Version 21.3
When to Use this Report
Use this report to determine whether you are being paid correctly compared to the cost of your vaccines. The report displays your costs versus insurance payments and the total collected (insurance + patient payments). Payments are color-coded: green indicates payments exceeding costs, and red indicates payments below cost.
About Vaccine Cost vs Reimbursment
Path: Tools > Reporting > Monthly Reports > Vaccine Cost vs Reimbursment
This detailed report is driven by payer, CPT code and Claim number. You must have Fee 19 loaded with the vaccine cost, and it must have a CPT Category of Vaccine, in order to pull the data. See the below image for an example of the CPT Fee Schedule used:
Monthly Reports: Vaccine Cost vs Reimbursment 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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Charge Date | This is the date of the charges, or the date of service. Select the date(s) for the displayed record's date range. Data that meets 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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Posted Date | Select the date(s) to display the transactions for the posted date selected. See the Dates section of the Filter Tutorial article for the different selections.
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3
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Rendering Provider | Use this filter to select the provider(s) who performed the services for the vaccines.
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4
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CPT Category | Select a CPT Category to display all claims with that code.
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5
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Vaccine CPT Code Range | You can type in a range for the CPT Codes relating to Vaccines here, to only pull those Vaccine codes. |
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6
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Total Charges | 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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Insurance Paid | This 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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8
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Insurance Paid Above Cost | This Summary tile shows the total amount paid by the insurance carrier that exceeded the cost of the vaccine charges (pulled from the totals in green of the Cost vs. Ins. Paid column). |
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9
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Insurance Paid Below Cost |
This Summary tile shows the total amount paid by the insurance carrier that were below the cost of the vaccine charges (pulled from the totals in red of the Cost vs. Ins. Paid column).
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10
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Total Collected Above Cost | The Total Collected Summary tile displays the total amount paid by the insurance carrier and the patient for those Vaccine charges that were paid above cost. |
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11
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Total Collected Below Cost | The Total Collected Summary tile displays the total amount paid by the insurance carrier and the patient for those Vaccine charges that were paid below cost. |
Detailed Report
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Number |
Section | Description |
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a |
Primary Insurance |
The name of the Primary Insurance that was used for the patient on the selected date of service. |
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b
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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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c
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Claim # |
The Claim # column displays the number for the claim where the transaction occurred. |
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d
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Charge Date | This column shows the date of service for the charge. |
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e
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Charge | The Charge column displays the charges for the service rendered for that particular patient. |
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f
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Vaccine Cost | This column pulls the cost of the Vaccine and is pulled from Fee 19. |
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g
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Patient Paid | The Patient Pay column displays the total amount paid by the patient. |
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h
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Insurance Paid | The Insurance Paid column displays the amount paid by the insurance carrier.
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i
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Total Collected | The Total Collected column displays the total amount paid by the insurance carrier and the patient (adding the Insurance Paid column and Patient Paid column together). |
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j
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Cost vs. Ins. Paid | This column shows the difference between the cost of the vaccine and what the Insurance paid, with exceeded costs in green and below cost in red. |
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k
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Cost vs. Total Paid |
This column shows the difference between the cost of the vaccine and what the total Insurance + patient paid, with exceeded costs in green and below cost in red. |
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l
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Location Name |
The Location column displays the location where the encounter occurred. This is useful for practices that have multiple locations. |
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m
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CPT Category | The CPT Category lists the Category (Vaccine) for the related CPT code. |
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n
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Rendering Provider |
The Rendering Provider lists the name of the provider for the transaction. |
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o
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Patient | The Patient column displays the patient's first and last name and the patient identifier for the indicated transaction. |
