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Due to today’s rapidly changing healthcare environment, medical practices have experienced rising overhead costs, declining reimbursement rates, and intense pressure on fees from managed care. Medical practices must re-evaluate and revise the way they work on the business side to stop the decline and bring physicians’ net income back in line in order to maximize both revenue and profit.
Physicians generally set fees without knowing the maximum payments allowed for various procedures by insurance company plans. Assisted by powerful software, BPCD&S can run a Comprehensive Medical Practice Assessment (CMPA) on your medical practice and tell you, among other things, if your fees are in line with what they should be. Chances are, a number of them are less than the going rate for reimbursements.
BPCD&S has implemented a CMPA software system that is nationally recognized as the most effective and financially rewarding practice-management tool. Taking into account all aspects of a practice’s revenue base, CMPA runs five valuable analyses:
- A procedure code analysis determines if all the procedure codes being used are valid.
- A fee and reimbursement analysis provides the basis for a balanced and defensible fee schedule by analyzing each procedure code individually and also in relation to the entire charge profile.
- An evaluation and management utilization review compares a medical practice to national utilization statistics for its specialty.
- A cost-accounting/break-even analysis provides vital information for managed-care negotiations and also for determining fee schedule.
New procedures pricing analysis provides an objective measure for establishing new fees until enough historical data can be accumulated for a fee analysis.
Using this sophisticated CMPA pricing software, BPCD&S does the detective work. To start the process, we gather data from our client’s practice -- data such as fee schedules, the number of times each procedure was performed over a one-year period, and a sample explanation of benefits (EOBs).
We then process this data through CMPA’s computer model where it undergoes a series of analyses. The CMPA results give us the direction we need to take to increase all codes up to the maximum allowable fee amount – or in some cases, reduce fees that are above the maximum allowable to the acceptable amount. However, before adjusting fees, we also look at the practice’s competitive situation to determine how aggressive they should be in revising their fee schedule. We also suggest setting fees that are fair to both doctors and patients in order to stay competitive.
BPCD&S has the ability to go into a medical office and analyze the huge amount of data in order to spot problems, trends and opportunities. We encourage our physician clients to meet with us quarterly to review their financial operations and their practices’ key performance indicators.
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