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Most people think of one type of account. They want a charge report, but there is a lot of different kinds of charge reports. There are summary reports and detailed reports. They are all different.
Most people do not think about how reports get created, the criteria, what records get pulled, what gets included, what the fields get fit, but these are all essential. Even just understanding what those individual fields mean, like “What does a particular date mean?”, “What does submit date mean?”, “Does submit date mean first to submit?”, “Does it mean last submit?”, “What does that mean?”, “If you have submitted dates for a primary and a secondary, does one overwrite the other when you get the claim submitted again to the secondary?” These are all things that are very important to understand if you want to utilize the data you are generating effectively.
Looking at reports by data service for charge versus submit date is also essential. It depends on your goal, what question you want to get answered.
Meaning of charge reports
Suppose you are looking at a charge report by data service. In that case, often, the primary question that people are trying to answer is to do reconciliation, meaning you intend to compare the patient encounters that you had during a particular period with what got entered into the billing system, charge reconciliation. We saw a patient; did he get into the system? Often, the best way to do that is to run a charge report by data service. You saw a certain number of patients, whether those are clinic visits, whether it is surgeries, whatever it might be on a particular date, and you can reconcile to everything that happened on that date.
What is the significance of the submission date?
The submission date is more often than not about cash flow prediction. If you want to know how much revenue you are likely to generate in an upcoming period, a good predictor of that, what is highly correlated, is the number of charges that went out the door. Of course, orders submitted correlate but are not always really closely related to the number of encounters you had. So a submission date is essential. Data service is necessary. They are very different reports.
Again, all this comes down to what you are trying to figure out. If you want to look at the cycle time, meaning “How fast are claims getting entered in the system?” or “How fast are claims getting out the door?”, typically, again, that is charge detailed, based on submit date. You can calculate all those things based on those fields, but you need to make sure you have the correct areas in that report.
If you want to do cycle time, typically, we suggest having the receive date. You have data service, you have receive date, which means the date the information got received: that might be when an operative report was put in the system by a physician. It could be when the data came over from a clinical approach to a billing system. Then, you have an entry date. That may be the same date, mainly if it is auto-load if there is an interface. Sometimes, those things post overnight, or it takes some time to reconcile, or some other issues, but then you have an entry date. Then, you have a first submission date. Then, you have subsequent submit dates or the last receive or submit data. We suggest tracking all of those things if you want to look at cycle time.
Significance of charge reports
If you want to track something like marketing and work overall, charge reports can effectively do that. You can see whether or not the encounters are increasing over time, whether chart dollars are growing over time.
- Even if revenue is dropping or staying static, you would want to look at that on an encounter basis rather than a dollar basis. It is possible that reimbursement is decreasing while patient volume is increasing. You can roll things up to an encounter level and determine the number of encounters and the number of new patient IDs and medical record numbers. It is essential to count the number of unique patient IDs. It can be very effective in looking at whether your marketing is working.
- Of course, ideally, you would want to be able to include referral sources in there like a referring physician or something else, if that is involve in that process, because again, that can tie out to your salespeople and other things, but that is another whole discussion. That is an entirely different use of charge reports.
- Understanding the question you want to answer in the report is probably the most critical thing you can do. Really focusing on saying, “Hey, this is what we try to answer,” and then identifying what report and then what fields will give you that information, and then having a good feedback loop where you run the analysis. If it does not answer how you want, add additional fields, run a different report, do joins, whatever it is, get the information you need is significant.
- Run something by submit date, and it did not get introduced yet, so if you run a detail charged report based on submit date, it should be something unique. Typically, it will not show up in that report, which means it is just completely missing. You cannot reconcile that, of course, because it is not visible. One always needs to be careful of what is missing from a report that you do not know is missing. So, quality control in tying out pieces is also really critical for success in revenue cycle management.
That is a little summary of some of the different uses of charge reports. And what types of essays and fields you would want to be successful in answering those questions.