Free Billing Software

Billing software is business accounting software that helps you manage your billing. It was created to help you keep track of projects, hours worked, and what your clients owe you. You can use billing software to manage your professional services business. It automatically creates a variety of reports, so you know how much you have worked, how much to bill, and who owes you what.

Billing software was designed for service industry professionals and anyone else who provides services. There are many kinds of free billing software available on the Internet, including:

Integra Office 5.2: INTEGRA OFFICE combines a powerful time and billing system with the "ultimate scheduler." Bill formats are completely customizable. The software allows any of a client's last ten bills to be re-prepared at any time.

BS/1 Professional 3.06: BS/1 Professional is an integrated time billing and accounting system, handling accounts payable, accounts receivable, general ledger, inventory, time billing, and sales analysis. Multi-currency features facilitate purchasing and international billing.

Excel Invoice Manager Platinum 2.1.1007: by integrating with Microsoft Excel, Excel Invoice Manager Platinum 2.1.1007 provides a true interface, not only for creating and editing invoices, but also for designing your own invoices with various tools provided by Microsoft Excel.

kBilling 1.2.11: kBilling - the ultimate software to use billing application runs on virtually any computer (even Windows 95) and is very simple to operate. Context-sensitive help and an intuitive user interface allows even the most novice computer user to invoice customers in seconds, not hours.

VOIP Call Shop Billing Software 5.1: using this system, you can even grant customers credit by taking payments before even they make their call. You have two options: bill your customers after the completion of a call (post-paid billing) and accept payment before they make a call (pre-paid billing).

InstantInvoice 3 3.4.8: InstantInvoice 3 3.4.8, an invoicing, billing and quotation software for small businesses, tracks customer payments and outstanding invoices. There is a powerful search-and-find option to find past invoices and quotes.

All of the above software runs on Windows 98, NT 4.0, 2000, ME and XP.

Billing Software provides detailed information on Billing Software, VoIP Billing Software, Chiropractic Billing Software, Free Billing Software and more. Billing Software is affliated with HIPAA Complaint Medical Billing Software

How To Choose The Right Small Business Billing Software

If you own or manage a small business, you know how much time can be spent chasing down paper invoices, purchase orders and sales reports. It can be a real nightmare! That is where billing software comes in. It allows you to record all your customers, sales, invoices, inventory, suppliers (and more) in a PC-based system that is easy to use.

Deciding that you need to invest in good quality billing software is not hard. The tricky part can be choosing the right software package for your requirements. There are dozens of systems on the market claiming to be the holy grail of all your business problems, but choosing the wrong one can cost you valuable time and money.

Here's a simple checklist of 11 things to look for when purchasing billing software for your small business:

1) Customer records This is the core element of any billing system. What sort of information do you need to record about your customers? There's the obvious things like address, phone, fax, mobile, email and web address. But what about marketing-related information like "how did the customer find out about your business?", and "standard discounts" for key clients.

2) Multiple contacts & Communication history If many of your clients are businesses with multiple contacts, can you record individual contact details for each person? Word of mouth is the most powerful form of advertising, and statistics show that one of the most important factors in customer satisfaction is good customer service. Have you thought about keeping a log of all communication with your customers? It can be extremely helpful for improving internal communication within your business, and results in a more personalised service for your clients.

3) Multiple shipments Obviously your billing software will need to create sales orders - that's a gimme. But do you need to record employee-related information, like who the "salesperson" was? What about flexible dispatch options, like multiple shipments per sales order?

4) Search facility There's no point recording all this really useful information if there's no easy way to get to it. Check that the search facility is flexible and easy to use. What criteria can you search by? Here are a couple useful fields you may want to use: customer phone number, customer address, order date, dispatch date and dispatch consignment number.

5) Tax & regional support Are you able to change the tax rates on an order line basis? What about currency formatting? If you and your clients are in Europe, then there's no point using billing software that can only handle US dollars.

