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Patient Billing, Accounts Receivable, and Managed Care

• Calculate days in accounts receivable
• Identify high dollar accounts
• Calculate average days from discharge to bill, bill to payment, by payor or department
• Calculate reimbursement percentages by payor
• Determine appropriate level of contractual allowance reserves
• Determine appropriate level of doubtful accounts reserves
• Compare detailed aging of receivables to timing cycle required by Medicare to identify opportunities for improvements in charge processing
• Age receivables on date-of-service versus invoice date to recalculate cash flow
• Compare date-of-service to invoice date to identify opportunities to re-engineer charge processing
• Age service billing dates to assess timely collections and write-offs
• Aging analysis by varying dates and sorts
• Test reserve amounts against accounts receivable
• Report on payer cash payment lag by region
• Report on prompt billing trends/ internal performance
• Analyze rejected payments by financial class, procedure code, cost center
• Summarize and age receivables by financial class, cost center, procedure code
• Determine average number of days from invoice to payment by financial class
• Determine average billing amount by financial class or cost center
• Determine typical billing amount range (stratification) by financial class or cost center
• Evaluate managed care payer performance
• Identify underpaid managed care accounts
• Identify missed stop-loss payments on managed care accounts
• Support managed care contract negotiations with payment history
• Model various reimbursement scenarios for profitability
• Identify unbilled accounts
• Determine profit margin by DRG, physician, financial class, etc.
• Track capitated utilization and match to member eligibility lists

Charges

• Identify late charges by department, by month, etc.
• Identify invalid or high-dollar charges
• Identify duplicate charges on patient bills
• Match procedure codes to appropriate billed charges
• Identify lost charges: match supplies used to supplies billed
• Identify charges posted outside of proper GL period

Accounts Payable

• Isolate vendor unit price variances by product over time
• Summarize large invoices without purchase orders, by amount, vendor, etc.
• Review recurring monthly expenses and compare to posted/paid invoices
• Extract invoices posted with duplicate purchase order numbers
• Create activity summary for suppliers with duplicate products
• Identify duplicate vendors on vendor master file
• Identify unused vendors
• List missing AP check numbers
• Find duplicate invoice payments
• Find freight and tax overcharges
• Identify cash discounts not taken
• Match patient refund payments to AR records
• Match vendor names/addresses/tax-id-numbers to payroll records
• Calculate days in accounts payable
• Calculate average days to pay invoices
• Determine frequency of non-purchase order check requests
• Evaluate purchasing contract compliance Review 1099 compliance

Salaries and Payroll

• Summarize and print payroll by selection criteria for general review
• Summarize payroll distributions for reconciliation to general ledger
• Identify changes in exemptions, gross pay, hourly rates, salary amounts, etc.
• Extract all payroll checks where the gross dollar amount exceeds set amount
• Report entries against authorization records for new or terminated employees
• Compare and summarize costs for special pay, overtime, premium, etc.
• Analyze productivity - hours of patient care, etc.
• Identify overtime abuses
• Review highly paid employees
• Match payroll records to A/P records
• Compare wage and salary rates to approved ranges
• Identify false/invalid/duplicate Social Security numbers

Physicians

• Evaluate physician practice history by patient type, payer, etc.
• Determine physician contract compliance
• Develop "ideal practice" marketing profiles
• Report on incomplete physician profiling information

Marketing

• Develop patient statistics by zip codes or other demographic data
• Identify profitable segments of patient population for advertising focus
• Report on incomplete or miscoded patient demographic information
• Compare patient ordering histories to patient demographic information for accuracy

Medical Records

• Identify duplicate medical records for same patient
• Track diagnosis coding deficiencies, incomplete records, etc.
• List incomplete records by physician
• List incompatible coding (e.g., male patient with obstetrical code)
• Report on procedure codes by physician, department, or patient information

Materials Management/Inventory

• Statistically analyze usage and ordering to improve turnover
• Report on stock and high value balances using any selection criteria
• Test clerical accuracy of totals and extensions
• Summarize and stratify turnover by stock item in any order
• Identify obsolete inventory by sorted turnover analysis
• Identify items with yearly volume under on-hand quantity
• Isolate and analyze high value transactions by value, group, etc.
• Identify starting and ending period balances by class or group
• Compare speed and accuracy of delivery by product and vendor
• Match stock receipts with vendor ledger and report variances
• Check product reordering volume by item, warehouse, vendor
• Divide inventory into classes and compare percent investment
• Physical inventory analysis from upload from bar code scanners
• Physical inventory variance analysis
• Identify duplicate supply items on inventory master
• Profile supply usage by month, by department, etc.

Purchase Order Management

• Extract pricing and receipt quantity variations by vendor and purchase order
• Track schedule receipt dates versus actual receipt dates, summary and detail
• Isolate purchase order types (blanket, release, drop-ship) for audit tracking
• Identify duplicate purchase orders or receipts without purchase orders
• Eliminate stale POs by analyzing and reporting on partial receipts
• Reconcile receipts by comparing accrued payables to received items
• Audit receipt and ordering by selective reports by vendor, date, etc.
• Compare vendor performance by summarizing item delivery and quality
• Report on best purchasing performance by various locations

Information Systems/Security

• Identification of corrupt files
• Identification of duplicate records
• Identification of inventory quantity errors
• Compare current employee lists to system user list to identify resigned employees who should not have access
• Sort current system lists by system privilege to identify people who have more access than required for job duties
• Compare current IS employee lists to system user lists to identify people who have more access than required for job duties

Medical Claims

• Analyze timeliness of claims payments by comparing claim date, date claim received, and date claim paid
• Test for duplicate billings and claim payments based on patient, provider, date of service, and amount

Flexible Benefits/Membership

• Compare list of valid signed-up employees to list of people actually receiving health benefits from insurance company
• Match service dates to member eligibility dates

Clinical Subsystems

• Compare patient visit data on lab/radiology systems to patient master
• Identify interface failures
• Identify pricing discrepancies between master and subsystem

     
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