Reports Pack TherapySource and Rehab ToolKit Version 1.1 February 2009
TABLE OF CONTENTS THERAPYSOURCE... 6 SCHEDULING REPORTS... 6 Appointment Card... 6 Daily Call List... 6 Daily Sign-In Sheet... 7 Cancelled, No Show, and Rescheduled Appointment List... 7 Un-Arrived Appointment List... 7 Voided Appointment List... 8 Patient Appointments List... 8 Print Schedule... 9 CLINICAL REPORTS BY FACILITY... 9 End of Day Reconciliation... 9 Patient Appointment... 10 Cancel/No Show... 10 Completed Notes... 11 Daily Co-Pay Collection Report (Optional)... 11 Patient Inactivity Report... 11 Open Notes... 12 Broken Continuity of Care Visits... 12 Broken Continuity of Care Future Appointments... 12 Expiration Alerts... 13 Expiration Hard Stop Override (Optional)... 13 Incomplete Cases Report... 13 Active Patients by Financial Service Class (FSC)... 14 Physician Referral by Physician... 14 Physician Referrals by Financial Service Class (FSC)... 14 Physician Referrals by Product Line... 15 REPORTS BY CORPORATION... 15 Combined Facility-Clinician Reconciliation... 15 Clinician Reconciliation... 16 Facility Reconciliation... 16 Initial Evaluations by Physician... 17 Visits/Revenue by Facility by FSC... 17 Clinician Billing Audit... 18 Referring Physician Billing Audit... 18 Discharged Patients... 18 Census Summary... 19 Billable/Non-Billable... 19 Clinician CPT Usage... 19 TherapySource Note Types Examples... 20 Initial Evaluation... 20 Daily Note... 21 Version 1.0, February 18, 2009 2
Progress Note... 22 Administrative... 23 Discharge Summary... 24 REHAB TOOLKIT... 25 MANAGEMENT REPORTS... 25 FINANCIAL... 25 Accounts Receivable by Period... 25 Average Collection Days... 25 Average Collection Percent... 25 Weekly Revenue Forecast... 26 Economy of Scale Cash... 26 Economy of Scale Percent... 26 Location Revenue Summary... 26 Copayment Analysis... 27 Payment and Rejection... 27 Cash Collections... 28 Copay Level Analysis... 28 Weekly Flash... 28 Month to Date Flash... 29 Month End Reports... 29 Revenue by Location... 29 A/R by Location... 29 A/R by Account Type... 30 Charges by Account Type... 30 Payments by Account Type... 31 Discounts by Account Type... 31 Adjustments by Account Type... 31 Cash Aging... 31 Net Effect by Period... 32 A/R Days... 32 Credit Balance Account... 32 REFERRALS... 33 New Patients by Location... 33 New Patients by Physician Group... 33 New Patients by Account Type... 33 Referral by Gross Charges... 34 Referral Visit Analysis... 34 STATISTICS... 34 Charges by Period... 34 Visits by Period... 35 Treatments by Period... 35 Average Charges... 35 Average Collections... 35 Active Patients... 35 Collections by Period... 36 Discounts by Period... 36 Version 1.0, February 18, 2009 3
Adjustments by Period... 36 Cash Posting by Period... 36 Payor Classification Analysis... 37 Location Analysis... 37 OUTCOMES... 38 Condition Code Outcomes... 38 Clinical Outcomes by Facility... 38 Monthly Outcome Summary... 38 PRODUCTIVITY... 38 Statistical Summary... 38 Statistical Summary by Location... 39 Workers Compensation... 40 Therapist Analysis... 40 Treatments by Location... 40 ADD-INS... 40 KPI Report... 40 New KPI Report... 41 New KPI by Category... 41 High Risk Account... 42 Report Generator... 42 PATIENT BILLING AND ACCOUNTING... 43 Maintenance... 43 Billing Reconciliation... 43 Patient Account Status... 44 Ledger... 44 Patient Statement Inquiry... 44 Patient Account Audit... 44 Patient Statements Examples... 46 Statement Type 1 All Outstanding Claims... 46 Statement Type 2 All Outstanding Patient Claims... 47 Statement Type 3 Account Summary Only... 48 Statement Type 4 Legal Summary Only... 49 Statement Type 5 Treatment Summary Only... 50 Statement Type 6 Claim/Service Grouping... 51 Statement Type 7 Visit Summary (EDI)... 52 Statement Type 8 Visit Summary (Print)... 52 Reports... 53 Copay by Period... 53 EOB Letters... 53 Dunning Letters... 53 Claim Transaction... 54 Billing Reports... 54 Cash Receipts Journal... 54 Discount Journal... 55 Over the Counter Payments... 55 Charge Reversal Journal... 55 Version 1.0, February 18, 2009 4
Posted Charges... 56 Posted Claims... 56 Unposted Claims Report... 57 Unbilled Claims... 57 EDI Analysis... 58 ERA Tracking... 58 A/R Reports... 58 A/R by Patient Account... 58 A/R by Insurance Carrier... 59 A/R by Insurance Type... 59 A/R by Insurance Group... 59 Anticipated Receipts... 60 Credit Balance Aging... 60 Utility Reports... 60 Unbalanced Accounts... 60 Coding Edits... 61 Claim Status... 61 Account Status... 61 Missing Information... 62 Release Missing Information... 62 Attachments... 62 Cap Payment Report... 63 Therapy Cap Report... 63 Hold Reports... 63 Claim Hold Status... 63 Release Claim Hold... 64 Insurance Carrier Hold Status... 64 Patient Account Hold Status... 64 Setup... 65 Customary Fees... 65 Billing Macros... 65 Billing QUICK Notes... 65 Charge Tickets/Forms/Labels... 65 Utilities... 66 Month End Processing... 66 A/R Roll Forward Trial Balance... 66 Collections... 66 Collection Workfile Productivity... 66 Batch Control... 67 Batch Received... 67 Batch Transaction... 67 Claim Printing Templates... 67 All Field Variables... 67 Template Field Variables... 68 Template Alignment... 68 Version 1.0, February 18, 2009 5
THERAPYSOURCE SCHEDULING REPORTS Appointment Card The Appointment Card Report provides a list of all future scheduled appointments for the selected patient. The Facility s Address and Phone Numbers are in the header. The Date, Time, Type of Appointment, Treating Clinician, and Expected Co-Pay (if applicable) are displayed. Daily Call List The Daily Call List Report provides a list of appointments for a specified date. It will display Appointment Time, Patient Name, Phone Number, Business Phone Number, Treating Clinician, Appointment Type, Expected Co-Pay (if applicable) and section to hand write any comments. Use this report to make Appointment Reminder phone calls to patients. Version 1.0, February 18, 2009 6
