Standard Grade

Formula

Details

Billing Denials

1% deduction in grade for every account past due for follow up

An account is qualified as past due when no follow up notation has been added to the account or the most recent notation is more than 14 days old. Accounts must have a CARC code in the billing parent category.

Grade calculated as 100 minus the number of Billing Denial accounts that have not been followed up on in the past 14 days. Detail view allows for review of accounts that are not current.

Coding Denials

1% deduction in grade for every account past due for follow up

An account is qualified as past due when no follow up notation has been added to the account or the most recent notation is more than 14 days old. Accounts must have a CARC code in the coding parent category.

Grade calculated as 100 minus the number of Coding Denial accounts that have not been followed up on in the past 14 days. Detail view allows for review of accounts that are not current.

Registration Denials

1% deduction in grade for every account past due for follow up

An account is qualified as past due when no follow up notation has been added to the account or the most recent notation is more than 14 days old. Accounts must have a CARC code in the registration parent category.

Grade calculated as 100 minus the number of Registration Denial accounts that have not been followed up on in the past 14 days. Detail view allows for review of accounts that are not current.

Posting Denials

1% deduction in grade for every account past due for follow up

An account is qualified as past due when no follow up notation has been added to the account or the most recent notation is more than 14 days old. Accounts must have a CARC code in the posting parent category.

Grade calculated as 100 minus the number of Posting Denial accounts that have not been followed up on in the past 14 days. Detail view allows for review of accounts that are not current.

Coding Days

10% deduction for every coding lag day beyond 3 days from date of discharge

Provides for an industry standard 3 day suspense period. Calculates the average age of all accounts sitting in Ready For Coding.

Grade calculated as 100 minus 5% per day that the average number of days a claim is in 'Ready for Coding' status past the standard 3 day turnaround. Detail view allows for review of all accounts in the 'Ready for Coding' status.

Days in AR

2% deduction for every day in AR beyond 45 days

Performs a rolling 90 days in AR calculation:

Calculated as: Balance * 90 / Last 90 Days Charges. Grade is calculated as 100 minus 2% per day over 60 days AR.

Outstanding Statements

Informational Only

This is an example of an informational only grade where no grade is calculated. It does not impact the facility or server level grade.

This Grade tile provides a count of Patient Accounts where a patient balance exists without an Approved Patient Balance. Detail view presents a listing of the affected accounts.

Ten Day Followup

1% deduction for every account in the top 200 highest balance accounts where follow up is past due

An account is qualified as past due when no follow up notation has been added to the account or the most recent notation is more than 10 days old and account is one of the top 200 highest balance accounts in your aging.

Grade calculated as 100 minus the number of accounts from top 200 balances that are past 10 days from last followup. Detail provides listing of all accounts over 10 days from the top 200 balances.

Thirty Day Followup

Calculates percentage of claims followed up on in past 30 days

Claims followed up on in past 30 days / Total claims in past 30 days

Unsubmitted Secondary

5% reduction for every 20 unsubmitted secondary claims

Identifies claims where a secondary payer is present, a primary adjudication has occurred, and the secondary claim has not been filed.

Grade calculated as 100 minus the number of accounts where a secondary payer is present but unbilled. Detail view displays all accounts where a seconadry payer is entered but not billed.