Medical Practice Finance Report Case Study

Healthcare Business Assignment:
Generate a 1000-word business report to examine the economy of scales of Road Office 1 and Sea Office 2. How
are these medical practices doing overall? Pay attention to the First Billed Charges, Payments and Accounts
Receivables.
How many patients are going to each practice in the last 12 months? Revenue in the last 12 months for each? Is one
practice doing better compared to the other? Are they generating the same revenues? How are the insurance claim
reimbursements influencing the practices revenue?
REMEMBER TO PROVIDE EVIDENCE FROM THE CHARTS
In your conclusion, make an assessment. Should the healthcare corporation continue to keep both medical practices?
Should only one remain? Or is business really good that the corporation could consider acquisition of more medical
practices? Use business analytic concepts to answer this question.
This link may help with healthcare economies of scale: https://revcycleintelligence.com/news/key-strategies-for-

health-systems-to-achieve-economies-of-scale
Be sure to include pictures and citations where you cite the page numbers from this case study.
*This is a case study of a finance report of a medical practice. Do not worry about the overload of information.
Simply focus on ensuring that you address the questions in the business report.
October 2020
Table of Contents
1. Summary
2. Patient Activity
a. Patients Seen
b. New Patients Seen
c. Scheduled Appointments
d. Encounters
3. Billing
a. First Billed Charges
b. First Billed Charges of New Patient Procedure Codes
c. First Billed Claims
d. First Billed Patient Statements
e. First Billed Cash Items
f. First Billed Charges Work RVU
4. Payments
5. Adjustments
6. Patient Refunds
7. Insurance Recoups and Refunds
8. Insurance Entity Level Transactions
9. Accounts Receivable
10. Reimbursement Management System (RMS)
a. Denials
b. First Denials
c. Client Responsibility Incidents
11. Reimbursement Analysis
This report generates every First Day of the Month. It is then updated one day after the Invoice Period is closed; all metrics are updated except
the Accounts Receivable and the Client Responsibility Incidents.
Please note, that many of the metrics are based on effective dates instead of entry dates, which causes some metrics to change from one
scorecard to another. For example, the March scorecard has a payment amount of $120,000 for January, and the April scorecard has a
payment amount of $125,000 for January; the difference of $5,000 is due to payments effective on January that were entered in April.
Page 2 of 36
1. Summary
Last 4 Months Benchmarks

Oct/20
Benchmark Jul/20 Aug/20 Sep/20 Oct/20 Standard
vs. STD
FPRR (First Pass Resolution Rate) 67.9% 66.8% 65.9% 64.5% 79.5% -19%
DSO (Days in AR) 29 30 38 38 63 -40%
AR>120 -2% 0% 5% 11% 34% -68%
Net Collections 96% 95% 93% 90% 94% -4%
Reimbursement per Encounter $99 $97 $102 $109 $73 49%
Last 4 Months Scorecard Summary

Jul/20-Sep/20 Oct/20
Section Jul/20 Aug/20 Sep/20 Oct/20
Average vs. AVG
Patients Seen 1,197 1,483 1,381 1,180 1,354 -13%
New Patients Seen 103 142 117 103 121 -15%
Scheduled Appointments 1,262 1,556 1,355 1,384 1,391 -1%
Canceled Appointments 286 306 229 262 274 -4%
Encounters 1,233 1,606 1,473 1,270 1,437 -12%
First Billed Charge Amount $406,683.85 $458,716.61 $480,087.71 $437,473.10 $448,496.06 -2%
Total Payment Amount $142,826.55 $135,167.11 $131,048.55 $160,056.50 $136,347.40 17%
Patient Payment Amount $9,168.20 $12,293.25 $12,212.93 $10,941.73 $11,224.79 -3%
Insurance Payment Amount $133,658.35 $122,873.86 $118,835.62 $149,114.77 $125,122.61 19%
Contractual Adjustment Amount $204,291.77 $168,409.57 $169,228.30 $206,350.68 $180,643.21 14%
Manual Adjustment Amount $95,498.18 $106,577.05 $94,923.90 $101,237.82 $98,999.71 2%
Patient Refund Amount $150.00 $0.00 $0.00 $0.00 $50.00 -100%
Insurance Recoup and Refund Amount $3,813.25 $9,010.85 $2,339.13 $11,308.29 $5,054.41 124%
Insurance Entity Level Transaction Amount $40.21 $570.74 $4.51 $1,144.65 $205.15 458%
Accounts Receivable Amount $625,872.17 $746,092.32 $879,847.86 $0.00 $750,604.12 -100%
Denials Billed Amount $180,511.88 $232,571.83 $242,746.87 $391,067.65 $218,610.19 79%

FPRR: The FPPR (First Pass Resolution Rate) is the number of charges who's first action resulted in a payments divided into the total number of
charges submitted during this period for which we obtained an adjudication. The First Pass Resolution Rate is also called the “Clean Claim Rate”.
MedClarity will work with you to achieve greater First Pass Resolution Rate by providing feedback on denials and claim submission errors.
DSO: The DSO (Days Sales Outstanding) measures the length of time from the date first billed to the payment date. We will report your DSO and focus
on trends that causes reimbursement delays. Unpaid patient balances and incidents in your RMS could have a negative impact on your DSO.
AR>120: Accounts Receivable greater than 120 days since first billed date. We will report your AR > 120 focusing on achieving the lowest % of AR >
120 days. The practice needs to respond timely to requests in the RMS for Medical Records, Authorizations, Coding and /or patient demographics to
ensure denials are worked timely. Unresolved RMS and unpaid patient balances will increase this percentage.
Net Collections: The Net Collection Rate is payments plus adjustments divided into the total billed charges. This is also called “Resolution Rate”. We
will report your Net Collection Rate focusing on achieving the highest possible results. Patient balances and incidents in your RMS could have a
negative impact on Net Collections if left unresolved.
Reimbursement per Encounter: Insurance plus patient payment divided into resolved encounter. We report an average of what you are receiving per
encounter compared to your specialty and industry averages.
Patients seen: Distinct patients seen on a date of service by a provider. An encounter has to be created, patients with unfulfilled appointments are not
included.
New Patients seen: Patients seen for the first time. An encounter has to be created; patients with unfulfilled appointments are not included.
Scheduled Appointments: Appointments scheduled.
Canceled Appointments: Scheduled appointments that were canceled.
Encounters: Encounters by date of service.
First Billed Charge Amount: Billed amount by first date on which procedures were submitted to the insurance as claims or sent to the patient as
statements; date on which cash items were effectively charged.
Payment Amount: Amount of insurance and patient payments effective during a period of time.
Patient Payment Amount: Amount of patient payments effective during a period of time.
Insurance Payment Amount: Amount of insurance payments effective during a period of time.
Contractual Adjustment Amount: Amount of contractual (insurance) adjustments effective during a period of time.
Manual Adjustment Amount: Amount of manual adjustments effective during a period of time.
Patient Refund Amount: Amount of patient refunds effective during a period of time.
Insurance Recoup and Refund Amount: Amount of insurance recoups and refunds effective during a period of time.
Insurance Entity Level Transaction Amount: Amount of insurance payments, recoups and adjustments, not applied to charges, effective during a period
of time. For example: capitation payments, provider adjustments, interests, penalties, etc.
Accounts Receivable Amount: Remaining balance of charge amounts after applying payments and adjustments.
Denials Billed Amount: billed amount of insurance denial charges.

