By Jeff Fox, VP of Operations
Either through their own stand-alone solution or via their outsourced billing partner, the majority of practices today have access to powerful business intelligence tools. With such a large volume of data, it can be overwhelming to know where to start.
Key Performance Indicators (KPIs) are a good place to begin. KPIs are numerical factors used to quantitatively measure performance, either against internal parameters or benchmarked against peer organizations. Examples of useful KPIs are volumes, payments, net days in A/R, days in A/R greater than 120 days, and denial percentages.
KPIs provide value to both the executive and the operational levels of a practice. The below executive level dashboard provides instant feedback on the global health of a practice, while simultaneously identifying a potential area for improvement in red.
Unlocking the power of business intelligence
Unlocking the power of business intelligence in day-to-day physician practice operations is still greatly under-utilized. For example, most practices monitor their trending denial percentage, but few dive deep enough to find real, actionable data. In the below example, this practice has 872 denials for not being medically necessary.
Using business intelligence, we are able to quickly determine that 80% of these are Medicare related, with the majority being some form of Doppler extremity study.
Further investigation reveals that over 80% of all the Doppler denials are related to unspecified or observation diagnoses such as M85.80 or Z03.89. In fact, five of the top six diagnoses are related to an unspecified condition or an observation ICD-10. The impact of ICD-10 is upon us!
This information can now be put to use by the practice to improve performance. A good place to begin would be to educate technologists to document all extremity studies with more definitive symptoms such as “lower left leg pain as result of diabetes” and to no longer use “observation” or “pain”. This radiology group should also follow-up with their hospital information systems department to make sure the ER, ordering physician, and technologist notes are following the patient all the way to the interpreting radiologists reading palette for both quality of care and for billing.
Business Intelligence is not just for benchmarking high-level indicators, it can unlock actionable data that can and will result in increased revenue for physician practices.