Executive Summary Calculations

Executive Summary Calculations

The Executive Summary Report provides Monthly totals incorporating key revenue cycle KPI components, broken down for each month over a 12 month reporting period.

  1. Net Payments: The Dollars Posted for the selected time period, not the Dollars Received.
  2. Payments and Receipts are fundamentally different and will not be reported the same. 
    1. Learn more: Receipt vs. Payment Information

 Twelve-Month Calculation   

  • Calculated by Post Date.

  • The calculation is the same as the Practice Analysis Report when run by the same criteria.

  • Beginning & Ending A/R (Charges, Payments, Adjustments, and Write-offs).

    • Calculation of Ending A/R: Beginning A/R plus Charges minus Net Payments minus All Adjustments

    • The Beginning and Ending A/R are available on the A/R Analysis Report.

  • Work RVUs

  • To Collections (Net): Write-offs (WOCOL) and Reversal of Collections (WOPR)

  • # of Patients: The Patient is counted once even if the person has had more than one Encounter during the specified period.

  • # of Encounters

  • # of Visits: The number of Visits is calculated by a distinct Date of Service.

  • Average Patient Charge (APC): Charges divided by the # of Patients.

  • Average Patient Revenue (APR): Net Payments divided by the # of Patients.



6-Month Review

Starting with the current month, a Lookback of 6 months and a Lag Time of 3 months:

Current Month: July 2022

  • Lag Time
  • July = Month 0
  • June = Month 1
  • May = Month 2
  • April = Month 3 (Lag Time)
  • Lookback Period 6 months: Starting with April count back 6 months. (April to November)
  • April 2022
  • February 2022
  • January 2022
  • December 2021
  • November 2021

For all of the 6-month Lookback Review KPIs used as examples below, these parameters will be used:

  • Report is run through July 2022
  • Lookback Period: 6 months
  • Lookback Lag: 3 months
  • November 2021 to April 2022
  • Includes only Zero balance Encounters
  • Charges = 326,362.85
  • Posted Payments = 319,168.30
  • Refunds = 0.00
  • Posted Allowed Amounts = 305,199.50
  • CO45 Adjustments = 742.59


Calculated Allowance Rate

The Calculated Allowance Rate is the percentage of Contractual Adjustments.


Calculation

  1. (Charges minus Adjustments) divided by Total Charges or Allowed amounts divided by Total Charges

Example

  1. (Charges - CO45 Adjustments) / Total Charges x 100 = Percentage Allowance Rate
    1. (326362.85 - 742.59) / 326362.85* 100 = 99.8%
  2. CO45 Adjustments / Total Charges x 100 = Percentage of Contractual Adjustments
    1. 742.59 / 326362.85 x 100 = 0.2%




Net Collection Rate

The Net Collection Rate shows the effectiveness of your practice at collecting the reimbursements that are Allowed. The goal is to get this KPI as close to 100% as possible. This KPI is generated by DOS, so for the reporting month you are seeing Encounters that fall within the Lookback Period and all Payments posted against those Charges.


Calculation

  1. Net Payments (payments minus refunds) divided by posted Allowed amounts.

Example:

  1. Payments - Refunds / Posted Allowed Amounts
  2. (319,168.30 - 0.00) / 324,358.00 * 100 = 98.4%
  3. The Net Collection Rate is 98.4%  (97.9)




Gross Collection Rate

The Gross Collection Rate is a comparison of your fees to what you were actually paid. A high Gross Collection Rate means your fees are close to the amount payers have paid.

Calculation

  1. Net Payments (payments minus refunds) divided by Charges.
  2. This KPI is generated by DOS, so for the reporting month, you are seeing visits that were performed in that month and all payments posted against those charges.


Bad Debt Ratio Calculation

  • Write-offs for the reported month divided by Average Posted Allowed amounts of the lookback period.




Days in A/R

Your Average Days in Accounts Receivable or “Days in A/R” is the average time that it takes for a service to be paid by a responsible party. Calculating days in A/R shows the efficiency of your billing process.

  1. The example reveals a problem with the Claims being paid in a timely manner.

Days in A/R = Accounts Receivable divided by Average Amount Charged in One Day


Accounts Receivable: (Charges - Payments - Adjustments - Write-Offs + Refunds +/- Transfers)

Average Amount Charged in One Day: ((Sum of Charges in Lookback Months) divided by (Billing Days)).

  • 196,568.43 / (810,735.74/365) = 195,486.23 / 2221.19 = 88 Days


What Part of the Workflow is the Problem?

