BIG Ideas from The Business Intelligence Guy: Recent Episodes
BIG Ideas from The Business Intelligence Guy
Today’s BIG Idea comes from data analysis projects I do for healthcare consultants. This consultant is working with a group that outsourced their billing and then had revenue cycle challenges. Today’s podcast describes an unusual challenge — the billing company was not consistently and correctly charging the billed charge per the fee schedule. The podcast describes how we used Excel’s Pivot Table feature to track variances in billed charges. You may be very comfortable that your billed charges are going out correctly, but the bigger question is what parts of your revenue cycle do you assume are being done correctly that are not? Where are the holes in your revenue cycle? I hope these podcasts give you something to think about.
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Today’s BIG Idea is from a practice in the Midwest who had a payer deny a claim because the pre-authorization was for one day and the day of the procedure moved. Are pre-authorizations giving your practice headaches, too? Listen for ideas from both AthenaPractice and AthenaOne on how to build an exception report to track appointments that may be a problem. The first step is to reliably filter those appointments to only find appointments that need pre-authorization. That may take standardization and consistency from your scheduling team. The second step is to data mine to find appointments without authorization. Some pre-authorizations are based on dates and other authorizations are based on procedure count. Some patients have more than one appointment/procedure that needs authorization. Matching the right authorization to the right procedure takes work. Standardization really helps. The process is not easy, but catching even one procedure that is has a missing or an expired authorization is well worth your time.
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Are you tired of seeing payments reduced due to advanced practitioners and incident to billing rules?
You are not alone.
Today’s BIG Idea is from a group of general surgeons in the Midwest whose policy is for physicians to review advanced practitioners’ charts to ensure maximum reimbursement. The analysis in the accompanying graphic shows some of the analysis we did to determine which surgeons had the opportunity to review the advanced practitioners’ charts, which advanced practitioners most frequently did not get their charts reviewed, and the procedure codes most frequently reduced by failing to comply with incident to rules. Listen to the podcast for ideas on how we made the analysis work and how something similar could save your practice a considerable amount of reimbursement. I hope you find incident to billing opportunities in your practice. Thanks for listening.
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Are you missing patients?
Today’s BIG Idea podcast is from a Rocky Mountain practice who wants to find patients that should have been seen by now but do not have a future appointment. The idea to look for patients you expect to have followed up with in a certain time period is common to many specialties and can help retain patients you may lose. After all of the marketing efforts you expend to invite patients to your practice, do not lose them by failing to help them follow up with your providers. The podcast also discusses how the report can be customized to choose how far back to look for patients you should have seen by now. By combining a macro-enabled spreadsheet with an input cell and a text box, you can add power and flexibility to your spreadsheets and your analysis. I hope these podcasts help your practice.
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Is estimating patient charges time consuming for your practice?
Medical practices are used to good faith estimates, but what if a self pay patient’s charge is more complex than a simple procedure code? Today’s BIG idea is from an orthopedic practice that wants to estimate more complex patient charges. Their idea is to grab all patient encounters with a given procedure code on the encounter, then use that historical data to estimate a patient’s charges and payments based on all encounters containing that procedure code. The podcast will give you some ideas about aging the claim to ensure the claim has had a chance to be paid and some ideas about how you might use this data. How would your practice use data like this? I hope these podcasts give you ideas to make your practice better.
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Still thinking about payer transparency data and knowing what your competitors are getting paid?
So am I.
Today’s BIG Idea is an overview approach to what competing medical practices are getting paid. The example is from an orthopedic practice in the Boston area. I took 5 major procedure codes and compared what Anthem is paying competing providers in four counties around Boston. The graphic accompanying the podcast shows orange for the highest contract for the provider I chose and blue for competing practices. This market overview report shows this practice is at the lower end of the scale for all 5 procedure codes. Note that for some codes there is a wide range of maximum contracted amounts and for other codes the range is more narrow. Either way, this practice is toward the bottom of the scale. As I play more with this data, today’s market overview report may be an ideal place to start with this payer transparency data. I said this the past two weeks and I will say it one more time. There is real opportunity in understanding and leveraging this data. Thanks for joining me.
