Compliance and Production

Compliance and Production

Coding Compliance

Good practice management includes regularly assessing coding compliance with reports such as the one shown here.  This graph compares individual physician charge patterns for evaluation and management codes against the practice overall and CMS utilization data for the same specialty nationwide.  CMS uses similar bell-curve assessments to identify unusual coding patterns and flag physicians who are both over and undercoding.  Of course, not all practices demonstrate a bell-curve utilization, certain types of specialties have more complex patients than average, for example.  As with all coding, the key is ensuring that the documentation supports the level of code chosen.


Submitting Claims - Measuring Efficiency

We have many reports that assess the effectiveness of the revenue cycle front end, highlighting areas that may need attention or training. For example:

  • Daily running charge total, compared to average daily running total.  This graph tells you immediately if patient volume is down or charges are stalled somewhere in the office.
  • Days from date of service to charge entry and submission.  This simple report provides a quick, effective assessment of the efficiency of the front end process overall.  
  • Error/Denial reports for front desk activities.  These reports itemize denials or pre-submission audit triggers such as no authorization or failure to verify benefits, allowing for accountability and identification of training opportunities.


Care Patterns and Volume

There are numerous front end reports to track production and illustrate charge patterns, allowing you to assess how, when, and where care is provided.  Two useful reports include:

  • Utilization reports.  These reports demonstrate which CPT codes are being used most often, with which diagnosis codes, by each provider, revenue center or place of service. 
  • Work Relative Value Units (RVUs).  Many practices use Work RVUs as a measure of productivity, since charge amounts can vary with changes in a fee schedule and payments are influenced by many factors.  RVUs are useful when trended over time, compared within the practice, or used in physician compensation formulas.  Of course, number of patients, charges, payments, and adjustments can all be easily tracked as well.
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