2. Patient Activity
120 new patients were entered in the in October 2020.
a. Patients Seen
1,180 patients were seen in October 2020.
Patients Seen in the Last 4 Months by Location

Location Jul/20 Aug/20 Sep/20 Oct/20
Average vs. AVG
Hospital A 6 11 2 6 -65%
Hospital B 5 8 3 5 -100%
Road Office 1 438 530 518 287 495 -42%
Beach Office 2 748 945 849 891 847 5%
TOTAL 1,197 1,483 1,381 1,180 1,354 -13%
Patients Seen in the Last 4 Months by Provider / Report Tag

Provider / Report Tag Jul/20 Aug/20 Sep/20 Oct/20
Average vs. AVG
Annie 5 9 2 11 5 106%
Brad 920 1,111 988 851 1,006 -15%
Debbie 237 328 330 254 298 -15%
Carter 34 24 52 35 37 -5%
Lauren 1 1 7 1 950%
Martha 11 8 22 6 247%
TOTAL 1,197 1,483 1,381 1,180 1,354 -13%

b. New Patients Seen
103 new patients were seen in October 2020.
New Patients Seen in the Last 4 Months by Location

Average vs. AVG
Hospital A 3 2 1 2 -40%
Hospital B 3 3 2 -100%
Road Office 1 41 64 45 32 50 -36%
Sea Office 2 56 75 70 70 67 4%
TOTAL 103 142 117 103 121 -15%
New Patients Seen in the Last 4 Months by Provider / Report Tag

Average vs. AVG
Annie 2
Brad 78 106 85 69 90 -23%
Debbie 21 26 24 25 24 6%
Carter 4 10 8 5 7 -32%
Lauren 1
Martha 1
TOTAL 103 142 117 103 121 -15%
New Patients seen: Patients seen for the first time. An encounter has to be created; patients with unfulfilled appointments are not included.
c. Scheduled Appointments
1,384 appointments were scheduled in October 2020.

999 (72%) appointments were fulfilled.
October 2020 Scheduled Appointments
Appointment Status Count
Fulfilled 999
Checked Out 999
Not Fulfilled 385
Canceled 262
Checked Out 2
In House 110
Pending Confirmed 2
Pending Not Confirmed 9
TOTAL 1,384
Scheduled Appointments: Appointments scheduled.
Fulfilled appointments: Appointments scheduled with encounters created.
Not fulfilled appointments: Appointments scheduled without encounters created.

262 appointments were canceled for October 2020.
October 2020 Appointments Top Cancellation Reasons
Cancellation Reason Count
NO SHOW 95
PATIENT RESCHEDULED 91
APPT GIVEN IN ERROR 5
Other (Grouped) 1
None Specified 70
TOTAL 262
Appointment cancellation: Scheduled appointments that were canceled.

d. Encounters
1,270 encounters occurred in October 2020.
Encounters by Entry Date: Encounters by create/entry date.
Encounters by Date of Service: Encounters by date of service.

3. Billing
a. First Billed Charges
$437,473.10 were first billed in October 2020, with an estimated value of $122,314.94.
October 2020 First Billed Charges
Billing Type Charge Count Amount Estimated Value
Insurance Claim 3,470 $422,306.16 $107,452.11
Patient Statement 110 $15,166.94 $14,862.83
TOTAL 3,580 $437,473.10 $122,314.94
October 2020 First Billed Lag

Lag (Business Days)
Location Receiving Posting Billing
Hospital A 26.9 -0.2 0.0
Hospital B 33.3 0.0 0.0
Road Office 1 8.6 -0.4 0.0
Sea Office 2 9.9 0.0 0.4
TOTAL AVERAGE 9.5 -0.2 0.3
Last 4 Months First Billed Amount by Location

Average vs. AVG
Hospital A $2,435.07 $2,240.74 $2,782.63 $3,900.06 $2,486.15 57%
Hospital B $1,575.23 $2,114.42 $2,485.53 $743.27 $2,058.39 -64%
Road Office 1 $164,209.18 $172,797.76 $169,387.81 $173,052.64 $168,798.25 3%
Sea Office 2 $238,464.37 $281,563.69 $305,431.74 $259,777.13 $275,153.27 -6%
TOTAL $406,683.85 $458,716.61 $480,087.71 $437,473.10 $448,496.06 -2%
Last 4 Months First Billed Amount by Provider / Report Tag

Average vs. AVG
Brad $315,559.25 $361,877.72 $371,080.05 $329,720.76 $349,505.67 -6%
Debbie $83,484.34 $92,097.93 $100,153.96 $97,081.35 $91,912.08 6%
Carter $7,160.54 $4,293.89 $6,586.33 $9,405.99 $6,013.59 56%
Lauren $479.72 $0.00 $80.00 $1,265.00 $186.57 578%
Martha $0.00 $80.00 $1,547.85 $0.00 $542.62 -100%
TOTAL $406,683.85 $458,716.61 $480,087.71 $437,473.10 $448,496.06 -2%

