Dr. Bob, Internal Medicine Department Chair, joined his Practice Council’s Strategic Planning Meeting just as the practice administrator, Mike McMager, provided a recap of the follow-up required to keep the practice on an aggressive planning schedule. Mike concluded the meeting with a round-table call for any other business. Dr. Bob quickly announced, “I’m concerned that our staff have fallen behind with charges again. My quarterly production report shows a decline and neither my nurse, Lisa, or I can explain why this would be. Our schedule hasn’t changed and we certainly haven’t been seeing fewer patients. The only explanation is that our staff is behind. After all, this isn’t the first time this has been a problem and we can’t afford to delay claims!”
The room begins to buzz with chatter from the other physicians. Not all of them have experienced the same downward trend, but they all seem to be in agreement that their production is lower than expected and are convinced that the staff has fallen behind. They demand answers and action, without sacrificing the important progress they need with their planning schedule.
After a lengthy review of the charge entry staff, assessing their outstanding work, Mike determined this was not the cause; all of the charge entry work was current. He considered several other causes, unable to identify the root cause of the decline.
With great pressure from the physicians to identify the cause but stay on track with the planning schedule, Mike engaged INTEGRATED Healthcare Strategies’ Physician Practice Operations team to identify the cause. INTEGRATED consultants were swift to schedule a focused practice assessment that included an on-site review. Mike’s team provided INTEGRATED with a detailed download of all charge data for the previous 36 months. The consulting and data analyst team was able to identify a subset of CPT codes that were being billed inconsistently.
INTEGRATED consultants had also identified, during their on-site interviews, a staffing change in the business office that occurred six months previously. The inconsistent billing data corresponded with the timing of the staffing change. They discovered that the training plan for the new hire did not include a critical process flow for what the practice defined as “add-on” procedures. The new staff person did not know when and where these procedure charges were routed, and thus the charges went unbilled.
INTEGRATED was able to identify and recommend the resubmission of claims data for the previous six months. The recaptured revenue from this component alone, was three times the cost of the practice assessment conducted by INTEGRATED. Several other revenue enhancements and cost reduction opportunities were also identified by INTEGRATED’s assessment. And, Mike McMager was able to focus his energies on the strategic planning follow-up, keeping the planning cycle on schedule.
If you notice a downward trend in production without a change in provider FTE, you need to understand what is impacting this production.
At INTEGRATED Healthcare Strategies, we have a team dedicated to Physician Practice Operations. Our entire focus is on measuring, benchmarking and improving operational performance. We can help your practice identify the root cause of a downward production trend.