Understand what payment patterns reveal about your organization's financial performance.
Multi-site PT organizations often discover reimbursement performance varies significantly across locations, payers, and referral sources, even when clinical operations are highly standardized. When you evaluate clinic performance from a financial perspective, it is important to consider multiple metrics rather than relying on a single indicator.
You must compare current performance with internal trends, industry benchmarks, and peer organizations to determine whether outcomes match established expectations.
You should apply the same extensive approach to Workers' Compensation and Auto reimbursement analysis.
Reimbursement performance is affected by factors beyond fee schedules. State regulations, payer practices, participation in preferred provider organizations, referral relationships, and payment processing procedures all affect the final reimbursement amount received.
An in-depth understanding of your clinic’s performance requires evaluating reimbursement from multiple perspectives.
You must compare current performance with internal trends, industry benchmarks, and peer organizations to determine whether outcomes match established expectations.
You should apply the same extensive approach to Workers' Compensation and Auto reimbursement analysis.
Reimbursement performance is affected by factors beyond fee schedules. State regulations, payer practices, participation in preferred provider organizations, referral relationships, and payment processing procedures all affect the final reimbursement amount received.
An in-depth understanding of your clinic’s performance requires evaluating reimbursement from multiple perspectives.
Benchmark 1: Start with Internal Performance
The initial benchmark is not an external organization.
Instead, you must begin with your own organization.
Instead, you must begin with your own organization.
Analysis of historical trends frequently provides stronger insights than examination of individual claims alone.
Consider the following questions:
- Have you observed changes in reimbursement trends over time?
- Do certain referral sources result in greater payment reductions?
- Which payers contribute most notably to payment variability?
- Are you experiencing an increase in reimbursement adjustments on a year-over-year basis?
- Do certain referral sources result in greater payment reductions?
- Which payers contribute most notably to payment variability?
- Are you experiencing an increase in reimbursement adjustments on a year-over-year basis?
Benchmark 2: Compare Against External Market Influences
After you have established internal trends, you should compare these data with relevant external variables.
Relevant external variables include:
Relevant external variables include:
- State Workers' Compensation fee schedules
- Regional reimbursement trends
- Payer-specific payment practices
- PPO and network participation
- Regional reimbursement trends
- Payer-specific payment practices
- PPO and network participation
Organizations such as the Workers' Compensation Research Institute (WCRI) regularly document significant variation in reimbursement across states. (Institute, 2023) This points to the necessity of evaluating performance within the context of your clinic’s specific market, rather than relying on a single national benchmark.
Benchmark 3: Compare Against High-Performing Clinics
Assessing the performance of clinics actively safeguarding reimbursement against organizations that do not implement such measures can be highly valuable as a final benchmark.
Among the thousands of clinics supported by BOOST, reimbursement performance consistently improves when Workers' Compensation and Auto claims are protected from subsequent payment reductions.
Today, BOOST supports more than 3,000 clinics and has developed reimbursement benchmarks across multiple states based on actual Explanation of Benefits (EOB) data.
Given the variability of reimbursement by state, BOOST recommends clinics compare their reimbursement performance to regional benchmarks instead of relying exclusively on national averages.
Given the variability of reimbursement by state, BOOST recommends clinics compare their reimbursement performance to regional benchmarks instead of relying exclusively on national averages.
Explore Your State's Reimbursement Benchmark
See how reimbursement performance compares in your region and discover how BOOST clients are protecting payment accuracy across Workers' Comp and Auto claims.
Sources:
Institute, W. C. (May 30, 2023). WCRI: Hospital Outpatient Payments Lower and Growing Slower in States with Fixed-Amount Fee Schedules. WCRI. [Link]
Institute, W. C. (May 30, 2023). WCRI: Hospital Outpatient Payments Lower and Growing Slower in States with Fixed-Amount Fee Schedules. WCRI. [Link]