Five reports for the employed physician to review monthly
Something we hear all too often from employed physicians is, “I’m just an employed physician.” Later, those same physicians are surprised when their contract is renegotiated at a lower salary.
High productivity isn’t everything; your employer must get paid for those services in order to support your salary. Savvy employed orthopedic surgeons routinely review billing office reports and keep abreast of payment issues.
Here are descriptions of five key reports for an employed surgeon to review monthly.
As you are likely compensated, in part, based on production, it is natural that your first inclination is to review productivity — a report that outlines the services that were generated by you during the month. Typically, this report shows CPT codes, frequency of the codes (the number of times billed), the value of work relative value units (RVUs), charges and payments.
Here is an example:
There are a few nuances of reporting that are helpful to examine, as these nuances are the cause of questions and frustrations for many.
Many reports are generally generated based on “post date” or “input date,” which is the date a transaction was entered into the billing system rather than the date of service. For example, in reviewing the September productivity report you notice Mrs. Jones isn’t listed, although you operated on her on Sept. 29. If there was a delay in getting the charges entered into the system, she will not show up on the September report. However, if charges are entered on Oct. 3, she will be included in the October report. Therefore, don’t fret (yet) that a patient is missing from a particular month’s productivity report. But, if they aren’t on the next month’s report, then it is time to raise concerns.
Another nuance is how and which payments are displayed. Some reports show payments on the actual charges, but other reports show payments received during the month, regardless of when the charge was generated. The advantage of the former methodology is that it is helpful to spot problematic payments. It allows you to ask the question, “Why haven’t we been paid for Mr. Smith’s hip arthroscopy?”
What are you looking for in the productivity report? The productivity report provides a snapshot of your billing productivity. It shows how many work RVUs you generated for the month, the amount of charges you generated and payments (see above discussion on nuances) for the month.
Frequently, employed physicians ask, “Why should an employed physician like me care about payment?” The answer is you can be the highest producer for your employer, but if the organization isn’t getting paid for your services, then eventually your compensation will be affected.
Aged accounts receivable report
An aged accounts receivable or aged A/R report reflects the amount of outstanding A/R as of a date in time. This report should be aged based on “service date.”
What are you looking for in this report? A well-run orthopedic practice will generally have less than 20% of A/R greater than 90 days old. A lot of old A/R signals possible account collection issues and/or payer issues.
Furthermore, request the aged A/R report that segregates patient A/R from insurance A/R. High amounts of patient A/R signify opportunities for increased collections in your practice. Is your orthopedic department collecting surgical deposits? Are you collecting for payment, in addition to copays, at the time of service for radiographs, injections, as well as from patients who have unmet deductibles and co-insurance amounts?
Missing encounter report
One question to ask the billing office is, “How do you ensure that all services rendered are indeed billed?”
As long as services are scheduled, both office and surgery, a missing encounter report can be generated. A complicating factor is when you are on call, since those services are unscheduled. Some hospitals offer mobile charge capture tools to help ensure on-call services are captured. If your hospital does not offer that, inquire how charges are captured and the mechanism used to ensure all charges were entered.
What are you looking for in the missing encounter report? A missing encounter report reflects patients who were scheduled for a service, but not yet billed. Ideally, this report will contain no data — which means that all scheduled patients have been billed.
Payer mix report
A payer mix report indicates the percentage of charges or payments that come from each payer. It can be generated by both charges and payments.
In the payer mix report, you are looking for shifts in payer mix that can predict future cash flow. For example, government payers, including Medicare and Medicaid, typically reimburse less than commercial payers. If Medicaid increases from 4% to 20% of the total payer mix, with all things being equal, then revenue will decrease, since Medicaid reimburses less than other payers.
Although controlling the payer mix is typically outside the power of the employed surgeon, understanding trends in payer mix and how they impact the bottom-line makes you a well-informed surgeon. Talk with your administrative team about the impact of the changing payer mix and its effect on your compensation long term.
A denial report reflects the reasons for denials and the quantity of the denials during the month. It can identify coding and billing issues that contribute to denial patterns for your claims. We are astounded by the number of employed physicians who share with us that they have never been asked to clarify a procedure or participate in an appeal of a claim.
What to look for in this report is whether your coding patterns are leading to unpaid claims. Are you routinely unbundling services? Are certain procedures deemed medically unnecessary and denied? As a surgeon, be acutely aware of payer policies and troublesome procedures. Even if you don’t do your own coding, your documentation is what a coder uses to obtain the billing codes. Is your documentation sufficient for appropriate coding? Are the coders attending orthopedic-specific coding training? Are denials routinely appealed? Are these appeal efforts successful?
Staying on top of a few billing reports a month can help ward off unwanted surprises, including a low collection rate, and a high volume of denials and unpaid claims. Being a partner in the revenue cycle cements your status as a valued team player.
- For more information:
- Cheyenne Brinson, MBA, CPA, is a Chicago-based, senior consultant with KarenZupko & Associates Inc., a consulting and education firm that has been advising physicians to increase revenue, optimize efficiency, reduce risk and improve the patient experience for more than 30 years. Her motto is, “you can’t manage what you do not measure,” and her projects focus on boosting the bottom line, using data to make decisions and streamlining workflow through automation and better processes.
Disclosure: Brinson reports she is a consultant with KarenZupko & Associates Inc., which develops and delivers CPT coding and practice management workshops presented by the American Academy of Orthopaedic Surgeons in conjunction with KarenZupko & Associates Inc.