View the Account Worklist
The Account Worklist displays accounts that meet your selection criteria. Using links in the worklist, you can drill down to detailed account and contract information and return to the worklist at any time. You can create worklists for both products or contracts.
Procedure
- Access the Account Worklist page:
- Select Go To > Account Research > from Worklist. The Account Research from Worklist page opens.
- From the Task list, select Create Worklist.
- Specify other selection criteria and click Display Accounts. The Account Worklist page opens. For more information about search criteria, refer to Specify Account Worklist Criteria
- Review the Account Worklist.
- Note that flagged accounts have a white rather than pale yellow background.
- An asterisk (*) appears next to the number in the No. column for an account to which an override was applied and the reprice was completed.
- For accounts with non-covered charges, the non-covered charges are subtracted from the billed charges and expected discount.
- To view the Patient Account Audit page for a particular account, click the account number in the Account Number column. For more information about the Patient Account Audit page, refer to View the Patient Account Audit Page
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- The Reprice Type column shows you the type of reprice that was performed for each account to help you differentiate accounts with the same account number.
- The number of claims or accounts associated with the account number display in parentheses. For example, if there are two claims with the same account number, the account number displays as “012345678 (2).”
- If Coordination of Benefits (COB) is enabled for your facility, the number of payors and accounts associated with the account number display in parentheses. For example, if there are two payors and three accounts associated with the same account number, the account number displays as “012345678 (2,3).”
- For more information about COB, refer to Coordination of Benefits.
- To display the Worklist Summary page for your current selections, click the name of the product in the Product field in the Selection Criteria section. For more information about the worklist summary, refer to View the Worklist Summary .
- The bottom of each page of your worklists results provides totals for that page in the Totals for Page row. To view grand totals for the entire worklist, go to the last page of your worklist results and click Display Grand Totals at the bottom of the page.
- To change your current view options:
- Select one of the following options from the View list.
- Select Single Line, which is the default view, to view one line of information per account.
- Select Details to display a more detailed view of the worklist (which includes the patient service dates, the earliest claim submission date, earliest payment date, service type, plan name, FinThrive processing date, and other information).
- Click Refresh View.
- Select one of the following options from the View list.
- To change you sort options to sort by a different column or in a different order:
- Select the name of the column you want to sort by from the Sort By list.
- Select whether you want to sort in Ascending or Descending order.
- Click Refresh View.
- To flag an account so that it appears as a flagged account and is included in worklists that only include flagged accounts:
- Select the check box to the left of the account number to mark it for flagging. You can mark up to 5 accounts at a time.
- Click Flag Account to display the Assign/Update Collection Information page. For more information about this page, refer to Assign / Update Collection Information.
- Click + (to the left of the account number) to expand the options. The Flag Account check box is already selected.
- Click Save Changes to save the flag.
When you flag an account, the background for that account turns white once the page is refreshed. The background also turns white on the Assign/Update Collection Information page, and a green check mark appears in the column to the left of the + column on the Comment line to show that the account is flagged.
- To remove the flag on an account:
- Select the check box to the left of the item in the worklist.
- Click Remove Flag. The Assign/Update Collection Information page opens.
- Click + (to the left of the account number) to expand the options.
- Clear the Flag Account check box.
- Click Save Changes to remove the flag.
- To export your worklist to an Excel or text file, click Export. The Account Worklist Export Options page opens. For more information, refer to Specify Account Worklist Export Options.
- The following columns also contain hyperlinks that let you drill down into additional information for a selected account:
- Click a link in the Service Type column to display the View Contract Profile page and view the service type details for the contract profile. For more information, refer to View a Contract Profile.
- Click the REIM link in the Service Type column to display the details of the most recent, non-reversal claim for the account.
- The Expected Reimbursement Detail page displays in a separate window that you must close to return to your account worklist.
- When you access the Expected Reimbursement Detail page from the Account Worklist, some of the hyperlinks on this page are unavailable. To access this page with all of the features enabled, you must access it from the Patient Account Audit page. For more information, refer to View the Expected Reimbursement Details and View the Patient Account Audit Page .
The REIM link is disabled for any account that is included in a PEM claim.
- Click a link in the DRG/APC/CMG column to view a description of that code.
- Click a link in the Bill Type column to open the Billing Type Definition page for a description of the selected bill type.
- Click a link in the Message Code column for a description of that message code.
- Click a link in the Patient Liability column to override the patient liability for the selected account. For more information, refer to Override Patient Liability.
