We are currently updating the OP Help Center content for the release of OP 14.19 or OP 19. OP 19 is a member of the certified OP 14 family of products (official version is 14.19.1), which you may see in your software (such as in Help > About) and in the Help Center tabs labeled 14.19. You may also notice that the version number in content and videos may not match the version of your software, and some procedural content may not match the workflow in your software. We appreciate your patience and understanding as we make these enhancements.

Reimbursement Analysis

Version 14.19

When to Use this Report

The Reimbursement Analysis report is commonly used for Payment history by CPT, Insurance payment monitoring, and Payment history by provider.  

About Reimbursement Analysis

Path: Billing tab > Transactions button > Reimbursement Analysis

The Reimbursement Analysis Report is a summary of billing data. It is best used when determining the average reimbursement of CPT codes. The data in this grid reflects the transactions that have been posted. The data selection can be based on a range of dates by either date of service or posted date. Only charge transactions are shown. Payment and adjustment transactions that have been applied to a charge are shown as summarized totals.


Note: More columns are available in the data grid than shown in the map below. The map only describes the columns displayed in the map. To see the total list of columns, select the column selection icon in the upper-left area of the grid ().

Reimbursement Analysis Map

Number
Section
Description

1

Analyze tab
The Analyze tab displays the claim billing data based on the selected search criteria. Each CPT has only one entry. All payments and adjustments are summarized on that single entry.

2

Under the hood tab
The Under the Hood tab provides a description for the Reimbursement Analysis report.

3

Date Range
The Date Range sets the date range for the displayed report.

4

Reference Date
The Reference date field sets the type of data to display for the selected date range. These selections include:
  • Charge/payment date: Charges are reported according to their charge date (usually date of service) and payments and adjustments according to their payment date (which can be backdated at the time of posting).
  • Posting (entry) date: This report accesses charges, payments, and transactions that have a posting date within the time frame selected. NOTE: This date is time stamped from the local computer where the user is posting payments and does not take into consideration the date of service for charges or any backdating done when posting payments.
  • Daysheet date: This report accesses charges, payments, and adjustments according to the date they were processed on a daysheet.

5

Paid Status
The Paid Status field determines the type of charges to be displayed. These selections include:
  • Fully paid: Returns all charge rows that have been fully paid either by insurance, patient, or both.
  • Ins paid: Returns all charge rows that have been fully paid by insurance.
  • Pat paid: Returns all charge rows that have been fully paid by the patient.
  • All: Returns all charge rows. This provides totals for patient and insurance paid and balance columns.
  • Ins Owes: Returns all charge rows that have an insurance balance owed.
  • Pat Owes: Returns all charge rows that have a patient balance owed.
6
Refresh Grid button
The Refresh Grid button displays the latest data in the grid based upon the Reference Dates and Report Reference Criteria filter selections.

7

Search Report Template
The Search Report Template creates a search template, saves a search template, and deletes a selected search template for a report.
8
Print/Export functions
The Print Grid and Export buttons are used to print the grid (using the Print Grid button) or Exporting the data to Excel (using the Export button).

9

D.O.S.
The Date of Service (D.O.S.) column lists the date of service for the indicated transaction.
10
CPT
The CPT Code column lists the medical code for the visit on the date of service.
11
Charge
The Charge column displays the total charges from the provider for the selected transaction.
12
Patient Owed
The Patient Owed column indicates the amount owed by the patient.
13
Patient Paid
The Patient Paid column displays the total amount paid by the patient.
14
Insurance Paid
The Insurance Paid column displays the amount paid by the insurance carrier.
15
Insurance Adjustment
The Insurance Adjustment column indicates the amount of the insurance adjustment that was written off for a particular CPT code.
16
Total Collected
The Total Collected column indicates the total amount paid by the insurance carrier and the patient.
17
Insurance Balance Calculated
The Insurance Balance Calculated column indicates the amount remaining to be paid by the insurance carrier for the indicated transaction.  
18
Patient Balance Calculated
The Patient Balance Calculated column indicates the amount remaining to be paid by the patient for the indicated transaction.  
Version 14.10

When to Use this Report

The Reimbursement Analysis report is commonly used for Payment history by CPT, Insurance payment monitoring, and Payment history by provider.  

