MEDHOST Enterprise Patient Accounting Sample Reports · REPORT MENU/TAB OPTION F Final Census...

SAMPLE REPORTS Introduction To Manual Page 1

Introduction To Manual

Overview: This manual describes reports that you can generate through Patientaccounting. The description includes information about accessing the report, what program produces the report, how you can use the information, any printing options that are available for the report, and the primary file(s) accessed to process the report. Any column headings that are not self-explanatory are described. A sample of each report is included along with the description.

The reports are grouped according to the Patient Accounting processes and in order that these processes flow. For example, all the census reports are grouped together and daily reports are presented before monthly reports.

The Manual Index lists the reports as they appear in the manual.

The Report Index lists the report names alphabetically.

Finding your way through the manual

The manual is set up so that the reports appear in the manual in the order they are generated.

The first line has the manual name, the topic name, and the tab. The second line is the name of the report and the page number.

SAMPLE REPORTS CENSUS REPORTS CENSUS Final Census .1

In the case above, the ‘2’ in the page number means that the Final Census is the second census report produced and the ‘1’ is the page number.

SAMPLE REPORTS Manual Index Page 1

DAILY REPORTS

Census Reports

1. Preliminary Census2. Final Census3. Alphabetic Census4. Religion Census5. Physician Census6. Observation Census7. Daily Room Charge Totals8. Automatic Room Charge Totals9. Temporary Room Charge Totals10. Daily ADT Activity11. Exception Reports12. Admit/Discharge Report13. Religion/Congregation Census14. Psych Final Census Report15. Recurring Charges Report16. Statistics Update Error Report17. Acuity Census18. Nurses Station Census19. Census Leave of Absence

Transaction Edit Reports

1. Daily Charge Transaction Input Edit List2. A/R Cash Receipts Entry Listing3. Remittance Advice Entry Listing

Bill Selection Reports

1. Bill Selection Status Report2. Bill Selection Error Listing3. Late Charge Bill Selection Status Report


DAILY REPORTS (CONTINUED)

Day End Reports

1. Daily O/P Registrations 2. Patient Transfer Report 3. Summary of Charges Update 4. Inpatient Posting Control Report 5. Outpatient Posting Control Report 6. Daily Transaction Audit Report 7. Daily Late Charge Transaction 8. Daily Statistics Report - F/C 9. Hospital Service Code Revenue Statistics 10. Inpatient/Outpatient Service Code Stat 11. Departmental Revenue by Financial Class 12. Daily Revenue Usage 13. Daily DRG analysis by physician 14. New Accounts Receivable Report 15. Payor Log Exception Report 16. Cash Receipts and Adjustments 17. Daily Transactions by Payor 18. Accounts Receivable Posting Recap 19. A/R Distribution Report 20. General Ledger Proof 21. General Ledger Detail Update 22. Daily Statement Selection 23. Daily Status Report 24. Invalid Charges Report 25. Statistical Update Error Report 26. Proration Summary Report 27. Audit Reports 28. Payor Log Balancing Report 29. Referral Intakes of Unknown Status 30. Industrial Billing Registrations 31. Industrial Charge Audit Report 32. Cancelled Bill Audit Report 33. Recurring Outpatient With No Activity


COLLECTION REPORTS 1. Cash Receipts by Patient Rep-Summary 2. Cash Receipts by Patient Rep-Detail 3. Patient Rep Activity by Transaction Code 4. Patient Rep Activity by Comment Type 5. Projected Follow-up by Patient Rep-Summary 6. Past due Follow-up Report 7. Cash Receipts by Month-Patient Rep 8. Summary Aging by Patient Representative 9. Detail Aging by Patient Representative 10. Accounts Receivable Query 11. Projected Follow-up by Patient Rep-Detail 12. Cash receipts by month - physician

PAYOR LOG REPORTS 1. Unbilled Claims 2. Unbilled Claims by Physician 3. Billed Claims - Log Summary 4. Billed Claims - Log Summary by Physician 5. Print Log Audit Report 6. Payor Log Error Report 7. Billed Claims Detail Log (1 page per patient) 8. Billed Claims Detail Log (for selected patients) 9. Bad Debt Payor Log 10. Log Reconciliation Report 11. Prior Year Payments Report

MONTHLY A/R & STATISTICAL REPORTS

A/R Reports

1. Physicians analysis report 2. Financial class statistical report 3. Financial class statistical report (comparison) 4. Financial class statistical report (comparison) by HSV 5. Statistical report by service 6. Accounts receivable transaction statistics report


MONTHLY A/R & STATISTICAL REPORTS (CONTINUED)

A/R Reports (continued)

7. Estimated Reserve Listing 8. A/R transaction analysis 9. General Ledger Proof 10. Summary aging by financial class 11. Detail aging by financial class 12. Payor aging report 13. Aged cash receipts summary 14. Credit balance report 15. Bad debt write-off report 16. Bad debt recovery listing 17. A/R patient name/number cross reference listing 18. Unbilled accts past Hold days rpt

Revenue & Usage Reports

1. Hospital service code revenue statistics 2. Revenue by service and class 3. Revenue/Usage statistics summary 4. Revenue detail (F/C-MTD,YTD) 5. Revenue/Usage statistics detail 6. Departmental revenue (F/C) 7. Revenue detail (F/C-Pd: Qty,$$) 8. Physicians analysis (F/C) 9. Physicians analysis (Service-F/C) 10. Revenue by payor 11. Departmental revenue by service 12. Physician profit and loss report 13. Critical Access I/P 96 Hr Report 14. RVU Analysis Report

Period Processing Reports

1. Accounts Receivable Accounts on Hold List 2. Accounts Receivable Purge List 3. Guarantor Purge Report 4. Purged A/R Account Listing 5. A/R Status Reports for Purged Accounts


Period Processing Reports (continued)

6. Purged Patient History Listing 7. Purged A/R Transaction Code Listing 8. Recurring Outpt Automation Report (Preliminary) 9. Recurring Outpt Automation Report (Production)

MISCELLANEOUS REPORTS 1. Leave of absence list 2. Admission register 3. Discharge register 4. Pre-admission register 5. Pre-registration register 6. Outpatient registration list 7. Recurring outpatient listing 8. Treatment worksheet 9. Periodic Billing Report 10. Billing Cycle Summary Report 11. Guarantors not to receive statements 12. Readmission list 13. Expired member listing

14. Leave of absence history

FILE LISTINGS See: System Manager's Guide

SAMPLE REPORTS Report Index Page 1

REPORT MENU/TAB OPTION

A

Acuity Census CENSUS RPTMN1 7 Admit/Discharge Report CENSUS DLYPRS 2 A/R Cash Receipts Entry Listing EDITS DLYPRS 6 A/R Distribution Report DAY END DLYPRS 10 A/R patient name/number cross reference listing A/R BUSOF2 20 A/R patient/number cross reference listing A/R PTMN2 21 A/R Status Reports for Purged Accounts PERIOD PROCESS PERPRS 5 A/R transaction analysis A/R RPTMN2 11 Accounts Receivable Accounts on Hold List PERIOD PROCESS PERPRS 2 Accounts Receivable Posting DLYPRS 10 Recap DAY DLYPRS 10 Accounts Receivable Purge List PERIOD PROCESS PERPRS 3 Accounts receivable query COLLECTION COLRPT 16 Accounts receivable transaction statistics A/R PERPRS 4 Accounts receivable transaction statistics A/R PERPRS 5 Accounts receivable transaction statistics A/R RPTMN2 5 Admission Register MISC RPTMN1 9 Aged cash receipts summary A/R RPTMN2 16 Alphabetic Census CENSUS DLYPRS 2 Alphabetic Census CENSUS RPTMN1 2 Audit Reports DAYEND DLYPRS 10 Automatic Room Charge Totals CENSUS DLYPRS 2

B

Bad debt payor logs LOGS LOGMNU 9 Bad debt recovery listing A/R RPTMN2 19 Bad debt write off report A/R RPTMN2 18 Bill Selection Error Listing BILL SELECTION BUSOF1 10 Bill Selection Error Listing BILL SELECTION DLYPRS 9 Bill Selection Error Listing BILL SELECTION DLYPRS 10 Bill Selection Status Report BILL SELECTION BUSOF1 10 Bill Selection Status Report BILL SELECTION DLYPRS 9 Bill Selection Status Report BILL SELECTION DLYPRS 10 Billed Claims- Log Sumary LOGS LOGMNU 3 Billed Claims by Physician- Log Summary LOGS LOGMNU 4


REPORT MENU/TAB OPTION B (continued) Billed Claims Detail Log (for selected patients) LOGS LOGMNU 8 Billed Claims Detail Log (1 page per patient) LOGS LOGMNU 7 Billing cycle summary report MISC RPTMN1 19 C Cancelled Bill Audit Report DAY END DLYPRS 8 Cash Receipts and Adjustments DAY END DLYPRS 10 Cash receipts by patient rep-summary COLLECTION COLRPT 1 Cash receipts by patient rep-detail COLLECTION COLRPT 2 Cash receipts by month- patient rep COLLECTION COLRPT 13 Cash receipts by month -physician COLLECTION COLRPT 18 Census Leave of Absence CENSUS DLYPRS 2 Credit balance report A/R RPTMN2 17 Critical Access I/P 96 Hr Report REVENUE RPTMN3 18

D

Daily ADT Activity CENSUS DLYPRS 2 Daily Charge Transaction Input Edit List EDITS DLYPRS 4 Daily DRG analysis by physician DAY END DLYPRS 10 Daily DRG analysis by physician DAY END PTMN1 15 Daily Late Charge Transaction DAY END DLYPRS 10 Daily O/P Registrations DAY END DLYPRS 10 Daily Remittance Advice Entry Listing EDITS DLYPRS 7 Daily Revenue Usage DAY END DLYPRS 10 Daily Room Cahrge Totals CENSUS DLYPRS 2 Daily Statement Selection DAY END DLYPRS 10 Daily Statistics Report - F/C DAY END DLYPRS 10 Daily Status Report DAYEND DLYPRS 10 Daily Transaction Audit Report DAYEND DLYPRS 10 Daily Transactions by Payor DAYEND DLYPRS 10


REPORT MENU/TAB OPTION D (continued) Departmental Revenue by Financial Class DAYEND DLYPRS 10 Departmental Revenue by Financial Class REVENUE PERPRS 4 Departmental Revenue by Financial Class REVENUE PERPRS 5 Departmental Revenue by Financial Class REVENUE RPTMN3 10 Departmental revenue by service REVENUE RPTMN3 16 Detail aging by financial class A/R PTMN2 14 Detail aging by patient representative COLLECTION COLRPT 15 Detail revenue analysis by financial class REVENUE PERPRS 4 Detail revenue analysis by financial class REVENUE PERPRS 4 Detail revenue analysis by financial class REVENUE PERPRS 5 Detail revenue analysis by financial class REVENUE PERPRS 5 Detail revenue analysis by financial class REVENUE RPTMN3 5 Detail revenue analysis by financial class REVENUE RPTMN3 11 Discharge register MISC RPTMN1 10 Doctor Census CENSUS DLYPRS 2 Doctor Census CENSUS RPTMN1 4

E

Estimated Reserve Listing A/R PTMN2 10 Exception Reports CENSUS DLYPRS 2 Expired member listing MISC RPTMN1 20


REPORT MENU/TAB OPTION F Final Census CENSUS DLYPRS 2 Financial class comparison by HSV A/R PERPRS 4 Financial class comparison by HSV A/R PERPRS 5 Financial class comparison by HSV A/R RPTMN2 4 Financial class comparison report A/R PERPRS 4 Financial class comparison report A/R PERPRS 5 Financial class comparison report A/R RPTMN2 3 Financial class statistical report A/R PERPRS 4 Financial class statistical report A/R PERPRS 5 Financial class statistical report A/R RPTMN2 2 G General Ledger Detail Update DAY END DLYPRS 10 General Ledger Proof A/R DLYPRS 10 General Ledger Proof A/R RPTMN2 12 General Ledger Proof DAY END DLYPRS 10 General Ledger Proof DAY END RPTMN2 12 Guarantor Purge Report PERIOD PROCESS PERPRS 5 Guarantors not to receive statements MISC RPTMN2 20



H

Hospital Service Code Revenue Statistics DAYEND DLYPRS 10 Hospital Service Code Revenue Statistics REVENUE PERPRS 4 Hospital Service Code Revenue Statistics REVENUE PERPRS 5 Hospital Service Code Revenue Statistics REVENUE RPTMN3 1

I

Industrial Charge Audit Report DAY END DLYPRS 10 Industrial Billing Registrations DAY END DLYPRS 10 Inpatient/Outpatient Service Code Stat DAY END DLYPRS 10 Inpatient Posting Control Report DAY END DLYPRS 10 Invalid Charges DAY END DLYPRS 10

L

Late Charge Bill Selection Status Report BILL SELECTION BUSOF1 10 Late Charge Bill Selection Status Report BILL SELECTION DLYPRS 9 Late Charge Bill Selection Status Report BILL SELECTION DLYPRS 9 Leave of absence history MISC RPTMN3 20 Leave of absence list MISC RPTMN1 21 Log Reconciliation Report LOGS LOGMNU 10

N

New Accounts Receivable Report DAY END DLYPRS 10 Nurses Station Census CENSUS DLYPRS 2 Nurses Station Census CENSUS RPTMN1 8 O

Observation Census CENSUS DLYPRS 2 Observation Census CENSUS RPTMN1 5 Outpatient Posting Control Report DAY END DLYPRS 10 Outpatient registration list MISC RPTMN1 13


REPORT MENU/TAB OPTION P Past due follow-up report COLLECTION COLRPT 6 Patient rep activity by comment type COLLECTION COLRPT 4 Patient rep activity by transaction code COLLECTION COLRPT 3 Patient Transfer Report DAY END DLYPRS 10 Payor aging report A/R RPTMN2 15 Payor Log Balancing Report DAY END DLYPRS 10 Payor log error report LOGS LOGMNU 6 Payor Log Exception Report DAY END DLYPRS 10 Periodic billing report MISC RPTMN1 18 Physician census CENSUS RPTMN1 4 Physician profit and loss report REVENUE RPTMN3 17 Physicians analysis by financial class REVENUE PERPRS 4 Physicians analysis by financial class REVENUE PERPRS 5 Physicians analysis by financial class REVENUE RPTMN3 13 Physicians analysis by service/financial class REVENUE PERPRS 4 Physicians analysis by service/financial class REVENUE PERPRS 5 Physicians analysis by service/financial class REVENUE RPTMN3 14 Physicians analysis report A/R PERPRS 4 Physicians analysis report A/R PERPRS 5 Physicians analysis report A/R RPTMN2 1 Pre-admission register MISC ADMMNU 8 Pre-admission register MISC RPTMN1 11 Pre-registration register MISC RPTMN1 12 Preliminary census CENSUS DLYPRS 1 Preliminary census CENSUS RPTMN1 1 Prior year payments report LOGS LOGMNU 11 Projected follow-up by patient rep-detail COLLECTION COLRPT 17 Projected follow-up by patient rep-summary COLLECTION COLRPT 5 Proration Summary Report DAY END DLYPRS 10 Print Log Audit Report LOGS LOGMNU 5 Psych Final Census Report CENSUS DLYPRS 2


REPORT MENU/TAB OPTION Purged A/R Account Listing PERIOD PROCESS PERPRS 5 Purged A/R Transaction Code Listing PERIOD PROCESS PERPRS 5 Purged Guarantor Listing PERIOD PROCESS PERPRS 5 Purged Patient History Listing PERIOD PROCESS PERPRS 5

R

Readmission list MISC RPTMN1 17 Recurring Charges Report CENSUS DLYPRS 2 Recurring Outpt Automation Report (Prelim) PERIOD PROCESS PERPRS 18 Recurring Outpt Automation Report (Prod) PERIOD PROCESS PERPRS 18 Recurring outpatient listing MISC RPTMN1 14 Recurring outpatient with no activity DAY END DLYPRS 10 Referral Intakes of Unknown Status DAY END DLYPRS 10 Religion Census CENSUS DLYPRS 2 Religion Census CENSUS RPTMN1 3 Religion/congregation census CENSUS RPTMN1 6 Revenue and usage statistics REVENUE PERPRS 4 Revenue and usage statistics REVENUE PERPRS 5 Revenue and usage statistics REVENUE RPTMN3 9 Revenue by payor REVENUE RPTMN3 15 Revenue by service and class REVENUE PERPRS 4 Revenue by service and class REVENUE PERPRS 5 Revenue by service and class REVENUE RPTMN3 2 Revenue usage summary by department REVENUE PERPRS 4 Revenue usage summary by department REVENUE PERPRS 5 Revenue usage summary by department REVENUE RPTMN3 4 RVU Analysis Report REVENUE RPTMN3 19

S

Statistical report by service A/R PERPRS 4 Statistical report by service A/R PERPRS 5 Statistical report by service A/R RPTMN2 4 Statistical Update Error Report DAY END DLYPRS 10 Statistics Update Error Report CENSUS DLYPRS 2 Summary aging by financial class A/R RPTMN2 13 Summary aging by patient representative COLLECTION COLRPT 14 Summary of Charges Update DAY END DLYPRS 10



T

Temporary Room Charge Totals CENSUS DLYPRS 2 Treatment worksheet MISC RPTMN1 16

U

Unbilled claims LOGS LOGMNU 1 Unbilled claims by physician LOGS LOGMNU 2

SAMPLE REPORTS CENSUS REPORTS CENSUS Preliminary Census Page 1.1

Preliminary Census

Overview: This option is used to print a preliminary census. The preliminarycensus is the same report as the final census but does not update the patients' accounts with room charges.

The census lists the room/bed, patient number, leave of absence code, patient name, admit dates, days of stay, financial class, hospital service code, current age, age code (Days or Months), sex, accommodation code, diet code, price code, observation patient indicator, and attending doctor.

Note: Non-observation outpatients will be included in the Preliminary and File Census, and will display a pound sign (#) at the end of the patient name on reports to indicate an Outpatient type.

Totals are shown for number of patients in four categories: accommodation, financial class, diet, and leave of absence. Totals are also shown for total beds occupied and beds available.

Access: Reports Menu I, Option 1 Daily Processing Menu, Option 1

Program: PB0R02

Selection: Site Location - Enter a site location, press F4 to search for a sitelocation, or leave blank for all

Note: This selection will only be displayed if the field Site Location Processing is answered 'Y' in the Admission Control Control Record, Option 26 on the System Control File Menu.

Statistics: Occupancy percentage

Column Heading: ACC CODE - Accommodation code of the patient

PRC CD - Price code (1-6) assigned to the patient LOA - Leave of absence code OBS - Observation patient


Use: This report can be used to verify the census before the final census is run and the room charges are applied to patients' accounts.

The Preliminary Census may be run as many times as necessary to verify the census before running the Final Census.

Files: RMBED, PATIENTS (No files updated)


CENSUS DATE 5/04/12 MEDHOST SAMPLE HOSPITAL RRB FAC# 245 PAGE

1 RUN DATE 9/13/12 TIME 1:12 PM P R E L I M I N A R Y C E N S U S R E P O R T PB0R02

NURSES STATION - ICU #=Outpatient KHERREN

ROOM-BED HISTORY PATIENT ADMISSION DAYS CUR ACC DIET PRC ATTENDING

NUMBER NUMBER NUMBER LOA PATIENT NAME DATE STAY F/C SERV AGE SEX CODE CODE CD OBS DOCTOR

-------- --------- ------- --- ------------------------ --------- ---- --- ---- --- --- ---- ---- --- --- --------------------

BED -1 151913 0600004 TEST EVANS 1/18/12 16 M ICU 36 M I 1 BAKER JAMES Q

ICU -06 151920 0600012 TEST BETTY 3/04/12 12 M ICU 32 F I 1 BAKER BART A

ICU -1 151913 0600005 TEST EVANS 1/20/12 44 B MED 36 M I 1 BAKER BILLIE Q

ICU -2 151832 0503805 BOWERS JACKSON 11/06/11 46 CA ICU 49 M I 1 BAKER BART A

ICU -3 151905 1000001 MSP GREENE 12/21/11 44 3 ICU 32 M I 1 BAKER ANNE T

ICU -4 151897 0600006 TEST 1/20/12 44 B CIP 37 F I 1 FITZGERALD LUKE Q

ICU -5 151897 0600007 TEST 1/20/12 44 B IIC 37 F I 1 FITZGERALD LUKE Q

** RECAP NURSES STATION - ICU **

** CENSUS SUMMARY ** ** F/C SUMMARY ** ** DIET SUMMARY ** ** LOA SUMMARY **

ICU L 3 7 SELF PAY 3

CAH MEDICARE 1

HMO DEAN HEALT 2

MEDICARE NURSI 1

-------- --------

TOTAL 7 TOTAL 7

======== ========



NURSES STATION - LNG1 #=Outpatient KHERREN



-------- --------- ------- --- ------------------------ --------- ---- --- ---- --- --- ---- ---- --- --- --------------------

323 -1 100742 0500439 GOTTSCHALL RUSSELL R 5/04/12 277 4 MCF 93 M H 1 PETERSON BART G

323 -2 ** AVAILABLE ROOM **

324 -1 107779 0501490 GEMPLER FLORENCE L 6/04/03 818 6 MCF 99 F H 1 ROBERTSON SANDRA R

324 -2 151939 0012363 HUDSON COCO 3/16/12 32 E MED 6 F A 1 BAKER ANNE T

325 -1 119795 0501757 GILBERTSON LOLA M 10/02/03 698 4 MCF 102 F F 1 ROBERTSON SUE R


326 -1 113415 0020090 MEUER LAVON L 3/20/01 624 4 MCF 95 F F 1 RODRIGUEZ BILLIE Q


327 -1 134672 0012565 SIEBARTH LYDIA E 7/29/00 858 4 MCF 93 F F 1 GREEN PETER A


328 -1 134604 0501276 BRECKBUHL JOHN J 3/09/03 905 4 MCF 86 M F 1 PETERSON BART G


329 -1 130374 0502615 MACHOTKA JUNE I 9/21/04 343 A MCF 95 F H 1 ROBERTSON SUE R


CENSUS DATE 5/04/12 MEDHOST SAMPLE HOSPITAL RRB FAC# 245 PAGE 14

RUN DATE 9/13/12 TIME 1:12 PM P R E L I M I N A R Y C E N S U S R E P O R T PB0R02

** TOTAL RECAP - ALL STATIONS **


LOASNF1 5 MEDICARE 1

NSY II 1 SELF PAY 9

LOASNF2 1 BLUE CROSS 3

NSY III 1 CAH MEDICARE 6

SNF 1 19 CAH MEDICAID 2

SNF 2 12 COMMERCIAL 8

ICU L 3 7 LANDS END (CO 1

ISN 3 HMO DEAN HEALT 3

LDRP I 4 OTHER CONTRACT 4

ICF 1-2 5 ALLIANCE 1

NSY I 5 MEDICARE NURSI 6

OBSERVAT 2 MEDICAID NURSI 28

PRIVATE 1 SELF PAY NURSI 9

SEMI PVT 11 HH COMMERCIAL 1

LDRP II 1

LDRP III 1

ICU L 4 1

MS OTHER 2

-------- --------

TOTAL 82 TOTAL 82

======== ========

TOTAL BEDS OCCUPIED 82

TOTAL BEDS AVAILABLE 52

PERCENTAGE OCCUPANCY 61.1 %

SAMPLE REPORTS CENSUS REPORTS CENSUS Final Census Page 2.1

Final Census

Overview: This option is used to print a final census report. The census lists the

room/bed, patient number, leave of absence code, patient name, admit dates, days of stay, financial class, hospital service code, age, age code (Days or Months), sex, accommodation code, diet code,

price code, observation patient indicator, and attending doctor. Note: Non-observation outpatients will be included in the Preliminary

and File Census, and will display a pound sign (#) at the end of the patient name on reports to indicate an Outpatient type.

Totals are shown for number of patients in four categories:

accommodation, financial class, diet, and leave of absence. Totals are also shown for total beds occupied and beds available.

Several other census reports will print along with the Final Census

including the Daily Room Charge Report, Temporary Room Charge Report, ADT Activity Report, Alphabetic Census, Religion Census, Doctor Census, Observation Census, and Nurses Station Census.

The census reports that should print during the Final Census and the

number of copies of these reports can be maintained in Census reports record, Option 6 on the System Control File Menu.

Access: Daily Processing Menu, Option 2 Program: PB0R02 Selection: Census date Printer ID Statistics: Occupancy percentage Column Heading: ACC CODE - Accommodation code of the patient PRC CD - Price code (1-6) assigned to the patient LOA - Leave of absence code OBS - Observation patient


Use: The final census reports are used to identify all patients currently in the hospital. Room charge totals and daily ADT activity are included in these reports. Files: RMBED, PATIENTS, PATEXT, CHRGTRAN, ABSTRACT, PHYMAST, FCDESC, STATDR, PASTAT, RVSTAT, ADTTRNAD, ADTTRNDC, ADTTRNPA, ADTTRNXF, ADTTRNAC, SYSCTL, SYSTABFL, PANSFIL



1 RUN DATE 9/13/12 TIME 1:29 PM F I N A L C E N S U S R E P O R T PB0R02

NURSES STATION - ICU #=Outpatient KHERREN



-------- --------- ------- --- ------------------------ --------- ---- --- ---- --- --- ---- ---- --- --- ------------------

--

BED -1 151913 0600004 TEST EVANS 1/18/12 16 M ICU 36 M I 1 BAKER JAMES Q

ICU -06 151920 0600012 TEST BETTY 3/04/12 12 M ICU 32 F I 1 BAKER BART A

ICU -1 151913 0600005 TEST EVANS 1/20/12 44 B MED 36 M I 1 BAKER BILLIE Q

ICU -2 151832 0503805 BOWERS JACKSON 11/06/11 46 CA ICU 49 M I 1 BAKER BART A

ICU -3 151905 1000001 MSP GREENE 12/21/11 44 3 ICU 32 M I 1 BAKER ANNE T

ICU -4 151897 0600006 TEST 1/20/12 44 B CIP 37 F I 1 FITZGERALD LUKE Q

ICU -5 151897 0600007 TEST 1/20/12 44 B IIC 37 F I 1 FITZGERALD LUKE Q

** RECAP NURSES STATION - ICU **


ICU L 3 7 SELF PAY 3

CAH MEDICARE 1

HMO DEAN HEALT 2

MEDICARE NURSI 1

-------- --------

TOTAL 7 TOTAL 7

======== ========


2 RUN DATE 9/13/12 TIME 1:29 PM F I N A L C E N S U S R E P O R T PB0R02

NURSES STATION - LNG1 #=Outpatient KHERREN



-------- --------- ------- --- ------------------------ --------- ---- --- ---- --- --- ---- ---- --- --- ------------------

--

323 -1 100742 0500439 GOTTSCHALL RUSSELL R 5/04/12 277 4 MCF 93 M H 1 PETERSON BART G


324 -1 107779 0501490 GEMPLER FLORENCE L 6/04/03 818 6 MCF 99 F H 1 ROBERTSON SANDRA R

324 -2 151939 0012363 HUDSON COCO 3/16/12 32 E MED 6 F A 1 BAKER ANNE T

325 -1 119795 0501757 GILBERTSON LOLA M 10/02/03 698 4 MCF 102 F F 1 ROBERTSON SUE R


326 -1 113415 0020090 MEUER LAVON L 3/20/01 624 4 MCF 95 F F 1 RODRIGUEZ BILLIE Q


327 -1 134672 0012565 SIEBARTH LYDIA E 7/29/00 858 4 MCF 93 F F 1 GREEN PETER A


328 -1 134604 0501276 BRECKBUHL JOHN J 3/09/03 905 4 MCF 86 M F 1 PETERSON BART G


329 -1 130374 0502615 MACHOTKA JUNE I 9/21/04 343 A MCF 95 F H 1 ROBERTSON SUE R


330 -1 4179 0503150 LONGSETH LENORE B 4/11/05 141 6 MCF 93 F H 1 UNDERWOOD JOHN A


331 -1 104025 0502774 JOHANNING FLORENCE E 11/27/04 276 4 MCF 95 F F 1 EDWARDS JOHN A


332 -1 8929 0501933 BUTTERIS HELEN D 12/08/03 631 4 MCF 91 F F 1 RODRIGUEZ BILLIE Q


333 -1 141100 0500934 WETMORE LOIS V 10/05/02 60 6 MCF 104 F H 1 ROBERTSON SUE R


SAMPLE REPORTS CENSUS REPORTS CENSUS Alphabetic Census Page 3.1

Alphabetic Census

Overview: This option lists census information alphabetically by patient name.The alphabetic census is generated as of the system date.

The census lists the patient name, room-bed number, patient number, patient name in directory, financial class, hospital service code, DRG, approved days, days in the hospital, history number, age, age code (Days or Months), sex, marital status, VIP code, admit date, doctor number, and doctor name.

Room occupied will appear as the Patient Name if the patient answered 'N' to having their name included in the Patient Directory during Admission/Registration.

Patients who have been inhouse for an extended period of time can be flagged with an asterisk to the right of the Days in Hospital column (D/IN HOSP). The number of days will be equal or over the number indicated in the heading. This number is established in the Admission Days Flag in Billing Control Record, Option 2 on the System Control Menu.

Indicate in the Census reports record, Option 6 on the System Control Menu, if this report should be generated automatically in the Final Census and the number of copies to print.

Totals are printed at the end of the report for the total beds occupied and the total for each accommodation code.

Access: Reports Menu I, Option 2

Program: PB0R03


Note: This selection will only be displayed if the field Site Location Processing is answered 'Y' in the Admission Control Record, Option 26

on the System Control File Menu.


Statistics: None Column Heading: P/N - Public notification: Identifies whether the patient wishes to have the public notified of their admission (ie. local paper or radio station). APP LOS - Approved length of stay: The number of days approved based on the certification dates and grace days entered during Admissions or Benefits Maintenance. Use: The Alphabetic Census can be used to easily locate patients and verify

the census. Files: PATIENTS


CENSUS DATE 4/16/04 FAC# 000 PAGE 1

RUN DATE 5/27/04 TIME 3:11 PM A L P H A B E T I C C E N S U S R E P O R T PB0R03

((*) DAYS EQUAL OR OVER 5)

RM-BD PATIENT APP D/IN HISTORY AGE SEX/ ADMIT DOCTOR

PATIENT NAME NUM NUMBER P/N F/C SVR DRG LOS HOSP NUMBER AGE CD MAR VIP DATE NO. NAME

HARRIS JANE ANNE 203-1 2055464 Y M MED 498 2.8 7* 40936 065 F-M N 2/07/01 00267 UNDERWOOD ANNE T

ODONNELL VAUGHN 409-1 2134051 Y P MED 000 2 275 037 F-S N 4/14/04 00001 PARKER NANCY

TOTAL NURSING ST- MS 2 ICU 0 PRIVATE 0 SEMIPRV 2 SWING 0 OTHER 0

TOTAL SITE LOC - W01 2 ICU 0 PRIVATE 0 SEMIPRV 2 SWING 0 OTHER 0

CENSUS DATE 4/16/04 FAC# 000 PAGE 2

RUN DATE 5/27/04 TIME 3:11 PM A L P H A B E T I C C E N S U S R E P O R T PB0R03

((*) DAYS EQUAL OR OVER 5)

RM-BD PATIENT APP D/IN HISTORY AGE SEX/ ADMIT DOCTOR

PATIENT NAME NUM NUMBER P/N F/C SVR DRG LOS HOSP NUMBER AGE CD MAR VIP DATE NO. NAME

ROOM OCCUPIED 217-3 6000113 N W SUR 000 1 48967 044 F-S N 4/13/04 00142 JONES LUKE A

TOTAL NURSING ST- ICU 1 ICU 0 PRIVATE 0 SEMIPRV 1 SWING 0 OTHER 0

BAKER HENERIETTA 100-A 0000015 Y C MED 000 11* 18031 076 F-M N 4/06/04 00144 BAKER PAT T

BAKER MABLE R 100-A 1040001 Y S MED 000 10* 5784 026 F-S N 4/06/04 00267 UNDERWOOD ANNE T

BOYD MICHAEL W 217-4 6000010 Y S ICU 000 11* 48991 030 M-M N 4/06/04 00257 BLACK JAMIE Q

ROOM OCCUPIED 216-2 6000067 N W SUR 000 11* 25764 044 M-S N 4/06/04 00142 JONES LUKE A

DOE JAY MARIE 204-2 2136405 Y M SUR 000 8* 17574 078 F-M N 4/08/04 00267 UNDERWOOD ANNE T

FITZGERALD BETTE Q 207-2 2136776 Y M MED 000 11* 48692 081 F-W N 3/22/04 00127 JACKSON GEORGE G

FITZGERALD PAULA 210-2 2136614 Y M MED 000 13* 47010 083 F-W N 3/20/04 00055 SMITH JAMES A

LANIUS EDWIN 206-1 2136785 Y C AMB 000 10* 48951 032 M-M N 3/23/04 00022 RODRIGUEZ JAMES G

LONG JASON J 201-2 0000013 Y C MED 000 10* 48962 027 M-M Y 4/06/04 00187 BAKER JANE R

PARKER MICK A 201-1 2136558 Y M MED 000 14* 23990 086 M-M N 3/19/04 00178 BROWN GEORGE A

PEEK THERESA 401-1 0000014 Y C MED 000 4 48963 038 F-M N 4/06/04 00001 PARKER NANCY

PETERSON ELISA 204-1 2135910 Y M MED 000 22* 14151 087 F-W N 3/11/04 00178 BROWN GEORGE A

ROBERTSON LYNN A 213-2 2136734 Y M MED 000 11* 46599 073 F-M N 3/22/04 00257 BLACK JAMIE Q

RODRIGUEZ GINA T 202-2 2136649 Y B MED 000 11* 10784 021 F-S N 3/22/04 00184 WHITE JAMES G

RODRIGUEZ PAUL 205-2 2136780 Y M MED 000 11* 2353 075 F-W N 3/22/04 00127 JACKSON GEORGE G

ROGERS VAUGHN 210-1 2136779 Y M MED 000 11* 44449 089 F-W N 3/22/04 00127 JACKSON GEORGE G

SMITH ROBERT 211-1 2136387 Y M MED 000 16* 4554 082 M-S N 3/17/04 00127 JACKSON GEORGE G

WHITE WILMA 207-1 0000016 Y C MED 000 10* 4920 055 F-M N 4/06/04 00120 BAKER JAMIE R

YOUNG PETER 209-1 6000011 Y S MED 000 11* 48993 040 M-S N 4/06/04 00392 BLACK PAT Q

TOTAL NURSING ST- MS 19 ICU 1 PRIVATE 2 SEMIPRV 16 SWING 0 OTHER 0

TOTAL SITE LOC - W99 20 ICU 1 PRIVATE 2 SEMIPRV 17 SWING 0 OTHER 0

TOTAL BEDS OCCUPIED- 22 ICU - 1 PRIVATE - 2 SEMIPRV - 19 SWING - 0 OTHER - 0

SAMPLE REPORTS CENSUS REPORTS CENSUS Religion Census Page 4.1

Religion Census

Overview: This option generates a census report by religion. The census is

printed alphabetically by religion and each religion begins on a new page.

Room occupied will appear as the Patient Name if the patient

answered 'N' to having their name included in the Patient Directory or answered 'N' to Religious affiliation during Admission/Registration.

Indicate in the Census reports record, Option 6 on the System Control

Menu, if this report should be generated automatically in the Final Census and the number of copies to print.

There is no prompt screen displayed after the option selection. Access: Reports Menu I, Option 3 Program: PB0P0A Selection: None Statistics: None Use: This census can be distributed to clergymen. File: PATIENTS

SAMPLE REPORTS CENSUS REPORTS CENSUS Religion Census Page 4.2

CENSUS DATE 3/09/03 EXAMPLE FACILITY OF AMERICA FAC# 004 PAGE 1

RUN DATE 3/10/03 TIME 8:03 AM R E L I G I O N C E N S U S R E P O R T PB0P0A

ASSEMBLY OF GOD

REL PATIENT NURSING ROOM & ADMIT DAYS C O M M E N T S

CD NAME STATION BED DATE STAYED EXT.

A SALVADOR ROBERTA NOR XHN-4 3/03/03 4 0000

A WILLIAMS BEVERLY NOR XHN-9 3/03/03 4 0000


RUN DATE 3/10/03 TIME 8:03 AM R E L I G I O N C E N S U S R E P O R T PB0P0A

BAPTIST

REL PATIENT NURSING ROOM & ADMIT DAYS C O M M E N T S

CD NAME STATION BED DATE STAYED EXT.

B KING HATTIE SCU CCU-B 3/02/03 4 0000

B WILSON BILLIE SCU ICU-A 3/01/03 5 0000

B CARSON ALLEN NOR XHN-1 2/28/03 7 0000

B MARTIN ALBERT NOR XHN-2 3/03/03 4 0000

B FUDD WILL NOR XH1-0 3/03/03 4 0000

B DANIEL HARVEY NOR XH1-1 3/05/03 1 0000

B SWAFFORD AILEEN NOR XH1-2 3/03/03 4 0000

B BUTLER KAY NOR XH1-3 3/03/03 4 0000

B CORDER MARGARET NOR 203-P 2/29/03 7 0000

B STRIDE OREL NOR 204-P 2/20/03 15 0000

B TAYLOR JANE NOR 206-A 3/01/03 5 0000

B COFFEY ELIZABETH NOR 207-P 2/25/03 10 0000

B CHAMBERS MONA NOR 210-B 2/22/03 13 0000

SAMPLE REPORTS CENSUS REPORTS CENSUS Physician Census Page 5.1

Physician Census

Overview: This option generates a census by admitting or attending physician.

This option also generates a physician census which lists the physician's status as either Admitting, Attending, Referring, and/or Consulting.

These census reports are printed alphabetically by patient name and

each doctor begins on a new page. The Doctor Census Report lists the patient name, nursing station,

room & bed, admit date, approved days, days stayed, age, age code (Days or Months), diet code, DRG, average length of stay, observation indicator, and comments.

The Physician Census Report lists the room/bed, patient number,

patient name, age, age code (Days or Months), sex, physician name, hospital service code, physician status, and observation indicator.

Room occupied will appear as the Patient Name if the patient

answered 'N' to having their name included in the Patient Directory during Admission/Registration.


Menu, if the Doctor Census Report should be generated automatically in the Final Census, the number of copies to print, and if the census should print the admitting or attending physician.

Access: Reports Menu I, Option 4 Program: PB0P0B - Admitting Doctor PB0P0BA - Attending Doctor PA0R44 - Selected Doctor or All Doctors


Selection: Print by doctor - Admitting, Attending, or All If All is selected, a window will appear to allow an individual physician number to be entered or the physician number field can be left blank to print all physicians. Include Observation Patients - Y or N Print for Site Location - Enter a site location, press F4 to search, or leave blank for all

Note: The site location selection will only be displayed if the field Site Location Processing is answered 'Y' in the Admission Control Record, Option 26 on the System Control File Menu.

Statistics: None Column Heading: APP DAYS - Approved days: The number of days approved based on the certification dates and grace days entered during Admissions or Benefits Maintenance. OBS - Observation: If the patient is an observation patient, an “O” will print in this column. Use: This census can be distributed to physicians. File: PATIENTS



RUN DATE 3/05/97 TIME 8:04 AM D O C T O R C E N S U S R E P O R T PB0P0BA

BY: ATTENDING DOCTOR

Site: WEST CAMPUS

DOCTOR - COFFEY BRYANT MD

PATIENT NURSING ROOM & ADMIT APP DAYS AGE DIET AVG OBS C O M M E N T S

NAME STATION BED DATE DAYS STAYED CODE DRG LOS

CARSON ALLEN NOR XHN-1 2/28/97 7 007M 132 4.0

CHAMBERS MONA NOR 210-B 2/22/97 13 059 00 088 5.9

COFFEY CHRISSIE NOR 207-P 2/25/97 10 059 000 .0

CORDER MARGARET NOR 203-P 2/28/97 7 088 00 320 6.7

JONES FLORA NOR 214-A 3/03/97 4 014D 000 .0

MAYS ANGELA NOR 212-P 2/16/97 19 080 00 022 4.4

ORICK RAYMOND NOR 215-B 3/02/97 2 051 000 .0 O

PATRICK TARAN NOR 201-A 3/03/97 3 022 00 000 .0

PENDERGRASS LUCY SCU ICU-C 2/27/97 8 072 00 127 6.0

PERKINS LEIGH 3RD 336-B 3/02/97 2 020D 000 .0 O

ROBINSON MARY NOR 216-P 2/24/97 9 084 089 7.1

STRIDE OREL NOR 204-P 2/20/97 15 076 00 320 6.7

TAYLOR JANE NOR 206-A 3/01/97 5 067 00 016 6.6

VANOVER GEORGE NOR 218-B 3/02/97 2 055 000 .0

WILSON BILLIE SCU ICU-A 3/01/97 5 062 00 000 .0


CENSUS DATE 2/20/98 MEDHOST GENERAL HOSPITAL FAC# 001 PAGE 1

DATE 2/20/98 TIME 11:32 AM PHYSICIAN CENSUS REPORT PA0R44

SITE LOCATION: WEST CAMPUS

PHYSICIAN: ADAMS JOHN

RM/BED PATIENT # PATIENT NAME AGE SEX ATTEND PHYS SVC STATUS OBSERVATION?

------ --------- ------------------------ --- --- ------------ --- ------ ------------

307/B 2000386 BAKER CASEY 99 M ADAMS JOHN MIP ADM

ATT

319/B 2000251 ROOM OCCUPIED 8 M ADAMS JOHN MED ADM O

ATT

305/B 2000306 WALTERS AMY K 2 M ADAMS JOHN MIP ADM

ATT

403/A 5041657 SULLIVAN TURNER 83 M BLAKE JOHN SIP REF

CENSUS DATE 2/20/98 MEDHOST GENERAL HOSPITAL FAC# 001 PAGE 2

DATE 2/20/98 TIME 11:32 AM PHYSICIAN CENSUS REPORT PA0R44

SITE LOCATION: WEST CAMPUS

PHYSICIAN: ATKINSON SUE

RM/BED PATIENT # PATIENT NAME AGE SEX ATTEND PHYS SVC STATUS OBSERVATION?

------ --------- ------------------------ --- --- ------------ --- ------ ------------

225/A 2000704 WILLIAMS NIKKI 35 F BAILEY DAVID MIP REF

133/A 2000531 SMITH MARY ANN 38 F ATKINSON SUE MIP ADM

ATT

226/A 2000542 UTLEY TERESA 64 F ROGERS GEORG MIP CON

316/B 5555162 YATES SARAH 38 M ATKINSON SUE MIP ADM

ATT

SAMPLE REPORTS CENSUS REPORTS CENSUS Observation Census Page 6.1

Observation Census

Overview: This option generates a listing of the current patients who are

classified as observation patients. This listing prints the patient number, patient name, admission date,

admission time, quick admit/register date, quick admit/register time, financial class, hospital service code, age, age code (Days or Months),

sex, doctor name, and room/bed. Room occupied will appear as the Patient Name if the patient

answered 'N' to having their name included in the Patient Directory during Admission/Registration.



