Payer Yield Report

athenaCollector

You can use the Payer Yield report to understand the root cause of payer yield loss so your organization can make changes that result in more revenue in the future. The Payer Yield report also helps you establish revenue loss and risk tied to specific kick codes even after claims are adjusted off or actively billed in the late stages of the claim cycle.

 

athenahealth calculates payer yield by dividing your total net payments for primary and secondary transfer types by your total charges minus net transfers, contractual adjustments, free care adjustments, and capitation adjustments.

 

Note: In this calculation, we remove adjustments types that are not aligned with revenue opportunities specific to payer yield. For this reason, the Payer Yield report is not the best report to evaluate underpayments and payment mismatch because we remove contractual adjustments.

 

Display the Report Library: On the Main Menu, click Reports. Under General, click Report Library. Click the Other tab. In the Standard Reports section of the tab, click run next to Payer Yield.

 

 

 

To access reports on the Other tab of the Report Library, you must have the Report: Report Library: Other permission. This permission is included in the following roles:

  • Practice Superuser role
  • Report Reader role

Note: To activate the Patient Panel report, use the Activate Reports page.

 

 

  1. Display the Report Library: On the Main Menu, click Reports. Under General, click Report Library.
  2. Click the Other tab.
  3. Click run or schedule next to Payer Yield in the Standard Reports section of the tab.
    The Run Report: Payer Yield page appears.
  4. Show Claim Detail — Check the box to filter for which claim details to include on the report (department place of service ID, supervising provider group, and so on).
  5. Department — Select which departments to include in the report.
  6. Supervising Provider — Select which supervising providers to include in the report.
  7. Report Format — Select the format for your report results.
    • HTML table — Display the report results on your screen.
    • Text (tab-delimited) — Export the report results to a .csv file in tab-delimited format.
    • Text (comma-delimited) — Export the report results to a .csv file in comma-delimited format.
  8. Report Options — Select report options.
    • Suppress Column Headings — Select this option to remove column headings from the report results.
    • Suppress Report Name — Select this option to remove the report name from the report results.
    • Show Filter Criteria — Select this option to include your selected filter criteria in the report results.
    • Run Offline (will appear in your Report Inbox tomorrow morning) — Select this option for very long reports. Reports that are run offline appear in your Report Inbox the morning after the request.
  9. Click Run Report.

 

Note: Most columns that display claim-level details appear only when you select the Show Claim Detail option.

 

 

  1. Display the Report Library: On the Main Menu, click Reports and then click Report Library.
  2. Select the Other tab.
  3. Find the Payer Yield report and click run.
    The Run Report page appears.
  4. Set any filter fields to your specification and select a report format that exports results to a .csv file.
  5. Click Run.
  6. Open the .csv file.
  7. Filter for claims with "Current Period" in the REPORTING_WINDOW column. This indicates whether the claim's date of service is 7-to-12-months from the date you run the report.
  8. Filter for claims with "1" or "2" in the TRANSFERTYPE column.
  9. Divide the total of the NET_PMT column by the total of the CHARGE_AMOUNT column, minus the totals of the NET_XFER, CONTRACT, FREE, and CAP columns.
    Note: As a function, this is: NET_PMT/(CHARGE_AMOUNT-NET_XFER-CONTRACT-FREE-CAP).

 

 

 

Payer yield is a critical measure in evaluating revenue cycle performance, as it measures how well athenahealth and your organization are performing against retrieving the payer-side collections owed to your organization.

 

athenahealth calculates payer yield by dividing your total net payments for primary and secondary transfer types by your total charges minus net transfers, contractual adjustments, free care adjustments, and capitation adjustments.

 

In this calculation, we remove adjustments types that are not aligned with revenue opportunities specific to payer yield. For this reason, the Payer Yield report is not the best report to evaluate underpayments and payment mismatch because we remove contractual adjustments.

 

athenahealth focuses the payer yield calculation on claims that are between 7 and 12 months old from the date of service. This calculation ensures that we allow enough time for the result to be weighted more toward revenue performance as opposed to pure cash flow.

 

 

 

The Payer Yield report returns data similar to the data available in the Activity Wizard report and in the Transaction Activity report type in the Report Builder (for example, amounts adjusted off the claim for various adjustment types). However, the Payer Yield report includes the original denial kick code received on the claim.