Daily Sign-In Sheet The Daily Sign-In Sheet provides a list of appointments for a specified date. It will ONLY display the Patient s First Name and First Letter of Patient s Last Name to preserve the patient s Personal Health Information (PHI). The patient s Appointment Time, Treating Clinician, and a place for the Patient s Signature are provided. Cancelled, No Show, and Rescheduled Appointment List The Cancelled, No Show, and Rescheduled Appointment List provides a list of appointments that have an Appointment Status of Cancelled, No Show, or Rescheduled. Appointment details include Appointment Date/Time, Patient Name, Financial Service Class (FSC), Account Number, Phone Number, Business Phone Number, Treating Clinician, Appointment Type, Appointment Status, Appointment Comment, Referring Physician, Number of Cancellations and No Shows, Number of Visits, Last Visit Date, and User ID of the person who performed the Status Change action. Un-Arrived Appointment List The Un-Arrived Appointment List provides a list of Scheduled Appointments for the purpose of identifying those patients who either did not show up for their appointment or those visits that were not arrived or documented on in the system. Version 1.0, February 18, 2009 7
Voided Appointment List The Voided Appointment List provides a list of Voided Appointments. Appointment Details include Appointment Date/Time, Patient Name, Financial Service Class (FSC), Account Number, Treating Clinician, Appointment Type, Void Comment, and User ID of the person who performed both the Status Change action and Appointment Last Change Date. Patient Appointments List The Patient Appointments List contains a list of appointments for the selected patient and allows users to filter by Appointment Status. Appointment Details include Appointment Date/Time, Appointment Status, Treating Clinician, Facility, Co-Pay Collected, Appointment Last Change Date, and User ID of the person who performed the Status Change action. Version 1.0, February 18, 2009 8
Print Schedule The Daily View provides the ability to print the entire facility s schedule for the selected date for each Scheduling Group. Users have the option to select how many clinicians to print per page. The Weekly View provides the ability to print a specific clinician s schedule for the Selected Week. Users have the option to select how many days print per page. CLINICAL REPORTS BY FACILITY End of Day Reconciliation The End of Day Reconciliation Report manages the end-of-day process to ensure all patients and charges are accounted for. Totals are provided by Appointment Type, including Total Number of Appointments, Total of Appointments in each Status and Total Number of Completed/Incomplete Appointments. Version 1.0, February 18, 2009 9
Patient Appointment The Patient Appointment Report provides a list of Appointments by Date Range for all Clinicians. It is in addition to those shown in Scheduling and shows the following for a Patient/Case: Cancellation/No Show History, Number of Visits, Authorization Limits, Co-Pay, Co-Pay %, Deductible, FSC, and Patient Level Comments. Cancel/No Show The Cancel/No Show Report lists Patients, by Date Range, which have had a Cancellation/No Show Note completed by a Clinician for their Appointment. Version 1.0, February 18, 2009 10
Completed Notes The Completed Notes Report provides a list of Completed Notes for the selected date range. A user can report on all Clinicians at a Facility or for Selected Clinicians. This report provides totals of Completed Notes by Note Type. Daily Co-Pay Collection Report (Optional) If the Scheduling Co-Pay Collection feature is enabled, the Daily Co-Pay Collection Report displays the Daily Record of Receipts of Co-Pay. Receipts are listed by Patient, Amount Received via Cash/Check/Credit, Date of Service, and the User who recorded the receipt. Patient Inactivity Report The Patient Inactivity Report provides the ability to actively manage Patient Census and minimize Self-Discharges. Users can report on all Clinicians at a Facility or for Selected Clinicians. Version 1.0, February 18, 2009 11
Open Notes The Open Notes Report provides a list of Notes that are currently Open (In Progress). Users can report on all Clinicians at a Facility or Selected Clinicians. Broken Continuity of Care Visits The Broken Continuity of Care Visits Report provides a list of Appointments where a Clinician has treated a Medicare patient without the coverage of a Physician-Signed Plan of Care. Users can report on all Clinicians at a Facility or Selected Clinicians. Broken Continuity of Care Future Appointments The Broken Continuity of Care Future Appointments Report provides a list of Appointments in the Future where there will not be coverage of a Physician-Signed Plan of Care if a patient is treated. Users can report on all Clinicians at a Facility or Selected Clinicians. Version 1.0, February 18, 2009 12
Expiration Alerts The Expiration Alerts Report provides a list of Patients who are approaching or exceeding the Limit on Number of Visits or Visit Expiration Date. Expiration Hard Stop Override (Optional) The Expiration Hard Stop Override Report provides a list of Notes for a Facility that were Approved and Closed for a Patient/Case even though the Visit Authorization has Expired. Incomplete Cases Report The Incomplete Case Report provides a list of Patients with Incomplete Case Information for Cases created within a Selected Date Range. This report ensures Key Billing Information has been captured. Users can report on all Clinicians at a Facility or Selected Clinicians. Version 1.0, February 18, 2009 13
