Account Research

Managing accounts in Contract Manager is dependent on the data received from your facility. Patient billing data is imported from your patient financial system to Contract Manager. FinThrive produces a report based on your billing data and the contract profile, which ultimately provides the foundation for you to conduct account research as well as follow up on underpayments. Through Contract Manager, you can create account and claim overrides without necessarily submitting a new UB. In addition, you can flag accounts and enter comments to document account follow-up activity, and create letters to payors and patients regarding reimbursements.

The account number is the customer-defined identifier taken from the imported claims data. The imported billing data includes UBs, CMS-1500s, billed charges, payments, adjustments, and CDMs. The account information that FinThrive produces includes expected payments, expected discounts, payment-to-charge ratios (PCRs) and variances based on payments or discounts, all of which are described further in this section.

Expected Payments

Some information is calculated by FinThrive based on the predefined contract terms and conditions, reimbursement rates and effective dates of a contract. The expected payment is the calculated amount that the payor is expected to reimburse for the services, based on the contract definitions that were effective at the time of service.

Expected Discounts

Most payors agree to pay less than the total billed charges for a service type. Expected Discounts can be expressed this way:

Billed Charges - Expected Payment = Expected Discount

Payment to Charge Ratio (PCR)

The PCR is the payment divided by the charge. A service type with a high PCR is more likely to be profitable than one with a low PCR. This information is valuable for identifying unprofitable service types and negotiating better reimbursement rates for service types that have a low PCR.

Cost and Profitability Information

The cost and profitability feature allows you to see cost and profitability information at the patient account level. To use this feature, your facility must have a cost accounting system that sends cost on either a CDM or case level to Contract Manager. For customers with FinThrive Profitability, this feature provides integration between Profitability and Contract Manager.

Cost and profitability information displays on the following pages:

• Account Worklist pages
• Patient Account Audit pages
• Detail Line Item Charges

In addition, the Additional Amount field in the Optional Selection Criteria of the Account Research from Worklist page allows you to search for accounts by cost and profitability values.

The cost and profitability feature must be activated for your facility before you can view and search by cost and productivity information.

How To Topics

The menu on the left provides step-by-step instructions on how to research accounts in Contract Manager.

The following topics provide step-by-step instructions on how to research accounts in Contract Management.

• Discount or Payment Variance
• Account Categories
• The Repricing Process at FinThrive
• Following Up on Accounts and Contracts
• Supplemental Billing Functional Security
• Account Research
• Query Queues
• Multiple Reimbursement Calculations
• Coordination of Benefits
• Account Research Summary Sections
• Alternate Late Charge Calculation
• Extended Search Functional Security
• Research Accounts by Account or Claim Number
• Research Accounts from a Worklist
• Maintain Worklist Information
• Manage Account Audits
• Override the Late Charge Status
• Billing Type Definition
• View the Account Write-Down Detail
• View the Expected Payment Detail
• Override Patient Liability
• Expected Reimbursement Details
• View Expected Reimbursement Calculation Details
• Hospital 1500 Claims Expected Reimbursement Details
• Lookup Remittance Advice Data
• View Remittance Advice Details
• Calculate Reimbursement
• View Payments and Adjustments
• View Detail Line Item Charges
• View Claim Representations
• Manage Payment and Productivity Tracking
• Research Supplemental Billing History
• Specify Preliminary Expected Reimbursement Criteria
• View Preliminary Expected Reimbursement
• Compare Prior and Current Reprices
• Compare Audit and Production Reprices