6) Reporting Producing accurate reports in seconds is something you no longer have to dream about. In fact it is a necessity in today's competitive market. Ensure your billing software can calculate information on sales based on date, salesperson and customer type. If you operate a B2B business, another key performance indicator may be dispatch totals, based on date, and employee. But one important thing to remember about software... you can only get out what you put in. So if you are looking for a specific report, make sure that information is being recorded by your billing software package.

7) Backup I've seen first-hand how devastating a hardware failure can be. Hundreds of thousands of dollars worth of data can be destroyed in seconds... if you do not have a backup procedure in place. Ensure you select a billing software package that has a built-in backup utility or works with your current backup system.

8) Online help & support If you're a new computer user, then you'll definitely need a software package that has a comprehensive online and easy-to-use help system. Also check out what direct technical support is available through the vendor. Some software companies charge very high fees for personal support, so ensure you include this in your budget.

9) Budget How much are you going to spend? That really depends on the complexity of the software package you are looking for. Smaller software packages can be found under US$100, and larger more complex packages can cost well over US$3000. Take a look at the number of customers you have, the number of sales orders you process, and choose a solution that fits your business.

10) Customisations If you purchase an off-the-shelf billing software package, you may require minor customisations to suit your unique business processes and industry. Some software vendors offer customisations at quite reasonable prices. But ensure you include this cost in your budget.

11) Other features What else do you want from you billing software? If you deal with fixed price products, you may need a comprehensive inventory management system allowing you to purchase stock, manage inventory levels and supplier relations. Some quality software packages also include a useful follow-up diary, allowing you to keep track of tasks and assign them to other staff members.

When choosing a billing software package for your business, make sure you check that it offers everything your business needs. And then the only thing you'll have to worry about is what to do with all your newly found spare time!

Josh Bender is an experienced database developer and qualified software engineer. He helps small-to-medium businesses streamline processes and improve efficiency using reliable and proven software solutions. Take a free test drive of 'InstantSalesTracker', easy-to-use billing software: http://www.InstantSalesTracker.com

How to Choose the Correct Chiropractic Billing Software

One important step in finding the perfect chiropractic billing software program to fit your needs is to take a look at your existing computer equipment. With system needs changing on a virtually daily basis, it is necessary that the software program you choose be compatible with your hardware.

You also have the option of upgrading your system if it is not currently compatible with the software option you choose.

Giving a rough estimate, there are approximately 30 different vendors that deal in chiropractic billing software. Prices can range from a couple hundred dollars to several thousand dollars. While cost is certainly a consideration, assuring that you get the best quality software to meet your needs should be the primary consideration. Many new chiropractors, fresh out-of-school may decide to go with a discount software solution in order to save costs. Experts in the field suggest that skimping on costs in the beginning can cause a huge headache in the future. It is often a lot of trouble and work to change over systems; not to mention that your files will temporarily be on hold while the change occurs. A good word of advice is to thoroughly examine your needs and then choose the appropriate chiropractic billing software program for your practice base your decision on need, not cost.

Chiropractic billing software can be a godsend for many practices. Not only will you save valuable space from limiting your need for paper files, your office staff will also be able to retrieve important medical information in a virtual instant. Most offices claim that the best aspect of the electronic billing software is the ability to instantly file insurance claims. This is an excellent way to reduce the cost of office staff and postage. Many of these billing software programs also have a built-in clearinghouse feature to enable the business manager to track and locate any outstanding claims.

Those using some of the more advanced chiropractic billing software programs are able to perform a wide variety of tasks that, in the past, could have taken hours or even days. Some programs allow the administrator to submit claims on a patient to multiple insurance companies. Other programs make billing less complicated when dealing with HCFA, Workers Compensation and Medicare: these programs have the necessary forms built into the program and are easily accessed. It is obvious that there is a plethora of variances in software; the key is to know what you need in a program and search for one that closely resembles your needs.

