Wednesday, April 25, 2007
Peer comparisons promote improved billing practices - Data Trends - hospitals should compare billing patterns among peer hospitals - Illustration
Hospitals can best understand the fall range of factors that can affect their outpatient revenue by comparing billing patterns among peer hospitals. To identify missed charges, regardless of cause, this comparison must consider both primary and secondary services appearing on the claims.
Focus 1: Practice Patterns
The analysis of differences in practice patterns, should begin with a comparison of the actual services performed. Simply looking at a charge description master (CDM) alone would not provide evidence of such differences. A hospital in a major Midwestern metropolitan area, for example, compared primary and secondary services delivered in association with echocardiograms with such services delivered by peer hospitals in its market. The peer hospitals had different practice patterns in the type and volume of services. Upon analyzing secondary services, the hospital found that its peers perform a number of additional examinations for a small percentage of patients that it typically does not perform or performs at a much lower rate. For example, the peer hospitals perform cardiovascular stress tests and nuclear medicine exams of the heart in conjunction with echocardiograms 1 to 4 percent of the time, whereas the hospital generally did not perform these exams. The analysis raised the question of whether all hospit als should be performing these studies, and alerted the hospital to a practice pattern that might need to be reviewed.
Focus 2: Internal Procedures
Comparing billing patterns of two or more hospitals also can allow a hospital to identify missed charges caused by deficient internal procedures. For example, upon comparing its MRI services with those of its peers, a large urban hospital found that it was not reporting MRIs in conjunction with emergency department services, whereas its peers were routinely reporting such MRIs. When hospital managers investigated this finding, they discovered that patients' charge tickets were not being updated following MRIs. As a result, billing information for the MRI was not being captured. A CDM review would not have identified this operational problem.
Focus 3: CDM
Following such an analysis, it is critical that the hospital update and maintain its CDM to account for all such secondary codes, as well as recent changes in factors such as HCPCS codes, APCs, and Medicare's rules for coverage. Failure to perform this step will likely lead to missed charges and denied claims.
Focus 1: Practice Patterns
The analysis of differences in practice patterns, should begin with a comparison of the actual services performed. Simply looking at a charge description master (CDM) alone would not provide evidence of such differences. A hospital in a major Midwestern metropolitan area, for example, compared primary and secondary services delivered in association with echocardiograms with such services delivered by peer hospitals in its market. The peer hospitals had different practice patterns in the type and volume of services. Upon analyzing secondary services, the hospital found that its peers perform a number of additional examinations for a small percentage of patients that it typically does not perform or performs at a much lower rate. For example, the peer hospitals perform cardiovascular stress tests and nuclear medicine exams of the heart in conjunction with echocardiograms 1 to 4 percent of the time, whereas the hospital generally did not perform these exams. The analysis raised the question of whether all hospit als should be performing these studies, and alerted the hospital to a practice pattern that might need to be reviewed.
Focus 2: Internal Procedures
Comparing billing patterns of two or more hospitals also can allow a hospital to identify missed charges caused by deficient internal procedures. For example, upon comparing its MRI services with those of its peers, a large urban hospital found that it was not reporting MRIs in conjunction with emergency department services, whereas its peers were routinely reporting such MRIs. When hospital managers investigated this finding, they discovered that patients' charge tickets were not being updated following MRIs. As a result, billing information for the MRI was not being captured. A CDM review would not have identified this operational problem.
Focus 3: CDM
Following such an analysis, it is critical that the hospital update and maintain its CDM to account for all such secondary codes, as well as recent changes in factors such as HCPCS codes, APCs, and Medicare's rules for coverage. Failure to perform this step will likely lead to missed charges and denied claims.
# posted by Medical Information : 4:22 AM
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