Active Patients by Financial Service Class (FSC) The Active Patients by Financial Service Class (FSC) Report displays a list of Patients in the same group (i.e. Medicare, Work Comp, BCBS, etc.) Physician Referral by Physician The Physician Referral by Physician Report displays the Total Number of Referrals by Physician. Physician Referrals by Financial Service Class (FSC) The Physician Referrals by Financial Service Class Report displays the Total Number of Referrals by Physician, broken down and subtotaled by FSC. Version 1.0, February 18, 2009 14
Physician Referrals by Product Line The Physician Referrals by Product Line Report displays the Total Number of Referrals by Physician, broken down and subtotaled by Product Line. REPORTS BY CORPORATION Combined Facility-Clinician Reconciliation The Combined Facility-Clinician Reconciliation Report provides a breakdown of Appointment and Documentation Statistics by Date Range for each Clinician per Facility. These statistics are based on Appointments in Scheduling. Version 1.0, February 18, 2009 15
Clinician Reconciliation The Clinician Reconciliation Report provides each Clinician s Appointment and Documentation Statistics for the full Corporation by Date Range. These statistics are based on Appointments in Scheduling. Facility Reconciliation The Facility Reconciliation Report provides statistics on the Appointment Types per Facility by Date Range. These statistics are based on Appointments in Scheduling. Version 1.0, February 18, 2009 16
Initial Evaluations by Physician The Initial Evaluations by Physician Report provides a list of Patients by Referring Physician with Initial Evaluations documented during the Date Range. The Referring Physician is based on the Physician listed on the Script when the Initial Evaluation was documented. Visits/Revenue by Facility by FSC The Visits/Revenue by Facility by FSC Report provides Statistics on Visits based on Financial Service Class (FSC) by Date Range. These statistics are based on Completed Notes. Version 1.0, February 18, 2009 17
Clinician Billing Audit The Clinician Billing Audit Report provides, by Facility, each Clinician s Total Billable Units, Total Billable Revenue, Average Billable Units per Visit, and Average Billable Revenue per Visit, by Date Range. These Visit Statistics are based on Visits where the Clinician is the Credited Clinician. Referring Physician Billing Audit The Referring Physician Billing Audit Report provides, by Facility, each Referring Physician s Total Billable Units, Total Billable Revenue, Average Billable Units per Visit, and Average Billable Revenue per Visit by Date Range. These Visit Statistics are based on Referred Visits. Discharged Patients The Discharged Patients Report provides each Facility s Discharged Patients by a Specified Date Range. These Statistics are based on Discharged Notes completed by Clinicians. Version 1.0, February 18, 2009 18
Census Summary The Census Summary Report provides each Facility s Weekly, Month-to-Date, Year-to-Date, and Quarterly Totals by Date Range. This report was designed to be run Weekly. Billable/Non-Billable The Billable/Non-Billable Report provides a list of all Documented CPT Codes, by Patient and by Date of Service. The report displays information relative to whether or not each Documented CPT Code was considered Billable or Non-Billable. Reasons why a charge would be considered Non-Billable include LCD Edits, CCI Edits, Time-Based Caps, and Caps on Maximum Number of Charges, which are determined during the Implementation Phase of the application. Clinician CPT Usage The Clinician CPT Usage Report provides, by Facility, each Clinician s Total Billable and Non- Billable documented CPT Codes by Date Range. It is used to show how many times, within the Specified Date Range, a Therapist documented a specific CPT Code and whether the CPT Code was Billable or Non-Billable. Version 1.0, February 18, 2009 19
TherapySource Note Types Examples Initial Evaluation Version 1.0, February 18, 2009 20
Daily Note Version 1.0, February 18, 2009 21
Progress Note Version 1.0, February 18, 2009 22
Administrative Version 1.0, February 18, 2009 23
Discharge Summary Version 1.0, February 18, 2009 24
REHAB TOOLKIT MANAGEMENT REPORTS FINANCIAL Accounts Receivable by Period The Accounts Receivable by Period report will create Accounts Receivable balances for the specified Period based on the Month End Closing Routine. Average Collection Days The Average Collection Days Report will display the Average Number of Collection Days for the Category and specified Period. The Average Collection Days Report is a Direct Data Access Report, which uses information stored in Rehab ToolKit without performing any calculations. The system does, however, calculate the Average Collection during the Month End Closing Routine. Average Collection Days is calculated as the difference between the claim s Payment Date and Posted Date. Average Collection Percent The Average Collection Percent Report will display the Average Percentage of Collection Days for the Category and specified Period. The Average Collection Percent Report is a Direct Data Access Report; however, the Percentage is found by dividing the Payment Amount by the Total Charges on the claim. Version 1.0, February 18, 2009 25
Weekly Revenue Forecast The Weekly Revenue Forecast Report is used to create a Forecast of Revenues based upon the Previous Week in the Current Period. The Weekly Revenue Forecast Report will display the Weekly Revenue for a Current Period, Projected Revenue for the Current Period, and the Previous Monthly Cash Receipts and Revenue. Economy of Scale Cash The Economies of Scale - Cash Report will display Number of New Patients, Number of Visits, Gross Revenue, and Collection/Cash Receipts for every Month during the selected Period. It will also display Working Days for that Month. The Economies of Scale Cash Report is a Direct Data Access Report. Economy of Scale Percent The Economies of Scale Percent Report will display Gross Revenue, Cash Receipts, and a Percentage for every Month during the selected Period. It will also display the Working Days for that Month. Percentage is calculated as Total Cash Receipts divided by Total Charges. Location Revenue Summary The Location Revenue Summary Report will display Total Charges, Collection Amount, Number of Visits, Number of Service Units, Number of Time Units, Average Treatments per Visit, Average Charge per Visit, and Average Collections per Unit for the Selected Dates and Period. The Location Revenue Summary Report will total the Categories at all Locations for the specified Provider. Version 1.0, February 18, 2009 26
