A Medical Practice Analysis is performed for the
medical practice using an Expert Information Technology (EIT) system
that involves both a computer program interface and interactive
consulting services. The primary focus of the analysis is on the revenue
of the practice from all sources (including commercial, private,
Medicare, capitation and other managed care providers) and the profit
component of the medical practice. For the past 10 years, the primary
focus in health care has been on cost
containment. While this should
not be overlooked, it should not be the driving force behind the
financial health of the medical practice. We have pioneered the area of
profit analysis using information technology to look beyond just the
operational components of the practice, focusing on statistical
modeling, compliance and clinical issues.
The Medical Practice Analysis is more of a tool
than a means to an end. As a fully integrated Information Technology
tool and Decision Support System (DSS), it provides the medical practice
with all of the information necessary to make the right decisions
required to solve the complex problems so many face. Recommendations may
involve including additional procedure codes in the fee schedule, or
revising the manner in which certain codes are used. It may include
recommendations to raise certain fees for specific procedures to
optimize both revenue and patient volume or reduce those that are too
high. Many times, we will identify coding and/or billing patterns that
may raise certain flags with government or third party payers, thereby
reducing the risk of a manual carrier review or insurance audit. We may
identify utilization patterns that are either unprofitable or indicate
potential compliance issues. Other possibilities include infrastructure
and operational considerations, clinical reengineering issues, changes
to physician compensation and bonus structures and bidding components
for participation in global pricing contracts.
Most consultants and systems tend to focus on
operational cost reductions only. This can have a very finite limit of
effectiveness as a business can only cut costs to a certain point until
the ability to compete effectively is lost. Aggressive cost cutting
measures, unchecked, begin to interfere with the quality of the delivery
system. Staff morale, product quality and profits are extremely
important in the survival of any business. If an equal amount of effort
is focused on the systems responsible for generating revenue, increasing
compliance and efficiency as is spent on cost containment, a practice
will realize substantial financial benefits without compromising the
quality of their service.
The business of health care has become far to
complex for the typical practice's management staff. More and more,
physicians and office administrators are turning to outside
professionals to help them in maintaining and bolstering their short and
long-term practice objectives. With the introduction of expert system
type programs, the medical practice can address these issues in a
proactive manner. This is very important to be able to maintain the
day-to-day operational aspects of the medical practice and avoid the
need for crisis management or damage control.
The complete service consists of the following
areas, each to be discussed in greater detail later:
-
EOB based Reimbursement Analysis
-
Procedural Cost Accounting Analysis
-
Charge Master Analysis
-
Ambulatory Diagnoses Related Group (ADRG) Cost Analysis
-
Evaluation and Management Code Utilization Review
-
Capitation Cost Analysis
-
Physician Productivity / Resource Allocation Study
-
Resource Allocation and Statistical Modeling by Location
by Physician
Using
expert system technology, we are able to perform these analyses for your
practice and work with you to generate as much revenue as is possible
while maintaining full compliance