First Billed Date: First date on which procedures were submitted to the insurance as claims or sent to the patient as statements; date on which cash
items were effectively charged. Only first billed charges are included.
First Billed Receiving Lag: For online billing, it is the lag between the charge effective date and the charge create date. For batch billing, it is the lag
between the charge effective date and the billing batch received date. This lag is in business days, Saturdays and Sundays are not included. Only first
billed charges are included.
First Billed Posting Lag: For online billing, this lag is always 0. For batch billing, it is the lag between the billing batch received date and the charge
create date. This lag is in business days, Saturdays and Sundays are not included. Only first billed charges are included.
First Billed Billing Lag: It is the lag between the charge create date and the first billed date. This lag is in business days, Saturdays and Sundays are not
included.
b. First Billed Charges of New Patient Procedure Codes
Last 4 Months First Billed Charge Count of New Patient Procedure Codes by Location
Average vs. AVG
Road Office 1 36 38 27 22 34 -35%
Sea Office 2 55 55 53 51 54 -6%
TOTAL 91 93 80 73 88 -17%
Last 4 Months First Billed Charge Count of New Patient Procedure Codes by Provider / Report Tag
Average vs. AVG
Brad 77 70 55 53 67 -21%
Debbie 11 18 20 16 16 -2%
Carter 3 5 5 3 4 -31%
Lauren 1
TOTAL 91 93 80 73 88 -17%
Last 4 Months First Billed Charge Amount of New Patient Procedure Codes by Location
Average vs. AVG
Road Office 1 $10,713.49 $9,912.60 $7,800.00 $6,410.87 $9,475.36 -32%
Sea Office 2 $16,179.12 $15,741.65 $15,042.57 $15,096.05 $15,654.45 -4%
TOTAL $26,892.61 $25,654.25 $22,842.57 $21,506.92 $25,129.81 -14%
Last 4 Months First Billed Charge Amount of New Patient Procedure Codes by Provider / Report Tag
Average vs. AVG
Brad $22,892.61 $19,781.65 $15,759.97 $15,794.30 $19,478.08 -19%
Debbie $3,250.00 $4,622.60 $5,800.00 $4,580.00 $4,557.53 0%
Carter $750.00 $1,250.00 $1,282.60 $882.62 $1,094.20 -19%
Lauren $0.00 $0.00 $0.00 $250.00 $0.00
TOTAL $26,892.61 $25,654.25 $22,842.57 $21,506.92 $25,129.81 -14%
October 2020 First Billed Charges of New Patient Procedure Codes by Top Referring Physicians
Referring Physician Patient Count Amount
73 $21,506.92
TOTAL 73 $21,506.92
First Billed Charges of New Patient Procedure Codes:

c. First Billed Claims
Last 4 Months First Billed Claim Amount by Location
Average vs. AVG
Hospital A $1,682.67 $1,765.61 $1,296.09 $1,944.33 $1,581.46 23%
Hospital B $1,575.23 $1,380.28 $2,118.46 $743.27 $1,691.32 -56%
Road Office 1 $163,834.18 $171,066.71 $166,937.46 $170,594.38 $167,279.45 2%
Sea Office 2 $235,653.32 $277,795.72 $299,594.59 $249,024.18 $271,014.54 -8%
TOTAL $402,745.40 $452,008.32 $469,946.60 $422,306.16 $441,566.77 -4%
Last 4 Months First Billed Claim Amount by Provider / Report Tag

Average vs. AVG
Brad $312,245.80 $356,062.55 $365,574.64 $317,282.08 $344,627.66 -8%
Debbie $83,184.34 $91,394.81 $97,931.11 $94,533.09 $90,836.75 4%
Carter $6,835.54 $4,183.89 $5,836.33 $9,285.99 $5,618.59 65%
Lauren $479.72 $0.00 $0.00 $1,205.00 $159.91 654%
TOTAL $402,745.40 $452,008.32 $469,946.60 $422,306.16 $441,566.77 -4%
October 2020 First Billed Claims by Top Payers
Payer Charge Count Amount
SUNSHINE STATE HEALTHPLAN 629 $73,761.72
PRESTIGE HEALTH CHOICE 393 $47,242.52
HUMANA INC 334 $41,306.94
HUMANA CARE PLUS M C 293 $36,963.29
UNITED HEALTHCARE 263 $30,981.90
FLORIDA BLUE 220 $27,786.36
AETNA 154 $17,660.67
WELLCARE OF FLORIDA 115 $14,003.06
BLUE CROSS BLUE SHIELD OF FLORIDA 135 $13,511.86

October 2020
October 2020 First Billed Claims by Top Payers
Payer Charge Count Amount
Other (Grouped) 934 $119,087.84
TOTAL 3,470 $422,306.16
October 2020 First Billed Claims by Top Procedures
Procedure Charge Count Amount
99213-OFFICE/OUTPATIENT VISIT EST 529 $103,703.80
99392-PREV VISIT EST AGE 1-4 152 $34,200.00
90460-IM ADMIN 1ST/ONLY COMPONENT 503 $31,741.86
90670-PNEUMOCOCCAL VACC 13 VAL IM 73 $21,900.00
99391-PER PM REEVAL EST PAT INF 94 $18,800.00

90686-Influenza virus vaccine, quadrivalent, split
virus, preservative free, pt. 3 years of age and 363 $17,273.22
older
90461-IM ADMIN EACH ADDL COMPONENT 139 $15,137.80
90698-DTAP-HIB-IP VACCINE IM 58 $11,310.00
99173-VISUAL ACUITY SCREEN 201 $11,306.25
90716-CHICKEN POX VACCINE SC 48 $11,280.00
92551-PURE TONE HEARING TEST AIR 215 $9,406.25
Other (Grouped) 836 $73,652.69
TOTAL 3,470 $422,306.16
October 2020 First Billed Claims by Provider / Report Tag and Top Procedures
Provider / Report Tag
Count Amount
Procedure
Bradley Bradford 2,616 $317,282.08

