Fully Worked Receivables

athenaCollector

athenaOne for Hospitals & Health Systems   

A fully worked claim is a claim that athenahealth considers uncollectable, even though it remains unpaid, or a claim for which athenahealth cannot confirm deposit or locate the remittance. The fully worked status is applied to a claim (or remittance record) under several circumstances. After a claim or remittance record is deemed "fully worked," athenahealth will no longer pursue payment of the claim or act on the remittance record.

 

This page allows you to generate worklists of claims marked as fully worked. You can adjust and close the claims on the worklist.

 

On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Fully Worked Receivables

 

 

 

To access this page, you must have the Billing Admin: Fully Worked Receivables permission.

 

 

 

 

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.

 

See To generate a FWR worklist.

 

You can use either the Fully Worked Receivables page or the View Claim Worklists page to view and work claims marked as fully worked. Here is the difference:

  • Claims in a worklist generated using the Fully Worked Receivables page can be worked and adjusted off as a group or on a claim-by-claim basis. Claims worked from this worklist are also removed from the MGRHOLD worklist on the View Claim Worklists page.
  • Fully worked claims on the View Claim Worklists page MGRHOLD list can be worked and adjusted off only on a claim-by-claim basis: in the Task Bar, click MGRHOLD. then select View By: Reason in the Workspace to check for these claims.

 

 

Sometimes athenahealth needs to make judgments about when to stop working on a claim. athenahealth has defined "endpoints" to our processes that, in our experience, are appropriately aggressive on your behalf without being pointless. athenahealth calls a claim that has hit one or more of these endpoints a "fully worked receivable" (FWR) and defines it as a charge that:

  • Was not billed within the payer's timely filing limit, has aged past the expected payment period for that payer, and has an open balance of $4.99 or less.
  • The payer has not responded after three attempts to process the claim; these attempts include (but are not limited to) phone calls, Web portal usage, written demand letters, and claim resubmissions.
  • Was denied and has subsequently failed a separate appeal process after confirmation that the payer has all necessary documentation.
  • athenahealth confirms that payment went to the parent organization or non-athenaOne entity with which your medical group shares a tax ID number (usually this entity is a hospital).

 

 

athenahealth designates a claim as fully worked using kick codes that indicate the reason and available resolution options. When a claim is marked as fully worked, athenaOne assigns it a claim status of MGRHOLD by default (see "Fully worked kick codes" for details on each fully worked reason).

 

If you believe a claim has been placed in a Fully Worked status in error, you can create a case to have it reviewed for removal from Fully Worked Status. If athenahealth finds the tag to be an error, athenahealth will use the kick code FWRCLEAR . However, if the claim was worked correctly, the Fully Worked status will remain on the claim.

 

After a claim is marked as fully worked, it appears on your Fully Worked Receivables worklist.

 

 

 

Meaning

This kick code is applied when it has been determined that there are no further opportunities to appeal. This code is also used when athenahealth has attempted to appeal the claim through its best practice workflows and no longer believes that additional efforts will be successful (meaning no incremental payment will be gained). A claim can also be marked with FWRAPPEALFAIL when a denial reflects an attempt on our part to overturn the filing limit. This denial is never appealable after it is received.

 

Next steps for practice

If you have access to additional information or payer contacts that are not available to athenahealth, you should leverage those now. You can also remove this balance from your accounts receivable using a kick code determined by your practice administrator. For credit balances, please review the claim for appropriate use of the kick code ABANDONED.

 

 

 

Meaning

This kick code is used to move claims out of an athenaOne workflow when athenahealth has received remittance without confirmation of deposit.

 

Next steps for practice

Please review the associated Remittance Advice Received record and confirm that the deposit was received at a non-athenahealth bank account.

 

 

 

Meaning

Claims are automatically kicked with FWRFILINGLIMIT if the charges were entered in athenaOne after the payer's filing deadline or if we received two timely filing denials (BDE) in a row. FWRFILINGLIMIT is also applied if the payer's filing limit has passed and there is no proof of timely filing available on the claim (USPS One Code Confirmation or Electronic Payor Acknowledgement).

