4. Keep Track of Outstanding Claims
The insurance biller's job would be easy if your demographic and insurance plan information was flawless, insurance companies always paid on time, and payors never rejected claims. Unfortunately, claims are not always paid, and insurance carriers do not always send you an explanation. Therefore, you need tools to track and work-down your outstanding claims. Two standard Partner reports, insaging and inscoar, are a good place to start.
4.1. The Insurance Company Aging Report (insaging)
4.1.1. Introduction: insaging, the A/R Summary
The insaging report shows you an aged summary of your practice's outstanding charges broken down by insurance group. It is a helpful collection tool that can show you which carriers owe you the most money and how old those balances are. insaging is also a quick way to see your total A/R, and it will help you determine which insurance carriers need follow-up attention.
When used in conjunction with other reports, like inscoar and activity, insaging helps explain the state of your receivables. You will be able to compare carriers and see how each one contributes to your total outstanding account receivable. For example, knowing that an insurance company comprises 25% of your total receivables, yet only represents a fraction of your patients, may be useful information the next time you review the payor's contract.
Sample Problems for insaging
Find out the total amount pending the Acme Insurance Group and how much of that amount is over 120 days old.
Compare your Account Receivables month after month and see if you are making progress with your collections.
Identify problem carriers that need special attention; identify carriers that you may need to resubmit HCFAs to before a submission deadline passes.
4.1.2. insaging Basics
You can find the insaging report in the "Insurance Billing" section of the "Billing Functions" window in your Partner Windows. You can also run it by typing insaging at a command prompt.
From the configuration screen, press [F1 -- Generate Report] to view the report. For report configuration options, see below.
Here is a sample insaging output:
Insurance Company Aging Report Generated on 06/01/00
By Transaction date, As of 05/31/00
All Providers
Current 30 - 59 60 - 89 90 - 119 120+ Total Perc
------------------------------------------------------------
Personal 3,515 9,410 12,994 9,408 24,342 59,671 32%
Other 7,357 777 399 0 0 8,534 4%
Anthem 361 230 0 0 0 591 0%
Aetna 3,392 2,011 0 0 0 5,403 2%
Aetna/HMO 2,542 171 105 0 0 2,818 1%
Affordable 1,185 497 171 0 0 1,853 1%
BCBS 4,652 1,024 385 0 0 6,062 3%
CIGNA 9,016 1,228 466 1,736 1,846 14,294 7%
HARRIS 1,544 1,015 215 24 0 2,798 1%
HUMANA 5,056 855 89 2,973 1,363 10,336 5%
Medicaid 829 41 0 0 0 870 0%
ONE Health 1,089 782 51 0 0 1,922 1%
PHCS 8,089 2,716 336 0 0 11,142 6%
. . . . . . . .
. . . . . . . .
. . . . . . . .
UNITED 5,897 793 331 3,370 1,685 12,076 6%
------------------------------------------------------------
Total 69,922 26,034 18,421 20,323 47,055 181,757
Percentage 38% 14% 10% 11% 25%
Total Aging 181,757
Personal Credits across entire practice 57,127
Medicaid Credits across entire practice 0
----------
Total A/R 124,629 |
Your practice's accounts receivable is shown subtotaled by insurance group, including a "Personal" group for outstanding personal charges. For each group, insaging lists the outstanding A/R that is "Current" or less than 30 days old, 30-59, 60-89, 90-119, and over 120 days old. The total outstanding balance and the percentage of your practice's total A/R are also listed. The report totals your A/R in each of the aging categories and also notes outstanding personal and Medicaid credits listed on the system.
 | All numbers are rounded to the nearest dollar amount. |
| Evaluating Insurance Companies |
|---|---|
Comparing the "Percent of Total A/R" column with the percentage figures from the activity report will allow you to see when an insurance group's percentage of your total outstanding balance do not line up with its percentage of your office's workload. This can help identify "good" and "bad" payors. |
4.1.3. Configuration and Customization Options for insaging
You can change how the report ages receivables, ask Partner to recalculate aging to a different date, limit the report to a specific provider, and make many other changes. Here is the options screen you will see when first running insaging:
Aging Options
Aged How?
By default, insaging calculates the age of your A/R by the "Transaction Date."
