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Medical Group Management Association

Data Insights

Understand the past and present to propel your practice into the future.

Make informed decisions for your practice through insights and benchmarks from industry-leading data analysis, reports and surveys.

Performance

Accounts receivable

Provide the information regarding the age of your practice's accounts receivable (to the nearest whole dollar). Do not include accounts that have been assigned to collection agencies.
If your practice does not have any accounts receivable for a certain range, enter "0.”

⭐Current to 30 days

Amounts owed to the practice by patients, third-party payers, employer groups, and unions for fee-for-service activities before adjustments for anticipated payment reductions, allowances for adjustments, or bad debts. Amounts assigned to “Accounts receivable” are due to “Gross fee-for- service charges.” Assigning a charge into “Accounts receivable” initiates at the time a practice submits an invoice to the payer or patient for payment. For example, if an obstetrics practice
establishes an open account for accumulation of charges when a patient is accepted into a prenatal program and the account will not be invoiced until after delivery, then “Accounts receivable” will not reflect these charges until the creation of an invoice. Deletion of charges from “Accounts receivable” is done when the practice receives payment, turns over debt to a collection agency, or writes off the account as bad debt. “Accounts payable to patients and payers” are subtracted from “Accounts receivable” before reporting “Accounts receivable.”

This is the net amount owed after patient refunds.
Do not Include:

  • Capitation payments owed to the practice by HMOs.

⭐31 to 60 days – See Current to 30 days.
⭐61 to 90 days – See Current to 30 days.
⭐91 to 120 days – See Current to 30 days.
⭐Over 120 days – See Current to 30 days.

⭐Total accounts receivable

Add “Current to 30 days,” “31 to 60 days,” “61 to 90 days,” “91 to 120 days,” and “Over 120 days.”
 

Did your practice re-age accounts receivable when a balance was transferred to a secondary carrier or the patient’s private account?

Answer “Yes” if accounts receivable were re-aged when a second insurance company or the patient was billed after the first insurance company refused to pay the entire billed amount.
 

Payer mix

Please estimate the percentage of your practice’s “Total gross charges” by type of payer. The sum of the percentages must add to 100 percent. If not applicable, please enter "0.”
Managed care: Managed healthcare is a system in which the provider of care is incentivized to establish mechanisms to contain costs, control utilization, and deliver services in the most appropriate settings.
There are three key factors:

  • Controlling the utilization of medical services;

  • Shifting financial risk to the provider; and

  • Reducing the use of resources in rendering treatments to patients.

Capitation: Capitation is when a provider organization receives a fixed, previously negotiated periodic payment per member covered by the health plan in exchange for delivering specified healthcare services to the members for a specified length of time regardless of how many or how few services are actually required or rendered. Per member per month (PMPM) is the commonplace calculation unit for such capitation payments.
 

Medicare

Include all fee-for-service, managed care fee-for-service and capitated charges for all services provided to Medicare patients.

Medicare: fee-for-service: Fee-for-service gross charges, at the practice’s established undiscounted rates, for all services provided to Medicare patients on a fee-for-service basis. If patients are covered by both Medicare and Medicaid or a similar state healthcare plan, all charges for such patients should be included as Medicare fee-for-service charges.
Do not Include:

  • Fee-for-service equivalent gross charges for services provided to Medicare/TEFRA (Tax Equity and Fiscal Responsibility Act) patients under capitated, prepaid or other “at-risk” arrangements.

Medicare: managed care fee-for-service: Fee-for-service gross charges, at the practice’s established undiscounted rates, for all services provided to Medicare patients through a managed care plan. If patients are covered by both Medicare and Medicaid or a similar state healthcare plan on a fee-for-service basis, all charges for such patients should be included as Medicare fee-for- service charges.
Include:

  • Charges for patients covered under discounted fee-for-service contract arrangements.

Do not Include:

  • Fee-for-service equivalent gross charges for services provided to Medicare/TEFRA (Tax Equity and Fiscal Responsibility Act) patients under capitated, prepaid arrangements.

