On our “Out with the Old & In with the New: A 2020 Review” webinar, Lucrezia Dunn, Operations Consultant at Health Prime, explained the importance of running End of Year (EOY) reports. Dunn also talked about how to prepare for 2021 and set some goals for your medical practice to succeed in this New Year.
Which reports should I run at the End of the Year?
Understanding the most common End of Year reports will help you improve your best medical practice analysis. This way, you will be able to know where your practice was last year, and it will also allow you to make plans for 2021.
The most common End of Year (EOY) reports you want to pay attention to are:
1. Key Performance Indicator Report
Provides a summary list of the most critical indicators associated with the financial performance of the medical practice. See how your charges, payments, and adjustments fluctuate every month.
In Kareo, there are three types of Key Indicator Reports:
2. Health Prime Datalytics Review
It allows you to gain complete visibility into your practice’s financial Key Performance Indicators, monitor and track your financial health, and identify billing issues early enough to intervene before submitting your claims to the payer.
3. Denials/ Rejections Report
Show trends by payer, CPT, ICD 10, or other factors. Identify trends, find reasonable solutions to stay ahead of the curve, and work on solutions to prevent payment loss.
“No matter how hard you try to make everything perfect, denials and rejections still happen. With all the 2021 coding changes, providers should prepare for the chance of an increase in denials. The good news is that a strategy supported by analytics can help prevent these denials and rejections”, said Dunn.
4. Top CPT Codes
Determine your top-performing CPT codes to identify where the bulk of your revenue is coming from. Understanding this report will help you set goals for the future. It will also help you determine which codes are not reimbursed at the rates you may have expected initially.
5. Top Carrier / Insurance Analysis (Payer Mix)
See which payers all your charges and payments are coming from. Knowing this information will help you set goals for the new year. You may notice that some payers consume most of your practice’s income while others only make a small impact.
6. Adjustment Report
Get a summary of the adjustments posted for last year by adjustment type. See all your write-offs and submit them to Tax Prepper to see what can be considered a financial loss of income when filing taxes. Also, see where money is being lost.
In Kareo, there are 2 types of adjustment reports:
7. Credit & Unapplied Reports
Allows you to see patients/claims with either unapplied payments or credits on their accounts. Running this report will enable you to review these credits and create projects to have these reviewed for accuracy. Once determined, you can discuss a plan to refund, hold credits on file, or wait for the insurance to execute an automatic takeback.
Are you ready for 2021?
Understanding when to let go of the old Accounts Receivable (A/R), creating a plan for bad debt, and getting insight into why refunds are essential are vital to setting your practice for success.
Regarding the Accounts Receivable (by aging) report, this document allows you to see outstanding insurance claims based on aging totals. Knowing how much is still outstanding, you can work and discuss with your Client Success Consultant to adjust your bad debt AR, set up an action plan, and define benchmarks.
“We pay special attention to our AR over 90 days because the older it is, the harder it is to collect. Our best practice benchmark for our AR over 90 days is 5%. If your account is not at 5% over 90 days, consider cleaning house and keeping this tradition open for all the years to follow”, Dunn said.
How can I create a plan for bad debt?
Some common scenarios may also require Bad Debt Adjustments, such as:
- Claims older than 1-2 years
- Claims passed timely filling
- Claims with exhausted/failed appeal attempts
- Secondary balances where the primary EOB is not available and where it allows more than the secondary.
Why refunds are important?
Much time and effort are devoted to collecting information, creating charges, submitting claims, and collecting payments, only to spend additional time and energy trying to return the money. It seems like the task that’s at the bottom of the list.
“Processing and returning credit balances is not optional but mandatory. It’s not uncommon for providers to keep such overpayments until specifically asked to return them or until payers have withheld them from subsequent payments. Some providers may not only keep the overpayments but continue to bill inappropriately, creating even more overpayments”, Dunn said.
Some scenarios that cause credit balances are defined as noncovered services, more than the allowed amount for an identified covered service, in error, as duplicate payments, and when another entity had primary responsibility for payment.
Credit balance procedures should include reviewing the credit balance report with your billing team, deciding if a project needs to be created to have credits reviewed for accuracy, identifying both patient and insurance refunds, initiating the refund process, delivering supporting documentation, and more.
Set your goals for 2021!
As you make your own New Year’s resolutions, it’s also the perfect time to set new goals for your practice. Learn how to report to set goals and increase your revenue for 2021, stick to new reporting routines for this year, gather some ideas to assist you in creating a plan with your Operations Consultant/Advisor to tackle patient collections to increase revenue; and lastly, review standard best practice benchmarks.
Before setting your goals, you must remember that every one of them needs to follow the SMART technique. That means your goals need to be Specific, Measurable, Attainable, Relevant, and Time-Based.
Setting goals may sound easy, but monitoring the progress to see how you are doing throughout the year is hard. Here are some recommended reports that you can run on a basis to monitor your medical practice and make sure that your progress is in line with your set goals:
Improve your patient collections
Due to all the recent changes in healthcare policies, from the Affordable Care Act to COVID, patients’ insurance policies now come with higher deductibles, copays, coins, and out-of-pocket expenses; patient payments now contribute to at least 35% of the total income, whereas back in 2005, it was only 15%.
You must prepare and have the discussions necessary to be as vigilant as possible in collecting these payments from patients upfront. The longer you wait to collect patient payments, the less likely they are to be recovered.
Here are seven key components to improve your patient collections:
Now that you know how to review what you have done in the past and how to set SMART goals for what you would like to do in the future for your practice, let us know how we can help you achieve those goals. Contact us at [email protected].
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