Conducting a Physician Practice Review

One of the important activities conducted by healthcare providers is a thorough performance review of physician practices. Healthcare organizations and their leaders, along with physicians should understand the importance of these reviews and how consumers rely on this information when making their healthcare buying choices. As the number of newly insured patients enter the marketplace for healthcare services as a result of the implementation of the Affordable Care Act, the information provided in these reviews serve to educate the public and identify areas for improvement.

The number of independent and third-party websites conducting these reviews is growing as more people become insured. This provides both a boon and bane for physicians and healthcare organizations, especially if these reviews are consumer-driven. Much like Yelp reviews for small businesses, negative information posted about a healthcare organization or physician may impact profits. Gaining control of the process for performing these reviews internally provides organizations with an advantage, if these reviews are performed by an unbiased, objective, third-party healthcare consulting firm.

Here is a step-by-step look at the physician of the physician practice review. Understanding the process and the importance of conducting these reviews on a periodic basis can provide physicians and healthcare providers with important and necessary feedback, as well as benefits for the operation of the organization.

Develop a Review Checklist

There are many tools available, including this booklet provided by the Centers for Medicare and Medicaid Services (CMS) that establishes basic guidelines for the internal audit of a physician’s practice. These guidelines, although not mandated by law, describe the value of performing self-assessments as a part of an organization’s regular procedures. Some of the benefits include:

    • A reduction and/or prevention of duplicate medical billings;
    • Improvements in the care provided to patients;
    • Compliance with applicable regulations, particularly those mandated under the ACA;
    • Provides substantiation of an organization’s commitment to providing quality care and meet

applicable standards, which can be marketed to healthcare consumers.

A self-assessment conducted by healthcare organizations and physicians should be complimented by an independent review performed by a healthcare consulting firm. This follow-up review validates the results of the self-assessment. Conducting such a review begins with an identification of specific operational risks, auditing such risks, documenting the results of the review and taking necessary corrective actions when deficiencies are noted.

Identify General Operational Risks

The identification of general operational risks focuses on those areas of a physician’s practice that are of greatest concern or pose the greatest risk to a practice if non-compliance occurs. This includes a review of the practices of the different functional areas of the organization. The most common areas subject to review include financial services, services provided by physicians and nursing staff, IT, legal and compliance.

The measurement or scoring of operational risks should follow a grading system of high, medium and low, as defined by the American Institute of CPAs or AICPA. The use of a scoring system, typically 1-3 where 1 can be high or low, allows for those examining functional areas to apply the same measurement when grading the physician practice.

Audit Risks

Once the risks of the functional areas of a physician’s practice have been identified, it is important to conduct a standards and procedures review, and a claims submission audit as part of the overall audit process. An operational review allows for an assessment of the current practices and standards of an organization to determine relevancy and completeness. A claims submission audit reviews billing and medical records maintained by the physician practice. This type of review provides important information about the use of technology within the practice and the security of al patient data and records.

Maintain Adequate Documentation

All reviews should be thoroughly documented. The collection of data during the review must reflect an accurate and complete record of the review, based on standards that are readily available. Documentation simply supports the finding and conclusions derived from the review. It also serves as support should a regulatory agency conducts an announced or unannounced external audit.

Review and Take Required Corrective Actions

The final step in a physician practices review is that of analysis and action. The results of the self-assessment should be shared with the healthcare organization’s leadership or in the case of an independent physician’s practice, its partners and practitioners. Deficiencies identified in the review should be addressed and affirmative steps taken to correct these items.

If an organization or physician group is not in the practice of conducting periodic reviews, it is important to consult with a healthcare consulting firm in order to begin the process. Incorporating this process as a regular aspect of a health organization or physician’s practice and culture allows for greater control of information concerning operational capabilities. It also gives control over negative information and allows the public access to unbiased and important information when making their decisions for healthcare services.

Stay in control and top of your practice performance and discover areas where your organization can improve with help from Altius Healthcare Consulting Group. At Altius, our team offers in-depth physician practice reviews to help you identify problem areas while developing solid strategies to help your team improve performance across the board. Don’t get left behind the ever-changing healthcare industry, and discover new areas of growth and opportunity with help from Altius Healthcare Consulting Group.

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