Copayment Analysis The Copayment Analysis Report will list Copayment, Actual Payments and Percent Received. It will be broken down by the selected Period criteria with Totals per Location, Account Type, Period, and Grand Totals. Summary Detail Payment and Rejection The Payment and Rejection Report will display Amount Paid to each Line Item, Expected Amount and Percent Difference. Over The Counter (OTC) Amounts are not included. The Expected Amount is calculated as the Allowed Amount multiplied by the Percent Coverage for that payer. The Percent Difference is calculated as the difference between the two payments divided by the number entered by the user in the Percent Difference field. Version 1.0, February 18, 2009 27
Cash Collections The Cash Collections Report will display Payments by Location and Account Type. Copay Level Analysis The Copay Level Analysis Report will display Total Cases, Total Visits, and Average Visits. Dates are based on a Discharge Status on file in Patient Information. Total Cases are based on an Evaluation Code in Patient Billing and Accounting. Total Visits are based on the BILLING file in Patient Billing and Accounting. Average Visits are calculated as Total Visits divided by Total Cases. Weekly Flash The Weekly Flash Report will create a Forecast of Revenues based upon the Previous Week in the Current Period. It will display the Weekly Revenue for a Current Period, Projected Revenue for the Current Period, and the Previous Monthly Cash Receipts and Revenue. Average Revenue per Day is calculated as Total Charges on file (within the Current Period) divided by Number of Actual Working Days on file. Projected Revenue is calculated as Average Revenue per Day multiplied by Number of Projected Working Days (with the Current Period/Month). Version 1.0, February 18, 2009 28
Month to Date Flash The Month to Date Flash Report will display Total Number of New Patients, Total Number of New Patients for the Month, Number of Scheduled Appointments, Number of Appointments marked as Cancellations/No-Shows, Month-To-Day (MTD) Average Visits per Day, Budgeted Visits per Day, MTD Percentage of Cancellations/No-Shows, MTD Total Visits, MTD Total Units, MTD Total RVU Units, MTD Units per Visit, MTD RVU Units per Visit, MTD Visits per Referral, YTD Total Units, YTD Total RVU Units, YTD Visits per Referral, Daily Charges, MTD Charges, Expected Collection %, and OTC (Over-the-Counter) %. Month End Reports Revenue by Location The Revenue by Location Report will display the Revenue generated at each Location for the specified Months. Also, it will display the information based on the Department(s) selected. The Revenue by Location Report is a Direct Data Access Report. A/R by Location The A/R by Location Report will display Total Accounts Receivable for each Location in the Aging Bracket. It will also calculate the Percentage of Total Accounts Receivable for each Aging Bracket. Percentage is calculated as Aging Bracket Grand Total of Accounts Receivable divided by Grand Total of All Accounts Receivable. Version 1.0, February 18, 2009 29
A/R by Account Type The A/R by Account Type Report will display the Aging Detail by the Account Type selected for each Location/Provider. It will list Patient Balances for each Account Type. Percentage is calculated as Aging Bracket Grand Total of Accounts Receivable divided by Grand Total of All Accounts Receivable. Summary Detail Charges by Account Type The Charges by Account Type Report will display the Account Type Charges for each Month in a selected Period for each Location. The Charges by Account Type Report is a Direct Data Access Report. Version 1.0, February 18, 2009 30
Payments by Account Type The Payment by Account Type Report will display the Account Type Payments for each Month in a selected Period for each Location. The Payments by Account Type Report is a Direct Data Access Report. Discounts by Account Type The Discounts by Account Type Report will display the Account Type Discounts for each Month in a selected Period for each Location. The Discounts by Account Type Report is a Direct Data Access Report. Adjustments by Account Type The Adjustments by Account Type Report will display the Account Type Adjustments for each Month in a selected period for each Location. The Adjustments by Account Type Report is a Direct Data Access Report. Cash Aging The Cash Aging Report will display the Collection/Cash Receipts and the corresponding Aging Bracket based upon the Posting Date of the Claim and the Age of the Claim when it gets paid. The Cash Aging Report is a Direct Data Access Report; however, the age of the claim can be calculated as Payment Date minus Post Date of the Claim. Version 1.0, February 18, 2009 31
Net Effect by Period The Net Effect by Period Report will display Beginning Accounts Receivable Amount, Revenue for the Current Period, Cash Collected, Discounts and Adjustments, Ending Accounts Receivable, and Net Effect. Net Effect is calculated as Ending A/R minus Beginning A/R. A/R Days The A/R Days Report will display Revenue generated, Average Daily Revenue, Aging Amount (Accounts Receivable Amount) and A/R Days. Average Daily Charges is calculated as Total Charges for the Period divided by Total Number of Days in the Period. A/R Days is calculated as A/R Balance divided by Average Daily Charges. Credit Balance Account The Credit Balance Account Report will select all Patient Accounts, for the indicated Location/Provider, which have a Credit Balance. It will list Patient Detail Charges, Payments, Discounts, Adjustments, and Balance by the selected Account Type. The Credit Balance Account Report is a Direct Data Access Report. Version 1.0, February 18, 2009 32
