User Guide — Weekly Best Practices

Best Practice: Review your overpaid claims every week.

On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Billing Worklists. On the Billing Worklists page, click Show Overpaid Claims.

The overpaid claims worklist should be reviewed in conjunction with Approve Insurance Refunds. This identifies all claims that are currently overpaid. Your practice may choose to move claims requiring a refund to MGRHOLD using the kick code "REFUND." This will also place claims on the Approve Insurance Refunds worklist.

Best Practice: Review your insurance refunds every week.

Insurance refunds should be processed on a weekly basis. Your payer contracts may include penalties for non-compliance. For detailed instructions on issuing insurance refunds, please see Insurance Refunds Workflow.

Best Practice: Review your patient unapplied credits every week.

Patient unapplied credit can be applied manually by your practice or automatically by athenaOne, based on your practice settings. Or, you may need to issue a patient refund.

UAP Patient Unapplied Credit Worklist

On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Billing Worklists. On the Billing Worklists page, click Show Credit Balance List.

To identify patient credit that may need to be refunded, your practice can run the custom Patient Refund Report: On the Main Menu, click Reports. Under General, click Report Library. Click the Other tab to locate the Patient Refund Report. For more information, see Report Library.

Best Practice: Review patient refunds every week.

Process Patient Refunds weekly. Some practices review upcoming patient appointments to determine whether to issue a refund. For detailed instructions on issuing patient refunds, please see Issue Patient Refund.

Best Practice: Review your refunds in process every week.

On the Main Menu, click Financials. Under REFUNDS, click Refunds in Progress

If your practice records refunds and enters refund check numbers separately, the Refunds Checks in Process worklist should be run and check numbers entered on a weekly basis.

Best Practice: Review your self-pay accounts every week.

The Self-Pay Account Worklist allows your practice to follow up on patients who have balances and receive statements. These worklists should be run on a weekly basis.

On the Main Menu, click Claims. Under SELF-PAY AND COLLECTIONS, click Self-Pay Account Worklists

Best Practice: Review your Collections worklist every week.

The Collections Worklist identifies patients who have become eligible for collections based on your practice's settings. This list should be reviewed on a weekly basis to identify patients who should either be sent to a collection agency or have their balances adjusted off.

On the Main Menu, click Claims. Under SELF-PAY AND COLLECTIONS, click Collections Worklist.

Best Practice: Review your fully worked claims every week.

Based on specific criteria, athenahealth may mark a claim as fully worked. A list of fully worked claims should be generated and reviewed on a weekly basis by your practice. When you process a claim from this worklist, the claim is removed from the MGRHOLD worklist.

You can use the Fully Worked Receivables page to generate this worklist: On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Fully Worked Receivables.

Best Practice: Match your deposit batches to your bank activity every week.

This streamlines your bank statement reconciliation at month-end.

See: To match deposit batches to daily bank activity

Best Practice: Review your claim attachment errors every week.

On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Claim Attachment Error Queue

The Resolve Document Upload Errors worklist contains claim attachment faxes that athenahealth couldn't associate with a claim. Attach missing attachments: if a matching claim is identified,you can delete all other claim attachment errors.

Best Practice: Run the Payment Mismatch Tracking Wizard every week.

The Payment Mismatch Tracking report uses your practice's allowable schedules to list payments received on primary insurance charges that were outside the expected range, according to your practice's allowable schedule. 

Best Practice: Review your Zero Pay Report every week.

The Zero-Pay Review page allows your practice to view closed charges that have received a zero payment and were adjusted off based on the primary insurer's payment rules. These claims may qualify for an appeal, and should therefore be reviewed on a weekly basis to determine if they were adjudicated correctly, or if you can appeal them.

On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Zero Pay Review.

Best Practice: Review your Best Practice Reports every week.

A group of custom Best Practice Reports is available to your practice. Run these reports weekly for insight on practice functions, such as check-in productivity, charge entry lag, and copay collections.

See: Report Library

Best Practice: Review the Financial Control Center content every week.

Use this page to monitor deposit activity, revenue, and clearing account items, including unpostables and undeposited transactions.

The FCC workflow is the recommended alternative to trying to reconciling bank account activity against the Activity Wizard report results.

On the Main Menu, click Financials. Under MONEY MANAGEMENT, click Financial Controls Center.

Best Practice: Review your unknown deposit batches every week.

Use the Manage Deposit Batches page to find any "UNKNOWN" deposit batches and associate them with a bank account, so that your reporting properly reflects activity in your respective the proper bank accounts.

On the Main Menu, click Financials. Under MONEY MANAGEMENT, click Deposit Batches.