Chiropractic Software provides detailed information on chiropractic billing and office management software, as well as detailed chiropractic software product comparisons. For more information go to http://www.e-chiropracticsoftware.com and/or visit our affiliate site at http://www.original-content.net

Medical Billing Software – New Features to Look for in Your In Your Next System

New features can benefit you with a more efficient practice, lower costs, and increased cash flow.

Medical Billing Software and Physician’s Practice Management Systems are the best tools you can use to improve the financial well being of your practice. Using one can help you to gain full control over your finances, and grow your business. Cutting-edge medical billing technology can significantly reduce time and costs spent processing claims. Not only will you have a better grasp of the health of your practice, you can watch your receivables increase and your payables decrease.

In the past couple of years, new features have began to emerge to increase your operational efficiency. Spurred on by the HIPAA regulations mandating electronic file transfer standards such as X12, and the growth and maturing of the internet, new features are now available to help your business.

Recent advancements include:

1. instant access from anywhere, even away from the office
2. manage multiple offices and functions from one database
3. enhanced scanning - electronically file all claims; even those needing supporting documentation attached.
4. rules engines to identify errors before submitting the claim
5. increased security to comply with new HIPAA standards
6. electronic patient statements
7. electronic remittance advice

Stay Connected

With the maturing of the internet, new technology supporting the ASP (Application Service Providers) architecture allows access to your data including data entry from anywhere with a internet connection. This flexibility is a true benefit to multi-office practices and billing services. Multiple offices can now share the same database without the need for specialized networking or wide area networks. The cost savings in communication expenses alone can be enormous. Billing services can benefit by allowing limited access to their clients. This can instill a higher level of comfort for the client. This access can allow give a billing service a competitive advantage by providing value added services such as scheduling, super bill printing, and patient lookup.

Built in Efficiencies

Leveraging newer technology such as EOB and insurance card scanning, electronic patient statements, and electronic remittance can cut time spent on billing chores by up to 30%. This can allow more time for focus on patients and collections.

Reduced paper handling

Newer systems provide insurance payer rules so that users can immediately identify and correct claim errors that would delay payment of claims. Some systems will submit all your claims on your behalf including paper claims. Carriers can respond immediately so you get faster payouts, most within 14 days. Practice Management Systems can also reduce staff workload by outsourcing the print and mail functions of processing patient claims and statements.

When supporting documentation is needed in order for a claim to be paid, some systems can attach scanned letters of medical necessity, accident reports, referral authorizations, worker’s compensation documents, and most importantly EOBs. This eliminates the need to photocopy paperwork and perform chart pulls later if there are any questions on the claims.

Increased Security:

When using the internet, many users are concerned about security. A well established vendor addresses these concerns on multiple levels. Just like banking at an ATM, all data is encrypted during transmission and is protected by a user name and password. Furthermore, with most ASP vendors, all data and servers are backed up by expert IT staff at the data center. Many ASp vendors offer redundant HIPAA-compliant servers, with backups in different locations to ensure data recovery in case of disaster.

Conclusion

What is becoming standard in ASP-based medical billing software is subscription style pricing, and low upfront cost which cover implementation and professional fees.

If your business is looking to upgrade the medical billing software, examine the new features listed to see if they will offer you cost savings and increased efficiency. If so, insist on the new features in your next system. The cost savings can easily justify the upgrade.

Lori Anderson is an independent consultant with LAtech working with AntekHealthware on their DAQbilling Medical Billing Software and LabDAQ Laboratory Information System projects.

Top 10 Selection Criteria for Outsourced Electronic Medical Billing Software as a Service (SaaS)

Software as a Service (SaaS) is the new generation of ASP model designed to reduce the exorbitant costs of specialized medical practice management software. SaaS model is available for all aspects of medical practice management, including scheduling, billing, and electronic medical records (EMR), which are mission-critical for high quality clinical service, business operations, and regulatory compliance. SaaS model extends the advantages of Application Service Provider (ASP) model, which in turn evolves from the traditional Client-Server model. This article briefly defines key concepts and outlines a set of guidelines for SaaS vendor selection.

