Topic Monitoring the Activity in your NextGen · Billing & Claims Processes › Tracking Unbilled &...

Topic

Level

Presenter(s):

Stacy Stenger

PM Corporate Trainer

Keep your Finger on the Pulse:

Monitoring the Activity in your NextGen® PM System

Practice Management 300

Safe Harbor Provisions/Legal Disclaimer

This presentation may contain forward-looking statements within the meaning of the federal securities laws, including statements

concerning future prospects, events, developments, the Company’s future performance, management’s expectations, intentions,

estimates, beliefs, projections and plans, business outlook and product availability. These forward-looking statements do not

represent a commitment, promise or legal obligation to deliver any material, code or functionality. The development,

release and timing of any features or functionality described for our products remains at our sole discretion. Future

products developed beyond what is contemplated by existing maintenance agreements, will be priced separately. This

roadmap does not constitute an offer to sell any product or technology. We believe that these forward-looking statements

are reasonable and are based on reasonable assumptions and forecasts, however, undue reliance should not be placed on such

statements that speak only as of the date hereof. Moreover, these forward-looking statements are subject to a number of risks and

uncertainties, some of which are outlined below. As a result, actual results may vary materially from those anticipated by the

forward-looking statements. Among the important factors that could cause actual results to differ materially from those indicated by

such forward-looking statements are: the volume and timing of systems sales and installations; the possibility that products will not

achieve or sustain market acceptance; the impact of incentive payments under The American Recovery and Reinvestment Act on

sales and the ability of the Company to meet continued certification requirements; the development by competitors of new or

superior technologies; the timing, cost and success or failure of new product and service introductions, development and product

upgrade releases; undetected errors or bugs in software; changing economic, political or regulatory influences in the health-care

industry or applicable to our business; changes in product-pricing policies; availability of third-party products and components;

competitive pressures including product offerings, pricing and promotional activities; the Company's ability or inability to attract

and retain qualified personnel; uncertainties concerning threatened, pending and new litigation against the Company; general

economic conditions; and the risk factors detailed from time to time in the Company’s periodic reports and registration statements

filed with the Securities and Exchange Commission.

Objectives

Learn how to monitor all the critical functions in your organization to ensure you complete them in a timely manner.

This session is designed to teach practice managers and administrators how to review the major activities in the NextGen Practice Management system, including:

› Appointments › Check-in and check-out › Charge capture › Billing & claims processes › Monitoring A/R

Appointments

Appointments

› Appointment utilization & productivity

› Tracking and managing No-shows

› Reports & tools:

Monthly tab of the PM Appt Book

Multi Resource report

Statistical Analysis of Appointments

Appointment Listing Report

Appt Book > Monthly Tab

Multi Resource Report

Reports > Scheduling > Multi Resource

Tracking No-Shows & Cancellations

Reports > Scheduling > Statistical Analysis of Appointments

› Columns for:

Nbr Sched, Nbr Kept, Nbr Canc, Nbr NS, Nbr Exp

“Per” columns calculate No Show %, Canc %, etc.

› Each report row represents an appt date (“roll-up” report,

summarizes appt data)


Considerations:

› The “No Show” Status does not revert until the nightly

Scheduling Update process

› “Nbr Pnd”, “Per Pnd” columns refer to “Pending”

Appointment Status

Managing No-Shows

How far in advance are appointments being made at your

practice?

Appointment Creation Lag Time

Reports > Scheduling > Appointments Listing

› Includes columns for “Appt Date” and “Orig Create Date”


Export to MS Excel, using “DATEDIF” formula to calculate

the number of days between the Original Create Date of

the appointment and the Appt Date:


Use the “AVG” formula to obtain the average number of

days for each grouped Event:

Check-in &

Checkout

Check-in & Checkout

› Check-in & Checkout Autoflow sequences

› Copay collection

› Check-in / Checkout “eTime”

Check-in & Checkout Autoflow Sequences

› Include screens for:

Patient Balance

Transaction Entry

RTS Eligibility

› RTS Eligibility

submission can be

performed at Check-in

› Most beneficial if

batch eligibility is not

being done prior

› Also ideal for those

practices with high

rate of same-

day/walk-in

appointments

(Urgent Care)

Copays Not Collected at Check-in

Reports > Daily > Encounters

› Columns for Enc Copay Amount & Pt Pay Amount on DOS

› Filter report to determine patients who did not pay their

copay at the time of their appointment (Pay Amt on DOS =

$0.00)

› Group by Created By column to determine which users are

not collecting copays at time of service

Copays Not Collected at Check-in

Check-in & Checkout eTime


› (Also available on Appointments Listing report)

› Columns for Check-in Date, Checkout Date, eTime

› eTime = elapsed time, in hours, between Check-in &

Checkout

Check-in & Checkout eTime

Charge Capture

Charge Capture

› How to detect potential lost revenue

› Charge Entry lag time


Appts Kept with No Charges

Unbilled Encounters with no Charges

Charge Entry lag time report

Possible Missing Charges

Option #1:

Reports > Scheduling >

Kept Appointments w/ no Charges

› Should be run at least once

weekly; ideally every day

› Run for “All to date” to catch

everything!


Option #2:

Reports > Accounts Receivable > Unbilled Encounters

› Should be run at least once weekly; ideally every day

› Run for all to date to catch everything!

› Filter for no charges (Charge Count = 0)

Reports > Daily > Charges

› Used to calculate the number

of days between DOS and

charge entry date

Charge Entry Lag Time

Billing & Claims

Processes

Billing & Claims Processes

› Tracking Unbilled & Rebill Encounters

› Encounter Lookup vs. Encounters reports

› Claim creation “lag time”

› Claims

Frequency and number of claims produced

“Dirty” claims that did not process

Payment “lag time”

Encounter Lookup


› Report version of the Encounter Lookup window

› Used to track outstanding Unbilled & Rebill Encounters

Unbilled & Rebill Encounters


› Utilize the “Create Date” and “First Bill Date” columns to

determine the amount of time between Encounter

creation and when it was first billed

› Exclude Self Pay Fin Classes

Claim Creation Lag time

Claims

› Tracking frequency and number of claims

› “Dirty” claims (why they occur & how to avoid them)


Claims Lookup & Claims Requests report

Claim Acknowledgment & Claim Status import files

Payment lag report

Claims Lookup

Reports > General > Claim Requests

› Used to track claim productivity, status, pending claims

› Create Date vs. Process Date

› Request Status: Pending vs. Archived

› Acknowledgement, Status Cat Code & Status Code

From Claim Status file (277)

Can import & take action before the EOB is received

Claim Requests Report

Claim Requests Report

Processed Claims Report

Compare Processed Claims to Clearinghouse

Pending “Dirty” Claims Report

Claim Status & Claim Acknowledgment

“999” file (“997” 4010)

File-level

acknowledgement from

Payer (EDI file in the

correct format, etc.)


“277” file

Claim-level status from

Payer (description of

how claim is to be

processed)


Encounter Claim Requests window

Reports > Daily > By Line Item > Payments

› Filter for Third Party payments only

› Include columns for “First Bill Date” (date the Encounter

was first billed) and “Tran Date” (or “Post Date” or

“Process Date”, if desired)

› Can be used to determine the number of days between

the Encounter being billed and payment received from

the Payer

Payment Lag Report

Payment Lag Report

Accounts Receivable

Evaluation

Accounts Receivable Evaluation

› Overall A/R review

› Calculating & evaluating days in A/R

› A/R by Event, Year, Month

› Aging Analysis reports

› Patient A/R, Payer A/R

› Credits:

Patient & Insurance credits

Unapplied credits

› Patient Statements

What is it, why do we care about it?

