The Contractual Analysis report is used as an internal audit to ensure that the contracts and contract exception fee schedule agreements your practice has with various payers are set up correctly and are being met by the payers.
When the report is generated, there are several values displayed that enable you to compare your contract fee schedules, which are defined in the Contracts Library, to the actual payment and adjustment amounts that were posted against each line item during payment entry. This comparison enables you to find cases in which an expected contract amount does not match an actual payment amount received from a payer.
In addition, this report has the same flexibility as the other reports in the application.
To access the report in NextGen® Enterprise PM, select the Reports menu and select Accounts Receivable, then select Aging Analysis, and then select Contractual Analysis.
From the Report Filter window, select the Info button to view the following information about the report:
Logic:
- This is a charge based report.
- Pulls charges based on report filters, and then transactions associated to those charges.
- The charge must qualify in order for its associated payment to qualify.
- Charges display under the primary Payer/Financial Class.
- Transactions display under the actual Payer/Financial Class selected on the Payment Entry screen.
- Voided charges are excluded by default.
- By default, this report only looks at encounters primary payer with a contract.
- It now has an option to also include encounters with no contract.
Filtering Info:
- If only a charge date range is entered, the report pulls all transactions associated to the charges that meet the criteria.
- If a transaction date filter is entered as well as a charge date, the report will pull all charges that meet the criteria first and then pulls all transactions associated to those charges which were posted within the transaction date range only.
- If no charge date range is selected, the report pulls all charges from day one.
The report has 3 major sets of columns:
- Allowed Amounts: pull from the contract.
- Actual Amounts: pull from the payment entry screen.
- Difference Amounts: calculated by taking allowed amount minus actual amount.
- Run Using option, pick the contract you want as if it was attached to all the encounter primary payers included on the report. Allows seeing numbers as if a different contract was used.
Common Uses:
- Verify contracts are setup correctly.
- Verify payers are paying the expected contract amount.
Balances to the Following Reports:
- Informational purposes only. Not used for balancing.