REFERRALS New Patients by Location The New Patients by Location Report will display Patient Detail (Name, Date, and Diagnosis Code) for each New Patient. The Patients will be listed by the Referral Source that sent them to Therapy. New Patients by Physician Group The New Patients by Physician Group Report will display the number of New Patients referred to Therapy by each Physician Group. Also, it will display a Summary Total for each Physician Group. New Patients by Account Type The New Patients by Account Type Report will display the number of New Patients referred to Therapy by each Insurance Type/Class (Account Type). Version 1.0, February 18, 2009 33
Referral by Gross Charges The Referral by Gross Charges Report will break apart by Account Type and Total for Each Doctor, Account Type, and All Charges. Referral Visit Analysis The Referral Visit Analysis Report will break apart and total by New Evals and All Visits. STATISTICS Charges by Period The Charges by Period Report or Graph will display Total Charges by the indicated Category and for the defined Selection Period. The Charges by Period Report is a Direct Data Access Report. Version 1.0, February 18, 2009 34
Visits by Period The Visits by Period Report or Graph will display Total Patient Visits for the selected Category and Period. Treatments by Period The Treatments by Period Report or Graph will display Total Treatment Units for the indicated Category, Date, and Period selection. Average Charges The Average Charges Report or Graph will display Average Charges per Visit for the indicated Category, Date, and Period selection. Average Collections The Average Collections Report or Graph will display Average Collections (Payments) Per Visit for the indicated Category, Date, and Period selection. Active Patients The Active Patients Report or Graph will display Active Patients for the indicated Category, Date, and Period selection. Version 1.0, February 18, 2009 35
Collections by Period The Collections by Period Report or Graph will display Total Collections (Cash Receipts) for the indicated Category, Date, and Period selection. Discounts by Period The Discounts by Period Report or Graph will display Total Discounts (Write-offs) posted during the indicated Category, Date, and Period selection. Adjustments by Period The Adjustments by Period Report or Graph will display Total Adjustments posted for each Category during the indicated Date and Period selection. Cash Posting by Period The Cash Posting by Period Report will display Cash Posting activity, per user, in Dollars or Transactions. Version 1.0, February 18, 2009 36
Dollars Transactions Payor Classification Analysis The Payor Classification Analysis Report will display Units, Charges, Visits, and New Patient (Evals). Also, it will display data by Insurance Carrier, Insurance Group, Insurance Type, or Account Type. Location Analysis The Location Analysis Report is based on the Payer Classification Analysis Report with the inclusion of Receipts. In addition, it has the ability to provide Forecast Data. Version 1.0, February 18, 2009 37
OUTCOMES Condition Code Outcomes Clinical Outcomes by Facility The Clinical Outcomes by Facility Report will produce a listing of Condition Code Outcomes for each Diagnosis. It will list the Account Type, Discharge Condition, Average Visits and Percent (%) Caseload for each Diagnosis. Average Visits is calculated as Total Visits divided by Total Patients in Diagnosis. Percent Mix is calculated as Total Patients in Diagnosis divided Total Cases. Monthly Outcome Summary The Monthly Outcome Summary Report will produce a listing of the Average Number of Visits and the Percent of Patients within each Discharge Condition Code. The report produces monthly figures for each Location selected. Average Visits is calculated as Total Visits divided Total Patients. Percent is calculated as Total Patients in a Category divided by Total Patients. PRODUCTIVITY Statistical Summary The Statistical Summary Report will produce a listing for each Location that details Race or Gender Statistics, Visits or Treatment Statistics, Diagnosis Statistics, Referral Statistics, and Version 1.0, February 18, 2009 38
Functional Status Statistics by Insurance Class and Discipline or Department. Average Treatment is calculated as Service Units divided by Total Visits. Average Treatment Amount is calculated as Total Charges divided by Service Units. Statistical Summary by Location The Statistical Summary by Location Report will produce a listing for each Location detailing the Evaluation and Treatment Units, Time Units, Service Units, Charges and Average Treatment Amount by Payor Class and Discipline. Average Treatment Unit Amount is calculated as Total Charges divided by Service Units. Version 1.0, February 18, 2009 39
Workers Compensation The Workers Compensation Report will list Totals of Patients and Visits for each Insurance Carrier/Workers Comp company for each Month selected. The Billing File is used to create the report. Therapist Analysis Treatments by Location The Treatments by Location Report will provide a listing of Time Units, Service Units, Visits and Charges by Location, Department, and Therapist. Units per Visit is calculated as Total Service Units divided by Total Visits. Charges per Visit is calculated as Total Charges divided by Total Visits. ADD-INS KPI Report The KPI Report will produce a spreadsheet that includes a number of statistics such as, Units of HCPC/CPT by Payor Class, Total New or Return Patients, Total Cancellations or No Shows, Total Charges, Average Charges, etc. The data provided by this report is accumulated from the Billing Data entered in the system. The following is a list of items and how they are derived: 1) New Patients = Patients who have an evaluation code on file for a day; 2) Return Patients = Patients who do not have an evaluation code on file; 3) FCAs = FCA codes are found on file for the date; 4) New Cancels = Evaluation codes and cancellation codes are found on file for a date; 5) Return Cancels = Cancellation Codes are found on file for a date; 6) Discharges = Discharge Codes must be found on file for a date. Version 1.0, February 18, 2009 40
