Part 4 of 12 – Stop Under-Coding and Over-Coding – Here is How

12 Part Series: MedCV Practice Financial Management – Insights & Tips You Need to Know About to Quickly Maximize Your Income

Tip 4 of 12 – Coding it right the first time makes you money, rework is costly!

Improve wRVU per Encounter:
a. Assessment: Compare wRVU per encounter to MGMA benchmarks for each specialty. If your practice is below benchmark on this ratio there are two possible causes. One cause is under coding and/or inadequate documentation. This problem is particularly evident for E&M encounters as you can compare the percentage of visits at each level to MGMA benchmarks. A second cause is a service mix that is less intensive than your physicians’ peers. This intensity differential could play out in a higher proportion of visits to procedures or a procedure mix that generates a lower value of wRVU’s per case.

The amount of opportunity on this factor can be determined by calculating the difference between the actual wRVU per encounter and the MGMA benchmark for each specialty and then multiplying that value by the number of encounters. Next, multiply the total WRVU shortfall by the dollar collected per wRVU to identify the additional revenue opportunity for each specialty.

b. Improvement Action: Improving a low wRVU per encounter ratio first requires identifying the cause. If the cause is driven by coding and documentation issues the corrective action will involve focused coding and documentation audits to address those providers generating below benchmark ratios. These audits can be conducted by in house coders if your organization has the required resources and expertise. Alternatively, several vendors offer this service. Bill Dunbar and Associates (BDA) for example is another trusted MedCV Teaming Partner that offers this service in a no risk arrangement with their clients. Their fees are based on a percentage of the actual revenue improvements which means there is only upside and no risk if you elect to have BDA help. You can learn more about BDA at: www.billdunbar.com

Improvement actions are more complex if the cause of the low wRVU to encounter ratio is driven by a less intensive service mix. Determining your improvement actions will require a deeper dive to get to a root cause. Areas to investigate for surgeons and proceduralists may be their utilization of advanced care practitioners to perform screening and post-op visits.

Utilizing APCs in these roles will improve the physician’s wRVU per encounter if there is sufficient demand. A second area for surgeons is the percent of their workload coming from the emergency department compared to specialty specific benchmarks. Studying the Emergency Department’s outsourced rates and developing mutually beneficial working relationships between the Emergency Department and specialty physicians are potential corrective actions for low emergency department referrals. Other factors having an impact on service mix are market demand and competition. Market development and primary care physician outreach activities are steps to increase physician and patient awareness of the organization’s physician expertise. Each physician’s scope of practice may also be a determinant of wRVU per encounter. The provider compensation system should address this factor. In summary, once the causal factor has been identified the organization will be better able to deploy the strategy that most appropriately addresses the problem.

Like we like to remind our physician members at the end of each of these 12 part series, as a physician, if this sounds like a lot of work and maybe even has your “business anxiety level” up a few notches, you are not alone. The great news is that your role in this should just be to make sure it gets done and that those who are going to be responsible and accountable for this can explain and report details about what the plan looks like and its status to you.

Share this article with your practice manager, group administration, or hospital administration to make sure they are working on this or see what resources they have to get at this work. If they need help in getting started, they should consider connecting with John Rezen at Value Health. The key is to be able to have your baseline, you would expect your team to report to you the improvement(s) made and the results.

Stay tuned for Part 5 of 12, Encounters per Provider/Provider Production next week. If you can’t wait that long, no problem, just contact John for the full 12 part series. Again, it’s in your best financial interest to make sure each of these 12 Key Performance Indicators are optimized, you understand them, and take action, even if the action you take is to share the series and your new found business insight with your group or hospital administration.

_{John Rezen, CAPT, USN (Ret), FACHE, MHA, LSSBB, CRCR
President & CEO
Value Health, LLC
jrezen@valuehealth1.com}
_{MedCV Advisory Board Member
https://www.linkedin.com/in/johnrezen/}

Financial Improvement

Each of the 12 part “2-3 minute reads” in this Financial Improvement series provided by John Rezen, FACHE, MHA and your MedCV team can quickly add CASH to your bottom line just by having your practice “work smarter” for you. Even if you are not directly responsible for the management of your practice, knowing this information will help you make sure you are making the income you deserve.

As hospitals and medical groups emerge from the COVID- 19 economic shutdown, they will be faced with significant pressure to improve their financial performance. The following checklist of performance measures should help physician enterprises identify financial opportunities and accelerate their improvements. Below are the 12 topics, to read a previous segment, click on the name/link. The current segment is Blue and upcoming segments are Black.

Revenue