Medical billing reports are a record of your facility’s billing history for a certain period of time. There can be different types of reports with different information, but they can all give you a helpful overview of how your facility is performing as related to insurance claims.
When a claim is sent out, as part of the Revenue Management Cycle, there are many situations that can occur before you receive payment. The claim could be denied by the clearinghouse if you use one, it could be accepted by the clearinghouse but denied by the insurance payer, it could be accepted by the payer but rejected for payment, it could require additional medical records to be sent, etc. In order to really understand what is going on with your claims and keep track of all this information, it is important to keep your claims’ details and billing history organized. Below are some common reports that can be helpful to keep track of.
You can keep a general billing report that shows each patients’ claims that are billed out. It can show information such as what the claim number is, what the CPT codes billed are, for which dates of service, what the status of the claim is, comments or inquiries made about the claim, etc. This can be a general overview that summarizes what is going on with the claims for each patient
Sometimes when claims are sent through a clearinghouse, some may be rejected and require adjustments to be re-submitted. Therefore, it is important to keep track of which claims went through the clearinghouse and which need to be looked at again. Some clearinghouses may have reports in your account, so it is important to keep track of this and make sure you are made aware of which claims need your attention.
Accounts Receivables Report
AR, or accounts receivables, describes claims that are sent out but not yet paid. This is crucial to your billing as you will need to know which claims were sent out and how many days it has been since the claim has been sent and not yet been paid, or the “aged days”. We’ve mentioned before how it is important to follow up on aged claims. It can take 30-45 days for insurance payers to process and make a decision on a claim, so after 45 days, for example, might be a good time to follow up on the claim. You may be submitting claims on different days, so 45 days for one batch of claims may not be 45 days for another. Therefore, it may also help to include an AR tracking log to show the follow-ups made by your team and to show what needs to be done for each claim to be paid. This report can help to manage your accounts receivables better.
Once a payment is received, it will need to be posted. If there are patient responsibilities, then patients will need to be notified. Therefore, it is important to keep track of which insurance payments have been made, how much was allowed, if there’s coinsurance, if there were any adjustments, etc. The payment details can be found on the Explanation of Benefits (EOB) and recorded into a report format. Or, you can show some details in the report and save the EOB as a reference. Either way, the EOB can provide helpful information and data such as how or when your payments were made, and these reports will also help you keep track of which patients may still need to pay out-of-pocket.
These reports, depending on how often you want to look at the information, can be generated at different time periods. Perhaps more summary information such as an overview of billing for a certain time period can be viewed bi-weekly or monthly. For others such as the clearinghouse report, depending on how often you submit claims, may need to be viewed daily or weekly for any changes at the clearinghouse level. In any case, because billing and revenue management is a cycle, it is important to have these reports and to keep track of your claims regularly.
At Americare Network we can provide these reports for your facility. We can customize reports to your requirements and you can view information that is important to you. Contact us today to learn more about how we can help with your medical billing needs.