1.2 Business Office Operations
This aspect of the assessment looks at the following:
Coding: This review examines the coding patterns of the practice and looks at improving revenue through appropriate coding enhancement. This review notes codes that are not being utilized, as well as the method of how codes are documented via an office superbill/encounter form, hospital/nursing home charge ticket or procedure charge ticket.
The individual actually doing the coding is reviewed and education is provided. It is generally recommended that the physician perform the actual coding function.
Billing Procedures: Procedures are reviewed to determine the timelessness of the billing process. The entire billing process comes down to filing accurate information that meets payor guidelines as well as filing charges in a standard time period. This review examines this process.
Account Receivable Analysis: Following the physician, accounts receivable is generally the next greatest asset in the practice. However, it is often treated as an after thought by the practice. If you have concerns with an ever increasing balance or a decreasing collection percentage, this area needs to be examined.
Payor Mix: This analysis examines where revenues come from within the practice. It is important to understand the importance of various payors to the practice and the effect of a lost contract or reduction in payment rates on the practice.
Management Reports: Practice management is all about the collection of information and placing it into formats that allows for the review of trends and indications of downward areas. The trick is to become aware of a downward trend early and make the appropriate adjustments. The creation of these reports allows for understanding a practices financial situation.
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1.3 Managed Care Services
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1.1 Facility Operations