Medicare: capitation: Fee-for-service equivalent gross charges, at the practice’s undiscounted rates, for all services provided to patients under a Medicare/TEFRA, received from a capitated contract.
Do not Include:

  • Charges for fee-for-service patients; or

  • Charges for patients covered under discounted fee-for-service contract arrangements.
     

Medicaid

Include all fee-for-service, managed care fee-for-service and capitated charges for all services provided to Medicaid or similar state healthcare program patients.

Medicaid: fee-for-service: Fee-for-service gross charges, at the practice’s established undiscounted rates, for all services provided to Medicaid or similar state healthcare program patients on a fee-for- service basis.
Do not Include:

  • Fee-for-service equivalent gross charges for services provided to Medicaid or other state healthcare program patients under capitated, prepaid or other “at-risk” arrangements; or

  • Charges for patients covered under discounted fee-for-service contract arrangements.

Medicaid: managed care fee-for-services: Fee-for-service gross charges, at the practice’s established undiscounted rates, for all services provided to Medicaid or similar state healthcare program patients under a managed care plan. If patients are covered by both Medicare and Medicaid or a similar state healthcare plan on a fee-for-service basis, all charges for such patients should be included as Medicare fee-for-service charges.
Include:

  • Charges for patients covered under discounted fee-for-service contract arrangements.

Medicaid: capitation: Fee-for-service equivalent gross charges, at the practice’s undiscounted rates, for all services provided to Medicaid or similar state healthcare program patients under a
capitated contract.
Do not Include:

  • Charges for fee-for-service patients; or

  • Charges for patients covered under discounted fee-for-service contract arrangements.
     

Commercial

Include all fee-for-service, managed care fee-for-service and capitated charges for all services provided patients under a commercial capitated contact.

Commercial: fee-for-service: Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to fee-for-service patients who were covered by commercial contracts that do not include a withhold but may or may not include a performance-based incentive. A commercial contract is any contract that is not Medicare, Medicaid, or workers’ compensation.
Do not Include:

  • Charges for Medicare patients;

  • Charges for Medicaid patients;

  • Charges for capitation patients;

  • Charges for patients covered by a managed care plan;

  • Charges for workers’ compensation patients;

  • Charges for charity or professional courtesy patients; or

  • Charges for self-pay patients.

Commercial: managed care fee-for-service: Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to patients who were covered by managed care contracts that do include a withhold and may or may not include a performance based incentive. A commercial contract is any contract that is not Medicare, Medicaid, or workers’ compensation.
Include:

  • Charges for patients covered under discounted fee-for-service contract arrangements.

Do not Include:

  • Charges for Medicare patients;

  • Charges for Medicaid patients;

  • Charges for capitation patients;

  • Charges for workers’ compensation patients;

  • Charges for charity or professional courtesy patients; or

  • Charges for self-pay patients.

Commercial: capitation: Fee-for-service equivalent gross charges, at the practice’s undiscounted rates, for all services provided to patients under a commercial capitated contract.
Do not Include:

  • Charges for fee-for-service patients; or

  • Charges for patients covered under discounted fee-for-service contract arrangements.
     

Workers’ compensation

Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to patients covered by workers’ compensation insurance.
Do not Include:

  • Charges for Medicare patients;

  • Charges for Medicaid patients;

  • Charges for charity or professional courtesy patients; or

  • Charges for self-pay patients.
     

Charity care

Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to charity patients. Charity patients are patients not covered by either commercial insurance or federal, state, or local governmental healthcare programs and who do not have the resources to pay for services. Charity patients must be identified at the time that service is provided so that a bill for service is not prepared.
 

Self-pay

Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to patients who pay the medical practice directly. Note that these patients may or may not have insurance.
Include:

  • Charges for patients who have no insurance but do have the resources to pay for their own care and do so; and

  • Charges for patients who have insurance but choose to pay for their own care and submit claims to their insurance company directly. Since the practice may or may not be aware of this situation, all charges paid directly by the patient should be considered as self-pay.
     

Other federal government payers

Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to patients who are covered by other federal government payers other than Medicare.
Include:

  • Charges for TRICARE patients.

Do not Include:

  • Charges for Medicare and Medicaid patients.
     