 

Next steps for practice

You can remove this balance from your accounts receivable using a kick code determined by your practice administrator. For credit balances, please review the claim for appropriate use of the kick code ABANDONED.

 

Note: If your practice uses the "athenaCollector (No Posting)" service or the "athenaCollector (No-Followup)" service, you can request a proof of timely filing for electronic submissions to assist you in addressing these claims. Here are the steps:

  1. Display the claim.
    If you are on the Claim Action page, click Go to Advanced View to display the Claim Edit page.
  2. Verify that you submitted the claim electronically at least once by checking that ANSI837 is shown on the claim note, indicating "Primary Billed."
  3. Force drop to paper for primary — Select Yes-Athena.
  4. Reason — Select CSTPRFSUBM.
  5. Status — Select DROP.
  6. Kick Reason — Select DRPBILLING.
  7. Enter a claim note indicating that you are requesting proof of timely filing.
  8. Click Save.
    The claim moves into ATHENAHOLD status. athenahealth will research the claim, attach the appropriate clearinghouse report, and resubmit the paper claim and its attachment to the payer.

 

 

Meaning

athenahealth has returned a live check to the practice for deposit but has not received any confirmation of deposit.

 

Next steps for practice

Please confirm the deposit of funds by updating the status of the remittance record and including the deposit information.

 

 

 

Meaning

This kick code is used to move claims out of an athenaOne workflow when athenahealth has determined that either the payment or remittance was sent to your practice.

 

Next steps for practice

Please submit a copy of the EOB with confirmation of deposit using the Submit Remittance tab of the Manage Remittance page. If you cannot upload the EOB on the Submit Remittance tab, you can send the EOB via BYOLB Remittance Template as a last resort. For instructions on how to fill out a BYOLB template, see the BYOLB Template Procedures document on the Success Community.

 

 

 

Meaning

This kick code is used by athenahealth when the payer cannot be reached. At least three attempts are made through all available avenues (payer Web portal, phone, and resubmission) before this kick code can be applied.

 

Next steps for practice

If you have access to additional information or payer contacts that are not available to us, you should leverage those now. You can also remove this balance from your accounts receivable using a kick code determined by your practice administrator. For credit balances, please review the claim for appropriate use of the kick code ABANDONED.

 

 

 

Meaning

This kick code is used to move claims out of an athenaOne workflow when athenahealth has received confirmation of deposit without remittance.

 

Next steps for practice

Please review the associated remittance record and submit a copy of the EOB using the Upload missing EOB option on the Remittance Record page.

 

 

 

Meaning

This kick code is used to move claims out of an athenaOne workflow when athenahealth has determined that the payment or remittance was sent to your practice or to the non-athenaOne entity with which you share a tax identification number (TIN) or National Provider Identifier (NPI) — for example, another practice or hospital.

 

Next steps for practice

Please work with the non-athenaOne entity to retrieve and submit a copy of the EOB with confirmation of deposit via the BYOLB Remittance Template. (For instructions on how to fill out a BYOLB template, see the BYOLB Template Procedures document.) After we receive the BYOLB, the EOB or payment is posted accordingly in athenaOne.

 

 

 

Meaning

This kick code is used for denied small-balance claims ($4.99 or less). The default claim status for this kick code is MGRHOLD. This kick code is also used under special circumstances for the payer AARP. AARP has requested that athenahealth write off all claims with a +/- $.01 cent balance. These penny balances frequently occur as a result of rounding.

 

Next steps for practice

Your practice can choose to write off FWRSMALLBAL claims automatically. To enable automatic write-off of small-balance claims, contact the CSC by selecting Support > Create Case or Call in the Main Menu. Your practice must submit a written waiver.

 

 

 

Meaning

athenaOne does not support the submission of electronic tertiary claims.

 

Next steps for practice

We recommend that you review the claim and payer and, if applicable, submit the claim through the payer's Web portal. You can also remove this balance from your accounts receivable using a kick code determined by your practice administrator. For credit balances, please review the claim for the appropriate use of the kick code ABANDONED.

