Insurance Adjustments Report

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The Insurance Adjustments Report shows all adjustments made to claim payments in Avea. It provides a detailed view of adjustment group codes, reason codes, and amounts. This information can help identify trends in write-offs, service line denials, and patient responsibility by payer over time. Using this report can inform decisions about claim submission, follow-up, and appeals.

Generating the Report

Let's review how to create the Insurance Adjustments Report report! 

      1. Navigate to the Reporting section.
      2. Under Billing Reports, select Insurance Adjustments Report.
      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.

      6. To include data from the last 24 hours, select Refresh Data.

Available Filters and Definitions

  • The Selected Practices filter allows users to filter search results based on the practice that claims were submitted under.
  • The Date Type instructs the system what payments should be included in the report within the time range set by the Start Date and End date.
    • Deposit Date: This is the date the payment was deposited into the bank. This field needs to be manually updated in the Payment Collection.
    • Payment Date: This is the check date of the payment.
    • Post Date (Default): The Post date of the Payment Collection. Reports run by Post date will show all payments and adjustments posted within the selected date range.
    • Service End Date: The "To Date" of the claim (last date of service listed). Service End will only show claim payments and adjustments with a To Date or last service date line item within the selected date range.
    • Service Start Date: This is the "From Date" of the claim (first date of service listed). Service Start will only show claim payments and adjustments with a From Date or first service date line item within the selected date range.
  • The Start Date and End Date establish a timeframe for the system to locate and include payments 

  • The Group Codes filter allows a user to generate a report based on the type of adjustment code. Each code describe why a service line was paid differently than how it was billed and can assign responsibility for the adjustment amounts.
    • All: (Default)
    • CO: Contractual Obligations
    • CR: Correction and Reversal 
    • OA: Other Adjustment
    • PI: Payer Initiated Reductions
    • PR: Patient Responsibility

Viewing the Report

This report consists of two tables of data. The first table includes the Insurance Adjustment Totals, which is also shown as the final row in the downloaded report. The second table includes a row for each service line payment, with each column providing different information about that specific service line payment.

To view an example of this report, click here

Columns and Definitions

Row Name Definition/Location
Date Paid This is the date of the check. 
Post Date This is the date the payment was entered into Avea.
Deposit Date This is the date the payment hit the organization's bank account. A user must manually input this data within the Payment Collection. 
Patient Name and Patient ID. Patient > Profile
MRN Patient > Treatment Episodes > Intake > Patient Profile
Claim Payer This is the primary payer for the claim. 
Claim ID This is the Avea claim number
Claim Sequence This indicates the payer's position within the patient's insurance set e.g. Primary, Secondary, etc. 
Claim Version This count indicates whether the claim paid was the original (1) or a correction (2+).
DOS Start, DOS End, Service, and Units. Patient > Services
Total Claim Amount Charged Patient > Services > Billable
Expected Allowed Amount This is the expected reimbursement rate set within the Payer Rate section of the payer profile.
Line Item Amount Charged Patient > Services > Billable > Instances > Control Number > Line Items
Group Code, Adjustment Code, Adjustment Reason Code Amount. Record Center > Insurance Payments > Payments > ICN > Details
Check Number  Record Center > Insurance Payments > Payments
Claim Status, Claim Queue, Claim Issue,  Follow-up Date, and Assigned User. Patient > Treatment Episodes > Insurance Billing > Claims
Practice, Facility, and Organization. This is the Organization and Practice that the Patient's Treatment episode is associated with, as well as the facility within the practice where the service was provided.

FAQ

  • The Insurance Adjustments Report breaks down adjustment amounts by group and reason code to the service line payment level for an in-depth view of data by payer, service, and facility. The Adjustment Codes By Prefix tile displays the percentage of total adjustments and the total dollar amount adjusted by group code for all payers and payments
    • Scroll to the center of the Totals section and hover your cursor over the timestamp to see the last time the data was refreshed.
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    • To quickly filter the report without needing to download to excel, use the Search bar. You can quickly search by patient name, claim ID, or check number.
                     

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