A/R Report (Insurance)

  • Updated

The A/R Report allows users to identify and monitor open insurance balances and accounts receivable. The report provides a sum of a patient's open claims, broken down by the length of time the claim has been open as well as any outstanding balance. 

Generating the Report

Let's review how to generate the A/R Report (Insurance).

    1. Navigate to the Reporting section.
    2. Under Accounting Reports, select A/R Report (Insurance).
    3. Update the filters to instruct the system on how to generate the report.
    4. Select Run Report.
    5. To download the report, select Download.

Available Filters and Definitions

  • The Selected Practices filter allows users to filter search results based on the practice that claims were submitted under.
  • The Age Basis Date filter enables users to customize the report by either using the Submitted Date or the Date of Service. By default, the Age Basis Date is set to the Submitted Date, but it can be updated to the Date of Service in the dropdown.
  • The Amount Type filter enables a user to customize the report using either Charges, Charged vs Paid, or Difference Covered vs Expected by default.
    • 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 by 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. 
  • By default, the report displays data on a per-patient basis, but this can be modified by adjusting the Primary Grouping filter. Once a Primary Grouping filter has been selected, two additional grouping filters can be used to further refine the report. Additionally, a user can choose to hide patient details once one or more grouping filters are applied. It's important to note that this filter does not affect how the amounts are calculated, only how the data is presented. The following can be used to update the grouping:
    • A/R Classification
    • Authorization Status
    • 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
  • The Patient Identifier Display adds a column to the report that provides an additional means of identifying the patient.
    • Insurance ID
    • Medical Record Number
    • Patient ID
  • Users have the option to include claims with negative balances. Negative balances are often an indication that multiple payments have been applied to one or more claims and need to be reviewed.
     
  • Users have the option to include Manual Claims, also known as Legacy Claims.
     
  • The Report Date instructs the system to generate the calculations based on the date selected.

Reviewing the Report

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

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 made against that claim.

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