New KPI Report The New KPI Report will produce a spreadsheet that includes a number of statistics such as, Units of HCPC/CPT by Payor Class, Total New or Return Patients, Total Cancellations or No Shows, Total Charges, Average Charges, etc. The report can be run by Account Type or Insurance Type, Therapist, Department; Location, County, Region, Provider, Division or Company. New KPI by Category The New KPI by Category Report will produce a spreadsheet that includes a number of statistics such as, Units of HCPC/CPT by Payor Class, Total New or Return Patients, Total Cancellations or No Shows, Total Charges, Average Charges, etc. The report can be run by Account Type or Insurance Type, Therapist, Department; Location, County, Region, Provider, Division or Company. In addition, the report can be printed in Summary or in Detail, which will break the report down by Location. Version 1.0, February 18, 2009 41
High Risk Account The High Risk Account Report will produce a listing of Patient Accounts by Account Type and Insurance Carriers that have an Age Balance greater than or equal to the Balance selected. The report will display Claim Detail (Claim Dates, Policy/Group Number, Age, Postdate, Balance and Contact/Comments). Also, it will total by Patient Account Type and Insurance Carrier. Report Generator The Report Generator allows for the creation of reports that do not already exist. Select the appropriate Page Fields, Row Dimensions, Column Dimensions and Data Fields for the report. Available Fields: The fields which are available to place in the other four areas of this window Page Fields: Fields entered here will determine the data selected for the other parameters. If you select Location, all the selected data will be displayed for each location included in the data file you created on the previous steps. Row Dimensions: This will determine the Row headings of your report. If you select Patient ID and Name, each row of your report will be data for each patient that has the locations included in your data file. Column Dimensions: This will determine the Column headings of your report. This is how you want your data sorted. If you select Week Day, data will be displayed for each day of the week. Data Fields: This will be the items on which mathematical equations are performed. If you select Visit Gross Amount, Visit Actual Payment Amount, Visit Actual Discount Amount, Visit Actual Adjustment Amount and Visit Balance, the data displayed will be Version 1.0, February 18, 2009 42
the Charges, Payment, Discount, Adjustments and Balance Remaining for each Day of the Week for each Payment at the Locations selected. PATIENT BILLING AND ACCOUNTING Maintenance Billing Reconciliation The Billing Reconciliation Report will list all charges that have not been Posted and /or Updated for the purpose of a Billing Review. The more criteria entered, the more restrictive the Billing Review will be. Billing Batch Update Reconciliation Report The Billing Batch Update Reconciliation Report will list all claims that were generated during the Batch Billing Update process. Data such as Claim ID, Patient ID, Account Type, Patient Name, Charges, Form (i.e. CMS-1500 or UB04), Service Dates, and Location are displayed. Version 1.0, February 18, 2009 43
Patient Account Status Ledger Patient Statement Inquiry The Patient Statement Inquiry Report, accessible from the Patient s Ledger, will list all transactions on a Patient s Account. Data displayed are Transaction Date, Transaction Type, Transaction Description, Units, and Amount. The following calculations are performed: Total Charges on Account, Total Payments on Account, Total Discounts on Account, Total Account Adjustments, Total Account Charge Reversals, and Account Balance Due. Patient Account Audit The Patient Account Audit Report will display any Claim IDs on the Patient Account. It will also show the IPTR, Department, Service Dates, Charges, Payments, Discounts, Adjustments, Claim Balance, and Age. Version 1.0, February 18, 2009 44
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Patient Statements Examples Statement Type 1 All Outstanding Claims Version 1.0, February 18, 2009 46
Statement Type 2 All Outstanding Patient Claims Version 1.0, February 18, 2009 47
Statement Type 3 Account Summary Only Version 1.0, February 18, 2009 48
Statement Type 4 Legal Summary Only Version 1.0, February 18, 2009 49
Statement Type 5 Treatment Summary Only Version 1.0, February 18, 2009 50
Statement Type 6 Claim/Service Grouping Version 1.0, February 18, 2009 51
Statement Type 7 Visit Summary (EDI) Statement Type 8 Visit Summary (Print) Version 1.0, February 18, 2009 52
Reports Copay by Period The Copay by Period Report will create a list of Patient Accounts that are Flagged with the Copay Option in Patient Information Insurance. EOB Letters EOB Letters will print based on a Payment being made on each Claim by an Insurance Carrier/Payor during the Range of Dates indicated. Dunning Letters Dunning Letters will be initiated and printed once all Outstanding Claim Balances are the patient s responsibility. Each time Selected Letters are processed, new Dunning Accounts will be added and stated at a level. Current Dunning Accounts will print for the next level (i.e., if a patient last received Level 2 letter, the patient will now a require Level 3 letter). There are five Dunning Letters available. Version 1.0, February 18, 2009 53
