In prior posts, I discussed the importance of managing your practice’s collections at the time of service (TOS). Those posts focused on outstanding balances and deductibles. When it comes to managing these efforts, it’s essential that you have an effective report that compares what should have been collected and what was actually collected.

The following pivot table takes TOS payment collection to the next level. Apart from the date of the encounter and total charges billed, it displays

1. The total patient responsibility for the encounter (i.e., what should have been collected at the time of service),
2. The payments that were collected at the time of service (i.e., copayments, deductibles, coinsurance), and
3. The TOS payments as a percentage of the total patient responsibility

In this example, we are looking for the total patient payments collected at the time of service as a percentage of the entire amount that is the patient’s responsibility. We basically want to know what portion of the patient’s responsibility is getting collected at check-in time.

Patient responsibility can be calculated as follows.

Total Charges — Contractual Write-offs — Insurance Payments = Patient Responsibility

Most PM systems don’t actually have a field or column for storing the total patient responsibility amount for the claim. The PM system knows what is currently in the “patient responsibility” bucket of the A/R. However, that amount is dynamic and will change over time as payments are made towards that balance. 

In this example, we want to know what the entire patient responsibility was for the encounter and not simply what is currently in the patient responsibility bucket. With common BI tools like Microsoft Power BI and Excel PowerPivot, we can build this calculation into the report.    

Keep in mind that the patient responsibility cannot be determined until you have all of the information about the claim. In other words, it cannot be calculated until the insurance has processed and paid on the claim. Therefore, you will have to consider the lag time it takes for these events to occur, and you will not be able to get an accurate glimpse of the true TOS collection percentage until adequate time has passed. 

This report is great for trending the practice’s collection rate over time. With this example, the user can filter by department or type of service. This is helpful because there are some visits – such as well/preventive visits –  for which no patient out-of-pocket is owed, per the ACA provisions. The other neat thing about this report is that you can drill down to the encounter and see exactly what was and what wasn’t collected.

Start tracking TOS payments and see how effective your front desk is at collecting!