This article defines the tiles and calculations in the Home Dashboards section of AveaOffice. Each tile can be cross-referenced against reports in the Reporting section to determine trends.
Managing Organization Admins are the only user types that can view the dashboard by individual organization and practice using filters.
Claims Submitted Tile
The Claims Submitted tile can be used to help indicate the health of the organization's census (low, average, or high?) and the billing team's efficiency.
This tile will display the total number of 1.1 claim instances that were submitted in the date range selected. This will include claims for all organizations and practices that the user has permission to access.
Claim Submission Report: Run with the "Only Original (1.1) Claims" filter selected to find the underlying data in the tile.
Active Patients Tile
The Active Patients tile, alongside the Claims Submitted tile, can help indicate the health of the organization's census (low, average, or high), facility capacity (full, average, or empty), performance of the admissions and treatment teams, and if teams are hitting internal goals.
This tile will display the total number of unique patients with active treatment episodes for the date range selected.
Open Claims Tile
The Open Claims tile can help gauge the performance of the billing team (are teams working claims to completion?, are there enough AR callers to work the current volume?, are supervisors closing claims?), potential revenue delays (increase in denials or appeals), and whether billing processes are correct (coding, rates, authorization).
This tile displays all open claims as of the current date and for the organizations and practices the user has permission to access. A claim is considered open when it has a claim state of "Open".
The Claim Status Report; however, it is recommended to research issues using the Records Center or Work Center.
Payments Received Tile
The Payments Received tile can help identify if an organization's payment posting team is entering payments in a timely and efficient manner, as well as provide insight into the state of the organization's cash flow.
This tile will display the dollar value of payments received for the date range selected. This will only include payments received for all organizations and practices the user has permission to access.
The calculation for this tile is the total interest and paid amount posted to claims, by post date, in the date range selected.
Collection Rate Tile
The Collection Rate tile helps gauge your overall success at collecting from payers. You can use this information to dive deeper and understand the quality of your payer mix (admitting patients with the right policies), if claims are being submitted with the correct codes and services for payers, and the appropriate rates are used.
This tile displays a percentage of collected versus billed. The calculation for this tile is
< Insurance Paid / Total Expected > for all claims associated to the organizations and practices the user has permission to access.
- Total Expected* = (payer rate** x units)
- Insurance paid = (Paid + Paid to Patient)
- Paid to Patient = Any 100 adjustment
- Dates use Post Date, not deposit date or payment date
*If a payer rate does not exist, the Total Charged amount will be used.
**Payer rates can be found in Practice Admin > Payers > Payer > Payer Rates
Clean Claim Rate Tile
The Clean Claim Rate quickly indicates the organization's success at claims being accepted by the payer on the first pass. Anything less than 100% is an opportunity to review billing practices and policies to identify issues that could lead to delayed payment or reduced reimbursements. Those issues might include incorrect coding and changing payer requirements.
This tile displays the percentage of claims that pass through clearinghouse edits and are accepted by the payer on initial claim submission (1.1 claims) without any rejections.
The calculation is (100 - (total rejected 1.1 claims / total number of 1.1 claims)) for the date range selected.
Claim Submission Report, Show: Only resubmitted (1.x, 2.x, 3.x) claims
Claim Status Report (By Claim), Add the Claim Issues column
Open A/R Tile
The Open A/R Tile provides insight into the success of A/R collection efforts so that any potential issues can be researched and addressed. Questions to ask include "Are these values in line with historical averages?" "Which payers, services, and codes have the largest outstanding balance?" "Do we need to avoid certain payers or adjust coding for certain services?"
This tile displays the total open A/R for the current date for claims associated to the organizations and practices the user has permission to access.
The calculation is (((expected rate x (payer or service rate* x units)) / covered amount) for claims in an open state with a balance greater than zero.
Total Payments Tile
The Total Payments Tile displays the organizations payment trends over time to assess financial health, overall performance of billing and collections teams, and help identify any potential issues (such as billing practices, coding issues, or performance issues).
This tile displays all payments received over the selected date range.
The calculation is total amount of payments and interest posted in the date range selected. This tile uses the Post Date, not the Deposit Date or Payment Date.
Claim Payments Report, Run with a Date Type of "Post Date"
Adjustment Codes By Prefix Tile
The Adjustment Codes by Prefix Tile displays how much of total charges are being adjusted by the group code and which specific adjustments are being made, to understand how processing charges are being handled, which will drive decisions around patient collections, appeals, and potentially admissions.
This tile displays all adjustment codes amounts over the selected date range.
The calculation is total amount of adjustments posted in the date range selected. This tile uses the Post Date, not the Deposit Date or Payment Date.