About Reimbursement Analysis

Path: Reports Menu > Reimbursement Analysis (Keyboard Shortcut keys: [Alt][R][R])

The Reimbursement Analysis Report is a summary of billing data. It is best used when determining the average reimbursement of CPT codes. The data in this grid reflects the transactions that have been posted. The data selection can be based on a range of dates by either date of service or posted date. Only charge transactions are shown. Payment and adjustment transactions that have been applied to a charge are shown as summarized totals.


Note: More columns are available in the data grid than shown in the map below. The map only describes the columns displayed in the map. To see the total list of columns, select the column selection icon in the upper-left area of the grid ().

Reimbursement Analysis Map

Number
Section
Description

1

Analyze tab
The Analyze tab displays the claim billing data based on the selected search criteria. Each CPT has only one entry. All payments and adjustments are summarized on that single entry.

2

Under the hood tab
The Under the Hood tab provides a description for the Reimbursement Analysis report.

3

Date Range
The Date Range sets the date range for the displayed report.

4

Reference Date
The Reference date field sets the type of data to display for the selected date range. These selections include:
  • Charge/payment date: Charges are reported according to their charge date (usually date of service) and payments and adjustments according to their payment date (which can be backdated at the time of posting).
  • Posting (entry) date: This report accesses charges, payments, and transactions that have a posting date within the time frame selected. NOTE: This date is time stamped from the local computer where the user is posting payments and does not take into consideration the date of service for charges or any backdating done when posting payments.
  • Daysheet date: This report accesses charges, payments, and adjustments according to the date they were processed on a daysheet.

5

Paid Status
The Paid Status field determines the type of charges to be displayed. These selections include:
  • Fully paid: Returns all charge rows that have been fully paid either by insurance, patient, or both.
  • Ins paid: Returns all charge rows that have been fully paid by insurance.
  • Pat paid: Returns all charge rows that have been fully paid by the patient.
  • All: Returns all charge rows. This provides totals for patient and insurance paid and balance columns.
  • Ins Owes: Returns all charge rows that have an insurance balance owed.
  • Pat Owes: Returns all charge rows that have a patient balance owed.
6
Refresh Grid button
The Refresh Grid button displays the latest data in the grid based upon the Reference Dates and Report Reference Criteria filter selections.

7

Search Report Template
The Search Report Template creates a search template, saves a search template, and deletes a selected search template for a report.
8
Print/Export functions
The Print Grid and Export buttons are used to print the grid (using the Print Grid button) or Exporting the data to Excel (using the Export button).

9

D.O.S.
The Date of Service (D.O.S.) column lists the date of service for the indicated transaction.
10
CPT
The CPT Code column lists the medical code for the visit on the date of service.
11
Charge
The Charge column displays the total charges from the provider for the selected transaction.
12
Patient Owed
The Patient Owed column indicates the amount owed by the patient.
13
Patient Paid
The Patient Paid column displays the total amount paid by the patient.
14
Insurance Paid
The Insurance Paid column displays the amount paid by the insurance carrier.
15
Insurance Adjustment
The Insurance Adjustment column indicates the amount of the insurance adjustment that was written off for a particular CPT code.
16
Total Collected
The Total Collected column indicates the total amount paid by the insurance carrier and the patient.
17
% Charge Paid
The % Charge Paid column indicates the percentage of the CPT charge paid versus what was written off as an adjustment.
18
Insurance Balance Calculated
The Insurance Balance Calculated column indicates the amount remaining to be paid by the insurance carrier for the indicated transaction.  
19
Patient Balance Calculated
The Patient Balance Calculated column indicates the amount remaining to be paid by the patient for the indicated transaction.