› Variety of reporting options available

Accounts Receivable

Aging Reports

› Aging Analysis (2)

› Receivable Analysis (3)

› Insurance Aging Analysis (2)

› Insurance Detail

› Insurance Summary

› Monthly > Change in A/R

› Service Item Summary

Tools for Evaluating A/R

Calculating Days in A/R

Reports > Monthly > Change in Accounts Receivable

› Utilized to calculate total Charges & Ending A/R

› Divide Total Charges by 365 = average daily charge

› Divide Ending A/R by average daily Charge amount =

days in A/R

Calculating Days in A/R

A/R by Event


› “Event” column returns change in A/R for each

appointment Event

› Sort/Group By Event column to tie revenue to

appointment activity

Service Item Summary

Reports > Monthly > Service Item Summary

› Returns Charges and their associated Payments,

Adjustments & Refunds

› Also includes columns for “Event”, “Year”, “Month”, and

“Mo/Yr”

› Month, Year, Mo/Yr based on Charge Process Date

A/R By Year, Mo/Yr

A/R By Month

› Evaluating and aging patient balances

› Insurance Aging Analysis report:

“Pat Amt” column (i.e. Pat Amt > $0.00)

“COB” column (i.e. COB = P)

Patient A/R

› Insurance Aging Analysis: Pat Amt Greater than $0.00

› Insurance Aging Analysis: COB Equals P

Accounts Receivable > Collections > Ins Aging Analysis

› Evaluating and aging Payer (or Financial Class)

balances

› COB “Not equals” P

Payer / Fin Class A/R

Payer Balances > 45 Days


Aging by Fin Class, COB


› COB Not Equals P

› Sorted / Grouped by Financial Class, then COB

› Displays aged payer balances by Fin Class, with an

additional grouping by their COB responsibility

Aging by Fin Class, COB

Accounts Receivable > Receivable Analysis > By Age

› Sorted/Grouped by Fin Class

› Include columns each aging category (0-30, 31-60, etc.)

and “Total” column for total balance by Fin Class

› Use the graphing feature to graph the percent of each

Fin Class’ A/R to the total A/R

Total A/R by Financial Class

Reports > Accounts Receivable Analysis > By Age

› Sorted by Fin Class

› Include columns each aging category (0-30, 31-60, etc.)

and “Total” column for total balance by Fin Class

› Export to MS Excel to calculate the percent of each aged

category to the Total A/R

Percent of Aged Categories to Total A/R

Insurance Credit Balances


› COB Not Equals P

› Line Item Amount < $0.00

› Displays insurance line item credits

Patient Credit Balances

Reports > Accounts Receivable > Insurance Aging Analysis

› COB Equals P

› Pat Amt < $0.00

› Include patient balances only (including line item credits)

Unapplied Credits

› Unapplied credits do not net out balances

(line item credits do; unapplieds don’t)

› Therefore, unapplied credits need to be applied prior to

sending Statements

Patient Balances w/ Unapplied Credits

Reports > Accounts Receivable > Collections >

Account Summary

› “Pat Amt” Greater than $0.00

› “Unapplied Amt” Less than $0.00

› Returns all Accounts (Guar) who both owe a balance

and have an unapplied credit

Reports > General > Statements

› Similar to the Statement Run Report (received after each

Statement batch is generated)

› Filter 1 Create Date = date Statements were generated

› Totals for # of Stmts generated, Pat Amts & Ins Amts

› Compare these totals to the total Patient & Insurance

A/R

Statements Report


Statements Report

› Count “Acct ID” or “Guar Name” columns to obtain a total

count of Statements generated

› Sum “Pat Amt” column to obtain the total dollar value of

Statements sent

› Compare Statement “Pat Amt” to Total Patient A/R (using

Insurance Aging Analysis report, Pat Amt > $0.00)

Statement Totals to Total Patient A/R


Total Statement Pat

Amt = $9,312.00

Total Patient A/R =

$42,857.00

$9,312.00 / $42,857.00

= 21%


Total Statement Pat

Amt = $9,312.00

Total number of

Statements sent = 60

$9,312.00 / 60

= $155.20

Index of Featured

Reports

Appointment Utilization


Columns: Res Name, Appt Dt, Slots Avail, Slots Booked, Util Pct

Filter 1: Appt Date = Next Month (or other desired date range)

Deleted = Exclude

Linked Appt = Only

Sorting: Res Name = Ascending & Group By (or other desired Grouping, such

as Event)

Appt Dt = Ascending (optional)

Totals: Total Lines Only = Checked

Count Records = Unchecked

Optional: Can filter by specific Event(s), Resource(s), Location(s), etc.