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Did you find last week’s podcast about payer transparency data interesting?
Today’s BIG Idea is another way to look at your practice’s competitor’s contracts. The graphic accompanying the podcast shows a OBGYN practice in Central Florida and how contracted rates vary widely in two counties. The benchmarking report shows where the practice’s contracts fit across all published contracts for that procedure code in that area. Listen to the podcast to hear why there are multiple contracted rates shown in the chart and why the highest rates shown may not be the most common rates paid. Even if your practice cannot negotiate your rates to the highest level, even moving up from one column in the histogram to the next may mean over $500 per procedure. Per patient. There is real opportunity in understanding and leveraging this data. I hope you find these podcasts helpful.
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Are your competitors being paid more for procedure codes than your practice is?
How much more?
Happy 2024 everybody. I am playing with a new toy this year. Insurance carriers are required by law to publish contracted rates by procedure code, but they have made it very difficult to access those rates. Until now. Would you like to see contracted rates by procedure code, payer, NPI number, and more? I have an example of the data in the graphic accompanying today’s podcast. You will see major procedure codes for an orthopedic practice and a competing orthopedic practice in the same market. This analysis compares Anthem, Cigna, and United rates for those top procedure codes for the two practices. Interestingly, for these codes in this market, Anthem is paying the two practices the same rate. That is not true for Cigna and United. You will some wide discrepancies between the two payers for the two practices. For the same service. How would this data change your payer contracting? How would knowing what competitors are being paid influence your strategic plans, whether that means expansion, mergers, or major changes in your practice? This data may drive the most important decisions and the most profit to your practice this year.
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How long has it been since you analyzed your practice’s revenue cycle?
Today’s BIG Ideas podcast describes several steps I use when analyzing a practice’s revenue cycle. Listen for the data I gather and for a general approach to get started. The graphic on my web page shows several columns you might build in a Pivot Table analysis. I start by looking at the major procedure codes for the major payers. Then I build columns to look at charge dollars, the average charge, the total number of units billed, the allowed percentage, the allowed amount in dollars, and the amount paid in dollars. There is more information in the podcast, but you would be surprised how often billed charges or allowed amounts are not consistent. There are also payer contracting insights gleaned from analyzing a revenue cycle using this approach. Watch for an example in the graphic where the average payment is more than the average allowed amount. What could be causing this?
How healthy is your revenue cycle? Are you sure? In today’s medical practice environment, you cannot be too sure.
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Recent podcasts have discussed tracking how patients come to your practice and how patients leave your practice. Today’s podcast is from one of my sessions at the recent MGMA Leaders Conference in Nashville about following patients through your practice. Which provider does the patient see first? What procedure codes and diagnosis codes are on the first visit? Where does the patient go next? How does the path the patient travels through your practice influence their care and your revenue cycle? Does the first provider seen impact how long it takes for the patient to be eventually treated? I hope these ideas help you and your practice.
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Are you absolutely certain that payers are taking appropriate contractual adjustments from your charges?
Watch contractual allowances carefully in your practice.
Today’s BIG Ideas podcast is from an onsite visit to a practice in the Midwest last week. The Revenue Cycle Director asked for a report of all adjustments that equaled the billed charge. After I wrote the code in SQL Server, we were surprised to find a payer writing off the entire charge as if it was a contractual allowance. Listen to today’s podcast for why that adjustment is a serious concern and how you might discover similar problems in your practice, with or without SQL code. This is another example of revenue leaking from a practice at a time when we need to find and collect every dollar. I hope these podcasts are helpful for you.
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I really am going to stop talking about finding missing revenue for your practice.
Just not today.
Today’s BIG Idea is actually two ideas to find missing practice revenue. The first example is for practices who get revenue information from an outside source. Listen for how a pathology practice in the Southeast looks for potential missing revenue by data mining for gaps in the feed of accession numbers coming from the hospital. If you have hospital based charges or other ancillary services that do not flow through your revenue cycle like traditional charges do, this idea may save you time and money. The second idea is from a practice in the Midwest who is building a customized claim scrubber. We started by looking for visits where a new patient visit was about to be charged where an established patient code may have been more appropriate. Then the practice manager suggested we automatically find the reverse — established patient codes that were about to be billed for a patient the practice had not seen in over three years. Again, potential revenue for the practice. I hope these podcasts are changing your bottom line, too.