Client-Server (CS) Model

CS model involves central servers for database and application logic and multiple client modules connected to the central servers via local area network. This architecture allows allocation of significant application logic on the client computer.

Applications architects considering CS model must weigh performance and security advantages against increased maintenance costs. CS benefits stem from local control of application logic and data. CS shortcomings too stem from localizing logic and data because local arrangement requires the user to take responsibility over application maintenance, including data security, redundancy, disaster recovery, upgrades, backups, etc.

The medical practice utilizing CS model must develop in-house expertise and manage numerous services, including

1. Internet connectivity, bandwidth, and routers
2. Servers for Web server software, email, and firewalls
3. Database management
4. Data feed management
5. Capacity management
6. Redundancy management
7. Application upgrade management

 

Financially, CS models require the software user to make significant upfront investment in hardware and licensing and justify the business case using ROI-based arguments, which make little sense because of software and hardware innovation pace.

Application Service Provider (ASP) Model

ASP model shields the medical practice from high cost of specialized software and data maintenance responsibilities but not from upfront investment in hardware and in software licenses. Early ASP applications were created from traditional CS applications by moving centralized data and application servers to a third-party hosting service provider and allowing access to the application via HTML user interface as an afterthought. The third-party hosting service provider would take the responsibility for application maintenance and data protection.

The medical practice using early ASP model manages two costs:

1. Licensing and monthly support fee to software vendor
2. Software hosting fee to hosting vendor (typically a "pay-as-you-use model")

 

Software as a Service (SaaS) Model

SaaS model extends ASP benefits from outsourcing of system maintenance to simplified financial responsibilities. SaaS vendors eliminate the upfront costs to medical practice by making the upfront investment in hardware and licensing on behalf of all medical practices using the application.

To make such a financial commitment, the hosting vendor must develop thorough expertise in application maintenance and new feature development. Such a requirement became feasible with recent technology progress in terms of security (128-bit SSL encryption) and browser-based client performance along with AJAX coding methodology. The new generation technology now compensates for earlier CS model deficiencies and justifies network-native SaaS software development by design.

Because of higher specialization, SaaS vendor is able to focus on client business requirements, resulting in more responsive service and higher client satisfaction.

SaaS Vendor Selection

Medical practice in search of SaaS vendor must focus on the following topics:

1. Functionality: Does the application deliver all required functionality? Have you documented functional requirements subject to practice business goals, including financial, practice workflow and personnel objectives? Have you considered integrated practice management functionality including patient scheduling, SOAP notes, and billing?

    

    

2. Training Plan: Will the vendor provide sufficient training? What drives the training process: practice workflow changes or available software functionality?

    

    

3. Third-Party Application Interface: Does the application work with existing applications already deployed in the office? What data exchange requirements must be satisfied if you decide to purchase another application later?

    

    

4. Performance: How do you measure application and service performance? Are formal performance metrics available continuously?

    

    

5. HIPAA Compliance: What controls are in place to enable access only on a "need to see" basis? Is every access instance logged using secure mechanism?

    

    

6. Service Level Agreement: What minimum service levels does the vendor guarantee to the client? What are the penalties for violating SLA?

    

    

7. Problem Resolution: Is there a formal process to communicate problem identification and resolution? How is it tracked?

    

    

8. Data Access and Ownership: Who owns the data? Keep in mind that according to HIPAA, the patient is the ultimate owner of health data. How secure and private is the connection? Does it have Role based Access Control (RBAC)?

    

    

9. Disaster Recovery: How long would it take to recover from a disaster? Is a secondary data center available 24 x 7?

    

    

10. Disengagement Procedures: How long is data available upon severing the relationship? Who is responsible for data transfer to the new vendor?