There is no prompt screen displayed after the option selection. Access: Reports Menu I, Option 5 Program: PB0R87 Selection: None Statistics: None Use: This census can be used to verify the observation patients. Files: PATIENTS, PHYMAST

SAMPLE REPORTS CENSUS REPORTS CENSUS Observation Census Page 6.2

CENSUS DATE 8/07/04 EXAMPLE HOSPITAL FAC# 100 PAGE 1

RUN DATE 8/13/04 TIME 01:10 PM * O B S E R V A T I O N P A T I E N T C E N S U S * PB0R87

PATIENT ADM ADM QKMNT QKMNT

NUMBER PATIENT NAME DATE TIME DATE TIME F/C HSV AGE SEX DOCTOR NAME ROOM/BED

------- ------------ ---- ---- ----- ----- --- --- --- --- ------------- -----------

8000006 Room occupied. 4/06/04 13:19 B OP 26 M SMITH JANE R 202/1

8000028 HENRY JOYCE 5/11/04 13:08 5/11/04 13:04 S OBV 32 F WALKER GEORGE A 209/2

8000039 HUDDLESTON NANCY 4/12/04 10:20 5/13/04 S OBV 32 F WALKER GEORGE A 215/2

8000090 ICEAM JOHN J 7/21/04 13:08 C EMR 27 M WALKER GEORGE A 609/A

8000127 LINCOLN JOE A 8/10/04 9:11 C EMR 35 M BAKER BILLIE Q 201/1

8000128 LONDON MARSHALL 8/12/04 12:09 C EMR 27 M BAKER BILLIE Q 201/2

8000012 MARCUS WILLIAM 4/28/04 9:43 C EMR 47 M BAKER BILLIE Q 208/2

8000010 ONEILL HURBERT 4/28/04 9:20 C EMR 27 M BAKER BILLIE Q 206/2

8000011 PAULSON SUSAN 4/28/04 9:30 C EMR 24 F BAKER BILLIE Q 208/1

8000002 REFERRAL INTKSOMETHI 4/08/04 16:18 C CPM 84 M NORRIS ANNE T 212/1

8000114 SMITH ROBERT S 8/02/04 14:55 C EMR 27 M FULLER GEORGE G 237/A

0000051 TURNER MARY A 6/01/04 12:00 S OBV 48 F SMITH JANE R 205/1

8000088 WILLIAMSON JAMES 7/16/04 10:04 S OP 50 M WALKER GEORGE A 203/2

** TOTAL OBSERVATION PATIENTS ** 13

SAMPLE REPORTS CENSUS REPORTS CENSUS Daily Room Charge Totals Page 7.1

Daily Room Charge Totals

Overview: The Daily Room Charge Totals report lists summary totals by

accommodation code. Indicate in the Census reports record, Option 6 on the System Control

Menu, the number of copies to print. Access: Daily Processing Menu, Option 2 Program: PB0P08 Selection: None Statistics None Use: This report should be verified against posting reports. File: RMBED, PATIENTS, CHRGTRAN

SAMPLE REPORTS CENSUS REPORTS CENSUS Daily Room Charge Totals Page 7.2

CENSUS DATE 1/28/98 EXAMPLE FACILITY FAC# 004 PAGE 1

RUN DATE 1/29/98 TIME 8:04 AM D A I L Y R O O M C H A R G E T O T A LS PB0P08

PRIVATE - 357.78 SEMI-PRI - 97.78 PCU - .00 ICU/CCU - 918.00 NURSERY - .00

PRIVATE - 3,690.00 SEMI-PRI - 4,830.00

OBSERVE - .00

SAMPLE REPORTS CENSUS REPORTS CENSUS Automatic Room Charge Totals Page 8.1

Automatic Room Charge Totals

Overview: The Automatic Room Charge Totals report lists in detail all automatic

charges. The report lists the charge code, charge description, quantity, and

charge amount. Automatic charges are established in the Billing Control File, Option 2

on the System Control File Menu. Access: Daily Processing Menu, Option 2 Program: PB0P08 Selection: None Statistics None Use: This report can be used to verify the automatic charges applied to patients' accounts. Files: PATIENTS, SYSCTL, CHRGTRAN

SAMPLE REPORTS CENSUS REPORTS CENSUS Automatic Room Charge Totals Page 8.2


RUN DATE 8/06/97 TIME 8:04 AM A U T O M A T I C C H A R G E T O T A L S PB0P08

CHARGE DESCRIPTION QTY AMOUNT CHARGE DESCRIPTION QTY AMOUNT CHARGE DESCRIPTION QTY AMOUNT

1230000 DAILY SUPPLIES 1 500.00 4360204 ROOM HUMIDIFIER 1 17.75

SAMPLE REPORTS CENSUS REPORTS CENSUS Temporary Room Charge Totals Page 9.1

Temporary Room Charge Totals

Overview: The Temporary Room Charge Totals report lists temporary room

charges by accommodation. A temporary room charge is generated when a patient is admitted and discharged on the same day - one day stay.


Menu, the number of copies to print. Access: Daily Processing Menu, Option 2 Program: PB0P09 Selection: None Statistics None Use: This report can be used to identify one day stay totals. Files: PATIENTS, RMBED, CHRGTRAN

SAMPLE REPORTS CENSUS REPORTS CENSUS Temporary Room Charge Totals Page 9.2

CENSUS DATE 1/28/98 EXAMPLE HOSPITAL FAC# 004 PAGE 2

RUN DATE 1/29/98 TIME 8:04 AM T E M P O R A R Y R O O M C H A R G E T O T A L S PB0P09

PRIVATE - .00 SEMI-PRI - .00 PCU - .00 ICU/CCU - .00 NURSERY - .00

PRIVATE - 250.00 SEMI-PRI - .00

OBSERVE - .00

SAMPLE REPORTS CENSUS REPORTS CENSUS Daily ADT Activity Page 10.1

Daily ADT Activity

Overview: The Daily ADT Activity report lists ADT activity separated into

admissions, pre-admissions, discharges, transfers, and a summary. Indicate in the Census reports record, Option 6 on the System Control

Menu, the number of copies to print. Access: Daily Processing Menu, Option 2 Program: PB0P0C Selection: None Statistics None Use: This report should be retained in the admissions area for reference and to serve as the ADT log. Files: ADTTRNAD, ADTTRNAC, ADTTRNDC, ADTTRNPA, ADTTRNXF



RUN DATE 8/06/01 TIME 3:15 PM DAILY ADT ACTIVITY PB0P0C

* * * A D M I S S I O N S * * *

PATIENT PATIENT HISTORY ROOM/ ACC F/C HSV AGE SEX MS DR. NAME ADMIT ADMIT

NAME NO NO BED CODE DATE TIME

------- ------- ------- ----- ---- --- --- --- --- -- -------- ----- -----

ABBOT RUSTY DUANE 1000002 000016527 100-B P I MAC 024 M U MISC DOCTOR 8/05/01 1450

AVED SHANNA MICHELLE 1000003 000039827 103-A P I MAC 023 F S MISC DOCTOR 8/05/01 1455

DONOVAN ELAINE W 1000001 123450000 310-A A B SAC 031 F M BARNES DONALD 8/05/01 1137



* * * D I S C H A R G E S * * *

PATIENT PATIENT HISTORY ROOM/ F R S M DOCTOR ADMISSION ----- DISCHARGE ------

NAME NO. NO. BED C HSV AGE C X S NAME DAYS DATE DATE TIME STATUS

------- ------- ------- ----- - --- --- - - - ------ ---- --------- ---- ---- ------

ABBOT RUSTY DUANE 9999999 000016527 SCU-2 M MAC 24 W M U AL-AMIN IHSANN 37 6/30/01 8/05/01 9:53 20

AVED SHANNA MICHELLE 1000003 000039827 103-A I MAC 23 B F S MISC DOCTOR 1 8/05/01 8/05/01 14:58 01



* * * O B S E R V A T I O N * * *

* * D I S C H A R G E S * *

PATIENT PATIENT HISTORY ROOM/ F R S M DOCTOR ADMISSION ---- DISCHARGE ----

NAME NO. NO. BED C HSV AGE C X S NAME HOURS DAYS DATE DATE TIME STS

------- ------- ------- ----- - --- --- - - - ------ ----- ---- --------- ---- ---- ---

WILLIAMS ROBERT E 0103047 000015527 350-2 M OBV 24 W M U BAKER THOMAS 40 1 8/04/01 8/05/01 15:10 20

* * = I/P TO O/P TRANSFER




* * * A D T S U M M A R Y * * *

ADMISSIONS 3

CANCEL ADMISSIONS

PRE-ADMITS

DISCHARGES 2

TRANSFERS

D/C OBSERVATIONS 1

SAMPLE REPORTS CENSUS REPORTS CENSUS Exception Reports Page 11.1

Exception Reports

Overview: The Exception Report lists error conditions detected while generating

room charges. Previously, the system would issue HALT messages which would provide the user the opportunity to cancel the census. Now, this report will print listing the following errors:

• Invalid Patient Number. • Invalid Accommodation Code. • Invalid Charge Code.

Note: Room charges for patients listed on this report will have to be

keyed manually through Ancillary Charge Entry. Indicate in the Census reports record, Option 6 on the System Control

Menu, the number of copies to print. Access: Daily Processing Menu, Option 2. Program: PB0P08 - Daily Room Charge Exceptions. PB0P09 - Temporary Room Charge Exceptions. PB0R1B - Psych Final Census Exceptions. PB0R67 - Recurring Charges Exception. Selection: None. Statistics None. Use: This report is used to identify which room charges did not generate and need to be entered manually. Files: RMBED, PATIENTS

SAMPLE REPORTS CENSUS REPORTS CENSUS Exception Reports Page 11.2

CENSUS DATE 1/28/98 M O N I T O R E X C E P T I O N R E P O R T FAC# 004 PAGE 1

RUN DATE 2/03/98 TIME 8:04 AM DAILY ROOM CHARGE TOTALS PB0P08

PATIENT# CODE ERROR MESSAGE

4444444 INVALID PATIENT NUMBER

5710920 Z INVALID ACCOMMODATION CODE

0011111 INVALID PATIENT NUMBER

SAMPLE REPORTS CENSUS REPORTS CENSUS Adm/Discharge Census Report By HSV Page 12.1

Adm/Discharge Census Report by HSV

Overview: The Admit/Discharge Census Report by Hospital Service Code lists

each admission and discharge by HSV and gender. The report prints the patient name, room/bed number, patient

number, financial class, hospital service code, and sex for each admission or discharge.

Totals are shown for each hospital service code by printing the

number of inhouse patients, admitted patients, discharged patients, remaining patients, female patients, and male patients.



Access: Daily Processing Menu, Option 2 Program: PB0R03A Selection: None Statistics None Use: This report can be used to determine the hospital's census by hospital service code and gender. The admission and discharge activity for each hospital service code can also be viewed from this report. Files: PATIEL07, STATHD

SAMPLE REPORTS CENSUS REPORTS CENSUS Adm/Discharge Census Report By HSV Page 12.2

CENSUS DATE 3/08/97 EXAMPLE HOSPITAL FAC # 004 PAGE 1

RUN DATE 3/09/97 TIME 8:03 AM A D M I T / D I S C H A R G E R E P O R T PB0R03A

RM-BED PATIENT HSV

PATIENT NAME NUMBER NUMBER F/C CODE SEX

INPATIENT MED

CONNORS FRAN 114-A 2000320 I MED F DISCHARGED

MED - ADMITTED TODAY - MALES - FEMALES -

DISCHARGED TODAY - MALES - FEMALES - 1

MED

IN-HOUSE 51

ADMITTED 0

------ FEMALES 26

TOTAL 51 MALES 24

DISCHARGED 1

------

REMAINING 50

PED

IN-HOUSE 2

ADMITTED 0

------ FEMALES 1

TOTAL 2 MALES 1

DISCHARGED 0

------

REMAINING 2

SUR

IN-HOUSE 3

ADMITTED 0

------ FEMALES 2

TOTAL 3 MALES 1

DISCHARGED 0

------

REMAINING 3

** TOTAL INHOUSE 55

** FEMALES INHOUSE 29

** MALES INHOUSE 26

SAMPLE REPORTS CENSUS REPORTS CENSUS Religion/Parish Census Page 13.1

Religion/Parish Census

Overview: This option generates a census report by religion and parish. The report prints the religion code, parish code, patient number,

patient name, nursing station, room/bed, admit date, days stayed, phone extension, and comments.

The census is printed alphabetically by religion and parish. Each

parish begins on a new page. Access: Reports Menu I, Option 6 Program: PA0R67 Selection: Parish code - Enter a code or leave blank for all. Statistics None Use: This census can be distributed to the clergy that visit patients. Files: PATIENTS, RMBED, PAPARISH

SAMPLE REPORTS CENSUS REPORTS CENSUS Religion/Parish Census Page 13.2

PA0R67 MEDHOST MEMORIAL HOSPITAL BAPTIST RUN DATE 7/22/01

HOSP# 001 R E L I G I O N / P A R I S H R E P O R T BRENTWOOD BAPTIST PAGE- 1

REL PRSH PATIENT PATIENT NURSING ROOM & ADMIT DAYS C O M M E N T S

CD CD NUMBER NAME STATION BED DATE STAYED EXT.

B A01 4000120 GREEN TIM 2ND 228-B 6/10/01 1 0228

B A01 4000250 BAKER ROBERT 2ND 231-A 6/10/01 1 0231

B A01 4000301 SMITH ANNA 3RD 315-B 5/21/01 1 0315

B A01 4000505 WILLIAMS JOHN 3RD 333-A 6/10/01 1 0333

MEDHOST MEMORIAL HOSPITAL BAPTIST RUN DATE 7/22/01

PA0R67 R E L I G I O N / P A R I S H R E P O R T FIRST BAPTIST PAGE- 2



B 001 5000112 MCINTRY DON K 3RD 334-A 4/22/01 2 0334

MEDHOST MEMORIAL HOSPITAL CATHOLIC RUN DATE 7/22/01

PA0R67 R E L I G I O N / P A R I S H R E P O R T FIRST CATHOLIC CHURCH PAGE- 3



C 003 4000112 BREWER ALICE 3RD 308-A 2/26/01 2 0305

C 003 4000500 ABBOTT JERRI A 3RD 319-B 5/21/01 1 0319

SAMPLE REPORTS CENSUS REPORTS CENSUS Psych Final Census Reports Page 14.1

Psych Final Census Reports

Overview: The Psych Final Census Report lists each patient that has a hospital

service code with a service code of Psych. The report prints the patient name, patient number, hospital service

code, education code, admission status, admit date, financial class, insurance verified, room code, employment date, previous admission, payor comments, charges to date, payments to date, and

review date. Totals are printed for the charges and payments. Totals are also printed for each financial class and accommodation

code. Indicate in the Census reports record, Option 6 on the System Control


Access: Daily Processing Menu, Option 2 Program: PB0R1B Selection: None Statistics None Use: This report can be used to determine the hospital's census by psychiatric hospital service code. Files: FCDESC, FINCLASS, PATIENTS, PATHIST, PATEXT, BENEFITS, SYSTABFL

SAMPLE REPORTS CENSUS REPORTS CENSUS Psych Final Census Reports Page 14.2

CENSUS DATE 3/04/97 TEST PSYCHIATRIC CENTER FAC# 004 PAGE 1

RUN DATE 3/05/97 TIME 8:04 AM DAILY CENSUS REPORT PB0R1B

PATIENT ED ADM IN RM EMPLOY PR CHARGES PAYMENTS REVIEW

PATIENT NAME NUMBER HSV CODE STS ADM DATE FC VF CD DATE HS PAYOR COMMENTS TO DATE TO DATE DATE

-------------------- ------- --- ---- --- -------- -- -- -- ------ -- --------------------- ------- -------- ------

PEPPERMINT PATTY 9600132 ATP 3/02/97 S S N/A .00 .00

PRYBER DAVID M 9600048 ATP U I 7/18/96 M S N/A Y 1,722.50 .00

RABENSTEIN WILLIAM 9600065 ADP H V 7/19/96 W Y S N/A N 9,242.50 .00

ROGERS VAUGHN 1000011 ACD 11/13/96 S P N/A .00 .00

ROSS JERRY RAY 9600039 CHD P V 7/14/96 W Y S N/A Y UNLIMITED 5,200.46 .00

SHERMAN TAMMIE K 9600037 ATP H V 7/13/96 W Y S N/A Y UNLIMITED 6,111.01 .00

SIMPSON O J 9600055 ATP H I 7/19/96 C S N/A N 9,242.50 .00

SMITH JANE 9600056 ADP B V 7/19/96 C S N/A N 9,242.50 .00

SNYDER ANITA JANE 9600042 ATP U V 7/15/96 M Y S N/A Y 4,251.16 .00

STINER MICHAEL 9600034 ADP P I 7/13/96 B Y S N/A N BC-BLUE CHIP 5,929.53 .00

TAYLOR HELENA 9600089 ATP B V 3/01/97 C P N/A N .00 .00

TEDESKI JEFFREY G 9600088 CHD P E 3/01/97 C Y S N/A Y 112.50 .00

TOMPKINS DANIEL 9600110 ADP 3/02/97 C S N/A .00 .00

TUCKER TOMMY L 8800004 ADP 3/02/97 C S N/A .00 .00

UPDEGROVE WAYNE C 9600117 ADP 3/02/97 S S N/A .00 .00

VANWORMER ANDY RAY 9600032 ACD H V 7/12/96 W Y S N/A Y 60 DAYS 7,207.87 .00

WADE BETTY A 9700014 ACD B V 3/04/97 C S N/A N .00 .00

WADE BETTY A 9700015 ACD B V 3/04/97 B S N/A N .00 .00

WEAVER CARL L 9600014 ACD P V 7/05/96 X Y S N/A N APPLYING FOR MA 12,636.57 .00

WILSON ROBERT 9600036 CHD P V 7/13/96 W Y S N/A N UNLIMITED 6,005.46 .00

YAKOVICH AMY J 9600063 ADP P V 7/19/96 C Y S N/A N 9,242.50 .00

YATES AUSTIN M 9600124 ACD 3/02/97 B S N/A .00 .00

YOUNG JAY W 9600104 ADP A E 3/02/97 S Y S N/A N .00 .00

* = LEAVE OF ABSENCE TOTAL CHARGES 267,515.09

TOTAL PAYMENTS .00

** F/C SUMMARY **

BC MAJOR MEDICAL 1

BLUE CROSS 9

COMMERCIAL 19

MEDICARE 7

ALL OTHER FC-PARTIAL 2

SELF PAY 20

MEDICAL ASSISTANCE 16

APPLYING FOR MA 2

---

TOTAL 76

===

** CENSUS SUMMARY **

SEMI PRI 68

PRIVATE 8

---

TOTAL 76

===

SAMPLE REPORTS CENSUS REPORTS CENSUS Recurring Charges Report Page 15.1

Recurring Charges Report

Overview: The Recurring Charges Report is generated during Final Census to

show all of the recurring charges. This report prints the batch number, sequence number, late charge

identifier, patient number, name, service date, service code, hospital service code, quantity, unit price, extended amount, standard amount, price code, physician number, physician amount, and non-

covered flag. Override prices are indicated on the listing with an asterisk (*).

Totals are printed for outpatient, inpatient, late charge, and grand

totals of quantity, extended amount, standard amount, and physician amount.


Menu, the number of copies to print. Access: Daily Processing Menu, Option 2 Program: PB0R67 Selection: None Statistics None Use: This report is used to verify charges entered and identify any errors to be corrected before Day End processing. Files: DALYBCTL, DALYTDTL, PATIENTS, ARMAST, SYSCTL, NUMAUDIT

SAMPLE REPORTS CENSUS REPORTS CENSUS Recurring Charges Report Page 15.2

CENSUS DATE 7/27/97 EXAMPLE MEMORIAL HOSPITAL FAC# 004 PAGE 1

RUN DATE 7/28/97 TIME 8:04 AM RECURRING CHARGES GENERATED DURING FINAL CENSUS PB0R67

REFERENCE # 001034

BATCH BATCH NUMBER OF NUMBER OF BATCH OVERRIDE INITIAL LAST

NUMBER DATE TRANSACTIONS UNITS AMOUNT USER ID USER ID EXCEPTION

897 7/27/97 1 2 .00 BARRY BARRY

BAT SEQ# L PATIENT PATIENT NAME SERVICE SERVICE HSV QTY# UNIT EXTENDED STANDARD PR PHY PHYSICIAN N

# C NUMBER DATE CODE PRICE AMOUNT AMOUNT CD # AMOUNT C

897 001 2000134 RICHARDSON SUE 7/27/97 00774000 OBI 2 1.50 3.00 3.00 1 001 .00

001 RECORDS IN BATCH BATCH TOTALS *** 2 3.00 3.00 .00

OUTPAT TOTALS ******* 0 .00 .00 .00

INPAT TOTALS ******** 2 3.00 3.00 .00

LATE CHARGE TOTALS ** 0 .00 .00 .00

GRAND TOTALS ******** 2 3.00 3.00 .00

SAMPLE REPORTS CENSUS REPORTS CENSUS Statistics Update Error Report Page 16.1

Statistic Update Error Report

Overview: The Statistics Update Error Report lists activities such as admissions,discharges, or cancelled admissions, that did not post to the statistics files due to an error with the doctor number, financial class, or hospital service code.

Note: Activities listed on this report should have updated the patient's account, but did not update the statistics file.

This report lists activity, patient number, patient name, financial class, hospital service code, doctor number, and error message.

Contact MEDHOST regarding correcting the errors on this report.

Access: Daily Processing Menu, Option 2

Program: PB0P40

Selection: None

Statistics None

Use: This report should be used to identify problems with statistics.

Files: PATIENTS, DOCMAST, ADTTRNAD, ADTTRNDC, ADTTRNAD, FCDESC, STATDR

SAMPLE REPORTS CENSUS REPORTS CENSUS Statistics Update Error Report Page 16.2

CENSUS DATE 8/25/97 S T A T I S T I C S U P D A T E E R R O R R E P O R T FAC# 004 PAGE 1

RUN DATE 8/26/97 TIME 8:04 PM A D M I S S I O N S PB0P40

ACTIVITY PATIENT F/C HSV DR # ERROR MESSAGE

NO. NAME

A 1238222 JONES SAMUEL X MIP 50 INVALID FINANCIAL CLASS

A 1245545 THOMAS TINA C XXP 120 INVALID STATISTIC CODE

D 5555544 SMITH YVETTE M SUR 100 INVALID DOCTOR NUMBER

SAMPLE REPORTS CENSUS REPORTS CENSUS Acuity Census Page 17.1

Acuity Census

Overview: This option generates a census report that lists all inpatients with an

acuity level code. The acuity level codes can be entered in Admission, Option 1 on the

Admission Menu and Patient Maintenance, Option 1 on the Business Office Menu I.

The census lists the patient name, patient number, acuity level,

financial class, history number, admit date, room/bed, days in hospital, sex, age, marital status, attending doctor number, and attending doctor name.

There is no prompt screen displayed after the option selection. Access: Reports Menu I, Option 7 Program: PB0R97 Selection: None Statistics: None Use: This census can be used to determine the acuity level of current inpatients. Files: PATIENTS, PHYMAST

SAMPLE REPORTS CENSUS REPORTS CENSUS Acuity Census Page 17.2

CENSUS DATE 1/12/98 *******QUALITY MEMORIAL HOSPITAL******** RUN DATE 3/04/98

PB0R97 A C U I T Y C E N S U S R E P O R T PAGE- 1

PATIENT PATIENT AC. FIN. HISTORY ADMIT ROOM/ D/IN MAR. DR. DOCTOR

NAME NUMBER LVL CLASS NUMBER DATE BED HOSP SEX AGE STAT NO. NAME

YEARLING RITA 2000272 01 I 003022288 7/24/97 227-B 034 F 030 S 007 GARBUTT LEO H

WELLS MARIANNA 2000448 01 C 003022308 8/16/97 225-B 011 F 039 M 014 CUNNINGHAM DARRIN

SMITH CAROL E 2000508 01 M 003022326 8/21/97 404-A 006 F 097 M 001 HUSKINS JAMES

NUGLE TEDDIE 2000530 01 C 003022335 8/22/97 317-A 005 M 030 M 035 CLEMENS ROY DALE

OPAL PAULA 2000531 01 C 003022336 8/22/97 133-A 005 F 038 M 267 ATWOOD H DANIEL

QUARLES ELLENA 2000542 01 C 003022340 8/22/97 226-A 005 F 064 M 267 ATWOOD H DANIEL

NEWMON CARON A 2000545 01 I 003022345 8/22/97 304-A 005 F 069 M 053 BAILEY DONALD C

PATTEN DARLENE 2000547 01 I 003022347 8/22/97 304-B 005 F 046 M 074 HARPER RICHARD

STAPLES CLARA 2000570 01 C 003022353 8/22/97 310-A 005 F 020 S 211 PRITCHARD SHARON JAMIE

TYSON JANE 2000573 01 B 003022360 8/22/97 321-A 005 F 058 M 532 MARTIN WILLIAM

MASON WILMA 2000582 01 B 003022361 8/22/97 500-D 005 F 001 S 267 ATWOOD H DANIEL

LAUGHTER ROGER A 0000001 02 S 000000070 10/30/97 323-B 015 M 042 M 999 MISC PHYSICIAN

SULLIVAN NICOLE 2000704 01 C 003022378 1/29/98 225-A 002 F 035 M 053 BAILEY DONALD C

BUTLER JIM S 2000717 01 I 003022380 8/22/97 224-B 005 M 049 M 001 HUSKINS JAMES

WHIMBLE LANE 5555162 01 C 000000084 1/29/98 316-B 002 M 038 S 267 ATWOOD H DANIEL

SAMPLE REPORTS CENSUS REPORTS CENSUS Nurses Station Census Page 18.1

Nurses Station Census

Overview: This option is used to print a census for authorized nurses’ stations.

If using secured nurses’ stations, the report can only be printed for the nurse’s stations which the user is authorized to access.

If this report is generated from Option 8 on the Reports Menu I, the

report will be a Preliminary Nurses Station Census. If this report is automatically generated during the Final Census, the report will be a Final Nurses Station Census.



The census lists the room/bed, patient number, leave of absence

code, patient name, admit dates, days of stay, financial class, hospital service code, age, age code (Days or Months), sex, accommodation code, diet code, price code, observation patient indicator, and attending doctor.

Totals are shown for number of patients in four categories:

• Accommodation, financial class, diet, and leave of absence.

Totals are also shown for total beds occupied and beds available. Access: Reports Menu I, Option 8 Program: PB0R02 - Preliminary Nurses Station Census PB0R02B - Final Nurses Station Census


Selection: Report sequence - Enter the sort order of the report. 1 = Room/Bed 2 = Alphabetical 3 = Patient Number Print all authorized nurses stations - Y or N Selected nurses stations - Enter up to 5 codes. Only the nurses station that the user is authorized to can be selected. Print all sites - Y or N Selected sites - Enter up to 5 site codes. Note: The site selections will only be displayed if the field Site Location Processing is answered 'Y' in the Admission Control Record, Option 26 on the System Control File Menu. After ENTER is pressed, a window will be displayed with the following selections: Copies - Enter the number of copies to print. Outq - Enter the outq where the report should be directed.

If the report is generated during the Final Census, the Nurses Stations file, Option 13 on the File Maintenance Menu II, will be checked. All nurses stations that have 'Y' in the Nurses station report distribution field will have a census generated and routed to the outq specified

in the Outq for report distribution field. Statistics: Occupancy percentage Use: This report can be used to verify the census before the final census is run and the room charges are applied to patient’s accounts.

The Preliminary Census may be run as many times as necessary to verify the census before running the Final Census.

Files: RMBED, PATIENTS (No Files updated)




NURSES STATION - NSY #=Outpatient KHERREN



-------- --------- ------- --- ------------------------ --------- ---- --- ---- --- --- ---- ---- --- --- ------------------

--

NYS -A 151651 0503596 AUSTIN DANIEL W 7/29/05 5 M NSY 7 M N 1 JORDAN GEORGE

NYS -F 151941 0012366 LOLLY DOLLY 4/24/12 1 CA OBV 41 F O 1 O BAKER ANNE T

NYS -2 151746 0503646 MOOTZ BABY GIRL 8/11/05 20 B NSY 7 F N 1 MARTIN PETER G

NYS -B 151927 3000069 SIANO JOEY 3/16/12 33 E NSY 30 M E 1 BAKER BART A

NYS -E 151927 0504085 SIANO JOEY 5/04/12 2 CA NSY 30 M N 1 BAKER ANNE T

NYS -D 151891 0503791 SMITH BABY MALE 5/31/11 49 C NSY 1 M N 1 FITZGERALD LUKE Q

NYS -C 151926 3000067 TEST JC 3/12/12 1 3 ORT 30 F O 1 O BAKER ANNE R

NYS -1 151913 0504081 TEST EVANS 3/16/12 33 Q MED 36 M B 1 BAKER BART A

NYS -3 151911 0504096 WATSON NATHAN 5/04/12 2 E MED 32 M N 1 BAKER ANNE T

NYS -4 ** AVAILABLE ROOM **





NURSES STATION - NSY


NUMBER NUMBER NUMBER PATIENT NAME DATE STAY F/C SERV AGE SEX CODE CODE CD DOCTOR

-------- --------- ------- ------------------------ --------- ---- --- ---- --- --- ---- ---- --- --------------------

** RECAP NURSES STATION - NSY **


NSY II 1 SELF PAY 1

NSY III 1 BLUE CROSS 1

NSY I 5 CAH MEDICARE 1

COMMERCIAL 2

HMO DEAN HEALT 1

OTHER CONTRACT 1

-------- --------

TOTAL 7 TOTAL 7

======== ========



** TOTAL RECAP - ALL STATIONS **


NSY II 1 SELF PAY 1

NSY III 1 BLUE CROSS 1

NSY I 5 CAH MEDICARE 1

COMMERCIAL 2

HMO DEAN HEALT 1

OTHER CONTRACT 1

-------- --------

TOTAL 7 TOTAL 7

======== ========

TOTAL BEDS OCCUPIED 7

TOTAL BEDS AVAILABLE 1-

PERCENTAGE OCCUPANCY 1166 %

SAMPLE REPORTS CENSUS REPORTS CENSUS Census Leave Of Absence Report Page 19.1

Census Leave Of Absence Report

Overview: The Census Leave of Absence Report lists the patients that were

discharged due to being on leave when the census was generated. Once a patient on leave has met the number of interrupt days, they

will automatically be discharged in the census process. The discharge date for the patient will be the leave of absence date.

Refer to the process below:

∙ Interrupt days are assigned to a Discharge Status Code in Option 2 on the File Maintenance Menu II. ∙ Transfer Codes (Discharge Status Codes) are assigned to LOA codes in Option 6 on the Hospital Table File Menu. ∙ LOA codes are used to record a patient leave in option 16 on the Admission Menu. ∙ If a patient has met the number of interrupt days, they will be

discharged in the census in Option 2 on the Daily Processing Menu. The report prints the patient number, patient name, LOA code, LOA description, leave date, return date, and LOA days. A total number of patients discharged will print at the end of the

report. Access: Daily Processing Menu, Option 2 Program: PB0R43 Selection: None Statistics None Use: This report should be used to verify the LOA patients that were discharged. Files: ADMREG, ADTTRNDC, DSSTAT, LOAHIST, PAOBSPF, PATHIST, PATIENTS, RMBED, RTINTK2, STATHD, SYSTABFL, TRANHIST

SAMPLE REPORTS CENSUS REPORTS CENSUS Census Leave Of Absence Report Page 19.2

PB0R43 FAC# 001

DATE 12/20/02 EXAMPLE FACILITY PAGE 1

CENSUS LEAVE OF ABSENCE REPORT - DISCHARGED

PATIENT PATIENT NAME LEAVE OF ABSENCE LEAVE RETURN LOA

NO. CODE DESC. DATE DATE DAYS

0103505 ADAMS DAVID MICHAEL H HOSPITAL 12/16/02 12/19/02 3

TOTAL DISCHARGED - 1

SAMPLE REPORTS TRANSACTION EDIT REPORTS EDIT Daily Charge Transaction Input Edit Page 1.1

Daily Charge Transaction Input Edit

Overview: The Daily Charge Transactions Input Edit List is generated to show allof the ancillary charge entries.

Batch control information prints at the top of the listing.

For each transaction, the listing prints the sequence number, late charge identifier, patient number, name, service date, service code, hospital service code, quantity, unit price, extended amount, standard amount, price code, physician number, physician amount, non- covered flag, and modifiers. Override prices are indicated on the listing with an asterisk (*).

Totals are printed for outpatient, inpatient, late charge, and grand totals of quantity, extended amount, standard amount, and physician amount.

Note: The SiteLoc column and totals will be printed if the field Site Location Processing is answered Yes in the Admission Control Record, Option 26 the System Control File Menu.

When Day End Processing is started, any edit listing(s) which have not been printed will automatically be generated.


Program: PB0P10

Selection: List batches for current user or for all usersPrint - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The Archive selection will only be shown if MEDHOST Archive

is installed.

Column Headings: LC - '*' indicates that this is a late charge.

PR CD - Price code (1-6) assigned to the patient.


NC - Indicates that the item is non-covered. Statistics: None Use: This report is used to verify charges entered and identify any errors to be corrected before Day End Processing. Files: DALYBCTL, DALYTDTL

WARNING/ERROR MESSAGE CAUSE OR CORRECTION

Error 1: Physician amount cannot be greater than unit price

Check price override or charge master for proffesional fee.

Error 2: Transaction date is out of range

The charge entered does not fall range between the patient's admission and discharge date or admission and system date.

Error 3: Extended amount is zero

This may not necessarily be an error. The Quantity multiplied by the override or standard price equals zero.

Batch totals do not match trans totals

Check batch header and review the batch.

This account not found in master files

Check for cancelled admissions or registrations.


POST DATE 4/05/08 EXAMPLE FACILITY FAC# 001 PAGE 1

SUBMITTED 4/05/08 BY ANNA PB0P10

RUN DATE 4/05/08 TIME 1:04 PM DAILY TRANSACTION INPUT EDIT LIST REF# 2488

BATCH BATCH NUMBER OF NUMBER OF BATCH OVERRIDE INITIAL LAST

NUMBER DATE TRANSACTIONS UNITS AMOUNT USER ID USER ID EXCEPTION

111 4/05/08 2 2 .00 ANNA ANNA

SEQ L PATIENT PATIENT NAME SERVICE SERVICE HSV QTY UNIT EXTENDED STANDARD PR PHY PHYSICIAN N MOD1 MOD2 MOD3 MOD4 SITELOC

# C NUMBER DATE CODE PRICE AMOUNT AMOUNT CD # AMOUNT C

001 900029 AARON CHARLOTTE A 3/31/08 00100010 MIP 1 54.65 54.65 54.65 1 000 .00 50 LT 001

002 900029 AARON CHARLOTTE A 3/31/08 00100020 MIP 1 18.27 18.27 18.27 1 000 .00 001

002 RECORDS IN BATCH BATCH TOTALS *** 2 72.92 72.92 .00



RUN DATE 4/05/08 TIME 1:04 PM DAILY TRANSACTION INPUT EDIT LIST REF# 2488

OUTPAT TOTALS ******* 0 .00 .00 .00

SITELOC 001 TOTAL** 0 .00 .00 .00

INPAT TOTALS ******** 2 72.92 72.92 .00

SITELOC 001 TOTAL** 2 72.92 72.92 .00

LATE CHARGE TOTALS ** 0 .00 .00 .00

SITELOC 001 TOTAL** 0 .00 .00 .00

GRAND TOTALS ******** 2 72.92 72.92 .00

SITELOC 001 TOTAL** 2 72.92 72.92 .00

SAMPLE REPORTS TRANSACTION EDIT REPORTS EDIT A/R Cash Receipts Entry Listing Page 2.1

A/R Cash Receipts Entry Listing

Overview: The A/R Cash Receipts Entry Listing is generated to show all of the

cash and/or adjustment entries. Batch control information prints at the top of the listing. For each transaction, the listing prints the batch number, sequence

number, transaction type, account number, cycle number, payor number, transaction amount, financial class change, transaction date,

transaction code or G/L number, and optional description. Totals are printed for inhouse, discharged, and a grand total for the

following categories: payments, miscellaneous cash, bad debt recoveries, adjustments, bad debt write-offs, collection fees, and bad debt reinstatements.

When Day End Processing is started, any edit listing(s) which have

not been printed will automatically be generated. Access: Daily Processing Menu, Option 7 Program: AR0R33 Selection: List batches for current user or for all users Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The Archive selection will only be shown if MEDHOST Archive

is installed. Statistics: None Use: This report is used to verify cash and adjustment entries and identify any errors to be corrected before Day End Processing. Files: ARTRBCTL, ARTRNDTL

SAMPLE REPORTS TRANSACTION EDIT REPORTS EDIT A/R Cash Receipts Entry Listing Page 2.2

POST DATE 6/09/99 EXAMPLE HOSPITAL FAC# 181 PAGE 1

SUBMITTED 6/09/99 BY ANNA AR0R33

RUN DATE 6/09/99 TIME 9:56 AM A/R CASH RECEIPTS ENTRY LISTING

BATCH NUMBER OF BATCH CONTROL BATCH

NUMBER TRANSACTIONS AMOUNT DATE

104 2 50.00 6/09/99

BATCH SEQ. TRANS ACCOUNT CYL PAYOR TRANS FINCL TRANS TRANS CODE

NO. NO. TYPE NUMBER NO. CO. AMOUNT CHANGE DATE OR G/L NO. DESCRIPTION

104 1 P 1105097 1 999 25.00 6/09/99 23

104 2 P 1105097 1 999 25.00 6/09/99 101

BATCH NO. 104 TOTAL 50.00 *

PAYMENTS MISC. CASH RECOVERIES ADJUSTMENTS BAD DEBT ADJ. BD-WRITE OFFS COL-FEES REINSTATE TOTAL

------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- --------------

INHOUSE

DISCHARGED

50.00 50.00

GRAND TOTAL

50.00 50.00

SAMPLE REPORTS TRANSACTION EDIT REPORTS EDIT Daily Remittance Advice Entry Listing Page 3.1

Daily Remittance Advice Entry Listing

Overview: The Daily Remittance Advice Input List is generated to show all of the

remittance advice entries. Batch control information prints at the top of the listing. For each transaction, the listing prints the sequence number, patient

number, cycle number, financial class change, payment amount, contractual amount, non-covered amount, blood deductible, patient deductible, and co-pay amount.

Totals are printed for inhouse, discharged, and a grand total for the

following categories: payment amount, contractual amount, noncovered amount, blood deductible, patient deductible, and co-pay amount.

When Day End Processing is started, any edit listing(s) which have

not been printed will automatically be generated. Access: Daily Processing Menu, Option 6 Program: AR0R28 Selection: List batches for current user or for all users Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The Archive selection will only be shown if MEDHOST Archive

is installed. Statistics: None Use: This report is used to verify remittance advice entries and identify any errors to be corrected before Day End Processing.


Files: ARRABCTL, ARRATDTL




RUN DATE 8/13/99 TIME 3:02 PM DAILY REMITTANCE ADVICE INPUT EDIT LIST

BATCH BATCH PAYOR # DOCUMENT PAYOR PAYMENT CONTRACTUAL NON-COVERED BLOOD PATIENT CO-PAY

NUMB. DATE CO. CONTROL # NAME AMOUNT AMOUNT AMOUNT DEDUCTIBLE DEDUCTIBLE AMOUNT

950 8/13/99 1 08121999 ABC INSURANCE 2.00 .00 .00 .00 .00 .00

TRANS. CODE CONTR. ADJ. 855 B/CROSS PAYMENT PAYMENT CODE 100 B/C CONTRACTUAL

SEQ PATIENT CYL PAYMENT CONTRACTUAL NON-COVERED BLOOD PATIENT CO-PAY

NO. NUMBER NO. FCL AMOUNT AMOUNT AMOUNT DEDUCTIBLE DEDUCTIBLE AMOUNT

1 9200480 1 2.00 .00 .00 .00 .00 .00

001 RECORDS IN BATCH BATCH TOTALS*** 2.00 .00 .00 .00 .00 .00

INHOUSE TOTALS * 2.00 .00 .00 .00 .00 .00

DISCHARGE TOTALS .00 .00 .00 .00 .00 .00

GRAND TOTALS *** 2.00 .00 .00 .00 .00 .00

SAMPLE REPORTS BILL SELECTION REPORT BILL SELECTION Bill Selection Status Report Page 1.1

Bill Selection Status Report

Overview: The Bill Selection Status Report lists the accounts which are ready tobe billed. The report prints the account number, patient name, discharge date, bill amount, financial class, inpatient/outpatient, bill type, and periodic billing description.

Charges posted after the report is run will still update to the patient bill. Therefore, Bill Amount Totals of the actual detail bills, 1500 bills, and UB bills may be greater than Bill Amount Total on the report. Note that the example report shown is an EDIT report. It represents Bill Selection Option 2, Printing Bill Reports Only. Bills are not actually selected until Bill Selection Option 1, Select Accounts is selected. The report will then print UPDATE rather than EDIT in the header.

The print order of the report, either sorted by patient number or patient name, can be selected in Miscellaneous Reports Record, Option 16 on the System Control File Menu.

Access: Daily Processing Menu, Option 9 Business Office Menu, Option 10

Program: PB0R41

Selection: None

Statistics None

Use: This report is used to verify detail bills, 1500 bills, and UB bills which are printed during Day End processing.

File: PATIENTS

SAMPLE REPORTS BILL SELECTION REPORT BILL SELECTION Bill Selection Status Report Page 1.2

RUN DATE 6/30/04 EXAMPLE FACILITY EDIT FAC# 100 PAGE 1

BILL SELECTION STATUS REPORT FOR 6/30/04 PB0R41

THE FOLLOWING ACCOUNTS HAVE BEEN SELECTED FOR BILLING TIME 10:35:18

ACCOUNT NO. NAME THRU DATE BILL AMT F/C HSV I/O BILL TYPE PERIODIC BILLING

2824167 STEPPENS RONIE ELIZABETH 6/30/04 100.00 W TOP O

2824241 DONCON KRISTINA VAUGHN 6/30/04 .00 W TOP O

2827152 CHAMBERS JOSEPHIA ANNE 6/15/04 50.00 W SOP O

2831469 GRINNITH AVA MARIE 6/15/04 .00 W EOP O

2831477 ALLYN WILLIE JAMES 6/15/04 .00 W EOP O

2831501 HOOPER JAMES DANIEL 6/15/04 .00 W EOP O

2831535 CHAMBERS JENNY JULIE 6/15/04 .00 W EOP O

2831543 KING SARAH ELIZABETH 6/15/04 .00 W EOP O

2831717 CHAMBERS TRACIE JEAN 6/15/04 350.00 W EOP O

2831725 TERRY ROBERT WESSON 6/15/04 .00 W EOP O

2831758 BROWN SHELLIE DAWN 6/15/04 .00 W EOP O

2831766 BROWN DONA RENEE 6/15/04 .00 W EOP O

2831782 PHILLIPS LINDA LOU 6/15/04 .00 W EOP O

2831832 TERRY RUTH JEAN 6/15/04 .00 W EOP O

2831840 MCCOY CINDY DEE 6/15/04 .00 W EOP O

2832046 BLEDINS MARK GREGORY 6/15/04 .00 W EOP O

2832145 POSES ANNA LOU 6/15/04 .00 W EOP O

2832236 ADDINS KEVIN WAYNE 6/15/04 .00 W EOP O

2832244 MCCANE BRITTANY ERICA 6/15/04 .00 W EOP O

2832251 HOLLAND NEQUILA SHAY 6/15/04 .00 W EOP O

2832269 STOKES TRAVIS DWAYNE 6/15/04 .00 W EOP O

2832277 HENRY NIKKY LAWRENCE 6/15/04 50.00 W EOP O

2832525 CHAMBERS KAREN SUE 6/15/04 .00 W EOP O

2833036 BLEVINS MARK GREGORY 6/30/04 .00 W EOP O

2833069 CAPWELL SCARLETT 6/30/04 .00 W EOP O

2833101 ALLEN WILLIE 6/30/04 .00 W EOP O

2833630 GRAHAM HARLEY NICHOLE 6/30/04 .00 W EOP O

2833960 PHILLIPS LOREENA DALE 6/30/04 .00 W EOP O

2833978 HILL ADAM LEE 6/30/04 150.00 W EOP O

============================================================================================================

TOTALS -- # OF BILLS: 81 CYCLE TOT$: 700.00 FINAL TOT$: .00

** NOTE ** TOTALS SHOWN REFLECT CHARGES POSTED TO ACCOUNTS - CHARGES KEYED TODAY MAY CHANGE TOTAL ACTUALLY BILLED

SAMPLE REPORTS BILL SELECTION REPORT BILL SELECTION Bill Selection Error Listing Page 2.1

Bill Selection Error Listing

Overview: The Bill Selection Error Listing lists all accounts that cannot be billed

and a reason why each cannot be billed. The report prints inpatient/outpatient, patient number, patient name,

physician name, bill amount, admission date, discharge date, elapsed days, financial class, hospital service code, medical record number, and error description.