90686-Influenza virus vaccine, quadrivalent,
split virus, preservative free, pt. 3 years of age 264 $12,562.80
and older
Page 15 of
October 2020 First Billed Claims by Provider / Report Tag and Top Procedures
Provider / Report Tag
Count Amount
Procedure
90651-Hpv vaccine non valent im 22 $7,040.00
Deborah Stemp 790 $94,533.09
90716-CHICKEN POX VACCINE SC 20 $4,700.00

split virus, preservative free, pt. 3 years of age 89 $4,234.62
and older
99381-INIT PM E/M NEW PAT INF 7 $2,100.00
Karen Kuhns 58 $9,285.99
99395-PREV VISIT EST AGE 18-39 3 $750.00

split virus, preservative free, pt. 3 years of age 10 $475.80
and older
90460-IM ADMIN 1ST/ONLY COMPONENT 8 $295.10
90471-IMMUNIZATION ADMIN 2 $75.00
Other (Grouped) 6 $944.62
Laura Waldron 6 $1,205.00
99213-OFFICE/OUTPATIENT VISIT EST 2 $392.00
Other (Grouped) 4 $813.00
TOTAL 3,470 $422,306.16
First Billed Claims: Procedure charges first billed as claim submissions.

October 2020
d. First Billed Patient Statements
Last 4 Months First Billed Patient Statement Amount by Media

Media Jul/20 Aug/20 Sep/20 Oct/20
Average vs. AVG
Mail $3,613.45 $6,154.29 $9,349.11 $15,166.94 $6,372.28 138%
TOTAL $3,613.45 $6,154.29 $9,349.11 $15,166.94 $6,372.28 138%
First Billed Patient Statements: Procedure charges first billed as patient statements. The patient statements include mailed statements and courtesy
calls.
Page 17 of
e. First Billed Cash Items
Last 4 Months First Billed Cash Item Amount by Location

Average vs. AVG
Road Office 1 $0.00 $55.00 $40.00 $0.00 $31.67 -100%
Sea Office 2 $325.00 $499.00 $752.00 $0.00 $525.33 -100%
TOTAL $325.00 $554.00 $792.00 $0.00 $557.00 -100%
Last 4 Months First Billed Cash Item Amount by Provider / Report Tag
Average vs. AVG
Brad $0.00 $444.00 $67.00 $0.00 $170.33 -100%
Carter $325.00 $110.00 $690.00 $0.00 $375.00 -100%
TOTAL $325.00 $554.00 $792.00 $0.00 $557.00 -100%
October 2020 First Billed Top Cash Items
Procedure Charge Count Amount
TOTAL
First Billed Cash Items: Cash item charges first billed.

f. First Billed Charges Work RVU
Last 4 Months First Billed Charge Work RVU by Location

Average vs. AVG
Hospital A 20.16 18.82 23.79 33.60 20.92 61%
Hospital B 13.64 18.13 20.43 6.40 17.40 -63%
Road Office 1 640.56 681.99 648.75 695.25 657.10 6%
Sea Office 2 965.57 1,106.25 1,198.64 1,028.88 1,090.15 -6%
TOTAL 1,639.93 1,825.19 1,891.61 1,764.13 1,785.58 -1%
Last 4 Months First Billed Charge Work RVU by Provider / Report Tag
Average vs. AVG
Brad 1,286.94 1,423.78 1,477.15 1,326.88 1,395.96 -5%
Debbie 314.26 373.96 371.93 375.56 353.38 6%
Carter 36.26 22.75 32.96 52.83 30.66 72%
Lauren 2.47 0.00 0.97 8.86 1.15 673%
Martha 0.00 1.50 5.73 0.00 2.41 -100%
TOTAL 1,639.93 1,825.19 1,891.61 1,764.13 1,785.58 -1%
October 2020 First Billed Charges Work RVU by Top Procedures
Procedure Work RVU
99213-OFFICE/OUTPATIENT VISIT EST 531.56
99392-PREV VISIT EST AGE 1-4 228.00
99391-PER PM REEVAL EST PAT INF 152.07
90460-IM ADMIN 1ST/ONLY COMPONENT 148.07
99214-OFFICE/OUTPATIENT VISIT EST 118.50

October 2020 First Billed Charges Work RVU by Top Procedures
Procedure Work RVU
90461-IM ADMIN EACH ADDL COMPONENT 69.60
99381-INIT PM E/M NEW PAT INF 42.00
Other (Grouped) 184.43
TOTAL 1,764.13
Work RVU: Medicare Fee Schedule Work Relative Value Unit times the procedure units of first billed procedures.
4. Payments
$160,056.50 payments were received in October 2020.

$10,941.73 were Patient Payments.
$149,114.77 were Insurance Payments.
October 2020 Patient Payments
Type Amount
Patient - Payment - Over the Counter-Cash $1,901.00
Patient - Payment - Over the Counter-Check $1,465.27
Patient - Payment - Over the Counter-Credit Card $7,387.33
Patient - Payment - Over the Counter-Debit Card $188.13
TOTAL $10,941.73
October 2020 Insurance Payments
Payer Amount
SUNSHINE STATE HEALTHPLAN $30,219.13
FLORIDA BLUE $13,499.88
PRESTIGE HEALTH CHOICE $10,289.78
UNITED HEALTHCARE $9,095.34
AETNA $8,425.06
HUMANA CARE PLUS M C $6,539.42
WELLCARE OF FLORIDA $6,498.83
HUMANA INC $6,268.91
BLUE CROSS BLUE SHIELD OF FLORIDA $6,192.96
Other (Grouped) $52,085.46
TOTAL $149,114.77
Last 4 Months Payment Amount by Location
Average vs. AVG
Hospital A $1,355.40 $1,175.58 $349.74 $953.58 $960.24 -1%
Hospital B $268.47 $516.26 $593.17 $634.47 $459.30 38%
Road Office 1 $56,806.74 $57,755.92 $50,913.28 $68,084.61 $55,158.65 23%
Sea Office 2 $83,982.51 $75,255.83 $79,192.36 $90,329.22 $79,476.90 14%
TOTAL $142,826.55 $135,167.11 $131,048.55 $160,056.50 $136,347.40 17%
Last 4 Months Payment Amount by Provider / Report Tag

Average vs. AVG
Brad $103,518.58 $102,879.02 $95,677.96 $116,078.16 $100,691.85 15%
Debbie $34,425.72 $24,804.81 $29,947.30 $38,796.47 $29,725.94 31%
Carter $2,330.20 $2,929.83 $4,320.03 $3,247.35 $3,193.35 2%
Lauren $72.58 $171.27 $82.10 $98.39 $108.65 -9%

Last 4 Months Payment Amount by Provider / Report Tag
Average vs. AVG
Martha $0.00 $70.00 $310.00 $333.00 $126.67 163%
TOTAL $142,826.55 $135,167.11 $131,048.55 $160,056.50 $136,347.40 17%
Payments: Insurance and patient payments effective during a period of time.

