1. 2015 User Conference Billing Analysis vs Reimbursement Analysis April 24, 2015 Presented by: Christopher Becker Director-RCM PM Session

2. 2015 Office Practicum User Conference Billing & Reimbursement Analysis Reports Billing Analysis Report Billing Analysis (BA) report is designed based on claim information. Essentially elements that are sent to payers. However, it does contain payment information. Features in this report are: 1.Four date filters. 2.82 different fields to choose from. 3.Custom Filtering for one or many fields 4.Ability to include/exclude current transactions and voids. 5.Reports can be created and saved. 6.Ability to print and/or export into excel. The BA report is commonly used for: 1.Financial Summary Reporting. 2.CPT utilization. 3.Provider breakdowns. 4.Insurance Plan breakdowns.

3. 2015 Office Practicum User Conference Billing & Reimbursement Analysis Reports Billing Analysis Report Don’t forget the Tabs! 1. Receipts for deposit. 2. Accounting Transfers 3. Patient Credit Account 4. Void Transactions 5. and what the….are PLA’s Limitations: 1.Payments for specific CPT codes. 2.Patient payments based on applied credits, not credits received, although Receipts for Deposit tab reconciles this. 3.Although not a true limitations dates are critical for accurate reporting. 4.Counts are based on numbers of transactions

4. 2015 Office Practicum User Conference Billing & Reimbursement Analysis Reports Reimbursement Analysis Report The Reimbursement Analysis Report (RA) is based on Charges and the sum of their payments. Features of this report are: 1.Three date filters. 2.6 paid statuses. 3.46 different fields to choose from. 4.Custom Filtering for one or many fields. 5.Ability to include/exclude voids (New in OP 14.0.37). 6.Reports can be created and saved. 7.Ability to print and/or export into excel. RA report is commonly used for: 1.Payment history by CPT. 2.Insurance payment monitoring. 3.Payment history by provider.

5. 2015 Office Practicum User Conference Billing & Reimbursement Analysis Reports Reimbursement Analysis Report The RA report has the ability to run special reporting for Fee Schedules 19 and 20: 1.Fee Schedule 19 is reserved for the input of the cost of items acquired by the practice. a.Vaccines Dose Cost (true cost...including taxes and shipping). b.Medication Cost (per HCPCS unit). c.Splints/Slings etc. d.Lactation and other supplies. e.Costs are entered in Utilities/Manage Codes/Manage CPT Codes. f.Reports can be run by plan to check payments (max, min, avg) against the actual cost (not the charge). 2.Fee Schedule 20 is reserved for RVU units. a.As above GPCI adjusted RVUs are entered in Fee Schedule 20 b.Reports can be run by provider, plan, etc.

6. 2015 Office Practicum User Conference Billing & Reimbursement Analysis Reports Reimbursement Analysis Report Limitations: 1.Adding current transactions is not an option 2.Dates reflected are not payment dates, but dates of service and posting of the original claim. 3.Do not use for counts of CPT procedures.

7. 2015 Office Practicum User Conference Questions ?

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