Claim Transaction The Claim Transaction Report will display data such as, Patient ID, Patient Name, SSN, DOB, Account Type, Employer, Claim ID, Primary Insurance Carrier, Current Insurance Carrier, Insurance Type, Policy #, Service Date, HCPC/CPT Code, Units, Charges, Charge Reversals, Insurance Payments, Patient Payments, Discounts, Adjustments, and Claim Balance. Billing Reports Cash Receipts Journal The Cash Receipts Journal Report will display Total Cash Receipts entered. Data such as Date, Check#, Patient Name, Amount, and Batch# are displayed. Version 1.0, February 18, 2009 54
Discount Journal The Discount Journal Report will display Total Discounts entered. Data such as Date, Check#, Patient Name, and Amount are displayed. Over the Counter Payments The Over the Counter Payments Report will display Total Over the Counter Payments entered. Data such as Date, Check#, Patient Name, Amount, and Transaction# will be displayed. Charge Reversal Journal The Charge Reversal Journal Report will display Total Charge Reversals entered. Data such as Date, Patient Name, and Amount are displayed. Version 1.0, February 18, 2009 55
Posted Charges The Posted Charges Report will display a list of Posted Charges. Data such as Patient ID, Account Type, Patient Name, Service Date, HCPC/CPT, Service Units, and Charges will be displayed. There is also an option to print the report for Posted and Unupdated Charges. Posted and Updated Charges Posted and Unupdated Charges Posted Claims The Posted Claims Report will display a list of Posted Claims. Data such as Date, Claim#, Patient Name, Service Dates, and Amounts are displayed. Version 1.0, February 18, 2009 56
Unposted Claims Report The Unposted Claims Report will display a list of Unposted Claims. Data such as Claim ID, Patient Name, Service Dates, and Amount are displayed. Unbilled Claims The Unbilled Claims Report will display a list of Unbilled (Unprinted) Claims. Data such as Claim ID, Account Type, Patient Name, Service Dates, and Amount will be displayed. There is also an option to print the report for Unbilled (Unprinted) and Unposted Claims. Unbilled (Unprinted) Claims Report Posted Claims Version 1.0, February 18, 2009 57
Unbilled (Unprinted) Claims Report Unposted Claims EDI Analysis The EDI Analysis Report will display the Number of Claims Generated using a particular ECS Subroutine as well as the Percent of Total EDI for each subroutine. ERA Tracking The ERA Tracking Report will display Total Number of Payments and Number of ERA Payments posted for each Insurance Carrier, Insurance Type, or Account Type. A/R Reports A/R by Patient Account The Accounts Receivable Aging by Patient Account Report will display Accounts Receivable by Account Type. Data such as Patient Name, Account Type, Aging Brackets, and Total Patient Balance are displayed. Version 1.0, February 18, 2009 58
A/R by Insurance Carrier The Accounts Receivable Aging by Insurance Carrier Report will display Accounts Receivable by Insurance Carrier. Data such as Insurance ID, Insurance Carrier Name, Claim ID, Aging Brackets, and Total Claim Balance are displayed. A/R by Insurance Type The Accounts Receivable Aging by Insurance Type Report will display Accounts Receivable by Insurance Type. Data such as Insurance Type ID, Claim ID, Aging Brackets, and Total Claim Balance are displayed. A/R by Insurance Group The Accounts Receivable Aging by Insurance Group Report will display Accounts Receivable by Insurance Group. Data such as Insurance Group ID, Claim ID, Aging Brackets, and Total Claim Balance are displayed. Version 1.0, February 18, 2009 59
Anticipated Receipts The Anticipated Receipts Report will display balances, per claim, that are expected based on Outstanding Accounts Receivable. Data such as Claim ID, Insurance/Payor Name, Charges, Payments, Adjustments, Discounts, Balance, Collections, and Age are displayed. Credit Balance Aging The Credit Balance Aging Report will select all Patients, for the indicated Location/Provider, that have a credit balance and display the Age of the Credit Balance by Claim ID. Available are the options to Age by Claim Posting Date, Last Payment Date, or Patient Responsibility Date. Utility Reports Unbalanced Accounts The Unbalanced Accounts Report will display any Accounts where the Patient Balance (PBALANCE), Account Balance (CBALANCE), and Claim Balance (XBALANCE) do not equal. The Unbalanced Accounts Report is typically run during Month-End Processing but can be run at any time. Data displayed includes Patient ID, Account Type, Patient Name, PBALANCE, XBALANCE, and CBALANCE. Version 1.0, February 18, 2009 60
Coding Edits The Billing Coding Edit Report will display information relative to Coding Edits that were set up at the Insurance-Carrier Level. Coding Edits available in Rehab ToolKit are CCI, LCD, and 8- Minute Rounding. Data such as Patient ID, Patient Name, Service Date, HCPC/CPT, and Coding Edit Message are displayed. Claim Status The Claim Status Report will display Claims that are On Hold for different Claim Statuses. Data such as Patient ID, Patient Name, and Claim ID are displayed. Account Status The Patient Account Status Report will display each Patient ID and the Account Balance. Version 1.0, February 18, 2009 61
