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Steve Verno CMBS, CEMCS:
A good practice thermometer is the insurance aging report.  I look at that and it tells me the financial health of the practice.  I pick out 20 charts at random.  I perform an audit of the documentation vs codes submitted.  I also look at the payment/adjustment report and compare that with the deposit report.  I also want to see the practice financial plan. 

Regarding Making sure they are charging the right amounts.  It is not my say so regarding how much the provider charges.  The problem is that if you say to an internal medicine specialist that other internal medicine specialists charge $125 for an office visit, so his charge of $200 is too high.  That could be considered as possible price fixing.  I do look to see if the provider is charging too low.  I look at provider contracts to see if the contracted insurance company is paying correctly.  One provider I audited ended up being paid $5 per visit based on the poor contract.  The $5 was usually applied to the deductible which she refused to collect.  Her complaint was she wasnt making any money.  In the end, she closed her doors for good.  She lost her medical license and was sanctioned from Medicare, Medicaid and every commercial carrier that had a Medicare/Medicaid product.   She moonlighted at a clinic.  The providers there were not par or enrolled with Medicare or Medicaid, yet, they saw Medicare and Medicaid patients.  The biller sent their claims using her Medicare and Medicaid number and put her down as the provider who saw the patient.  Medicre caught this and stopped all payments wile they did an audit.   She and the clinic providers were brought up on charges of fraud and sbuse.  The biller was also sanctioned.  Her excuse was she was told to do this by the office manager.  My problem as the consultant to the doctor was that she didnt want to listen to me.  She didnt want to redo her poor contracts an she refused to bill her patients for their copay,deductibles and coinsurance.  You can only go so far.  Its like leading a horse to water.....
I never tell a doctor what to charge.  iIf I see multiple fees for a service, my only recommendation is to have one fee.  The fee selected by the provider is up to the provider.

Michele:
It is absolutely amazing what you can find by just looking at the insurance aging report.  I went into a practice and pulled an insurance aging report from their PM system, (which his office manager told the Dr couldn't be done) and in five minutes I found that NO inpatient hospital visits were being billed, NO nursing home visits were being billed, and NO medicaid was being billed.  All just in 5 minutes of looking at the insurance AR.  This practice had 3 DRs, 3 NP's, and saw all their own patients at the hospital (daily!) and was the director at FIVE nursing homes.  Funniest part  -    Office Manager (and Biller) still has her job!

Michele

Steve Verno CMBS, CEMCS:
You have the old saying:

Screw Up and Move Up!

ChristineS:
Thanks everyone!! I appreciate the help!

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