How well do you really know your payors? A recent analysis for one practice turned up some very interesting revelations with operational ramifications for the provider, but this was possible only because the provider had access to the entire fee schedule of the insurance company.
Some management techniques take advantage of basic receivables-system information to monitor charge capture and forecast future exam caseloads. The models shown here use real data; a complex hospital-based practice was purposely chosen, with a trend line of January 2008 through August 2009. To understand the power of today’s receivables systems,
All insurance accounts fall into one of two groups: full resolution (at negotiated fees, where the credits only consist of cash, contract adjustment, and probable bad debt, if any patient balance cannot be collected) or full write-off (where the practice did not comply with a payor-based rule).
In the 1980s and 1990s, payor fees were generous for the newest modalities, and most freestanding imaging facilities were quite profitable. There was little need for advanced cost accounting. Imaging centers and facilities within physician’s offices proliferated, however. Payors became far more aggressive in discounting what they would pay. When
Medical billing systems are database files managed using programs that perform accounting functions. These are written to accommodate a daunting number of rules imposed by health-insurance companies and state/federal programs. They contain edit functions that screen all relevant acquired demographic and clinical information for completeness and
Radiology practices create the largest number of new accounts per month of any specialty within a health care delivery system. On average, a practice reading 500,000 examinations per year would generate 35,000 new accounts per month. The billing issue that confronts every radiology practice is achieving a balance between processing costs and
The largest asset of a radiology practice is the cash value of its accounts receivable, and that valuation is prominent in the deferred-compensation package for a retiring member. The language in that section of the employment agreement generally stipulates a formula that is based on historic collection ratios taken from the practice’s receivables