5. Adjustments
$307,588.50 were adjusted in October 2020.

$206,350.68 were Contractual Adjustments.
$94,404.64 were Manual Adjustments.
October 2020 Adjustments
Type Amount
Corrected Claim Adjustment $6,833.18
Insurance - Charge Level - Negative Adjustment -$21,713.99
Insurance - Charge Level - Positive Adjustment $228,064.67
Manual Adjustment - Other $92,510.71
Manual Adjustment - Collections $43.85
Manual Adjustment - Courtesy $1,850.08
TOTAL $307,588.50
Last 4 Months Manual Adjustment Amount by Location

Average vs. AVG
Hospital A $0.00 $367.07 $0.00 $0.00 $122.36 -100%
Road Office 1 $9,426.96 $13,894.14 $11,025.70 $18,490.07 $11,448.93 62%
Sea e $86,071.22 $92,315.84 $83,898.20 $82,747.75 $87,428.42 -5%

Office 2
TOTAL $95,498.18 $106,577.05 $94,923.90 $101,237.82 $98,999.71 2%
Last 4 Months Manual Adjustment Amount by Provider / Report Tag

Average vs. AVG
Brad $69,444.63 $82,596.28 $82,059.24 $78,022.49 $78,033.38 0%
Debbie $17,791.07 $22,632.38 $10,588.17 $22,401.27 $17,003.87 32%

Last 4 Months Manual Adjustment Amount by Provider / Report Tag
Jul/20-Sep/20Oct/20
Provider / Report Tag Jul/20 Aug/20 Sep/20 Oct/20 Average vs. AVG
Carter $437.16 $0.00 $633.50 $281.90 $356.89 -21%
Lauren $71.47 $0.00 $0.00 $150.01 $23.82 530%
Martha $569.74 $0.02 $0.00 $0.00 $189.92 -100%
TOTAL $95,498.18 $106,577.05 $94,923.90 $101,237.82 $98,999.71 2%
Adjustments: Contractual (insurance) and manual adjustments effective during a period of time.
6. Patient Refunds
Patient Refunds: Patient refunds effective during a period of time.

7. Insurance Recoups and Refunds
$11,308.29 were recouped or refunded to insurances in October 2020.
October 2020 Insurance Recoups
Payer Amount
PRESTIGE HEALTH CHOICE $6,698.52
PRESTIGE INTERNATIONAL $2,225.55
WELLCARE OF FLORIDA $882.39
STAYWELL HEALTH PLAN $449.25
AETNA $434.26
MOLINA HEALTHCARE OF FLORIDA $222.80
MIAMI CHILDRENS HEALTH PLAN $185.09
FLORIDA BLUE $73.47
HUMANA INC $70.92
STAYWELL MEDICAID MSO $42.03
Other (Grouped) $24.01
TOTAL $11,308.29
Insurance Recoups and Refunds: Insurance recoups and refunds effective during a period of time.
8. Insurance Entity Level Transactions
October 2020 Insurance Entity Level Transactions
Type Amount
Insurance - Entity Level - Positive Adjustment $1,144.65
TOTAL $1,144.65
Insurance Entity Level Transactions: Insurance payments, recoups and adjustments, not applied to charges, effective during a period of time. For
example: capitation payments, provider adjustments, interests, penalties, etc.
9. Accounts Receivable
Unbilled Charges
Billing Status Charge Count Amount Value
TOTAL
October 2020 Accounts Receivable

New Patient Insurance TOTAL
First Billed Age Balance % Balance % Balance % Balance %
TOTAL 100% 100% 100% 100%
October 2020 Patient Responsibility Accounts Receivable

Balance by First Billed Age %
Unbilled0-1516-3031-6061-9091-120120+TOTAL
120+ of
Billing Status
Balance
TOTAL
October 2020 Top Payers Accounts Receivable

Balance by First Billed Age %
Unbilled0-1516-3031-6061-9091-120120+TOTAL
120+ of
Payer
Balance
TOTAL
Last 4 Months Accounts Receivable Balance Amount by Location

Jul/20-Sep/20Oct/20
Location Jul/20 Aug/20 Sep/20 Oct/20 Average vs. AVG
Hospital A $6,412.12 $6,256.73 $8,116.39 $0.00 $6,928.41 -100%
Hospital B $5,000.54 $5,166.89 $5,216.77 $0.00 $5,128.07 -100%
Road Office 1 $215,363.75 $221,091.31 $244,843.07 $0.00 $227,099.38 -100%
Sea Office 2 $397,374.42 $511,933.45 $620,176.43 $0.00 $509,828.10 -100%
Telemed $1,421.34 $1,343.94 $1,195.20 $0.00 $1,320.16 -100%
Senior Medical Center $300.00 $300.00 $300.00 $0.00 $300.00 -100%
TOTAL $625,872.17 $746,092.32 $879,847.86 $0.00 $750,604.12 -100%

