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Indian Health Service The Federal Health Program for American Indians and Alaska Natives


     Indian Health Manual
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Part 5, Chapter 1:  Manual Exhibit 5-1-D

Sample Reports (Summary Listing)


  1. Cancelled Claims Report [Chief Executive Officer (CEO)].  To monitor cancelled or deleted claims from RPMS. Claims are cancelled when a claim is determined as un-billable or all potential billing has been completed.  When a claim is cancelled, it is permanently removed and no further editing or approval of the claim can occur.  The End User will have to populate a field noting why the claim is being cancelled for this report to be accurate.  The report will provide management with a tool to monitor accuracy, ensuring staff are consistent with following appropriate standards and there is a mechanism for sufficient justification and reasonableness when claims are cancelled.

  2. Adjustments Report [CEO].  To monitor all write-offs for proper justification, accuracy, reason codes, and compliance with Debt Collection legislation/ regulations/policies.

  3. Days to Collection Summary Report [CEO].  To monitor the account process from patient check-in to PCC data entry to creating batches and posting of payments in order to identify delays, problems, and overall turn around time for collection on third party claims.

  4. Current Procedural Terminology (CPT) Code Level Report [CEO].  To identify over- and under-coding for all CPT code levels by date range, provider, payer, and allowance category and to assist with trend analysis.

  5. Third-party Table Maintenance Site Parameter Report [CEO].  To track specific Table Maintenance changes that were done to the Third-party Billing Site Parameter File.  This report will assist with monitoring edits to the Payment Site fields, which identifies for the Payers where to send the checks.  The Site Parameter changes affect all third-party claims.

  6. Incomplete Coding Report-Inpatient [Health Information Management (HIM)].  To monitor inpatient visits that are not coded or are missing important data to complete the coding process resulting in third party-claims not being submitted to payers.

  7. Incomplete Coding Report-Outpatient [HIM].  To monitor outpatient visits that are not coded or are missing important data to complete the coding process resulting in third-party claims not being submitted to payers.

  8. Incomplete PCC Visits by Provider Report-Inpatient [HIM].  To monitor incomplete visits by Provider and delays in PCC data entry for inpatient visits (which in turn delay claim submission and the collection of third-party revenue).

  9. Incomplete PCC Visits by Provider Report-Outpatient [HIM].  To monitor incomplete visits by Provider and delays in PCC data entry for outpatient visits (which in turn delay claim generation and the collection of third-party revenue).

  10. PCC Incomplete/Error Report [HIM].  To monitor incomplete visits in PCC, identify missing required data elements, and correct “orphan visits” (which in turn delay claim generation, missed charges, and the collection of third-party revenue).

  11. Incomplete PCC Visits by Ancillary Department Report [HIM].  To monitor incomplete visits by other departments such as radiology, laboratory, etc., resulting in PCC data-entry delays (which in turn delay claim generation and the collection of third party revenue).

  12. Patient Errors/Warning Audit Detailed Report [Business Office/Patient Registration].  To monitor patient registration entry errors (incorrect and missing data) that delay and/or cause claim denials for third-party eligible patient services.

  13. Benefit Coordinator Productivity Report [Business Office/Benefits Coordinator].  To monitor the productivity of the Benefits Coordinator to ensure third-party resource applications are properly completed and timely filed.

  14. Exception Report-Patients Under 18 [Business Office/Benefits Coordinator].  To identify patients under 18with no third-party coverage who may be eligible for the Medicaid Children’s Health Insurance Program (CHIP).  If eligible, applications must be processed to the appropriate local agency.

  15. Exception Report-Patients Over 65 [Business Office/Benefits Coordinator].  To identify patients over 65 with no third-party coverage who may be eligible fro the Medicaid benefits.  If eligible, applications must be processed to the appropriate agency.

  16. Brief Claims Listing Report [Business Office/Management].  To monitor unbilled claims created in RPMS that have not been approved.

  17. Bills Awaiting Export Report [Business Office/Management].  To monitor third-party claim forms that have not been printed or electronically submitted for payment.

  18. Incomplete Claims Status Report [Business Office/Management].  To monitor claims that are not approved because of missing or inaccurate data.  The information on the claim is returned to coding, provider, PCC, HIM, or others for various reasons.

  19. Batch Statistical Report [Business Office/Management].  To monitor collection hatches (including incomplete batches) within a facility database to ensure posting is current and accurate.  Negative balances can also be identified and should be researched as to why there are negative balances to any one account.

  20. Transaction Report [Business Office/Management].  To allow the end user to list transactions by collection batch, batch item, transaction date range, A/R entry clerk, and provider.  This report can also be used to monitor the accuracy of data entry for adjustments.

  21. Zero Pay/Adjustment Correspondence Rpt. [Business Office/Management].  To identify, monitor, and ensure the timeliness of batching and posting zero pay/adjustment correspondence.

  22. Period Summary Report [Business Office/Management].  To monitor and compare billed, adjusted, and posted amounts for services provided to actual reimbursement received for each type of service for a specific time period.

  23. Age Summary Report [Business Office/Management].  To provide summary information on all open balance bills by insurer or Clinic.  The report summarizes the outstanding bill totals by age category.

  24. Summary A/R Bill and Transaction Synchronization (ASYNC) Report [Business Office/Management].  To allow the end user to see which bills are not in synchronization with the transaction history after a patch is installed.  The users are expected to work these accounts.  They will NOT automatically receive a transaction to make them balance.

  25. Bills Listing Report [Business Office/Management].  To provide detailed information on bills uploaded from the Third-party Billing package.  The report may be sorted by Date Range, Clini/Visit Type, Billing Entity, and Provider.

  26. Bill Negative Balance List [Business Office/Management].  To monitor inaccurate posting amounts entered by the A/R posting staff or refunds processed to Finance.

For copies of the following please contact your Area Directives, Delegations and Control Officer of the Management Policy and Internal Control Staff at 301-443-2650

  1. Cancelled Claims Report

  2. Adjustments Report [CEO]

  3. Days to Collection Summary Report [CEO]

  4. Current Procedural Terminilogy (CPT) Code Level Report [CEO]

  5. Third-Party Table Maintenance Site Parameter Report [CEO]

  6. Incomplete Coding Report-inpatient [Health Information Management (HIM)]

  7. Incomplete Coding Report-Outpatient [HIM]

  8. Incomplete PCC Visits by Provider Report-Inpatient [HIM]

  9. Incomplete PCC Visits by Provider Report-Outpatient [HIM]

  10. PCC Incomplete/Error Report [HIM]

  11. Incomplete PCC Visits by Ancillary Department Report [HIM]

  12. Patient Errors/Warning Audit Detailed Report [Business Office/Patient Registration]

  13. Benefit Coordinator Productivity Report [Business Office/Benefits Coordinator]

  14. Exception Report-Patients Under 18 [Business Office/Benefits Coordinator]

  15. Exception Report-Patients Over 65 [Business Office/Benefits Coordinator]

  16. Brief Claims Listing Report [Business Office/Management]

  17. Bills Awaiting Export Report [Business Office/Management]

  18. Incomplete Claims Status Report [Business Office/Management]

  19. Batch Statistical Report [Business Office/Management]

  20. Transaction Report [Business Office/Management]

  21. Zero Pay/Adjustment Correspondence Rpt. [Business Office/Management]

  22. Period Summary Report [Business Office/Management]

  23. Age Summary Report [Business Office/Management]

  24. Summary A/R Bill and Transaction Synchronization (ASYNC) Report [Business Office/Management]

  25. Bills Listing Report [Business Office/Management]

  26. Bill Negative Balance List [Business Office/Management]


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