Three reports print at the end of the listing summarizing the accounts

on the error listing by financial class, physician, and error message. The summary page lists the total accounts in error and the total dollar

amount of unselected bills. This is the total amount to be billed for all the accounts that are currently in error on the error listing. This amount will be listed by Inpatient, Outpatient, Physician, and Financial Class. The summary page also lists a dollar amount beside the description of each error found. The heading is “Total Billed”, but this is actually the amount to be billed for the account that has that error message. If an account has multiple errors, then this dollar amount will be reflected in each error message dollar amount listed. This identifies how much money is being held up for certain errors. This amount will not balance back to the Total unselected bills, since one account may have many error messages.

Access: Daily Processing Menu, Option 9 Business Office Menu, Option 10 Program: PB0R14 - Sorted by Patient number PBDR14 - Sorted by Physician number Selection: None


Statistics None Use: This report is used to review and correct errors so that bills can be

generated. For an explanation of the reason codes and action required, see Appendix F in the System Manager's Guide.

File: FCDESC, PABILERR, PATALIXR, PATIENTS, PHYMAST, PROCPAIR, SYSCTL


PB0R14 EXAMPLE HOSPITAL PAGE 1

FAC# 100 BILL SELECTION ERROR LISTING DATE 10/04/04

POST DATE 10/04/04 TIME 8:21:56

ADMIT DISCHARGE ELAPSED

I/O PATIENT# PATIENT NAME PHYSICIAN NAME BILL AMOUNT DATE DATE DAYS F/C HSV MEDREC#

/ERROR DESCRIPTION

I 1011257 PICKNEY LYNNE ROGER SMITH 1,552.68 3/14/04 3/14/04 202 M MED 47209

CPT Required For Charge Code 2200762


I 1011355 YOUNG RITA FAY ROGER SMITH 500.15 3/14/04 3/15/04 203 M MED 48221

Abstract Not Final

I 1011487 YATES GEORGE ROGER SMITH 1,400.50 3/14/04 3/15/04 203 M MED 52114

No Policy# - Primary Pay

I 1011527 DOYLE SAMUEL R ROGER SMITH 8,625.37 3/28/04 3/31/04 185 M MED 45221





I 1011529 NELSON COLLEEN ROGER SMITH .00 3/15/04 3/16/04 202 M MED 65142

No Charges Entered

I 1011600 HENRY DOROTHY SMITH ROGER 8,757.10 3/30/04 4/05/04 180 M MED 32118








I 1011685 BAKER CATHERINE SMITH ROGER 284.32 8/30/04 8/30/04 33 M MED 46412

No Policy # - Primary Pay

I 1011881 SILLS JANIE SMITH ROGER .00 8/30/04 8/30/04 33 M MED 51448

No Charges Entered

* INPATIENT TOTAL 103,316.49

** TOTAL ACCOUNTS 12




POST DATE 10/04/04 TIME 8:21:56

ADMIT DISCHARGE ELAPSED

I/O PATIENT# PATIENT NAME PHYSICIAN NAME BILL AMOUNT DATE DATE DAYS F/C HSV MEDREC#

/ERROR DESCRIPTION

O 1011624 DOUGLAS CALEB WILSON GEORGE 63.75 3/31/04 3/31/04 185 P EMR 78991

No Disch. ICD-9 CD

Abstract Not Final


O 1011629 MELTON JOHN WILSON GEORGE 424.66 9/01/04 9/01/04 31 C EMR 87154

Multiple bilateral procedures without modifier 50

Medical visit on same day as a type T or S procedure without modifier 25



O 1011745 HAYWOOD ROY R WILSON GEORGE 390.88 4/06/04 4/06/04 179 P EMR 95121

No Disch. ICD-9 CD

Abstract Not Final




O 1011750 DUNLAP ANTHONY DANIEL WILSON GEORGE 129.70 4/06/04 4/06/04 179 P EMR 65432

No Disch. ICD-9 CD

Abstract Not Final

O 2033746 HORTON EDWARD WILSON GEORGE 960.00 3/01/04 3/31/04 185 M REC 78965

WRN MSP Not Complete


O 2033749 CHAPLIN MARY ELIZABETH WILSON GEORGE 80.00 3/01/04 3/03/04 213 M REC 12454

WRN MSP Not Complete


O 2034212 MEADOWS IRENE M WILSON GEORGE 90.00 3/07/04 3/07/04 209 P OP 23456

No Disch. ICD-9 CD

Abstract Not Final



O 2034249 THOMPSON PAUL P WILSON GEORGE 1,194.79 3/07/04 3/31/04 185 W REC 56781



* OUTPATIENT TOTAL 125,558.22




POST DATE 10/04/04 SUMMARY PAGE TIME 8:21:56

TOTAL ACCOUNTS IN ERROR 220

TOTAL UNSELECTED BILLS 228,874.71

AVERAGE ELAPSED DAYS 181

FINANCIAL CLASS SUMMARY

* * * * * * * INPATIENT SUMMARY * * * * * * * * * * * * * * * OUTPATIENT SUMMARY * * * * * * * *

# OF # OF

F/C DESCRIPTION ACCTS TOTAL BILLED F/C DESCRIPTION ACCTS TOTAL BILLED

M MEDICARE 11 92,846.41 P MEDICAID 17 5,587.14

C COMMERCIAL INSUR 1 10,470.08 B BLUE CROSS 15 6,085.11

C COMMERCIAL INSUR 76 40,855.97

W WORKERS COMPENSATION 24 12,723.11

M MEDICARE 59 48,270.08

L LITIGATION 1 41.00

F CHAMPUS 2 611.46

A BAIPA 4 6,702.56

H RKFD HEALTH PLANS 9 3,841.79

S SELF PAY 1 840.00

INPATIENT TOTALS 12 103,316.49 OUTPATIENT TOTALS 208 125,558.22








PHYSICIAN SUMMARY

* * * * * * * INPATIENT SUMMARY * * * * * * * * * * * * * * * OUTPATIENT SUMMARY * * * * * * * *

# OF # OF

PHY PHYSICIAN NAME ACCTS TOTAL BILLED PHY PHYSICIAN NAME ACCTS TOTAL BILLED

105 SMITH ROGER 5 100,001.49 552 WILSON GEORGE 208 124,043.22

205 PETERSON JAMES 2 310.00 587 BAKER WILLIAM 8 1,515.00

348 BERRY SAMUEL 5 3,005.00

INPATIENT TOTALS 12 103,316.49 OUTPATIENT TOTALS 208 125,558.22








ERROR MESSAGE SUMMARY

* * * * * * * * INPATIENT SUMMARY * * * * * * * * * * * * * * * * * * * * * * OUTPATIENT SUMMARY * * * * * * * * * * * * * * * * *

# OF # OF

ERROR MESSAGE ACCTS TOTAL BILLED ERROR MESSAGE ACCTS TOTAL BILLED

Abstract No Final 1 500.15 No Disch. ICD-9 CD 17 5,587.14

No Policy # - Primary Pay 2 1,684.82 Abstract Not Final 17 5,587.14

CPT Required For Charge Code 7 101,131.52 CPT Required For Charge Code 206 125,540.07

No Charges Entered 2 Multiple bilateral procedures without mod 1 424.66

Medical visit on same day as a type T or 1 424.66

WRN MSP Not Complete 18 17,238.20

No Charges Entered 1

SAMPLE REPORTS BILL SELECTION REPORT BILL SELECTION Late Charge Bill Selection Status Page 3.1

Late Charge Bill Selection Status

Overview: The Late Charge Bill Selection Report lists the late charges which are

ready to be billed. The report prints the account numbers, patient names, discharge

dates, bill amounts, financial classes, and inpatient/outpatient status. Access: Daily Processing Menu, Option 9 Business Office Menu, Option 10 Program: PB0R61 Selection: None Statistics None Use: This report is used to verify the bills that are generated in Day End processing. File: PATIENTS

SAMPLE REPORTS BILL SELECTION REPORT BILL SELECTION Late Charge Bill Selection Status Page 3.2

POST DATE 10/05/00 EXAMPLE FACILITY PAGE 1

RUN DATE 10/05/00 LATE CHARGE BILL SELECTION STATUS REPORT PB0R61

FAC# 001

ACCOUNT NO. NAME DISCH. DATE BILL AMT F/C HSV I/O

----------- ------------------------- ----------- ------------ --- --- ---

2017783 ZEKER DONALD W 8/31/00 61.00 C OP O

2028871 SMITH WILLIAM 9/30/00 54.00 C OP O

2051121 BAKER HENRY F 9/30/00 105.00 C OP O

SAMPLE REPORTS DAY END REPORTS DAY END Daily O/P Registrations Page 1.1

Daily O/P Registrations

Overview: The Daily O/P Registration Report is a list of all outpatient activitysince the last Day End.

The report lists registrations that have been cancelled, pre-registrations, registrations, and visits for recurring outpatients.


Program: PB0P2D

Selection: Number of copies on the Day end reports record, Option 7on the System Control File Menu.

Statistics: None

Use: This report is used to verify the outpatient activity for the day.

Files: OUTRANSC, OUTRANSR, OUTRANSD


POST DATE 7/01/02 EXAMPLE HOSPITAL NAME FAC# 004 PAGE 1

SUBMITTED 7/02/02 BY ANNA PB0P2D

RUN DATE 7/02/02 TIME 5:41 PM DAILY O/P ACTIVITY REF# 2097

* * * C A N C E L R E G I S T R A T I O N * * *

PATIENT PATIENT HISTORY PTYPE F/C HSV PRICING AGE SEX MS DR. NAME REG. REG.

NAME NO NO CODE DATE TIME

------- ------- ------- ----- --- --- ------- --- --- -- -------- ---- ----

HOFFMAN CHRISTINA VERA 7473853 000012987 E 2 MDS 1 081 M JOHNSON SUE 6/25/02 0023




* * * P R E - R E G I S T R A T I O N S * * *

PATIENT PATIENT HISTORY PTYPE F/C HSV PRICING AGE SEX MS DR. NAME EXP. EXP.


------- ------- ------- ----- --- --- ------- --- --- -- --------- ---- ----

DALLBERN ERIC LYNN 5555555 000037698 R B MDS 1 021 M S BONE GEORGE 8/03/02 1144





* * * O / P R E G I S T R A T I O N S * * *

PATIENT PATIENT HISTORY PTYPE F/C HSV PRICING AGE SEX MS DR. NAME REG. REG.


------- ------- ------- ----- --- --- ------- --- --- -- -------- ---- ----

KROUSE ZETH TRAVIS 7531551 000017803 E 4 EER 1 006 M S STOVALL ISAAC H 6/26/02 1856

LATT HENRY MARSHALL 7531437 000040324 E 1 EER 2 040 M M STOVALL ISAAC H 6/26/02 1347

LATT HENRY MARSHALL 7531585 000040324 E 1 EER 2 040 M M MURRAY ROBERT E 6/26/02 1919

LAMIER RAYMOND RECARDO SR 7531338 000024954 E 3 EER 1 031 M M TIDMORE KAREN A 6/26/02 0605

LERERET BETTY MAY 7475320 000005364 E 2 MDS 1 089 F W STIMPSON CHARLES L 6/26/02 1515

LORE SHIRLEY LOUISE 7474885 000025458 E U AOP 1 033 F M STIMPSON CHARLES L 6/26/02 1836

LYNN MICHELLE JANE 7475379 000039037 E 3 AOP 1 019 F M RICH EARL F 6/26/02 1602

MCBEE EDNA LOIS 7474869 000009527 E 1 AOP 2 049 F M JOHNSON SUE 6/26/02 1317

MCCLANAHAN CHRISTOPHER V 7474794 000005025 E 2 MDS 1 040 M M GIPSON BRUCE 6/26/02 0731

MCMANUS BRUCE WAYNE 7531494 000040304 E 3 EER 1 031 M S STOVALL ISAAC H 6/26/02 1614

NAPP GARLAND BLAKE 7474265 000006691 E 2 MDS 1 083 M W JOHNSON SUE 6/26/02 0710

NOLEN JOHN SAMUEL 7472723 000037247 E 3 AOP 1 060 M M OWNBY FRED 6/26/02 0715

OVERESON RUBY NELL 7475445 000006844 E 3 AOP 1 063 F M JOHNSON SUE 6/26/02 1322

PEACOCK GEORGIA MAE 7531452 000007011 E 2 EER 1 078 M S STOVALL ISAAC H 6/26/02 1426

PERRY JOHNNIE BRANCH 7474273 000014567 E 2 MDS 1 071 M S COURTESY 6/26/02 0932

PHILLIPS CORY BLAKE 7531544 000030757 E 3 EER 1 002 M S STOVALL ISAAC H 6/26/02 1846

PHILLIPS LAURA PARKS 7472798 000007150 E 3 AOP 1 037 F M STIMPSON CHARLES L 6/26/02 1400

POPE CODY DUSTIN 7472756 000015388 E 4 AOP 1 005 M S MAGNUSON CAROL 6/26/02 0025

POWELL PHILLIP LAWRENCE 7475312 000028909 E 3 AOP 1 029 M M RICHARDS AUBREY T 6/26/02 1148

PELANT LINDA JEAN 7475783 000013190 E U AOP 1 038 F S STIMPSON CHARLES L 6/26/02 1153

RICO PETRO MARTINEZ 7531403 000040748 E 3 EER 1 042 M S STOVALL ISAAC H 6/26/02 1242

RODDY MICHAEL WAYNE 7531296 000037860 E 4 EER 1 009 M S TIDMORE KAREN A 6/26/02 0241

RUTLEDGE AUDREY MAY 7531379 000040808 E U EER 1 020 F S STOVALL ISAAC H 6/26/02 1118

RUTLEDGE CALVIN RIDDELL 7531395 000038783 E U EER 1 036 M S STOVALL ISAAC H 6/26/02 1209

SANDERS AILEEN FRANCES 7531460 000024694 E 2 EER 1 084 F W STOVALL ISAAC H 6/26/02 1428

SANDERS KENNETH ROSS 7531577 000008190 E U EER 1 016 M S MURRAY ROBERT E 6/26/02 1911

SAWYER NELLIE MAY 7531387 000015157 E 2 EER 1 080 F S WOMACK SARA 6/26/02 1152

SEAL VIRGINIA ANNIE 7475478 000008301 E U AOP 1 049 F W RICHARDS AUBREY T 6/26/02 1249

SHAW BERTHA JEWELL 7475387 000022914 E 2 MDS 1 077 F W DERRYBERRY JOHN 6/26/02 1606

SMITH JOHN ALONZO 7475460 000008665 E 2 MDS 1 085 M W RICHARDS AUBREY T 6/26/02 1317

SMITH SARA ALENE 7475791 000012183 E 3 AOP 1 050 F M JOHNSON SUE 6/26/02 1402

SOLOMON GRACE C 7474786 000008850 E 2 MDS 1 087 F W JOHNSON SUE 6/26/02 0711

SPEEGLE INEZ MAE 7474778 000025943 E U AOP 1 064 F W RICHARDS AUBREY T 6/26/02 0704

STONECIPHER WALTER 7474844 000018991 E 2 OPT 1 082 M M DERRYBERRY JOHN 6/26/02 1016

SWEENEY BRANDY NICHOLE 7531445 000009177 E 4 EER 1 007 F S STOVALL ISAAC H 6/26/02 1357

SWEETON JESSE MICHAEL 7472749 000039344 E 1 AOP 2 013 M S MAGNUSON CAROL 6/26/02 0819

TALLEY PEARLELA GILL 7472772 000038808 E 2 MDS 1 080 F W COURTESY 6/26/02 1104

THIRAULT ROY WILLIAM 7531510 000011416 E 4 EER 1 018 M S STOVALL ISAAC H 6/26/02 1707

WEBB BUFORD NMN 7475296 000036949 E 2 MDS 1 062 M W DERRYBERRY JOHN 6/26/02 0749

WIGGS DOROTHY NMN 7475346 000015051 E 2 MDS 1 074 F W WOMACK SARA 6/26/02 1553

WILLIAMS LARISA DENISE 7474851 000032255 E 4 AOP 1 015 F S GATELY LAURA 6/26/02 1020

WILLIAMS MICHAEL DAVID 7531502 000016710 E U EER 1 017 M S STOVALL ISAAC H 6/26/02 1654

WRIGHT TIMOTHY ERIC 7531569 000014670 E U EER 1 005 M S STOVALL ISAAC H 6/26/02 1906





* * * R E C U R R I N G V I S I T S * * *

PATIENT PATIENT HISTORY PTYPE F/C HSV DR. NAME VISIT VISIT

NAME NO NO DATE TIME

------- ------- ------- ----- --- --- --------- ----- -----

GUNE LILLIS STONE 7328479 000013089 R U AOP WOMACK SARA 3/01/02 0800

HETTON JAMES GLENN 7402530 000012218 R U EER COURTESY 3/02/02 0800

GROSSLIN JENNIFER 7442072 000034493 R 3 OPT RICH EARL F 5/01/02 0800

MORGAN MARY LOU 7456296 000012284 R 2 AOP STIMPSON CHARLES L 5/06/02 0800

SCANES JAMES ELMER 7450422 000026981 R U AOP RICHARDS AUBREY T 5/07/02 0800

SUMMARELL MARY OPEL 7411085 000019253 R 2 OPT COURTESY 5/22/02 0800

HARDEN JAMES CLAUDE JR 7441975 000003874 R 2 OPT COURTESY 5/26/02 0800

LYNN JEAN PATY 7460751 000026788 R I HHC COURTESY 5/31/02 0800

ALBERT CLAYTON ELWOOD 7423676 000035690 R 4 OPT COURTESY 6/08/02 0800

NARR EDNA LEE 7452659 000006522 R 3 OPT RICH EARL F 6/08/02 0800

WARDEN JAMES THOMAS 7449663 000037010 R 3 OPT RICH EARL F 6/08/02 0800

WILSON DONNA FAYE 7446578 000033267 R 3 OPT RICH EARL F 6/08/02 0800

BEARDEN STEVEN DOUGLAS 7446396 000000563 R 3 OPT JAYAKODY FRANK 6/09/02 0800

DOWELL HARRIETT ELIZABETH 7418346 000002663 R 4 OPT GOMEZ ALBERT 6/09/02 0800

LAWRENCE JAMES RONNIE 7454838 000040286 R 3 OPT JAYAKODY FRANK 6/09/02 0800

REED LELA MAY 7453400 000021480 R 2 OPT RICH EARL F 6/09/02 0800

SNYDER FRANK FRANCIS 7452220 000039460 R 3 OPT GIPSON BRUCE 6/09/02 0800

HALL LINDSEY BROWNING 7471816 000012887 R 2 OPT COURTESY 6/25/02 0800

PERRYMAN CHRISTINE WILSON 7470735 000011884 R 2 OPT COURTESY 6/25/02 0800

THOMPSON GLENN COLLIER 7401409 000019313 R 2 OPT DERRYBERRY JOHN 6/25/02 0800

STEPHENS ARTHUR M 8457121 000008987 R 1 EER AL-AMIN IHSANN 7/23/02 1500

STEPHENS ARTHUR M 8457121 000008987 R 1 EER AL-AMIN IHSANN 7/23/02 1500

POPE RUBY GLADYS 7319031 000019700 R I HHC COURTESY 11/15/01 0800

* * * O / P S U M M A R Y * * *

REGISTRATIONS 96

CANCEL REGISTRATIONS 1

PRE-REGISTRATIONS 1

RECURRING VISITS 23

CANCEL OUTPATIENT DISCHARGE

SAMPLE REPORTS DAY END REPORTS DAY END Patient Transfer Report Page 2.1

Patient Transfer Report

Overview: The Patient Transfer Report provides a detail list of patients

transferred from O/P to I/P or I/P to O/P. The report prints the status, old patient number, new patient number,

patient name, patient balance, and detail balance. Totals will print at the end of the transfers.

If there are any patient account combines, the Patient Combine

Report will be generated. The report prints the status, old patient number, new patient number, patient names, old account balance, new account balance, and total balance.

Access: Daily Processing Menu, Option 10 Program: PB0R82 - Patient Transfer Report PB0R82 - Patient Combine Report Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is used to verify the amounts transferred from O/P to I/P, I/P to O/P, and Combines for posting and balancing totals on the control sheets. Files: NUMCHG, NUMAUDIT, PATIENTS, ARCNTRL



SUBMITTED 7/01/01 BY ANNA PB0R82

RUN DATE 7/01/01 TIME 5:41 PM PATIENT TRANSFER REPORT REF# 2097

STATUS OLD NUMBER NEW NUMBER PATIENT NAME PATIENT BALANCE DETAIL BALANCE

O/P-I/P 2831808 0050028 ALLEN MATTHEW 104.00 104.00

O/P-I/P 2777324 0050029 ANDERSON CHUCK 2,353.40 2,353.40

O/P-I/P 2824431 0050042 BROWN AMY FAYE 81.00 81.00

O/P-I/P 2824530 0050043 ALLEN NATASHA JOY 1,349.50 1,349.50

O/P-I/P 0060013 0050060 AARON BRENDA SUE .00 .00

O/P-I/P 0060011 0050062 ABARCA ANTHONY A .00 .00

TOTAL: 3,887.90 3,887.90



RUN DATE 7/01/01 TIME 5:41 PM PATIENT TRANSFER REPORT REF# 2097

INPATIENT OUTPATIENT

INPATIENT TO OUTPATIENT .00 .00

OUTPATIENT TO INPATIENT ______________ _______________

NET TRANSFER AMOUNT: 3,887.90 3,887.90-

=============== ===============




RUN DATE 7/01/01 TIME 5:41 PM PATIENT COMBINE REPORT REF# 2097

STATUS OLD NUMBER NEW NUMBER PATIENT NAMES OLD ACCT BALANCE NEW ACCT BALANCE TOTAL BALANCE

COMBINE 1234567 7845641 JONES MARY M 141.00 104.00 245.00

COMBINE 4545454 6565656 KIZER GENNIE L 250.00 .00 250.00

COMBINE 2229444 6543210 WILLIAMS SUSAN 150.00 1,542.50 1,692.50

COMBINE 9851114 4321012 YATES SARAH A .00 .00 .00

COMBINE 3212141 4321012 YATES SARAH A 150.00 .00 150.00

SAMPLE REPORTS DAY END REPORTS DAY END Summary Of Charges Update Page 3.1

Summary of Charges Update

Overview: The Summary of Charges Update is a batch control report. It shows

charges, credits, payments, and adjustments segregated by inpatient and outpatient, and proves the update to the accumulated charges file has been performed during the Day End processing. This report also

shows totals for late charges and industrial billing charges. Access: Daily Processing Menu, Option 10 Program: PB0R81 Selection: Print selection and number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report should be retained for reference and to support the charge edit and posting control reports. File: CHRGTRAN

SAMPLE REPORTS DAY END REPORTS DAY END Summary Of Charges Update Page 3.2



RUN DATE 7/01/02 TIME 5:42 PM *** SUMMARY OF CHARGES UPDATE *** REF# 2097

I/P O/P TOTAL LATE CHGS INDUSTRIAL

----- ----- ------- --------- ----------

CHARGES : 16,600.63 500.75 17,101.38 .00 453.00

CREDITS : .00 .00 .00

PAYMENTS : 116.50- 433.00- 549.50-

ADJUSTMENTS : .00 .00 .00

TOTAL -- 16,484.13 67.75 16,551.88 .00 453.00

* * * * * *

*** THESE TOTALS SHOULD AGREE WITH THE POSTING CONTROL REPORTS ***

SAMPLE REPORTS DAY END REPORTS DAY END Inpatient Posting Control Report Page 4.1

Inpatient Posting Control Report

Overview: The Inpatient Posting Control Report is a summary by patient of all

charge activity for the day. This report prints the patient number, patient number, room, hospital

service, financial class, and pricing code. Also, the report prints by patient the beginning balance, each charge by batch and sequence

number, date, description, quantity, service code, and extended amount as well as the ending balance for each patient.

This report prints in patient number order. Access: Daily Processing Menu, Option 10 Program: PB0P12 Selection: Print selection and number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is used to verify the daily charge activity for each inpatient and can be balanced to the Charge Edit Listing. Files: PATIENTS, CHRGTRAN, ARCNTRL




RUN DATE 7/31/01 TIME 5:43 PM INPATIENT POSTING CONTROL REPORT REF# 2097

BATCH SEQ *SER DATE* *DESCRIPTION* *QUANTITY* *SER CD* *AMOUNT*

000 002 7/30/01 ROOM CHARGE CCU-5 1 3110000 459.00

NEW BALAN 6,316.00

PAT NO NAME ROOM HSV FC PC OLD BALANCE

1466846 BLACKWELL SAMMY FRANK 202-B MAC 2 1 2,445.00


000 020 7/30/01 ROOM CHARGE 202-B 1 3100002 210.00

NEW BALAN 2,655.00


1466853 MANEY MARY ANNE 317-B MAC 2 1 2,235.00


000 030 7/30/01 ROOM CHARGE 317-B 1 3100003 210.00

NEW BALAN 2,445.00


1472190 BURGNON KIMBERLY LYNN 306-B SAC 1 2 3,589.56


1472232 COATS RITA FAY 203-B SAC 3 1 4,684.57


2124542 MARTIN ADAM CORY NUR-B MAC M 1 605.00


000 018 7/30/01 ROOM CHARGE 200-B 1 3100000 220.00


8888888 STEPHENS ANDREW CARL 100-A MAC B 1 4,285.00


9888888 STEPHENS ANDREW CARL 101-A MAC B 1 1,470.00


9999999 AARON ROBERT DARREL SCU-2 MAC M 1 1,975.75

TRANS POSTED- 36 BEGINNING BALANCE 680,954.45

GROSS NET

CHARGES 10,173.53 9,813.53

CREDITS .00 .00

PAYMENTS - - - - .00

ADJUSTMENTS - - - - .00

TOTAL GROSS 10,173.53 AMOUNT POSTED 9,813.53

ENDING BALANCE 690,767.98


Posting Control Error Report

Overview: The Posting Control Error Report (Charges with no matching patient

record) will print any charges for a patient that does not exist in the Patients file. If all charges are posted to the Charge Transaction file (CHRGTRAN), this error report will not be generated.

This report prints the patient number, first three characters of the

patient's last name, charge amount, batch number, sequence number, quantity, and charge code, and charge description.

Access: Daily Processing Menu, Option 10 Program: PB0P12E Selection: Print selection and number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is to determine charges that are not posted to the Charge Transaction File. Files: CHRGTRAN, PAIBILL



SUBMITTED 7/30/01 BY ANNA PB0P12E

RUN DATE 7/31/01 TIME 5:43 PM CHARGES WITH NO MATCHING PATIENT RECORD REF# 2097

PAT# NAM AMT BATCH SEQ# QTY SER CD DESCR

1070532 HED 150.00 * 437 001 1 4000045 CHEM SCREEN PROF 160

1070532 HED 50.00 * 437 002 1 3900845 CREATININE CLEARANCE

3040643 WIL 75.00 * 438 001 1 4903023 TYLENOL ELIXIR 1ML

3040643 WIL 25.00 * 438 002 1 4000099 HEMOGLOBIN

SAMPLE REPORTS DAY END REPORTS DAY END Outpatient Posting Control Report Page 5.1

Outpatient Posting Control Report

Overview: The Outpatient Posting Control Report is a summary by patient of all

charge activity for the day. This report prints the patient number, patient number, hospital

service, financial class, and pricing code. Also, the report prints by patient the beginning balance, each charge by batch and sequence number, date, description, quantity, service code, and extended

amount as well as the ending balance for each patient. This report prints in patient number order. Access: Daily Processing Menu, Option 10 Program: PB0P13 Selection: Print selection and number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is used to verify the daily charge activity for each outpatient and can be balanced to the Charge Edit Listing. Files: PATIENTS, CHRGTRAN, ARCNTRL




RUN DATE 7/31/01 TIME 5:44 PM OUTPATIENT POSTING CONTROL REPORT REF# 2097


000 002 7/30/01 ROOM CHARGE CCU-5 1 3110000 459.00

NEW BALAN 6,316.00


1466846 BRADY WILLIAM FRANK 202-B MAC 2 1 2,445.00


000 020 7/30/01 ROOM CHARGE 202-B 1 3100002 210.00

NEW BALAN 2,655.00


1466853 MOODY LONNIE SUE 317-B MAC 2 1 2,235.00


000 030 7/30/01 ROOM CHARGE 317-B 1 3100003 210.00

NEW BALAN 2,445.00


1472190 BURCH KIMBERLY LISA 306-B SAC 1 2 3,589.56


1472232 COTTS VERA KAY 203-B SAC 3 1 4,684.57


2124542 MARRIN ALBERT ROMA NUR-B MAC M 1 605.00


000 018 7/30/01 ROOM CHARGE 200-B 1 3100000 220.00


8888888 STEPPS ALBERT RAY 100-A MAC B 1 4,285.00


9888888 STEPPS ALBERT RAY 101-A MAC B 1 1,470.00


9999999 ADAMS RUSS DUANE SCU-2 MAC M 1 1,975.75

TRANS POSTED- 36 BEGINNING BALANCE 680,954.45

GROSS NET

CHARGES 10,173.53 9,813.53

CREDITS .00 .00

PAYMENTS - - - - .00

ADJUSTMENTS - - - - .00

TOTAL GROSS 10,173.53 AMOUNT POSTED 9,813.53

ENDING BALANCE 690,767.98


Posting Control Error Report

Overview: The Posting Control Error Report (Charges with no Matching PatientRecord) will print any charges for a patient that does not exist in the Patients file. If all charges are posted to the Charge Transaction file (CHRGTRAN), this error report will not be generated.

This report prints the patient number, first three characters of the patient's last name, charge amount, batch number, sequence number, quantity, and charge code, and charge description.


Program: PB0P12E

Selection: Print selection and number of copies on the Day end reports record,Option 7 on the System Control File Menu.

Statistics: None

Use: This report is used to determine charges that are not posted to the Charge Transaction File.

Files: CHRGTRAN, PAIBILL



SUBMITTED 7/30/01 BY ANNA PB0P12E

RUN DATE 7/31/01 TIME 5:44 PM CHARGES WITH NO MATCHING PATIENT RECORD REF# 2097

PAT# NAM AMT BATCH SEQ# QTY SER CD DESCR

1070532 HED 150.00 * 437 001 1 4000045 CHEM SCREEN PROF 160

1070532 HED 50.00 * 437 002 1 3900845 CREATININE CLEARANCE

3040643 WIL 75.00 * 438 001 1 4903023 TYLENOL ELIXIR 1ML

3040643 WIL 25.00 * 438 002 1 4000099 HEMOGLOBIN

SAMPLE REPORTS DAY END REPORTS DAY END Daily Transaction Audit Report Page 6.1

Daily Transaction Audit Report

Overview: The Daily Transaction Audit Report lists each charge by batch of all

charge activity for this Day End Processing. This report identifies all charges in each batch.

This report prints by batch number and sequence number order.

Batch Number 000: Charges generated during the final census (ie. room charges, automatic charges).

Batch Number 897: Charges generated by recording outpatient visits. Batch Number 995: Charges generated through Materials Management. Batch Number 899: Charges generated from Order Entry. Note: The SiteLoc column and totals will be printed if the field Site

Location Processing is answered Yes in the Admission Control Record, Option 26 the System Control File Menu.

Access: Daily Processing Menu, Option 10 Program: PB0P1D Selection: Print selection and number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is used to verify that charges entered and printed on the Daily Charge Transactions Input Edit List have actually been posted. File: CHRGTRAN

SAMPLE REPORTS DAY END REPORTS DAY END Daily Transaction Audit Report Page 6.2



RUN DATE 8/05/08 TIME 5:46 PM D A I L Y T R A N S A C T I O N A U D I T R E P O R T REF# 2097

BATCH SEQ PATIENT SERVICE CHARGE QTY DATE OF DEPT STANDARD NET OVERRIDE

NO. NO. NUMBER CODE DESCRIPTION SERVICE NO. AMOUNT AMOUNT AMOUNT SITELOC

000 254 0010005 1240000 ADMISSION KIT 1 7/23/08 350 1,250.00 1,250.00 001

000 255 0050000 1240000 ADMISSION KIT 1 7/23/08 350 1,250.00 1,250.00 300

000 256 0050001 1240000 ADMISSION KIT 1 7/23/08 350 1,250.00 1,250.00 001

000 257 0050008 1240000 ADMISSION KIT 1 7/23/08 350 1,250.00 1,250.00 001

000 258 0050003 1240000 ADMISSION KIT 1 7/23/08 350 1,250.00 1,250.00 300

000 259 0050004 1240000 ADMISSION KIT 1 7/23/08 350 1,250.00 1,250.00 001

000 260 0050005 1240000 ADMISSION KIT 1 7/23/08 350 1,250.00 1,250.00 001

000 261 1246781 1240000 ADMISSION KIT 1 7/23/08 350 1,250.00 1,250.00 001

NUMBER POSTED--431 TOTALS OF BATCH 000 431 124,778.61 122,071.61 .00

895 001 0050000 4030718 SERUM INSULIN 1 8/04/08 403 68.00 68.00 001

895 002 0050000 4030718 SERUM INSULIN 1 8/04/08 403 68.00 68.00 001

NUMBER POSTED-- 2 TOTALS OF BATCH 895 2 136.00 136.00 .00

897 001 7401409 4375000 P THER VISIT 1 6/25/08 437 .00 .00 001

897 002 7470735 4375000 P THER VISIT 1 6/25/08 437 .00 .00 001

897 003 7471816 4375000 P THER VISIT 1 6/25/08 437 .00 .00 001

897 004 8457121 4375000 P THER VISIT 1 7/23/08 437 .00 .00 001

NUMBER POSTED-- 4 TOTALS OF BATCH 897 4 .00 .00 .00

995 001 1237370 0220482 SPLINT ANKLE 1 2/07/08 376 47.75 47.75 001

NUMBER POSTED-- 1 TOTALS OF BATCH 995 1 47.75 47.75 .00

NUMBER POSTED-- 438 TOTALS OF ALL BATCHES- 438 124,962.36 122,255.36 .00

NUMBER POSTED -- 430 TOTALS OF SITE LOC 001 430 124,555.00 .00 114,462.36

NUMBER POSTED -- 8 TOTALS OF SITE LOC 300 8 10 500.00 .00 10,500.00

NUMBER POSTED-- 0 TOTAL INDUSTRIAL CHARGES--- 0 .00 .00 .00

SAMPLE REPORTS DAY END REPORTS DAY END Daily Late Charge Transaction Page 7.1

Daily Late Charge Transaction

Overview: The Daily Late Charge Transaction Report lists all late charges for Day

End processing. Note: Late charges are charges posted to accounts after a final bill

has been produced by the system. This report prints in batch number and sequence number order. Access: Daily Processing Menu, Option 10 Program: PB0R12 Selection: Print selection and number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is used to identify departments with late charge problems. File: CHRGTRAN

SAMPLE REPORTS DAY END REPORTS DAY END Daily Late Charge Transaction Page 7.2



RUN DATE 2/08/02 TIME 5:46 PM D A I L Y L A T E C H A R G E A U D I T R E P O R T REF# 2097

DEPT. BATCH SEQ PATIENT SERVICE CHARGE QTY DATE OF STANDARD NET OVERRIDE

NO. NO. NO. NUMBER CODE DESCRIPTION SERVICE AMOUNT AMOUNT AMOUNT

376 995 001 1237370 0220482 SPLINT ANKLE 1 2/07/02 47.75 47.75

NUMBER POSTED-- 1 TOTALS OF DEPT. 376 1 47.75 47.75 .00

NUMBER POSTED-- 1 TOTALS OF ALL DEPTS ---- 1 47.75 47.75 .00

SAMPLE REPORTS DAY END REPORTS DAY END Daily Statistics Report – F/C Page 8.1

Daily Statistics Report – F/C

Overview: The Daily Statistics Report - Financial Class recaps all statistical

activity for this Day End processing by financial class. This report prints the number of admissions, discharges, registrations,

patient days, and monetary amounts for inpatient/outpatient revenue cash receipts and adjustments.

This report prints alphabetically by financial class. Access: Daily Processing Menu, Option 10 Program: PB0R16 Selection: Print selection and number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is used to verify daily activity by financial class. The total revenue can be verified with the revenue on the Daily Charge Audit Report. This report should be retained for reference. File: FCDESC

SAMPLE REPORTS DAY END REPORTS DAY END Daily Statistics Report – F/C Page 8.2



RUN DATE 7/02/02 TIME 5:46 PM DAILY STATISTICS REPORT - FINANCIAL CLASS REF# 2097

FINANCIAL ADMISSIONS REGISTRATIONS DISCHARGES PATIENT DAYS REVENUE CASH RECEIPTS ADJUSTMENTS

CLASS I/P O/P

------------------------------------------------------------------------------------------------------------------------------------

M 2 1,970.00 .00 .00 .00

P 2 2 0 .00 .00 .00 .00

Z 1 97.78 .00 .00 .00

1 1 210.00 .00 .00 .00

2 13 4,056.75 .00 .00 .00

3 17 3,839.00 .00 .00 .00



RUN DATE 7/02/02 TIME 5:46 PM DAILY STATISTICS REPORT - FINANCIAL CLASS REF# 2097

FINANCIAL ADMISSIONS REGISTRATIONS DISCHARGES PATIENT DAYS REVENUE CASH RECEIPTS ADJUSTMENTS

CLASS I/P O/P

------------------------------------------------------------------------------------------------------------------------------------

** TOTAL ** 2 2 34 10,173.53 .00 .00 .00

SAMPLE REPORTS DAY END REPORTS DAY END Hospital Service Code Revenue Stats Page 9.1

Hospital Service Code Revenue Stats

Overview: The Hospital Service Code Revenue Statistics recaps revenue for the

day and month-to-date by hospital service. This report lists the units and revenue for each general ledger department by hospital service.

This report prints alphabetically by hospital service. Access: Daily Processing Menu, Option 10 Program: PB0R35 Selection: Print selection and number of copies on the Day end reports records, Option 7 on the System Control File Menu. Statistics: None Use: This report is used to support reasonableness tests of daily revenue volumes. It also can be used to track departmental revenue by service on a daily basis. The total revenue can be verified with the revenue on the Daily Charge Audit Report. This report should be retained for reference to support monthly statistics. File: STATRV

SAMPLE REPORTS DAY END REPORTS DAY END Hospital Service Code Revenue Stats Page 9.2



RUN DATE 7/02/02 TIME 5:46 PM HOSPITAL SERVICE CODE - REVENUE STATISTICS REF# 2097

HOSPITAL SERVICE/ ------- TODAY ------- ---------- MONTH ------------

DEPARTMENT UNITS REVENUE UNITS REVENUE

PEDIATRICS ACUTE CARE

-------------------------

ROOM & BOARD 18.00 16,500.00 6.00 1,170.00

NURSERY .00 .00 3.00 354.00

EQUIPMENT RENTAL .00 .00 11.00 207.50

CENTRAL SUPPLY .00 .00 34.00 296.25

I V SOLUTIONS .00 .00 15.00 233.50

EMERGENCY ROOM .00 .00 3.00 117.00

EMERGENCY RM DOCTOR .00 .00 4.00 147.00

LABORATORY .00 .00 63.00 1,592.75

MEDICAL IMAGING .00 .00 6.00 402.25

PHARMACY .00 .00 9.00 1,022.75

INHALATION THERAPY .00 .00 2.00 58.00

TOTALS ** 18.00 16,500.00 156.00 5,601.00

SURGICAL ACUTE CARE

-------------------------

ROOM & BOARD 46.00 9,375.00 70.00 13,730.00

TELEMETRY 1.00 1,250.00 15.00 629.00

OPERATING ROOM .00 .00 48.00 9,514.00

OR ROOM SUPPLIES .00 .00 806.00 17,473.50

EQUIPMENT RENTAL .00 .00 96.00 1,265.00

RECOVERY ROOM .00 .00 15.00 1,536.00

CENTRAL SUPPLY .00 .00 336.00 4,391.00

I V SOLUTIONS .00 .00 219.00 3,400.75

EMERGENCY ROOM .00 .00 4.00 156.00

EMERGENCY RM DOCTOR .00 .00 6.00 211.00

LABORATORY .00 .00 216.00 8,845.50

EKG .00 .00 10.00 807.50

MEDICAL IMAGING .00 .00 36.00 2,557.25

ULTRASOUND .00 .00 1.00 186.25

PHARMACY .00 .00 86.00 9,033.14

ANES ADMINISTRATION .00 .00 20.00 7,479.00

INHALATION THERAPY .00 .00 179.00 4,162.75

PHYSICAL THERAPY .00 .00 6.00 328.50

TOTALS ** 47.00 11,625.00 2,169.00 85,706.14

** GRAND TOTALS** 456.00 142,664.61 35,273.00 1,403,729.16

SAMPLE REPORTS DAY END REPORTS DAY END Inpatient/Outpatient Service Code Stat Page 10.1

Inpatient/Outpatient Service Code Stat

Overview: The Inpatient/Outpatient Service Code Statistics lists inpatient

admissions, discharges, and patient days for today and month-to-date by each hospital service. This report also lists outpatient registrations and visits for today and month-to-date.

