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    Accounts Receivable

    The age of a practice's accounts receivable (to the nearest whole dollar). Accounts that had are assigned to collection agencies are not included.

    Current to 30 Days

    Amounts owed to the practice by patients, third-party payers, employer groups, and unions for fee-for-service activities before adjustments for anticipated payment reductions, allowances for adjustments, or bad debts. Amounts assigned to “Accounts receivable” are due to “Gross fee-for-service charges.” Assigning a charge into “Accounts receivable” initiates at the time a practice submits an invoice to the payer or patient for payment. For example, if an obstetrics practice establishes an open account for accumulation of charges when a patient is accepted into a prenatal program and the account will not be invoiced until after delivery, then “Accounts receivable” will not reflect these charges until the creation of an invoice. Deletion of charges from “Accounts receivable” is done when the practice receives payment, turns over debt to a collection agency, or writes off the account as bad debt. This is the net amount owed after patient refunds.

    Not included:

    • Capitation payments owed to the practice by HMOs.

    31 to 60 Days – See Current to 30 Days

    61 to 90 Days – See Current to 30 Days

    91 to 120 Days – See Current to 30 Days

    Over 120 Days – See Current to 30 Days

    Re-Aged and Not Re-Aged Accounts Receivable

    We asked participants to answer “Yes” or “No” if accounts receivable were re-aged when a second insurance company or the patient was billed after the first insurance company refused to pay the entire billed amount.

    Months of gross fee-for-service charges in accounts receivable:

    (Total accounts receivable)


    (Gross FFS charges) x (1/12)

    Months of adjusted fee-for-service charges in accounts receivable:

    (Total accounts receivable)


    (Adjusted FFS charges) x (1/12)

    Days of gross fee-for-service charges in accounts receivable:

    (Total accounts receivable)


    (Gross FFS charges) x (1/365)

    Days of adjusted fee-for-service charges in accounts receivable:

    (Total accounts receivable)


    (Adjusted FFS charges) x (1/365)

    Gross fee-for-service collection percentage:

    (Net FFS revenue) x 100


    (Gross FFS charges)

    Adjusted fee-for-service collection percentage:

    (Net FFS revenue) x 100


    (Adjusted FFS charges)

    Payer Mix

    The percentage of a practice’s “Total gross charges” by type of payer. The sum of the percentages for Medicare, Medicaid, Commercial, Workers’ compensation, Charity care, Self-pay, and other federal government payers must have added to 100 percent.

    Medicare

    The sum of all fee-for-service, managed care fee-for-service and capitated charges for all services provided to Medicare patients.

    Medicaid

    The sum of all fee-for-service, managed care fee-for-service and capitated charges for all services provided to Medicaid or similar state healthcare program patients.

    Commercial

    The sum of all fee-for-service, managed care fee-for-service and capitated charges for all services provided patients under a commercial capitated contact.

    Workers’ Compensation

    Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to patients covered by workers’ compensation insurance.

    Not included:

    • Charges for Medicare patients;
    • Charges for Medicaid patients;
    • Charges for charity or professional courtesy patients; or
    • Charges for self-pay patients.

    Charity Care

    Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to charity patients. Charity patients are patients not covered by either commercial insurance or federal, state, or local governmental healthcare programs and who do not have the resources to pay for services. Charity patients must be identified at the time that service is provided so that a bill for service is not prepared.

    Self-Pay

    Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to patients who pay the medical practice directly. Note that these patients may or may not have insurance.

    Included:

    • Charges for patients who have no insurance but do have the resources to pay for their own care and do so; and
    • Charges for patients who have insurance but choose to pay for their own care and submit claims to their insurance company directly. Since the practice may or may not be aware of this situation, all charges paid directly by the patient should be considered as self-pay.

    Other Federal Government Payers

    Fee-for-service gross charges, at the practice’s undiscounted rates, for all services provided to patients who are covered by other federal government payers other than Medicare.

    Included:

    • Charges for TRICARE patients.

    Not included:

    • Charges for Medicare and Medicaid patients.

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