Multi Resource “Logjam”

Reports > Scheduling > Multi Resource

Form Criteria: Appointment Date = [desired appointment date]* *report can only be generated for 1 day at a time

Resources: Select the desired Resource(s), or leave blank for all Resources

Locations: Select the desired Locations, or leave blank for all Locations



Columns: Event, Appt Dt, Nbr Sched, Nbr Canc, Per Canc, Nbr NS, Per NS

Filter 1: Appt Date = Current Year (or other desired date range)

Deleted = Exclude

Linked Appt = Only

Sorting: Event = Ascending & Group By (or other desired Sorting/Grouping)



Optional: Can filter by specific Resource(s), Location(s), Event(s), etc.

Appointment Creation Lag time

Reports > Scheduling > Appointment Listing

Columns: Event, Orig Crt Dt, Appt Dt

Filter 1: Appt Date = Current Year (or other desired date range)

Deleted = Exclude

Linked Appt = Only

Sorting: Event = Ascending & Group By (or other desired Sorting/Grouping)

Totals: Count Records = Unchecked

Optional: Can filter by specific Resource(s), Location(s), Event(s), etc.

Filter 1, Appt Statuses = No Show

*Export to MS Excel, using “DATEDIF” and “AVG” formulas to

calculate the average number of days between the Original Create

Date & the Appt Date

Copays not collected at time of service


Columns: Created By, Enc Dt, Pat Name, Encounter, Co Amt (if using), Enc

Copay Amt (if using), Pat Pay Amt on DOS, Payer Name

Filter 1: Enc Date = Current Month (or other desired date range)

Enc Status = Billed, Rebill, Unbilled

Filter 2: Co Amt / Enc Copay Amt (whichever is being used) Not Equals $0.00

Pat Pay Amt on DOS Equals $0.00

Sorting: Created By = Ascending & Group By (if desired)

Enc Dt = Ascending

Check-in & Checkout Elapsed Time


Columns: Encounter, Enc Dt, Pat Name, Chkin Dt, Chkout Dt, ETime

Filter 1: Enc Date = Current Month (or other desired date range)

Enc Status = Bad Debt, Billed, History, Rebill, Unbilled

Filter 2: Chkin Dt Not Equals <blank>

Chkout Dt Not Equals <blank>

Sorting: ETime = Descending (to view elapsed time in order of longest time)

Optional: Can filter “Etime” column (Filter 2) for certain time frames in minutes

(i.e. Greater than 60, Between 60 and 120, etc.)

Kept Appointments w/ No Charges

Reports > Scheduling > Kept Appointments w/no Charges

Columns: Encounter, Appt Dt, Pat Name, Chkin Dt

Filter 1: Appt Dt = All to Date

Sorting: Encounter = Ascending & Group By (or other desired Grouping)

*<Unknown> grouping at top represents Kept appts with no linked

Encounter

Optional: Can filter and/or Group By specific Location(s), Resource(s), etc.

Unbilled Encounters w/ No Charges


Columns: Enc Dt, Encounter, Pat Name, Enc Age, Payer Name

Filter 1: Enc Date = All to Date

Enc Status = Unbilled

Filter 2: Chg Count Equals 0

Sorting: Enc Dt = Ascending

Optional: Can filter and/or Group By specific Location(s), Resource(s), etc.

