This new accounting report provides comprehensive analysis of amounts recorded during claim posting (charged, allowed, paid, charged-off, etc.). It displays amount percentages which allow you to analyze payer performance.

1. In the Report Editor, select Report Category "Accounting," and Report "Claim Detail Summary" (Figure 1).

Figure 1 - Report Editor

2. The report shows the following amounts: Charged, COB, Allowed, Payer Paid, Charge-Off, Coinsurance, and Deductible. Each of these amounts (except Charged) shows a corresponding percentage in group summaries and grand totals. The COB percentage is computed as a direct percentage of the Charged amount (COB% = COB Amount / Charged Amount).

The remaining percentages for Allowed, Payer Paid, Charge-Off, Coinsurance, and Deductible must take the COB amount into account for their computation. This simply means that the COB amount is subtracted from the Charged amount before the percentage is calculated. For example, the Payer Paid percentage is computed as:

Payer Paid % = (Charged Amount - COB Amount) / Payer Paid Amount.

Example:

$100 - Charged Amount
$40 - paid by Primary Payer
$60 – transferred to Secondary Payer

Then the secondary claim is filed.

$100 - Charged Amount
$40 – COB amount (paid by primary payer)
$60 – the MAXIMUM allowed amount for the secondary Payer
$50 – the ACTUAL allowed amount the secondary payer granted
$50 – paid by secondary
$10 – charge-off or transfer to guarantor

When this item is reported for the secondary payer it is important that the COB amount is considered when computing the percentages. The Payer Paid percentage for the secondary is 83.33%, which is computed as:

83.33% paid = $50 (paid) / $60 (maximum allowable).

If the COB amount was not included in the computation the Payer Paid percentage would be 50%

50% paid = ($50 paid / $100 Charged).

This would be incorrect since the maximum amount the secondary payer could be responsible for is $60, not $100.

3. To better understand how the percentages are computed, study the sample Claim Detail Summary Report in Figure 2 below.

(scroll right if necessary to view Figure 2 completely)

Figure 2