April 17, 2019
We know physicians and managers are busy, but data powers good decision-making. Here are nine priority reports to review each month.
1. Profit and Loss (P&L)
The “P&L” provides a high level view of total revenues and expenses, and indicates how efficiently the practice is being financially managed. The practice’s operating overhead percentage is derived from the data in this report. Well-run offices include current and last year’s period-to-date and year-to-date, as well as budget data in this report. And they keep a keen eye on the overhead percentage when they review it.
2. Aged Accounts Receivable (A/R)
Shows you the outstanding receivables due. Generate this report aged by service date (not posting date) and be sure to separate insurance balances from patient balances. With patient receivables on the rise due to high deductible health plans, it’s essential that the physicians see the amounts patients owe, in each aging category. Remember that those dollars are real money – not inflated charges awaiting contractual adjustments after insurance pays. A large dollar amount of patient collections can indicate the need for implementing or improving collection at the time of service and pre-surgical deposits.
3. Charges, Payments, and Adjustments
This report comes directly from the practice management system, and should be reviewed by provider, payor, location (if multiple sites), and CPT category.
4. Credit Balances
Credit balances are a financial liability and as such you must monitor how much you owe payors and patients on a monthly basis so that you process timely refunds. They also negatively offset the total A/R which results in an inaccurate total on that report. Ideally, the report total should be as close to zero as possible.
5. Non-Contractual Adjustments
Provides the granular detail of the charges that were adjusted off to reasons other than contractual adjustments. Monitoring this report enables you to question amounts written off to categories such as bad debt, small balances, timely filing, no authorization, etc. Ask questions about non-contractual adjustments may lead to the need for improved front-end workflows or modified collection processes.
6. Missing Encounters
Missing encounters (sometimes called missing tickets) should be identified and located as part of the daily close. This catchall report unbilled encounters at the end of each month.
7. CPT Code Frequency
This report can help practices identify areas of risk as well as potentially lost revenue. Review E/M coding patterns to identify physicians who may be using too many lower level codes, or too many higher level codes. Compare your practice data to Medicare’s data for your specialty, state, and nationally. (A product like the E/M Profile Analyzer can save hours of time and displays the data in a line graph.) Pull records for high and low coding outliers to verify that documentation meets CPT guidelines, and to ensure the physicians are missing out on legitimate revenue.
8. Denials and Rejections
Smart managers and physicians look at this report for patterns that are clues to front-end workflow, coding, or other processes that need improvement.
9. Unapplied Payments
To keep your accounting clean, it’s important that every dollar collected be posted to a specific category in the practice management system. In some cases, staff collect money upfront – for instance, in the case of pre-surgical deposits – and then allocate it to a specific account and category after payor reimburses for the service. Sometimes this gets overlooked. So, monitoring the unapplied payments report can identify large sums that may be still sitting in “unapplied,’ and should be moved to the correct category and account.