This report prints alphabetically by hospital service. Access: Daily Processing Menu, Option 10 Program: PB0R36 Selection: Print selection and number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is used to support reasonableness tests of daily statistical volumes. This report should be retained as a day-to-day reference to support monthly statistical reports. File: STATDR

SAMPLE REPORTS DAY END REPORTS DAY END Inpatient/Outpatient Service Code Stat Page 10.2



RUN DATE 7/02/02 TIME 5:46 PM STATISTICAL REPORT BY SERVICE - INPATIENT REF# 2097

HOSPITAL SERVICE ------ ADMISSIONS ------ ------ DISCHARGES ------ ------ PATIENT DAYS ------

TODAY MONTH TODAY MONTH TODAY MONTH

LONG TERM CARE INTERMEDIATE 0 0 0 0 0 1,457

LONG TERM CARE SKILLED 0 0 0 0 0 591

MEDICAL ACUTE CARE 6 152 2 139 310 872

NEWBORN ACUTE CARE 4 12 0 15 26 52

OBSTETRICS ACUTE CARE 0 14 0 14 2 37

PEDIATRICS ACUTE CARE 0 4 0 8 8 9

SURGICAL ACUTE CARE 1 17 0 17 46 70

SWING BED 0 4 0 9 12 76

INPATIENT SERVICE ** TOTAL 11 203 2 202 412 3,164



RUN DATE 7/02/02 TIME 5:46 PM STATISTICAL REPORT BY SERVICE - OUTPATIENT REF# 2097

HOSPITAL SERVICE ----- REGISTRATIONS ---- -------- VISITS --------

TODAY MONTH TODAY MONTH

AMBULATOR OUT PATIENT 34 710 3 2

AMBULATOR SURGERY 0 58 0 0

EMERGENCY EMERGENCY ROOM 43 836 3 2

MEDICARE DIAGNOSTIC SERVICES 16 390 2 0

OUT PATIENT PHYSICAL THERAPY 2 24 15 33

OUTPATIENT SERVICE ** TOTAL 95 2,018 27 37

SAMPLE REPORTS DAY END REPORTS DAY END Departmental Revenue By Financial Class Page 11.1

Departmental Revenue By Financial Class

Overview: The Departmental Revenue by Financial Class lists revenue by general

ledger department, segregated by inpatient and outpatient for today and month-to-date. Column headings are defined by the Revenue by Financial Class, Option 7 on the Hospital Table File Menu.

This report prints in department number order. Access: Daily Processing Menu, Option 10 Program: PB0R37 Selection: Print selection and number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is used to classify departmental revenue by major financial class groups. The total revenue can be verified with the revenue on the Daily Charge Audit Report. File: GLKEYSR

SAMPLE REPORTS DAY END REPORTS DAY END Departmental Revenue By Financial Class Page 11.2



RUN DATE 7/02/02 TIME 5:47 PM DEPARTMENTAL REVENUE BY FINANCIAL CLASS REF# 2097

MEDICARE MEDICAID BLUE CROSS PRIVATE NURS HOME HHA OTHER *TOTAL*

***** 310 ROOM & BOARD *****

DAY-IP 30,470.00 975.00 2,265.00 195.00 2,385.00 .00 36,093.36 72,383.36

-OP .00 .00 .00 .00 .00 .00 .00 .00

**** 30,470.00 975.00 2,265.00 195.00 2,385.00 .00 36,093.36 72,383.36

MTH-I 58,952.24 16,020.00 2,945.00 7,800.00 205.00 .00 34,189.06 120,111.30

-O .00 .00 .00 .00 .00 .00 .00 .00

*** 58,952.24 16,020.00 2,945.00 7,800.00 205.00 .00 34,189.06 120,111.30

***** 311 CRITICAL CARE UNIT *****

DAY-IP 7,146.00 .00 .00 .00 .00 .00 5,857.00 13,003.00

-OP .00 .00 .00 .00 .00 .00 .00 .00

**** 7,146.00 .00 .00 .00 .00 .00 5,857.00 13,003.00

MTH-I 11,362.00 1,748.00 437.00 .00 .00 .00 2,185.00 15,732.00

-O .00 .00 .00 .00 .00 .00 .00 .00

*** 11,362.00 1,748.00 437.00 .00 .00 .00 2,185.00 15,732.00

***** 312 SPECIAL CARE UNIT *****

DAY-IP .00 .00 .00 .00 .00 .00 984.00 984.00

-OP .00 .00 .00 .00 .00 .00 .00 .00

**** .00 .00 .00 .00 .00 .00 984.00 984.00

MTH-I 33,456.00 984.00 1,640.00 984.00 .00 .00 5,576.00 42,640.00

-O .00 .00 .00 .00 .00 .00 .00 .00

*** 33,456.00 984.00 1,640.00 984.00 .00 .00 5,576.00 42,640.00

***** 350 NURSERY *****

DAY-IP 3,750.00 .00 .00 .00 17,105.00 .00 17,500.00 38,355.00

-OP .00 .00 .00 .00 .00 .00 .00 .00

**** 3,750.00 .00 .00 .00 17,105.00 .00 17,500.00 38,355.00

MTH-I .00 4,724.00 .00 .00 472.00 .00 1,266.00 6,462.00

-O .00 .00 .00 .00 .00 .00 .00 .00

*** .00 4,724.00 .00 .00 472.00 .00 1,266.00 6,462.00

***** TOTALS *****

DAY-IP 41,419.25 975.00 2,265.00 195.00 19,490.00 .00 60,570.36 124,914.61

-OP .00 .00 .00 .00 .00 .00 .00 .00

**** 41,419.25 975.00 2,265.00 195.00 19,490.00 .00 60,570.36 124,914.61

MTH-I 361,067.82 100,258.77 20,602.10 41,709.48 95,483.40 .00 154,424.31 773,545.88

-O 121,694.87 82,318.28 55,282.86 75,240.48 .00 .00 195,646.79 530,183.28

*** 482,762.69 182,577.05 75,884.96 116,949.96 95,483.40 .00 350,071.10 1,303,729.16

SAMPLE REPORTS DAY END REPORTS DAY END Daily Revenue Usage Page 12.1

Daily Revenue Usage

Overview: The Daily Revenue Usage lists today's detail charges by department. This report lists the patient number, patient name, charge code,

description, and date. It also prints quantity and revenue segregated by inpatient and outpatient.

This report prints in department number order with each department

beginning on a new page. Access: Daily Processing Menu, Option 10 Program: PB0P16 Selection: Print selection and number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report shows charges by day for each patient and identifies late charges. The total revenue can be verified with the revenue on the Daily Charge Audit Report. This report can be distributed to each department. File: CHRGTRAN

SAMPLE REPORTS DAY END REPORTS DAY END Daily Revenue Usage Page 12.2



RUN DATE 7/02/02 TIME 5:47 PM D A I L Y R E V E N U E U S A G E REF# 2097

DEPT NO./NAME 403 / LAB MEDICAL ARTS BLDG

(* = LATE CHARGE)

------------- PATIENT ------------ --------------- SERVICE --------------- ----- QUANTITY ---- --------- REVENUE ---------

NUMBER / NAME CODE DESCRIPTION DATE I/P O/P TOTAL I/P O/P TOTAL

0050000 TIDWELL VONDA M 4030718 SERUM INSULIN 8/04/02 1 1 68.00 68.00

0050000 TIDWELL VONDA M 4030718 SERUM INSULIN 8/04/02 1 1 68.00 68.00

SERVICE TOTALS 2 2 136.00 .00 136.00

DEPT. TOTALS 2 2 136.00 .00 136.00




DEPT NO./NAME 436 / INHALATION THERAPY

(* = LATE CHARGE)



1466150 YORK WILLIE WESTERN 4360204 ROOM HUMIDIF302-A 7/26/02 1 1 17.75 17.75



SERVICE TOTALS 3 3 53.25 .00 53.25

DEPT. TOTALS 3 3 53.25 .00 53.25




DEPT NO./NAME 437 / PHYSICAL THERAPY

(* = LATE CHARGE)



7401409 THOMPSON GLENN COLLIER 4375000 P THER VISIT 6/25/02 1 1 .00 .00

7470735 PERRYMAN CHRISTINE WILSON 4375000 P THER VISIT 6/25/02 1 1 .00 .00

7471816 HALL LINDSEY BROWNING 4375000 P THER VISIT 6/25/02 1 1 .00 .00

8457121 STEPHENS ARTHUR M 4375000 P THER VISIT 7/23/02 1 1 .00 .00

SERVICE TOTALS 4 4 .00 .00 .00

DEPT. TOTALS 4 4 .00 .00 .00

FINAL TOTALS 433 5 438 24,914.61 47.75 124,962.36

SAMPLE REPORTS DAY END REPORTS DAY END Daily DRG Analysis By Physician Page 13.1

Daily DRG Analysis By Physician

Overview: This report lists the patient number, patient name, room/bed,

accommodation code, admit date, payor plan, financial class, sex, age, estimated payment, cost, variance, DRG, actual length of stay, average length of stay, and current balance. Each physician prints

on a new page. If an admitting diagnosis is entered in the Medical Records system,

the estimated payment is based on this DRG. The cost amount is the actual charge amounts multiplied by the percentage cost to charge

defined for each UB92 revenue code. Access: Daily Processing Menu, Option 10 Program: PB0R45 Selection: If selected from the Reports Menu Report date If generated through Daily Processing Menu Print selection and number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report assists in discharge planning and utilization review. Files: PATIENTS, PHYMAST, INSPLAN

SAMPLE REPORTS DAY END REPORTS DAY END Daily DRG Analysis By Physician Page 13.2



RUN DATE 3/31/02 TIME 5:49 PM DAILY DRG ANALYSIS BY PHYSICIAN REF# 2097

009 CONNEY BARRY MD

PATIENT ROOM/ A ADMIT PAYOR F S ESTIMATED ACT AVG CURRENT

NUMBER PATIENT NAME BED C DATE PLAN C X AGE PAYMENT COST VARIANCE DRG LOS LOS BALANCE

4572640 WILLIS BILLIE DORIS ICU-A I 3/01/02 780 001 B F 062 2,841.46 2,841.46 .00 5 2,841.46

4572657 TAYLOR DEEDEE JEAN 206-A S 3/01/02 001 001 M F 067 99,554.23 4,724.20 94,830.03 016 5 6.6 4,724.20

4572665 OLINE ARVILLE RAY 215-B S 3/02/02 001 001 M M 051 .00 2,007.30 2,007.30- 000 2 .0 2,007.30

4572806 PETTYJOHN LUCILLE ICU-C I 2/27/02 001 001 M F 072 5,347.37 8,810.30 3,462.93- 127 8 6.0 8,810.30

4573176 MARS AGNES 212-P P 2/16/02 001 001 M F 080 14,717.13 20,633.77 5,916.64- 022 19 4.4 20,633.77

4573465 SAINT PAUL 204-P P 2/20/02 001 001 M M 076 99,154.72 9,502.01 89,652.71 320 15 6.7 9,502.01

4591277 CORREN MARY MARGARET 210-B P 2/29/02 001 001 M F 088 91,518.16 4,310.05 87,208.11 320 7 6.7 4,310.05

4591558 JONES FLORENCE 214-A S 3/03/02 001 001 M F 084 .00 .00 .00 000 4 .0 .00

4591574 VANOVER ROMAN 218-B S 3/02/02 001 001 M M 055 .00 603.95 603.95- 000 2 .0 603.95

4591798 PATRICK CARA 201-A S 3/03/02 950 001 C F 022 381.75 381.75 .00 3 381.75

4591814 PERKINS RUTH LEE 336-B S 3/02/02 400 001 I F 050 1,161.00 1,161.00 .00 2 1,161.00

4591822 CARSON ALTA ALLEN XHN-1 P 2/28/02 001 001 M F 078 14,585.97 4,547.24 10,038.73 132 7 4.0 4,547.24

4591863 COFFEY CHRISTEEN 207-P P 2/25/02 400 001 I F 059 9,790.05 9,790.05 .00 10 9,790.05

4591921 ROBINSON BERTHA MAY 216-P P 2/24/02 001 001 M F 084 5,522.26 12,100.63 6,578.37- 089 9 7.1 12,100.63

4611158 CHAPPELL NORA 203-P P 2/22/02 001 001 M F 059 10,504.95 18,442.73 7,937.78- 088 13 5.9 18,442.73

SAMPLE REPORTS DAY END REPORTS DAY END New Accounts Receivable Report Page 14.1

New Accounts Receivable Report

Overview: The New Accounts Receivable Report lists for all final billed patients

the patient name, patient number, financial class, admission date, patient type, doctor number, final bill date, discharge date, balance, payor plans, guarantor name, guarantor number, address, and telephone number.

This report prints in patient number order. Access: Daily Processing Menu, Option 10 Program: PB0P2C Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report should be retained for reference and to prove the number and amount which was added to the discharged accounts receivable file. This report should balance to the A/R Posting Recap Report and the Daily Status Report. File: ARMAST

SAMPLE REPORTS DAY END REPORTS DAY END New Accounts Receivable Report Page 14.2


SUBMITTED 8/01/02 BY ANNA PB0P2C

RUN DATE 8/01/02 TIME 6:04 PM NEW ACCOUNTS RECEIVABLE REPORT REF# 2097

PAT/GUAR NAMES ACCT NO FC ADM DATE TYP DOC FINAL DATE DISCHG DATE BALANCE PAYOR PLANS

BRADY CARLEEN N 1336502 U 7/01/02 S 501 7/31/02 7/05/02 1,500.00 001 000 000

BRADY VICTOR W 1045671 145 POPLAR AVENUE NASHVILLE TN 37210 6152991234

NUMBER ACCTS ADDED - 1

NUMBER ACCTS REJECTED

AMOUNT ADDED - - - - 1,500.00

SAMPLE REPORTS DAY END REPORTS DAY END Payor Log Exception Report Page 15.1

Payor Log Exception Report

Overview: The Payor Log Exception Report prints errors for payments or

adjustments being posted to the logs. The report prints the patient number, cycle number, date logged, date

paid, financial class, covered charges, patient deductible, expected contractual adjustment, actual contractual adjustment, contractual

adjustment difference, expected payment, actual payment, payment difference, DRG, and warning/error number.

This report prints in patient number order. The Payor Log Exception also prints those payments/ adjustments that

did not post to the Payor Log system due to one of the following warnings/errors:

∙ Warning 1: Payment Previously Posted A payment has already been posted to the patient's account in the Payor Log system. Multiple payments can be posted to a patient's account. Payments can be displayed using F11=Payments on the first screen in Payor Log Maintenance. ∙ Warning 2: Adjustment Previously Posted An adjustment has already been posted to the patient' account in the Payor Log system. Multiple adjustments can be posted to a patient's account. Adjustments can be displayed using F11= Adjustments on the second screen in Payor Log Maintenance. ∙ Error 3: No Payor Log Found A payment/adjustment cannot be posted because the account does not exist in the Payor Log system. The account can be manually set up through Payor Log Maintenace. ∙ Warning 4: Payment and Adjustment Previously Posted Both a payment and an adjustment have already been posted to the patient's account in the Payor Log system. Multiple payments and adjustments can be posted to a patient’s account. Payments can be displayed using F11=Payments on the first screen in Payor Log Maintenance, Option 15 on the Payor Logs Menu. Adjustments can be displayed using F11=Adjustments on the second screen in Payor Log Maintenance. ∙ Warning 5: Exp Payment-Medicare Exhausted/Medigap The patient has exhausted Medicare benefits and the Long Term Accute Care DRG expected reimbursement calculation is continuing continuing because Medigap is secondary for the patient Access: Daily Processing Menu, Option 10


Program: AR0P48 Selection: Print selection and number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report identifies possible logging errors and maintenance required to the patients log. Files: ARTRNDTL, ARRATDTL, MEDLOG



SUBMITTED 7/02/02 BY ANNA AR0P48

RUN DATE 7/02/02 TIME 6:12 PM PAYOR LOG EXCEPTION REPORT REF# 2097

PATIENT CY DATE DATE F BF COVERED PATIENT EXPECTED ACTUAL CONT. ADJ. EXPECTED ACTUAL PAYMENT

NUMBER NO LOGGED PAID C CT CHARGES DED. CONT. ADJ. CONT. ADJ. DIFFERENCE PAYMENT PAYMENT DIFFERENCE DRG

7449176 01 6/15/02 6/26/02 W 1 2,500.00 50.00 50.00 50.00 .00 1,750.00 1,000.00 750.00

7449374 01 6/15/02 6/26/02 W 1 3,000.00 100.00 50.00 50.00 .00 2,000.00 1,500.00 500.00

7461197 01 6/26/02 ERROR 3

7461569 01 6/26/02 ERROR 3

7461981 01 6/26/02 ERROR 3

7462401 01 6/26/02 ERROR 3

WARNING 1 :PAYMENT PREVIOUSLY POSTED

WARNING 2 :ADJUSTMENT PREVIOUSLY POSTED

ERROR 3 :NO PAYOR LOG FOUND

WARNING 4 :PAYMENT AND ADJUSTMENT PREVIOUSLY POSTED

WARNING 5 :EXP PAYMENT-MEDICARE EXHAUSTED/MEDIGAP

SAMPLE REPORTS DAY END REPORTS DAY END Cash Receipts And Adjustments Page 16.1

Cash Receipts and Adjustments

Overview: The Cash Receipts and Adjustments lists A/R activity. This report lists the source code, account number, patient name,

financial class, patient type, date, transaction code and transaction amount. It is segregated into columns by payment, adjustment,

late charges, batch number and sequence number. This report prints alphabetically by source code. Access: Daily Processing Menu, Option 10 Program: AR0R01 Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report supports the A/R detail which goes to the general ledger. The general ledger entries can be supported by the detail in this report. This report should balance to the Cash Entry Edit Listing and the Daily Status Report. File: ARTRNDTL

SAMPLE REPORTS DAY END REPORTS DAY END Cash Receipts And Adjustments Page 16.2



RUN DATE 7/15/02 TIME 6:12 PM CASH RECEIPTS AND ADJUSTMENTS REF# 2097

SOURCE ACCOUNT NAME FC TP DATE CODE PAYMENT ADJUSTMENT LATE CHARGES BATCH NO. SEQ. NO.

PA 6399562 BRANDON COOKIE O 6/26/02 0000113 8.80 102 36

PA 9999999 AARON RUSTY DUANE I 7/21/02 0000176 200.00 500 1

PA 7465446 GALLAGHER DAVID MICH E 7/14/02 0000104 550.00- 680 2

TOTAL -SOURCE CODE TRANS TOTAL CASH PAYMENTS TOTAL ADJUSTMENTS TOTAL LATE CHARGES NET TOTAL

3 208.80- 550.00- .00 758.80-

RC 1302603 SULLIVAN LISA MIA 0 I 6/26/02 0000836 25.00 102 12


1 25.00- .00 .00 25.00-

BA 6783500 WICHE JONATHAN DANIE E 6/26/02 0000965 20.00- 800 5

BA 6233324 WICHE JONATHAN DANIE E 6/26/02 0000965 20.00 800 6


2 .00 .00 .00 .00

TOTALS- RECEIPTS AND ADJUSTMENTS TRANS TOTAL PAYMENTS TOTAL ADJUSTMENTS TOTAL LATE CHARGES NET TOTAL

228 30,332.20- 7,955.25- .00 38,287.45-

SAMPLE REPORTS DAY END REPORTS DAY END Daily Transactions By Payor Page 17.1

Daily Transactions by Payor

Overview: The Daily Transactions by Payor lists by payor all all transactions in

today's entries such as payments and adjustments. This report lists the patient number, patient name, current balance,

cycle balance, cycle number, transaction code, transaction description, transaction amount, old financial class, new financial class, secondary and tertiary payors.

This report prints in payor number order and then in patient number

order. Access: Daily Processing Menu, Option 10 Program: AR0R35 Selection: Print selection and number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report can be used to review or verify payments and adjustments by payor. This report can be used by the business office to identify accounts which may need attention since a payment or adjustment has been made. Secondary and tertiary payors are listed to identify other payors which may need to be billed. File: ARTRNDTL

SAMPLE REPORTS DAY END REPORTS DAY END Daily Transactions By Payor Page 17.2



RUN DATE 7/02/02 TIME 6:12 PM DAILY TRANSACTIONS BY PAYOR REF# 2097

PAYOR 002 MEDICAID

SEC/TER

PATIENT CURRENT CYCLE CY TRANS. TRANSACTION TRANSACTION OLD NEW PAYORS

1454826 GROSSLIN ZETTIE ANN 2,933.00- 3,585.00- 1 112 PAYMENT MEDICAID 3,585.00 /

8,556.00- 9,208.00- 1 222 CON ADJ MEDICAID 5,623.00- /



RUN DATE 7/02/02 TIME 6:12 PM DAILY TRANSACTIONS BY PAYOR REF# 2097

PAYOR 003 BLUE CROSS/BLUE SHIELD

PATIENT CURRENT CYCLE CY TRANS. TRANSACTION TRANSACTION OLD NEW SEC/TER

NUMBER PATIENT NAME BALANCE BALANCE NO CODE DESCRIPTION AMOUMT F/C F/C PAYORS

1446947 MCCOLLOUGH LARRY RAY 1,659.04 1,756.79 1 110 PAYMENT BLUE CROSS 241.84 /

1465095 NAYMAN ARLENE MIRIAM 104.21 94.21 1 220 CON ADJ BLUE CROSS 7.54- /

7355670 JOHNSON YVONNE FERN 264.71 264.71 1 110 PAYMENT BLUE CROSS 255.71- /

.00 .00 1 110 PAYMENT BLUE CROSS 264.71 /

7411184 WRIGHT MICHAEL THOM 175.37 174.86 1 218 BCBS PPO DISCOUNT 162.18 /

13.19 12.68 1 218 BCBS PPO DISCOUNT 162.18- /

43.60 43.09 1 220 CON ADJ BLUE CROSS 30.41 /

.51 .00 1 220 CON ADJ BLUE CROSS 43.09- /

10.07 10.07 2 218 BCBS PPO DISCOUNT 9.56 /

.51 .51 2 218 BCBS PPO DISCOUNT 9.56- /

2.54 2.54 2 220 CON ADJ BLUE CROSS 2.03 /


7414030 HOLAN DAISY MUSTANG 18.08 18.08 1 218 BCBS PPO DISCOUNT 6.30- 1/ 7

16.74 16.74 1 220 CON ADJ BLUE CROSS 1.34- 1/ 7

7426281 WOODS ESTER JANE 1.67 1.67 1 218 BCBS PPO DISCOUNT 6.30- /


7445372 SAVAGE CONNIE JEAN 14.42 14.42 1 110 PAYMENT BLUE CROSS 65.83 /

8.80 8.80 1 218 BCBS PPO DISCOUNT 5.62- /

7.46 7.46 1 220 CON ADJ BLUE CROSS 1.34- /

7445752 SINGLETON TERESA LOU .00 14.77- 1 218 BCBS PPO DISCOUNT 6.30- /

7449028 MOON ERMA LINDSEY 2.89 2.89 1 218 BCBS PPO DISCOUNT .82- /

2.73 2.73 1 220 CON ADJ BLUE CROSS .16- /

7449176 NELLEY THOMAS STEPHE 10.25 10.25 1 218 BCBS PPO DISCOUNT .72 /

9.53 9.53 1 218 BCBS PPO DISCOUNT .72- /

7449374 LODDERS LILLIE POTTS .82- .82- 1 218 BCBS PPO DISCOUNT .82- /

7452055 MOON ERNA LINDSEY 2.89 2.89 1 218 BCBS PPO DISCOUNT .82- /

2.73 2.73 1 220 CON ADJ BLUE CROSS .16- /

7452279 MONNE MAGGIE SUE 17.68- 4.87 1 110 PAYMENT BLUE CROSS 17.68 /

19.38- 3.17 1 218 BCBS PPO DISCOUNT 1.70- /

19.74- 2.81 1 220 CON ADJ BLUE CROSS .36- /

SAMPLE REPORTS DAY END REPORTS DAY END Accounts Receivable Posting Recap Page 18.1

Accounts Receivable Posting Recap

Overview: The Accounts Receivable Posting Recap summarizes beginning and

ending balances for accounts receivable. This report lists for accounts receivable: the beginning balance,

number of accounts, amount added, number of accounts added, bad debt amount, bad debt accounts, payments, adjustments, late charges, ending balance, and number.

This report lists for bad debt: the beginning balance, number of

accounts, transfer amount, number of transfers, payments, adjustments, ending balance, and number.

Access: Daily Processing Menu, Option 10 Program: AR0P35 Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report can be used to reconcile manual control totals and should be retained for reference. The activity on this report should balance to the Cash Receipts and Adjustments Report and the Daily Status Report. Files: ARMAST, ARTRNDTL, ARCNTRL, PATIME, PACASG

SAMPLE REPORTS DAY END REPORTS DAY END Accounts Receivable Posting Recap Page 18.2



RUN DATE 7/02/02 TIME 6:12 PM ACCOUNTS RECEIVEABLE RECAP REPORT REF# 2097

** ACTIVE ACCOUNTS **

BEGINNING ADDED ADDED BAD DEBT BAD DEBT LATE

BALANCE ACCTS AMT ACCTS AMT ACCTS PAYMENTS ADJUSTMENTS CHARGES

2,436,974.92 49078 6,930.28 5 12,320.85- 1,563.00-

INDUST ENDING ENDING

CHRGS BALANCE ACCTS

2,430,021.35 49083

** BAD DEBT ACCOUNTS **

BEGINNING FROM A/R FROM A/R ENDING ENDING

BALANCE ACCTS AMT ACCTS PAYMENTS ADJUSTMENTS BALANCE ACCTS

5,867,981.17 24,560 5,867,981.17 24560

SAMPLE REPORTS DAY END REPORTS DAY END A/R Distribution Report Page 19.1

A/R Distribution Report

Overview: The A/R Distribution Report lists detailed A/R transactions before they

are summarized and posted to general ledger. This report lists the patient number, patient name, financial class,

source code, transaction code, debit G/L number, credit G/L number, and amount.

This report prints alphabetically by source code. Access: Daily Processing Menu, Option 10 Program: AR0P50

AR0P5A – Produced if the G/L HSV digit is 3 or 4 in the Patient Accounting Install Record.

Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is used to support entries to the general ledger from the

patient level. Files: ARTRNDTL, ARDESC, ARSTRAN

SAMPLE REPORTS DAY END REPORTS DAY END A/R Distribution Report Page 19.2

POST DATE 7/01/02 EXAMPLE HOSPITAL NAME FAC# PAGE 1


RUN DATE 7/02/02 TIME 6:29 PM A/R DISTRIBUTION REPORT REF# 2097

SOURCE TRANS

PATIENT # PATIENT NAME CLASS CODE CODE DEBIT G/L CREDIT G/L ** AMOUNT **

7411184 WRIGHT MICHAEL JOHN U AR 220 0111200 0151300 30.41

7411184 WRIGHT MICHAEL JOHN U AR 220 0111200 0151300 2.03

TOTALS - 0111200 0151300 6/26/02 32.44

1431238 NELLON KAREN ANN L AR 233 0111200 0111200 52.80

1431238 NELLON KAREN ANN L AR 233 0111200 0111200 242.37

6126298 SEYBERS JIMMY DALE L AR 233 0111200 0111200 177.95



7237530 VICTORS CINDY GAYE # AR 233 0111200 0111200 83.64

7237530 VICTORS CINDY GAYE # AR 233 0111200 0111200 43.05

7317332 SEYBERS KIMBERLY DIA U AR 233 0111200 0111200 177.95

7319254 SEYBERS KIMBERLY DIA U AR 233 0111200 0111200 108.70

7368160 SEYBERS BRENDA LOUIS U AR 233 0111200 0111200 102.25

7377096 VICTORS CINDY GAYE U AR 233 0111200 0111200 83.64

7435894 SMITH KAREN NELSON U AR 233 0111200 0111200 52.80

7452634 VICTORS CINDY GAYE U AR 233 0111200 0111200 43.05

7454325 SMITH KAREN NELSON U AR 233 0111200 0111200 242.37

TOTALS - 0111200 0111200 6/26/02

1460807 SANAGE CONNIE JEAN U AR 234 0111200 0111200 61.90

7450802 SANAGE CONNIE JEAN U AR 234 0111200 0111200 61.90

TOTALS - 0111200 0111200 6/26/02

5001599 NEWMAN ANNA MAE M AR 260 0294000 0111200 374.44

TOTALS - 0294000 0111200 6/26/02 374.44

1418037 ADEE ANDREA CLABORN U AR 113 0111000 0111200 50.00

7459084 CAFFEY CINDY KAY U AR 113 0111000 0111200 10.00

TOTALS - 0111000 0111200 6/26/02 60.00

5006333 BRACEY LOIS ANN P AR 198 0111000 0111200 1,835.79

TOTALS - 0111000 0111200 6/26/02 1,835.79

5001599 NEWMAN ANNA MAE M AR 199 0111267 0111200 1,874.50

TOTALS - 0111267 0111200 6/26/02 1,874.50

1302603 SULLIVAN LISA MICHEL 0 RC 836 0111000 0111237 25.00

TOTALS - 0111000 0111237 6/26/02 25.00

TOTAL DISTRIBUTION - 22,376.95

REMITTANCE TOTAL 2,038.00-

CASH RECEIPTS TOTAL 24,414.95

GRAND TOTAL 22,376.95

SAMPLE REPORTS DAY END REPORTS DAY END General Ledger Proof Page 20.1

General Ledger Proof

Overview: The General Ledger Proof Report (GL0R50) lists each summarized

general ledger entry. This report lists the sequence number, source code, G/L reference number, date, debit account, credit account, debit amount, credit amount, account description, detail key, and if required an error message. This report prints alphabetically by source code.

The General Ledger Proof Error Report (GL0R52) will only contain the

transactions that error on the General Ledger Proof Report (GL0R50). The GL Proof Error Report will help resolve invalid account issues to make the balance process easier. The report details included are patient account number, department number, batch number, charge/transaction code and hospital service code.

When correcting an error, the Detail Key that prints on the Proof

Report can be matched up with the Detail Key on the Proof Error report.

Access: Daily Processing Menu, Option 10 Program: GL0R50 – General Ledger Proof Report GL0R52 – General Ledger Proof Error Report Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report aids in supporting G/L entries as the G/L is updated and identifies errors in case of invalid account numbers or out of balance conditions. Files: ARSTRAN, ARSTRANDTL, GLM.XXX (where XXX = hospital number)

SAMPLE REPORTS DAY END REPORTS DAY END General Ledger Proof Page 20.2

G/L

Pro

of R

epor

t Exa

mpl

e POST DATE 1/30/09 EXAMPLE HOSPITAL NAME FAC# 004 PAGE 1

SUBMITTED 1/31/09 BY ANNA GL0R50

RUN DATE 1/31/09 TIME 6:29 PM GENERAL LEDGER PROOF REF# 2097

SEQ. ACCOUNT AMOUNT

NO SRCE REF# DATE DEBIT CREDIT DEBIT CREDIT DESCRIPTION DETAIL KEY MESSAGE

----- ---- ------ -------- ---------------- --------------------- ----------- ---------- -------

00001 AR 000112 1/30/09 110001 6,917.42 MEDICAID IP PMT 00010 ** INVALID ACCT#

00002 AR 000112 1/30/09 504100 6,824.60 MCAID IP CONTRL 00011 ** INVALID ACCT#

00003 AR 000111 1/30/09 110002 5,760.10 BLUE CROSS OP 00012 ** INVALID ACCT#

00004 AR 000112 1/30/09 504104 4,233.53 MEDICAID OP CONTR 00013 ** INVALID ACCT#

00005 AR 000109 1/30/09 110002 3,795.23 COMMERICAL INS PMT 00014 ** INVALID ACCT#

G/L

Pro

of E

rror

Rep

ort

Exam

ple

POST DATE 1/30/09 MEDHOST SAMPLE HOSPITAL FAC# 070 PAGE

1 SUMITTED 1/31/09 BY ANNA GL0R52

RUN DATE 1/31/09 TIME 11:30 GENERAL LEDGER PROOF ERROR REPORT REF# 002077

ACCOUNT AMOUNT CHG/TRANS

DETAIL KEY PT ACCT# F/C HSV DEPT# TRANS DATE DEBIT CREDIT DEBIT CREDIT CODE DESCRIPTION

----------- -------- --- ---- ----- ---------- --------------- ------------------------- --------- ----------------------

00010 1234567 MC

MED 250 1/30/09 110001 6,917.42 INVALID ACCOUNT

00011 2334233 MD


00012 4544433 BC


00013 1233367 MD


00014 1233335 CO


SAMPLE REPORTS DAY END REPORTS DAY END General Ledger Detail Update Page 21.1

General Ledger Detail Update

Overview: The General Ledger Detail Update provides a list of summarized

general ledger entries as they are posted to the general ledger detail file.

This report lists the source code, G/L reference number, date, account

description, account number, debit amount, and credit amount. This report print alphabetically by source code. Note: The Site Location code, description, and totals will be printed if the field Site Location Processing is answered Yes in the Admission Control Record, Option 26 the System Control File Menu. Access: Daily Processing Menu, Option 10 Program: AR0P52 Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is only available if the MEDHOST General Ledger module is installed on site. This report is used as a general ledger audit trail. Files: ARSTRAN, GLM.XXXX (where XXXX = hospital number)

SAMPLE REPORTS DAY END REPORTS DAY END General Ledger Detail Update Page 21.2



RUN DATE 3/11/08 TIME 6:30 PM G/L DETAIL UPDATE REF# 2097

SITE LOCATION 001 EXAMPLE HOSPITAL

SOURCE REF DATE ACCOUNT DESCRIPTION ACCOUNT DEBIT CREDIT

DC 000335 3/10/08 RADIOLOGY DIAGNOSTIC BLUE CROSS 3290403 43.15

DC 000335 3/10/08 RADIOLOGY DIAGNOSTIC REVENUE DISCOUNT 3290450 43.15

SOURCE 43.15 43.15

LC 000335 3/10/08 ACCOUNTS RECEIVABLE ACCT REC PATIENTS 1101000 597.80

LC 000335 3/10/08 LABORATORY CLINICAL SELF PAY 3210706 597.80

SOURCE 597.80 597.80

PA 000335 3/10/08 ACCOUNTS RECEIVABLE ACCT REC PATIENTS 1101000 16.00

PA 000335 3/10/08 REVENUE DEDUCTIONS NON BILLABLE M/C OP 4020001 16.00

SOURCE 16.00

SITE LOCATION TOTAL 656.95 656.95

SAMPLE REPORTS DAY END REPORTS DAY END Daily Statement Selection Page 22.1

Daily Statement Selection

Overview: The Daily Statement Selection identifies patients who will receive a

statement. This report lists the patient number, patient name, guarantor

number, guarantor name, financial class, current balance, and balance of the last statement.

This report prints in patient number order. Access: Daily Processing Menu, Option 10 Program: AR0R43 Selection: Optional selection in Statement/Mailer record, Option 8 on the System Control File Menu. Statistics: None Use: This report is identifies patients who will receive statements, based on account transactions during the Day End. File: SELACCTS

SAMPLE REPORTS DAY END REPORTS DAY END Daily Statement Selection Page 22.2



RUN DATE 7/01/02 TIME 6:30 PM DAILY STATEMENT SELECTION REF# 2097

----- PATIENT ----- ----- GUARANTOR ----- F/C CURRENT BAL BAL LST STMT

1324904 BRADY SUSAN CARY 1456 BRADY JAMES VICTOR 1 640.25- 663.25

6127025 HITE WILLIAM J 3444 HITE DANA MARIE U 77.42- 77.42

SAMPLE REPORTS DAY END REPORTS DAY END Daily Status Report Page 23.1

Daily Status Report

Overview: The Daily Status Report summarizes all account activity and compares it to

existing files. This report lists charges, credits, payments, transfers to A/R, late charges, industrial charges, adjustments, transfers to bad debt, small balance write-offs, and bad debts purged. The End Balance is the sum of the beginning balance and the day's transactions. The File Balances are the actual balances of accounts. The Variance will be the difference between the End Balance and File Balances. If the Total File Balance and GL Accounts Receivable Balance do not match, the following messages will print on the report: *** GL DID NOT UPATE *** *** OUT OF BALANCE - SEE GL PROOF REPORT/ GL PROOF ERROR REPORT TO RESOLVE *** Access: Daily Processing Menu, Option 10 Program: SYS010 Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report should be reviewed daily and compared to manual records. File: ARCNTRL


• How to tie the different amounts on the daily status report (DSR) 1. The Beginning Balance should be the same numbers as the ending balance from the prior Day End Daily Status Report. 2. The transfer OP to IP and IP to OP amounts should be found on the Patient Transfer Report that prints with Day End. It is PB0R82. 3. The cancel bill amount should be found on the Cancel Bill Audit Report that prints with Day End. This is report PA0R24. 4. The Charges, Credits, Late Charges, and Industrial Charges can be verified on the Summary of Charges Update Report. Also, the payments and adjustments for inhouse accounts can be verified here. This report is PB0R81. 5. The inpatient, inhouse charges and credits detail can also be found on PB0P12, the Inpatient Posting Control Report. 6. The outpatient, inhouse charges and credits detail can be found on PB0R13, the Outpatient Posting Control Report. 7. The late charges detail can be found on the Late Charge Transaction Report, PB0R12. 8. The industrial charges detail can be found on the Industrial Charges Transaction Report, IB0R12. 9. The transfer to AR amount can be verified on the New Accounts Receivable Report. The total will print at the bottom of PB0P2C. 10. The payments and adjustments for AR (final billed) and bad debt accounts can be verified on the AR Posting Recap Report. Also, the accounts that are written off to bad debt or reinstated from bad debt to AR will be shown here. This is AR0P35. 11. The small balance write-off amounts can be verified on the Cash Receipts and Adjustments Report, AR0R01, under source code 'SB'. 12. The GL Detail Update Report, AR0P52, will show all of the detail that updates to the GL.


POST DATE 6/08/08 MEDHOST COMMUNITY HOSPITAL FAC# 001 PAGE

1 SUBMITTED 6/08/08 BY ANNA SYS010

RUN DATE 6/08/08 TIME 4:39 PM DAILY STATUS REPORT REF# 496

INPATIENT OUTPATIENT DISCHARGED TOTAL BAD DEBTS MISC CASH TOTAL

BEG BALANCE 267,867.74 182,044.70 2,422,174.81 2,872,087.25 5,867,981.17

TRANS OP TO IP 371.00 371.00CR

TRANS IP TO OP 4,620.00CR 4,620.00

CANCEL BILL AMOUNT 8,940.60 461.50 9402.10CR

COMBINED ACCOUNTS 500.00 500.00CR

ADJ BEG BALANCE 273,059.34 186,255.20 2,412,772.71 2,872,087.25 5,867,981.17

CHARGES 13,577.50 1,162.00 14,739.50

CREDITS

PAYMENTS 1,000.00CR 1,000.00CR 1,000.00CR

TRANSFER TO AR 7,750.48CR 5,365.95CR 13,116.43

LATE CHARGES 80.50 80.50

INDUSTRIAL CHRGS

ADJUSTMENTS 25,425.43CR 25,425.43CR 80.50

TRANSFER TO B/D

SMALL BAL W/O

BAD DEBTS PURGED

END BALANCE 253,460.93 182,051.25 2,424,969.64 2,860,481.82 5,868,061.67

FILE BALANCES 253,460.93 182,051.25 2,424,969.64 2,860,481.82 5,868,061.67

VARIANCE

GENERAL LEDGER ACC# BALANCE

CASH 0111000 162,848.74

ACCOUNTS RECEIVABLE 0111200 2,860,481.82

ACCOUNTS PAYABLE 0220000 45,437.75-

* ENDING BALANCE = SUM OF BEGINNING BALANCE AND TODAY'S TRANSACTIONS

* FILE BALANCE = ACTUAL BALANCES OF ACCOUNTS


•O

ut

of B

alan

ce E

xam

ple

POST DATE 6/06/08

HMS COMMUNITY HOSPITAL

FAC# 001 PAGE 1

SUBMITTED 6/06/08 BY ANNA

SYS010

RUN DATE 6/06/08 TIME 4:10 PM

DAILY STATUS REPORT

REF# 452

INPATIENT OUTPATIENT

DISCHARGED TOTAL BAD DEBTS

MISC CASH

TOTAL

BEG BALANCE

745,892.05 877,659.10 5,439,207.07 1,219,231.29

TRANS OP TO IP

TRANS IP TO OP

CANCEL BILL AMOUNT

COMBINED ACCOUNTS

ADJ BEG BALANCE 745,892.05 877,659.10 5,439,207.07 1,219,231.29

CHARGES

183.10

183.10

CREDITS

PAYMENTS

60.00CR

60.00CR

TRANSFER TO AR 3,266.77CR 5,334.34CR 8,601.11

LATE CHARGES

80.50

80.50

INDUSTRIAL CHRGS

ADJUSTMENTS

19.00CR

19.00CR

TRANSFER TO B/D

SMALL BAL W/O

BAD DEBTS PURGED

END BALANCE

742,625.28 872,507.86 5,447,729.18 7,062,862.32 1,219,231.29

FILE BALANCES 660,898.82 39,709.01 257,580.61 958,188.44

441.45

---------- --------- ------------ ------------ ------------

VARIANCE

81,726.46 832,798.85 5,190,148.57 6,104,673.88 1,218,789.84

GENERAL LEDGER

ACC# BALANCE

CASH

0111000 .00

ACCOUNTS RECEIVABLE 0111200

.00 *** GL DID NOT UPDATE ***

ACCOUNTS PAYABLE 0220000

.00

*ENDING BALANCE = SUM OF BEGINNING BALANCE AND TODAY'S TRANSACTIONS

*FILE BALANCE = ACTUAL BALANCES OF ACCOUNTS

*** OUT OF BALANCE - SEE GL PROOF REPORT/ GL PROOF ERROR REPORT TO RESOLVE ***

SAMPLE REPORTS DAY END REPORTS DAY END Invalid Charges Page 24.1

Invalid Charges

Overview: The Invalid Charges report lists charges that did not post due to an

error. For example, if the charge was not correctly converted while transferring an inpatient to an outpatient, the charge would not post and would appear on this report.

This report lists patient number, patient name, charge code, quantity,

price, error message, and charge date. Access: Daily Processing Menu, Option 10 Program: PB0P18 Selection: None Statistics: None Use: The charges listed on the report should be re-keyed to the appropriate account. File: CHRGTRAN

SAMPLE REPORTS DAY END REPORTS DAY END Invalid Charges Page 24.2



RUN DATE 7/02/02 TIME 6:30 PM MONITOR INVALID CHARGES REF# 2097

PATIENT# PATIENT NAME CHARGE CODE QTY PRICE ERROR MESSAGE CHARGE DATE

1178458 DAVID LORENIA 3100002 1 315.00 INVALID PATIENT TYPE 7/01/02

SAMPLE REPORTS DAY END REPORTS DAY END Statistics Update Error Report Page 25.1

Statistics Update Error Report

Overview: The Statistics Update Error Report lists charges that did not post to

the statistics files due to an error with the doctor number, financial class, department number, or hospital service code.

Note: Charges listed on this report have updated the patient's

account, but did not update the statistics file. The report lists patient number, financial class, doctor number,

inpatient/outpatient indicator, hospital service code, charge code, date, room, department, amount, quantity, batch number, sequence number, and error message.

To correct the errors on this report, access Month end statistic errors,

Option 20 on the Period Processing Menu. Enter the batch and sequence number containing the error. The charge information will be displayed. Make changes to the doctor number, financial class, department number, or hospital service code. If errors still exist when exiting this screen, a new Statistics Update Error Report will be generated.

