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To-Do Lists

One of the strengths of our practice management system is its capacity to keep track of details that you need to attend to in a way that makes it easy for you to pick up where you left off and to navigate to the problem areas within your database.

List items appear on the application tree not as simple text items, but rather as actual data items needing attention, data items on which you can click to see their content or from which you can navigate to neighboring data items in order to see the context. A number of the lists post "Submissions" to the tree, that is, records representing a planned or already-executed submission of a claim to a particular payer. Other entity types are patients, service lines, appointments, payer reports or payments--whatever requires your special attention. Items disappear from the list as you deal with them and mark them as dealt with or simply by solving the problem.

Here are some of the lists:
  • Submissions on Hold: These are submissions automatically sidelined by the scrub process or placed on hold manually, not yet submitted to a payer.
  • Submissions to be Fixed: These represent a particular rejection of a particular claim. These items result largely from electronic payment remittance notices (ERN). We write any error text and codes from the ERN directly into the submission record--and into particular offsets against service lines themselves, if present in the ERN.
  • Submissions Never Filed: These are generally queued-up secondary and tertiary submissions that got held up because of a lack of response from prior payers. After a certain length of time we consider the failure of a secondary or tertiary filing to occur something worth investigating.
  • Submissions Pending too Long: This list involves claims submitted but never answered. After 40 days, if you haven't heard from an insurance company, this list begins to grow. This list gives you a chance to investigate, phone or refile.
  • Unexamined Payer Reports: Payers send "next-day" reports that give their first (but necessary) final reaction to the claims you submit. You must examine these reports as promptly as possible. To take the item off the list, simply mark it as examined.
  • Open Insurance Payments: Payments with any unappplied balance are open. Posting of such payments must be completed or the unapplied amount must be refunded to the payer.
  • Open Private Payments: Again, posting of such payments must be completed or refunded to the responsible party.
  • Unreceived Insurance Checks: This is any check announced by an ERN but not yet in hand. This gives you a chance to account for all physical checks (as opposed to electronic funds transfers) of which you have been notified electronically.
  • Overapplied Service Lines: We allow charges to be overapplied. But once this occurs, funds must either be transferred to other service lines or the posted amounts must be unposted and refunds must be issued against the newly-unapplied amounts of the payment(s) involved. When more funds are received than there are charges toward which to post them, you've received too much and should give it back.
  • Payments with Unresolved Remittance Adjustments: Sometimes ERNs give you more or less money than they ask you to post toward individual accounts. The difference is a remittance adjustment, which you should account for in one of many possible ways, sometimes with a refund, other times with a manual posting to some account, sometimes doing nothing, as with interest payments. The system gives you a chance to review such payments.
  • Unreconciled Electronic Funds Transfers: When funds are direct-deposited, this is your list to insure that you have matched each one against a payment entered into your database, generally electronically. It is a form of bank reconciliation.
  • Patients without Responsible Parties: A patient often is the responsible party or is a dependent of the responsible party. Patients sometimes cease to be responsible themselves or cease to be a dependent of another. Either way, it is possible for a patient not to have a responsible party and therefore never get billed.
  • Unprocessed Past Appointments: This is an appointment past but pending, for which no charges were entered, they kind of thing you want to watch out for.
  • New Patients with Past Appointments: This is similar to the preceding list. Once a patient has been seen and charges entered, the patient is no longer new--or, rather, should no longer be new.
  •  And others ...

If these lists are kept short and are attended to daily, nothing should fall between the cracks. Your practice will run smoothly; statements will be in order; your cash flow will be at its best.