The Outstanding Balances section provides a detailed breakdown of the amounts owed by each account. It separates the total outstanding amount into two key components: Account Portion (or Patient Portion) and Insurance Portion (or Insurance Estimate). This data is not only reflected on the Account Detail Page but also forms the basis for Auto Collection Rules.
Key Components
1. Total Outstanding
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Definition: The combined amount owed by the patient and the insurance company.
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Formula:
Total Outstanding = Account Portion (Patient Portion) + Insurance Portion (Insurance Estimate). -
Purpose: Provides a complete view of the total unpaid balance for an account.
2. Account Portion (Patient Portion)
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Definition: The amount the patient is directly responsible for paying.
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Details:
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Also referred to as the "Patient Portion."
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Represents the out-of-pocket amount not covered by insurance.
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Use Case:
- Focus on collecting this amount from patients as part of payment collection activities.
3. Insurance Portion (Insurance Estimate)
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Definition: The amount expected to be covered by the patient’s insurance provider.
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Details:
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Also referred to as the "Insurance Estimate."
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Reflects the projected payment from the insurance based on coverage details.
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Use Case:
- Monitor and follow up with insurance companies to ensure timely reimbursement.
How This Data is Used
1. Account Detail Page
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The Total Outstanding, Account Portion, and Insurance Portion are prominently displayed on the Account Detail Page.
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This breakdown allows you to quickly see the financial responsibility split for each account and take informed actions.
2. Auto Collection Rules
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Foundation for Rules:
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The Account Portion is used to trigger auto collection activities for overdue balances.
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Balances with an Insurance Portion are excluded from auto collection, focusing efforts on amounts the patient owes directly.
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Customizable Rules:
- Auto collection rules can be tailored to target specific aging buckets, total outstanding thresholds, or patient balances.
How to Use This Information
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Track Balances:
- Quickly identify how much is owed by the patient versus the insurance provider for better prioritization.
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Focus on Collections:
- Prioritize collecting the Account Portion (Patient Portion) to reduce outstanding balances.
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Leverage Auto Collection:
- Use the data to set effective rules for automated payment reminders and collections.
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Insurance Follow-Up:
- Ensure claims are processed and reimbursed for the Insurance Portion (Insurance Estimate).
This breakdown simplifies managing outstanding balances by clearly distinguishing between patient and insurance responsibilities, while also enabling efficient automation through auto collection. For further assistance, contact support or your account manager.
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