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Accounting, Production, Reimbursement and Collection

A single set of drillable, printable, and configurable billing and collection grids provides you the following:
  • The top-level grid lists your total charges, payments, adjustments, writeoffs and percent uncollected either in summary or broken out by provider and/or accounting period, day, week, month, quarter, year.
  • One second-level grid lists the people responsible for unpaid amounts within the item from the top grid.
  • Another second-level grid lists the payers responsible for unpaid amounts within the item from the top grid.
  • These second-level grids can also be listed in summary or by period/provider breakouts.
  • Items from the second-level grids can be sent to the application tree. From there you can navigate to surrounding context, including insurance submissions, service lines, collection history, and phone numbers to call.
  • The top-level uncollected percentage, when broken out by period, provides a clear metric of how well your collection operation is running. The less recent the period, the lower the percentage should be.
  • The top-level totals, broken out by period, provide you with a clear basis for estimating furture of cash flow.
  • The ordered list of aged uncollected amounts, and the ability to send items to the tree, provides the user all that is needed to make phone calls are target collection priorities.
Two similar sets of drillable, printable grids list the following:
  • The payer reimbursement set shows payer or payer group performance in terms of amounts allowed, and average time to pay and fee contract conformance, again broken out (or not broken out) by any combination of payer, procedure, and accounting period.
  • The production set shows practice production volume, units and dollars by any combination of rendering provider, procedure code, and acounting period (week, month, quarter, year, etc.).
  • Again, users can drill to deeper levels of detail and send detailed items to the tree for detail and context.
Managing Payers:

Payers are one of the more difficult entities even to understand. The payer to whom you send a claim might not be the entity from which you receive your check. The boundary between payer and plan can be murky. Two insurance cards sometimes show the same payer with two different addresses. A series of payers with different names can yet be owned and managed by a single parent company. To manage the mess we provide two kinds of payer grouping, one to group together all payers that are likely to be represented on a single EOB, another to group all payers that might be represented by a single managed care contract. Fee schedules can be entered against any of these--and against individual, ungrouped payers, as well. Payments can be made also be made against a payer group or against an individual payer.

Other items of interest:
  • Copay amounts are easily viewable when the patient pays at the front desk.
  • Bank reconciliation is available for electronic funds tranfers.
  • No special action other than counting your money against the payment report is required for closing a day.
  • Holds can be placed on dilinquent accounts, preventing unsuspecting users from allowing patients to acrue fresh charges.
  • When collection becomes impossible the program facilitates placing specific claims in collection, thereby placing them in a quaranteened collection and reporting category. Demographic information and charge information can be generated in machine-readable format, saving time reporting to collection agencies.
  • Within the responsible party account, users can set up payment plans and maintain a narrative records of contacts with patients, attempts to contact patients, promises, issues, arguments, excuses, etc.
  • Refunds, whether to persons or payers, are possible only against the unapplied amount of a specific payment, maintaining a refund paper trail.
  • Partially or totally uanpplied payments land on an urgent to-do list because these distort statements and litter the system with unapplied amounts that should be refunded if unpostable.