You can set insaging to age by "Posting Date", which is when each charge was entered into your system. This will change the amounts in the report's aging categories if your office often posts visits long after they occur.
Finally, you can choose to age by "Payor Date," which ages by the date each balance became the current carrier's responsibility. For example, charges that have recently been forwarded to a secondary insurance will appear as "Current" even though the transaction occurred more than a month ago.
Aged as of what date?
Since aging calculations involve every charge on your system, they are performed each night and stored in a "Nightly File". insaging uses the previous evening's Nightly File by default. You can tell insaging to regenerate a file representing unpaid charges aged to any date you prefer. Once you have regenerated an aged nightly file, you can select that report again by choosing the "Use Existing File..." option.
Output Options in insaging
Destination
Choose whether you want to view the report on your screen, mail it to your e-mail inbox, or print it on a specified printer.
When To Run
Run the report "Right Now" and have your terminal wait for the job to finish, run it "In The Background" so you can go on and do other things at the same time, or schedule the job to run "Later At" a specified time.
Generate...
You can include charges for all providers, or select individual providers or a provider group. PCC can help you set up any provider group you would find useful for A/R Analysis.
As with aging, all credits are assigned (by default) to the Office provider. If this provider is not included when the report is run, then no credits will be reported.
Understanding and Configuring Insurance Groups in insaging
insaging tallies charges by the plan they are pending. Charges that do not pend an insurance company are totaled in the Personal line of the report.
If you see a blank line in the middle of the insaging report, there is an active insurance group in the Table Editor (ted) with no plans assigned to it.
Use the byins program to review how your insurances are grouped. Edit your Insurance Companies and Insurance Groups tables in ted) to regroup plans if necessary. For example, you may want to consolidate two insurance groups with very few plans and little activity, or you may choose to break up an insurance group if it represents a large portion of your business and you want to track it more closely.
4.2. The Insurance Company Accounts Receivable Report (inscoar)
4.2.1. Introduction: inscoar, Accounts Receivable Detail and Work-Desk
The inscoar report provides a detailed charge-by-charge accounts receivable for your insurance companies. Use inscoar to find insurance charges that have not been paid and to work down old, overdue charges. Interactive inscoar is a great work environment from which you can research billing history, make changes, and resubmit claims.
4.2.2. inscoar Basics
You can find the inscoar report in the "Insurance Billing" section of your "Billing Functions" window in your Partner Windows. You can also run it by typing inscoar at a command prompt.
From the configuration screen, press [F1 -- Generate Report]. For an interactive report or to learn about special report options, see below.
Here is a sample inscoar report:
ACCOUNTS WITH BALANCES PENDING AETNA $10 (1-800-123-4567)
Peterson, Elizabeth (ID: 81343492, Grp: M53043)
PARTNER: Peterson, Elizabeth
Peterson, Mark (09/28/95)
01/22/96 OPV #2 90712 V20.2 $ 14.00
01/22/96 PREV. EST. NB-1 YR 99391 V20.2 $ 24.40
01/22/96 ACT/HIB #2 90720 V20.2 $ 43.60
-----------
$ 82.00
===========
TOTAL: $ 82.00
ACCOUNTS WITH BALANCES PENDING BCBS (1-800-999l-1101)
Klein, Matthew (ID: WR-343 3453633, Grp: ER9909)
PARTNER: Klein, Matthew
Klein, Amanda (03/03/92)
09/07/95 X-Decadron 90782 464.4 $ 20.00
09/07/95 3 LEVEL, OV, EST. PATIENT 99213 464.4 $ 55.00
11/15/95 QUICK STREP 86403 034.0 $ 29.00
11/15/95 3 LEVEL, OV, EST. PATIENT 99213 034.0 $ 40.00
-----------
$ 144.00
Sullivan, Jeanette (ID: HRH55, Grp: 875286)
PARTNER: Sullivan, Candy
Sullivan, Charlie (11/18/90)
09/27/95 OV, LEVEL 3, NEW PATIENT 99203 473.9 $ 87.00
09/30/95 Throat Culture 87081 382.9 $ 19.00
09/30/95 QUICK STREP 86403 462 $ 29.00
09/30/95 3 LEVEL, OV, EST. PATIENT 99213 382.9 $ 55.00
-----------
$ 190.00
===========
TOTAL: $ 334.00
. . .
. . .