Charge Entry Lag time

Reports > Daily > Charges

Columns: E/I, Name, Chg Amt, Dt of Svc, Crt Dt

Filter 1: Create Date = Last 90 Days (or other desired date range)

Charge Type = Encounter

Void Charges = Exclude

Filter 2: Chg Amt Greater than $0.00

Sorting: E/I = Ascending

Seq# = Ascending

Optional: Can filter and/or Group By specific Location(s), Rendering, Primary

Payers, etc.



Columns: Status, Encounter, Enc Dt, Hold Dt (if using), Enc Age, Rendering, Loc

Name, Chg Amt, Chg Count, Bal Amt

Filter 1: Enc Date = All to Date

Enc Status = Rebill, Unbilled

Sorting: Status = Ascending & Group By

Enc Dt = Ascending

Optional: Can filter and/or Group By specific Location(s), Rendering, Primary

Payers, etc.

Claim Creation Lag time


Columns: Encounter, Chg Amt, Crt Dt, First Bill Date, Payer Name

Filter 1: Enc Date = Last Month (or other desired date range)

Enc Status = Billed, Rebill

Sorting: Encounter = Ascending


Fin

Classes:

Exclude all Self Pay Fin Classes

Optional: *Export to MS Excel, using “DATEDIF” and “AVG” formulas to

calculate the average number of days between the Enc Create Date &

the First Bill Date

Processed Claims


Columns: Payer Name, Encounter, Pat Name, Billed Amt, Created By, Proc Date

Filter 1: Processed Date = Last 90 Days (or other desired date range)

Request Status = Archived

Payer Seq = Primary, Secondary, Tertiary

Media Type = Paper, Electronic

Sorting: Payer Name = Ascending & Group By

Totals: Encounter = Count

Optional: Can filter by specific Payers, Rendering Phys, etc.

Can filter and/or Group By Created By for user productivity

Pending “Dirty” Claims


Columns: Payer Name, Encounter, Pat Name, Billed Amt, Created By


Request Status = Pending

Payer Seq = Primary, Secondary, Tertiary

Media Type = Electronic


Totals: Encounter = Count

Optional: Can filter by specific Payers, etc.

Can filter and/or Group By Created By to determine who created the

“dirty” claim

Payment Lag time

Reports > Daily > By Line Item Payments

Columns: Payer Name, E/I/A/B, Billed Amt, Alwd Amt, Pay Amt, First Bill Dt, Tran

Dt (or Post Date or Proc Dt)

Filter 1: Tran Date = Last Month (or other desired date and/or range)

Transaction Type = Encounter

Unapplied Tran = Exclude

Filter 2: Source Equals “Third Party” (to include only Payer payments)

Sorting: Payer = Ascending & Group By


Optional: *Export to MS Excel, using “DATEDIF” and “AVG” formulas to

calculate the average number of days between the First Bill Date &

the Tran Date (or Post Date or Process Date, if using)

Calculating # of Days in A/R


Columns: Chg Amt, Ending A/R

Filter 1: Process Date = Fiscal Last Year (or other desired date range)

Sorting: Remove all Sorting & Grouping options



Optional: *Divide total Charge Amount by 365 = average daily charges

*Divide Ending A/R amount by average daily charges = days in A/R

A/R by Event


Columns: Chg Amt, Beg A/R, Chg Amt, Adj Amt, Pay Amt, Ref Amt, Ending A/R

Filter 1: Process Date = Last Month (or other desired date range)

Sorting: Event = Ascending & Group By


A/R by Year, Month/Year


Columns: Year, Mo/Yr, Chg Amt, Count, Adj Amt, Chg-Adj Amt, Pay Amt, Ref

Amt, Bal Amt

Filter 1: Chg Process Date = Last Month (or other desired date range)

Sorting: Year = Ascending & Group By

Mo/Yr = Ascending


A/R by Month


Columns: Month, Chg Amt, Count, Adj Amt, Chg-Adj Amt, Pay Amt, Ref Amt, Bal

Amt

Filter 1: Chg Process Date = Last Month (or other desired date range)

Sorting: Month = Ascending & Group By


Patient A/R (Pat Amt > $0.00)

