How to Analyze Revenue Cycle Performance of Medical Practice Using Vericle Reporting
Collect claim submission and payment data in real time, including provider, CPT code, payer, facility, and referral., Examine **Operational Report**, which shows total claims and $ amounts submitted, paid, adjusted, written off, and failed and...
Step-by-Step Guide
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Step 1: Collect claim submission and payment data in real time
Examples:
Billed, paid, balance, AR (30, 60, 120 days) 2005 and for each month by facility, doctor, CPT code, and payer.
Which CPT code was the best (worst) in terms of revenue (% paid) in 2005? Which office and which doctor was the most productive in 2005 ($ paid/visit) by CPT code and in total? Which payer underpaid the most in 2005 across all offices and individually within each office? Which payer underpaid the most on the best revenue-generating CPT code? Which referring physician referred most business in 2005 across all offices and individually within each office? What was the distribution of CPT codes for the best referring physician? Which office had most no-shows in 2005 across all offices and individually within each office? Which doctor had most violations of coding audit guidelines in 2005? Who is the worst offender right now? Of the total number of patient visits in January 2006, how many were paid, are still held by payers, waiting for doctor's response, not charged? Same question for July
2005. ,, Examples of questions to answer:
How many claims were underpaid in 2005? Which claims were underpaid during 2005 according to contract and what was done to recover the differences? , What is the turnaround time for new reports? How frequently can you receive the reports? What is the method to access them? , Is it possible to refine and sort reports on-line and along multiple criteria? Is it possible to export to Excel spreadsheets for further analysis? -
Step 2: including provider
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Step 3: CPT code
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Step 4: facility
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Step 5: and referral.
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Step 6: Examine **Operational Report**
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Step 7: which shows total claims and $ amounts submitted
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Step 8: adjusted
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Step 9: written off
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Step 10: and failed and allows breakdown by cpt
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Step 11: referral
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Step 12: or a combination of such dimensions.
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Step 13: Examine Denials Report
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Step 14: which shows a list of denied claims and a log of followup actions.
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Step 15: Sort Denials Report by amount paid
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Step 16: to tell the smallest payment the billing service is willing fight for.
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Step 17: Understand Reporting Frequency.
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Step 18: Re-examine Data Aggregation and Analysis capabilities: If web-based access is available
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Step 19: do the reports allow drill-into more detail?
Detailed Guide
Examples:
Billed, paid, balance, AR (30, 60, 120 days) 2005 and for each month by facility, doctor, CPT code, and payer.
Which CPT code was the best (worst) in terms of revenue (% paid) in 2005? Which office and which doctor was the most productive in 2005 ($ paid/visit) by CPT code and in total? Which payer underpaid the most in 2005 across all offices and individually within each office? Which payer underpaid the most on the best revenue-generating CPT code? Which referring physician referred most business in 2005 across all offices and individually within each office? What was the distribution of CPT codes for the best referring physician? Which office had most no-shows in 2005 across all offices and individually within each office? Which doctor had most violations of coding audit guidelines in 2005? Who is the worst offender right now? Of the total number of patient visits in January 2006, how many were paid, are still held by payers, waiting for doctor's response, not charged? Same question for July
2005. ,, Examples of questions to answer:
How many claims were underpaid in 2005? Which claims were underpaid during 2005 according to contract and what was done to recover the differences? , What is the turnaround time for new reports? How frequently can you receive the reports? What is the method to access them? , Is it possible to refine and sort reports on-line and along multiple criteria? Is it possible to export to Excel spreadsheets for further analysis?
About the Author
Carolyn Kennedy
Creates helpful guides on pet care to inspire and educate readers.
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