. . .
REPORT TOTAL: $ 9140.38
These insurance companies had no pending charges within the date range:
AFFORDABLE, AMERICAN HEALTH, BCBS $10, EMPLOYERS HEALTH, MEDICAID, TRAVELERS $10,
TRAVELERS $15, TRAVELERS $5, TRAVELERS, USHC |
Every account with unpaid insurance charges appears on the report. The accounts are sorted by the insurance company to which their charges are pending. inscoar shows you the insurance company's name and phone number. With each account name, you can see the family's insurance ID number and group number. The patient name, procedure dates, names, codes, and primary diagnoses codes are all shown, along with the outstanding balance information.
| Working With Insurance Companies |
|---|---|
Because the report shows insurance ID information, full procedure information, and the insurance company's phone number, inscoar is a great report for working down old, unpaid claims. |
| Interactive inscoar |
|---|---|
With the Interactive option, you can jump straight from this report into more information and different Partner programs, making inscoar an even more powerful insurance billing tool. See below to learn more. |
4.2.3. Configuration Options and Tools
You can choose the age of receivables you wish to review, limit the report by insurance company, provider, or place of service, and make many other configuration choices that change the output of inscoar. Here is the options screen you will see when first running inscoar:
Output Options for inscoar
Send report to:
You can view the inscoar report on the computer screen, print it out, or have it sent to your e-mail inbox. You can also view the report as an "Interactive Screen," which allows you to work on the charges as you review them.
Criteria Options for inscoar
Age of Receivables:
You can limit the inscoar report to only those charges that are over a certain age, those that within a certain age range, or those that occurred during a specific date range. Using these options, you could, for example, choose to view only insurance charges that are nearing the end of a particular carrier's timely filing limit.
All Insurances?
If you enter "No," you will be prompted to select insurance plans or groups that you wish to view. Otherwise, you will see all insurance plans that have outstanding charges. This option is useful if you are dealing with a particularly poor payor.
All Servicing Providers?
If you enter "No," you will be prompted to select providers or provider groups for which you wish to view charges. The default of "Yes" will run the report for all providers that have any outstanding charges.
All Places of Service?
If you enter "No," you will be prompted to select the place of service for which you wish to view charges. The default of "Yes" will run the report for all places of service for which there are outstanding charges.
Include Personal Charges?
Change this item to "Yes" if you wish to view all charges, regardless of whether they pend an insurance carrier or are the guarantor's responsibility. In this way, you could analyze personal charges at the same time as insurance charges.
Formatting Options for inscoar
Show Batch HCFA Dates?
Change this item to "Yes" if you want the date the charges were batched to show in the report. This may be useful when dealing with old charges that have been resubmitted several times.
List Insurances with no pending charges?
By default, inscoar will create a list at the bottom of the report of insurance plans that meet your criteria but do not currently have any outstanding charges pended to them. Change this option to "No" to suppress the list.
Suppress page breaks when printing?
Change this field to "Yes" if you wish to print the report in one long section. By default, inscoar prints different insurance plans to different pages for your convenience.
Extra Information To Show:
Use these settings to show the information from the four boxes in the Patient Editor (notjane) on the report. For example, if your office stores insurance ID# information in one of those boxes, it may be useful to have that information on your inscoar report.
4.2.4. Interactive inscoar
The inscoar report has lots of useful information. In addition to reading the report and using it to call insurance companies, you can perform a wide range of functions while viewing inscoar. You can research account history, correct and resubmitting problem claims, and add notes to the patient or account. These features and more are available through the "interactive" inscoar output.
To access the advanced, interactive features of inscoar, check off the "Interactive Screen" option on the configuration screen:
As with other output settings, you can modify the other options on the screen, such as the "All Insurances?" option, to limit what portion of your A/R you will view interactively.
When you run the report, you will notice a significant change:
Every item on the report, whether an insurance company, an account, a patient, or a charge, has a selection box at the left hand side of the screen. Function keys at the bottom of the screen let you show or hide additional information, work with an item, or move around the report by searching.
4.2.4.1. [F1 -- Show More Info]
When you select an item and press [F1 -- Show MoreInfo], the report expands to include additional information about that item. If you have selected an insurance company, you will see that company's address, insurance table number, and copay information. If you select an account and press F1, you will see all of the account's contact information and active insurance plans.
