Physician Practice Analytics

Physician Practice Analytics: MIPS, Revenue, and Panel Management Without a BI Team

Practice managers ask Vizier 'which of our payers has the worst denial rate for 99214 codes this quarter?' and get an answer in seconds — no data analyst, no IT ticket, no Excel pivot table.

See Practice Demo →
18%average denial rate in physician practices — most never identify the root cause by payer and code
The Data Challenge in Physician Practices

Practice Managers Run on Excel. MIPS Runs on a Different Calendar Than Your Revenue Cycle.

Most physician practices — independent, physician-owned groups, or multi-specialty — do not have BI analysts. The practice manager handles quality reporting, billing oversight, scheduling analytics, and provider productivity all with Excel spreadsheets and whatever standard reports come out of the PM system. eClinicalWorks, athenahealth, Kareo, and Modernizing Medicine all have reporting modules with fixed templates. None of them let a practice manager ask a free-form question about cross-referencing payer denial patterns with specific CPT codes and specific providers.

MIPS adds a parallel analytics burden. The MIPS performance period runs on a calendar year, but revenue cycle reporting runs on whatever fiscal year the practice uses. MIPS cost category measures (MSPB — Medicare Spending Per Beneficiary) are calculated by CMS on Medicare claims data that the practice cannot directly access. Quality measures require clinical documentation review. PI (Promoting Interoperability) measures require EHR attestation data. Four separate data domains, one composite score, one payment adjustment affecting all Medicare Part B claims for the following year.

Generic BI tools require a data analyst to build the logic. Vizier already knows what a first-pass resolution rate means, how to calculate days in A/R by payer bucket, and what MGMA benchmark percentiles are for wRVU production by specialty. The practice manager can ask the question without translating it into database queries.

MIPS Composite Score Opacity
Most practices don't know their estimated MIPS composite score until CMS publishes final scores the following year. By then the performance period is closed. Vizier tracks Quality, Cost, PI, and Improvement Activity scores in real time so practices can course-correct during the performance period.
Denial Rate by Payer and Code
A denial rate of 15% is meaningless without knowing which payer denies which codes and why. A practice billing 99215 codes at 35% of encounters may have a high denial rate from one payer for documentation insufficiency — a pattern invisible in aggregate denial reports.
Provider wRVU vs. MGMA Benchmarks
An employed physician producing 3,800 wRVUs/year may be at the 40th percentile for their specialty (underperforming) or the 75th percentile (overperforming) depending on specialty and practice setting. MGMA benchmark comparison requires specialty-specific adjustment that Excel doesn't do automatically.
What Vizier Tracks

Physician Practice Analytics Capabilities

⚖
MIPS Composite Score
Quality measure performance by provider, Cost category MSPB trending, PI attestation status, and Improvement Activity tracking — aggregated into a real-time estimated composite score and projected payment adjustment.
$
Revenue Cycle Health
First-pass resolution rate, days in A/R by payer bucket (0-30, 31-60, 61-90, 90+), denial rate by payer and reason code, clean claim rate, and collection rate vs. net production.
↻
Claim Lag by Payer
Track the average days from date of service to claim submission, submission to payment, and payment to posting. Identify payers with unusually long processing times affecting cash flow.
◎
Provider Productivity
wRVU by provider per month vs. MGMA benchmark by specialty, new patient volume as percentage of total encounters, panel size, and schedule utilization — percentage of available slots filled at 24, 48, and 72 hours before appointment time.
◇
Payer Mix and Prior Auth Burden
Revenue by payer, payer-specific denial patterns by CPT code range, prior authorization request volume by payer and procedure code, and prior auth approval rate — revealing which payers create the most administrative burden for the least revenue.
⧖
Scheduling Performance
No-show rate by provider and appointment type, cancellation rate vs. rebooking rate, days to third next available appointment (access metric), and new patient wait time by specialty or provider.
Built for Every Role in the Practice

Practice Owner, Practice Manager, Clinical Quality Coordinator

Practice Owner / Physician Owner
"What is our operating margin by payer this quarter?"
"Which providers are performing below MGMA median wRVU for their specialty?"
"What is our projected MIPS payment adjustment if current performance holds?"
"Which payer contracts should we renegotiate based on denial patterns?"
Practice Manager
"Which payer has the worst denial rate for 99214 codes this quarter?"
"What is our no-show rate by day of week and provider?"
"How many days are patients waiting for new patient appointments?"
"Which reason codes are driving our highest denial volume?"
Clinical Quality Coordinator
"Which MIPS quality measures are we at risk of failing this performance period?"
"Which providers have the lowest quality measure documentation rates?"
"Are we meeting PI requirements for all eligible clinicians?"
"What is our HEDIS gap rate for diabetes management measures?"
Quality Programs & Reporting

Physician Practice Reporting Requirements

MIPS (Merit-Based Incentive Payment System) is the primary quality program for eligible clinicians — physicians, PAs, NPs, and other eligible professionals billing Medicare Part B. The MIPS composite score weighs four performance categories: Quality (30%), Cost (30%), Promoting Interoperability (25%), and Improvement Activities (15%). The composite score determines whether a practice receives a positive, neutral, or negative payment adjustment applied to all Medicare Part B claims two years later.

Alternative Payment Models (APMs) provide a separate pathway — practices in qualifying APMs earn a 5% bonus and are exempt from MIPS. ACO participation, PCMH recognition, and specialty-specific APMs (Oncology Care Model, Bundled Payments) all affect MIPS eligibility status. Vizier tracks APM participation status alongside MIPS performance to identify when APM participation is worth the administrative investment.

Primary Quality Program
MIPS — Quality, Cost (MSPB), Promoting Interoperability, Improvement Activities
Alternative Pathways
MSSP ACO Track, PCMH recognition, specialty APMs (OCM, BPCI-A, CJR)
Key Quality Measures
CMS quality measure set — specialty-specific measures including HbA1c control, preventive care, chronic disease management, patient experience
Payment Impact
MIPS payment adjustment ±9% of Medicare Part B allowed charges (2024 performance year); APM bonus 5%
Physician Practice Analytics

The First Analytics Tool Built for the Practice Manager, Not the Data Analyst

Upload your billing system data, ask questions in plain English, get MIPS scores, denial rates, and wRVU benchmarks without writing a single formula.

Ask Your Vizier →Schedule Consultation