Patient Responsibility (REM)
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.
Business Use
- This report allows hospitals to compare patient responsibility trends between payers and to understand how the margin varies.
- View detailed claim-level information within each payer.
Running the Report
To generate the Patient Responsibility (REM) report:
- Click Run on the Patient Responsibility (REM) report pod.
- Select the option of whether or not to include test claims.
- Select one or more CIDs from the values displayed.
- Use the calendar function to enter a Payment Date (Start).
- Use the calendar function to enter a Payment Date (End).
- Click Run Query.
Tab Views and Field Descriptions
See the following pages for details on these tabs:
Patient Responsibility (REM): Summary
This tab shows patient responsibility by payer breakdown. Per each payer, users will be able to see the total number of claims, the total amount of patient responsibility, and rates illustrating a patient’s claim share.
| Field | Description |
|---|---|
| Payer | Name of payer designated on the claim. |
| Number of Claims | Count of claims for each payer. |
| Patient Responsibility Amount | Patient Refund + Deductible Amount + Coinsurance Amount + Copayment Amount + Blood Deductible |
| % of Total Claim Charge | Per each payer: Patient Responsibility/Total Charges |
| % of Total Reimbursement | Per each payer: Patient Responsibility/Total Reimbursement |
| % of All Patient Responsibility | Patient Responsibility/Sum of Patient Responsibility Amount |
Patient Responsibility
(REM): Detail
This tab allows users to view claim-level patient responsibility.
| Field | Description |
|---|---|
| Payer | Name of payer designated on the claim. |
| Primary/Secondary | Primary or Secondary claim. |
| Claim Form Type | UB (Institutional) or 1500 (Professional). |
| Inpatient/Outpatient | Denotes whether the claims are inpatient or outpatient. |
| Facility ID | Facility ID within CID. |
| Patient Control Number | Unique number assigned by the facility or the patient. |
| Patient Responsibility | Patient Refund + Deductible Amount + Coinsurance Amount + Copayment Amount + Blood Deductible |
| Total Claim Charge Amount | Claim Amount – MSP Amount (MSP Amount reflects payment by a previous payer and will only be non-zero on a Secondary or Tertiary claim). |
| % of Total Claim Charge | Per each claim: Patient Responsibility/Total Charges. |
| % of Total Reimbursement | Per each claim: Patient Responsibility/Total Reimbursement. |
