Insurance Adjustments Report

The Insurance Adjustments Report displays all service line item adjustments for claim payments recorded in AveaOffice. This comprehensive view of adjustment group codes, reason codes, and amounts can give insight into how write-offs, service line denials, and patient responsibility trend by payer over time - driving decisions around claim submission, follow-up, and appeals.

This report can be run at the Organization and Managing Organization levels. 

Organization: Insurance Adjustments Report

Let's review how to run the Insurance Adjustment Report at the Organization level.

  1. Open the Reporting section.mceclip0.png
  2. In the Organization tab, choose Insurance Adjustments Report from the Billing Reports section.
  3. On the Insurance Adjustments Report, use the following filters to run your report.mceclip8.png
  4. Selected Practices: By default, all practices in the organization will be included in the report. Use the drop-down to select one or more individual practices to only display data for the selected practices.
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  5. Date Type: Choose one of the following date fields to run the report by. mceclip4.png 
  • Post (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. 
  • Payment: The Payment date of the Payment Collection. Reports run by Payment date will show all payments and adjustments with a check date within the selected range. 
  • Deposit: The Deposit date of the Payment Collection. Deposit Date will only show payments and adjustments with a deposit date set within the selected date range.
  • Service Start: 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.
  • Service End (Detail Type Only): 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.
  • Start Date and End Date: These two dates determine the date range for the report. The output will include any payment/adjustment with a date within the time frame selected, depending on the Date Type selection.
  • Group Code: Group Codes describe why a service line was paid differently than how it was billed and can assign responsibility for the adjustment amounts.mceclip5.png
    • All (default): All will display any payments with service lines adjusted by all 5 group codes. 
    • CO: Only display payment service lines adjusted by Contractual Obligation.
    • CR (uncommon): Only display payment service lines adjusted by Corrections and Reversals.
    • OA: Only display payment service lines adjusted by Other Adjustments.
    • PI: Only display payment service lines adjusted by Payer Initiated Reductions.
    • PR: Only display payment service lines adjusted by Patient Responsibility.
  • Next, click Run Report to view the report.mceclip6.png
  • Refresh Data: To improve speed, reporting and dashboard data is cached up to the last 24 hours. To use real-time data, click Refresh Data to update report results using the most recently available data.mceclip9.png
  • Tip: 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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  • Download: Use this button to export the report data to a CSV. Your CSV file can be opened with Excel or Google Sheets.mceclip10.png
  • Viewing Report Results

    The top of the report contains the Insurance Adjustment Totals table. This data is also displayed as the final row of the downloaded CSV file.

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    The Insurance Adjustments table contains a row for each service line payment and each column is a different piece of information about that service line payment.

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    Report Columns    
    • Date Paid
    • Post Date
    • Deposit Date
    • Patient
    • MRN
    • Patient ID
    • Claim Payer
    • Claim ID
    • Claim Sequence
    • Claim Version
    • DOS Start
    • DOS End
    • Service
    • Units
    • Total Claim Amount Charged
    • Expected Allowed Amount
    • Line Item Amount Charged
    • Group Code
    • Adjustment Reason Code
    • Adjustment Reason Code Amount (GRPRC)
    • Check Number
    • Claim Status
    • Claim Queue
    • Claim Issue
    • Follow-up Date
    • Assigned User
    • Practice
    • Facility

    Tip: 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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    Managing Organization: Insurance Adjustments Report

    Let's review how to run the Insurance Adjustment Report at the Managing Organization level. This allows you to view adjustments across the different organizations you manage. 

    1. Open the Reporting section.mceclip17.png
    2. In the Managing Organization tab, choose Insurance Adjustments Report from the Billing Reports section.
    3. For users with access to more than one managing organization, you can choose the desired Managing Organization from the drop-down. mceclip19.png
    4. The fields for this report are exactly the same as described above. Please see the previous section for full definitions. 
    5. The one exception is the Organizations section. Use the radio buttons to either run the report for all organizations or select which organizations should be included in the report. mceclip20.png
    6. When ready, click Create Report. 
    7. The report will run in the background.
    8. Once complete, you'll receive a notification with the download link and the download link will also be sent to the email address associated with your account. mceclip21.png
    9. Click View to download. 
    10. Open in Excel or a similar software.
    11. You will have two tabs: Insurance Adjustment Totals and Insurance Adjustments. These tabs mirror the data that is available in the Organization report as described above. mceclip23.png

    FAQ

    What is the difference between the Insurance Adjustments Report and the Adjustment Codes By Prefix tile?

    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. 

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