Do Not Put Your Practice Revenue
At Risk: Monitor Charge Reporting
A continuing series of practice management columns to educate OFP's on financial evaluation techniques.
By Judy Capko
Dropping charges, under coding, and failure to report charges are a threat to your future revenue. We have previously discussed in this column the importance of conducting mini-audits, as a method to ensure charges are reported and documentation exists to support the charges.
The mini audit is a snapshot in time that shows the picture of how the practice is performing in these areas, but it does not replace the need to monitor charge reporting over time.
Here are a few tips to help you protect your future revenue.
Missing office charge tickets
Part of your daily procedures should include verifying that a charge ticket exists and has been posted for every patient appearing on the appointment schedule. This requires diligence in making sure staff enters every patient on the schedule, including work-ins. In addition, a consistent method of indicating the patient has arrived in the office must be put in place, whether it is manual or automated. No shows and late cancellations must also be documented.
When this is accomplished, you have an accurate appointment record to compare to the charge tickets. Verifying that each charge ticket has been posted is a simple matter of comparing the batch total to the sum total of the charge tickets with a calculator.
Hospital charges
It is not uncommon for hospital charges to be missed, whether it is a consult, hospital admit and follow up, or an emergency room visit. The key to collecting all hospital charges depends on you, the physician. This is best accomplished by documenting and reporting your charges daily.
An important element of making this realistic is to be sure your hospital charge card/ticket that is “user friendly.” If you find this tool awkward, inconvenient or time consuming it is time to go to the drawing board. Sit down with your manager and biller to discuss a design that will be more functional. Some physicians use a card that folds over to a 3x5 that can fit in their pocket with a cheat sheet on the reverse side that shows the most common hospital diagnostic and procedure codes.
It is your job to report your hospital charges, but it is your staff’s responsibility to be sure hospital charge tickets exist for each day and, when appropriate, admit and discharge dates are clearly defined. Examine those monthly reports
Assuming the majority of physicians are on an automated billing system, you are provided with a series of month-end reports. The productivity report will reveal the charges for each provider for the month.
A procedure revenue report will itemize these charges by provider, by CPT code. These reports will help you monitor charge activity. I suggest your office manager prepare a graph of your top ten codes each month.
Over time you will begin to measure trends. For example, charges appearing on the productivity report and the number of visits itemized on the procedure revenue report will decline the month you are on vacation and may spike the month your partner is on vacation and you see some of his or her patients. These are predictable changes.
If, however, there is a spike or dip that does not make sense, you will need to research it further. I was recently in a practice where a new biller was inadvertently using the wrong doctor number and reporting charges for a physician that was no longer with the practice. It was unintentional but still fraudulent. If a penal audit occurred results could be catastrophic.
These suggestions may seem laborious to you, but they are essential to prudent management of finances and protecting your future practice revenue. Be committed to these processes and hold both the staff and the physicians accountable.
Judy Capko is a healthcare consultant with more than 20 years experience. Her focus is practice operations, staffing, finance and marketing. Judy is a national lecturer and has participated in ACOFP conferences. She is based in Thousand Oaks, CA and can be reached at (805) 499-9203 or e-mail: judycapko@aol.com
