It's getting more and more important in your small business to monitor the performance of all aspects of your business so you can make better business decisions moving forward. You can't improve what you don't measure, and having the right systems and tools installed in your practice will make it easier for you to monitor the things most important to your bottom line.
Today we want to specifically talk about one report to monitor when it comes to your insurance billing and claims management. This is your utilization report, comparing you to state and national averages.
What to Know about Your Utilization Report
A utilization report gives you the chance to analyze the frequency a single procedure within a given set of codes is used in your practice and then compares it against the industry's average rate of use. Diagnostic medical testing utilization reports are used by payers to identify statistical anomalies as a trigger for audits. Oftentimes, notifications are sent to a large number of practices about any and all variances. Payers know that the notification itself and the chance of an audit will reduce usage across the board. At the end of the day, insurance companies want the money paid to be reduced. Nothing accomplishes that goal like the threat of an audit.
What To Look For
You'll need state or national data to make this comparison, and it's best if you can produce charts and metrics that are tailored to your practice (we can help you accomplish this). For instance, if your rate of usage for XYZ instrument is higher than the industry average, but you know that your patients' demographics dictate the use, there isn't a problem.
While payers will notify a practice of statistical variances when they result in increased payments, they aren't concerned about the codes that are used less frequently than other practices.
Verify that your tests are being ordered and performed based on medical necessity. If you are confident about that fact and the proper documentation is being made in the chart, nothing else really matters.
As we started out saying, these metrics and reports can be hard to follow if you don't have the tools and processes in place to help you monitor them. With VisionWeb's Revenue Cycle Management Service, you get access to a reporting dashboard that makes it super easy to check on things like your utilization reports. Get a demo today, or download our eBook, OD Growth Guide: 5 Essential Insurance Reports, to see what else you could uncover in your practice.