    Yuval Lirov, PhD, author of Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk (Affinity Billing) and Mission Critical Systems Management (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

     

Chiropractic Office Billing Software Precision Index Improves 3.3% in June - PHCS Replaces BCBS MI

PHCS replaced Blue Cross Blue Shield Michigan on the Chiropractic Office Billing Software Precision Index (BPI). Overall, June 2007 BPI climbed 3.3%, bringing the index from 18.1 up to 14.8, almost 3% above the national average of 17.7%. Blue Cross Blue Shield Michigan dropped from its lead position down to the 8th place. June BPI replaced eight BPI participants on the list of top ten performers. BPI guides chiropractic office managers and helps the development of both chiropractic billing software and billing performance standards.

BPI = 14.8 means that the average of ten top performing payers working with Billing Precision clients have 14.8% of Accounts Receivable beyond 120 days. BPI is a key billing performance characteristic, as it is a proxy of the claims that are never paid. Obviously, the lower is the index the better is billing performance. The table below also lists the top ten performing payers and their relative index as recorded in the Billing Precision's system.

 

• Billing Precision Index 14.8
• PHCS 0.3
• Qual Care 0.9
• Atlantic Administrators 1.2
• HereIU Welfare 8.2
• Unicare 9.6
• Principal Life Insurance 10.6
• CBSA 12.4
• Blue Cross Blue Shield Michigan 13.6 (down from 3.2 in May)
• Blue Cross Blue Shield Illinois 15.9 (up from 16 in May)
• Medicare Illinois 30.4

 

May BPI dropped eight participants since May:

 

• GHI 11.5
• Humana 11.8
• Blue Cross Blue Shield Colorado 12.3
• Medicaid Pennsylvania 15.1
• Assurant Health 15.4
• United Health Care 22.6
• Medicare New Jersey 20
• Cigna 24.1

   

   

 

Although BCBS IL improved its index by 0.1%, its ranking dropped from seventh place in May down to ninth in June.

BCBS MI lowered its index from 3.2 in May and April down to 13.6 in June, dropping down to the 8th place in BPI.

June BPI added eight new participants since May:

 

• PHCS 0.3
• Qual Care 0.9
• Atlantic Administrators 1.2
• HereIU Welfare 8.2
• Unicare 9.6
• Principal Life Insurance 10.6
• CBSA 12.4
• Medicare Illinois 30.4

 

Coverage

BPI is rule-based, i.e., payer participation in the index is defined by dynamically rules at the time of computation and not by a static listing of specific payers. Therefore, any specific payer may start or discontinue participation in the index, dependent on satisfaction of rule's conditions.

Current selection of payers for participation in the BPI is based on fifty top-volume providers across all United States that have received Billing Precision services for more than six months and have more than two hundred claims in their current Accounts Receivable.

Update Cycle

BillingPrecision.com updates BPI on a monthly basis.

Volume Weighting

BPI is volume weighted, which is important to accommodate future growth of provided information, index combinations, and sensitivity across multiple indices.

Information Provided

BPI computes the percent of Accounts Receivable beyond 120 days. Note that national average across all medical specialties of percent of accounts receivable beyond 120 days is 17.7%.

Summary

Chiropractic Office Billing Software Performance Index helps the development of both chiropractic office billing software and billing performance standards. Chiropractic office managers can use the index to benchmark their billing performance and guide its improvement over time. Rule-based index definition allows for automated inclusion and exclusion of payers in the index based on payer attributes, such as numbers of processed claims, accounts receivable distribution, certain mix of CPT codes, or patient demographics.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP  Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

Top 5 Metrics For Chiropractic Office Billing Software and Service Performance

Effective practice management depends on solid billing performance. Its measurement is an integral part of practice management process and its importance grows in step with growth of patient volume. Traditional billing metrics are limited in scope and focus on claim submission process, ignoring process imperfections on the insurance (payer) side. Modern computer technologies allow both measurement and action to improve revenue cycle efficacy and efficiency.

Useful metrics must be comprehensive and simple. They must combine both complete end-to-end processes and their individual components. Metrics must be used consistently over time and compared to standards.