Reports > Accounts Receivable > Collections

> Insurance Aging Analysis

Columns: Pat Name, E/I/A/B, Dt of Svc, Sv It, Chg Amt, Pat Resp Dt, Pat Amt,

COB, Ins1 Amt, Ins2 Amt, Ins3 Amt

Filter 1: Process Date = Today

Aging Dates = Date of Patient Resp (or other desired aging date)



Filter 2: Pat Amt Greater than $0.00

Sorting: Pat Name = Ascending & Group By

Totals: Count records = Unchecked

Patient A/R (COB = P)



Columns: Pat Name, E/I/A/B, Dt of Svc, Sv It, Chg Amt, Pat Resp Dt, Pat Amt


Aging Dates = Date of Patient Resp (or other desired aging date)




COB Equals P

Sorting: Pat Name = Ascending & Group By


Payer Balances > 45 Days



Columns: Payer Name, E/I/A/B, Dt of Svc, Pat Name, Policy # (optional), Chg

Amt, COB, Ins1 Amt, Ins2 Amt, Ins3 Amt, Pat Amt


Aging Dates = Last Bill Date (or other desired aging date)



Aging Days 45 to 9999

Filter 2: COB Not Equals P



Aging by Financial Class, COB



Columns: Fin Class, COB, Payer Name, Ins1 Amt, Ins2 Amt, Ins3 Amt, 0-30, 31-

60, 61-90, 91-120, 121-150, 151-180, 181-up, Ln Itm Amt






Sorting: Fin Class = Ascending & Group By

COB = Ascending & Group By

Totals: Total lines only = Checked

Total A/R by Financial Class

Reports > Accounts Receivable > Receivable Analysis

> By Age

Columns: Fin Class, 0-30, 31-60, 61-90, 91-120, 121-150, 151-180, 181-up,

Total




Charge Status = Billed, Rebill, Unbilled

Sorting: Fin Class = Ascending & Group By


Optional: *Use “Graph Report” feature to create graph of each Fin Class’ A/R


Reports > Accounts Receivable > Receivable Analysis

> By Age

Columns: Sect Name, Fin Class, 0-30, 31-60, 61-90, 91-120, 121-150, 151-180,

181-up, Total




Charge Status = Billed, Rebill, Unbilled

Sorting: Sect Name = Ascending & Group By

Fin Class = Ascending


Optional: *Export to MS Excel, divide each Aging Category total by the total A/R




Columns: Payer Name, Pat Name, E/I/A/B, Policy # & Group # (optional), Dt of

Svc, Ins1 Amt, Ins2 Amt, Ins3 Amt, Pat Amt, Ln Itm Amt


Aging Dates = Date of Service (or other desired aging date)




Ln Itm Amt Less than $0.00

Sorting: Payer name = Ascending & Group By


Patient Credit Balances



Columns: Pat Name, E/I/A/B, Dt of Svc, Sv It, Pat Amt


Aging Dates = Date of Service (or other desired aging date)



Filter 2: Pat Amt Less than $0.00

COB Equals P

Sorting: Payer name = Ascending & Group By




> Account Summary

Columns: Guar Name, Acct ID, Pat Amt, Unappld Amt


Unappld Amt Less than $0.00

Sorting: Guar Name = Ascending


Statement Productivity


Columns: Acct ID, Guar Name, Pat Amt, Ins Amt, Crt Dt, Exported/Printed, Next

Stmt Date, Stmt Counter


Sorting: Pat Amt = Descending (optional)

Totals: Count records = Checked

Acct Id = Count

Pat Amt = Sum

Ins Amt = Sum

Optional: *Divide total Pat Amt by Total Patient A/R = % of Stmts to total A/R

*Divide total Pat Amt by # of Stmts sent = average Stmt amount

For more information, please visit the

“Hands-On Room”

All presentations are available on the mobile app:

ONE UGM 2015

- Stacy Stenger

Thank you!!

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Topic Monitoring the Activity in your NextGen · Billing & Claims Processes › Tracking Unbilled &...

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