Last 4 Months Accounts Receivable Balance Amount by Provider / Report Tag
Average vs. AVG
Brad $437,899.40 $516,156.88 $627,964.78 $0.00 $527,340.35 -100%
Debbie $145,911.77 $180,242.37 $204,317.68 $0.00 $176,823.94 -100%
Carter $11,435.10 $10,415.56 $13,079.25 $0.00 $11,643.30 -100%
Lauren $762.20 $757.70 $493.70 $0.00 $671.20 -100%
Martha $360.53 $10,508.01 $4,875.84 $0.00 $5,248.13 -100%
TOTAL $625,872.17 $746,092.32 $879,847.86 $0.00 $750,604.12 -100%
Unbilled Charges: Open balances of charges never billed.
Accounts Receivable: Remaining balance of charge amounts after applying payments and adjustments.
Insurance Claim - Billing - New: Claims assembled recently that will be submitted to the corresponding insurance during the nightly process.
Insurance Claim - Billing - Saved: Charges that have not been posted, but are saved under insurance responsibility.
Insurance Claim - Billing - Hold: Claims not submitted due to holds at the client or insurance level.
Insurance Claim - Billing - Warning: Claims that cannot be assembled and require some kind of correction.
Patient Statement - Billing - New: Statements scheduled to be sent during the nightly process.
Patient Statement - Billing - Saved: Charges that have not been posted, but are saved under patient responsibility.
Patient Statement - Billing - Hold: Statements not sent due to holds at the patient level.
Patient Statement - Billing - Limit: The patient responsibility balance does not meet the minimum amount per statement, or the patient responsibility
balance is less than the patient unapplied payments, or the patient statement count has reached the statement count limit (usually 3.)
10. Reimbursement Management System (RMS)
a. Denials
October 2020 Denials
Denial Type Charge Count Billed Amount Balance Amount Balance Value
First Denials 1,472 $157,971.72 $78,417.94 $12,396.75
Total Denials 3,165 $391,067.65 $219,609.57 $45,840.87
Denial: Insurance denial of a charge.
First Denial: First time a charge is denied.
Total Denials: all denials of a charge: first time, second time, etc.
b. First Denials
October 2020 First Denial Reasons

Charge Billed Balance Balance
Denial Reason
Count Amount Amount Estimated Value
45 - Amount Disallowed per Contract 228 $26,620.21 $1,383.35 $605.24
16 - Lacks information needed for adjudication 138 $23,154.31 $14,251.84 $2,245.48
96 - Non-covered charge(s) 207 $19,637.87 $8,365.37 -$3,060.85

204 - This service/equipment/drug is not covered
192 $19,100.12 $13,119.79 $3,923.29
under the patients current benefit plan
97 - Payment included in the allowance for
189 $17,806.73 $9,927.69 $1,947.95
another service/procedure
18 - Duplicate claim/service 112 $14,147.08 $4,623.16 $1,642.95
A1 - Denial 144 $8,656.18 $3,958.66 $302.72
27 - Expenses incurred after coverage terminated 54 $6,883.55 $6,403.78 $1,555.59
B13 - Previously paid 75 $6,725.60 $4,908.85 $680.31
Other (Grouped) 133 $15,240.07 $11,475.45 $2,554.07
TOTAL 1,472 $157,971.72 $78,417.94 $12,396.75
October 2020 First Denials by Top Payers

Payer
PRESTIGE HEALTH CHOICE 366 $42,787.83 $23,903.85 $4,972.26
SUNSHINE STATE HEALTHPLAN 415 $42,024.92 $13,223.05 $2,997.47
PRESTIGE INTERNATIONAL 122 $14,549.04 $10,562.64 $1,828.26
WELLCARE OF FLORIDA 73 $7,682.03 $2,918.95 $28.48
STAYWELL HEALTH PLAN 53 $5,882.32 $1,377.54 $153.13
BLUE CROSS BLUE SHIELD OF FLORIDA 59 $5,261.31 $2,848.34 $565.72
HUMANA CARE PLUS M C 48 $4,960.83 $1,600.51 -$1,775.44
HUMANA INC 38 $4,340.16 $1,329.84 -$1,133.00
FLORIDA BLUE 44 $3,999.12 $2,928.27 $767.74
Other (Grouped) 254 $26,484.16 $17,724.95 $3,992.13
TOTAL 1,472 $157,971.72 $78,417.94 $12,396.75
October 2020 First Denials by Top Procedures

Procedure
99213-OFFICE/OUTPATIENT VISIT EST 91 $17,832.48 $12,095.22 $4,602.28
90670-PNEUMOCOCCAL VACC 13 VAL IM 50 $15,000.00 $6,000.00 $3,507.78
90460-IM ADMIN 1ST/ONLY COMPONENT 125 $10,692.84 $5,756.63 $1,720.33
99392-PREV VISIT EST AGE 1-4 46 $10,350.00 $6,975.00 $136.72
90716-CHICKEN POX VACCINE SC 43 $10,105.00 $3,740.00 $1,506.39
99173-VISUAL ACUITY SCREEN 178 $10,012.50 $2,979.31 -$2,587.50

90686-Influenza virus vaccine, quadrivalent, split
virus, preservative free, pt. 3 years of age and 186 $8,850.30 $2,807.64 $936.79
older
October 2020 First Denials by Top Procedures
99393-PREV VISIT EST AGE 5-11 37 $8,325.00 $5,850.00 $64.97
Procedure
90461-IM ADMIN EACH ADDL COMPONENT 67 $7,536.40 $4,388.80 $1,142.08
Other (Grouped) 649 $59,267.20 $27,825.34 $1,366.91
TOTAL 1,472 $157,971.72 $78,417.94 $12,396.75
Last 4 Months First Denial Charge Count by Location

Average vs. AVG
Hospital A 1 -100%
Hospital B 1 3 1 2 2 20%
Road Office 1 370 394 359 621 374 66%
Road Office 2 719 672 897 849 763 11%
TOTAL 1,090 1,070 1,257 1,472 1,139 29%
Last 4 Months First Denial Charge Count by Provider / Report Tag

Average vs. AVG
Brad 834 906 975 1,194 905 32%
Debbie 236 155 262 270 218 24%
Carter 4 7 7 7 6 17%
Lauren 1 1 200%
TOTAL 1,090 1,070 1,257 1,472 1,139 29%
First Denial: First denial of a charge.

c. Client Responsibility Incidents
Client Responsibility Incident Balance Amount

Incident Status Balance by Incident Age
0-5 6-10 11-20 21-30 31 + TOTAL
TOTAL
Client Responsibility Incidents: Incidents in the RMS that need client's attention.
11. Reimbursement Analysis
Last 12 Months Reimbursement by First Billed Date

