View the Account Worklist

The Worklist page allows you to view the account number, DRG, billed charges, actual/expected total payments, actual/expected total discounts and other information for all accounts in the selected facilities that meet your worklist criteria. Each account appears as a line item in the worklist, from which you can drill down to account details. You use the Account Worklist to find suspected underpayments, daily reporting, and for defined searches.

Procedure

Access the Account Worklist tab on the Worklist page.
1. Open the Account Research page:
  - For hospitals, select Go To > Account Research > Advanced Account Research.
  - For physicians, select Go To > Invoice Research > Advanced Account Research.
2. Click View Worklist in the Actions column for the completed worklist that you want to review. The Worklist page opens.
3. Click the Account Worklist tab.
Review the account worklist details.
- The Account Worklist limits the number of rows that display on a single page. When the number of rows exceeds the maximum for a single page, the results are broken into multiple pages and a navigation bar appears at the bottom of the page. For more information, refer to Results Pages.
- To flag an account so that it appears as a flagged account and is included in worklists that only include flagged accounts, click Flag Accounts. For more information about flagging accounts, refer to Flag Accounts from the Worklist.
- To sort the results by a particular column, click the header for the column you want to sort by. Your account worklist is sorted by the selected column in ascending order. To sort in descending order, click the column header again.
  Note: By default, your worklist is sorted by the Discount Variance column, in descending order.
- To filter the list of accounts so that only accounts that meet specific criteria display, click the filter icon in the header of the column you want to filter by. For more information about filtering, refer to Column Filters.
- If you accessed the Account Worklist by clicking a product name in the Product Summary Worklist, the Account Worklist only displays the accounts for the selected product. To view the accounts for all products, click Clear Product Filter in the Criteria Summary section.
- If you are viewing the results of a Model Worklist, each patient list included in the model also displays in the Criteria Summary section.
  - To view estimate information for a specific patient list, expand the patient list to view the patient list details and click the Facilities tab. The details section displays the number of estimated accounts for the patient list, by facility.
  - To view the criteria used to create a specific patient list, expand the patient list to view the patient list details and click the Criteria tab. The specific search criteria used to create the patient list display.
The following columns also contain hyperlinks that let you drill down into additional information for a selected account:
- Click a link in the Patient Number column to open the Patient Account Audit page and view the details for a particular 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.
- Click the REIM link in the Service Type column to open the Expected Reimbursement Detail page and view the reimbursement details for a particular account.
  Note: 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 Descriptions

The following table describes each of the fields on the Account Worklist tab. The fields are sorted by section and listed in alphabetical order.