*Total payer mix gross charges

The sum of the percentages for "Medicare," "Medicaid," "Commercial," “Workers’ compensation,” “Charity care,” “Self-pay” and “Other federal government payers” should equal 100%.
 

*Specify the number of Level 1, 2 and 3 trauma centers serviced

ANESTHESIOLOGY PRACTICES ONLY

If your group provides services to a level one, two, or three trauma center, specify the number of trauma centers serviced at each level in the boxes provided.
 

*Number of Hospital, Same-Day Surgery Center, Surgeon Offices and Other facilities staffed

ANESTHESIOLOGY PRACTICES ONLY

Indicate the number of facilities you covered in each facility type category. Please count any facilities not physically in the same location as separate facilities. For example, if you provide services (inpatient and outpatient) at one hospital in the same block of operating rooms, please count this as one facility. If the outpatient department is sufficiently removed that a separate staff is assigned to cover that “facility” on any given day, please count that as a separate facility (hospital or same day surgery center, as appropriate).
 

*Number of Hospital, Same-Day Surgery Center, Surgeon Offices and Other anesthetizing locations

ANESTHESIOLOGY PRACTICES ONLY

Indicate the number of anesthetizing locations including cath lab, ESWL, MRI, or OB suite, your practice covers at 7:30 AM (or another time that represents your typical first case of the day) in each facility type category. If one person “floats” to multiple places during the day such as MRI in the morning and cath lab in the afternoon within the same facility, please count this as one anesthetizing location. If some anesthetizing locations are not staffed daily, use partial numbers. For example, if you provide services at two hospitals and Hospital A has eight operating rooms (OR) and a cath lab where you provide services two days per week (0.4 anesthetizing locations) and Hospital B has 16 OR, an OB suite, an ESWL truck that comes twice per week (0.4 anesthetizing locations) and an MRI lab that you cover once per week (0.2 anesthetizing locations), you would list “2” as the number of facilities under “hospitals.” For hospital anesthetizing locations you would add the 8.4 (8 OR + 0.4 cath lab) at Hospital A and the 17.6 (16 OR + 1 OB + 0.4 ESWL + 0.2 MRI) at Hospital B to list a total of “26.” Recognizing that some facilities may have eight OR’s but only run six or seven on some days, include only those OR’s that you are committed to cover on a daily basis and exclude or use partial numbers for rooms that you only cover on a “staff available” basis.
 

What was the total number of hospitals covered that paid a stipend?

ANESTHESIOLOGY PRACTICES ONLY

Report the total number of hospitals staffed by the practice’s physicians and advanced practice providers that received a stipend.
 

*Total stipend amount for top 3 entities

ANESTHESIOLOGY PRACTICES ONLY

List up to three entities’ stipends. If you receive stipends from more than three entities, provide data for your three entities that have been allotted the largest stipends.

Net stipend = the amount of the stipend – any money you must refund the facility under the arrangement. For example, if you receive $1,000,000 for CRNA salaries but have an arrangement whereby any revenue you collect on CRNA services must be turned over to the facility and the amount of that revenue for last year was $400,000, the net stipend you received for CRNA salaries should be listed as $600,000.

Entity 1 Amount
Indicate the net stipend amount for the entity with the largest total stipends.

Entity 2 Amount
Indicate the net stipend amount for the entity with the second largest total stipends.

Entity 3 Amount
Indicate the net stipend amount for the entity with the third largest total stipends.
 

Number of beds for top 3 entities

ANESTHESIOLOGY PRACTICES ONLY

Provide the number of licensed beds for the entity listed in "Total stipend amount,” columns Entity 1, Entity 2, Entity 3, and total.

Entity 1 Amount
Provide the number of licensed beds for the entity with the largest total stipends, using the same entity reported in "Total stipend amount.”

Entity 2 Amount
Provide the number of licensed beds for the entity with the second largest total stipends, using the same entity reported in "Total stipend amount.”

Entity 3 Amount
Provide the number of licensed beds for the entity with the third largest total stipends, using the same entity reported in "Total stipend amount.”

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