Field DescriptionsThe following table describes each of the fields on the Account Worklist page. The fields are sorted by section and listed in alphabetical order.
Field | Description |
Submitted Criteria | |
______ Date | Date range for your query. The type of date that displays is determined by your selection in the Date Type field. For example, if you selected “Submit Date,” this field displays as “Submit Date” and shows the selected date range. |
Account Category | Types of account(s) to search for |
Contract | Name of the contract profile |
Flag Display | Whether or not flagged accounts are shown |
Patient Type | Patient type assigned to the account: Inpatient/Outpatient |
Payor Class | Payor class associated with the account, either Primary, Secondary, or Tertiary. This option is only available if COB is enabled for your facility. For more information about COB, refer to Coordination of Benefits. |
Plan Ids | Plan IDs included in the worklist |
Product | Name of the insurance product |
Service To Date | Date range for claim Service To dates |
Sorted By | Order in which the results are sorted |
Optional Submitted Criteria | |
Additional Amount | Specifies the criteria of (greater than, less than or equal to) account balance, actual discount, actual payment, expected discount, insurance payment, billed charges or patient payment AND/OR (greater than, less than or equal to another amount) |
Day Filter | Indicates the type of day filter selected as search criteria and the parameters defined for that filter, such as “Days to Payment Greater than 30 Days.” The available day filters include the following: Days to Payment – The difference between the submit date of the claim and the date of the initial payment Days Outstanding – The difference between the submit date of the claim and today’s date Length of Stay – The length of stay for the claim, in days |
Denial Amount | The criteria of (greater than, less than, or equal to) the denial amount. This field only displays if your facility is set up for Contract Manager Denial Management. For more information, refer to Denial Management Methodologies. |
Denial Resolution | The specific denial resolutions included in the search; options include All, Resolved, and Open. This field only displays if your facility is set up for Contract Manager Denial Management. For more information, refer to Denial Management Methodologies. |
Denial Type | Specifies the type of denials included in the search; options include All, Final, Information, Pending, and Review. This field only displays if your facility is set up for Contract Manager Denial Management. For more information, refer to Denial Management Methodologies. |
Denials | Indicates whether accounts that were identified as denials by FinThrive Denials Management were included in the results. Options include Denial Accounts Only and Non-Denial Accounts. This field only displays if your facility is set up for Integrated Denial Management. For more information, refer to Denial Management Methodologies. |
Discharge Status | Specifies where the patient is physically located at the time of discharge or where the patient is located at the end of the billing cycle. When selecting the search criteria for your worklist, you can enter multiple discharge status codes separating each code with a comma. |
DRG/APC/CMG (Highest Value) | Includes or excludes the specified DRG/APC/CMG codes with the highest value |
Exclude Stop Caps | Indicates whether accounts identified as meeting the stop cap threshold. Stop cap is a clause in a contract/proposal that adjusts the reimbursement of claims with low charges and high reimbursement. Stop cap accounts are indicated by a (c) in the Service type column of the results. |
Exclude Stop Losses | Indicates whether accounts identified as meeting the stop loss threshold were excluded. Stop loss is a clause in the contract/profile that adjusts the reimbursement of claims with unusually high charges or lengths of stay. The contract/proposal sets a condition based on a threshold of charges or days. Stop loss accounts are indicated by a (s) in the Service type column of the results. |
Late Charge Alternate Calculation | The amount of the expected reimbursement if you resubmit the claim and include the late charges associated with the claim on the resubmission. This column only displays if you selected Late Charge Alt Calc in the Additional Amount field on the Account Research from Worklist page. |
Late Charge Alternate Variance | The variance between the original total expected payments and the late charge alternate calculation. This column only displays if you selected Late Charge Alt Calc in the Additional Amount field on the Account Research from Worklist page. |
Late Payment Penalty | Indicates whether your results were limited to accounts with a late payment penalty applied. The rules defining late payment penalties are defined in the contract profile. |
Opportunity Type | Specifies whether accounts where the expected reimbursement was capped were included in the search. Options include the following:
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Other Codes | Other codes selected, using the Extended Search option |
Patient Liability | Specifies whether patient liability amounts were included in the search |
Payment Ratios | Specifies an expected or actual payment-to-charge ratio of greater than, less than or equal to a certain amount AND/OR (greater than, less than or equal to) another amount |
Production Status | Contract production status |
RA Claim Status | Specifies the RA claim status included in or excluded from the search. This option is only available if your facility uses the Remittance Advice (RA) feature. For a description of each RA claim status, refer to Remittance Advice Status Codes. |