Field	Description
Criteria Summary
This section lists the facilities and specific worklist criteria used to create this worklist. To change this criteria, click Edit This Criteria. The Worklist criteria page opens. For more information about editing criteria, refer to Create Worklist Criteria. To flag an account so that it appears as a flagged account and is included in worklists that only include flagged accounts, click Flag Accounts. For more information about flagging accounts, refer to Flag Accounts from the Worklist. If you are viewing the results of a Model Worklist, each patient list included in the model also displays in the Criteria Summary section. To view estimate information for a specific patient list, expand the patient list to view the patient list details and click the Facilities tab. The details section displays the number of estimated accounts for the patient list, by facility. To view the criteria used to create a specific patient list, expand the patient list to view the patient list details and click the Criteria tab. The specific search criteria used to create the patient list display.
Account Worklist
Account Balance	Billed Charges, minus total payments, minus total adjustments
Actual Discount	Total insurance adjustments for all accounts; Explanation of Benefits (EOB) write-off
Actual PCR%	Actual Payment-to-Charge ratio (Total Payment divided by Billed Charges, times 100)
Admit Date	Date of admission for the account
Bill Type	Specifics the three-digit code displayed on a UB that provides specific information about the intent of the claim. The first digit describes the type of facility, the second digit classifies the type of care being billed, and the third digit indicates the sequence of the bill for a specific episode of care. For example: 117 stands for an acute care facility - inpatient - replacement of a prior claim. To view bill type digit information, refer to Bill Types.
Billed Charges	The total charges incurred for the claim or set of claims that have been repriced
Claim Number	Claim number associated with the account. For accounts with multiple claim numbers, all claim numbers are listed on one row, separated by a comma. Note: This column in the results grid is limited to displaying 12 to 14 characters. Longer claim numbers are indicated by an ellipsis at the end, for example, "000123456789...". Hover your mouse over a longer claim to view the entire claim number or multiple claim numbers.
Cost	The actual cost amount associated with this account. Negative values display in red with parentheses. The Cost column only displays if your facility has a cost accounting system that sends Contract Manager cost on either a CDM or case level, and the cost and profitability feature has been activated for your facility. For more information, refer to Cost and Profitability Information.
Days To Payment	The difference between the submit date of the claim and the date of the initial payment.
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.
Discount Variance	Expected Discount minus the Actual Discount.
DRG/APC/CMG	The specified DRG/APC/CMG codes with the highest value on the account.
EOB Discount Variance	The difference between the expected discount amount and the EOB (Explanation of Benefits) amount provided by your facility, expressed as a dollar amount.
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.
Facility	Name of the facility where the account resides.
Insurance Payment	The amount paid by the insurance company.
Last Payment Date	Date of the last payment from 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	Exception message code. The value in this column is a link to the message code description.
No.	Sequential reference number of the line item.
Pass Through Amount	Pass-through amount for the account. Pass-throughs are service types for which the facility can collect amounts in addition to the per diem or case rate (such as implants, high-cost drugs and prosthesis). These service types are identified in the Pass-Through section of the Contract Profile. This field only displays for modeling worklists.
Patient Liability	The dollar amount of the patient’s responsibility on the account. The values in this column are hyperlinks that open the Patient Liability Override page. For more information, refer to Override Patient Liability..
Patient Name	Name of the patient associated with the account.
Patient Number	Patient account number (for UB claims) or insured ID (for CMS-1500 claims). This column can accommodate account numbers that are up to 80 characters in length, but the column in the results grid is limited to displaying 12 to 14 characters. Longer account numbers are indicated by an ellipsis at the end, for example, "000123456789...". Hover your mouse over a longer account to view the entire account number. Values in this column are links to the Patient Account Audit page that displays additional details for a selected account. For more information about this page, refer to View Patient Account Audit.
Payment Variance	Difference between the total expected reimbursement and actual payment.
Payor Class	Payor class associated with the account: P – Primary S – Secondary T – Tertiary Note: This column only displays for Production and Audit worklists and only for facilities with the Coordination of Benefits feature enabled. For more information, refer to Coordination of Benefits.
Plan Liability Amount	Total amount calculated within the Reimbursement section of the contract profile. This field only displays for modeling worklists.
Plan Name	Name of the coverage plan for the account.
Profitability	The profitability amount associated with this account. The profitability is calculated as the Expected Payment minus Cost. Negative values display in red with parentheses. The Profitability column only displays if your facility has a cost accounting system that sends Contract Manager cost on either a CDM or case level, and the cost and profitability feature has been activated for your facility. For more information, refer to Cost and Profitability Information.
Reporting Service Type	The highest reimbursing service type from the reporting scenario. For more information about reporting service types, refer to Reporting Service Type Templates. This field only displays for modeling worklists.
Reporting Service Type (By Rank)	The primary reporting service type, which is the highest ranking reporting service type from the reporting scenario. For more information about reporting service types, refer to Reporting Service Type Templates. This field only displays for modeling worklists.
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.
Reversals Only	Indicates whether a reversal has been performed on a previously repriced account. Reversals are determined by accounts with message code 007. Valid values are Y (Yes) or N (No).
Scenario Name	Name of the modeling scenario for the account. This field only displays for modeling worklists.
Scenario Service Type (By Rank)	The highest ranking service type for the scenario associated with the line item. This field only displays for modeling worklists. The values in this column are hyperlinks that open the View Contract Profile page. For more information, refer to View a Contract Profile. The REIM link in this column is a hyperlink that opens the Expected Reimbursement Detail page. For more information, refer to View the Expected Reimbursement Detail.
Scenario Service Type (By Reimb)	The highest reimbursing service type for the scenario. This field only displays for modeling worklists. The values in this column are hyperlinks that open the View Contract Profile page. For more information, refer to View a Contract Profile. The REIM link in this column is a hyperlink that opens the Expected Reimbursement Detail page. For more information, refer to View the Expected Reimbursement Detail.
Service Type	The highest ranked service type found in the Reimbursement section of the terms and conditions. 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. The values in this column are hyperlinks that open the View Contract Profile page. For more information, refer to View a Contract Profile. The REIM link in this column is a hyperlink that opens the Expected Reimbursement Detail page. For more information, refer to View the Expected Reimbursement Detail.
Severity of Illness	Severity of illness code associated with the DRG.
Stop Cap Amount	Stop cap amount for the account. 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. This field only displays for modeling worklists.
Stop Loss Amount	Stop loss amount for the account. 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. This field only displays for modeling worklists.
Submit Date	Date the claim was initially submitted for payment.
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.
User Code	Specifies a user-defined FinThrive or Client (customer) user code associated with the account.