Effective Date of Charges for all formulas should be Date Posted.
Effective Date of Items for all formulas should be Charge Date.
A/R 120 Days
Description: A/R 120 Days - Debit transaction balance for all transactions with aging from effective date that is greater than 120 days
Calculation: The sum of all debit transactions balance (where the balance is greater than 0) for all transactions with aging from effective date greater than 120 days regardless of responsibility.
Days A/R
Description: Average number of days it takes to collect the payments owed to the practice (total outstanding debit transactions over average daily charges).
Calculation:
Days in A/R = Total A/R (any Medical Charges and Items that have a positive balance) / *Average daily charges
*Average daily charges = Total charges (billed amount) for a specific period** / Number of days in that specific period
**The specific period is considered to be [(Today’s date - 7 months or Practice Management System activation date, whichever is more recent)] to [today’s date - 1 month]
Example 1:
Today is Nov 7, 2019 and your PMS activation date was Jan 1, 2019.
The Specific Period will be from (today’s date - 7 months) to (today’s date - 1 month)
Example 2:
Today is Nov 7, 2019 and your PMS activation date was Sep 1, 2019.
The specific Period will be (from Sep 1, 2016) to (today’s date - 1 month)
Example 3:
Today is Nov 7, 2019 and your PMS activation date is Nov 1, 2019.
In this case, do not calculate Days A/R, just display N/A
Net Collection Rate
Description: Collectible Revenue divided by Net Charges
Calculation: (Payments-Refunds)/(Charges-Contractual Adjustments) x 100
Comments:
*Payments- patient payments and insurance payments. This includes the whole payment, not only the applied amount
*Refunds- includes patient refunds and insurance refunds
*Charges- includes charges from the billing encounter as well as charges from items
*Contractual adjustments- includes insurance adjustments and withhold
*We should consider all payments/adjustments/charges and items from (today’s date - 1year) to (today’s date - 120days) – e.g. We have a charge in that period, but we received a payment yesterday and have done a refund today – only the charge will be included in the calculation.
Gross Collection Rate
Description: Sum of payments over the total billed
Calculation: (Payments-Refunds)/Total Charges x 100
Comments:
*Payments- patient payments and insurance payments. This includes the whole payment, not only the applied amount
*Refunds- includes patient refunds and insurance refunds
*Charges- includes charges from the billed encounter as well as charges from items
*We should consider all payments/adjustments/charges and items from (today’s date - 1year) to (today’s date - 120days) – e.g. We have a charge in that period, but we received a payment yesterday and have done a refund today – only the charge will be included in the calculation.
Reimbursement / Visit
Description: The amount of applied payments collected on average for each encounter billed
Calculation: (Sum of payments from encounters in specific period*)/(number of encounters in specific period*)
Comments:
*Payments- Includes applied patient payments and applied insurance payments related to billable billing encounters (not to items) in a specific time period. It does not matter what the payment date is. The only important thing is that the payment is related to the encounter that belongs to that specific period.
*Specific time period- (today’s date - 1year) to (today’s date - 120days)
DASHBOARD - FINANCIALS - BILLING:
Includes all claim charges and all items.
Date filters(run day sheet report by date posted):
- For billing encounters we use values from Date Posted field
- For items we use values from Date field
Filters:
- Attending Provider - billed amount for all charges (billing encounters and items) for the selected time period filtered by attending provider
- Billing Provider- billed amount for all charges (includes billing encounters that have been posted) for the selected time period filtered by billing provider
- Clinic- billed amount for all charges (billing encounters and items) for the selected time period filtered by clinic
- Top 10 Payers rename to “Top 10 Primary Payers” - billed amount for all claim's charges filtered by primary payer. In the results we should show only insurance companies (top 10).
- Top 10 procedures: procedures from billing encounters and items
- Top 10 Referring Providers: billed amount for all charges from the billing encounter that has referring provider, filtered by referring provider (here we should use referring provider documented under the Billing Encounter -> Referring Physician)
- Responsibility: billed amount for all charges (billing encounters and items) filtered by current responsibility (Primary, secondary, tertiary, patient).
DASHBOARD - FINANCIALS - PAYMENTS:
Includes all patient and insurance APPLIED payments
Date filters:
- For insurance payments we use values from Post Date field
- For patient payments we use values from Payment Date field
Filters:
- Applied vs. Unapplied (default filter) - Shows total patient and insurance payment filtered by applied/unapplied.
- Attending Provider: applied payment amount for all patient and insurance payments for the specific time period filtered by attending provider
- Billing Provider: applied payment amount for all patient and insurance payments for the specific time period filtered by billing provider
- Clinic: applied payment amount for all patient and insurance payments for the specific time period filtered by clinic
- Top 10 Payers: applied payment amount for the insurance payments filtered by payer
- Top 10 procedures: paid procedures from billing encounters and items (only applied amount)
- Top 10 Referring Providers: applied payment amount for all patient and insurance payments for the item period filtered by referring provider (referring provider is provider from Billing Encounter -> Referring Physician)
- Responsibility: applied payment amount for all patient and insurance payments filtered by responsibility.
Includes all charges from claims and all items.
Effective date for charges is Date Posted.
Effective date for items is Charge Date.
Only charges and items with positive balance are being calculated.
Filters:
- Billing provider: all charges with a balance filtered by billing provider
- Attending provider: all charges and items with balance filtered by attending provider
- Clinic: all charges and items with balance filtered by clinic
- Top 10 payers: all claim charges with balance and filtered by payer
- Top 10 procedures: we take all charges and items with balance filtered by procedure type
- Responsibility: all charges and items with balance filtered by responsibility (primary, secondary, ..., patient)
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