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Have you found all of your unbilled charges?
Today’s BIG Idea follows up on last week’s podcast about looking for missing charges. The example is from a practice that uses Greenway’s Intergy product, but the principles apply no matter which practice management system you use. Listen for ideas on how and where to look for missing charges, but the biggest take home idea may be the approach to looking for missing charges. I am not trying to find one missing charge. I am far more interested in a pattern or a workflow or a process that is somehow leaving money on the table. If finding a missing charge can show me a crack in my revenue cycle, I will find a lot more missing revenue than a single charge. Listen for ideas on casting a wide net and then categorizing what we find to make the analysis as powerful and efficient as we can. I hope you find these podcasts helpful in your practice.
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How sure are you?
Today’s BIG Idea is to make absolutely sure you are billing all of your patient visits. The example is a practice who wanted to make sure that a patient who saw two providers on the same day was being appropriately billed by each provider. The project led us to question some assumptions the practice management system made that all patient visits has been billed. You do not have to find many unbilled visits to come out a hero. It may be well worth your time to get your IT team looking to make sure there are no holes in your revenue cycle, especially in today’s medical practice environment. Listen to today’s podcast for ideas to get started.
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Do you have patients show up to see the wrong provider?
Today’s BIG Ideas podcast describes an orthopedic practice who data mines their clinical data and then compares the results to their appointment data to catch patients scheduled to see the wrong provider. The example I describe is primarily used to catch patients scheduled to see a doctor when they were supposed to see the advanced practitioner next, and vice versa. It took some standardization from the providers to be able to do this type of analysis, but the exception report I describe is so much more efficient than having staff try to catch these mistakes. The process I describe can be used to combine a variety of clinical and practice management data to better practice operations. How much longer will your practice do things the hard way?
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Ready for a new analysis dashboard idea?
Today’s BIG Idea is an analysis dashboard I’m building for an orthopedic practice in the Midwest. The revenue cycle team has a variety of Pivot Tables, dashboards, and other tools to monitor data. The new analysis dashboard is designed to give a high-level look at several revenue cycle areas at once so that the team knows where to drill down for more information. In the example dashboard, we look at charges, payments, denials, pre-authorizations and more. Trends and major areas to focus on are quickly available across the practice so the team can quickly identify potential problems. If the high-level information isn’t enough detail, the team can quickly access more granular information to find exactly what needs to be done. You might consider adding a high level analysis dashboard to your practice. Saving time with better information in today’s medical practice environment is becoming more essential every day.
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Are you ready to start a business intelligence project in your medical practice?
Today’s BIG Ideas podcast describes a great place to begin — a charges dataset. I think of a dataset as a table with rows and columns. A charges dataset has a row for every procedure code and columns describing that procedure code. For example, I would want a column for the patient, patient demographics like age, city, state, and zip, the amount of the charge, the procedure code and modifiers, the rendering and referring providers, primary insurance, location, primary diagnosis, and a lot more. In a perfect world, that charges dataset would live in SQL Server and connect to Excel spreadsheets with Pivot Tables that automatically refresh. All I would need to do is to open Excel to see the same analysis I had yesterday, only with fresh data. Listen to today’s podcast for ideas on how you might use a charges dataset in a variety of settings to drive change in your practice.
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Does your practice have credit balances?
Is the stack of credit balances to work only getting larger?
Today’s BIG Ideas podcast talks about credit balances and has some ideas for reducing the balances to work in the first place by putting in workflows to make the numbers more accurate. More accurate numbers leads to more believable reports which should then lead to less time working each balance. Also listen for ideas about building reports to show any other balances on the encounter, patient, or guarantor to expedite the work required to process credit balances. My credit balance experience with a local hospital left a positive impression. What impression is your practice leaving?
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Still thinking about monitoring productivity in your practice?
Today’s BIG Ideas podcast describes how a surgical practice in the Midwest is measuring medical transcription productivity. Whether your practice deals with transcription or not, there are several ideas in the podcast about accessing data outside of your EHR, where to put the data, and how to integrate the data into your business intelligence reporting. You’ll also benefit from ideas about what to measure and how to report what you measure to maximize productivity gains. I hope these podcasts make your practice better.
