The following are commonly used tests (grouped by type).
Accounts Receivable, Patient Billing and Managed Care
- Calculate average days from discharge to bill, bill to payment, by payer or department
- Determine appropriate level of contractual allowance and doubtful accounts reserves
- Age receivables on date-of-service rather than invoice date to recalculate cash flow
- Analyse rejected payments by financial class, procedure code, cost centre
- Evaluate managed care payer performance
- Identify underpaid managed care accounts
- Determine profit margin by physician, financial class, etc.
- Identify late charges by department, by month, etc.
- Look for invalid, high dollar or duplicate charges on patient bills
- Look for lost charges by matching supplies used to supplies billed
- Check procedure codes and billed charges to identify inappropriately billed charges
- Compare patient visit data on clinical subsystems to patient master
- Identify interface failures
- Identify pricing discrepancies between subsystems and master
- Develop patient statistics by post codes or other demographic data
- Look for incomplete or miscoded patient demographic information
- Identify profitable segments of patient population
- Analyse usage and ordering to improve inventory reordering
- Report on stock and high value balances using any selection criteria
- Identify obsolete inventory by turnover analysis
- Compare speed and accuracy of delivery by product and vendor
- Profile supply usage by month, by department, etc
- Analyse timeliness of claims payments by comparing claim date, date claim received, and date claim paid
- Look for duplicate billings and claim payments based on patient, provider, date of service and amount
- Identify duplicate medical records for same patient
- Track diagnosis coding deficiencies, incomplete records, etc.
- List incomplete records and incompatible coding
- Report on procedure codes by physician, department or patient
- Determine specialist/doctor contract compliance
- Evaluate specialist/doctor practice history by patient type, payer, etc.
- Report on incomplete specialist/doctor profiling information
Purchase Order Management
- Report on purchasing performance by location
- Identify pricing and receipt quantity variations by vendor and purchase order
- Identify duplicate purchase orders and receipts without purchase orders
- Reconcile receipts by comparing accured payables to received items
- Compare vendor performance by summarising item delivery and quality