Finally, when you select a procedure and press [F1 -- Show MoreInfo], you will see complete information about the charge:
If you then select "View Charge History" and press F1, you will see billing history messages about the charge:
Press [F2 -- Hide MoreInfo] whenever you wish to collapse or hide the extra details.
Using just the "Show More Info" option in interactive inscoar, you can already see an advantage over printing the report when trying to untangle a difficult billing problem.
4.2.4.2. [F4 -- Work With Entry]
What if you call the insurance company about a claim listed on the report, and they want to know more details about the patient? What if they explain the problem, and you then need to correct a diagnoses code and resubmit the claim? You can do all of this from within interactive inscoar by using the "Work With Entry" function. You can also use this tool to reach any information stored in Partner about any patient or account listed on the report.
To start, select any item on the screen that you wish to work with. Then press [F4 -- WorkWith Entry].
Work With What Kind of Entry?
Insurance Plans. Select an insurance plan and press F4 to view the plan's entry in the insurance table in ted, the Table Editor. From there you can review plan information, claim batch, plan notes, and other data.
Account Name. Select an account name and press F4 to run the Family Editor (fame). From there you can view collection and account history reports, add notes about your interaction with the insurance company, review insurance information, and perform many other functions.
Patient Name. Select a patient name and press F4 to view an interactive "Patient Information" screen:
From this screen, you can do the following:
Select any item listed and press [F1 -- Show MoreInfo] to view further details.
Press [F3 -- Edit Patient] to run notjane.
Press [F5 -- Imms Record] to jump straight to the patient's immunizations.
Press [F6 -- Schedule Patient] to run sam, from which you can schedule a new appointment or review past and upcoming appointments in inquire.
Press [F7 -- Patient Forms] to generate form letters for the patient.
Procedures. Select a charge or procedure and press F4 to view an interactive "Visit Information" screen:
Select any item listed and press [F1 -- Show MoreInfo] to view further details. This is especially useful when viewing existing billing messages in the "Billed/Payment History" section shown above.
Press [F3 -- Refund] to run refund. You can use refund to post refunds or any accounting adjustment that takes money away from an account or increases its balance.
Press [F4 -- Pam] to run pam, the Payment Posting program. Use pam to post personal payments or any accounting adjustment that reduces its balance.
Press [F6 -- Correct Mistakes] to run oops, the Correct Mistakes program. Use oops to modify charge information, such as diagnoses and claim information, as well as for printing or batching a new claim.
Press [F7 -- Post Charges] to run chuck, the Charge Posting program. Use chuck to post additional charges or repost a charge that you deleted in oops.
Press [F8 -- Family Editor] to run fame, the Family Editor. Use fame to review account history, insurance policies, or other account information.
| When you are finished working with an entry, press F12 to go back one screen. You can repeatedly press F12 and move back through each screen, all the way to the original inscoar configuration screen. |
4.2.4.3. [F5-F8] -- Searching For Items
Depending on the criteria you used, your Interactive inscoar report may be very long. Use the four search function keys (F5 through F8) to navigate the report and jump directly to the account or insurance with which you wish to work.
In the example below, a user wanted to review information for the the account of David Inzana.
Searching Through Interactive inscoar
Press [F5 -- New Pattern]
Enter the Search Pattern
Type in the desired account, insurance name, or other criteria. Press [F1 -- Process] to continue.
Work With Results
There will be a brief pause as inscoar finds the information you entered.
You will then see the first matching name or item matching your search criteria:
You may use all of the usual Interactive inscoar tools to work with this account, patient, or charge.
Optional: Press [F6 -- Next Match]
If there are several matching entries, you can use F6 and [F7 -- Previous Match] to rotate through all instances of your search.
Optional: Press [F8 -- Bop to Top]
If you get to the end of the report and wish to jump to the top and repeat the search, press F8.
4.2.5. Conclusion: Work Down Old Insurance Charges
The inscoar report is the perfect tool for reviewing details about your insurance accounts receivable. Not only does it gather all the needed information into one place and allow you to generate lists limited by various criteria, inscoar can also create an interactive report that helps you make changes and jump to other Partner programs as you deal with problem claims.
For more help with inscoar or any other Partner program, contact PCC support at 1-800-722-1082 or support@pcc.com.