The sections below can reveal where the workflow is lacking so that it can be addressed.
  1. Is it taking too long to Add, Complete, or Submission of the Charges?
  2. Is there a problem with Rejections from a specific Payer?
  3. Is there a problem with a specific Provider?
  4. Are there too many Claims that are not being accepted at the Clearinghouse level?
Average Days to Add

This is the Average number of days that it takes to add the Charges after the Dates of Service.

  1. The difference of the Days from the Date of Service to the Date Added (Posted) is summed for all Encounters posted for the month and divided by the Total number of Encounters posted for the month.
  • Example for the month of October:
  • Encounter 1
  • Date of Service: 10/29/22
  • Added (Posted) Date: 10/31/22
  • Days to Add: 2
  • Encounter 2
  • Date of Service: 10/28/22
  • Added (Posted) Date: 10/31/22
  • Days to Add: 3
  • Encounter 3
  • Date of Service: 10/30/22
  • Added (Posted) Date: 11/01/22
  • Days to Add: 2
  • Calculation: Sum of "Days to Add" (2 + 3) divided by 2 Encounters
  • Average Days to Add: 5 divided by 2 = 2.5 Days
  • Encounter 3 was not included because it was posted in November, whereas, Encounter 1 & 2 were posted in October.


Average Days to Complete an Encounter

This is the Average number of days from the Added Date to Charge Completion.

  1. The difference of the Days from the Date Added to the Completion Date is summed for all Encounters posted for the month and divided by the Total number of Claims Posted for the month.


Average Days to Bill an Encounter

This is the average number of days from the Added Date to the Billed Date.

  1. The difference of the Days from the Date Added to the first Claims Submission Date is summed for all Encounters posted for the month and divided by the Total number of Claims Submitted to the Clearinghouse for the month.


Average Total Days to Bill an Encounter

This is the Average number of Total Days from the  Date of Service to the Billed Date.
  1. The difference of the Days from the Date of Service to the first Claims Submission Date is summed for all Encounters posted for the month and divided by the Total number of Claims Submitted to the Clearinghouse for the month.


Charges Billed within 48 hours

This is the number of charges that are sent to the clearinghouse within 48 hours based on the service date and the date billed (submitted).

  1. Billed Within 48 Hours = Number of Charges with: (Charge Date of Service - Earliest Date Sent to Clearinghouse) less than or equal to 2 divided by Total Number of Claims Sent multiplied by 100.


Clean Claim Rate: Clearinghouse

This is the percentage of Claims sent to the Clearinghouse that were accepted by the Clearinghouse on the first Submission.

  1. Total Number of Claims Sent minus the Number of Claims Rejected by the Clearinghouse divided by the Total Number of Claims Sent multiplied by 100.


Clean Claim Rate: Payer

This is the percentage of Claims sent to the Payer that were accepted by the Payer on the first Submission.
  1. Total Number of Claims Sent minus the Number of Claims Rejected by the Payer divided by the Total Number of Claims Sent multiplied by 100.




Section Panel

Use the check boxes in the Sections Panel to include them in the Executive Summary Report.



Activity by Claim Filing Indicator (CFI)

Select the Activity by CFI check box to include a comparison by CFI of the Current Year to the Previous Year.


Activity by Insurance Reporting Group

Select the Activity by Insurance Reporting Group to include the comparison of the Current Year to the Previous Year.



Aging by CFI

  1. By Bill Date


  • By Post Date



Aging by Insurance Reporting Group

  1. By Bill Date


  • By Post Date



    • Related Articles

    • Executive Summary Report Overview

      Executive Summary Report The Executive Summary Report provides Monthly totals incorporating key revenue cycle KPI components, broken down for each month over a 12 month reporting period. Report Features Beginning & Ending A/R (Charges, Payments, ...

    • Why use the Executive Summary Report?

      Why should you care about using a report to identify Key Performance Indicators? Performance can be measured over a specific time period Staff transparency and accountability Identifies problem areas Increased Revenue Better overall delivery of care ...

    • Charge Summary Report

      Charge Summary Overview The Charge Summary Report is found on the Reports Dashboard. Use Filters and Reporting Groups to determine the information that appears on the Report. Use the Save Report Filters to retain the same filters for running later. ...

    • Estimator Criteria and Calculations

      Patient Responsibility Estimator Criteria As more information is entered into the Estimator, the higher the potential confidence level for the Estimate. Patient/DOS A Patient and DOS are required to evaluate Estimation. This will be used to ...

    • Practice Analysis

      Practice Analysis This is one of the most used reports in the System due to the output calculations and the ability to create multiple Group By levels. Report Features Date Type allows reporting by Post Date, Date of Service, or on an individual ...