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Interested in speeding up your revenue cycle?
How long has it been since you analyzed your days to bill?
Days to bill a claim is the subject of today’s BIG Ideas podcast. The story is from a pathology practice with delays in billing claims coming from the hospital. The practice administrator wants to make sure the hospital claims are being submitted timely and wants to keep an eye on the billing company. If you aren’t in pathology or do not use a billing company, keep listening. You will hear ideas for other practices with lags in billing and how practices have subdivided the days to bill metric to add accountability to their revenue cycle processes. I hope these podcasts drive change and profitability in your practice.
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How long has it been since you really saw your practice data?
Would it help to visualize your medical practice data geographically?
Today’s BIG Ideas podcast describes how a practice used Excel’s 3D Maps feature to see the growth in patients at a new location. Microsoft has not done much with 3D Maps since it was introduced years ago, but 3D Maps can be very helpful in seeing where your patients are coming from, where your referring physicians practice, or how your marketing efforts are progressing. The maps are not super fancy graphic design masterpieces, but they are in Excel, making it easy to write formulas to analyze your data before mapping. Listen for ideas on how you might get started using maps with your data. Using 3D Maps is a very helpful way to see your practice in a new light.
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How do you generate medical dashboards from a data warehouse?
Today’s BIG Ideas podcast comes from a slide I’m using at next week’s MGMA Financial and Operations Conference in Orlando. After I finish a presentation about using business intelligence in a medical practice, I will often get questions about how the business intelligence is built. Listen to discover how I build a data warehouse in Microsoft’s SQL Server and then leverage that data throughout the practice. Once you get your data into SQL Server, you can build all kinds of customized logic to drive value in your practice. SQL Server is also an easy source for a variety of different tools to consume that data. If you are still stuck with the same old canned reports, think about investing in a data warehouse instead.
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Is staffing still an issue in your practice?
Would it help to know which staff you need where tomorrow?
Today’s BIG Ideas podcast describes a practice that needed to know how many imaging patients they could expect tomorrow, but similar principles can help your practice, too. Listen to see why and how the practice chose to mine appointment data to estimate when and where staff would be needed. Once you have the data, you can project staffing needs throughout your practice tomorrow, next week, or for as far out as you have appointment data. Why fly blind when medical practices know better than almost any other business what future staffing needs will be? I hope these podcasts help your practice.
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Do you track second opinion patients in your practice?
Do you know how many of those patients end up being treated?
Today’s BIG Idea is from a neurosurgery practice in the Midwest who decided to track second opinion patients and wanted to know how successful the practice is at turning those patients into surgeries. Here is another example of data I have never seen in a canned report but that SQL Server can track for you. Once you know how successful at converting patients you are overall, it is easy to drill down to see success by rendering provider, referring provider, patient demographics, and more. Even if you do not see second opinion patients, similar analyses can provide similar benefits for patients who come to your practice from a variety of sources. Just because you can’t get the data you need from a canned report does not mean the data will not benefit your practice. Most of the valuable information I see does not come from canned reports.
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How do you manage medical AR in your practice?
Could you do better?
Managing medical AR is the topic of today’s BIG Ideas podcast. We will focus specifically on how many claims staff work daily and when the work gets done. As practices continue to struggle with staffing shortages and work from home, getting good data about staff productivity can really help your bottom line. Too many medical practices have too much old accounts receivable. Listen to how a practice using Greewnway’s Intergy product mined actionable data to better manage their team.
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Is your practice synergistic?
Do different specialties drive patients to your practice, even without formal referrals?
Can you put a number on it?
Today’s BIG Ideas podcast comes from a group in the Northeast with two distinct specialties, a main specialty we’ll call specialty A and an unrelated specialty we’ll call specialty B. The question is how many patients who start at B end up seeing patients at A. In your practice, the question may be how many urgent care patients drive revenue to the rest of the practice, how many patients use an ancillary service, or many other synergies. Listen to today’s podcast for ideas on how to track and then value patients throughout the practice. The calculation is complex in Excel, but very doable in SQL Server. The information you glean may change your entire approach to the practice.