 

 

 

 

 

 

  1. Display the Fully Worked Receivables page: On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Fully Worked Receivables.
  2. Use the filter fields to limit the claims on the list (see the Field Reference).
  3. Click Filter results. The list of claims appears below. You can click column headings to sort the list.
    • Click Generate Worklist to generate a worklist of "clickable" claims in the Task Bar.
    • Click Download CSV to generate the list as a CSV file. The CSV file includes additional information that could be useful for a Provider Relations representative for a further appeal.

 

  1. Generate a Fully Worked Receivables worklist (see To generate an FWR worklist).
  2. Select each claim that you want to adjust as bad debt and close. (You can select the Check all option at the bottom of the Task Bar worklist to select all claims in the list.)
  3. Enter a text note to document your actions in the Note field.
  4. Click Close Claims. The selected claims are adjusted and closed, and are removed from your FWR worklists.

 

 

You can continue to bill a claim with an FWR status to the payer. However, athenahealth will not follow up on the claim. If you are adding an attachment to the Attachments section, the claim will be sent via paper submission.

 

You can manually change a claim submission to paper. To submit a claim on paper:

  1. Display the Claim Edit page.
  2. Locate the Force drop to paper field for the appropriate payer, and select Yes-Athena from the menu.
  3. Select a reason from the Reason menu.
  4. Click Save.

 

 

Note: At least one change must be made to the claim before it can be resubmitted. It is not compliant to resubmit a claim without changes only to see whether the claim will be paid if you resubmit it to the payer.

  1. Display the Claim Edit page for the claim that you want to re-drop. Click the edit claim link on the Claim Review or Post Payment page (the link is on the line item's advanced view).
  2. Scroll down to the Add Note section.
  3. Applies to — Make sure that the correct insurance type (primary or secondary) is selected.
  4. Status — Select DROP.
  5. Kick reason — Enter a period to display the Kick Code Lookup tool.
  6. In the Kick Code Lookup tool, select Claim Redrop from the menu to display a list of kick codes used to re-drop claims.
  7. Select the appropriate kick code from the list. The DRPBILLING kick code is most commonly used in this case.
  8. Note — Enter a clear, detailed note to describe what you corrected or updated.
  9. Click Save Claim.
  10. Review the claim, making sure that the claim status is no longer HOLD or MGRHOLD.
    Note: If the claim is still in HOLD or MGRHOLD status, the claim requires additional work.

 

 

Filter Claims fields
Status

Select the claim status of the claims that you want to appear in the worklist.
Payor

Select the payer to whom the claims were submitted.
Transfer type

Select the transfer type for claims on the worklist (Primary, Secondary, or Patient).
Balance

Enter the balance range for the claims that you want to appear on the worklist.
Current Athena kickcode

Enter specific athenaOne kick codes for the claims that you want to appear in the worklist. You can enter up to eight kick codes in the fields provided. To search for kick codes, enter a period (.) in a field to display the Kick Code Lookup tool.
Reason marked FWR

Select the reason that the claims were marked as fully worked.
Medical group Select the medical groups associated with the claims (you can use the Ctrl key to select more than one medical group). This field appears only if your practice has more than one medical group.
Provider group Select the provider groups associated with the claims (you can use the Ctrl key to select more than one provider group). This field appears only if your practice uses provider groups.
Providers Select the providers associated with the fully worked claims (you can use the Ctrl key to select more than one provider).
Department Select the departments associated with the fully worked claims (you can use the Ctrl key to select more than one department).
Column headings for worklist results
Service date

The date of service of the claim.
Claim ID

The claim ID number.
Patient name

The patient name on the claim.
Status

The claim status.
Payor

The payer to whom the claim was submitted.
Transfer type

The transfer type for the claim balance.
Reason marked

The reason that the claim was marked fully worked.
Department The department associated with the claim.
Provider The provider associated with the claim.
Outstanding

The outstanding balance for the claim.
Current Athena Kickcode The kick code currently assigned to the claim.
Provider group The provider group associated with the claim (if your practice uses provider groups).
Medical group The medical group associated with the claim (if your practice has more than one medical group).
Note When you select one or more claims from the FWR table, you can enter a note to document your action.

 

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