Attrition / Attendance / Absenteeism Calculator
AR Team Metrics Calculator
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Monthly Entry Summary
| Date | Headcount | Attrition | Percentage % |
|---|---|---|---|
| Monthly Average % | -- | ||
Medicare AWV (Annual Wellness Visit) & Preventive Services Billing Guidelines
Annual Wellness Visits: G0402, G0438 & G0439
G0402 – Initial Preventive Physical Examination (IPPE):
- This code must be billed within the first 12 months of Medicare Part B enrollment.
- It can be billed only once in a lifetime.
- It cannot be billed after the first 12 months of Part B coverage.
- If G0402 has already been billed within the first 12 months of Medicare Part B enrollment, any subsequent wellness visit during the same 12-month period cannot be billed as another preventive wellness visit. In such cases, appropriate office visit CPT codes (99212–99215) may be billed if medically necessary.
G0438 – Initial Annual Wellness Visit:
- This code must be billed after the first 12 months of Medicare Part B enrollment.
- It can be billed once in a lifetime.
- It cannot be billed within the first 12 months of Part B coverage.
- If G0438 has already been billed, any subsequent wellness visit within the next 12-month eligibility period cannot be billed as another Annual Wellness Visit. In such cases, appropriate office visit CPT codes (99212–99215) may be billed if medically necessary.
- After completion of 12 months from G0438, the next eligible wellness visit should be billed using G0439.
G0439 – Subsequent Annual Wellness Visit:
- This code must be billed at least 12 months after G0438.
- It can be billed once every 12 months thereafter.
- If G0439 has already been billed, any subsequent wellness visit within the next 12-month eligibility period cannot be billed as another Annual Wellness Visit. In such cases, appropriate office visit CPT codes (99212–99215) may be billed if medically necessary.
Preventive Services CPT Codes: 99381 – 99397
Routine preventive physical exam CPT codes (99381–99397) are typically not covered by Medicare. Instead, Medicare covers:
- G0402 – Welcome to Medicare Visit (IPPE)
- G0438 – Initial Annual Wellness Visit
- G0439 – Subsequent Annual Wellness Visit
- Problem-oriented office visits (99212–99215) when medically necessary
Days in AR Calculator
This tool calculates the number of days it takes to receive payment for services.
Please use data from a specific and consistent time period to ensure accurate calculation. For example, if you are using 3 months of data, enter the Total Billed Charges and Total Accounts Receivable for that same period, and set the Number of Days to 90. The Number of Days should vary depending on the time period used for the data.
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Understanding Negative Claim Balance in Account Receivable
- In Account Receivable (AR), accurate posting is critical to ensure the claim balance reflects the correct financial position. Even a small error in posting can move the account into a credit (negative balance) or debit (positive balance). Let’s understand this with a simple example.
- Suppose a claim is submitted for $100.00 and it is processed by insurance and allowed & paid for $20.00 then it should be posted as follows.
- Allowed - $20.00
- Paid - $20.00
- Coinsurance - $0.00
- Deductible - $0.00
- Copayment - $0.00
- Adjustment - $80.00
- Calculation: $100.00 (Charge Amount) – $20.00 (Paid Amount) – $80.00 (Adjustment Amount) = $0.00
- With the above posting, the balance amount will become zero. However, if there is any incorrect posting in the adjustment or payment amount, the account may move into either a credit or debit balance. Let's understand this with the following scenarios.
- Scenario 1: In the above posting example, if the adjustment is incorrectly posted as $90.00 then the claim balance will move into a credit of (-$10.00).
- Calculation: $100.00 (Charge Amount) – $20.00 (Paid Amount) – $90.00 (Adjustment Amount) = -$10.00 (Credit Balance)
- Scenario 2: In the above posting example, if adjustment is incorrectly posted as $75.00 then the claim balance will move into a debit of ($5.00).
- Calculation: $100.00 (Charge Amount) – $20.00 (Paid Amount) – $75.00 (Adjustment Amount) = $5.00 (Debit Balance)
- If you find any account in credit then always check whether the posting is done correctly or not.
- The claim may not be always in credit due to incorrect posting. Below are other possible reasons.
- Duplicate Insurance Payment:
- The insurance company may accidentally pay the claim twice. In such cases, it is important to verify whether the claim was actually paid twice or if the payment was posted twice in error. If the insurance company truly issued two payments then it is required to send refund back to the insurance carrier.
- To issue a refund to the insurance company, it is necessary to contact the insurance representative to confirm the appropriate method and address for sending the refund. Sometimes, a refund request is already sent by the insurance and the request includes all the detailed instructions on how and where the refund should be submitted.
- Excess Patient Payment:
- Sometimes, a patient may pay more than their actual responsibility, which can also result in a credit balance. In such cases, The excess amount may be applied to other outstanding claims with pending patient responsibility.
- If no other claims with outstanding balance exists then the amount may be refunded to the patient or can be adjusted with the patient resp of future claims.
- All of the above activities are typically handled by the Credit Balance (CB) team when a claim balance is in credit. However, in the absence of a CB team, these responsibilities fall under the Account Receivable (AR) team.
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