 

1. Days in Accounts Receivable (DAR)

    

   A growing number of days in accounts receivable are symptomatic of a faulty billing process. One way to determine DAR is to count days from the date of service to the date of payment for every claim and then average across all claims. A simpler way to compute average number of days in accounts receivable by taking a ratio of accounts receivable to average daily charges, or

   DAR = (Accounts Receivable / Average Charge) x 365

   The main downside is this metric is its sensitivity to provider as it counts the lag time of unsubmitted claims for services already delivered.

   One obvious advantage of DAR metric is its independence of charges. The averaging feature of this metric eliminates sensitivity to specific day or CPT code but also hides the behavior shape of the accounts receivable curve.

   Note that national average of DAR hovers around 73 days. Advanced billing service providers leveraging powerful Vericle technologies often drive average DAR as low as 15 days.

    

2. Percent of Accounts Receivable Beyond 60, 90, and 120 Days (PARB60, PARB90, and PARB120)

    

   PARBX resolves the sensitivity issue of DAR metric and offers simple and charge-invariant metric of billing process. Its graphic representation has a skewed bell shape. Its steepness represents billing process quality: a steep curve and thin tail means healthy billing process, while a flat bell and a fat tail means billing problems.

   According to the MGMA survey, 25.35 percent of the average family practice's accounts receivables were more than 120 days old in 1997. This number has improved down to 17.7% in 2004.

   PARBX metric is especially helpful to identify patterns of problem claims containing specific payer or CPT code. Advanced billing service providers leveraging powerful Vericle technologies often drive average PARB120 as low as 5%, significantly below the national average of 17.7%.

   Further, PARB120 has been used to develop rule-based Billing Performance Index, which helps the development of billing industry standards. Chiropractors can use the index to benchmark their billing performance and to guide its improvement over time. Rule-based index definition allows for automated inclusion and exclusion of payers in the index based on payer attributes, such as numbers of processed claims, accounts receivable distribution, certain mix of CPT codes, or patient demographics.

    

3. First-Pass Pay (FPP Rate) and Denial Rate

    

   FPP is the percentage of claims paid in full the first time upon submission (subject to federal or state timely payment regulations: 15 days for electronic submission and 30 days - for paper).

   Denial rate is the complementary metric to FPP rate. It counts the percent of claims that require followup and therefore cost more to process. Followup may take the form of a phone call to payer to discover a lost claim or to receive interpretation of denial message, correction of earlier submitted data, resubmission of the original claim, consultation with the provider and medical notes, or denial appeal.

   Both FPP and Denial rates are very important metrics often used for billing process improvement. The upside of FPP/Denial metric is that it is charge-invariant but its downside is that it hides the differences between process imperfections on the claim submission and claim payment sides. To identify patterns of problem CPT codes or payers, FPP/Denial metric needs to be computed and compared across all pairs of payer-CPT code, which is a standard feature for modern billing technologies.

    

4. Patient Liability Rate

    

   Percent of Patient Liability is the ratio of patient responsibility to total billed charges and it roughly reflects patient deductibles. This measure is important in measuring front office function as it has little to do with clean claim submission or effective followup.

    

5. Collection Ratios

    

   Gross and net collection ratios metrics used to be popular metrics in the early day of digital computing. They compare (often arbitrary) charges to (allowed) payments. Net collection rate is defined as a ratio of Total Collections and Total Charges less Adjustments. Gross collection rate is defined as a ratio of Total Collections to Total Charges only. The main drawback of Collection Ratios metrics is the use of charges in defining gross and net collections, which precludes productive discovery of process improvement opportunities.

