can truly make a difference in your overall bottom line.