Access: Daily Processing Menu, Option 10 Program: PB0P41 Selection: None Statistics: None Use: This report should be used to correct errors in order for all charges to be posted. Files: CHRGERR, STATHD, GLKEYSM, FCDESC, PHYMAST

SAMPLE REPORTS DAY END REPORTS DAY END Statistics Update Error Report Page 25.2



RUN DATE 5/01/08 TIME 6:30 PM STATISTICS UPDATE ERROR REPORT REF# 2097

THE FOLLOWING CHARGES DID NOT POST TO REVENUE FILES.

PATNO F/C DR# I/O HSV CHARGE DATE ROOM DEPT AMOUNT QTY BATCH SEQ ERROR MESSAGE

CODE

------ --- --- --- --- ------ ---- ---- ---- ------ --- ----- --- -----------------

1238222 Z 160 I MIP 9990001 4/15/08 304 265.00 001 000 015 INVALID FINANCIAL CLASS

1238258 M 061 I XXX 9990001 4/15/08 304 265.00 001 000 025 INVALID STATISTIC CODE

1238268 M 500 I SIP 9990004 4/15/08 305 265.00 001 000 088 INVALID DOCTOR NUMBER

SAMPLE REPORTS DAY END REPORTS DAY END Proration Summary Report Page 26.1

Proration Summary Report

Overview: The Proration Summary Report prints a summary of each patient's

bill. During the Day End procedure the system will automatically prorate the patient's bill based on the type of payor coverage at the time of interim or final billing and print the summary report.

The report lists the billing number, patient name, patient type,

financial class, bill type, gross charges, contractual allowance, payments or adjustments, and the prorated amounts due from primary payor, secondary payor, tertiary payor, and patient.

Note: This report will only print if Proration is installed in Hospital

name/addr/id # record, Option 1 on the System Control Menu. Access: Daily Processing Menu, Option 10 Program: PB0R6A Selection: None Statistics: None Use: This report can be used to review each patient's bill to verify the amounts that have been prorated to each payor and to the patient. Files: BILLSMRY, PATHIST

SAMPLE REPORTS DAY END REPORTS DAY END Proration Summary Report Page 26.2


SUBMITTED 3/02/02 BY ANNA PB0R6A

RUN DATE 3/02/02 TIME 6:30 PM PRORATION SUMMARY REPORT REF# 2097

BILLING I F BILL GROSS CONTRACTUAL PAYMENT AMT DUE AMT DUE AMT DUE AMT DUE

NUMBER NAME O C TYPE CHARGES ALLOWANCE ADJUSTMENT PAYOR 1 PAYOR 2 PAYOR 3 PATIENT

4573341-02 HUCKEBY, JOHN G. JR. I C CYC 6,053.20 .00 .00 4,927.20 926.00 .00 200.00

4572764-02 TERRY, RUBY P. I M CYC 10,305.55 2,805.55 .00 7,450.00 50.00 .00 .00

4572814-02 POSEY, ANDY I M CYC 14,722.69 3,176.72 .00 11,445.97 .00 .00 100.00

4591913-02 RAMSEY, ARTIS I M CYC 1,449.85 .00 .00 900.00 .00 .00 549.85

4592200-02 RICHARDSON, HOBERT ARLIN I M CYC 20,421.82 8,625.17 .00 11,098.65 698.00 .00 .00

4610861-02 WEST, RACHEL ELIZABETH I M CYC 5,675.40 1,856.40 .00 3,819.00 .00 .00 .00

2825446-02 BRANSCUM, THOMAS LENVILLE O M CYC 1,030.00 238.75 .00 716.25 .00 .00 75.00

# ACCOUNTS 7 GRAND TOTAL 59,658.51 16,702.59 .00 40,357.07 1,674.00 .00 924.85

CYCLE 6 INPATIENT GRAND TOTAL 58,628.51 16,463.84 .00 39,640.82 1,674.00 .00 849.85

1 OUTPATIENT GRAND TOTAL 1,030.00 238.75 .00 716.25 .00 .00 75.00

FINAL INPATIENT GRAND TOTAL .00 .00 .00 .00 .00 .00 .00

OUTPATIENT GRAND TOTAL .00 .00 .00 .00 .00 .00 .00

SAMPLE REPORTS DAY END REPORTS DAY END Audit Reports Page 27.1

Audit Reports

Overview: The Audit Reports are produced showing changes in patients' financial

classes, accommodation codes, or hospital service codes. The reports print the patient number, patient name, current code,

code description, history of changes, original balance, current balance, workstation ID of the workstation making the change, and the user ID of the individual making the change.

Access: Daily Processing Menu, Option 10 Program: PB0R84 - F/C Change Audit Report PB0R88 - Accommodation Code Audit Report PB0R89 - HSV Code Audit Report PB0R91 - I/O Patient Maintenance Audit Report Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: These reports can be used to track any changes in financial class, accommodation code, hospital service code, and patient maintenance. Files: PAAUDIT, PATRAIL




RUN DATE 12/03/02 TIME 16:10:22PM F/C CHANGE AUDIT REPORT REF# 2076

PATIENT CURRENT F/C ORIGINAL CURRENT WRKSTN USER

NUMBER PATIENT NAME F/C F/C DESCRIPTION HISTORY BALANCE BALANCE ID ID

------- ------------ --- --------------- ------- ------- ------- ------ ----

1237865 MATHENY ALBERT T S SELF PAY CU 18,191.00 652.00 W3 POLLY

1237873 GUERRERO IRENE Q CREDIT BALANCES SC 6,842.00 652.00- XC DEBRA

5644654 NELSON DANNY L JR S SELF PAY 2L 420.50 31.53 W3 POLLY

5677034 SHIFLETT TERESA Q CREDIT BALANCES TS 1,652.03 10.00- XC DEBRA

5685803 MOSLEY TARSHISH L S SELF PAY QL 939.00 9.31 XC DEBRA

5686667 KING TERRY E E EMPLOYEES S2 342.75 125.93 W8 JAN

5687075 AARON CHARLOTTE A 1 MEDICARE BAD DEBT TS 3,091.55 3,071.55 WL LUWANA

5688019 ROACHE BEVERLY E T TIME PAY ACCOUNTS SB 3,448.40 201.02 W8 JAN

5688165 MORGAN ROBERT T TIME PAY ACCOUNTS SK 7,891.25 768.60 WN FRAN

5688292 SNYDER BARBARA A S SELF PAY QC 281.50 90.90- XC DEBRA

5688876 POE JIMMY C M MEDICARE B 137.00 137.00 W7 JOY



RUN DATE 12/03/02 TIME 16:10:22PM ACCOMMODATION CODE AUDIT REPORT REF# 2076

PATIENT CURRENT ACC ORIGINAL CURRENT WRKSTN USER

NUMBER PATIENT NAME ACC ACC DESCRIPTION HISTORY BALANCE BALANCE ID ID

------- ------------ --- --------------- ------- ------- ------- ------ ----

1237999 MCGILL SARA P PRIVATE I 1,085.00 1,085.00 WW ADMIT2

5702504 TURNER GLADYS P PRIVATE I 9,822.00 9,822.00 WH ADMIT1

5702594 MCDANIEL JAMES ELDER P PRIVATE I 5,214.00 5,214.00 WW ADMIT2

5702749 WILKEY AUDRA P PRIVATE P 2,354.00 2,354.00 WS TMB013

5702865 MCDONALD CONNIE E O OBSERVATION E 454.50 454.50 WP KIM

5702881 SKILES OLIVER O OBSERVATION E .00 .00 WP MDH




RUN DATE 12/03/02 TIME 16:10:22PM HSV CODE AUDIT REPORT REF# 2076

PATIENT CURRENT HSV ORIGINAL CURRENT WRKSTN USER

NUMBER PATIENT NAME HSV HSV DESCRIPTION HISTORY BALANCE BALANCE ID ID

------- ------------ --- --------------- ------- ------- ------- ------ ----

1237999 MCGILL SARA MIP MEDICAL INPATIENT ICU 1,085.00 1,085.00 WW ADMIT2

1238011 ADAMS ANNA BELL MIP MEDICAL INPATIENT SIP .00 .00 WL LUWANA

5702504 TURNER GLADYS MIP MEDICAL INPATIENT ICU 9,822.00 9,822.00 WH ADMIT1

5702594 MCDANIEL JAMES ELDER MIP MEDICAL INPATIENT ICU 5,214.00 5,214.00 WW ADMIT2

5702749 WILKEY AUDRA MIP MEDICAL INPATIENT MIP 2,354.00 2,354.00 WS TMB013

5702865 MCDONALD CONNIE E OOP OBSERVATION OUTPATIE EOP 454.50 454.50 WP KIM

5702881 SKILES OLIVER OOP OBSERVATION OUTPATIE EOP .00 .00 WP MDH

SAMPLE REPORTS DAY END REPORTS DAY END Payor Log Balancing Report Page 28.1

Payor Log Balancing Report

Overview: The Payor Log Balancing Report lists the bills that are designated to

post to the logs. The report shows each patient's total charges billed and total charges logged. These two totals should always agree for every patient. If these totals do not agree, verify that all UB92 revenue codes are setup in the appropriate payor log.

This report prints the patient number, cycle number, patient name,

payor plan, financial class, facility type, bill classification, amount billed, amount logged, non covered, hospital based physician amount (professional fee charges), deductible/co-pay amount, gross reimbursed, outlier payment, outlier type (cost outlier or days outlier), and DRG.

Two exclamation points (!!) printed for a patient will indicate that the

patient has exhausted Medicare benefits and the Long Term Accute Care DRG expected reimbursement calculation is continuing because Medigap is secondary for the patient.

Access: Daily Processing Menu, Option 10 Program: MED002 Selection: Number of copies on the Day end reports record, Option 7 on the

System Control File Menu. Statistics: None Use: This report can be used to help balance patient revenue and

payments/adjustments to the logs. Files: INSUB82, FCDESC, INSPLAN, PAREIMB, PACPTRMB ,INSCDSUM,

MEDLOG, PATIENTS, PATEXT, PATHIST, DRGDESC, DRGRATE, ABSTRACT, MEDLOGRV, BENEFITS, CPTCODE, PAASCFL, PABNFEX

SAMPLE REPORTS DAY END REPORTS DAY END Payor Log Balancing Report Page 28.2

PAYOR LOG MAINTENANCE REPORT

SAMPLE REPORTS DAY END REPORTS DAY END Referral Intakes Of Unknown Status Page 29.1

Referral Intakes Of Unknown Status

Overview: The Referral Intakes of Unknown Status Converted to Non-Admits

Report prints if any intakes with an unknown status have been changed to a non-admit status.

Intakes with an admit status of U = Unknown that are older than the

days defined in the Referral Tracking System Control Record are changed to admit status of N = Non-admit.

Note: This report will only print if Referral Tracking is installed and if

there are intakes which meet the criteria set up in the Referral Tracking System Control Record.

This report prints the intake number, patient name, age, sex, financial

class, intake/assessment indicator, intake date, intake by, referral source, referral source name, referral agency, and agency name.

Access: Daily Processing Menu, Option 10 Program: RF0R77 Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report can be used to track the intakes that have been converted to non-admits. Files: RFINTK, RFSYS, RFTABL, RFMAST, RFAGCY, RFPROV

SAMPLE REPORTS DAY END REPORTS DAY END Referral Intakes Of Unknown Status Page 29.2


SUBMITTED 6/22/05 BY ANNA REFERRAL INTAKES OF UNKNOWN STATUS RF0R77

RUN DATE 6/22/05 TIME 5:50 PM CONVERTED TO NON-ADMITS REF# 2097

FOR THE INTAKES LISTED BELOW, ADMISSION STATUS INFORMATION HAS BEEN AUTOMATICALLY CHANGED TO THE FOLLOWING DEFAULTS:

ADMISSION STATUS: N NON-ADMIT

DISPOSITION: 30 NO ACTION TAKEN

NON-ADMIT REASON: 9V DECISION EXCEEDS 30 DAYS

TO PROVIDER: 0000022 PROVIDER NOT APPLICABLE

INTAKE PATIENT F INTAKE INTAKE REF REF SOURCE REF AGENCY

NUMBER NAME AGE SEX C I/A DATE BY SRC NAME AGCY NAME

0015642 FLYNN BECKY A 28 F H I 1/09/05 MARK 6172 COUNTRY, 1887 COMMUNITY HOSPITAL

0015644 PRINCE KEVIN 27 M B I 1/09/05 JANNIE 6591 YELLOW PAGES 2919 GENERAL PUBLIC

0015645 BRAY JENNIFER 24 F S A 1/09/05 ANITA 6625 FRIEND/FAMILY 2721 PSYCHIATRIC CENTER

0015648 QUARKES CHUCKIE 24 M I I 1/09/05 MARY 3493 GARRETT, JIM 3717 EWA BEACH GENERAL HOSPITAL

0015649 CRAWSTON CARLOS 16 M W I 1/09/05 MARY 3493 GARRETT, JIM 3717 EWA BEACH GENERAL HOSPITAL

0015650 COX DEAN 20 M I I 1/09/05 MARY 3357 SMITH, JEFF K 3717 EWA BEACH GENERAL HOSPITAL

0015653 FLETCH TINA 36 F H I 1/10/05 MARK 3357 SMITH, JEFF K 3717 EWA BEACH GENERAL HOSPITAL

TOTAL NO. RECORDS: 7

SAMPLE REPORTS DAY END REPORTS DAY END Industrial Billing Registrations Page 30.1

Industrial Billing Registrations

Overview: The Industrial Billing Account Registrations is a list of all industrial

billing accounts that have been registered since the last Day End. The report lists the account number, account name, financial class,

hospital service code, doctor number, and price code. The total accounts added for the day will be printed at the end of the

report. Access: Daily Processing Menu, Option 10 Program: IB0R04 Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is used to verify the industrial billing accounts that have been registered for the day. Files: IBTRANS, PATHIST

SAMPLE REPORTS DAY END REPORTS DAY END Industrial Billing Registrations Page 30.2

POST DATE 8/14/06 EXAMPLE MEMORIAL HOSPITAL PAGE 1

SUBMITTED 8/15/06 BY ANNA IB0R04

RUN DATE 8/15/06 TIME 2:19 PM INDUSTRIAL BILLING ACCOUNT REGISTRATION REF# 1034

ACCT# ACCOUNT NAME F/C HSV DR# PRC

----- ------------ --- --- --- ---

9000002 ADAMS SURGICAL SUPPLY 3 IND 900 1

9000003 BATES MEDICAL CENTER 3 IND 875 1

9000004 CITY OF BRUCETON 3 IND 900 1

9000005 CITY OF CARDONDALE 3 IND 930 1

9000006 COBB-WILLIAMS 3 IND 900 1

9000007 SUPER D DRUGS 3 IND 650 1

9000008 EDWARD DAVID 3 IND 900 1

9000009 GEORGES SUPERMARKET 3 IND 950 1

9000010 GRIFFENS MEDICAL CENTER 3 IND 900 1

9000011 HARPS PHARMACY 3 IND 900 1

9000012 HIGGINS DONNA 3 IND 900 1

9000013 JACKS DRUG STORE 3 IND 450 1

9000015 L.W. YATES AND ASSOCIATES 3 IND 900 1

9000016 MCELROY ANNA RAYE 3 IND 900 1

9000017 PETERSON DANIEL 3 IND 850 1

9000018 SAPLES WAY LIVING CENTER 3 IND 900 1

9000022 SANDERS MILL VET CLINIC 3 IND 900 1

9000023 SMITH AVID T 3 IND 980 1

9000028 SUPERIOR FORD 3 IND 900 1

9000024 WAL-MART # 4 3 IND 900 1

9000025 WESTVILLE EMS 3 IND 501 1

9000032 UNKNOWN 3 IND 900 1

TOTAL ACCOUNTS ADDED : 22

SAMPLE REPORTS DAY END REPORTS DAY END Industrial Charge Audit Report Page 31.1

Industrial Charge Audit Report

Overview: The Industrial Charge Transaction Report lists each charge by batch of

all charge activity for industrial billing account for this Day End Processing.

This report prints by department number, batch number, and

sequence number order. Department totals print for the quantity, standard amount, net

amount, and override amount. Access: Daily Processing Menu, Option 10 Program: IB0R12 Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is used to verify that charges entered have actually been posted. Files: IBTRANS, PATHIST

SAMPLE REPORTS DAY END REPORTS DAY END Industrial Charge Audit Report Page 31.2

POST DATE 8/15/06 MEDHOST MEMORIAL HOSPITAL FAC# 004 PAGE 3

RUN DATE 8/15/06 TIME 11:00 AM I N D U S T R I A L C H A R G E T R A N S A C T I O N R E P O R T IB0R12

REF# 2668

DEPT. BATCH SEQ PATIENT SERVICE CHARGE QTY DATE OF STANDARD NET OVERRIDE

NO. NO. NO. NUMBER CODE DESCRIPTION SERVICE AMOUNT AMOUNT AMOUNT

402 899 085 0004010 0850150 CBC PROFILE 1 8/15/06 44.00 3.00

402 899 088 0004010 0850150 CBC PROFILE 1 8/15/06 44.00 3.00

402 899 091 0004011 0823640 PSA 1 8/15/06 45.00 8.00

402 899 093 0004013 0800229 POB SMAC 1 8/15/06 165.00 4.00

402 899 092 0004013 0850150 CBC PROFILE 1 8/15/06 44.00 3.00

402 899 095 0004016 0800229 POB SMAC 1 8/15/06 165.00 4.00

402 899 097 0004016 0800230 MANUAL DIFF 1 8/15/06 17.00 .00

402 899 096 0004016 0850150 CBC PROFILE 1 8/15/06 44.00 3.00

402 987 002 0004016 0870557 SENSITIVITIES 1 8/15/06 54.00 .00

402 899 094 0004016 0870560 FUNGUS CULTURE 1 8/15/06 80.00 23.40

402 899 098 0004018 0800236 URINE CULTURE 1 8/15/06 98.00 9.00

402 899 099 0004018 0860343 THROAT OR NOSE CULTU 1 8/15/06 65.00 9.00

402 899 100 0004018 0860343 THROAT OR NOSE CULTU 1 8/15/06 65.00 9.00

402 899 101 0009000 0810001 EMPLOYEE URINALYSIS 1 8/15/06 37.00 .00

402 899 104 0009000 0820101 EMPLOYEE RUBELLA 1 8/15/06 26.00 .00

402 899 103 0009000 0822452 EMP DRUG SCREEN UA 1 8/15/06 .00 .00

402 899 102 0009000 0850149 EMPLOYEE CBC 1 8/15/06 44.00 .00

NUMBER POSTED-- 17 TOTALS OF DEPT. 402 17 1,037.00 78.40 .00

433 987 001 0004016 0108101 OGEN .625 1 3/31/06 2.00 .00

NUMBER POSTED-- 1 TOTALS OF DEPT. 433 1 2.00 .00 .00

NUMBER POSTED-- 18 TOTALS OF ALL DEPTS ---- 18 1,039.00 78.40 .00

SAMPLE REPORTS DAY END REPORTS DAY END Cancelled Bill Audit Report Page 32.1

Cancelled Bill Audit Report

Overview: The Cancelled Bill Audit Report lists each bill that has been cancelled.

The Cancel Patient Bill process will update the Cancel Bills Audit File (CANCELB) which will then be used to produce this report during Day

End Processing. The report prints the patient number, patient name, amount

cancelled, user ID, workstation, and description. The description column will indicate the type of bill and cycle number cancelled.

The report prints in patient number order. Totals will print for inpatient, outpatient, and total cancelled bills. Note: The totals do not include cycle bills. Access: Daily Processing Menu, Option 10 Program: PA0R24 Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is used as an audit trail of cancelled bills which can be used when balancing the Daily Status Report. Files: CANCELB, SYSCTL

SAMPLE REPORTS DAY END REPORTS DAY END Cancelled Bill Audit Report Page 32.2


SUBMITTED 5/25/06 BY ANNA PA0R24

RUN DATE 5/25/06 TIME 11:41 PM CANCELLED BILL AUDIT REPORT-INPATIENT REF# 269

PATIENT# PATIENT NAME AMOUNT CANCELLED USER WRKSTN DESCRIPTION

-------- ------------ ---------------- ---- ------ -----------

6002085 BRADLEY TYLER QUENTIN 6062.90 BOBBY QPADEV001K CANCELLED UB92 BILL, CYCLE 01

6002442 HENRY FRANCIS MAI 2019.85 BOBBY QPADEV000R CANCELLED UB92 BILL, CYCLE 01

6004721 CLARK ERNEST THOMAS 9406.64 BOBBY QPADEV000R CANCELLED UB92 BILL, CYCLE 01

6004721 CLARK ERNEST THOMAS 120.00 BOBBY QPADEV000R CANCELLED 1500 BILL, CYCLE 02

6017569 BENNETT GEORGE 3176.15 BOBBY QPADEV000R CANCELLED UB92 BILL, CYCLE 01

6019507 DAVIS KAYLIE F 2832.05 BOBBY QPADEV000R CANCELLED UB92 BILL, CYCLE 01

6019949 CRABTREE SANDRA 4406.95 BOBBY QPADEV001K CANCELLED UB92 BILL, CYCLE 01

6019949 CRABTREE SANDRA 63.60 BOBBY QPADEV001K CANCELLED 1500 BILL, CYCLE 02



6020036 HARRELL DIANE 4900.39 BOBBY QPADEV000R CANCELLED UB92 BILL, CYCLE 01

6020036 HARRELL DIANE 116.80 BOBBY QPADEV000R CANCELLED 1500 BILL, CYCLE 02

6021091 JONES BETTY ANN 116.80 BOBBY QPADEV001K CANCELLED 1500 BILL, CYCLE 01

6021091 JONES BETTY ANN 31.80 BOBBY QPADEV001K CANCELLED 1500 BILL, CYCLE 02

INPATIENT TOTAL: 34447.78


SUBMITTED 5/25/06 BY ANNA PA0R24

RUN DATE 5/25/06 TIME 11:41 PM CANCELLED BILL AUDIT REPORT-OUTPATIENT REF# 269

PATIENT# PATIENT NAME AMOUNT CANCELLED USER WRKSTN DESCRIPTION

-------- ------------ ---------------- ---- ------ -----------

6000019 WILSON LISA MARIE 1638.00 PETER QPADEV000R CANCELLED UB92 BILL, CYCLE 01

6000284 KENNEDY DARLENE 655.10 PETER QPADEV000R CANCELLED UB92 BILL, CYCLE 01

6000296 GOSS ROBERT L 306.90 PETER QPADEV001K CANCELLED UB92 BILL, CYCLE 01

6000448 NEEL JOHN ALLEN JR 198.85 PETER QPADEV001K CANCELLED UB92 BILL, CYCLE 01

6000749 BAKER ERIC L 1951.30 PETER QPADEV001K CANCELLED UB92 BILL, CYCLE 01

6000987 WATSON JAMIE 244.85 PETER QPADEV001K CANCELLED UB92 BILL, CYCLE 01

6004121 FLOWERS MAXINE D 461.30 PETER QPADEV000R CANCELLED UB92 BILL, CYCLE 01

6004577 YOUNG CHASE DOUGLAS 291.55 PETER QPADEV000R CANCELLED 1500 BILL, CYCLE 01

OUTPATIENT TOTAL: 5747.85

**TOTAL CANCELLED BILLS** 40195.63

SAMPLE REPORTS DAY END REPORTS DAY END Recurring Outpatient With No Activity Page 33.1

Recurring Outpatient with No Activity

Overview: The Recurring Outpatient With No Activity report will list all recurring

outpatients with no activity for a user defined number of days. The number of days is specified in the Billing Control Record, Option 2 on

the System Control File Menu. The system will compare the user defined number of days to the last

bill date, or if no bill date, the registration date to determine if the patient should appear on the report.

The report prints the patient number, patient name, financial class,

last bill date, registration date, current balance, and number of days since last activity.

The report prints in patient name order. The total number of patients on the report will print at the end of the

report. Access: Daily Processing Menu, Option 10 Program: PA0R74 Selection: Number of copies on the Day end reports record, Option 7 on the System Control File Menu. Statistics: None Use: This report is used to monitor recurring outpatients. Files: PATIENTS, SYSCTL

SAMPLE REPORTS DAY END REPORTS DAY END Recurring Outpatient With No Activity Page 33.2

PA0R74 HOSP# 001 EXAMPLE HOSPITAL PAGE: 1

USER: ANNA MONITOR RECURRING OUTPATIENT WITH NO ACTIVITY OVER 34 DAYS TIME: 19:43:20 DATE: 6/12/06

LAST BILL REGISTRATION CURRENT DAYS SINCE

PAT # PATIENT NAME F/C DATE DATE BALANCE LAST ACTIVITY

3062437 ADERS RITA F D 2005-09-30 0001-01-01 .00 255

4062434 BAKER ROBERT C M 2005-09-30 0001-01-01 240.00 255

2552438 CARTER ARTHUR M 2005-10-11 0001-01-01 50.00 244

2511558 DAVIDSON ANDREW C 2005-09-21 0001-01-01 1,144.50 264

Patient Count : 4

********* E N D O F R E P O R T *********

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Cash Receipts By Patient-Rep Summary Page 1.1

Cash Receipts By Patient-Rep Summary

Overview: This option is used to print a summary report showing the month-to-date and the year-to-date dollar amount of the cash receipts for each patient representative as of the month ending date entered on the prompt screen. The report also indicates average dollar amounts per contact for the month and year-to-date.

Note: Contacts are based on comments entered into the Collection Work List.

Access: Collections Report Menu, Option 1

Program: PA0R07

Selection: Month ending date

Note: The date entered cannot be a previous month in a prior year if the month end has been run for the previous month. For example, on 1/09/01 the report cannot be run for 12/31/00 if a month end has been run for 12/31/00.

Statistics: Month and Year-to-date average receipts by patient representative.

Use: This report is used to track patient representative contacts and receipts.

Files: PACAMT, PACMST

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Cash Receipts By Patient-Rep Summary Page 1.2

DATE: 7/24/02 EXAMPLE HOSPITAL PAGE 1

TIME: 8:52:28 CASH RECEIPTS BY PATIENT REPRESENTATIVE - SUMMARY PA0R07

FOR MONTH ENDING 5/31/02

PATIENT MONTH TO DATE MONTH TO DATE MONTH TO DATE YEAR TO DATE YEAR TO DATE YEAR TO DATE

REPRESENTATIVE CONTACTS RECEIPTS AVG RECEIPTS CONTACTS RECEIPTS AVG RECEIPTS

-------------- ------------- ------------- ------------ ------------- ------------ ------------

BILL 7 400.00 57.14 7 400.00 57.14

DENNEY 600.00 .00 600.00 .00

VICKIE .00 .00 .00 .00

** TOTALS ** 7 1,000.00 142.86 7 1,000.00 142.86

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Cash Receipts By Patient-Rep Detail Page 2.1

Cash Receipts By Patient-Rep Detail

Overview: This option is used to print a detail showing the dollar amount of the

cash receipts for each patient representative during the date range entered on the prompt screen.

Access: Collections Report Menu, Option 3 Program: PA0R13 Selection: Date range – From and To

Select representative code or leave blank to print all patient representative.

Statistics: None. Use: This report is used to identify the detail cash receipt transactions attributed to each patient representative. File: ARACCUM

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Cash Receipts By Patient-Rep Detail Page 2.2


TIME: 9:05:00 CASH RECEIPTS BY PATIENT REPRESENTATIVE - DETAIL

PA0R13

FOR THE PERIOD ENDING 5/01/02 TO 5/31/02

PATIENT REPRESENTATIVE: ANNA

PATIENT# PATIENT NAME TRANS DATE TRANS DESCRIPTION TRANS AMOUNT

-------- ------------ ---------- ----------------- ------------

1236272 UNDERWOOD LINDA M 5/18/02 PATIENT PAYMENT 100.00-

1252691 AIKINS HERMAN 5/18/02 PATIENT PAYMENT 100.00-

1268903 FAWES WILLIAM K 5/18/02 PATIENT PAYMENT 100.00-

8300000 WILLIAMS SUSAN 5/17/02 COMMERICAL INS PMT 2,000.00-

PATIENT REPRESENTATIVE BAL- 2,300.00-

PATIENT REPRESENTATIVE: BILL

1121233 ABRAM MARY 5/16/02 BLUE CROSS IP 100.00-

5291171 BLANTON MARILYN 5/15/02 COMMERICAL INS PMT 100.00-

5300592 DEBAUGHT HELEN 5/15/02 MISC CASH PMT 100.00-

5300592 DEBAUGHT HELEN 5/16/02 BLUE CROSS IP 100.00-

5716117 NEWARK SAMUEL 5/15/02 PATIENT PAYMENT 100.00-

5716141 NEWARK DELANA 5/15/02 COMMERICAL INS PMT 100.00-

PATIENT REPRESENTATIVE BAL- 600.00-

PATIENT REPRESENTATIVE: DENNEY

1261452 STALKS CLIFFORD 5/18/02 PATIENT PAYMENT 100.00-

1266865 SUCKER MARCUS 5/18/02 PATIENT PAYMENT 100.00-

1272996 SIMS JAMES 5/18/02 PATIENT PAYMENT 100.00-

1281765 ADAMS GLENDA 5/18/02 PATIENT PAYMENT 100.00-

1283969 ADAMS MANLEY 5/18/02 PATIENT PAYMENT 200.00-

1289982 AGREY JANNA 5/18/02 PATIENT PAYMENT 100.00-

PATIENT REPRESENTATIVE BAL- 800.00-

TOTAL BAL- 3,600.00-

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Patient Rep Activity By Trans Code Page 3.1

Patient Rep Activity by Trans Code

Overview: This option is used to print a report showing the month-to-date and

year-to-date patient representative receipts by transaction code. Access: Collections Report Menu, Option 3. Program: PA0R09 Selection: Month ending date; Select a patient representative name or leave blank to print all patient representatives Note: The month ending date entered cannot be a previous month in a prior year if the month end has been run for the previous month. For example, on 1/09/05 the report cannot be run for 12/31/04 if a month end has been run for 12/31/04.

Statistics: None. Use: This report provides a summary of the A/R transactions processed by each patient representative. Files: PACAMT, ARDESC

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Patient Rep Activity By Trans Code Page 3.2


TIME: 10:40:06 PATIENT REPRESENTATIVE ACTIVITY BY TRANSACTION CODE PA0R09

FOR MONTH ENDING 6/30/02

TRANSACTION CODE MONTH TO DATE YEAR TO DATE

DESCRIPTION ACTIVITY ACTIVITY

---------------- ------------- ------------

PATIENT REPRESENTATIVE: BILL

MISC CASH PMT 100.00 100.00

BLUE CROSS IP 200.00 200.00

COMMERICAL INS PMT 200.00 200.00

PATIENT PAYMENT 100.00 100.00

** PATIENT REPRESENTATIVE ** 600.00 600.00



---------------- ------------- ------------

PATIENT REPRESENTATIVE: DENNEY

PATIENT PAYMENT 600.00 600.00




---------------- ------------- ------------

PATIENT REPRESENTATIVE: VICKIE

BLUE CROSS IP 100.00 100.00


*** TOTALS *** 1,300.00 1,300.00

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Patient Rep Activity By Comment Type Page 4.1

Patient Rep Activity by Comment Type

Overview: This option is used to print a report showing the monthly patient

representative activity by comment type. There is no prompt screen displayed after the option selection. Access: Collections Report Menu, Option 4 Program: PA0R06 Selection: None

Statistics: None. Use: This report is used to track the type of comment activity each patient representative is performing. File: PACMSTAT

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Patient Rep Activity By Comment Type Page 4.2

DATE: 7/24/02 EXAMPLE FACILITY OF AMERICA PAGE 1

TIME: 11:36:46 PATIENT REPRESENTATIVE ACTIVITY BY COMMENT TYPE PA0R06

COMMENT TYPE

DESCRIPTION JAN FEB MARCH APRIL MAY JUN JULY AUG SEPT OCT NOV DEC

------------ --- --- ----- ----- --- --- ---- --- ---- --- --- ---

PATIENT REPRESENTATIVE: ALICE

CREDIT BAL-REFUND RQ 1 1 1 1

INSURANCE FOLLOWUP

COMMENT ONLY 360 265 40 296 385 358 379 422 350 344 228 289

PATIENT FOLLOWUP 165 221 36 163 198 199 197 204 174 176 169 169

RETURNED MAIL

STOP ACTION ON ACC 198 238 52 286 184 367 343 353 385 200 209 474

PATIENT REP TOTALS: 724 724 128 745 768 924 919 980 909 720 607 932

PATIENT REPRESENTATIVE: BEV

COMMENT ONLY 1 1

ATTEMPT NO CONTACT 3 1 4 2 1 7 2

BILLED SEC INS. 9 12 28 15 26 17 17 20 17 19 7 15

CREDIT BAL-REFUND RQ

INSURANCE FOLLOWUP 71 61 9 60 64 45 60 54 73 72 60 50

COMMENT ONLY 143 123 23 105 186 124 226 133 140 210 121 154

PATIENT FOLLOWUP 60

SELF-PAY AFTER INS 1

STOP ACTION ON ACC 5

REFILED INS CLAIM 3 1 2 2 1

PATIENT REP TOTALS: 227 197 60 244 279 190 305 208 235 311 191 219

GRAND TOTALS: 1673 1542 308 1758 1700 1613 1773 1715 1896 1702 1197 1566

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Projected F/U By Patient Rep-Summary Page 5.1

Projected F/U By Patient Rep-Summary

Overview: This option is used to print a report showing the projected dollar

amount of the accounts based upon required follow-up dates entered by patient representatives.

Access: Collections Report Menu, Option 5 Program: PA0R10 Selection: Include inhouse accounts – Y or N Include inpatient, outpatient, or both Inlcude credit balances – Y or N

Statistics: None Use: This report is used to track in summary when accounts are due

to be worked by the patient representatives based on the follow-up dates entered. The number of accounts and dollar amounts are indicated in the appropriate aging categories.

Files: ARMAST, PATIENTS

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Projected F/U By Patient Rep-Summary Page 5.2

DATE: 7/24/02 EXAMPLE HOSPITAL PA0R10

TIME: 13:28:18 PROJECTED FOLLOW-UP BY PATIENT REPRESENTATIVE - SUMMARY INHOUSE -INCLUDED

CREDITS -INCLUDED

(AMOUNTS ARE ROUNDED TO NEAREST DOLLAR)

PATIENT REPRESENTATIVE 0-30 31-60 61-90 91-120 121-150 151-180 181-365 366-730 OVER 731 TOTAL

** NO PATIENT REP ** $1,181,344 $1,181,344

2398 2398

BILL $457,025 $457,025

1420 1420

BOB $56,858 $56,858

379 379

DAN $51,106 $51,106

344 344

DENNIE $564,809 $564,809

1684 1684

DIANE $107,328 $107,328

54 54

JIM $146,994 $146,994

1030 1030

JANE $116,123 $116,123

462 462

NELLEY $51,251 $51,251

164 164

PAM $78,312 $78,312

37 37

TRAVIS $28,960 $28,960

12 12

TREY $5,294 $5,294

4 4

VICKY $33,445 $33,445

61 61

TOTALS--- $2,878,849

$2,878,849

8049 8049

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Past Due Follow-Up Report Page 6.1

Past Due Follow-Up Report

Overview: This option is used to print a report showing the assigned patient

representative, patient number, patient name, date that follow-up was required, billed balance, billed balance, bad debt balance, and in-house balance.

Totals will print for each patient representative and for the entire

report for the number of patients, each balance, and total for all balances.

The first page of the report will show the report selections. Access: Collections Report Menu, Option 6 Program: PA1R12 Statistics: None Use: This report identifies accounts which are past due for follow-up based

on the previous follow-up date entered by the patient representative. This report may be used as a worklist for the patient representative and as a management tool for evaluation of the patient representatives.

Files: ARMAST, PATIENTS, ARCOLLX, FCDESC


Past Due Follow-Up By Patient Representative

Action

Include in-house accounts: Select Yes or No.

Patient representative: Blank - Allows up to 10 patient representatives to be entered. F4 - Allows an individual patient representative to be selected. 99 - All patient representatives

Include Bad Debt Accounts: Select Yes or No.

Include Credit Balances: Select Yes or No.

Financial Class Selection: Blank - Allows up to 10 financial class codes to be entered. F4 - Allows an individual financial class to be selected. 99 - All financial classes

Sort Options: Select By Patient Representative/Patient Name or By Patient Representative/Follow Up Date.

Press OK to continue or click Previous to return to the previous screen.


Patient Representative Lookup Window

The Patient Representative Lookup Window displays when the Patient representative drop down arrow is clicked on the Past Due Follow-Up By Patient Representative window. Action

Select a Representative name then, click OK to continue or click Previous to return to the previous screen.


Financial Class File Lookup Window

The Financial Class File Lookup Window displays when the Financial Class drop down arrow is clicked on the Past Due Follow-Up By Patient Representative window. Action

Select a Code then, click OK to continue or click Previous to return to the previous screen.


Patient Representative Selection

The Patient Representative Selection Window displays when the

button is clicked on the Past Due Follow-Up By Patient Representative window. Action

To select a Patient Representative Code, click on a down arrow and select a code from the Patient Representative Lookup Window. Up to ten Patient Representative Code can be selected.

Click OK to continue or click Previous to return to the previous screen.


Financial Class Selection

The Patient Representative Selection Window displays when the button is clicked on the Past Due Follow-Up By Patient Representative window. Action

To select a Financial Class, click on a down arrow and select a class from the Financial Class File Lookup Window. Up to ten Financial Classes can be selected.

Click OK to continue or click Previous to return to the previous screen.


PA1R12 EXAMPLE HOSPITAL PAGE: 1

USER: ANNA MONITOR PAST DUE COLLECTION FOLLOW UP REPORT TIME: 15:57:38 DATE: 1/11/02

INCLUDE IN HOUSE ......... Y

INCLUDE BAD DEBT ......... N

INCLUDE CREDIT BALANCES .. N

PATIENT REPRESENTATIVES... AB

FINANCIAL CLASSES ........ ALL

SORT OPTION .............. PAT REP/PATIENT NAME



USER: ANNA MONITOR PAST DUE COLLECTION FOLLOW UP REPORT TIME: 15:57:38 DATE: 1/11/02

PATIENT REPRESENTATIVE: ANDREA

PATIENT# PATIENT NAME FOLLOW UP DATE BILLED BALANCE BAD DEBT BAL IN HOUSE BAL

________ ____________________ ______________ ______________ ____________ ____________

7000805 ALBRIGHT MARIE 2001-07-11 264.00

7000796 ALLEN PAUL JR 2001-07-29 1,189.01

7000824 ANSON GENEVIEVE A 2001-07-07 2,973.80

7000789 BADGER ANTHONY MICH 2001-07-08 210.60

7000711 BOARD JEAN P 2001-06-28 132.00

7000799 CARR LUCY A 2001-06-26 882.50

7000790 CASSIDY CARLIE 2001-06-20 366.00

7000812 CASSIDY CARLIE 2001-07-14 585.60

7000822 CRONIN DENNY W 2001-07-07 1,578.40

4091365 DAUGHERTY JAMES H 2001-07-25 366.63

7000826 DAVIS MARGARET 2001-07-14 1,128.00

7000819 ENGELBRECHT MARIE A 2001-07-14 1,723.20

7000830 FIEDLER VERONICA 2001-06-07 170.50

7000813 FLAMION DORIS A 2001-07-14 1,611.60

7000623 GENTRY RUTH 2001-07-01 1,441.56

7000784 GODTHAAB EARL F 2001-07-19 922.62

7000792 HARRISON SARAH S 2001-07-08 366.00

7000801 HARRISON SARAH S 2001-07-05 2,671.60

7000836 HARRISON SARAH S 2001-06-12 366.00

7000827 HEIN MILLIE J 2001-07-15 2,673.20

7000825 HILL LEE M 2001-07-14 718.00

7000788 HUBER GREGORY 2001-07-08 1,369.82

4089954 HURTT VIVIAN M 2001-07-14 362.09

7000730 KELLEMS ROSE A 2001-06-30 3,039.04

7000804 LAWSON CHELSEA 2001-07-05 235.01

7000803 MALONE DAISY E 2001-07-19 396.00

7000786 MARTIN MARY A 2001-07-14 1,573.60

7000842 MARTIN MARY A 2001-07-25 278.40

7000724 MOSBY HENRIETTA 2001-06-27 1,579.60

7000810 OBRIEN KEITH W 2001-07-19 1,964.00

7000794 POWERS GEORGE 2001-07-19 188.50

7000818 ROGIER PAULIE 2001-07-19 1,089.00

7000793 SPRINKLE GENIA 2001-07-08 542.80

7000815 SPRINKLE GENIA 2001-06-29 469.60

7000829 SPRINKLE TINA R 2001-06-07 264.00

7000823 WHEELER TAYLER E 2001-06-28 528.00

7000769 YATE JAMES Y 2001-07-11 633.00

7000785 YATE JAMES Y 2001-06-27 1,338.00

-------------- ------------ ------------ ------------

PATIENT COUNT: 38 BALANCES: 37,561.28 .00 .00 38,191.28

-------------- ------------ ------------ ------------

TOTAL COUNT : 38 BALANCE TOTALS: 37,561.28 .00 .00 38,191.28

********* E N D O F R E P O R T *********

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Cash Receipts By Month – Patient Rep Page 7.1

Cash Receipts by Month – Patient Rep

Overview: This option is used to print a report showing the monthly cash

receipts by transaction type codes for each patient representative. There is no prompt screen displayed after the option selection. Access: Collections Report Menu, Option 13 Program: CL0R07 Selection: None Statistics: None Use: This report is used to track in detail the cash receipts for each month and by each patient representative. File: PACAMT

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Cash Receipts By Month – Patient Rep Page 7.2

DATE: 7/22/02 EXAMPLE FACILITY PAGE 1

TIME: 13:57:39 CASH RECEIPTS BY MONTH - PATIENT REPRESENTATIVE CL0R07

TRANS JAN FEB MARCH APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC

CODE

----- --- --- ----- ----- --- ---- ---- --- ---- --- --- ---

PATIENT REPRESENTATIVE: ANGELA

104 1.00 2.29- .00 .00 .77 .00

.69 1.42- .88 4.78 10.04 12.00

** TOTAL ** 26.45

105 .00 33.20 .00 .00 .00 .00

.00 .00 .00 .00 .00 .00

** TOTAL ** 33.20

106 .00 .00 .00 .00 .00 .00

65.00 41.50 .00 .00 .00 .00

** TOTAL ** 106.50

107 17.66- .00 .00 .00 .00 .00

.00 .00 .00 .00 .00 .00

** TOTAL **

17.66-

110 79,817.55 47,075.85 42,741.92 85,719.88 78,142.16 60,550.85

45,196.99 58,897.27 43,040.05 57,623.31 62,175.16 67,630.01

** TOTAL ** 728,611.00

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Summary Aging By Patient Rep Page 8.1

Summary Aging By Patient Rep

Overview: This option is used to print a summary aging report for patient

accounts by patient representative. Access: Collections Report Menu, Option 14 Program: COL011 Selection: Include in-house accounts – Yes or No Include inpatient, outpatient, or both Include credit balances - Yes or No Date to age from Age by bill date, discharge date, or last payment date Statistics: None Use: This report is used to track in provide summary accounts receivable aging information by patient representative. Files: ARMAST, PATIENTS


COL011 AGE BY EXAMPLE HOSPITAL AGE FROM 6/01/02 INHOUSE - INCLUDED

CREDITS - INCLUDED

*** DISCHARGE DATE *** SUMMARY AGING BY PATIENT REPRESENTATIVE (AMOUNTS ARE ROUNDED TO NEAREST DOLLAR) 7/24/02


ANGELIA $1,074 $1,074

100.0 % 100%

1 1

BILL $214,415 $1,707 $396- $1,182 $585 $272 $672 $204- $57- $218,176

98.2 % .7 % .1-% .5 % .2 % .1 % .3 % 100%

340 29 8 10 3 3 21 6 2 422

BOB $50,705 $6,297 $1,323 $1,002 $1,466 $782 $6,175 $2,006 $384 $70,140

72.2 % 8.9 % 1.8 % 1.4 % 2.0 % 1.1 % 8.8 % 2.8 % .5 % 100%

326 31 14 14 14 8 37 8 2 454

DAN $49,730 $4,005 $2,632 $927 $253 $37 $143 $57,727

86.1 % 6.9 % 4.5 % 1.6 % .4 % .2 % 100%

327 45 18 10 1 1 3 405

DENNEY $582,646 $733 $270- $42 $89 $583,240

99.8 % .1 % 100%

1751 3 2 1 2 1759

DIANE $108,46 $563 $109,031

99.4 % .5 % 100%

54 1 55

JIM $170,414 $318 $435 $720 $703 $977 $6,858 $1,288 $181,713

93.7 % .1 % .2 % .3 % .3 % .5 % 3.7 % .7 % 100%

715 3 9 12 13 19 77 27 875

JOY $121,23 $121,238

100.0 % 100%

508 508

NELLEY $22,19 $22,194

100.0 % 100%

11 11

PAMELA $75,11 $48 $75,164

99.9 % 100%

39 1 40

TRACEY $27,896 $1,692 $1,049 $361 $543 $270 $31,811

87.6 % 5.3 % 3.2 % 1.1 % 1.7 % .8 % 100%

12 1 1 1 1 2 18


COL011 AGE BY EXAMPLE HOSPITAL AGE FROM 6/01/02 INHOUSE - INCLUDED

CREDITS - INCLUDED

*** DISCHARGE DATE *** SUMMARY AGING BY PATIENT REPRESENTATIVE (AMOUNTS ARE ROUNDED TO NEAREST DOLLAR) 7/24/02


TOTALS--- $2,939,740 $8,117 $18,916 $54,802 $4,864-

$54,695 $20,530 $5,222 $29,534 $3,126,692

94.0 % 1.7 % .2 % .6 % .6 % .1 % 1.7 % .9 % .1-% 100%

8070 324 141 113 69 56 231 132 30 9166

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Detail Aging By Patient Rep Page 9.1

Detail Aging By Patient Rep

Overview: This option is used to print a detail aging report for patient accounts

by patient representative. The report includes the discharge date, last payment date, original

balance, last payment amount, and aged amount of current balance. The aging groups are inhouse, 0-30, 31-60, 61-90, 91-120, 121-150, 151-180, and over 180 days.

