Billing Overview and Workspace

Billing Overview

The Billing application area is used to manage patient accounting functions related to billing and claims management and to view billing-related analytics data. The Billing workspace allows the user to work with billing exceptions, late charges, claim errors, and claim denials. The scorecards quantify work done on billing exceptions, claim errors, etc., and the dashboards measure performance in areas such as clean claim rate, denial rate, and days in billing.

Billing Workspace

The Billing workspace gives the user access to work queues, tabs, and Quick Actions related to billing. The data panel displays patient data (name, status, balance, etc.) and the User Productivity chart.

The Billing workspace is used to manage billing event information, including handling denials and claim errors. The tabs and Quick Action applications allow users to view claim history, create payment and denial overrides, resolve claim errors, create rebills, and annul bills.

The Billing Event tab allows the user to select billing events that need to be worked. Other tabs can be used to update patient, insurance, guarantor, and visit information. The EOB/Denials tab is used to view claim and service line denials and post payment and claim denial overrides.

Quick Actions allow users to rebill a billing event, annul a bill, and attach images.

Billing Work Queues

The Billing workspace includes a variety of standard work queues designed to complete tasks on visits/patient accounts/billing events related to billing.

Billing’s base set of work queues includes:

• Billing Exception – Biller – Displays accounts with billing exceptions, with the exception of medical records-related exceptions (no final diagnosis, no DRG number, abstract incomplete, or no admitting diagnosis). The queue is sorted by billing exception description then visit number.
• Billing Exception – MR – Displays accounts with the no final diagnosis, no DRG number, abstract incomplete, or no admitting diagnosis billing exceptions. The queue is sorted by billing exception description then visit number.
• Late Charges – Displays episodes with a “late” frequency and charges and a balance (credit or debit). The queue is sorted by the date the episodes entered the work queue.
• Manual Bill Hold – Displays unbilled accounts with a balance and a bill hold on the insurance. The queue is sorted by the date the accounts entered the work queue.
• Rejected Claim – Displays accounts with a balance (credit or debit) and an open claim revisions activity error. The queue is sorted by the date the accounts entered the work queue.

Billing Scorecards

The Billing application area has multiple scorecards that measure productivity by work queue and by event.

Billing Scorecard

The Billing scorecard displays the following information in the primary panel:

• Period – The selected Date Grain (Day, Month, or Quarter).
• Prev. Balance – Ending balance from prior period.
• End Balance – Sum of balances of all open items in the selected work queue or queues.
• Attrition Rate – The difference between the previous balance and ending balance, divided by days in the period.
• Turnover (Days) – Records processed divided by ending records.
• Prev. Records – Ending record from the previous period.
• Comp. Records – Completed records for the period.
• End Records – Count of all records in the selected work queue or queues.
• Avg. Queue Age – Total days of open records in queue(s) divided by ending records.
• Avg. Work Time – Average amount of time (in minutes) to perform actions in queue(s).
• Max Queue Age – Maximum age of a record in queue(s).

The other panels and charts allow the user to drill down to totals by work queue and user.

Billing – Event Scorecard

The Billing – Event scorecard displays the following information in the primary panel:

• Period – The selected Date Grain (Day, Month, or Quarter).
• Total Events – Total number of events during the period.
• Avg. Time – Total events divided by total minutes worked.
• Total Min – Total time in minutes worked.
• Daily Events – Total events divided by number of days in the period.
• Daily Time – Total time divided by number of days in the period.

The other panels and charts allow the user to drill down to totals by event (resolved claim errors, POT requests, added adjustments, charge updates, combined visits, etc.) and user.

Billing Dashboards

The Billing application area includes dashboards that display a variety of financial and performance information, including trending data. The following dashboards are available in Billing:

• Clean Claim Rate – Displays the percentage of initial claims processed by the payer with no rejections/errors. The dashboard can be used to monitor claim rate trends and determine any facilities, financial classes, or bill types with repeated rejections. The clean claim rate is calculated by dividing the number of accepted claims by the number of initial claims submitted during the selected time period. Only the initial claim submission is factored into the rate in order to eliminate any double counting that may skew the rate.
• Days in Billing – Displays the length of time it takes to collect outstanding accounts receivable. It is calculated by dividing the sum of open charges, payments, and adjustments by the average daily charges over the last 90 days.
• Denial Rate (by Billed Amount) – Displays the percentage of billed insurance claim charges that have been denied by the payer. Only the initial denial is factored into the rate in order to eliminate any double counting that may skew the rate. Only denials from the primary payer are included. The dashboard can be used to monitor denial rates overall and for specific financial classes, services, etc. For example, if a visit was billed for $100 and $10 was denied, the denial rate would be 10 percent.
• Denial Rate (by Volume) – Displays the percentage of accounts that had a payment and had any amount denied. For example, if there were payments for 100 visits and eight of the payments included denials, the denial rate would be 8 percent.
• Revenue – Displays the amount of charges posted each month. For billed charges, the financial class is set to the visit’s financial class.