Missing Information The Missing Information Report will display any information that is missing from a claim based on Required Fields that are set up at the Insurance-Carrier Level. Claim Posting, Claim Printing, and Electronic Claim Submission can be placed on hold if claims are Missing Information. Data such as Patient Name, Patient ID, Account Type, Claim ID, Insurance Plan, Insurance Type, Days on Hold, Date of Service, and Bill Amount are displayed. Release Missing Information The Missing Information Release Report will facilitate the Release of Claims that were placed On Hold after the Required Fields have been populated. Data such as Patient Name, Patient ID, Account Type, Claim ID, Insurance Plan, Insurance Type, Days on Hold, Date of Service, and Bill Amount are displayed. Attachments The Attachments Report will display any claims that require attachments. Data such as Patient Name, Patient ID, Account Type, Claim ID, Insurance Plan, Insurance Type, Days on Hold, Date of Service, and Bill Amount are displayed. Version 1.0, February 18, 2009 62
Cap Payment Report The Copay Payment Allocation Report will display Allocation of Cap Payments for those Insurance Carriers that have Cap Payment Allocation setup in Insurance Carrier Maintenance. Data such as Total New Patients, Total Visits, Total RVU, Percent of New Patients, Percent of Visits, Percent of RVU, Allocation Percent, and Allocation Amount are displayed. Therapy Cap Report The Therapy Cap Report will display Accounts that have exceeded the Threshold Dollar Amount for Therapy. Data such as Patient ID, Patient Name, Account Type, Insurance Plan, Insurance Type, Department, Allowed Amount, Charge Amount, First Date of Service, Last Date of Service, and Number of Visits are displayed. Hold Reports Claim Hold Status The Claim Hold Status Report will display all Claims On Hold for any Status. Data such as Patient Name, Patient ID, Account Type, Claim ID, Insurance Plan, Insurance Type, Days on Hold, Date of Service, and Bill Amount are displayed. Version 1.0, February 18, 2009 63
Release Claim Hold The Claim Status Hold Release Report will Release any Claims On Hold where the Hold Status is removed from the Department in Patient Information or where the Hold Status is removed in Insurance Carrier Maintenance. Data such as Patient Name, Patient ID, Account Type, Claim ID, Insurance Plan, Insurance Type, Days on Hold, Date of Service, and Bill Amount are displayed. Insurance Carrier Hold Status The Insurance Carrier Hold Status Report will display all Claims with the Hold All Claims box checked in Insurance Carrier Maintenance. Data such as Patient Name, Patient ID, Account Type, Claim ID, Insurance Plan, Insurance Type, Date of Service, and Bill Amount are displayed. Patient Account Hold Status The Patient Account Hold Status Report will display all Accounts with the Account Hold Status box checked in Patient Account Status. Data such as Patient Name, Patient ID, Account Type, and Account Balance are displayed. Version 1.0, February 18, 2009 64
Setup Customary Fees The Customary Fees Master Report will display Customary Fees by Insurance Carrier set up in Insurance Carrier Customary Fee Entry. Data such as Insurance Carrier, HCPC/CPT Code, HCPC/CPT Description, and Allowable Amount are displayed. Billing Macros The Billing Macros Master Report will display Billing Macros set up in Billing Macro Definition Maintenance. Data such as Macro ID, Macro Description, HCPC/CPT Description, Units, and Price are displayed. Billing QUICK Notes The Billing QUICK Notes Master Report will display any Billing QUICK Notes set up in Billing QUICK Note Maintenance. Data such as Note ID, QUICK Note Description, and Note Text are displayed. Charge Tickets/Forms/Labels Charge Tickets/Forms/Labels allows users to produce SUPERBill Forms. Print options include the following: Daily Style Charge Ticket, Month Style Procedure Ticket, Barcoding Interface, and Medifile Interface. Data such as Location, Department, Therapist, Primary Physician, Insurance Carrier, Comments, Service Date, Patient Name, Patient Address, and Patient Date of Birth are displayed. Version 1.0, February 18, 2009 65
Utilities Month End Processing A/R Roll Forward Trial Balance The A/R Roll Forward Trial Balance Report will display any Differences between Ending A/R and Current A/R. The A/R Roll Forward Trial Balance Report is primary used during Month End Processing to ensure A/R for the Current Financial Period is in balance. Data such as Beginning A/R, Revenue, Cash Collected, Discounts, Ending A/R, Current A/R, and Difference are displayed. Collections Collection Workfile Productivity The Collection Detail Report will display all Collection Activities on a Claim. Data such as Collector Name, Patient ID, Claim ID, Action Dates, Action Type, and Comments are displayed. Version 1.0, February 18, 2009 66
Batch Control Batch Received The Batch Received Report will display a list of Batches that were created in Rehab ToolKit and is used to ensure that Batches balance. Data such as Batch ID, Deposit Date, Transaction Date, Deposit Amount, Applied Amount, and Unapplied Amount are displayed. Batch Transaction The Batch Transaction Journal Report will display any Batch Transfer or Batch Non-System Cash Transactions that were posted in a Batch. Data such as Batch ID, Deposit Date, Transaction ID, Transaction Date, Transaction Amount, and Transaction Code are displayed. Claim Printing Templates All Field Variables The Field Variable Report will display a list of all Field Variables available for use with Claim Form Designer Data Mode. The available Field Variables are for the CMS-1500 and UB04 Claim Forms. Data such as Item ID, Variable Name, Tip Text, and Valid Forms are displayed. Version 1.0, February 18, 2009 67
Template Field Variables The Claim Form Template Field Variable Report will display a list of the selected Field Variables for all existing CMS-1500 and UB04 Claim Form Templates in Claim Form Designer Data Mode. Data such as Form Type, Claim Payer Status, Field Name, Item ID, Field Variable, and Format String are displayed. Template Alignment The Claim Form Alignment Template Report will display the Alignment Values for all existing CMS-1500 and UB04 Claim Form Templates in Claim Form Designer Align Mode. Data such as Form Type, Field Name, Horizontal Adjustment, and Vertical Adjustment are displayed. Version 1.0, February 18, 2009 68