This report prints in either patient name or patient number order

depending on the user selection. Access: Collections Report Menu, Option 15 Program: COL013 Selection: Date to age by Print inhouse accounts - Yes or No Include zero balance - Yes or No Sort by patient name or patient number Select a patient representative code or leave blank to print all patient representatives Age by - Bill Date, Discharge Date, or Last Payment Date Statistics: None Use: This report is used to provide detail aging information by patient representative. Files: ARMAST, PATIENTS, CLSUMM, ARCOLLX, PATHIST

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Detail Aging By Patient Rep Page 9.2

COL013 EXAMPLE HOSPITAL 4/19/00

AGED BY BILL DATE DETAIL AGING BY PATIENT REPRESENTATIVE CODE

FOR THE PERIOD ENDING 4/01/99 (ROUNDED TO NEAREST DOLLAR) PAGE 5

** JOE SMITH **

PAT NO. NAME IN HOUSE 0-30 31-60 61-90 91-120 121-150 151-180 OVER 180 TOTAL

4414893 ROGERS CLINT

DISC 11/19/99 ORG BAL 304 13 13

LSTP 1/03/00 LST PMT 203

BILD 11/24/99

4412340 ROGERS VERNA

DISC 12/30/98 ORG BAL 736 481 481


BILD 1/13/99

4414628 ROGERS WILL

DISC 10/20/99 ORG BAL 1658 17 17


BILD 10/27/99

4414869 SAMUELS MITCH

DISC 11/16/99 ORG BAL 753 110 110


BILD 11/21/99

4414811 SINCLAIR MIKE

DISC 11/08/99 ORG BAL 272 272 272

BILD 11/14/99

4414851 SMITH PAUL

DISC 11/14/99 ORG BAL 386 386 386

BILD 11/21/99

4414699 SMITH ROBERT

DISC 10/27/99 ORG BAL 25 25 25

BILD 11/04/99

TOTAL JOE SMITH 11220 481 3759 15460

TOTAL ACCTS: 63

COL013 EXAMPLE HOSPITAL 4/19/00

AGED BY BILL DATE DETAIL AGING BY PATIENT REPRESENTATIVE CODE

FOR THE PERIOD ENDING 4/01/99 (ROUNDED TO NEAREST DOLLAR) PAGE 7

*G R A N D T O T A L S **

TOTAL ACCT: 63 UNBILLED 0 - 30 31 - 60 61 - 90 91 - 120 121 - 150 151 - 180 OVER 180 TOTAL

11220 481 3759 15460

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Accounts Receivable Query Page 10.1

Accounts Receivable Query

Overview: This option is used to print an accounts receivable aging report for

patient accounts in patient representative order. Access: Collections Report Menu, Option 16 Program: COLR64 Selection: Print alphabetically by guarantor name and group all patients within guarantor or Print alphabetically by patient name Include inhouse accounts - Y or N Print in inpatient/outpatient order - Y or N Print in patient representative name order - Y or N Date to age from Print zero balance accounts - Y or N Age by discharge date or last payment date Age ALL account or SELECT - ALL or SELECT If SELECT, the following selection options are available: Print all patient representative codes - Y or N If No, enter up to 10 codes Age category - From and To Patient account number - From and To Dollar amount - From and To Inpatient, Outpatient, or Both Print all hospital service codes - Y or N If No, enter up to 10 codes Statistics: None Use: This report is used to assist in follow-up and collection processes and is helpful with accounts receivable analysis. Files: ARMAST, PATIENTS

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Accounts Receivable Query Page 10.2

CL0R6F EXAMPLE FACILITY 7/22/92

*** DISCHARGE DATE *** AGED ACCOUNTS RECEIVABLE AS OF 6/30/92 INHOUSE PATIENTS NOT INCLUDED PAGE 1

ALPHABETIC BY PATIENT NAME

SELECTION CRITERIA - - PATIENT REPRESENTATIVE CODES - - - 08

SORTED BY AGING CATEGORY - - - FROM 0 DAYS TO 90 DAYS INPATIENTS AND OUTPATIENTS

PATIENT REPRESENTATIVE ACCOUNT NUMBERS - - - FROM 0000000 TO 9999999 HOSPITAL SERVICE CODES

DOLLAR AMOUNTS - - - FRO $0 T $10,000 ALL

PAT/GAR PAT/GAR NAME CLTR DIS DATE CUR BAL AGE *STATEMENT* ***** LAST PAYMENT ***** DOC ********* PAYOR ********** T

NO DATE SCE DATE AMOUNT NO NO. PAYORS PLAN CODES Y

5001656 DAVIS FRAN MARIE 145 MAPLE STREET NASHVILLE TN TN 37210 615-659-9302 I

6045546 SORRELLS ANNIE 0 4/29/92 5,964.58 62 2 6/04/92 5 6/16/92 150.00 1 540

5001649 ROBERGE RITA 333 EASTLAND ROAD NASHVILLE TN TN 37214 615-564-5000 I

0013978 PIERCE ROSE 0 4/28/92 3,064.21 63 2 6/04/92 5 6/11/92 453.46 1 503

5001623 CHESNUTT MARION 1101 GLENN OAKS DRIVE NASHVILLE TN TN 37217 615-684-1744 I

4096291 CHESNUTT EDGAR 0 4/15/92 2,638.72 76 2 6/04/92 5 6/09/92 166.59 1 505

F/C BAL- 11,667.51

TOTAL BAL- 11,667.51

SAMPLE REPORTS MCOLLECTIONS REPORT MENU COLLECTION Projected F/U By Patient Rep-Detail Page 11.1

Projected F/U By Patient Rep-Detail

Overview: This option is used to print a detail report showing the projected dollar

amount of accounts based upon the required follow-up dates entered by patient representatives.

The report is in patient alphabetic order for each patient

representative and shows patient number and name, discharge date, financial class, current balance, and the age of the account in days.

Access: Collections Report Menu, Option 17 Program: PA0R11 Selection: Age category - From and To Include inhouse accounts - Yes or No Include credit balances - Yes or No Print Inpatient, Outpatient, or Both Print all patient representative codes - Yes or No If No, enter up to 10 codes Statistics: None Use: This report is used to identify by patient representative the individual accounts that need to be followed up. Files: ARMAST, PATIENTS

SAMPLE REPORTS MCOLLECTIONS REPORT MENU COLLECTION Projected F/U By Patient Rep-Detail Page 11.2

DATE: 7/29/02 EXAMPLE MEMORIAL HOSPITAL PAGE 4

TIME: 10:08:04 PROJECTED FOLLOW-UP BY PATIENT REPRESENTATIVE - DETAIL PA0R11

FROM 1 DAYS TO 90 DAYS INPATIENTS ONLY

ALPHABETIC BY PATIENT NAME INHOUSE PATIENTS INCLUDED

CREDIT BALANCES NOT INCLUDED

PATIENT REPRESENTATIVE: MELISSA

PATIENT# PATIENT NAME DISCHARGE DATE F/C CURRENT BALANCE AGE

-------- ------------ -------------- --- --------------- ---

3117524 BEBEE VERA A 2/22/02 M 4,054.50 10

0103497 MYERS HARRISON 5/19/02 M 15,292.00 10

PATIENT REPRESENT BAL- 19,346.50






PATIENT REPRESENTATIVE: SHELLY


-------- ------------ -------------- --- --------------- ---

4000032 JONES JOEY 7/02/02 Q 7,679.00 10







PATIENT REPRESENTATIVE: DEFAULT


-------- ------------ -------------- --- --------------- ---

4000015 DREW VAUGHN 6/04/02 MC 5,081.97 9

4000043 ISABELL SAMUEL 7/25/02 MC 3,553.00 26

4000042 NAVIAUX FLORENCE G 7/25/02 MC 3,633.00 9


TOTAL BAL- 39,293.47

SAMPLE REPORTS COLLECTIONS REPORT MENU COLLECTION Cash Receipts By Month - Physician Page 12.1

Cash Receipts By Month - Physician

Overview: This option is used to print a report showing the received payments

sorted by each admitting physician. The report is in patient alphabetic order for each physician. The

report prints the admit date, patient name, payments for bills previous to the report date range, payments for each month, total amount received, and percentage of the claim.

If the report is run for all physicians, the report will also print in

physician number order and each physician will begin on a new page. Totals print for each physician. Final totals print for all physicians. Access: Collections Report Menu, Option 18 Program: PA0R96 - Collection Report by Admitting Physician PA0R96 - Collection Report Summary by Admitting Physician Selection: From date To date Admitting Physician - Enter a physician number or leave blank for all. Printer Outque Statistics: Percentage of claim Percentage received each month Use: This report is used to track the cash receipts for each month by physician. Files: ARACCUM, INSPLAN, PATIENTS, PHYMAST, SYSCTL


EXAMPLE HOSPITAL PAGE 1

PA0R96 MONITOR COLLECTION REPORT BY ADMITTING PHYSICIAN DATE 6/18/03

FOR THE PAYMENT PERIOD 1/01/03 THRU 3/31/03 TIME 9:41:54

PHYSICIAN: 32 BENTON JOSEPH

ADMIT AMT BILL JAN FEB MAR APR MAY JUN TOTAL %

DATE PREV RCVD JUL AUG SEP OCT NOV DEC RCVD CLAIM

9/17/02 COPELAND JOHN S 48.00 .00 .00 .00 .00 .00 .00 .00 %

MEDICARE/IN CRITICAL CAR .00 .00 .00 .00 .00 .00 .00

11/07/02 COPELAND JOHN S 48.00 .00 .00 .00 .00 .00 .00 .00 %


11/01/02 FELTNER MARIE JEAN 860.00 172.00- .00 .00 .00 .00 .00 172.00- 20%

CONSECO .00 .00 .00 .00 .00 .00 .00

12/02/02 FELTNER MARIE JEAN 602.00 156.52- 120.40- .00 .00 .00 .00 276.92- 46%

CONSECO .00 .00 .00 .00 .00 .00 .00

12/30/02 HANSON VAUGHN 48.00 22.08- .00 .00 .00 .00 .00 22.08- 46%


12/26/02 HANSON VAUGHN 48.00 22.08- .00 .00 .00 .00 .00 22.08- 46%


1/15/03 HANSON VAUGHN 48.00 .00 22.08- .00 .00 .00 .00 22.08- 46%


11/05/02 HORN PAULINE ELLEN 4,306.28 848.76- .00 .00 .00 .00 .00 848.76- 19%

COUNTRY COMPANIES .00 .00 .00 .00 .00 .00 .00

12/19/02 KENTON DOROTHY S 48.00 22.08- .00 .00 .00 .00 .00 22.08- 46%


1/09/03 KENTON DOROTHY S 48.00 22.08- .00 .00 .00 .00 .00 22.08- 46%


1/06/03 WATSON LARRY A 289.50 .00 133.17- .00 .00 .00 .00 133.17- 46%


PHYSICIAN TOTAL: 6,393.78 1,266- 276- 0 0 0 0 1,541.25- 24%

.00 0 0 0 0 0 0

%Revd 82 17


EXAMPLE HOSPITAL PAGE 1

PA0R96 MONITOR COLLECTION REPORT SUMMARY BY ADMITTING PHYSICIAN DATE 6/18/03

FOR THE PAYMENT PERIOD 1/01/03 THRU 3/31/03 TIME 9:41:54

AMT BILL JAN FEB MAR APR MAY JUN TOTAL %

PHYSICIAN: PREV RCVD JUL AUG SEP OCT NOV DEC RCVD CLAIM

32 BENTON JOSEPH 6,393.78 1,266- 276- 0 0 0 0 1,541.25- 24%

.00 0 0 0 0 0 0

%Revd 82 17

TOTAL ALL PHYSICIANS: 6,393.78 1,266- 276- 0 0 0 0 1,541.25- 24%

.00 0 0 0 0 0 0

%Revd 82 17

MISC TOTAL: 6,393.78 0 0 0 0 0 0 .00 %

.00 0 0 0 0 0 0

%Revd

TOTAL ALL PHYSICIANS: 6,393.78 1,266- 276- 0 0 0 0 1,541.25- 24%

Including Misc .00 0 0 0 0 0 0

%Revd 82 17

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Unbilled Claims Page 1.1

Unbilled Claims

Overview: This option prints a list of charges and expected payments forMedicare and Medicaid patients that are unbilled as of the last Day End, including patients still inhouse.

Patients are listed on these reports if the patient’s account is set to log and the Type of Coverage field in the patient’s logging payor plan is set to Contracted.

The in-house and discharged DRG patients are reported separately and have some different column headings and totals.

Two exclamation points (!!) printed for a patient will indicate that the patient has exhausted Medicare benefits and the Long Term Acute Care DRG expected reimbursement calculation is continuing because Medigap is secondary for the patient.

If applicable for the patient, CMGs or Psych DRGs will be used in calculating the Expected Payment.

Access: Payor Logs Menu, Option 1

Program: PB0R0H - Inhouse Unbilled Claims for DRG patients PB0R0H - Discharged Unbilled Claims for DRG patients PB0R0M - Inpatient Unbilled Claims for other patients PB0R0M - Outpatient Unbilled Claims for other patients PB0R1I – Inhouse Unbilled Report for LTAC

Selection: Report sequence - Numeric or AlphabeticPayor plan selection - All = All payor plans Blank = Select up to 10 payor/plans Payor = All plans for a selected payor

Select by Site Location - All = All site locations Blank = Select up to 5 site locations

Note: The site selection will only be displayed if the field Site Location Processing is answered Yes in the Admission Control Record, Option 26 on the System Control File Menu.

The reports are generated as of the last Day End posting date.

Note: Selection options will only be available if Bypass Options is set to No in the Miscellaneous Report Record, Option 16, in the System Control Maintenance Menu.


Note: The “&” (3M indicator) will only show on the Log reports when the customer has purchased Contract Management.

Statistics: None Use: The reports assist the financial officer in accruing contractual

allowances for the month for unbilled patients. File: PAUNLOG


Payor Logs

Action

Report Sequence: Select Numeric or Alphabetic

Payor plan Selection: Select All payor plans: When this option is selected, “ALL” displays in the boxed field to the right of All plans for company.

or

Select payor plans: When this option is selected, type a payor plan number in the boxed field to the right of All plans for company.

Click OK to continue.


Printer/Archive Options

FIELD DESCRIPTION

Print

Indicate if the report should be printed. Yes = The report should be printed. No = The report should not be printed. This field will be displayed and can be changed in the Printer/Archive Options window when a report is selected.

Copies Indicate the number of copies of the report to be printed 1-99. This field will be displayed and can be changed in the Printer/Archive Options window when a report is selected.

Outq Enter the printer outq name. Defaults to the outq of the user.

Archive Indicate if the report should be stored in the Archive system.


In-house Unbilled Claims


Discharged Unbilled Claims


In-Patient Unbilled Claims


Outpatient Unbilled Claims


LTAC Unbilled Claims

DATE: 1/15/14 ABC MEDICAL CENTER PAGE: 1 TIME: 6:59:37 LTAC Daily Utilization Report PB0R1I Unbilled Payor/Plan: 818/801 CAH MEDICARE Adm Date/ Elig Act 5/6 --Short Stay-- Inlier Outlier Covered Patient# Name Dis Date Days Days SLOS SLOS %Cost Day Payment Payment Charges DRG Medigap ================================================================================================================================= 6000381 CARTER LARRY 3/01/08 CVD 60 50 28.6 34.3 85755.66 63876.30 73031.98 913.09 182458.86 207 3/26/08 CID 30 63876.30 Blend LRD 60 NCD TOTAL 150 50 ** Message 1 - Patient coinsurance days within 5 days of expiration or have expired. ** ** Message 2 - Patient must elect to use Life Time Reserve days. ** ** Message 3 - Patient must be abstracted, DRG is missing. ** ** Message 4 - Complete data not currently available for plans with a non-M(edicare) payor type. **

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Unbilled Claims By Physician Page 2.1

Unbilled Claims By Physician

Overview: This option prints a listing sorted by physician of charges and

expected payments for Medicare or Medicaid patients that are unbilled as of the last Day End.

Patients are listed on these reports if the patient’s account is set to

log and the Type of Coverage field in the patient’s logging payor plan is set to Contracted.

The in-house and discharged DRG patients are reported separately

and have some different column headings and totals. Two exclamation points (!!) printed for a patient will indicate that the

patient has exhausted Medicare benefits and the Long Term Acute Care DRG expected reimbursement calculation is continuing because Medigap is secondary for the patient.

If applicable for the patient, CMGs or Psych DRGs will be used in

calculating the Expected Payment. Access: Payor Logs Menu, Option 2 Program: PB0R0I - Inhouse Unbilled Claims for DRG patients PB0R0I - Discharged Unbilled Claims for DRG patients PB0R0N - Inpatient Unbilled Claims for other patients PB0R0N - Outpatient Unbilled Claims for other patients Selection: Report sequence - Numeric or Alphabetic Payor plan selection - All = All payor plans Blank = Select up to 10 payor/plans Payor = All plans for a selected payor Select by Site Location - All = All site locations Blank = Select up to 5 site locations

Note: The site selection will only be displayed if the field site Location Processing is answered 'Y' in the Admission Control Record, Option 26 on the System Control File Menu.

The reports are generated as of the last Day End posting date.

Note: The “&” (3M indicator) will only show on the Log reports when the customer has purchased Contract Management.


Statistics: None Use: Financial data is presented for each physician for comparison. File: PAUNLOG


Print Unbilled Claims by Physician Report In-house Unbilled Claims PB0R0I


Print Unbilled Claims by Physician Report Discharged Unbilled Claims PB0R0I


Print Unbilled Claims by Physician Report In-Patient Unbilled Claims PB0R0N


Print Unbilled Claims by Physician Report Outpatient Unbilled Claims PB0R0N

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Billed Claims Page 3.1

Billed Claims

Overview: This option prints a report indicating paid and unpaid claims selected

with from and through date criteria. Usually selected by discharge date, this report indicates a summary of claims that have been

billed. The detail report prints the admission date, discharge date, or date

logged depending on the report selection. The detail report shows patient information, total days, covered days,

covered charges, denial amount, deductible, co-pay, net benefits, payment computed, outlier amount, expected payment, contractual adjustment, remittance advice date, and remittance advice amount.

Two exclamation points (!!) printed for a patient will indicate that the


The summary report shows the totals by payor company/ plan for the

total days, covered days, covered charges, denial amount, deductible, co-pay, net benefits, payment computed, outlier amount, expected payment, contractual adjustment, and remittance advice amount.

On either the summary or detail report, if the expected payment is

not equal to the remittance advice amount, an asterisk will print to the right of the remittance advice amount and the following footer will be printed at the bottom of the page * Remit differs from Expected. If either amount is zero, the asterisk will not print.

Each report prints in payor/plan order. Also from this option, the Remittance Advice Summary can be

generated for a specific Document Control Number. This is a summary of the payments and adjustments for each batch. This report can be used in balancing the payor logs to the remittance advice. Each insurance will begin on a new page.



Program: MED003 - Log Summary MEDR441 - MEDLOG Remittance Advice Summary Statistics: None Column Headings: PAYMENT COMPUTED - Only reported for payor company/plans with a

type of coverage of Contracted (3). Use: This report provides a summary of billed claims on demand. If selected by remittance advice date, the report can be used to ensure that all payments on a particular remittance advice posted to the logs successfully. The unpaid report is used to indicate claims that may require further follow-up action. The remittance advice summary can be used in balancing the payor logs to the remittance advice. Files: MEDLOG, MEDLOGRAL2, DRGDESC, INSPLAN


Insurance Logs

Action:

Print report by: (Select from one of the following) • Admission Date • Discharge Date • Date Logged • Remittance Date • R/A Recap Summary

Account Sequence: Select either Numeric or Alphanumeric.

Report Type: Select either Detail or Summary.

Format to print report: Select either Page break by PAYOR or No page break Click OK to continue.

Note: The site selection will only be displayed if the field Site Location Processing is answered 'Y' in the Admission Control Record, Option 26 on the System Control File Menu.


Site Location Code Selection

The Site Location Code Selection screen displays when the option for Select Multiple Sites is selected when a Site Location is required. Action

Select a Site Code then click OK to continue and the Log Site Location Selection screen displays.

Log Site Location Selection

The Log Site Location Selection screen displays when a Site Code is selected from the Site location Selection screen. Select up to five difference Site Codes.


Payor Log Summary

Action:

Beginning Date: Enter a beginning date to run the report using this format 010101.

Ending Date: Enter an ending date using this format 010101

Payor plan selection: ALL=all payor plans Blank=select payor/plans Payor=all plan for payor

Hospital Type: Enter a numeric value

Billing Classification: Enter a numeric value

Late Charge Logs: L= Late charges logs

Print Paid/Unpaid/All Bills: Select either Paid, Unpaid or All

Type of Bill: Select either UB, 1500 or Both

Click OK or Submit to Batch to continue.


Log Payor Plan Selection

The Log Payor Plan Selection screen displays when Payor Plans are required for report. Up to ten Payor plans can be selected. Action

Click to select a Payor/Plan from the Payor Company/Plan Alpha Search screen then click OK to continue.

Payor Company/Plan Alpha Search

The Payor Company/Plan Alpha Search screen displays when the is clicked on the Log Payor Plan Selection screen. Action

Select a Payor name then click OK to continue.


Printer/Archive Options

Action

Printer Options: Print: Select Yes or No Copies: Enter a numeric value from 01-99 Outq: Enter a printer name of leave the default value of DOC.

Click OK to submit to batch.


Billed Claims Log Summary

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Billed Claims By Physician Page 4.1

Billed Claims By Physician

Overview: This option prints a report sorted by physician indicating paid and

unpaid claims selected with from and through date criteria. Usually selected by discharge date, this report indicates a summary of claims that have been billed, by payor plan and by physician.

The report prints the admission date, discharge date, or date logged

depending on the report selection. The report shows patient information, total days, covered days,

covered charges, denial amount, deductible, co-pay, net benefits, payment computed, outlier amount, expected payment, contractual adjustment, remittance advice date, and remittance advice amount.

The report prints in physician number order. Two exclamation points (!!) printed for a patient will indicate that the


Access: Payor Logs Menu, Option 4 Program: MED004


Selection: Print report by - 1 = Admission Date 2 = Discharge Date 3 = Date Logged 4 = Remittance Date Account sequence - 1 = Numeric 2 = Alphabetic Beginning and Ending Date - MMDDYY Payor plan selection - All = All payor plans Blank = Select up to 10 payor/plans Payor = All plans for a selected payor Hospital type - 1 through 9 Billing Classification - 1 through 9 Late Charge Logs - L = Late charge logs Print Paid/Unpaid/All Bills - A = All P = Paid U = Unpaid Type of Bill - 1 = UB82 2 = 1500 3 = Both Select by Site Location - All = All site locations Blank = Select up to 5 site locations Note: The site selection will only be displayed if the field Site

Location Processing is answered 'Y' in the Admission Control Record, Option 26 on the System Control File Menu.

Statistics: None Column Headings: PAYMENT COMPUTED - Only reported for payor company/plans

with a type of coverage of Contracted (3). Use: This report provides a summary of billed claims by physician for

comparison. If selected by remittance advice date, the report can be used to

ensure that all payments on a particular remittance advice posted to the logs successfully.

The unpaid report is used to indicate claims that may require further

follow-up action. Files: MEDLOG, DRGDESC, PHYMAST, INSPLAN


Payor Logs

Payor Log Summary

SAMPLE REPORTS PAYOR LOGS REPORTS LOGS Payor Log Audit Report Page 5.1

LOGMNU Option 5: Print Log Audit Report

Overview: The Log Audit Report identifies changes to the Reimbursement Amount field in the Payor Log File (Payor Logs Menu, Option 15: Payor Log Maintenance). The types of changes that are monitored include additions and deletions. The audit will help increase the accuracy of Contract Management Payment Variance Reports.

The Log Audit Report can also be accessed from Contract Management Reports, Option 13: Log Audit Report.

An example of a Log Audit Report is shown in the section, “Example Log Audit Report.”


Program: PB0R75

Files: LOGAUDITV1, SYSCTL


The Log Audit Report screen opens when you select the Print Log Audit Report link in the Payor Logs Menu.

Action To print the Log Audit Report, indicate the desired Output Queue and the From and Thru Dates. Use dates that overlap when the Expected Payment changes were made in Payor Log Maintenance (Payor Logs Menu, Option 15). The report will be sent to the indicated output queue.


EXAMPLE LOG AUDIT REPORT

PB0R75 ABC MEDICAL CENTER PAGE: 1

LOG AUDIT REPORT DATE: 10/26/11

FAC# 250 Tran Dates10/26/11 through 10/26/11 TIME: 11:47:10

Patient# Cycle Old Estpay New Estpay User Wrkstn ID Chg Date Chg Time Action

6000461 - 1 .00 7,250.00 KMACDOWELL QPADEV0033 2011-10-26 11.42.36 MODIFIED

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Payor Log Error Report Page 6.1

Payor Log Error Report

Overview: This option is used to print a listing of insurance revenue summary

codes for each facility type and bill class that were not found in the payor log file.

There is no prompt screen displayed after the option selection. Access: Payor Logs Menu, Option 6 Program: PB0R42 Selection: The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the

System Control File Menu. The Archive field will default to 'N'. Be sure to change it to 'Y' to archive the report.

The default number of copies to print and a distribution list can be set

up for the report in the Miscellaneous reports record, Option 16 on the System Control Menu.

Statistics: None Use: This listing is used to determine which insurance revenue summary codes need to be set up in Update log descriptions, Option 16 on the Payor Logs Menu. Files: MEDLOGRV, INSCDSUM

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Payor Log Error Report Page 6.2

PB0R42 5/11/06 EXAMPLE HOSPITAL PAGE 1

PAYOR LOG ERROR REPORT

THESE INSURANCE CODES WERE NOT FOUND IN THE PAYOR LOG FILE. FACILITY TYPE: 1

BILL CLASS: 1

CODE DESCRIPTION

110 ROOM-BOARD/PVT

112 OB/PVT

113 PEDS/PVT

114 PSYCH PRIVATE

116 DETOX PRIVATE

122 OB SEMI-PVT

123 PEDS/SEMI-PVT

124 PSYCH/ S/P

126 DETOX SEMI-PVT

130 ROOM-BOARD/SEMI

132 OB/WARD

133 PEDIATRIC

134 PSYCH SEMI-PVT

140 ROOM/BOARD GEN CLASSIFICATION

144 PSYCHIATRIC PRIVATE

164 STERILE ENVIRONMENT

171 NURSERY NEWBORN

172 INTERMEDIATE NURSERY

175 NEONATAL ICU

200 ICU/CCU

203 ICU PEDIATRIC

204 ADULT CD/INT

206 POST ICU

207 ICU/BURN CARE

210 CCU

219 CCU/OTHER

223 UTILIZATION REVIEW

230 NURSING INCREM

239 NURSING INCREM

258 IV SOLUTIONS

261 PUMP IV MED

272 STERILE SUPPLY

274 PARENTERAL/ENTERAL THERAPY

310 PATH LAB

341 NUC MED/DX

350 CT SCAN

351 CT SCAN-HEAD

360 OR SERVICES

370 ANESTHESIA

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Billed Claims DETAIL Logs Page 7.1

Billed Claims DETAIL Logs

Overview: This option prints a summary or a detail report of claims that have

been billed for patients. The detail report prints one page for each patient, while the summary

report is a one page report showing the summary of all patients. The detail report shows patient information, room and board charges,

ancillary charges, deductibles, patient summary, and summary totals. An exception report also prints if a patient's billed amount and logged

amount disagree. Access: Payor Logs Menu, Option 7 Program: PB0R40


Selection: Print by – Admission DateDischarge Date Date Logged Remittance Date

Account sequence - Numeric or Alphabetic Beginning and Ending Date Payor plan selection - All payor plans

Select 10 payor/plans All plans for a selected payor

Hospital type Billing Classification Late Charge Logs Summary report - Yes or No Type of Bill - 1 = UB

2 = 1500 3 = Both


Note: The site selection will only be displayed if the field Site Location Processing is answered 'Y' in the Admission Control Record, Option 26 on the System control File Menu.

The Printer/Archive Options window will be displayed to allow the following selections to be entered:

Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N

Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the System Control File Menu. The Archive field will default to 'N'. Be sure to change it to 'Y' to archive the report. The default number of copies to print and a distribution list can be set up for the report in the Miscellaneous reports record, Option 16 on the System Control Menu.

Statistics: None

Use: These reports are used at year end for reconciling Medicare cost reports and for maintaining and reconciling indvidual accounts when expected payments do not agree with actual payments.

Files: BENEFITS, INSPLAN, MEDLOG, MEDLOGDS


● Exception Report

PB0R40 HOSPITAL TYPE 1 EXAMPLE HOSPITAL OF AMERICA DATE: 7/05/05 PAGE 1

BILL CLASSIFICATION 1 PAYOR LOG EXCEPTION LISTING TIME: 8:55:41

FROM 3/01/05 THRU 4/01/05 ADMISSION DATE

PATIENT CYC AMOUNT AMOUNT

NUMBER NO. NAME BILLED LOGGED

1239831 01 JOHNSON TINA 35,028.66 34,971.66

1239858 01 SMITH JOE 14,638.23 13,798.23

5775543 01 PETERSON JOHN 7,729.50 7,672.50


● Detail Report

PB0R40 HOSPITAL TYPE 1 EXAMPLE HOSPITAL PAGE 20

BILL CLASSIFICATION 1 MONITOR BILLED CLAIMS PAYOR LOG DETAIL DATE: 9/15/05

MEDICARE/IN CRITICAL CARE TIME: 14:33:23

FINANCIAL CLASS(ES)Q FROM 1/01/04 THRU 1/31/04 ADMISSION DATE

1038820 01 DEWEY HELEN A CLAIM# 352106352A ADMIT 1/21/04 DISCH 1/22/04 *UB92*

------- ROOM BOARD -------- ------- ANCILLARY ----- ---------- DEDUCTIBLES -----------

DESC DYS AMOUNT DESC AMOUNT DESC AMOUNT

NON-COVR PHARMACY 13,844.30 PATIENT 876.00

SEMI 9 5,130.00 SUPPLIES 3,577.50 BLOOD .00

ICU 2 1,950.00 LAB/CLN 3,383.50 CO-PAY .00

NURS .00 LAB/PATH .00 ------------

RESERVED .00 XRAY 534.00 TOTAL 876.00

RESERVED .00 NUC MED .00

RESERVED .00 BLOOD .00 NON-COVERED .00

----- ------------ RESP TH 4,290.00 DENIED .00

TOTAL 11 7,080.00 PHYS TH 525.50

SPCH/AUD .00

SURG/REC .00 ---------------------- PAYMENT SUMMARY ----------------------

US&MAMMO 689.00

EMERG 314.00 OPERATING CAPITAL TOTAL

PMCY/RAD .00 PMT COMPUTED(NON-TRF) .00 .00 .00

OTHER INFORMATION: CARDIO 700.00 PMT COMPUTED(TRANSFR) .00 .00 .00

AMB SURG .00 ---------- ---------- ----------

LOGGING DATE 1/18/04 CT SCAN .00 TOTAL PAYMENT .00 .00 .00

PAYMENT DATE 2/07/04 OBSERV .00 ADD OUTLIER PMT .00 .00 .00

PHYSICIAN 179 OTHER .00 LESS: DEDUCTIBLES 876.00

MDC CODE 00 EKG 1,000.00 ----------

DRG CODE 000 EEG/EMG .00 EXPECTED PAYMENT 876.00

DRG WEIGHT .0000 CRNA .00

PROF FEE .00

PROF-URG .00

RESERVED .00

RESERVED .00

RESERVED .00

------------

TOTAL 28,857.80 ACTUAL PAYMENT 20,211.00

SUMMARY APPROVED NET

TOTAL CHARGES NON-COVER COVERED DENIED CHARGES DEDUCTIBLE BENEFITS

35,937.80 .00 35,937.80 .00 35,937.80 876.00 35,061.80


● Summary Report

PB0R40 HOSPITAL TYPE 1 EXAMPLE HOSPITAL PAGE 9

BILL CLASSIFICATION 1 MONITOR PAYOR LOG SUMMARY DATE: 9/15/05

FROM 1/01/04 THRU 1/31/04 TIME: 15:09:52

MEDICARE/IN CRITICAL CARE ADMISSION DATE



NON-COVR PHARMACY 194,606.38 PATIENT 41,931.15


ICU 16 15,600.00 LAB/CLN 82,294.50 CO-PAY .00

NURS .00 LAB/PATH 396.00 ------------

RESERVED .00 XRAY 15,272.00 TOTAL 41,931.15

RESERVED .00 NUC MED 943.00

RESERVED .00 BLOOD 7,116.00 NON-COVERED .00

----- ------------ RESP TH 27,708.00 DENIED .00

TOTAL 285 169,090.00 PHYS TH 8,173.50

SPCH/AUD 1,167.00

SURG/REC 83,056.00 ---------------------- PAYMENT SUMMARY ----------------------

US&MAMMO 8,083.00

EMERG 15,774.00 OPERATING CAPITAL TOTAL


CARDIO 13,375.00 PMT COMPUTED(TRANSFR) .00 .00 .00

AMB SURG .00 ---------- ---------- ----------

CT SCAN 16,836.00 TOTAL PAYMENT .00 .00 .00

OBSERV 360.00 ADD OUTLIER PMT .00 .00 .00

OTHER 6,770.00 LESS: DEDUCTIBLES 41,931.15

EKG 7,200.00 ----------

EEG/EMG .00 EXPECTED PAYMENT 41,931.15-

CRNA 1,380.00

PROF FEE .00

PROF-URG .00

RESERVED .00

RESERVED .00

RESERVED .00

------------


SUMMARY: APPROVED NET


748,196.88 .00 748,196.88 .00 748,196.88 41,931.15 706,265.73

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Billed Claims DETAIL - Select Patient Page 8.1

Billed Claims DETAIL – Select Patient

Overview: This option prints a report of claims that have been billed for a

selected patient. The report shows patient information, room and board charges, ancillary charges, deductibles, patient summary, and summary totals. Access: Payor Logs Menu, Option 8 Program: MED005 Selection: Patient number Cycle number The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the




Statistics: None Use: This report is used at year end for reconciling Medicare cost reports

and for maintaining and reconciling individual accounts when expected payments do not agree with actual payments.

Files: BENEFITS, INSPLAN, MEDLOG, MEDLOGDS

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Billed Claims DETAIL - Select Patient Page 8.2

MED005 HOSPITAL TYPE 1 MEDHOST REL TWO FOUR ZERO PAGE 1

FINANCIAL CLASS(ES) M MONITOR BILLED CLAIMS DETAIL DATE: 9/15/05

BILL CLASSIFICATION 1 MEDICARE/IN CRITICAL CARE TIME: 16:01:40

1038443 01 SMITH SARAH CLAIM# 346189868D ADMIT 1/02/04 DISCH 1/13/04 *UB92*



NON-COVR PHARMACY 13,844.30 PATIENT 876.00


ICU 2 1,950.00 LAB/CLN 3,383.50 CO-PAY .00

NURS .00 LAB/PATH .00 ------------

RESERVED .00 XRAY 534.00 TOTAL 876.00

RESERVED .00 NUC MED .00

RESERVED .00 BLOOD .00 NON-COVERED .00

----- ------------ RESP TH 4,290.00 DENIED .00

TOTAL 11 7,080.00 PHYS TH 525.50

SPCH/AUD .00

SURG/REC .00 ---------------------- PAYMENT SUMMARY ----------------------

US&MAMMO 689.00

EMERG 314.00 OPERATING CAPITAL TOTAL


OTHER INFORMATION: CARDIO 700.00 PMT COMPUTED(TRANSFR) .00 .00 .00

AMB SURG .00 ------------

LOGGING DATE 1/18/04 CT SCAN .00 TOTAL PAYMENT .00 .00 .00

PAYMENT DATE 2/07/04 OBSERV .00 ADD OUTLIER PMT .00 .00 .00

PHYSICIAN 179 OTHER .00 LESS: DEDUCTIBLES 876.00

MDC CODE 00 EKG 1,000.00 ------------

DRG CODE 000 EEG/EMG .00 EXPECTED PAYMENT 876.00-

DRG WEIGHT .0000 CRNA .00

PROF FEE .00

PROF-URG .00

RESERVED .00

RESERVED .00

RESERVED .00


SUMMARY APPROVED NET


35,937.80 .00 35,937.80 .00 35,937.80 876.00 35,061.80

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Bad Debt Payor Logs Page 9.1

Bad Debt Payor Logs

Overview: This option prints a report of Bad Debt Payors.

The report shows patient information: admit date, discharge date, deductible amount, co-pay amount, blood deductible amount, non-covered amount, write-off date, write-off amount, recovery amount, current balance, remittance advice date, and bad debt financial class.

The first contact date printed is the date of the first letter or statement that was sent.

If the patient has Medicaid as a payor, the Medicaid policy number will also be printed.

The report should be run at month end as well as year end. It is also recommended to run periodic year-todate reports to ensure contractual allowances are being accrued and claims are being paid in a timely manner.


Program: MED007

Selection: Beginning and ending write off dates.

Payor plan selection - All payor plans

Select 10 payor/plans All plans for a selected payor Hospital type Bill classification Account sequence - Numeric or Alphabetic Type of Bill –

1 = UB82 2 = 1500 3 = Both



Note: The site selection will only be displayed if the field Site Location Processing is answered 'Y' in the Admission Control Record, Option 26 on the System Control File Menu.



Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the System Control File Menu. The Archive field will default to 'N'. Be sure to change it to 'Y' to archive the report. The default number of copies to print and a distribution list can be set up for the report in the miscellaneous reports record, Option 16 on the System Control Menu.

Statistics: None

Use: The Bad Debt Payor Logs are used to reconcile recoveries and bad debt reporting on cost reports.

Files: ARMAST, MEDLOG


Medicare Bad Debt Payor Log

Action

Enter the report selections. See explanations on next page.

Click Submit to Batch to continue.


Field Description

Beginning Date Type or select a date from the calendar the beginning write off date.

Ending Date Type or select a date from the calendar the ending write off date.

Payor Plan Selection All=all payor plans Blank=select payor plans Payor=all plans for payor

Hospital Type

Key the applicable one digit code for this facility for UB04 billing purposes. This field becomes the first digit in Locator 4 on the UB04. Valid codes are:

1 - Hospital 2 - Skilled Nursing Facility 3 - Home Health Agency 4 - Christian Science (Hospital). 5 - Christian Science (Extended Care) 6 - Intermediate Care 7 - Clinic 8 - Special Facilities 9 - Reserved for National Use

Billing classification

Key the one digit bill classification code. Refer to the state uniform billing guide for more specific information. This field becomes the second digit in Locator 4 on the UB04. Valid codes are: Regular Facility: 1 - Inpatient (Medicare Part A)

2 - Inpatient (Medicare Part B only) 3 - Outpatient 4 - Outpatient other (MC/MD only) 5 - Intermediate care Level I (not TN) 6 - Intermediate care Level II (not TN) 7 - Intermediate care Level III (not TN) 8 - Swing beds 9 - Reserved for national use

Clinics:

1 - Rural Health 2 - Free Standing Renal Dialysis 3 - Free Standing 4 - O/P Rehab Facility 5 - Comprehensive O/P Rehab Facility 6-8 - Reserved for national use 9 - Other

Special Facility:

1 - Free Standing Hospice 2 - Provider based Hospice 3 - Ambulatory surgery center 4 - Free standing birthing center 5-8 - Reserved for national use 9 - Other


Field Description

Account Sequence Select either Numeric or Alphabetic

Type of Bill UB = UB04 institutional claim (837I) 1500 = 1500 Professional claim (837P) Both

Select Date Type by Report

Select either Collection efforts exhausted or Bad debt write off date.


Log Payor Plan Selection

Action

To select a Company Plan Number, click on the drop down arrow and select a company from the Payor Company/Plan Alpha Search search screen.

Click Submit to batch to run report.

Payor Company/Plan Alpha Search

Action

To select, click on a Company Plan Number and click OK.

Note: Click on Expand/Truncate button to view Payor Company address.


Bad Debt Payor Log - Report

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Log Reconciliation Report Page 10.1

Log Reconciliation Report

Overview: This option prints a listing of logging errors needing reconciliation. The Log Reconciliation Report (reconciled by Master Patient Index)

shows patient type, patient number, billing cycle, patient name, history number, bill type/class, financial class, admit date, discharge

date, and a description of the logging error. The logging errors that will be included on this report are listed below:

• A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A FIN CLASS THAT REQUIRES LOGGING.