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Are the procedure codes you authorize the procedure codes you actually bill?
Are you sure?
Today’s BIG Ideas podcast describes an advanced orthopedic practice in the Midwest who developed workflows to support an automatic email that tracks procedure codes that were billed without being pre-authorized. Listen for ideas on the workflow changes you need to make to get this data automatically and in time to add the procedure codes to the pre-authorization. How often do your providers add un-authorized procedure codes? How many of these do you have to catch and get paid for to make it worth your time to look?
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Does your medical practice have more denials than you have time to appeal?
You are not alone.
Today’s BIG Ideas podcast describes how a practice tracked appeals to see which appeals were most successful by payer. Listen to get insight into how your practice might do something similar. If you know which appeals are most likely to be worth your time, you can prioritize those appeals and get the most bang for your buck. You can even justify hiring more staff to do the appeals. Your providers have done the work. Your practice has incurred the cost. It is time to get paid accordingly.
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Do patients who miss an appointment get rescheduled?
Are you sure?
Today’s BIG Idea comes from a cardiology group that tracks patients who no show or cancel their appointment to make sure those patients get rescheduled with the practice. We built a report that automatically finds patients who no show or cancel, but do not have a future appointment. Since it is an exception report, you only see the patients your team needs to focus on. Listen for ideas on how you might prioritize which patients to call back. Occasionally podcasts like this get me in trouble with practices who have more patients than they can see, but this report is not just about driving revenue for the practice. There is a significant patient care aspect to this report as well. I hope these podcasts are helpful.
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Is it taking your medical practice longer to get paid?
How do you know?
How much longer?
Today’s BIG Ideas Podcast describes what a savvy practice in the Southeast is doing to track how long it takes payers to respond to a clean claim. You will not be surprised to see that we use Pivot Tables to analyze the data, focusing first on payers. The data behind the Pivot Table also allows to track days to pay by insurance plan, provider, procedure code and more, while trending the data by month and year. What would your practice do with this kind of data? Would you change workflows or processes to get paid sooner? The pandemic, quiet quitting, and inflation have all taken a significant toll on medical practices. Those same factors have also impacted payers. What do your numbers look like?
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Do you REALLY know what is happening in your practice?
Would you like to know more?
I spoke at a conference recently where I had not spoken before. When I asked how many medical practice administrators used Excel’s Pivot Table feature, only about half raised their hands. Today’s BIG Idea encourages medical practice managers to use Pivot Tables to better understand their practice data. Fancy dashboards are nice, but really understanding and being able to filter and trend your data can be at least as helpful to savvy practice managers. If you aren’t familiar with Pivot Tables, today is a good day to start.
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Are you failing to capture missing medical revenue?
Are you trusting that systems are still working properly?
It might be a good idea to check. Even better, find ways to automatically check that processes, systems, and workflows are still working so you can capture missing medical revenue. Today’s BIG Ideas Podcast describes how ophthalmology practices can automatically ensure they can bill for expensive injections like Eylea®. Your ophthalmology practice very likely has a system to always schedule appointments 28 days out, but what happens when the appointment gets moved because of transportation, illness, or other issues? I spoke at an ophthalmology conference the other day and described how to capture missing medical revenue. If you aren’t an ophthalmology practice, there are ideas for you in the second half of the podcast with more ways to make sure you are not leaving revenue on the table. I hope these podcasts save you time and make your practice money.
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Is inflation catching up with your practice?
Is it time to capture some of that money you are leaving on the table?
Today’s BIG Idea is to mine your ANSI codes, the Group and Reason codes on your EOBs. There is typically a lot of data to sift through, but when you sift, there is plenty of gold to be found. Today’s example is looking for timely filing denials. What types of claims are falling through the cracks? Where are those cracks, and how can you capture that missing revenue? Is it a staffing issue, do you need better reporting tools, or is the real issue sending out incomplete claims that will slow down and clog up the entire process? Use the ANSI code analysis to find problems and search for root causes. Fix those problems and dig again. The process will reward you over time.
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Still trying to help your employees be more productive?
