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Insurance Participation and Utilization

This topic contains 3 replies, has 2 voices, and was last updated by  Dayna Johnson – founder and CEO of Novonee 5 months, 3 weeks ago.

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  • #1181

    Penny Reed
    Participant

    Hi Dayna!

    What have our found to be the best reports to see the following information?
    1. How many active patients are on each ppo plan (patients that have been in to the office for the last 24 months)?
    2. The utilization of those plans by the patients
    3. Any other reports to measure the impact of a particular plan on the practice

    I thought I would check with the guru on the best reports to run. Thank you!

    Penny

    #1182

    Hello Penny,
    1) If the office is using Fee Schedules you can run a report and find all patients attached to a certain fee schedule with a Last Visit Date. Go to the Office Manager > Custom Lists > Patient Reports by Filters > click Edit and then you can filter this report to search by fee schedule and last visit date. You can download this report into Excel or the List Manager.
    1) If the office is not using Fee Schedules then the only way to find patients attached to a certain insurance plan is by using the Insurance Carrier List by Patient and do a manual count. Go to the Office Manager > Reports > Resource > Insurance Carrier List.
    2) The Utilization Report for Insurance will show you the transactions posted by patient in a date range. This report will show you the transactions posted and the full fee compared to the reduced fee. This report is only helpful if the office is using fee schedules.

    If the office is not using fee schedules then it is difficult to see the impact except by using adjustment types.

    Hope this helps.

    #1353

    Penny Reed
    Participant

    Dayna, I have another client using fee schedules, yet their full fee isn’t showing on the utilization reports, it is only showing the fee schedule fee. I have double checked and the full fee is going on the claims and fee schedule fee on the ledger… so I am not sure if it has something to do with how the reports are run? I appreciate your help!

    #1354

    Make sure you are selecting the full office fee schedule to compare to. This way the utilization report will show what was posted on the ledger compared to the full fee.

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