• THE FIN CLASS IN THE ADMISSION REGISTER FILE IS X WHICH DOES NOT MATCH THE FIN CLASS IN THE LOGS. (X = Financial class code)

• A PATIENT RECORD THAT HAS BEEN LOGGED IS NOT CONTAINED IN THE ADMISSION REGISTER FILE.

• A LOG RECORD WAS PRESENT FOR A FIN CLASS WHICH SHOULD NOT BE LOGGED.

The Log Reconciliation Report (reconciled by Accounts Receivable)

shows the patient number, bill cycle, patient name, error code, A/R amount, net log, logged charges, deductions, payment, contractual,

and comments. Each financial class and payor will begin on a new page. Access: Payor Logs Menu, Option 10 Program: MED008 - Reconciliation - Master Patient Index MED015 - Reconciliation - Accounts Receivable


Selection: Reconciliation - Master Patient Index From and To dates Reconciliation - Accounts Receivable Inpatient, Outpatient, or Both The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the




Statistics: None Use: Both reports are used to ensure that accounts are being logged

properly. • The Log Reconciliation Report (Master Patient Index) reconciles

the Admission/Register file to the Payor Log File. • The Log Reconciliation Report (Accounts Receivable) reconciles the

A/R Summary file to the Payor Log file. Files: ADMREG, MEDLOG, ARSUMMRY, ARMAST, MEDRECL


MED008 EXAMPLE HOSPITAL

LOG RECONCILIATION REPORT DATE: 5/14/06 PAGE 1

DISCHARGES 4/01/06 THRU 4/30/06 TIME: 7.27.48

P PATIENT HISTORY BILL F/ ADMIT DISCHARGE

T NO. CYC NAME NO. TY/CL C DATE DATE ERROR

I 1107144 01 JONES STEPHEN 000064152 1 1 M 3/29/06 4/06/06 A PATIENT RECORD THAT HAS BEEN LOGGED IS NOT CON-

TAINED IN THE ADMISSION REGISTER FILE.

I 1107623 WILLIS PERVISS 000064427 1 1 A 4/12/06 4/14/06 A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A

FIN CLASS THAT REQUIRES LOGGING.

I 1107649 01 POOLE DRACH 000006652 1 1 C 4/13/06 4/15/06 A LOG RECORD WAS PRESENT FOR A FIN CLASS WHICH

SHOULD NOT BE LOGGED.

I 1107680 01 WAYNE ANDREW 000064459 1 1 B 4/15/06 4/16/06 A LOG RECORD WAS PRESENT FOR A FIN CLASS WHICH

SHOULD NOT BE LOGGED.

O 2060444 BLANGTON ROBERT 000000087 1 3 M 1/30/06 4/01/06 A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A


O 2061632 BIVENS DAVID 000062265 1 3 M 2/01/06 4/01/06 A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A


O 2061937 PRINCE EDITH 000015224 1 3 M 2/01/06 4/01/06 A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A


O 2062044 PARNELL JOHN 000005874 1 3 M 2/01/06 4/01/06 A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A


O 2062066 WESTERSON MAVIS 000013717 1 3 M 2/01/06 4/01/06 A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A


O 2062151 LITTLEMAN TERRY 000062671 1 3 M 2/01/06 4/01/06 A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A


O 2062458 ADAMS JOHNNY 000000043 1 3 M 2/06/06 4/06/06 A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A


O 2062418 HANSEN JACK 000010197 1 3 M 2/06/06 4/06/06 A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A


O 2062433 YATES DOROTHIA 000003523 1 3 A 2/06/06 4/06/06 A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A


O 2063659 01 BROWSER PAULA 000006994 1 3 M 2/04/06 4/12/06 THE FIN CLASS IN THE ADMISSION REGISTER FILE IS S,

WHICH DOES NOT MATCH THE FIN CLASS IN THE LOGS.

O 2063266 DOWNS ROGER 000094575 1 3 A 3/20/06 4/05/06 A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A


O 2063506 01 JOHNSON CATHY 000003862 1 3 M 3/20/06 4/12/06 THE FIN CLASS IN THE ADMISSION REGISTER FILE IS B,


O 2064477 MATTERSON JAY 000006745 1 3 M 2/08/06 4/08/06 A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A


O 2065216 01 ROGERS ANNE 000001210 1 3 M 3/27/06 4/09/06 THE FIN CLASS IN THE ADMISSION REGISTER FILE IS A,


O 2063081 01 TEAGUE GEORGE 000005625 1 3 M 3/27/06 4/12/06 THE FIN CLASS IN THE ADMISSION REGISTER FILE IS K,


O 2065280 01 ROGERS ANNE 000001210 1 3 M 2/06/06 4/12/06 THE FIN CLASS IN THE ADMISSION REGISTER FILE IS S,


O 2065745 FARRIS WILLIAM 000062307 1 3 M 2/09/06 4/09/06 A PATIENT WAS NOT LOGGED, BUT WAS BILLED WITH A


TOTAL NO. ERRORS: 77


MED015 EXAMPLE HOSPITAL PAGE 1

5/14/06 LOG RECONCILIATION REPORT

BOTH

FINANCIAL CLASS - M CHAMPUS

PAYOR - 001 002 MEDICARE

PATIENT BILL ERR A/R NET LOGGED

NUMBER CYCLE PATIENT NAME CODE AMOUNT LOG CHARGES DED PAYMENT CONTRACTUAL COMMENTS

0427594 01 BAKER JOHN 02 7.00- 28.50- 79.00 21.50 32.25 53.75

0432493 01 BAKER JOHN 02 47.81 .00 219.05 47.81 64.22 107.02

0432718 01 BAKER JOHN 02 20.60- 28.50- 48.00 7.96 32.44 36.16

0440104 01 BUSH REBECCA 03 247.87 .00 .00 .00 .00 .00

0446077 01 HENSON EDIE 01 16.40 82.00- .00 16.40 33.12 32.48

0446083 01 HENSON EDIE 01 14.55 36.37 107.25 14.55 32.20 24.13

0446995 01 LYNN MYCHELINE 02 23.59 23.76- 65.25 23.60 24.54 40.87

0447548 01 WILLIAMS OPHELI 02 83.40 .00 137.00 83.40 .00 53.60

0448539 01 CAMPBELL CATHY 02 9.75 24.37 140.25 11.75 50.52 53.61

0449478 01 WILLIAMS OPHELI 02 9.75 .00 170.50 9.75 65.86 94.89

0454413 01 HENSON EDIE 01 38.79 25.49 175.50 38.80 72.32 38.89

0457078 01 SMITH LOU ANNA 02 30.00- 42.50- 20.00 12.50 18.75 31.25

0457938 01 BAKER JOHN 02 31.39 23.76- 104.25 31.40 36.24 60.37

0458518 01 SHORT WILLIAM 03 68.50 .00 68.50 68.50 .00 68.50

0458706 01 HODGES SHERRY 03 58.19 61.12 217.25 60.63 53.33 42.17

0459871 01 SMITH LOU ANNA 02 12.85 25.00 162.00 .35 54.39 82.26

0459918 01 HENSON EDIE 01 14.70 36.75 182.75 14.70 80.43 50.87

0462277 01 BAKER JOHN 02 16.60 .00 105.00 16.60 34.30 54.10

0463437 01 SMITH LOU ANNA 02 23.47 .00 117.37 23.47 35.22 58.68

0464148 01 SMITH LOU ANNA 02 8.50 .00 42.50 8.50 12.75 21.25

TOTAL 668.51 19.92- 2161.42 512.11 732.88 1004.85

01 = NO LOG FOUND

02 = INCORRECT PRO-RATED AMOUNT OR LOGGING ERROR

03 = NO BILLING RECORD FOUND

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Prior Year Payments Report Page 11.1

Prior Year Payments Report

Overview: This option prints a listing of accounts billed prior to the selected year

ending date but paid after the year ending date. The report shows the date logged, total days, covered days, covered

charges, denial amount, deductible, co-pay, net benefits, payment computed, outlier amount, expected payment, contractual adjustment, remittance advice date, and remittance advice amount.

Totals are printed for each payor and plan. Access: Payor Logs Menu, Option 11 Program: MLBLPR

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Prior Year Payments Report Page 11.2 Selection: Fiscal year end date Payor plan selection - All payor plans Select 10 payor/plans All plans for a selected payor Hospital type Billing classification Print report by patient number or patient name Late charge logs Type of Bill - 1 = UB 2 = 1500 3 = Both Select by Site Location - All = All site locations Blank = Select up to 5 site locations Note: The site selection will only be displayed if the field Site

Location Processing is answered 'Y' in the Admission Control Record, Option 26 on the System Control File Menu.

The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the




Statistics: None Use: This report can be used at the fiscal year end to determine the accounts that posted payments after the year end but were were billed before the year end. File: MEDLOG

SAMPLE REPORTS PAYOR LOG REPORTS LOGS Prior Year Payments Report Page 11.3 MLBLPR EXAMPLE HOSITAL PAGE 1

HOSP TYPE 1 BILL CLASS 1 MONITOR PRIOR YEAR PAYMENTS DATE: 9/16/05

PAYOR PLAN 002/001 TRICARE YEAR ENDING 12/31/04 TIME: 10:08:46

DATE --DAYS-- COVERED DENIAL DEDUCTIBLE NET PAYMENT OUTLIER EXPECTED CONTRACTUAL R/A DATE

LOGGED TOT CVD CHARGES AMOUNT & CO-PAY BENEFITS COMPUTED AMOUNT PAYMENT ADJUSTMENT R/A AMOUNT

-------- ---- ---- ------------ ---------- ---------- ------------ ----------- ---------- ----------- ----------- ------------

2159796-01 STRATTON EILEEN A F/C - F *1500*

1/28/05

12/19/04 1 1 4578.55 15.00 .00 4563.55 .00 .00 935.00 3628.55 935.00

---- ---- ------------ ---------- ---------- ------------ ------------ ---------- ------------ ----------- ------------

PLAN TOTALS:

1 1 4578.55 .00 .00 935.00 935.00

1 15.00 4563.55 .00 3628.55

PAYOR TOTALS:

1 1 4578.55 .00 .00 935.00 935.00

1 15.00 4563.55 .00 3628.55

MLBLPR EXAMPLE HOSPITAL PAGE 2

HOSP TYPE 1 BILL CLASS 1 MONITOR PRIOR YEAR PAYMENTS DATE: 9/16/05

PAYOR PLAN 338/001 BLUE CROSS YEAR ENDING 12/31/04 TIME: 10:08:46

DATE --DAYS-- COVERED DENIAL DEDUCTIBLE NET PAYMENT OUTLIER EXPECTED CONTRACTUAL R/A DATE

LOGGED TOT CVD CHARGES AMOUNT & CO-PAY BENEFITS COMPUTED AMOUNT PAYMENT ADJUSTMENT R/A AMOUNT

-------- ---- ---- ------------ ---------- ---------- ------------ ----------- ---------- ----------- ----------- ------------

1044049-01 DILLON REBECCA ANN F/C - B *UB92*

3/09/05

11/05/04 4 4 6971.45 .00 .00 6971.45 .00 .00 6971.45 .00 6971.45

2154962-01 JONES FRANK K F/C - MS *UB92*

3/14/05

10/28/04 2 2 2407.15 .00 .00 2407.15 .00 .00 2407.15 .00 2407.15

2159311-01 ADAMS ROLAND D F/C - B *UB92*

4/01/05

12/18/04 4 4 21714.67 .00 .00 21714.67 .00 .00 21714.67 .00 21714.67

---- ---- ------------ ---------- ---------- ------------ ------------ ---------- ------------ ----------- ------------

PLAN TOTALS:

3 10 31093.27 .00 .00 31093.27 31093.27

10 .00 31093.27 .00 .00

PAYOR TOTALS:

3 10 31093.27 .00 .00 31093.27 31093.27

SAMPLE REPORTS A/R REPORTS A/R Physicians Analysis Report Page 1.1

Physicians Analysis Report

Overview: This option is used to print summary statistics for the following formonth and year-to-date by physician: admissions, registrations, patient days, and revenue.

This report can be automatically selected at Month End.

Access: Reports Menu II, Option 1

Program: PB0R15 - Month to Date selection NPB0R15 - Historical Data selection

Selection: Month to DateHistorical Data

From and Thru Date

Statistics: Admissions - Month and YTDRegistrations - Month and YTD Patient days - Month and YTD Revenue - Month and YTD Contractual Adjustment Amount - Total Bad Debt Write-Off Amount - Total

Use: This report is used to analyze statistical information for each physician.

File: DOCMAST

||

SAMPLE REPORTS A/R REPORTS A/R Physicians Analysis Report Page 1.2

REPORT DATE 1/31/05 MEDHOST GENERAL HOSPITAL FAC# 001 PAGE 1

RUN DATE 2/25/05 TIME 2:33 PM PHYSICIANS ANALYSIS REPORT PB0R15

DOCTOR ADMISSIONS REGISTRATIONS PATIENT DAYS REVENUE

# NAME MONTH YTD MONTH YTD MONTH YTD MONTH YTD CONTRACTUALS WRITE-OFF

AMT AMT

------------------------------------------------------------------------------------------------------------------------------------

501 BARNES DONNY 5 53 38 426 14 172 43,502.88 491,353.44 116,094.78 31,836.63

502 BEAVERS LAURA 20 304 65 689 285 2575 101,493.52 1,005,343.93 334,250.30 37,345.60

503 DERRINGTON JOHN 17 300 86 1377 1093 13270 145,370.56 2,204,181.52 339,425.75 60,430.43

505 JOHNSON SUE 22 308 273 3537 557 7024 115,299.87 1,664,195.98 362,788.03 2,584.03

507 OWNBY THEO 6 74 48 592 24 374 61,142.73 825,749.82 193,685.44 1,790.55

508 RICH MERYL 9 151 84 1173 85 1560 29,893.20 530,790.20 104,872.37 8,298.99

509 RICHARDS AUBREY 23 220 119 1569 245 3283 91,279.00 1,193,030.89 488,826.41 52,607.95

511 WOMACK SUSAN 26 11 393 240 3327 14,338.82 337,622.24 73,060.30 5,490.19

515 JACKSON FRANK 38 350 47 958 409 4518 104,183.52 1,051,362.03 220,639.49 50,456.57

517 SELLS JACK 28 54 534 91 1155 11,783.72 176,712.28 752.33 3,754.92

526 WILLIAMS MICHAEL 10 45 26 289 37 173 51,134.64 336,956.58 88,397.54 17,234.84

** TOTALS ** 150 1809 851 11537 3080 37431 769,422.46 9,817,298.91 2,322,792.70 271830.70

SAMPLE REPORTS A/R REPORTS A/R F/C Statistical Report Page 2.1

F/C Statistical Report

Overview: This option is used to print summary statistics by financial class for

month and year-to-date for the following: admissions, discharges, registrations, patient days, cash receipts, adjustments, bad debts,

inpatient revenue, outpatient revenue, gross revenue, revenue discounts, and net revenue.

This report prints in alphabetical order by financial class with each

financial class on a separate page. This report can be automatically selected at Month End. Indicate in the Month end reports record, Option 15 on the System

Control Menu, if this report should be generated automatically in the Month End Process, the number of copies to print, if the report should be archived, and if a distribution list is needed for the report.

Access: Reports Menu II, Option 2 Program: PB0R17 - Month to Date selection NPB0R17 - Historical Data selection Selection: Month to Date Historical Data From and Thru Date The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the


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Statistics: None Use: This report is used to analyze statistical information for each financial class. Files: FCDESC, STATRV


REPORT DATE 1/31/05 MEDHOST GENERAL HOSPITAL FAC# 001 PAGE

1 RUN DATE 2/25/05 TIME 2:33 PM FINANCIAL CLASS STATISTICAL REPORT PB0R17

FINANCIAL CLASS - M MEDICARE

MONTH YTD

----- ---

ADMISSIONS 1 1

DISCHARGES 0 0

REGISTRATIONS 0 0

PATIENT DAYS 285 9,819

CASH RECEIPTS 143,850.64 1,659,549.76

ADJUSTMENTS 5,125.06- 35,892.47-

BAD DEBTS .00 .00

I/P REVENUE 134,892.38 1,635,831.32

O/P REVENUE .00 .00

GROSS REVENUE 134,892.38 1,635,831.32

REVENUE DISCOUNTS .00 .00

NET REVENUE 134,892.38 1,635,831.32

SAMPLE REPORTS A/R REPORTS A/R F/C Comparison Report Page 3.1

F/C Comparison Report

Overview: This option is used to print summary statistics for month and year

based on user defined financial class groupings which are maintained in Revenue by F/C, Option 7 on the Hospital Table File Menu.

This report prints admissions, discharges, registrations, patient days,

cash receipts, adjustments, bad debts, inpatient revenue, outpatient revenue, total revenue, discount amount, and net revenue.

The bad debt amount only includes bad debt writeoffs. It does not

include reinstates or recoveries. This report can be automatically selected at Month End. Indicate in the Month end reports record, Option 15 on the System


Access: Reports Menu II, Option 3 Program: PB0R54 - Month to Date selection NPB0R54 - Historical Data selection Selection: Month to Date Historical Data From and Thru Date The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the


Statistics: None Use: This report is used to compare statistics for each financial class grouping. Files: FCDESC, STATRV

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FIELD DESCRIPTION

Print

Indicate if the report should be printed. Yes = The report should be printed. No = The report should not be printed. This field will be displayed and can be changed in the Printer/Archive Options window when a report is selected. R = The system automatically prints some reports. In these cases, an 'R' for Required will be shown in this field. H = The report should be placed on hold and not printed.

Copies

Indicate the number of copies of the report to be printed 1-99. This field will be displayed and can be changed in the Printer/Archive Options window when a report is selected.

Outq Enter the printer outq name.

Distribution Yes or No - Allows a distribution list to be set up for the report.

Archive Select Yes if the report should be saved to optical disk (archive). Otherwise, select No.


FAC# 001 PAGE 1

RUN DATE 2/25/98 TIME 2:33 PM FINANCIAL CLASS COMPARISON REPORT PB0R54

F/C BLUE CROSS CHAMPUS COMMERCIAL MEDICARE SELF PAY WORK COMP OTHER TOTAL

MO ---------- ---------- ---------- ---------- ---------- ---------- ----- -----

---

YTD

ADMISSIONS 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

DISCHARGES 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

REGISTR. 2 0 1 1 2 0 0 6

2 0 1 1 2 0 0 6

PAT. DAYS 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

$ RECEIPTS .00 .00 .00 2.00 .00 .00 .00 2.00

.00 .00 .00 2.00 .00 .00 .00 2.00

ADJUSTMENT .00 .00 .00 .00 .00 .00 .00 .00

.00 .00 .00 .00 .00 .00 .00 .00

BAD DEBTS .00 .00 .00 .00 .00 .00 .00 .00

.00 .00 .00 .00 .00 .00 .00 .00

I/P REV. .00 .00 .00 5.00 .00 .00 .00 5.00

.00 .00 .00 5.00 .00 .00 .00 5.00

O/P REV. .00 .00 .00 .00 .00 .00 .00 .00

.00 .00 .00 .00 .00 .00 .00 .00

TOTAL REV. .00 .00 .00 5.00 .00 .00 .00 5.00

.00 .00 .00 5.00 .00 .00 .00 5.00

DISC. AMT. .00 .00 .00 .00 .00 .00 .00 .00

.00 .00 .00 .00 .00 .00 .00 .00

NET REV. .00 .00 .00 5.00 .00 .00 .00 5.00

.00 .00 .00 5.00 .00 .00 .00 5.00

SAMPLE REPORTS A/R REPORTS A/R F/C Comparison Report By HSV Page 4.1

F/C Comparison Report By HSV

Overview: This option is used to print summary statistics for selected hospital

service codes for month and year based on user defined financial class groups which are maintained in Revenue by F/C, Option 7 on the

Hospital Table File Menu. This report prints cash receipts, adjustments, bad debts, inpatient

revenue, outpatient revenue, total revenue, discount amount, and net revenue.

Note: Totals will be based on data for full month / year selected. The bad debt amount includes bad debt writeoffs and recoveries. This report can be automatically selected at Month End. If this report is run during Month End Processing, all hospital service

codes will be selected. Indicate in the Month end reports record, Option 15 on the System


Access: Reports Menu II, Option 4 Program: PA0R68 - Month to Date selection NPA0R68 - Historical Data selection

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Selection: Month to Date Historical Data From and Thru Date The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The archive selection will only be shown if MEDHOST Archive is

installed in the Hospital name/addr/id# record, Option 1 on the System Control File Menu. The Archive field will default to 'N'. Be sure to change it to 'Y' to archive the report.

Statistics: None Use: This report is used to compare dollar amounts for each financial class grouping and selected hospital service code. Files: STATHD, RVSTATS, SYSCTL, SYSTABFL


NPA0R68 MEDHOST SAMPLE HOSPITAL Page:

1 FAC#: 990 Financial Class Comparison by HSV Date: 9/28/2011

AMBULATORY SURGERY Period Beginning Date 2/21/10 Period Ending Date 2/28/11 Time: 11:25 AM

Totals will be based on data for full month / year selected.

F/C MEDICARE MEDCAID DEAN CARE LANDS END ALLIANCE CONTRACTS OTHER TOTAL

--- ---------- ---------- ---------- ---------- ---------- ---------- ----------- ------------

$ RECEIPTS MTD .00 .00 .00 .00 .00 .00 .00 .00

YTD .00 .00 .00 .00 .00 .00 .00 .00

ADJUSTMENT .00 .00 .00 .00 .00 .00 .00 .00

.00 .00 .00 .00 .00 .00 .00 .00

BAD DEBTS .00 .00 .00 .00 .00 .00 .00 .00

.00 .00 .00 .00 .00 .00 .00 .00

I/P REV. .00 .00 .00 .00 .00 .00 .00 .00

.00 .00 .00 .00 .00 .00 .00 .00

O/P REV. 737.45 48.25 .00 .00 1037.40 .00 20316.85 22139.95

737.45 48.25 .00 .00 1037.40 .00 20316.85 22139.95

TOTAL REV. 737.45 48.25 .00 .00 1037.40 .00 20316.85 22139.95

737.45 48.25 .00 .00 1037.40 .00 20316.85 22139.95

DISC. AMT. .00 .00 .00 .00 .00 .00 .00 .00

.00 .00 .00 .00 .00 .00 .00 .00

NET REV. 737.45 48.25 .00 .00 1037.40 .00 20316.85 22139.95

737.45 48.25 .00 .00 1037.40 .00 20316.85 22139.95

SAMPLE REPORTS A/R REPORTS A/R Statistical Report By Service Page 5.1

Statistical Report By Service

Overview: This option is used to print statistical reports by hospital service code. ● Inpatients:

The report prints the admissions, discharges, and patient days for month and year-to-date by hospital service code. ● Outpatients: The report prints the registrations and visits for month and year-to date by hospital service code. The report prints in alphabetic order by hospital service code. Separate reports and totals print for inpatient, nursing home, outpatient, home health, emergency, inpatient rehab, industrial, pharmacy, and clinic service. This report can be automatically selected at Month End. Indicate in the Month end reports record, Option 15 on the System


Access: Reports Menu II, Option 5 Program: PB0R27 - Month to Date selection NPB0R27 - Historical Data selection

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Selection: Month to Date Historical Data From and Thru Date The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the


Statistics: Admissions - Month and YTD Discharges - Month and YTD Patient days - Month and YTD Registrations - Month and YTD Visits - Month and YTD Use: This report is used to analyze statistical information for each type of service. File: STATDR



RUN DATE 2/25/04 TIME 2:33 PM STATISTICAL REPORT BY SERVICE-INPATIENT PB0R27

HOSPITAL SERVICE ------ ADMISSIONS ------ ------ DISCHARGES ------ ------ PATIENT DAYS ------

MONTH YTD MONTH YTD MONTH YTD

LONG TERM CARE INTERMEDIATE 0 0 0 0 1,457 18,636

LONG TERM CARE SKILLED 0 0 0 0 582 6,646

MEDICAL ACUTE CARE 150 1,699 137 1,659 746 9,752

NEWBORN ACUTE CARE 12 164 15 166 52 498

OBSTETRICS ACUTE CARE 14 177 14 169 37 420

PEDIATRICS ACUTE CARE 4 194 8 194 9 599

SURGICAL ACUTE CARE 17 207 17 186 51 715

SWING BED 4 68 9 73 70 793

INPATIENT SERVICE ** TOTAL 201 2,509 200 2,447 3,004 38,059


RUN DATE 2/25/04 TIME 2:33 PM STATISTICAL REPORT BY SERVICE-OUTPATIENT PB0R27

HOSPITAL SERVICE ----- REGISTRATIONS ---- -------- VISITS --------

MONTH YTD MONTH YTD

AMBULATOR OUT PATIENT 710 8,930 2 164

AMBULATOR SURGERY 58 706 0 0

EMERGENCY EMERGENCY ROOM 836 12,046 2 8

HOME HEALTH DAY CARE 0 646 0 644

LONG TERM CARE SKILLED 0 96 0 102

MEDICARE DIAGNOSTIC SERVICES 390 5,332 0 42

MEDICAL RECORDS REPORT 0 107 0 0

OUT PATIENT PHYSICAL THERAPY 24 203 33 967

OUTPATIENT SERVICE ** TOTAL 2,018 28,066 37 1,927

SAMPLE REPORTS A/R REPORTS A/R A/R Transaction Statistics Report Page 6.1

A/R Transaction Statistics Report

Overview: This option prints receipts and adjustments month and year-to-date

for each accounts receivable transaction code. This report prints in numerical order by transaction code. This report can be automatically selected at Month End. Indicate in the Month end reports record, Option 15 on the System


Access: Reports Menu II, Option 6 Program: AR0R21 - Month to Date selection NAR0R21 - Historical Data selection Selection: Month to Date Historical Data From and Thru Date The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the System Control File Menu. The Archive field will default to 'N'. Be

sure to change it to 'Y' to archive the report.

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Statistics: None Use: This report is used to analyze cash receipts and adjustments by transaction code. File: ARDESC



RUN DATE 2/25/04 TIME 2:33 PM ACCOUNTS RECEIVABLE TRANSACTION STATISTICS REPORT AR0R21

TRANSACTION RECEIPTS ADJUSTMENTS

CODE DESCRIPTION MONTH YTD MONTH YTD

837 TRANSFER CREDIT 100.00- 97.49- .00 .00

838 REC COLL AGENCY 17,198.44 167,657.66 .00 .00

860 C.O. MCAID CTR. ADJ .00 .00 559.31- 8,043.67-

864 RETURN CHECK .00 .00 .00 145.27

958 EMPLOYEE DED ABDEBT .00 .00 110.00- 1,658.88-

959 REFUND BAD DEBTS .00 .00 .00 166.10

960 MCARE BDEBT CTR ADJ .00 .00 .00 1,183.36-

966 MEDICARE CHARGE OFF .00 559.53- .00 .00

967 BD CONTR ADJ OTHER .00 .00 12.94- 64.22-

968 MEDICAID BADDEBT PAY 759.69 7,591.49 .00 .00

969 BAD DEBT ADJUSTMENT .00 .00 605.35- 1,093.24-

970 BAD DEBT COMBINED .00 .00 595.25- 595.25-

972 CREDIT CARD PAY BD .00 50.00 .00 .00

974 MCARE BD CR ADJ .00 .00 .00 979.39

976 MISC INC OTHER C O .00 .00 .00 220.69

** T O T A L S ** 1,424,555.87 16,974,838.29 288,272.78- 2,965,380.86-

SAMPLE REPORTS A/R REPORTS A/R Estimated Reserve Page 7.1

Estimated Reserve

Overview: This option is used to print the Expected Value Listing of patient

accounts where 100% of the billed amount is not expected to be received.

A credit code must have been set up for the percentage of billed

amounts deemed uncollectible using Update Credit Code File, Option 3 on the Collections Maintenance Menu. The system assigns credit codes 1 through 9 to reflect 10% through 90%. The credit code that is used to calculate the expected value is assigned to the patient in Collections work list, Option 1 on the Collections Menu.

The report shows the patient number, patient name, original balance,

current balance, reserve percent, allowance, and expected value. There is also a comment field that displays comments entered through Collections work list or Admission/Registration.

There is no prompt screen displayed after the option selection. Access: Reports Menu II, Option 10 Program: PA0R08 Selection: None Statistics: None Use: This report is used to show the anticipated amount that will need to be written off at the end of the month. Files: PATIENTS, ARMAST, COMNTFIL

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SAMPLE REPORTS A/R REPORTS A/R Estimated Reserve Page 7.2


TIME: 12:41:52 EXPECTED VALUE LISTING PA0R08

PATIENT PATIENT NAME ORIGINAL CURRENT RESERVE ALLOWANCE EXPECTED

NUMBER BALANCE BALANCE PERCENT VALUE

------- ------------ -------- ------- ------ --------- --------

0012531 SYKES MENDALE S 2,775.20 2,209.57 .2500 552.39 1,657.18

5/06/00 JIMMY WATTS IN MEDICAL RECORDS HAS JACKET, HE IS GOING TO GET ATTESTATION

AND BRING TO SHAWN AND LET HER FILE BACK TO MEDICARE.

0013564 PUGHES PAMELA 3,507.50 649.00 .3500 227.15 421.85

5/27/00 ACCOUNT IN MEDICAL REVIEW.

SAMPLE REPORTS A/R REPORTS A/R A/R Transaction Analysis Page 8.1

A/R Transaction Analysis

Overview: This option prints a detailed A/R transaction analysis. Depending on the type of transaction selected, the heading of the report will be one of the following: ∙ Cash Receipts Analysis ∙ Adjustment Analysis ∙ Late Charges ∙ Miscellaneous Cash The Miscellaneous Cash report prints the G/L account number, transaction date, transaction amount, and G/L account number description. The other reports list the patient number, patient name, transaction date, amount, financial class, hospital service code, patient type, physician number, G/L credit account number, A/R transaction code, cycle number, and transaction code description. The reports print in numerical order by transaction code and

transaction date. Access: Reports Menu II, Option 11 Program: AR0P57

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Selection: Type of transaction Payments Adjustments Late charges * Miscellaneous Cash Date range - From and Thru Account number range - From and Thru Select by Financial Class - Y or N If Yes, enter up to 10 financial class codes. Select by Hospital Service Code - Y or N If Yes, enter up to 10 hospital service codes. All transaction codes or select transaction codes If select codes, enter up to 10 A/R transaction codes The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the


* Late charges that have been billed on a late charge bill will not appear on this report. Also, transactions for accounts which have been purged will not appear on this report. Statistics: None Use: This report is used to provide supporting detail based on user selection for all A/R transactions. File: ARACCUM


RUN DATE 5/24/01 TIME 12:15:47 EXAMPLE HOSPITAL FAC# 001 PAGE 1

SELECTED F/C : S D P CASH RECEIPTS ANALYSIS AR0P57

FROM 1/01/00 THRU 3/31/00

SELECTED HSV : EMR MED

PATIENT TRAN PHY G/L TRAN

NUMBER NAME DATE AMOUNT F/C HSV TYP NO. CREDIT CODE CYCLE DESCRIPTION

------- ---- ---- ------ --- --- --- --- ------ ---- ----- -----------

4021381 BAKER JOSHUA 1/03/00 82.82- S EMR E 392 0011010 751 01 PRISON HEALTH SERV

4044152 WILSON HAROLD S 1/03/00 842.62- S EMR E 683 0011010 751 01 PRISON HEALTH SERV

4044154 WHITE DAVID L 1/03/00 340.09- S EMR E 683 0011010 751 01 PRISON HEALTH SERV

1101268 FUCHES JOSEPH E 2/16/00 518.34- S EMR E 683 0011010 751 01 PRISON HEALTH SERV

1102134 FREELEY ANTHONY 2/16/00 1,209.24- S MED I 683 0011010 751 01 PRISON HEALTH SERV

4028725 SMITHE ELEAZAR 2/16/00 568.02- S EMR E 238 0011010 751 01 PRISON HEALTH SERV

4043410 HENRY RONALD 2/16/00 290.22- S EMR E 277 0011010 751 01 PRISON HEALTH SERV

4044989 GLENN LEON RAY 2/16/00 133.37- S EMR E 277 0011010 751 01 PRISON HEALTH SERV

4045953 ANTELL WILLIAM A 2/16/00 472.45- S EMR E 683 0011010 751 01 PRISON HEALTH SERV

4046423 BARNES MAHLON T 2/16/00 273.35- S EMR E 683 0011010 751 01 PRISON HEALTH SERV

4047390 FARMER LORENZO 2/16/00 214.50- S EMR E 683 0011010 751 01 PRISON HEALTH SERV

6001289 MALIN LARRIO 2/16/00 286.93- S EMR E 277 0011010 751 01 PRISON HEALTH SERV

4485746 VICKERS STANLEY 3/09/00 1,238.80- S MED I 683 0011010 751 01 PRISON HEALTH SERV

TOTAL TRANS - 6,470.75-

4040539 TAYLOR MICHAEL DUANE 2/07/00 476.46- P EMR E 001 0011010 804 01 GE PREFERRED PY

4040940 TAYLOR MICHAEL DUANE 2/07/00 126.54- D EMR E 001 0011010 804 01 GE PREFERRED PY

4042577 PETERSON RYAN A 2/07/00 333.17- D EMR E 046 0011010 804 01 GE PREFERRED PY

4046557 GREENE JOSHUA MICHAEL 2/07/00 462.72- D EMR E 277 0011010 804 01 GE PREFERRED PY

4046727 TURNER JAMES R 2/07/00 897.50- D EMR E 278 0011010 804 01 GE PREFERRED PY

4047385 WALTERS BRIAN MATTHEW 2/07/00 117.09- D EMR E 046 0011010 804 01 GE PREFERRED PY

4047578 GREENE JOSHUA MICHAEL 2/07/00 289.23- D EMR E 046 0011010 804 01 GE PREFERRED PY

4047605 COWELL CODY ALLEN 2/07/00 509.27- D EMR E 105 0011010 804 01 GE PREFERRED PY

4047640 DEWITT TRINITY JADE 2/07/00 161.07- D EMR E 278 0011010 804 01 GE PREFERRED PY

4047652 EDWARDS DENA K 2/07/00 238.50- D EMR E 278 0011010 804 01 GE PREFERRED PY

4047874 BRAUNS MYRNA L 2/07/00 90.40- D EMR E 384 0011010 804 01 GE PREFERRED PY

4048019 SENN JOHN WILLIAM 2/07/00 149.26- D EMR E 041 0011010 804 01 GE PREFERRED PY

4048082 WHEELER CHARLES W 2/07/00 198.55- D EMR E 244 0011010 804 01 GE PREFERRED PY

4048405 WHEELER CHARLES W 2/07/00 296.20- D EMR E 267 0011010 804 01 GE PREFERRED PY

4048422 HOWE LOREN A 2/07/00 249.79- D EMR E 239 0011010 804 01 GE PREFERRED PY

4048498 TURNER JAMES R 2/07/00 25.85- D EMR E 002 0011010 804 01 GE PREFERRED PY

4048521 DAVIS ASHLEY N 2/07/00 281.46- D EMR E 278 0011010 804 01 GE PREFERRED PY

4048573 GOFFINET DENNIS L 2/07/00 36.92- D EMR E 785 0011010 804 01 GE PREFERRED PY

4048609 BAUR JORDAN M 2/07/00 9.30- D EMR E 333 0011010 804 01 GE PREFERRED PY

4048613 HENZE VIRGINIA LOUISE 2/07/00 9.30- D EMR E 333 0011010 804 01 GE PREFERRED PY

4048623 WALTERS JANET K 2/07/00 498.57- D EMR E 267 0011010 804 01 GE PREFERRED PY

4048656 WALTERS CHRISTOPHER C 2/07/00 130.29- D EMR E 014 0011010 804 01 GE PREFERRED PY

4048687 HAGEDORN TAMARA LOUISE 2/07/00 209.99- D EMR E 384 0011010 804 01 GE PREFERRED PY

4048779 MCCASLIN PENNY J 2/07/00 321.87- D EMR E 014 0011010 804 01 GE PREFERRED PY

4048800 WALTERS BRIAN MATTHEW 2/07/00 126.48- D EMR E 046 0011010 804 01 GE PREFERRED PY

4048945 COWELL CODY ALLEN 2/07/00 114.02- D EMR E 105 0011010 804 01 GE PREFERRED PY

TOTAL TRANS - 6,359.80-

FINAL TOTAL - 12,830.55-


RUN DATE 5/24/01 TIME 13:17:07 EXAMPLE HOSPITAL FAC# 001 PAGE 1

SELECTED F/C : N MISCELLANEOUS CASH AR0P57

FROM 1/01/00 THRU 3/31/00

G/L TRAN

NUMBER DATE AMOUNT DESCRIPTION

------ ---- ------ -----------

0011698 2/23/00 318.54 A/R CLEARING ACCOUNT

TOTAL TRANS - 318.54

0095087 1/07/00 41.00 COLLECTION FEES

TOTAL TRANS - 41.00

FINAL TOTAL - 359.54

SAMPLE REPORTS A/R REPORTS A/R G/L Reports Page 9.1

G/L Reports

Overview: This option generates a listing of entries from the General Ledger file. The report lists the sequence number, source code, reference

number, date, debit account, credit account, debit amount, credit amount, and account description.

Totals are printed for each day, source code, and facility. Note: This report is not available for facilities with the MEDHOST

General Ledger Module. Access: Reports Menu II, Option 12 Program: ZZ0R06 Selection: Print by month ending date or reference number Summary or Detail report Statistics: None Use: Facilities that do not have the MEDHOST General Ledger Module can

use this listing to key journal entries into a general ledger system. File: ZZGLDETL

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SAMPLE REPORTS A/R REPORTS A/R G/L Reports Page 9.2

ZZ0R06 EXAMPLE FACILITY RUN DATE 6/22/06 PAGE 1

FOR REFERENCE NO.: 000424

SEQ. ACCOUNT AMOUNT

NO SRCE REF# DATE DEBIT CREDIT DEBIT CREDIT DESCRIPTION

----- ---- ------ -------- ---------------- --------------------- -----------

00001 AR 000424 12/02/05 1010100 2,497.60 PAT. ACCT. POSTED 12/02/05


** DAY 12/02/05 2,497.60 2,497.60


** DAY 12/03/90 .00 3,269.13


00005 AR 000424 12/03/05 1040700 960.08 PAT. ACCT. POSTED 12/03/05

00006 AR 000424 12/03/05 1010100 676.12 PAT. ACCT. POSTED 12/03/05


** DAY 12/03/05 3,269.13 3,269.13

*** SOURCE 5,766.73 9,035.86

*** FACILITY 5,766.73 9,035.86

SAMPLE REPORTS A/R REPORTS A/R Summary Aging (F/C) Page 10.1

Summary Aging (F/C)

Overview: This option prints a summary aging which includes the amount,

percentage, and number of accounts by aging group by financial class. The aging groups are 0-30, 31-60, 61-90, 91-120, 121-150, 151-180, 181-365, 366-730, and over 731 days.

This report prints in alphabetical order by financial class. The amounts on the report will differ depending on the selection

options entered when generating the report. ● If the report is aged by Bill Date, the report will exclude zero

balance and bad debt accounts and the amounts will be totaled from ARSUMMRY which contains each billing cycle.

● If the report is aged by Discharge Date or Last Payment Date, the

report will exclude zero balance and bad debt accounts and the amounts will be totaled from ARMAST which contains current account balances.

Access: Reports Menu II, Option 13 Program: AR0R92

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Selection: Include inhouse accounts - Yes or No Include IP, OP, or both - I, O, or B Include credit balances - Yes or No Print by hospital service code - Yes or No If Yes, enter up to 10 codes. Date to age from Age by bill date, discharge date, last payment date Print F/C comparison summary line - Yes or No If Yes, a summary page will print with totals for the 6 financial classes defined in Revenue by F/C, Option 7 on the Hospital Table File Menu, a Miscellaneous total for all of the other financial classes on the aging, and a Summary Grand Total. The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Distribution – Y or N Archive - Y or N Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the


Statistics: None Use: This report is used to provide summary accounts receivable aging information on demand. Files: ARMAST, PATIENTS (discharge date, last payment date), ARSUMMRY (billing date)


RUN DATE 6/15/05 TIME 14:15:32 MEDHOST TEST FACILITY INHOUSE EXCLUDED PAGE 1

ASU AMBULATORY SURGERY CENTER SUMMARY AGING BY FINANCIAL CLASS CREDITS EXCLUDED AR0R92

AGE BY DISCHARGE DATE AGE FROM 6/30/05 IP & OP FAC# 001

(AMOUNTS ROUNDED)

FC DESCRIPTION 0-30 31-60 61-90 91-120 121-150 151-180 181-365 366-730 OVER 731 TOTAL

+ MEDICARE TO CHG OFF $656 $2892 $43 $3591

18.2 % 80.5 % 1.1 % 100 %

1 3 1 5

$ BANKRUPT PENDING CU $27 $23 $1109 $1333 $12933 $11024 $8337 $34786

3.1 % 3.8 % 37.1 % 31.6 % 23.9 % 100 %

1 1 6 7 33 37 21 106

% ESTATES TO DELETE $412 $109 $1272 $1546 $586 $1694 $5619

7.3 % 1.9 % 22.6 % 27.5 % 10.4 % 30.1 % 100 %

1 1 1 6 3 4 16

: MED RECORDS REPORTS $33 $22 $108 $104 $267

12.3 % 8.2 % 40.4 % 38.9 % 100 %

1 2 6 4 13

# MONTHLY CHARGE-OFF $187 $5952 $2093 $5064 $69975 $21232 $38160 $142663

.1 % 4.1 % 1.4 % 3.5 % 49.0 % 14.8 % 26.7 % 100 %

2 4 8 17 311 54 27 423

A EMPLOYEE DEDUCTION $464 $1427 $4505 $2472 $895 $17154 $51022 $25432 $103371

.4 % 1.3 % 4.3 % 2.3 % .8 % 16.5 % 49.3 % 24.6 % 100 %

1 7 9 3 7 21 36 29 113

B BLUE CROSS OF TN $4331 $3071 $5190 $12592

34.3 % 24.3 % 41.2 % 100 %

5 15 17 37

F M'CAID OUT OF STATE $333 $383 $486 $2006 $164 $10030 $1680 $116 $15198

2.1 % 2.5 % 3.1 % 13.1 % 1.0 % 65.9 % 11.0 % .7 % 100 %

2 4 2 4 2 215 27 1 257

G MEDICARE TO B C $3723 $2875 $1359 $18002 $646 $1484 $2101 $633 $30823

12.0 % 9.3 % 4.4 % 58.4 % 2.0 % 4.8 % 6.8 % 2.0 % 100 %

34 24 19 14 3 18 26 18 156

H MEDICARE TO OTH INS $23025 $21451 $15378 $4862 $3915 $9924 $17918 $7507 $103980

22.1 % 20.6 % 14.7 % 4.6 % 3.7 % 9.5 % 17.2 % 7.2 % 100 %

138 115 91 45 35 116 161 54 755


RUN DATE 6/15/05 TIME 14:15:32 MEDHOST TEST FACILITY INHOUSE EXCLUDED PAGE 1

ASU AMBULATORY SURGERY CENTER SUMMARY AGING BY FINANCIAL CLASS CREDITS EXCLUDED AR0R92

AGE BY DISCHARGE DATE AGE FROM 6/30/05 IP & OP FAC# 001

(AMOUNTS ROUNDED)


TOTALS -- $647425 $631107 $474381 $328065 $301182 $269455 $834835 $655407 $786241 $4928098

13.1 % 12.8 % 9.6 % 6.6 % 6.1 % 5.4 % 16.9 % 13.2 % 15.9 % 100 %

1609 1543 1209 956 826 665 2281 1318 670 11077


AR0R92 MEDHOST TEST FACILITY 6/15/05

SELECTED FINANCIAL CLASS A/R SUMMARY 16:48:17

MEDICARE MEDICAID HMO HMO-Q COMM & BC PATIENT MISCELLANEOUS SUMMARY GRAND TOTAL

----------- ----------- ----------- ----------- ----------- --------- ------------- -------------------

TOTALS $951098.00 $34391.00 $167365.00 $148577.00 $387589.00 $240132.00 $2998946.00 $4928098.00

SAMPLE REPORTS A/R REPORTS A/R Detail Aging (F/C) Page 11.1

Detail Aging (F/C)

Overview: This option prints a detailed aging by account which includes the

discharge date, last payment date, original balance, last payment amount, and aged amount of current balance. This report prints in either patient name or patient number order depending on the user selection.

