A/R Report (Insurance)

  • Updated

This report shows the total amounts of open claims submitted to insurance payers. Each row is given at the per-patient level by default, but several grouping options exist for specifying what should define a row. The amount totals for each row are calculated and grouped by age range. The date ranges for these ages are as follows:

  • 0-30 days
  • 31-60 days
  • 61-90 days
  • 91-120 days
  • 121-150 days
  • 151-180 days
  • 181-210 days
  • 211-240 days
  • 241+ days

There is then a Per-Patient Grand Total calculated, as well as a total given for each age range. The amounts given by the report can change based on user input. The default calculation, as well as the effects that inputs have on this calculation, is described in the Calculations section.

Report Options

Age Basis Date

The Age Basis Date can be either be the submitted date or the date of service.

  • Submitted Date: Amounts will be grouped by how much time has passed between the report date and the date the claim was first submitted.
  • Date of Service: Amounts will be grouped by how much time has passed between the report date and the date of service listed on the claim line Item.

Amount Type

The Amount Type defines the dollar figure amounts calculated by the report. It can be one of three options:

  • Charges: The amount charged on the claim
  • Difference Covered vs. Expected: The expected allowed amount minus the covered amount. This metric should alert users that the payer did not pay in accordance with their contractual obligations, or that the payer did not cover as the provider expected them to (or if no expected allowed amount was entered, this amount will show that the payer did not cover 100% of charges). Patient Responsibility amounts from payments are not considered in this balance amount.
  • Expected vs Paid: This is calculated as the Expected Amount minus what was Paid to the facility. 

Groupings

By default, the report rows are broken up per patient. The user can select up to three additional levels of grouping.

If a different Primary Grouping category is selected, the user has the ability to hide patient-level grouping. For example, if a user selected Facility as the Primary Grouping category and set the Show Patient Detail toggle to No, then each row would be the amounts per Facility over the age ranges. If the Show Patient Detail toggle was set to Yes, then each row would be the amounts per Patient per Facility and so forth.

The grouping does not change how amounts are calculated, just how they are broken up and displayed.

There are grouping options that can be added to the report to provide specificity to the reporting 

  • A/R Classification
  • Claim Queue
  • Claim Status
  • Facility
  • Has Single-Case Agreement
  • Issue Source (Newest)
  • Issue Source (Oldest)
  • Issue Type (Newest)
  • Issue Type (Oldest)
  • Payer
  • Practice
  • Service
  • Service Billing Profile

Any combination of up to three groupings can be used in one report to gather specific information. All reports can be exported to Excel and templated to run on command.

Patient Identifier Display

  • Patient Identifier Display: By default, the amounts will be given on a per-patient basis. This input can specify how those patients should be identified:
    • None (Patient last name and first name)
    • Medical Record Number
    • Patient ID

Other Fields

  • Report Date: This is the date from which the A/R periods will be measured.
  • Include Manual Claims: This is a Yes/No flag to include manual claims in the report calculations
  • Include Negative Balances: This is a Yes/No flag to include claims with negative balances in the report calculations

In addition, if a Primary Grouping is selected, the user has the option to turn off patient details by using the Show Patient Detail toggle.

Calculations

Using the default report inputs:

  • Age Basis Date as Submitted Date
  • Amount Type as Difference Covered vs. Expected

The amounts calculated by the report will be the total Difference Covered vs. Expected of each patient’s claims shown across the age ranges.

The special effects of changing the Age Basis Date and/or Amount Type are as follows:

  • If the Age Basis Date is set to Date of Service, the Amount Type will always be calculated by Line Item Total Units multiplied by Line Item Unit Rate. This Amount Type is ONLY available when the Age Basis Date is set to Date of Service.
  • If the Age Basis Date is set to Submitted Date, the other Amount Type options will be available.
    • The Difference Covered vs Expected amount is the Expected Allowed Amount minus the Covered Amount
    • The Insurance Balance from the Expected amount is the current actual balance of the claim
    • The Charges amount is the total amount of charges on the claim, not taking into account any payments that have been made against that claim.

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