Okie doke, before you get cross-eyed and start bleeding from the ears at the though of what this month's title means, I promise you that there is nothing highly technical. Instead, pretend that you are about to learn how to find money. Not in a get-rich-quick sort of way, mind you, but in a steady, methodical fashion. And are you ready for the best part? You, the physician, probably don't have to do any of this work. Why? Because your practice's business manager should do this for you. So breathe a sigh of relief, kick back and read.

Let's make the assumption that you have some sort of practice management software that tracks your patients by insurance company, i.e. which patients are insured by which payer. And let's assume that this same software package also handles your billing and accounts receivable. Finally, let's assume that you can export data from your system into a spreadsheet or, failing that, assume that your software can at least print any report that you wish to create. Armed with just these tools, you have the keys to improving your practice's cash flow.

First, identify the 20 most-frequently-performed procedures. Now generate a report that shows the average reimbursement rate paid by all insurers (exclude Medicare, Medicaid and cash) for each of these 20 procedures. Congratulations, your practice manager has performed data mining and generated an internal benchmark that shows your practice's average reimbursement rates.

Next, for each of the 20 procedures, run a report that shows what each individual insurer pays per procedure. In your spreadsheet program, make a matrix for each procedure. On one axis list the payer and on the other list the dollar range. Rank each payer with its position on the matrix, i.e. Payer A pays the most for Procedure A, thus it is ranked #1. Once all 20 matrices are made, add up the payer ranks. The best score is 20. The worst is dependent upon how many payers you have, i.e. if you have 10 payers, the worst score is 200 because the lowest ranked payer finishes in 10th place on all 20 procedures. Make one matrix that combines the 20 procedures with the ranking. Now you have a single view of your practice's payer rankings as determined by rate of reimbursement for the top 20 procedures.

Next, your business manager will want to find out what the patient mix is and how it is spread out among the payers. Run a report on your patient population such that it identifies the percentage of patients covered by an insurer but excludes Medicare, Medicaid and cash. Add a column to your matrix and fill it with that data. This matrix would look like this:

	Proc. 1	Proc. 2	Proc. 3	Proc. 4	Proc. 5	Score	Mix %
Payer 1	1	3	4	1	2	11	15
Payer 2	3	2	5	5	4	19	26
Payer 3	2	1	2	2	1	8	18
Payer 4	5	4	3	4	5	21	24
Payer 5	4	5	1	3	3	16	16

By looking at this simple matrix, your business manager now knows which insurers, on average, pay more than others and the percentage of your patients who are with these firms. So now that some data mining has been performed, what should be done with this newfound data? The answer, of course, is "it depends."

Now that you know who pays more, you have a couple of different options. First, you can launch a marketing campaign to attract those patients who are covered by the top payers. As the practice grows with those patients, you can begin to phase out the patients who are with insurers who pay less.

Second, the business manager can perform similar data mining tasks on procedures that you don't perform as often, but appear to be more profitable. Once identified and depending on the types of procedures identified, your practice could launch a marketing effort to attract those patients who would benefit from more profitable procedures.

Third, depending on your practice's situation and proximity to retirement, you could choose to hire an employee to manage the cases of lesser reimbursing insurers so that you can focus on your golf game. Or, if you're not in a position to retire and have no hobbies you wish to pursue, you could focus on highly targeted marketing activities to bring in the patients who fit the first and second options previously noted.

Fourth, you could bring on a coding specialist to analyze your coding decisions. There is a fine line to be watched here, but in many instances your billing staff may not be totally aware of all coding nuances. A specialist may be able to identify some areas suitable for "right coding" that can legitimately increase your billing rates.

Fifth, you could choose to do nothing and simply monitor these statistics on a monthly or quarterly basis. By analyzing trends and being aware of the changes, your practice may be in a better position to negotiate a more favorable (or less damaging?) contract than if you were unaware of the statistics.

In and of itself, data mining is not an answer. It does, however, provide access to data that, when combined with knowledge about the data's origins, becomes transformed into information. When information is used in a decision-making process, it becomes knowledge. In today's cutthroat contracting environment, knowledge can make the difference between simply surviving or thriving.