CentralReach’s “Patient Responsibility” or “PR AMT” is the cumulative sum of the insurance copayment/copay, the coinsurance, and the deductible amounts the client is monetarily responsible to pay, for the services provided. “Patient Responsibility” was previously referred to in CentralReach as “Copay.”
Billing CentralReach’s “Patient Responsibility”
Coinsurance is a client’s share of the costs of a healthcare service. It is usually figured as a percentage of the amount a client is to be charged for services. A client would start paying coinsurance after they have paid their plan’s deductible. In CentralReach, the coinsurance amount is included as part of the Patient Responsibility or PR AMT in billing screens and client invoices.
New clients must complete a payor import file before beginning implementation. The purpose of this file is to ensure clients’ payors match payors in CentralReach’s database, so that claims will be sent correctly. A spreadsheet application, such as Excel, WPS Spreadsheets, or Google Sheets, will be needed in order to open and complete the payor import.
See below for a breakdown of how to complete columns A-M of the payor import:
- Column A: The name of the insurance company
- Column B: The name of the specific plan under the insurance company
- Columns C- F: The insurance company’s mailing address
- Column G: The payor’s ID with Office Ally, which indicates where claims should be sent. The ID can be located here, by conducting a search for the payor.
- Please note, it is important that this ID is inputted correctly, so claims are submitted to the right payor. If you are unsure of the payor ID, contact the payor directly to confirm their ID.
- Columns H-I: These columns indicate if pre-enrollment is required with the payor to submit claims or receive responses electronically.
- Columns J-M: These columns let CentralReach know how you are currently billing and how you want to bill in CentralReach.
A copay is a fixed amount a client is responsible for paying for a health care service and is usually paid when the service is received. The amount can vary by the type of service. In CentralReach, the copay amount is included as part of the Patient Responsibility or PR AMT in the billing screens and client invoices.
A deductible is an amount a client is responsible for paying for healthcare services before the health insurance begins to pay. In CentralReach, the deductible amount is included as part of the Patient Responsibility or PR AMT in billing screens and client invoices.
Billing / Scheduling Enable Schedulers to Convert Other Employees’ Appointments
The following permission can be granted in the Permissions module, under the Billing section, for employees, such as the person responsible for scheduling all of your organization’s appointments, to convert other employee appointments into timesheets:
- Billing > Manage Timesheets
- Manage timesheets on behalf of other employees and clients in their network. This includes converting appointments, add/edit others’ timesheets, view billed rates, as well as override authorization over-billing restrictions
These employees also need to have permission to manage other employees’ calendars, which is enabled via the Scheduling module. Permissions to view or manage calendars can be established via Contact Forms, so new users added to CentralReach already have these permissions enabled based on your Contact Form.
Click here to learn how to create a permission group to grant employees permission to convert other employees’ appointments.
Click here to learn how to review and edit an employee’s permissions.
Click here to learn how to edit the permissions of a group.
Billing / Scheduling Office Location on Billing Entry Different from Appointment Details
If your billing entries are not pulling in the same information as what is set in the appointment details, that can be due to:
- A location set in the service code properties will override what is set on the appointment.
- The fee schedule linked to the client’s payor is also linked to the service code.
- The location in the modifier overrides the location set in the service code and appointment details.
The Revenue Cycle Management (RCM) report, formerly the Sales report, will be located in the Billing and Insights modules to provide a summary of billing data. This report allows users with the (Insights > Access) and (RCM Report > Access) permissions to view revenue, payments, receivables, overpayments, resolutions, and payor trends. Click here to learn how to view and download the RCM report.
Users can filter by a desired date range , and by selecting the payor or client bubbles at the top of the report.
The following icons on the right-hand side change the report’s display:
The search icon on the left-hand side provides the following filters:
- Client ID or Name
- Code Label
- Contact Label
- Billing label
- Insurance or Plan Name
- Provider ID or Name
- Service Code
Below the search filters, the “Overpayments by payor/client” and “Receivables by payor/client” charts include the following information:
- Overpayments by payor/client: a total of the payments within a selected date range, paid in excess for a service, as well as the overall total amount of overpayments.
- The red bubbles represent the overpayments.
- Receivables by payor/client: a total of the remaining payments within a selected date range, owed for a service, as well as an overall total of the amount of receivables.
- The blue bubbles represent receivables.
Selecting each bubble will also filter the grid on the bottom of the report by the information contained in the pop-up.
The following KPIs are located on the left-hand side:
- Gross collection rate (GCR): the total percentage of payments.
- Net collection rate (NCR): the total percentage of resolved payments.
Below both charts are the following columns in the grid:
- Charges: Regular charges and agreed charges.
- Sales Adjustments: All sales adjustments posted.
- Adjusted Charges: (Charges – Sales adjustments)
- Payments: The five payment types, cash, check, credit card, electronic, and credit memos.
- Please note, this column excludes overpayments.
- Gross Collection Rate (GCR)
- Bad Debt: All bad debt payments posted.
- Net Collection Rate (NCR)
- Receivables: Dollars still outstanding.
- Overpayments: Dollars overpaid.
The Receivables report is located in the Billing and Insights modules and provides a summary of overpayments and receivables. Users with the (Insights > Access) and (Receivables Report > Access) permissions will receive an insight into collections aging by payor and client. Click here to learn how to view and download the Receivables report.
Users can filter by a desired date range , sort by payor or client, date of service and first billed, and net, outstanding, and overpayments, located at the top of the report.
- Net: summation of Outstanding and Overpayments.
- Outstanding: Outstanding revenue at the billing entry line level and by type (Insurance vs. Patient).
- Overpayments: Overpaid revenue at the billing entry line level and by type (Insurance vs. Patient).
The following icons on the top right-hand side change the report’s display:
The search icon on the left-hand side contains the following filters:
- Client ID
- Client Name
- Code Label
- Billing Label
- Payor Name
- Plan Name
- Provider ID
- Provider Name
- Service Code
Below the search filters, the “AR Aging by payor” charts include the following filters:
- Primary insurance: select to highlight the circular bubbles that represent primary insurance.
- Secondary insurance: select to highlight the rhombus (diamond shape) bubbles that represent secondary insurance.
- Tertiary insurance: select to highlight the triangular bubbles that represent tertiary insurance.
Selecting each shape will also filter the grid on the bottom of the report by the information contained in the summary pop-up.
On the left-hand side of the chart are the following KPIs:
- AR Outstanding
- Over Payments
- AR > 90 Days
- Aging breakdown
Below “Aging Breakdown,” the following columns are contained in the grid:
- 0-30 days
- 60-90 days
- 90-120 days
- 120-180 days
- 190-365 days
- 365+ days
The “Name” column has a list of payors or clients’ IDs (depending on if the report is sorting by payor or client), along with the Insurance payments and Patient responsibility amounts under each aging bucket. Clicking each amount will bring you directly to the billing entry.