About Reimbursements (REM) Reports

Reimbursements (REM) show how daily payment processes are affecting overall reimbursement amounts and timelines.

This module contains the following reports:

General

DRG Payment Variance (REM) compares reimbursement rates for claims for the given payer and DRG.
MDE Payment Forecast (REM) shows the monthly trend of the final MDE status returned for claims. Use this report to understand the rate in which issues most frequently need to be addressed on MDE claims to receive reimbursement.
Monthly MDE Status Trend (REM) shows the monthly trend of the final MDE status returned for claims. Use this report to understand the rate in which issues most frequently need to be addressed on MDE claims to receive reimbursement.
No Payment Aging (REM) identifies released claims that have not received a remittance back from the payer. It also provides insight into where follow-up is needed to obtain reimbursement and accelerate cashflow. The ‘Summary by Payer’ tab shows outstanding gross charges, average aging from today’s date, and the oldest release date. The ‘Claim Details’ tab lists each claim by charges, with aging from today’s date with primary indicator, PCN claim type, TOB, and number of claims released.
Monthly Reimbursement Trend (REM) provides insight on claim payment breakdowns. A monthly-trended distribution of claim charges is divided into four groups: Denied Charges, Contractual Adjustments, Patient Responsibility, and Payer Payment. This information is shown per each CID as well as LOB.
Patient Responsibility (REM) provides the amount and percentage of claim payments that patients are responsible for. Per each payer, users will be able to see the total volume and amount of claims, the total assigned Patient Responsibility amount, and the overall rate of a patient's share on a claim. For each Payer, users will be able to drill-down to a secondary report and view the given information at a claim-level.
Patient Responsibility Type Analysis (REM) provides insight into the amount and percentage of claim payments patients are responsible for. It allows hospitals to understand how Patient Responsibility is assigned by breaking down co-pays, from deductibles, coinsurance, etc. The report contains a summary tab, payer comparison, and a non-covered/other patient responsibility tab.
Payer Reimbursement (REM) gives analytical insight into the number of payments and payment amount each Payer has reimbursed the provider. It also lists claims falling within payments each Payer has reimbursed the provider.
Payment Method (REM) shows the rate at which Payers are reimbursing providers through Electronic Funds Transfer (EFT) vs. Paper Checks. For each Payer, the report will provide overall payment metrics, in addition to a breakdown of EFT and Paper Check volumes and comparative rates. Detailed report dives into paper check payments.
Remit Adjustments (REM) provides trending on remittance adjustments, reporting on claim amounts with denied charges, non-covered charges, contractual adjustments, patient responsibility, and payment amounts of claims. Summary adjustment tabs show total adjustments by payer and adjustment code for claim- and service-level adjustments. Detail tabs show claim adjustment amounts by patient control number and adjustment reason code at the claim- and service- line level.

All Remits

Complete Remit Analysis (REM) provides insight into both matched and unmatched payments, denials, and adjustments from the payer. The summary tab accounts for all differences between the billed and payer payment amount. The adjustment tabs provide details on the types of adjustments codes received at a claim and service line level both at a summary and claim-level.
PLB Adjustment Summary (REM) provides a summary of adjustments received in the PLB segment of remits. It allows users to understand the dollar amount of financial adjustments received that are not related to a specific claim.