Gross Net
Estimated Total Total Patient Insurance
First Billed Date Billed Amount Total Balance Collect Collect
Billed Value Payments Adjustments Balance Balance
Rate Rate
Nov-2019 $554,959.65 $226,315.65 $173,338.92 $376,005.13 $5,615.60 $1,569.63 $4,045.97 31% 99%
Dec-2019 $529,256.74 $206,189.51 $164,222.09 $355,481.83 $9,552.82 $2,701.72 $6,851.10 31% 98%
Jan-2020 $526,558.45 $197,028.67 $165,984.97 $350,111.88 $10,461.60 $5,599.29 $4,862.31 32% 98%
Feb-2020 $538,052.04 $210,395.67 $160,040.88 $358,289.42 $19,721.74 $7,210.73 $12,511.01 30% 96%
Mar-2020 $652,708.89 $247,035.59 $200,867.69 $429,461.76 $22,379.44 $6,424.92 $15,954.52 31% 97%
Apr-2020 $302,385.42 $103,015.15 $89,944.35 $191,356.86 $21,084.21 $9,169.36 $11,914.85 30% 93%
May-2020 $356,302.97 $91,463.73 $104,257.74 $217,308.40 $34,736.83 $6,695.67 $27,891.56 29% 90%
Jun-2020 $389,091.68 $91,554.60 $114,770.73 $231,401.20 $42,919.75 $9,758.52 $33,161.23 29% 89%
Jul-2020 $406,683.85 $97,337.81 $122,412.98 $252,201.11 $32,069.76 $5,819.86 $26,249.90 30% 92%
Aug-2020 $458,716.61 $96,778.59 $115,204.45 $237,761.58 $105,750.58 $7,063.42 $98,687.16 25% 77%
Sep-2020 $480,087.71 $122,140.69 $113,500.71 $222,269.61 $144,317.39 $14,233.53 $130,083.86 24% 70%
Oct-2020 $437,473.10 $122,314.94 $83,506.48 $157,640.85 $196,325.77 $18,559.11 $177,766.66 19% 55%
TOTAL $5,632,277.11 $1,811,570.60 $1,608,051.99 $3,379,289.63 $644,935.49 $94,805.76 $549,980.13 28% 88%
TOTAL
$4,255,999.69 $1,470,336.38 $1,295,840.35 $2,761,617.59 $198,541.75 $54,949.70 $143,442.45 30% 95%
(90 days Lag)
Last 12 Months First Billed Charges Reimbursement by Top Payers

Gross Net
Payer Billed Amount Total Balance Collect Collect
Rate Rate
SUNSHINE STATE
HEALTHPLAN $982,965.37 $276,527.29 $313,793.57 $634,665.22 $34,506.58 $175.00 $34,331.58 32% 96%
PRESTIGE HEALTH
CHOICE $660,238.69 $187,216.36 $118,052.84 $388,742.87 $153,442.98 $507.60 $152,935.38 18% 77%
HUMANA INC $634,376.75 $136,545.97 $160,232.57 $374,506.91 $99,637.27 $458.84 $99,178.43 25% 84%
HUMANA CARE PLUS M
C $462,779.85 $84,494.21 $116,890.27 $233,658.25 $112,231.33 $281.82 $111,949.51 25% 76%
FLORIDA BLUE $289,678.25 $113,340.87 $101,856.61 $171,174.73 $16,646.91 $2,349.88 $14,297.03 35% 94%
UNITED HEALTHCARE $279,811.25 $124,561.89 $95,168.28 $171,367.89 $13,275.08 $4,153.20 $9,121.88 34% 95%
AETNA $194,014.77 $79,220.90 $70,549.52 $114,761.61 $8,703.64 $2,722.26 $5,981.38 36% 96%
CIGNA $186,658.81 $72,005.62 $71,767.23 $111,689.63 $3,201.95 $1,680.21 $1,521.74 38% 98%
STAYWELL HEALTH
PLAN
$181,667.78 $60,001.56 $44,357.07$129,414.01 $7,896.70 $120.00 $7,776.7024%96%
Other (Grouped) $1,760,085.59 $677,655.93 $515,384.03 $1,049,308.51 $195,393.05 $82,356.95 $112,886.50 29% 89%
TOTAL $5,632,277.11 $1,811,570.60 $1,608,051.99 $3,379,289.63 $644,935.49 $94,805.76 $549,980.13 30% 90%
Last 12 Months First Billed Charges Reimbursement by Top Procedures