RA Payment Code | Specifies the RA payment code(s) included in the search. This option is only available if your facility uses the Remittance Advice (RA) feature. For a description of each RA payment code, refer to Remittance Advice Reason Codes and Remittance Advice Remark Codes. |
Recurring O/P | Specifies whether recurring outpatients were included in the search |
Secondary Payor | An insurance policy, plan, or program that pays an additional amount on the portion of a claim not paid by the primary payor |
Service Type | Limits the worklist to a specific service type using the following parameters: equal to, not equal to, starts with, ends with, contains, does not start with, does not end with, or does not contain |
Stop Cap | Indicates whether your results were limited to accounts identified as meeting the stop cap threshold. Stop cap is a clause in a contract/proposal that adjusts the reimbursement of claims with low charges and high reimbursement. Stop cap accounts are indicated by a (c) in the Service type column of the results. |
Stop Loss | Indicates whether your results were limited to accounts identified as meeting the stop loss threshold. Stop loss is a clause in the contract/profile that adjusts the reimbursement of claims with unusually high charges or lengths of stay. The contract/proposal sets a condition based on a threshold of charges or days. Stop loss accounts are indicated by a (s) in the Service type column of the results. |
User Code | User-defined code; four digit maximum |
Variance Amount | Specifies a discount or payment variance in relationship to (greater than, less than or equal to) a dollar amount or a percentage |
Variance By | Type of account variance employed in the search |
Variance Percent | Specifies a percentage of variance in relationship to a dollar amount or a percentage |
Results Area | |
Account Balance | Billed Charges, minus total payments, minus total adjustments |
Actual Discount | Total insurance adjustments for all accounts; Explanation of Benefits (EOB) write-off |
Bill type | |
Billed Charges | The total charges incurred for the claim or set of claims that have been repriced |
Contract Profile | The name of the contract profile associated with this account. |
Cost | The actual cost amount associated with this account.
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Day | The number of days that display is determined by the day filter selected when creating the worklist. The available day filters include the following:
If no day filter is selected, this column defaults to Days Outstanding. |
Discount Variance | Expected Discount minus the Actual Discount |
DRG/APC/CMG (Highest Value) | The specified DRG/APC/CMG codes with the highest value on the account |
Expected Discount | Billed Charges minus non-covered charges, minus Total Expected Reimbursement |
Expected Insurance Payment | The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data, minus patient liability |
Expected PCR % | Expected Payment-to-Charge ratio |
Grand Totals for Worklist | Shows the sum of all entries in each column of the worklist for the entire worklist. This row only displays on the last results page for the worklist LOS calculations exclude 1500 claims, Medicare Part-B claims, and non-inpatient claims |
Insurance Payment | The amount paid by the insurance company |
Length of Stay | Length of Stay, in days |
Medicare Outlier Date | The date on which Medicare Inpatient claims reach the outlier threshold, based on detail charges. |
Message Code | Message code (a link to the message code description) |
No. | Sequential reference number of the line item. An asterisk (*) appears for an account to which an override was applied and the reprice was completed |
Patient Account Number | Patient account number (for UB claims) or insured ID (for CMS-1500 claims). The number of claims or accounts associated with the account number display in parentheses. If Coordination of Benefits (COB) is enabled for your facility, the number of payors and accounts associated with the account number display in parentheses. |
Patient Liability | The amount the patient is responsible for |
Profitability | The profitability amount associated with this account. The profitability is calculated as the Expected Payment minus Cost.
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Reprice Type | Indicates the reason the claim was repriced separately from other claims for this account. This column also helps to distinguish between multiple claims on an account. For more information about reprice types, refer to Reprice Types. |
Service Type | The highest ranked service type found in the Reimbursement section of the TAC. If the account matches a stop loss condition, an (s) precedes the service type name. If the account matches a stop cap condition, a (c) precedes the service type name. |
Sort By | Allows you to specify the name of the column you want to sort your results by and the order (ascending/descending) of the sort |
Total Expected Payment | The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data |
Total Payment | Insurance and patient payment posted to the account, as defined in the data |
Totals for Page | Shows the sum of all entries in each column of the worklist for the results page that is currently displayed. |
View | Allows you to switch between the Single Line summary view and the Details view |
Links on the Account Worklist Page- View Worklist Summary for All Products summarizes all products by the same selection criteria as you selected for the Account Worklist. For more information, refer to View the Worklist Summary .
- View Worklist Summary for All Products returns to the Account Worklist Criteria page. For more information, refer to Specify Account Worklist Criteria.