How This Doctor Discovered -- and Solved -- a Claims-Denial Problem

How do you know the difference between an industry downturn and an isolated issue? When this ophthalmologist saw his practice’s financial statements, he noticed a key decline compared to previous years. But thanks to the Academy’s free benchmarking tool, he soon learned that other, similar practices had fared better.

In this interview, AAOE board member Robert Wiggins, MD, MHA, shares how his team used insights from the benchmarking tool to identify and solve a problem, greatly improving financial performance the following year. Dr. Wiggins serves as a physician administrator at Asheville Eye Associates, a multispecialty ophthalmology group private practice in North Carolina.

AAOE: How did AcadeMetrics help you improve your practice’s financial operations?
Dr. Wiggins: When we compared our accounts-receivable ratios to prior years, we noticed they were trending negatively in terms of the percentage of A/R in the 121+ Day Bucket by internal benchmarking. The Academy’s benchmarking tool confirmed that: we were also lower than other practices participating in the survey in the current year.

Based on this finding, we formed a team to evaluate the causes of this trend. They identified an increase in the denial rate of claims. After evaluating the cause for the denials, they addressed it. The following year, we had better numbers than any prior year results.

AAOE: Did AcadeMetrics help you improve operations in any other ways?
Dr. Wiggins: We evaluate all of the ratios to see where we are doing well and where there are opportunities for improvement. We present these results annually to the owners of the practice; they comprise a key component of the financial review.

AAOE: Do you have any tips for gathering or entering information that might help others?
Dr. Wiggins: Get started! If you are a physician, ask the administrator to begin collecting the data and review the results with the physicians and administrators in the practice.

Likewise, if you are an administrator, discuss with the managing partner(s) the importance of this data in managing the practice and get the buy-in to begin. In an era of declining reimbursement and rising expenses, we do not have the luxury of discovering problems that imperceptibly worsen over a period of years until they have finally reached a crisis point.