    

 

In summary, comprehensive and charge-invariant billing metrics, such as PARBX, are more informative and objective than collection ratios. Modern Vericle-like technology using such metrics helps identifying billing bottlenecks as it allows interactive review of multiple metrics along different aggregation dimensions.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

Electronic Medical Billing OLAP Software for Lost Revenue Discovery

Average medical practice may lose as much as 11% of its revenue due to underpayments. But underpayment recovery potential averages only 5% of revenue and involves costly appeal process. To avoid unrecoverable losses, some providers discontinue servicing patients insured by the worst performing payers. Unfortunately, such a drastic loss reduction measure may boomerang and increase losses depending on complexity of referral relationships. This article outlines limitations of traditional database queries used to identify payer candidates for contract termination and demonstrates alternative decision choices with superior performance in terms of revenue and risk management, facilitated with On Line Analytical Processing (OLAP) technology.

First Order SQL Queries for Accounts Receivable Analysis

Traditional accounts receivable analysis includes identification of payers that systematically underpay and refuse denial appeals. Such analysis is based on simple queries, designed to identify the best CPT code or the worst payer in absolute terms:

• Comparison of revenue for various CPT codes for a given time-period
• Comparison of underpayments for various payers for a given time-period
• Comparison of denials for various payers for a given time-period

 

A single key database indexing is a standard measure to improve time performance of such queries. It builds an ordered relationship within the data elements based on the value of the selected metric. But single key indexing precludes implementation of more complex queries like "who is the payer that underpays the most for the best CPT code," or "who is the worst referring physician for my worst payer?" and require complex SQL programming skills because of the need to store and process intermediate results. Therefore, ranking the data elements along a single attribute, forces a limited choice for management decision:

• Ignore the problem,
• Renegotiate the contract with the payer, or
• Stop serving patients insured by the worst payer.

 

But to find more subtle solutions the office manager requires the ability to aggregate and drill into data and formulate queries in real time, in response to observed results to the previous queries. Specifically, a low frequency under performing payer with a high degree of underpayment may not be as detrimental to the office as a high frequency under performing payer with a low degree of underpayment. Contract termination with a wrong payer may accomplish the opposite result to practice goals in terms of revenue maximization and workload reduction. Additionally, a decision to stop serving patients insured by any one payer may cause reduction of referral volume of other patients across all payers for a particular referring physician.

Combinatorial (Second Order SQL) Queries for Accounts Receivable Analysis

Fortunately, modern database query technology can address both limitations by enabling "second order SQL" queries, which allow data manipulation based on multiple criteria and using functions of combinations of such criteria.

In our case, second-degree SQL queries allow finding the worst payer for best revenue generating code. Such a discriminating approach allows focusing on higher priority items first, resulting in more effective management. In general, the manager performs a custom comparison of payers according to the following four-step sequence:

 

• Select metrics (e.g., % paid, % accounts receivable beyond 120 days, % denials)
• Select dimensions (providers, payers, CPT codes, ICD-9 codes, referring physicians)
• Partition
• Aggregate, drill-down, pivot

 

Worst Payer Query

To find a payer with highest amount of underpayments for the most-frequent CPT code, a second order SQL query can be written along the following lines:

For a given time-interval,

Select payers

Where sum of underpayments over

(all CPT codes Where Revenue > Revenue Threshold) > Underpayment Threshold

Worst Referring Physician Query

To avoid the risk of losing referrals from better-performing payers, the manager may consider severing referral relationship with some referring physicians instead of payers. In such a case, distribution of patients across various payers plays an important role for each referring physician. A single combinatorial query may fetch the Worst Referring Physician as follows:

For a given time-interval,

Select referring physicians Where Revenue for the Worst Payer > Threshold

Summary

Underpayment management involves all phases of claims processing and requires powerful Vericle-like computing platforms for exhaustive comparisons of payments versus allowed amounts and subsequent appeal management. OLAP allows better analysis of accounts receivable and more effective management because of the ability to handle queries with functions of multiple attributes and dimensions. Note that in the absence of native OLAP mechanism, effective Vericle-like billing platforms allow similarly powerful analysis by introducing intermediary steps. Such steps may add insight to analysis and improve decision quality.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP nventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com