Are you looking for a new metric to help?
Today’s BIG Ideas podcast describes a productivity dashboard called Task Resolution Rate. A savvy group in the Midwest uses this dashboard to track task load, task completion rate, average days to complete a task, and more. As staffing medical billing offices becomes increasingly harder, a set of documented work flows, processes, and procedures with appropriate measurements can become a lifesaver when you are training new employees…again. Having a way to measure performance, especially in a work from home environment, is particularly helpful. I hope ideas like Task Resolution Rate and these podcasts help your practice thrive in this challenging environment.
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How many services do you render per patient compared to your peers?
What are you missing?
Today’s BIG Idea builds on earlier podcasts about CMS’s Provider Utilization data. I have talked about analyzing E&M coding using the CMS data in the past. I have also discussed using the Provider Utilization data to compare what your competition is charging and how many patients they are treating. Today’s example is a pain management clinic trying to understand how their drug screen utilization compares to their peers. Are your providers over or under national averages for procedures per patient? Are you an audit risk? The Provider Utilization Data can help you find out.
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Is it getting harder to see your providers?
Are rescheduled patient appointments making it even harder to see your providers?
Today’s BIG Idea comes from a specialty group in the Southeast. The wait times to see their providers are relatively long, though not as long as their university-based competition. The practice wanted to know how many new patient appointments were being rescheduled, how many times the same new patient was being rescheduled, and what all that rescheduling did to overall wait times. Listen to today’s podcast for ideas on what to measure and how to respond to the results of your analysis.
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Are you one of the medical practices affected by the great resignation?
Can you quantify how the great resignation is affecting your practice?
Today’s BIG Idea describes a practice in the Midwest where one provider has decided to retire and other providers have decided to leave. The practice knows that their days to third next available appointment is increasing. My assignment was to quantify what the lengthened availability of the remaining providers is doing to patient retention. We decided to pull all new patient appointments and determine the percentage of new patient appointments that were kept, rescheduled, or lost (the patient either canceled or no-showed and did not make another appointment.) The number of lost patients in this practice is increasing. What do your numbers look like? What do the numbers mean for the great resignation in your practice?
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Do you need to find Medicaid appointments early in the month?
If you don’t find those Medicaid appointments, especially surgical appointments, what are the odds that the patient is still eligible for Medicaid next month and you will be paid?
Today’s BIG Idea describes an email I developed for a savvy orthopedic practice in the Midwest. The practice is concerned that Medicaid eligibility renews at the first of each month. If, for whatever reason, the patient is no longer eligible for Medicaid, a surgical appointment could go either unpaid or unused. I built an email that sends automatically and finds potential Medicaid patients scheduled for a surgical procedure. The practice can easily review the patient’s chart to determine if there is a risk of not being eligible for Medicaid and whether the patient might be better scheduled later in the month when Medicaid eligibility is confirmed. Listen to the podcast for ideas on consistently and reliably entering appointment data so that you can find Medicaid appointments early in the month or whatever else your practice needs to see.
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Would it help to have another way to assess your office staff’s productivity?
Are you deploying your limited staff resources optimally?
Today’s BIG Idea describes a practice in the Midwest that uses Greenway’s Intergy practice management system. We mined the practice’s tasks data to get a better sense for how many tasks are being generated and completed by month and by task category. We used that data to determine if we have enough staff assigned to different functions and whether staff have been more or less productive over time. Listen to today’s podcast for ideas on how you might benefit from analyzing your practice’s tasks data. I hope you find these podcasts helpful.
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Is your medical practice trying to do more with less?
Today’s principle might help…
This BIG Ideas Podcast describes a principle as much as it describes an application of business intelligence for medical practices. The principle is standardization leads to automation. The more practices can standardize workflows, procedures, and even the language providers use, the more I can consistently pull data and run reports. If you can standardize more of your practice operations, I can automate process and help you do more with fewer staff. Today’s example is a practice that can automatically tell whether a patient was properly scheduled with a provider or their advanced practitioner for their next appointment. Rather than pay someone to look at all future appointments for problems, the practice standardized the clinical language to indicate who the patient should see next.
What have you done to standardize operations in your practice?
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