Gross Net
Procedure Billed Amount Total Balance Collect Collect
Rate Rate
99213-
OFFICE/OUTPATIENT $1,632,723.47 $769,330.25 $480,004.60 $1,065,197.59 $87,521.28 $28,374.95 $59,146.33 29% 95%
VISIT EST
99392-PREV VISIT EST $418,940.00 $37,363.62 $141,967.81 $202,659.74 $74,312.45 $4,574.55 $69,737.90 34% 82%
AGE 1-4
Last 12 Months First Billed Charges Reimbursement by Top Procedures
Gross Net
Procedure Billed Amount Total Balance Collect Collect
Rate Rate
90460-IM ADMIN
1ST/ONLY COMPONENT $337,169.90 $136,277.75 $148,653.80 $147,452.10 $41,064.00 $3,378.12 $37,685.88 44% 88%
90670-PNEUMOCOCCAL
VACC 13 VAL IM $312,900.01 $178,180.98 $68,067.31 $211,514.69 $33,318.01 $3,018.01 $30,300.00 22% 89%
99214-
OFFICE/OUTPATIENT $276,233.52$130,205.62 $80,817.02$179,754.70 $15,661.80 $3,805.91 $11,855.8929%94%
VISIT EST
99391-PER PM REEVAL
EST PAT INF $275,640.00 $29,343.20 $96,015.18 $125,016.86 $54,607.96 $6,882.27 $47,725.69 35% 80%
99393-PREV VISIT EST AGE
5-11
$248,180.00 $23,267.34 $80,014.25$119,823.07 $48,342.68 $2,288.90 $46,053.7832%81%
90461-IM ADMIN EACH
ADDL COMPONENT $199,617.52 $70,366.82 $53,437.69 $119,792.81 $26,387.02 $2,090.36 $24,197.06 27% 87%
99394-PREV VISIT EST AGE
12-17
$160,390.00 $13,724.47 $54,923.51 $77,495.32 $27,971.17 $2,303.49 $25,667.6834%83%
90716-CHICKEN POX
VACCINE SC $137,710.01 $38,395.96 $28,789.70 $94,432.79 $14,487.52 $1,092.52 $13,395.00 21% 89%
99173-VISUAL ACUITY
SCREEN
$120,768.76 $900.01 $1,568.74 $95,150.70 $24,049.32 $1,157.76 $22,891.56 1%80%
90651-Hpv vaccine non
valent im $116,800.00 $2,710.00 $40,533.40 $63,076.06 $13,190.54 $1,226.04 $11,964.50 35% 89%
87804-INFLUENZA
ASSAY W/OPTIC
$109,306.28 $49,457.05 $31,227.10 $74,514.83 $3,564.35 $1,115.03 $2,449.3229%97%
90698-DTAP-HIB-IP
VACCINE IM $97,695.00 $3,581.08 $14,755.89 $66,117.11 $16,822.00 $1,807.00 $15,015.00 15% 83%
Other (Grouped) $1,188,202.64 $328,466.45 $287,275.99 $737,291.26 $163,635.39 $31,690.85 $131,894.54 24% 86%
TOTAL $5,632,277.11 $1,811,570.60 $1,608,051.99 $3,379,289.63 $644,935.49 $94,805.76 $549,980.13 27% 87%
Reimbursement Analysis: Last 12 month first billed charges analysis of billed amount, billed value, payments and adjustments.
Gross Collection Rate: Payment Amount divided by Billed Amount.
Net Collection Rate: The Net Collection Rate is payments plus adjustments divided into the total billed charges.
Patient Balance: Accounts Receivable in patient responsibility.
Insurance Balance: Accounts Receivable in insurance responsibility.
Payments: Insurance and patient payments received by the first billed charges.
Adjustments: Contractual (insurance) and manual adjustments applied to the first billed charges.

Medical Practice Finance Report Case Study

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Medical Practice Finance Report Case Study

Uploaded by

Copyright:

Available Formats

Healthcare Business Assignment:

This link may help with healthcare economies of scale: https://revcycleintelligence.com/news/key-strategies-for-

Last 4 Months Benchmarks

DSO (Days in AR) 29 30 38 38 63 -40%

AR>120 -2% 0% 5% 11% 34% -68%

Net Collections 96% 95% 93% 90% 94% -4%

Reimbursement per Encounter $99 $97 $102 $109 $73 49%

Last 4 Months Scorecard Summary

Patients Seen 1,197 1,483 1,381 1,180 1,354 -13%

New Patients Seen 103 142 117 103 121 -15%

Scheduled Appointments 1,262 1,556 1,355 1,384 1,391 -1%

Canceled Appointments 286 306 229 262 274 -4%

Encounters 1,233 1,606 1,473 1,270 1,437 -12%

Total Payment Amount $142,826.55 $135,167.11 $131,048.55 $160,056.50 $136,347.40 17%

Patient Payment Amount $9,168.20 $12,293.25 $12,212.93 $10,941.73 $11,224.79 -3%

Insurance Payment Amount $133,658.35 $122,873.86 $118,835.62 $149,114.77 $125,122.61 19%

Contractual Adjustment Amount $204,291.77 $168,409.57 $169,228.30 $206,350.68 $180,643.21 14%

Manual Adjustment Amount $95,498.18 $106,577.05 $94,923.90 $101,237.82 $98,999.71 2%

Patient Refund Amount $150.00 $0.00 $0.00 $0.00 $50.00 -100%

Accounts Receivable Amount $625,872.17 $746,092.32 $879,847.86 $0.00 $750,604.12 -100%

Denials Billed Amount $180,511.88 $232,571.83 $242,746.87 $391,067.65 $218,610.19 79%

Scheduled Appointments: Appointments scheduled.

Canceled Appointments: Scheduled appointments that were canceled.

Encounters: Encounters by date of service.

Denials Billed Amount: billed amount of insurance denial charges.

120 new patients were entered in the in October 2020.

1,180 patients were seen in October 2020.

Patients Seen in the Last 4 Months by Location

Road Office 1 438 530 518 287 495 -42%

Beach Office 2 748 945 849 891 847 5%

TOTAL 1,197 1,483 1,381 1,180 1,354 -13%

Patients Seen in the Last 4 Months by Provider / Report Tag

Brad 920 1,111 988 851 1,006 -15%

Debbie 237 328 330 254 298 -15%

TOTAL 1,197 1,483 1,381 1,180 1,354 -13%

103 new patients were seen in October 2020.

New Patients Seen in the Last 4 Months by Location

Road Office 1 41 64 45 32 50 -36%

TOTAL 103 142 117 103 121 -15%

New Patients Seen in the Last 4 Months by Provider / Report Tag

Brad 78 106 85 69 90 -23%

TOTAL 103 142 117 103 121 -15%

1,384 appointments were scheduled in October 2020.

October 2020 Scheduled Appointments

Appointment Status Count

Checked Out 999

Not Fulfilled 385

Pending Not Confirmed 9

Scheduled Appointments: Appointments scheduled.

Fulfilled appointments: Appointments scheduled with encounters created.

Not fulfilled appointments: Appointments scheduled without encounters created.

October 2020 Appointments Top Cancellation Reasons

Cancellation Reason Count

APPT GIVEN IN ERROR 5

Appointment cancellation: Scheduled appointments that were canceled.

1,270 encounters occurred in October 2020.

Encounters by Entry Date: Encounters by create/entry date.

Encounters by Date of Service: Encounters by date of service.

a. First Billed Charges

October 2020 First Billed Charges

Billing Type Charge Count Amount Estimated Value

Insurance Claim 3,470 $422,306.16 $107,452.11

Patient Statement 110 $15,166.94 $14,862.83

TOTAL 3,580 $437,473.10 $122,314.94