 

This report allows you to better establish revenue loss and risk tied to specific kick codes even after claims are adjusted off or actively billed in the late stages of the claim cycle. In either case, the original denial persists as a reporting element to bring more consistency to reporting on revenue loss and impact.

 

 

 

Run Report: Payer Yield
Show Claim Detail Filter which claim details to include in the report (department place of service ID, supervising provider group, etc.).
Department Filter the departments that appear in the report results.
Supervising Provider Filter the supervising providers that appear in the report results.
Report Format

Select the format for your report results.

  • HTML table — Display the report results on your screen.
  • Text (tab-delimited) — Export the report results to a .csv file in tab-delimited format.
  • Text (comma-delimited) — Export the report results to a .csv file in comma-delimited format.
Report Options

Select other options for your report results.

  • Suppress Column Headings — Select this option to remove column headings from the report results.
  • Suppress Report Name — Select this option to remove the report name from the report results.
  • Show Filter Criteria — Select this option to include your selected filter criteria in the report results.
  • Run Offline (will appear in your Report Inbox tomorrow morning) — Select this option for very long reports. Reports that are run offline appear in your Report Inbox the morning after the request.
Column headings
SNAPSHOT_DATE Date that the report was run.
SERVICE_MONTH Service date of the claim.
REPORTING_WINDOW Displays "Current Period" if the claim is 7 to 12 months old from the date of service. This indicates the claim data should be included in the payer yield calculation.
CLAIMID athenaOne claim ID.
DEPARTMENTID Service department ID where the charge was incurred.
DEPARTMENTNAME

Service department name where the charge was incurred.
SUPERVISINGPROVIDERID

Supervising provider ID.
SUPERVISINGPROVIDERNAME

Supervising provider name.
TRANSFERTYPE Indicates the transfer type ("p" for patient, "1" for primary, or "2" for secondary).
INSURANCEPACKAGE_NAME Insurance package name.
INSREPORTINGCATEGORY_NAME Insurance reporting category (IRC) name.
CHARGE_COUNT Number of charge items included in this report row.
CHARGE_AMOUNT Amount of the current charge dollars.
NET_PMT Payment amount.
CONTRACT Amount of the contractual adjustments associated with this report row.
FREE Amount adjusted off as free care associated with this report row.
BADDEBT Amount of charges adjusted off with a BADDEBT adjustment. This category contributes to yield loss.
PRE_COLLECT Amount adjusted to pre-collect associated with this report row. Your practice must have the "Auto Pre-Collect Adjustments" feature enabled to see this column.
COLLECT Amount adjusted off to collections associated with this report row.
RECOVERY

Recovery adjustment associated with this report row. The recovery adjustment is posted to reverse the collection adjustment. This positive adjustment provides the patient with a positive account balance. The rest of the transactions then work down this balance.

 

The amount of the recovery adjustment is the sum of any recovery payments and fee adjustments. This adjustment typically represents the total amount paid by the patient.
FEE Fee adjustment associated with this report row.  The amount collected from the patient that is retained by the collection agency as commission.
CAP Capitated adjustment amount associated with this report row. The capitation adjustment closes the charge line on claims whose payers have a capitation contract with the practice.
GLOBL Amount of charges adjusted off with a GLOBAL adjustment. This category contributes to yield loss.
WHOLD Withholding adjustment amount associated with this report row. Withholding is payment held back by payers from the practice for a variety of reasons, including owed back taxes or penalties.
INTEREST Interest adjustment amount associated with this report row. Interest may be positive or negative. It is either paid to the practice by the payer, usually because the payer owes a penalty due to processing delays or paid by the practice to the payer, usually because the practice delayed sending requested refunds.
ADJOTH Amount of charges adjusted off with an OTHER adjustment type. This category contributes to yield loss.
NET_XFER Net amount of transfers associated with this report row. When you filter for claims with "1" or "2" in the TRANSFERTYPE column, the amount represents the total dollars sent to the patient.
NETRECEIVABLE Total outstanding A/R associated with report row.
ORIGINAL_DENIAL Kick code of the first denial from the payer.
UNCOLLECTED_DOLLARS Sum of the ADJOTHER, BADDEBT, GLOBL, and NETRECEIVABLE columns. The amount is largely charge dollars given the adjustment types.
KICKED_PROCEDURECODE Procedure code related to the denial that appears in the ORIGINAL_DENIAL column.

 

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