BIG Ideas from The Business Intelligence Guy

[https://mooresolutionsinc.com/wp-content/uploads/2024/03/March-2024-Track-Variance-in-Billed-Charges.png] Today’s BIG Idea comes from data analysis projects I do for healthcare consultants.  This consultant is working with a group that outsourced their billing and then had revenue cycle challenges.  Today’s podcast describes an unusual challenge — the billing company was not consistently and correctly charging the billed charge per the fee schedule.  The podcast describes how we used Excel’s Pivot Table feature to track variances in billed charges.  You may be very comfortable that your billed charges are going out correctly, but the bigger question is what parts of your revenue cycle do you assume are being done correctly that are not?  Where are the holes in your revenue cycle?  I hope these podcasts give you something to think about. The post Track Variances in Billed Charges [https://mooresolutionsinc.com/track-variances-in-billed-charges/] appeared first on Moore Solutions Inc [https://mooresolutionsinc.com].

[https://mooresolutionsinc.com/wp-content/uploads/2024/03/March-2024-Find-Missing-and-Expired-Authorizations.png] Today’s BIG Idea is from a practice in the Midwest who had a payer deny a claim because the pre-authorization was for one day and the day of the procedure moved.  Are pre-authorizations giving your practice headaches, too?  Listen for ideas from both AthenaPractice and AthenaOne on how to build an exception report to track appointments that may be a problem.  The first step is to reliably filter those appointments to only find appointments that need pre-authorization.  That may take standardization and consistency from your scheduling team.  The second step is to data mine to find appointments without authorization.  Some pre-authorizations are based on dates and other authorizations are based on procedure count.  Some patients have more than one appointment/procedure that needs authorization.  Matching the right authorization to the right procedure takes work.  Standardization really helps.  The process is not easy, but catching even one procedure that is has a missing or an expired authorization is well worth your time. The post Find Missing and Expired Authorizations [https://mooresolutionsinc.com/find-missing-and-expired-authorizations/] appeared first on Moore Solutions Inc [https://mooresolutionsinc.com].

[https://mooresolutionsinc.com/wp-content/uploads/2024/02/February-2024-Find-Incident-to-Billing-Opportunities.png] Are you tired of seeing payments reduced due to advanced practitioners and incident to billing rules? You are not alone. Today’s BIG Idea is from a group of general surgeons in the Midwest whose policy is for physicians to review advanced practitioners’ charts to ensure maximum reimbursement.  The analysis in the accompanying graphic shows some of the analysis we did to determine which surgeons had the opportunity to review the advanced practitioners’ charts, which advanced practitioners most frequently did not get their charts reviewed, and the procedure codes most frequently reduced by failing to comply with incident to rules.  Listen to the podcast for ideas on how we made the analysis work and how something similar could save your practice a considerable amount of reimbursement.  I hope you find incident to billing opportunities in your practice.  Thanks for listening. The post Find Incident To Billing Opportunities [https://mooresolutionsinc.com/find-incident-to-billing-opportunities/] appeared first on Moore Solutions Inc [https://mooresolutionsinc.com].

[https://mooresolutionsinc.com/wp-content/uploads/2024/02/February-2024-Find-Patients-We-Should-Have-Seen-By-Now.png] Are you missing patients? Today’s BIG Idea podcast is from a Rocky Mountain practice who wants to find patients that should have been seen by now but do not have a future appointment.  The idea to look for patients you expect to have followed up with in a certain time period is common to many specialties and can help retain patients you may lose.  After all of the marketing efforts you expend to invite patients to your practice, do not lose them by failing to help them follow up with your providers.  The podcast also discusses how the report can be customized to choose how far back to look for patients you should have seen by now.  By combining a macro-enabled spreadsheet with an input cell and a text box, you can add power and flexibility to your spreadsheets and your analysis.  I hope these podcasts help your practice. The post Find Patients We Should Have Seen By Now [https://mooresolutionsinc.com/find-patients-we-should-have-seen-by-now/] appeared first on Moore Solutions Inc [https://mooresolutionsinc.com].

[https://mooresolutionsinc.com/wp-content/uploads/2024/01/COSSA-Self-Pay-Estimator.png] Is estimating patient charges time consuming for your practice? Medical practices are used to good faith estimates, but what if a self pay patient’s charge is more complex than a simple procedure code?  Today’s BIG idea is from an orthopedic practice that wants to estimate more complex patient charges.  Their idea is to grab all patient encounters with a given procedure code on the encounter, then use that historical data to estimate a patient’s charges and payments based on all encounters containing that procedure code.  The podcast will give you some ideas about aging the claim to ensure the claim has had a chance to be paid and some ideas about how you might use this data.  How would your practice use data like this?  I hope these podcasts give you ideas to make your practice better. The post Estimating Patient Charges [https://mooresolutionsinc.com/estimating-patient-charges/] appeared first on Moore Solutions Inc [https://mooresolutionsinc.com].