Payment Review Report

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The Payment Review Report takes a two-fold approach to improperly paid claims.  Some of those claims were mis-paid by the payor while others were not responded to (paid or denied) by the payor.  The report is generally used in meetings with payor representatives to review mis-paid claims.  The report produces a list of patients that have payments posted that were not paid according to the contract as well as claims that are still open after a user-defined number of days.  The report can produce a list of payments in which the charge allowed amount (from the Fee Schedule) and the payor approved amount (entered in Payment Entry) differ by more than a user-defined percentage.  It is different from the Payment Exception Report in that it includes demographic and charge information such as policy number, claim number, CPT/ASA code, etc. and not the batch number, document number or exception type.

 

The Payment Review Report request form is a tabbed dialog that consists of a General tab, a Sorting tab, and a Selection tab.

 

General Tab

 

Task Name

Task Name displayed in the Task Viewer

Select Payments By

Payment Date to examine:

•Entered
•Remit
•Posted
•Accounting
•Accounting - Previous
•Accounting - Current

From

Beginning date of the (entered, remit, or posted) date range

Thru

Ending date of the (entered, remit, or posted) date range

Payment Reason Exceptions

Indicates if Payment Distributions with Payment Reasons that have been flagged as exceptions will be included in the report.

Allowed Amount Exceptions

Indicates if Payment Distributions in which the charge allowed amount (from the Fee Schedule) and the carrier approved amount (entered in Payment Entry) will be included in the report.

Within Pct

The percentage difference between the allowed and approved amounts that will qualify a payment to appear on the report.

Report Under-Payments

Indicates Payment Distributions Only in which the charge allowed amount (from the Fee Schedule) is GREATER than the carrier approved amount (entered in Payment Entry) will be included in the report.

Report Over-Payments

 

Indicates Payment Distributions Only in which the charge allowed amount (from the Fee Schedule) is LESS than the carrier approved amount (entered in Payment Entry) will be included in the report.

Min Days

Enter the minimum age of open claims to be selected in the report

Max Days

Enter the maximum age of open claims to be selected in the report

Cube Data

Indicates if report results should be output to a data cube

Generate Standard Report

Indicates if report results should be output to a formatted report

Run Now

Indicates in the report should be run immediately

Schedule

Indicates that the report should be scheduled to run at a future time

Schedule Button

Invokes the Task Schedule Wizard to guide the user through setting the report run date(s) and time(s)

 

 

 

Sorting Tab

 

The Sorting tab consists of two lists.  The first list is comprised of the available sort fields for the report and the second list is comprised of the fields that have been selected as sort fields.  The fields in the second list may be sequenced in any order.  The report will sort the data into the sequence defined and perform a "break" on the sort field as well.

 

Selecting Sort Options:

 

Right-Arrow Button

Click on item to be selected in the left-hand list and press the right-arrow button.

Drag-and-Drop

Click on the item to be selected in the left-hand list and while holding the mouse button down, "drag" the item to the right-hand list and release the mouse button.

Double-Click

Double-click on the item to be selected in the left-hand list.

 

 

De-Selecting Sort Options:

 

Left-Arrow Button

Click on item to be de-selected in the right-hand list and press the left-arrow button.

Drag-and-Drop

Click on the item to be de-selected in the right-hand list and while holding the mouse button down, "drag" the item to the left-hand list and release the mouse button.

Double-Click

Double-click on the item to be de-selected in the right-hand list.

 

 

 

 

Selection Tab

 

Frequently when a report is run, you only wish to see data meeting certain criteria.  The Selection tab consists of a list of fields they you may use to include or exclude specific data values from the report.  For example, you may wish to run a report for just a certain physician or excluding a certain location.

 

By clicking on the checklist for the appropriate field (physicians, facilities, etc.) you may then select to include or exclude certain values from the respective tables.  The limit to the number of specific values you can select is limited to your ability (or willingness) to enter them.  While there is a theoretical limit to the number of selections you can make, you will run out of patience before MedSuite runs out of room to save them.  Muli-Selections work with standard Windows keyboard functionality.  CTRL+Click to select one at a time, SHIFT+Click to select a range of maintenance files.