Setting Up Insurance > Running Insurance Reports > Running Insurance Practice Management Reports
This report lists all productions posted using a DMO/capitation fee schedule and compares their charges to the total of the same production for fee schedule 0.
To run the Contractual Plan Analysis report:
Select Reports > Practice Management > Insurance Reports > Contractual Plan Analysis. The Output Options window is displayed.
Select the output and click OK. The Contractual Plan Analysis Setup window is displayed.
In the Date Range section, click the drop-down arrows to select the dates from a calendar.
In the Doctors section, use the drop-down arrows to select specific providers, or leave 999 to report on all providers.
In the IDs section, use the drop-down arrows to select a specific insurance company or plan, or leave as 0 for all companies and plans.
To include transaction details, click the Include Transaction Details checkbox.
If you do not want to include plan details in the report, deselect Include Plan Details.
Click OK.
The Contractual Plan Analysis report contains the following sections:
Production
Production—Total of insurable codes (100.00+) posted by using the contractual fee.
Charges—Total of all charges posted for the specified period (codes 61.00-89.99).
Adj to Prod—Total adjustments to production posted for the specified period (codes 40.00-59.99). Excludes reserved budget plan codes 48.00 and 48.90.
Prod total if charged at Fee Schedule 0—Total dollar amount of transactions if they had been posted using fee schedule 0.
Per Visit Charges—Total per visit charges posted during the specified period (code 40.90).
Insurable Production—Total of all transactions posted that are insurable.
Uninsured Production—Total of all transactions posted that are not insurable.
Collections
Personal Payments—Total payments posted (excluding insurance payments) for the specified period (codes 1.00-20.99).
Insurance Payments—Total insurance payments posted for the specified period (codes 2.00-2.89; includes codes 11.93, 12.93, 13.93, and 14.93).
Total Income Generated—Total Income Generated = Personal Payments + Insurance Payments
Plan Profitability Index
All Production Posted/All Production at Fee 0—Production (insured and uninsured) charged at contractual fee divided by Production total if charged at fee schedule 0.
This percentage shows how much money you are collecting on the dollar for the plan.
Example:
Example:
Insurance Payments/Insured Transactions at Fee 0—This figure is used to determine if the plan is profitable, based on the percentage collected from the plan compared to the insurable production if charged using fee schedule 0.
This percentage tells you how much money you are collecting on the dollar for insured procedures on this plan.
All Payments/All Production at Fee 0—This figure is used to determine if the plan is profitable, based on the percentage collected from the plan and patients compared to the insured and uninsured production using fee schedule 0.
The figure is calculated using Total Income Generated divided by Production Total if charged at Fee Schedule 0.