Why should you incur more costs for these reports?

• Receive reports in an easy to understand format
• Identify items that enable you to better your position within a contract
• Understand proper utilization, PCP referrals, top CPT and/or ICD-9 codes
• Enable you and your peers to identify best practice protocols
• Audit Claims management company
• Proper reimbursement based on practice or network business rules
• Analyze data to assist physicians in developing business rules
• Assessing the viability of the contracts of your practice
• Understand the elements of managed care risk contracting
• Gain a position in the market place as an entity with managed care understanding

Available Reports and Their Benefits…..

Utilization Reports
Allow you to establish a network mean for all aspects of medical care – Evaluation and Management, Surgical (inpatient, outpatient), Ancillary Procedures, etc. This enables your network to monitor all providers within the network and identifies problem areas for correction. Once a network's mean is established reasonable reimbursement rates based on network wide statistics will be established. This report may enable a network to re-negotiate rates based on utilization experience from an at risk population.

Reimbursement Reports
Will assist in analyzing the variance above and below RBRV with a Detailed Provider EOB. A monthly Summary Practice Financial Report may also be provided. This analysis will be based on per CPT code as well as RVUs to enable a finance committee to establish the proper reimbursement for all participating providers. Guidelines for rates received from payers for work units performed may be defined.

CPT/ICD-9 Reports
Will show what is the most referred diagnosis as well as the most utilized CPTs. ICD-9 analysis is used to develop protocols for the network providers as well as establishing how the network can assist referring doctors to treat common problems instead the unnecessary referring to the specialist for treatment. With a CPT analysis certain procedures may be reviewed for carve out purposes. This analysis can also assist in measuring referral rates per thousand to assure appropriate at risk rates are being received based on the number of referrals being experienced with risk type contracts.

Peer Measurement Report
Enable physicians to monitor themselves as well as other physicians within the network. This is a valuable tool when analyzing utilization reports as well as contract workload by physician and their groups as it relates to overall network statistics.

PCP Referral Report
Monitors incoming referrals to the specialist's office to determine if they are appropriate and inappropriate. It will allow the network, payer and PCP to correct inappropriate referrals within any risk contract that your network may have. This may have an affect on rates received for at risk contracts as well, whether from inappropriate or appropriate referrals.

Financial Reports
Reconcile any "at risk" dollars that may have been erroneously paid by your claims management company. These reports will identify incoming monthly revenues as well as pay outs that have been made by your claims management company. These payouts can include in and out of network provider reimbursements, administrative fees, withholds, risk pools, IBNR, etc. This report will assure that proper business rules were followed when paying any provider's claims. Financial reports will be in three forms to include network statistics, practice statistics and individual provider statistics. These reports can assist in developing reimbursement methodology from a network to practice to individual provider level. They can also assist in establishing distribution of excess funds, if any, during any time for the year whether it be quarterly, semi-annually or annually. These reports will also allow the practice administrators to establish proper productivity payments to their physicians that may participate in the network.

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