Version 21.3
When to Use this Report
Use this report to view your reimbursement values from your payers vs what your contracted allowable rates are. Users can easily see in the column Allowable Difference if they are seeing a trend of less or more for reimbursements.
About Compare Allowable to Payment
Path: Tools > Reporting > Monthly Reports > Compare Allowable to Payment
This report shows the estimated reimbursement/payer allowable for a charge along with the actual amount of payments from the insurance company.
Monthly Reports: Compare Allowable to Payment Map
Hover over each of the Summary Tiles, to see specific data. For instructions on how to drill down and expand that information from the Summary Tiles, please see the Drill Down section of the Data Element Tutorial.
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Note: All columns in the Detailed Report section will show by default. To hide columns, see the Visualization section of the Maximized Elements article. |
Filters and Summary Tiles
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Number |
Section | Description |
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1
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Date of Service | This is the date the service was performed. Select the date(s) for the displayed record's date range. Reports that meet the criteria and fall within the selected date range will appear in the detailed reports grid. See the Dates section of the Filter Tutorial article for the different selections. |
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2
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Location | Select a Location to display all encounters that occurred at that location. This is useful for practices that have multiple locations. |
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3
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Rendering Provider | Selecta Rendering Provider to display all claims from that provider.
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4
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Primary Insurance | Select a Primary Insurance to display all claims filed under that insurance. |
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5
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CPT Code | Select a CPT code to display all claims with that code. |
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6
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Total Charge | The Total Charges Summary Tile displays the total amount of charges for the combined services rendered. |
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7
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Total Collected | The Total Collected Summary Tile displays the total amount collected from both the Patients and the Insurances. |
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8
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Insurance Adjustment |
The Insurance Adjustments Summary tile displays total of all Insurance Adjustment transactions with the processed daysheets (total from the Insurance Adjustment column).
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9
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Patient Adjustment |
The Patient Adjustments Summary tile displays total of all Patient Adjustment transactions with the processed daysheets (total from the Patient Adjustment column).
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10
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Insurance Paid |
The Insurance Paid Summary tile shows the total amount paid by the insurance carrier in the filtered report (totals from the Insurance Paid column).
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11
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Patient Paid |
The Patient Paid Summary tile shows the total total amount paid by the patients in the filtered report (totals from the Patient Paid column).
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12
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Payer Allowable | The Payer Allowable Summary tile shows the total amount allowed by the payers in the filtered report (total from the Payer Allowable column). |
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13
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Allowable Difference | The Allowable Difference Summary tile shows the total amount of allowable difference between the Pater Allowable and the Total Collected (total from the Allowable Difference column). |
Detailed Report
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Number |
Section | Description |
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a
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Date of Service (DOS) | This is the date of service for payments. |
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b
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Claim # | The Claim # column displays the number for the claim where the transaction occurred. |
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c
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Patient | The Patient column displays the patient's first and last name and the patient identifier for the indicated transaction.
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d
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Rendering Provider | The Rendering Provider lists the name of the provider for the transaction. |
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e
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Billing Provider | The Billing Provider lists the name of the billed provider on the claim. |
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y
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Location | The Location column displays the location where the encounter occurred. This is useful for practices that have multiple locations. |
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g
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Primary Insurance | The name of the Primary Insurance that was used for the patient on the selected date of service. |
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h
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Secondary Insurance | The name of the Secondary Insurance that was used for the patient on the selected date of service. |
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i
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CPT | The CPT code column lists the medical code for the visit on the date of service. |
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j
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CPT Description |
The CPT Description describes the medical code provided in the CPT Code column. |
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k
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Charge | The Charges column displays the total charge for the service rendered for that particular patient. |
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l
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Insurance Paid | The Insurance Paid column displays the amount paid by the insurance carrier.
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m
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Insurance Adjustment |
The Insurance Adjustment column indicates the amount the insurance adjusted.
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n
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Patient Paid | The Patient Pay column displays the total amount paid by the patient.
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o
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Patient Adjustment |
The Patient Adjustment column indicates the amount of the charge adjustment that was written off for a particular CPT code.
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p
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Total Collected | The Total Collected column displays the total amount collected by the Patient and the Insurance (total from Insurance Paid and Patient Paid column). |
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q
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Payer Allowable | The Payer Allowable column indicates the contractually allowable charge as indicated by the insurance carrier. |
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r
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Allowable Difference | The Allowable Difference is the difference in the amounts between the and the Total Collected column and the Payer Allowable column. |
