This bulletin is primarily for Business Office Managers and CFO types who have a need to decipher UNBILLED NET revenue.
As many of you know, MEDIK NET UNBILLED reports have not been able to calculate an UNBILLED NET amount on payors who require a DRG contractual unless the DRG was calculated, i.e. admit was discharged and the diagnosis codes were entered, until now.
Users will have the options to enter an allowed RATIO in the insurance master screen found under, OPTIONS>PAYOR or BILLING PAYOR.
Search for, and select the appropriate payor to UPDATE.
Once in the payor master screen, navigate to MOREINFO and select the new option of DRG REIMBURSEMENT RATIO.
The screen below will display. Based on the history of this payor, enter the appropriate RATIO. This RATIO can be different from payor to payor. Once the RATIO has been entered, select GO/F1 and be sure to SAVE/F1 on the insurance master screen.
NOTE: This ratio will ONLY be used for payors with a DRG CONTRACTUAL billing rule for REPORTING the NET UBILLED and will not be used to figure the actual DRG contractual posted at the time of billing. The billing contractual will still be based on the actual DRG calculation.
Once the payor RATIO is set up, the following reports will be affected.
- CHARGES AND ROOM CHARGES
The CHARGES AND ROOM CHARGES report is found under REPORTS>DAILY POSTING>CHARGES + ROOM CHARGES.
Choose the date range and other criteria. Nothing in the search criteria has changed.
Once the report displays, the user will see the NET CHRG column that is figured by the RATIO entered on the Insurance Master screen. The net will display on the spreadsheet or pdf output.
- PERIODIC NET REVENUE
The PERIODIC NET REVENUE report is found under REPORTS>END OF MONTH<PERIODIC NET REVENUE. Again, the options of this program have not changed. The only difference is within the report.
Once the report is created, the UNBILLED revenue for DRG payors will use the RATIO from the Insurance Master screen.
NOTE: Remember, this report calculates the DAILY AVERAGES from the number of days shown on the report and the charges that have been generated.
- AGED RECEIVABLE (Net Unbilled)
The AGED RECEIVABLE Report is found under REPORTS>END OF MONTH>AGED RECEIVABLE.
Once the user is in this program, there are several options for different reports.
The only change is with the NET U/B report. The NET amount on this report will calculate from the RATIO in the payor set up for DRG payors.
Notice in the report below, the CHARGES are the GROSS charges, but the BALANCE is the NET BALANCE. To get the CHARGES, ADJUSTMENT and PAYMENT on this report, one of the sort options has to be the BILL#.
If you have any questions, please contact any of the Support team.