Healthcare

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.

Charges

  • 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

Clinical Subsystems

  • Compare patient visit data on clinical subsystems to patient master
  • Identify interface failures
  • Identify pricing discrepancies between subsystems and master

Marketing

  • Develop patient statistics by post codes or other demographic data
  • Look for incomplete or miscoded patient demographic information
  • Identify profitable segments of patient population

Materials Management

  • 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

Medical Claims

  • 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

Medical Records

  • 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

Specialists

  • 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

See Also

Accounts Payable