The aging groups are determined by the report selection to round the

amounts. See the explanation below: ∙ Round amounts to nearest dollar = Y The aging groups are In House, 0-30, 31-60, 61-90, 91-120, 121- 150, 151-180, and over 180 days. ∙ Round amounts to nearest dollar = N The aging groups are In House, 0-30, 31-60, 61-90, 91-120, and over 120 days. Access: Reports Menu II, Option 14 Program: AR0R02

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Selection: Include inhouse accounts - Yes or No Include IP, OP, or both - I, O, or B Include credit balances - Yes or No Print by hospital service code - Yes or No If Yes, enter up to 10 codes. Date to age from Age by bill date, discharge date, or last payment date If aging by Bill date, the following selection will be shown: Print billed financial class - Y or N If 'Y', the financial class at the time of billing is used. If 'N', the financial class at the time of discharge or the current financial class is used. Select up to 10 Financial Class (F/C) codes or print all Select up to 10 Hospital Service Code (HSV) codes or print all The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Distribution – Y or N Archive - Y or N Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the


Statistics: None Field Heading: DISCH - Discharge date BILL - Bill date ORG BAL - Original balance LSTP - Last payment date LST PMT - Last payment amount Use: This report is used to provide detail aging for research or reference. Files: ARMAST, PATIENTS, ARSUMMRY


RUN DATE 6/30/06 TIME 15:34:03 EXAMPLE FACILITY FAC# 001 PAGE 1

AGED BY DISCHARGED DATE DETAIL AGING BY FINANCIAL CLASS AR0R02

FOR THE PERIOD ENDING 6/30/06 (ROUNDED TO NEAREST DOLLAR)

SELECTION CRITERIA - - INHOUSE - INCLUDED ZERO BALS-NOT INCLUDED INPATIENTS ONLY

FINANCIAL CLASSES SELECTED C

HOSPITAL SERVICE CODES ALL

** MEDICARE **

PAT NO. NAME IN HOUSE 0-30 31-60 61-90 91-120 121-150 151-180 OVER 180 TOTAL

5001615 ALLEN PEARL JANNA

DISCH 3/11/06 ORG BAL 0 3242 3242

LSTP 6/18/06 LST PMT 1680-

5001540 APPLE OLA LONELL

DISCH 1/07/06 ORG BAL 0 2536 2536


0003053 BOMAR EMMY SHANNON

DISCH 11/24/05 ORG BAL 950 1270 1270


5006085 BONNE ARTHUR JANMES

DISCH 6/12/86 ORG BAL 0 2713 2713


5007224 BOSTIS RAY CLIFFORD

DISCH 10/23/87 ORG BAL 0 2733 2733


5000070 BOYCE RICHARD JOHN

DISCH 1/04/89 ORG BAL 0 3429 3429


5001458 BRANTLEY ANNA MARIE

DISCH 9/04/91 ORG BAL 0 3714 3714


5001359 BRAY DANNY ROY

DISCH 4/16/05 ORG BAL 0 2478 2478


5000427 BROWN ESSIE

DISCH 11/04/89 ORG BAL 0 2758 2758


5001557 BROWN ELIZABETH JOY

DISCH 1/09/06 ORG BAL 0 7241 7241


5000039 BURROWS DOT GINA

DISCH 11/14/02 ORG BAL 0 3362 3362


SAMPLE REPORTS A/R REPORTS A/R Payor Aging Report Page 12.1

Payor Aging Report

Overview: This option prints either a detail or summary payor aging report which

shows billed amounts in aging categories. The detail report prints an aging by payor which includes the patient

number, patient name, cycle number, bill date, date filed (if entered), and aged balance. The aging categories are 30, 60, 90, 120, 180, and over 180. The report prints in payor order and then in either patient name or patient number order depending on the user

selection. A patient total will print for accounts with multiple cycles. Payor totals will print for the total amount billed and for each aging category. A grand total will print at the end of the report for all payors and each aging category.

The summary report prints an aging which includes the company

number (payor), company name, and the following aging categories 0-30, 31-60, 61-90, 91-120, 121-150, 151-180, 181-365, 366-730, and over 731. For each aging category, the total amount billed for each payor, the percentage of the total amount billed, and the number of accounts for each payor will be printed. Totals will

print for each payor and each aging category. Access: Reports Menu II, Option 15

AS/400 Archive must be set to Yes in the Hospital name/addr/id# record to send to optical (BIGBRO). Electronic Archive must be set to Yes in the Hospital name/addr/ id# record to send to the eArchive application.

Program: AR0R42 - Detail AR0R41 - Summary Selection: Date to age by Age by - Date billed or Date filed Sort by - Patient name or Patient number Include zero/credit balances - Y or N Payor/Plan Selection - Select up to 5 Payors/Plans Select up to 5 Payors and leave Plans blank for all Leave Payor/Plans blank for all Summary or Detail Report - S or D

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SAMPLE REPORTS A/R REPORTS A/R Payor Aging Report Page 12.2

Statistics: None Use: This report is used to identify balances by cycle for billed patients and can be used to track balances for secondary carriers. File: ARSUMMRY

AR0R42 SORT BY: PATIENT NUMBER MEDHOST FACILITY RUN DATE 1/20/10 PAGE 1

AGED BY: DATE BILLED PAYOR AGING REPORT

ZERO: EXCLUDED AGE FROM 01/23/09

CREDIT: EXCLUDED

PAYOR CO. 300 PAYOR PL. 001 MEDICAID

PATIENT DISCHARGE CYC CYC ORG DATE DATE *********************************************** D A Y S *************************************************

NUMBER PATIENT NAME DATE # BALANCE BILL FILED TOTAL ---- 30 ---- ---- 60 ---- ---- 90 ---- ---- 120 --- ---- 180 --- -- OVER 180 --

9307039 EDWARDS PETER A 1/07/08 02 54.00 1/16/08 NOT FILED 54.00 54.00

9307060 BAKER JOHN G 1/03/08 01 8388.00 1/12/08 NOT FILED 8388.00 8388.00

9307060 BAKER JOHN G 1/03/08 02 220.00 1/12/08 NOT FILED 220.00 220.00

** PATIENT 9307060 TOTAL ** 8608.00

9307607 BROWN JOHN Q 1/07/08 01 10293.00 1/16/08 NOT FILED 10293.00 10293.00

9308339 PARKER SUE R 1/10/08 02 1155.00 1/18/08 NOT FILED 1155.00 1155.00

9312763 FITZGERALD PAT R 2/07/08 01 50737.50 2/15/08 NOT FILED 50737.50 50737.50




** PATIENT 9312763 TOTAL ** 51858.50

9313016 FULLER MARK G 2/05/08 01 28398.00 2/13/08 NOT FILED 28398.00 28398.00

9313016 FULLER MARK G 2/05/08 02 182.00 2/13/08 NOT FILED 182.00 182.00

** PATIENT 9313016 TOTAL ** 28580.00

9313953 JACKSON SUE Q 2/06/08 01 2114.00 2/14/08 NOT FILED 2114.00 2114.00

9314525 FITZGERALD PAT Q 2/11/08 01 29603.00 2/18/08 NOT FILED 29603.00 29603.00

9314525 FITZGERALD PAT Q 2/11/08 02 214.00 2/18/08 NOT FILED 214.00 214.00

** PATIENT 9314525 TOTAL ** 29817.00



** PATIENT 9315867 TOTAL ** 38381.00

9316277 ROGERS JAMES Q 2/15/08 01 19527.56 2/20/08 NOT FILED 19527.56 19527.56



** PATIENT 9316277 TOTAL ** 21284.06

9316425 WHITE BILLIE R 2/22/08 01 48745.50 2/27/08 NOT FILED 48745.50 48745.50

9316425 WHITE BILLIE R 2/22/08 02 382.00 2/27/08 NOT FILED 382.00 382.00

** PATIENT 9316425 TOTAL ** 49127.50

9316967 WHITE PAT Q 2/20/08 01 20225.80 2/26/08 NOT FILED 20225.80 20225.80



** PATIENT 9316967 TOTAL ** 21189.80

9318723 PARKER BART G 2/25/08 01 9141.50 2/29/08 NOT FILED 9141.50 9141.50

9318723 PARKER BART G 2/25/08 02 47.00 2/29/08 NOT FILED 47.00 47.00

** PATIENT 9318723 TOTAL ** 9188.50

TOTAL 300 271,650.36

AR0R41 EXAMPLE HOSPITAL PAGE: 1

TIME 15:03:34 PAYOR AGING SUMMARY REPORT RUN DATE: 5/25/01

AGE FROM 3/31/01

CO# COMPANY NAME 0 - 30 31 - 60 61 - 90 91 - 120 121 - 150 151 - 180 181 - 365 366 - 730 OVER 731 TOTAL

001 MEDICARE 267,925.86 267,925.86

17.71 100.00 %

705 14,950

002 MEDICAID 3724.50 3,724.50

26.85 100.00 %

357 2,252

GRAND TOTALS : 271,650.36 271,650.36

19.24 100.00 %

1,062 17,202

SAMPLE REPORTS A/R REPORTS A/R Aged Cash Receipts Summary (F/C) Page 13.1

Aged Cash Receipts Summary (F/C)

Overview: This option prints a summary of cash receipts by financial class into

age categories. Each age category prints amount, percent and number of payments by financial class. Age categories are 0-30, 31-60, 61-90,91-120, 121-150, 151-180, 181-365, 366-730, over

731 days, and total balances. All dollar amounts are rounded to the nearest dollar. This report prints in alphabetical order by financial class. Access: Reports Menu II, Option 16 Program: AR0R37 Selection: Age by bill date or discharge date Month ending date Statistics: None Use: This report is used to evaluate the length of time it takes to collect payments by financial class. File: ARACCUM

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SAMPLE REPORTS A/R REPORTS A/R Aged Cash Receipts Summary (F/C) Page 13.2

AR0R37 EXAMPLE FACILITY AGED BY DISCHARGE DATE

MONTH ENDING 6/30/06 PERIOD 12 AGED CASH RECEIPTS SUMMARY (AMOUNTS ARE ROUNDED TO NEAREST DOLLAR) 7/22/06


Y HOME HEALTH

100%

Z SWING BED - $4,894 $3,176 $810 $8,880

55.1 % 35.7 % 9.1 % 100%

3 3 1 7

1 BLUE CROSS $17,711 $15,311 $3,764 $4,468 $1,503 $993 $9 $43 $43,802

40.4 % 34.9 % 8.5 % 10.2 % 3.4 % 2.2 % 100%

133 53 19 10 5 3 1 2 226

2 MEDICARE $37,149 $82,246 $20,537 $661 $446 $3,498 $1,780 $5,200 $151,517

24.5 % 54.2 % 13.5 % .4 % .2 % 2.3 % 1.1 % 3.4 % 100%

418 136 39 11 6 9 8 3 630

3 OTHER INSUR $73,731 $173,087 $30,776 $16,336 $14,242 $603 $1,717 $393 $310,885

23.7 % 55.6 % 9.8 % 5.2 % 4.5 % .1 % .5 % .1 % 100%

187 409 100 40 30 11 21 5 803

4 MEDICAID $50,726 $14,743 $10,856 $7,855 $1,361 $2,080 $7,387 $601 $95,609

53.0 % 15.4 % 11.3 % 8.2 % 1.4 % 2.1 % 7.7 % .6 % 100%

498 54 53 42 25 19 28 8 727

5 PRI PAY STA $5 $50 $395 $25 $315-

1.5-% 15.8-% 125.3 % 7.9-% 100%

2 1 4 1 8

6 MEDICARE PR $770 $1,344 $2,292 $1,307 $1,061 $145 $2,384 $755 $362 $10,420

7.3 % 12.8 % 21.9 % 12.5 % 10.1 % 1.3 % 22.8 % 7.2 % 3.4 % 100%

13 18 38 26 16 5 28 20 21 185

TOTALS- $190,872 $318,967 $101,385 $51,804 $28,544 $14,795 $29,738 50,605 $124,742 $911,452

20.9 % 34.9 % 11.1 % 5.6 % 3.1 % 1.6 % 3.2 % 5.5 % 13.6 % 100%

1378 1022 463 257 168 122 354 300 323 4387

SAMPLE REPORTS A/R REPORTS A/R Credit Balance Report Page 14.1

Credit Balance Report

Overview: This option prints a listing showing patients with a credit balance. The

report lists patient number, guarantor number, patient name, financial class, admit date, discharge date, last payment date,

payment service, and balance. All amounts on this report are credit balances and appear without the

sign. This report prints in patient number order or patient name order

depending on the user selection. Access: Reports Menu II, Option 17 Program: AR0R25 Selection: Credit balance to print Active A/R credit accounts Bad Debt credit accounts All credit accounts Print in patient number order or patient name order Statistics: None Use: This report is used to evaluate the length of time it takes to collect payments by financial class. File: ARMAST

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SAMPLE REPORTS A/R REPORTS A/R Credit Balance Report Page 14.2


AR0R25 ACCOUNTS RECEIVABLE -- CREDIT BALANCE REPORT

- ACTIVE CREDIT ACCOUNTS -

PATIENT GUARANTOR PATIENT F/C ADMIT DISCHARGE LAST PAY PMT BALANCE

NO. NO. NAME DATE DATE DATE SRC

7138001 0013968 ADAMS ALEXANDER COLE I 4/01/99 4/01/99 11/08/99 5 104.00

7171457 0021066 BAKER MARY CATHERINE 6 7/25/99 7/25/99 9/27/99 5 45.16

1397231 4158316 COOKE BEATRICE G 12/31/97 1/04/98 3/13/98 5 9.60

1444611 4158316 COOKE BEATRICE G 8/19/99 8/24/99 1/23/00 5 19.35

7253008 4158316 COOKE BEATRICE H 9/29/99 9/29/99 11/15/99 5 14.45

7510100 0024400 DAVIS ROBERT EDWARD 6 5/02/00 5/02/00 6/14/00 3 44.40

7287469 0015322 EDEN PEARL SMITH 6 9/30/99 9/30/99 10/25/99 5 3.00

1335801 6067698 FENDERS ARINE 6 2/09/96 2/12/96 7/14/96 5 540.00

6133769 6067698 FENDERS ARINE 6 1/28/96 1/28/96 6/08/96 5 30.80

9781540 0019998 GAINS WILLIAM DEAN J : 4/08/99 4/08/99 7/24/99 5 25.00

7448499 0024234 HARRIS FORREST WILL 6 5/12/00 5/12/00 6/05/00 5 35.00

7256209 0011829 LAWRENCE BERNICE MAY 6 10/08/99 10/08/99 1/21/00 5 55.90

7170160 0004396 NELSON MAMIE ELIZA H 7/16/99 7/16/99 4/15/00 5 351.80

1418359 0017416 ROGERS ELSIE DEE G 9/06/98 9/11/98 11/26/99 5 4.60

7364144 4097201 SMITH BOBBY CARTER 6 1/25/00 1/25/00 2/17/00 5 33.36

7440696 0024345 SMITH DONNA SUE 3 4/29/00 4/29/00 6/19/00 1 5.92

1461367 0023844 SMITH KATIE MARY G 3/31/00 4/08/00 6/22/00 1 569.19

1439785 0001960 TATE JAMES EDWARD U 6/03/99 6/05/99 1/30/00 5 312.80

7271174 0001960 TATE JAMES EDWARD 3 10/23/99 10/23/99 2/05/00 5 47.20

1462647 0001960 THOMAS STELLA JO U 5/01/00 5/04/00 6/16/00 1 80.50

7298714 4083979 UTLEY MARY ELLEN 2 10/23/99 10/23/99 1/23/00 5 14.40

7314446 0004471 UTLEY CHRISTINE G 11/25/99 11/25/99 1/27/00 5 30.00

1433967 0019627 WILLIAMS SUSAN NELL G 3/21/99 3/22/99 12/23/99 5 26.00

7100423 0001804 ZACKARY JOHN FRANK I 1/01/99 3/29/99 9/09/99 5 80.75

7160179 0001804 ZACKARY JOHN FRANK I 6/01/99 6/30/99 10/17/99 5 80.75

7199935 0017516 ZACKARY SUE VANELLA I 8/01/99 8/31/99 4/21/00 5 934.25

------------------

** TOTAL ** 3,498.18

SAMPLE REPORTS A/R REPORTS A/R Bad Debt Write-Off Report Page 15.1

Bad Debt Write-Off Report

Overview: This option lists all accounts that have been written off to bad debt. The report by bad debt financial class prints the patient number,

patient name, financial class, write-off date, write-off amount, total recoveries, collection expense,total adjustments, date of last payment, and balance of write-off.

The report by financial class prints the patient number, patient name,

discharge date, bad debt write-off financial class, date of write-off, original write-off amount, total amount recovered, collection expense, total amount adjusted, date of last payment, and balance of write-off.

This report prints in patient number order or patient name order

depending on the user selection. Access: Reports Menu II, Option 18 Program: AR0R24 - Bad Debt Financial Class AR0R30 - Financial Class 1 AR0R31 - Financial Class 2 AR0R32 - Financial Class 3

|

|


Selection: Print by bad debt financial class, financial class 1, financial class 2, or financial class 3 Print all bad debt accounts, select by write-off date or select by bad debt financial class Write-off date - From and Thru Financial class - Enter up to 10 codes Exclude zero balances - Yes or No Exclude credit balances - Yes or No The Printer/Archive Options window will be displayed to allow the following selections to be entered:

• Print - Y or N • Copies - Number of copies • Outq - Printer outq name • Archive - Y or N

Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on

the System Control File Menu. The Archive field will default to 'N'. Be sure to change it to 'Y' to archive the report.

Statistics: None Use: This report is used to track bad debt write-off activity and support bad debt summaries for year end audits. File: ARMAST


RUN DATE 4/15/06 TIME 14:13:25 MEDHOST TEST FACILITY FAC# 001 PAGE 1

ZERO BALANCES EXCLUDED BAD DEBT WRITE-OFF REPORT BY BAD DEBT F/C AR0R24

CREDIT BALANCES EXCLUDED

BAD DEBT F/C - 7 COLLECT AGY

PATIENT PATIENT A/R DATE OF ORG. WRITE- TOTAL AMT. COLLECTION TOTAL AMT. DATE OF BALANCE OF

NUMBER NAME FCL. WRITE OFF OFF AMOUNT RECOVERED EXPENSE ADJUSTED LAST PYMT WRITE OFF

1138114 CARROL KAREN ANNE + M 9/30/97 393.81 .00 .00 .00 0/00/00 393.81

1256205 HARRIS MARGERETTA + M 5 9/30/97 6,966.04 .00 .00 .00 0/00/00 6,966.04

5005467 SWINDLE LARRY + M 9/30/97 3,450.62 .00 .00 .00 0/00/00 3,450.62

1299874 THOMAS JOHNSON M U L 7/28/05 1,000.00 839.80 .00 189.90- 6/26/01 60.10

TOTALS FOR F/C --7 # OF ACCTS 4 11,810.47 839.80 .00 189.90- 10,870.57


ZERO BALANCES EXCLUDED BAD DEBT WRITE-OFF REPORT BY BAD DEBT F/C AR0R24

CREDIT BALANCES EXCLUDED

BAD DEBT F/C - 8 BANKRUPTCY

PATIENT PATIENT A/R DATE OF ORG. WRITE- TOTAL AMT. COLLECTION TOTAL AMT. DATE OF BALANCE OF

NUMBER NAME FCL. WRITE OFF OFF AMOUNT RECOVERED EXPENSE ADJUSTED LAST PYMT WRITE OFF

6614267 COLEMAN MARK TIMOTHY # U 1 5/25/00 193.00 177.52 .00 .00 3/06/02 15.48

6152276 DONNER ASHLEY NICOLE C U 3 6/21/99 58.25 425.86 .00 1,811.25 6/22/02 1,443.64

6222350 FLOYD HENRIETTA # 8 U 3/27/00 434.50 394.50 .00 .00 3/23/02 40.00

1331610 FLOYD BOBBY DARRELL # U 4 7/27/99 365.00 305.42 .00 164.00 6/22/02 223.58

6196018 HENDERSON RICKY # 8 # 3/27/00 967.25 1,166.38 .00 1,989.75 6/22/02 1,790.62

6387955 MORRIS SHANNON MICHE 8 # 8 3/27/00 97.50 61.00 .00 .00 5/17/02 36.50

6220073 NELSON KATHY VAUGHN # U 3 8/29/99 16.00 1,029.62 .00 1,175.00 6/22/02 161.38

1235225 NORTON FREDA GAIL R 6/23/99 .00 1,073.00 .00 1,094.20 2/24/02 107.00

6654545 PETERS ROBERT LOUIS 8 # 8 3/27/00 119.50 493.33 .00 1,734.83 4/22/01 1,361.00

6188197 ROGERS TERRY ROY # U 3 7/27/99 169.25 455.28 .00 780.68 6/22/02 494.65

6358659 ROGERS BRENDA KAY # 8 3 3/27/00 267.75 45.75 .00 .00 3/23/02 222.00

6263602 SAMUELS BRITTANY DON # 8 3 3/27/00 23.00 326.44 .00 1,283.94 2/24/02 980.50

1333160 SAWYERS LLOYD EVAN C U 3 12/13/88 505.00 421.50 .00 367.45 6/22/02 450.95

6125529 SIDNEY LUCAS SCOTT C U 4/28/88 20.00 2,166.58 .00 2,506.25 6/22/02 359.67

1375708 SHELTON ALEXIS DEE # U 3 12/14/99 130.85 1,803.67 .00 2,503.35 6/22/02 830.53

6141853 SHELTON TIMMY LEON C U 1/25/99 38.50 239.37 .00 271.00 6/22/02 70.13

TOTALS FOR F/C --8 # OF ACCTS 16 3,405.35 10,585.22 .00 15,681.70 8,587.63

** GRAND TOTALS * # OF ACCTS 7242 2,075,470.08 160,220.64 .00 250,985.67 2,013,009.45



ZERO BALANCES EXCLUDED AR0R30

CREDIT BALANCES EXCLUDED BAD DEBT REPORT-BY ACC/REC. F/C-1

ACC/REC F/C - A CHAMPUS

BAD DATE OF DATE OF

PATIENT PATIENT D/C DEBT WRITE ORG. WRITE- TOTAL AMT. COLLECTION TOTAL AMT. LAST BALANCE OF

NUMBER NAME DATE F/C OFF OFF AMOUNT RECOVERED EXPENSE ADJUSTED PYMT WRITE OFF

0418032 BUTLER ANNA 4/09/04 3 9/14/04 208.17 .00 .00 .00 0/00/00 208.17

0415878 EDWARDS AMY LEE 3/17/04 3 9/14/04 852.66 .00 .00 .00 0/00/00 852.66

0422431 EDWARDS AMY LEE 5/25/04 3 1/26/05 579.01 .00 .00 .00 0/00/00 579.01

0391540 HUGHES LANELLE R 6/18/93 3 12/12/04 293.00 .00 .00 .00 0/00/00 293.00

0426845 JACKSON ANGELA P 7/12/04 3 1/26/05 243.75 .00 .00 .00 0/00/00 243.75

0425404 JOHNSON JENNIE A 6/26/04 3 12/12/04 105.00 .00 .00 .00 0/00/00 105.00

0401986 KILLEBREW MARYANN 10/13/93 3 8/26/04 143.00 .00 .00 .00 0/00/00 143.00

0416295 MAIN HENNA 3/22/04 3 8/26/04 121.14 .00 .00 .00 0/00/00 121.14

0420400 RASBERRY RITA L 5/03/04 3 9/27/04 89.00 .00 .00 .00 0/00/00 89.00

0421359 SMITH NICHOLAS 5/14/04 3 3/28/05 89.00 .00 .00 .00 0/00/00 89.00

0130325 STATON CHELREA 12/02/93 3 8/26/04 731.50 .00 .00 .00 0/00/00 731.50

0130223 THOMAS ALEX 11/10/93 3 11/10/04 926.50 .00 .00 .00 0/00/00 926.50

0427419 WALL JAMES A 7/19/04 3 1/26/05 835.21 .00 .00 .00 0/00/00 835.21

TOTALS FOR F/C --A # OF ACCTS 13 5216.94 .00 .00 .00 5216.94

SAMPLE REPORTS A/R REPORTS A/R Bad Debt Recovery Listing Page 16.1

Bad Debt Recovery Listing

Overview: This option lists all bad debt recoveries in detail. The report prints

patient number, patient name, write-off date, write-off amount, each recovery date, and recovery amount.

This report prints in bad debt financial class order and then in patient

number order. Access: Reports Menu II, Option 19 Program: AR0R26 Selection: From and Thru Date Statistics: None Use: This report provides detail support for accounting summaries for month end analysis or year end audit. Files: ARMAST, ARACCUM

|

|

SAMPLE REPORTS A/R REPORTS A/R Bad Debt Recovery Listing Page 16.2

RUN DATE: 7/22/05 EXAMPLE FACILITY PAGE 3

BAD DEBT RECOVERY LISTING AR0R26

FOR THE PERIOD 1/01/05 THRU 6/30/05

PATIENT WRITE OFF WRITE OFF RECOVERY RECOVERY

BANKRUPTCY BAD DEBT # PATIENT NAME DATE AMOUNT DATE AMOUNT

==================== ------- -------------------- --------- ------------ -------- ------------

1401066 BRAVO SHELLIE MARY 9/28/98 7,020.25

2/24/05 91.99-

PATIENT TOTAL RECOVERY 91.99-

1411719 BATTEN GENNIE ANN 1/29/99 480.40

2/24/05 34.97-

3/23/05 33.87-


6362958 FLOYD BETTY JEAN 3/05/99 62.50

2/24/05 15.00-

4/20/05 15.00-


6718199 DAVIS KAYLA LOUISE 9/28/98 15.10

1/22/05 15.10-


6813232 GLASSMEYER CINDY 11/29/98 111.85

1/22/05 30.53-

3/23/05 15.79-


6815047 BURKS MARLEEN CLAIRE 4/01/99 96.25

1/22/05 16.47-

2/24/05 15.00-

3/23/05 21.13-


6964274 SLOAN TERRI LYNN 5/01/99 41.43

3/23/05 15.00-


7070063 DAVIS TONYA LOU 7/31/99 54.47

6/22/05 50.69-


TOTAL FOR FINANCIAL CLASS 370.54-

** GRAND TOTAL ** 370.54-

PATIENT TOTAL

** GRAND TOTAL ** 127,141.41-

SAMPLE REPORTS A/R REPORTS A/R A/R Cross Reference Listing Page 17.1

A/R Cross Reference Listing

Overview: This option is used to print a cross reference report. The report prints patient name, patient number, guarantor name, guarantor number, financial class, discharge date, current balance,

last payment source, last payment date, last payment amount, and date the account transferred to bad debt. One line is printed per discharged A/R or bad debt.

Access: Reports Menu II, Option 21 Business Office Menu II, Option 20 Program: AR0R11 - A/R Patient Name/Number Cross Reference Listing AR0R13 - A/R Guarantor Name/Patient Cross Reference Listing Selection: Print in patient or guarantor order First character of beginning and ending name Include zero balance accounts - Yes or No Print all financial classes - Yes or No If no, select up to 10 financial classes. The Printer/Archive Options window will be displayed to allow the following selections to be entered:


Note: The archive selection will only be shown if MEDHOST Archive is

installed in the Hospital name/addr/id# record, Option 1 on the System Control File Menu. The Archive field will default to 'N'. Be sure to change it to 'Y' to archive the report.

Statistics: None

Use: This report is used to reference patient name, number, balance, and guarantor name. It may be used as a quick reference for looking up a balance. Files: GUARANT, ARMAST

|

|


RUN DATE 4/15/98 TIME 12:17:13 EXAMPLE MEMORIAL HOSPITAL FAC# 001 PAGE 1

A/R PATIENT NAME/NUMBER CROSS REFERENCE LISTING AR0R11

PATIENT NAME PATIENT GUARANTOR GUARANTOR FC. DISC. CURRENT **** LAST PAYMENT **** TRANS TO

NUMBER NAME NUMBER DATE BALANCE SCE DATE AMOUNT BAD DEBT

ABBOTT CARON F 4003968 ABBOTT CARON F 0069352 T 8/12/96 95.93 2/10/97 25.00

ABBOTT STEPHEN 2026244 ABBOTT STEPHEN 0076547 I 2/11/97 56.00 0/00/00 .00

ABBOTT RANDALL 4004446 ABBOTT RANDALL 0072760 T 12/10/96 382.53 2/22/97 2,273.54

ABBOTT RANDALL 5038247 ABBOTT RANDALL 0072760 P 12/02/96 185.85 2/22/97 148.68

ABERNATHY MAXINA 2026319 ABERNATHY ABE 0050174 T 2/19/97 24.51 3/18/97 98.04

ABRAMS NED RAY 4004415 ABRAMS NED RAY 0075343 A 11/27/96 1,182.20 3/10/97 75.00

ABSHIRE CANDY J 5034200 ABSHIRE JOHNNY 0017919 N 7/17/96 115.10 0/00/00 .00 9/29/96

ADAIR AMY W 5035119 ADAIR AMY W 0073793 N 8/16/96 81.51 0/00/00 .00 1/29/97

ADAIR ANNA M 5040422 ADAIR ANNA M 0076534 I 2/10/97 196.15 0/00/00 .00

ADAIR ANNA M 5039188 ADAIR ANNA M 0061718 T 1/01/97 31.58 3/17/97 178.97

ADAIR BETTY A 5039388 ADAIR BETTY A 0061718 T 1/06/97 24.54 3/17/97 139.06

ADAIR BETTY A 5040996 ADAIR BETTY A 0068038 O 3/01/97 109.00 0/00/00 .00

ADAIR SARAH J 5033098 ADAIR SARAH J 0068038 N 6/12/96 211.50 0/00/00 .00 9/29/96

ADAIR SAMUEL C 0109994 ADAIR SAMUEL C 0061295 F 11/17/95 10.00- 2/14/97 92.93 1/29/97

ADAMS BECKY A 5037669 ADAMS DONALD A 0063221 N 11/11/96 237.00 0/00/00 .00 1/29/97

ADAMS CATHY LEE 5041270 ADAMS JAMIE LEE 0077009 B 3/08/97 109.00 0/00/00 .00

ADAMS JASON 2022832 WOOD PHYLLIS 0072659 N 6/06/96 133.00 0/00/00 .00 9/29/96

ADAMS JOHN F 5040132 ADAMS STAN F 0076395 P 2/01/97 169.25 0/00/00 .00




ADAMS MICHAEL 5040868 ADAMS STAN F 0054925 M 2/25/97 500.25 0/00/00 .00

ADAMS RITA 2025950 ADAMS TINA 0073142 T 1/17/97 45.37 3/14/97 408.26

ADAMS RITA J 5041535 ADAMS ALAN RYE 0077168 P 3/16/97 243.00 0/00/00 .00

ADKINS JIMMY 0110157 ADKINS WILLIAM H 0066201 N 12/12/95 2,150.00 3/10/97 358.95 8/26/96

AGUILAR ABBOTT 1004802 AGUILAR ANNA 0076055 T 1/12/97 123.22 3/03/97 208.97

AGUILAR ABBOTT 1004910 AGUILAR ANNA 0076055 B 2/27/97 997.82 0/00/00 .00

AGUILAR BRANDY 5039769 AGUILAR ANNA 0076174 P 1/19/97 137.00 3/03/97 43.20

AGUILAR CHRIS M 1004852 AGUILAR JOSE A 0069869 I 1/29/97 299.45 0/00/00 .00

AGUILAR JANICE E 5040531 AGUILAR JOSE A 0076610 I 2/14/97 119.10 0/00/00 .00

TOTAL CURRENT BALANCE: 45,393.81

TOTAL BAD DEBT BALANCE 35,067.97


RUN DATE 4/15/98 TIME 13:57:30 EXAMPLE MEMORIAL HOSPITAL FAC# 001 PAGE 1

A/R GUARANTOR NAME / PATIENT CROSS REFERENCE LISTING AR0R13

GUARANTOR NAME GUAR NO/ GUARANTOR ADDRESS/ GUAR CITY/ST/ GUAR ZIP GUAR PHONE TRANS TO

PAT. NO PATIENT NAME FC DISC DATE CUR BAL BAD DEBT

ABBOTT CARON F 69352 120 OAK CREST WASHINGTON 72761-0000 501-524-8151

4003968 ABBOTT CARON F T 8/12/96 95.93

ABBOTT STEPHEN 76547 2103 ANN STREET SPRINGVILLE 72762-0000 501-756-5855

2026244 ABBOTT STEPHEN I 2/11/97 56.00

ABBOTT RANDALL 72760 120 OAKCREST RD WASHINGTON 72761-0000 501-549-3199

4004446 ABBOTT RANDALL T 12/10/96 382.53

5038247 ABBOTT RANDALL P 12/02/96 185.85

ABERNATHY ABE 50174 12678 OAK KNOLL CIRCLE LAWRENCE 72734-0000 501-736-2849

2026319 ABERNATHY MAXINA T 2/19/97 24.51

ABRAMS NED RAY 75343 RT 4 BOX 277 CONCORD 74338-0000 918-422-5248

4004415 ABRAMS NED RAY A 11/27/96 1,182.20

ABSHIRE JOHNNY 17919 RT 1 BOX 52B LAWRENCE 72734-0000 501-736-8071

5034200 ABSHIRE CANDY J N 7/17/96 115.10 9/29/96

ADAIR AMY W 73793 PO BOX 754 LAWRENCE 72734-0000 501-549-3468

5035119 ADAIR AMY W N 8/16/96 81.51 1/29/97

ADAIR ANNA M 61718 PO BOX 246 RT 1 EASTVILLE 74965-0000 918-723-5728

5039188 ADAIR ANNA M T 1/01/97 31.58

5039388 ADAIR ANNA M T 1/06/97 24.54

ADAIR BETTY A 76534 12569 N ARKANSAS 59 MEADOWS 72769-0000 501-824-5379

5040422 ADAIR BETTYA I 2/10/97 196.15

ADAIR SARAH J 68038 PO BOX 222 HAMILTON 74359-0000 918-868-3198

5033098 ADAIR SARAH J N 6/12/96 211.50 9/29/96

5040996 ADAIR SARAH J O 3/01/97 109.00

ADAIR SAMUEL C 61295 2635 A E ALBANY BIG SANDY 74014-0000 918-723-4524

109994 ADAIR SAMUEL C F 11/17/95 10.00- 1/29/97

ADAMS BECKY A 77168 RR 4 BOX 111 CONCORD 74338-0000 918-422-5576

5041535 ADAMS BECKY A P 3/16/97 243.00

ADAMS JAMIE LEE 62919 PO BOX 536 FORT ANDERS 74434-0000 918-478-9747

112299 ADAMS CATHY LEE T 10/26/96 254.04

TOTAL CURRENT BALANCE: 45,393.81

TOTAL BAD DEBT BALANCE 35,067.97

SAMPLE REPORTS A/R REPORTS A/R Unbilled Reports past Holds days rpt Page 18.1

Unbilled Reports past Holds days rpt

Overview: This report will indicate which patient accounts have not been final

billed but are past the hold days in the Billing Control record.

The Unbilled Reports past Holds days report checks for accounts that are:

• discharged • not final billed • equal or greater than the Hold days in billing control

Access: Reports Menu II, Option 9 Program: PA2R80 Use: This report is used for the reporting of account past hold days, but not

yet billed.


After entering the From Discharge Date and the Thru Discharge Date the user has three Select by options from which to choose: • Payor plan (new screen allowing for selection of payor plans will display). • Hospital service code (new screen allowing for selection of hospital service

codes will display). • All (all accounts meeting date range criteria)


PAYOR PLAN

Users selecting Payor Plan can either select individual payors or select ALL payor plans by leaving the payor plan number blank. Action

Click OK to generate the selected report.


HOSPITAL SERVICE CODE

Enter or select (F4) the service code you want to run the unbilled reports past holds days. Action

Click OK to generate the selected report.


After the payor selection has been chosen the Printer/Archive Options screen will appear. Action

Select Yes to print, No to not print. Enter the number of Copies to be printed (01-99). Enter the name of the printer Outq. Select Yes to Archive the document or No to bypass the archiving option. Click OK. The report will be generated by the payor plan you selected.


PA2R80 MEDHOST SAMPLE HOSPITAL PAGE 1

SORT BY: PATIENT NUMBER UNBILLED ACCTS PAST HOLD DAYS RPT DATE 9/26/11

FAC# 091 DISCHARGE DATE 08/01/05 - 08/05/05 TIME 14:45:00

DISCHARGE ELAPSED

I/O PATIENT# PATIENT NAME PHYSICIAN NAME AMOUNT PAYOR PLAN DATE DAYS F/C HSV MEDREC

/ERROR DESCRIPTION

PAYOR: 818 PLAN: 001 CAH MEDICARE

I 0503563 WEPKING ROBERT H SR UNDERWOOD JOHN A 31,510.70 818/001 08/01/05 14 CA MSU 10391

No admitting or reason for visit ICD-9 code

I 0503594 WEIMER ADA E PETERSON PETER Q 14,951.17 818/001 08/01/05 14 CA MSU 11041

Blood furnished

I 050380 OLSON VERA L ROBERTSON SUE R 3,921.86 818/001 08/01/05 14 CA MSU 11882

-----------------------------------------------------------------------------------------------------------------------------

TOTAL: CAH MEDICARE 50,383.73

TOTAL ACCTS: 3

TOTAL: ALL ACCOUNTS 50,383.73

TOTAL ACCTS: 3

SAMPLE REPORTS REVENUE REPORTS REVENUE Hospital Service Code Rev Stat Page 1.1

Hospital Service Code Rev Stat

Overview: This report lists revenue units and dollars for the month and year todate segregated by G/L departments within each hospital service category. The report summarizes departmental revenue by service.

This report prints in alphabetical order by medical service.

This report can be automatically selected at Month End.

Access: Reports Menu III, Option 1

Program: PB0R28 - Month to Date selection NPB0R28 - Historical Data selection

Selection: Month to DateHistorical Data

From and Thru Date

Statistics: None

Use: This report is used to analyze revenue by medical service at the department level.

File: STATRV

||

SAMPLE REPORTS REVENUE REPORTS REVENUE Hospital Service Code Rev Stat Page 1.2


RUN DATE 2/25/06 TIME 2:33 PM HOSPITAL SERVICE CODE REVENUE STATISTICS PB0R28

SERVICE-CATEGORY/ ------- MONTH ------- ------- YEAR TO DATE --------

DEPARTMENT UNITS REVENUE UNITS REVENUE

AMBULATORY OUTPATIENT

-------------------------

ROOM & BOARD .00 .00 2.00- 390.00-

CRITICAL CARE UNIT .00 .00 3.00- 1,269.00-

SPECIAL CARE UNIT .00 .00 7.00 2,296.00

TELEMETRY 11.00 407.00 62.00 2,317.75

CARDIAC CARE UNIT 7.00 1,474.00 103.00 23,453.75

OPERATING ROOM 31.00 5,791.00 123.00 24,762.50

OR ROOM SUPPLIES 399.00 9,344.25 1,727.00 39,814.75

EQUIPMENT RENTAL 57.00 1,077.00 326.00 6,177.25

SPECIAL PROCEDURE RM 3.00 496.25 15.00 3,203.75

RECOVERY ROOM 11.00 1,056.00 51.00 4,944.00

OBSTETRICS .00 .00 1.00 204.00

CENTRAL SUPPLY 174.00 2,592.22 2,851.00 40,428.03

I V SOLUTIONS 88.00 1,473.80 1,068.00 15,543.05

EMERGENCY ROOM 30.00 1,861.75 369.00 32,173.00

EMERGENCY RM DOCTOR 6.00 267.25 180.00 7,224.50

HOSPICE & HOME CARE .00 .00 8.00- 832.00-

LABORATORY 145.00 5,090.50 4,139.00 67,725.25

LAB MEDICAL ARTS BLDG 1,513.00 27,176.25 33,548.00 363,744.10

DOCTORS CLINIC LABORATORY 2.00 824.23 24.00 26,036.23

EKG 27.00 2,180.25 540.00 25,941.50

EEG 3.00 707.25 29.00 6,836.75

MEDICAL IMAGING 93.00 10,167.50 1,218.00 127,855.75

MEDICAL IMAGING MED ARTS 249.00 16,310.00 3,333.00 212,408.75

CAT SCAN 43.00 9,529.75 436.00 92,754.00

ULTRASOUND 56.00 9,197.00 723.00 116,685.00

CARDIOVASCULAR SERVICE 42.00 6,772.00 483.00 85,300.00

PHARMACY 67.00 3,296.04 655.00 47,392.91

ANES ADMINISTRATION 12.00 3,948.00 51.00 17,176.00

INHALATION THERAPY 67.00 2,136.25 861.00 20,835.25

PHYSICAL THERAPY 16.00 .00 434.00 9,295.25

NUR W PAT OT HOSP .00 .00 3.00 430.50

OTHER REVENUE 3.00 736.00 15.00 4,246.00

TOTALS ** 3,155.00 123,911.54 53,362.00 1,424,714.57

** GRAND TOTALS** 34,034.00 1,331,898.24 501,822.00 16,828,363.61

SAMPLE REPORTS REVENUE REPORTS REVENUE Revenue Service By Class Page 2.1

Revenue Service By Class

Overview: This report summarizes revenue by G/L department within hospital

service. The revenue is distributed into financial classes based on Revenue by F/C, Option 7 on the Hospital Table File Menu.

This report prints in alphabetical order by hospital service and then by

G/L department. This report can be automatically selected at Month End. Access: Reports Menu III, Option 2 Program: PB0R59 - Month to Date selection NPB0R59 - Historical Data selection Selection: Month to Date Historical Data From and Thru Date

Statistics: None Use: This report provides a summary analysis of departmental revenue by

medical service presented by user-defined financial class groups. Files: GLKEYSM, RVSTATS, STATHD, STATRV, SYSCTL, SYSTABFL


Example Revenue Service by Class Report: Month End

REPORT DATE 7/31/11 ABC HOSPITAL FAC# 920 PAGE 1

RUN DATE 8/26/11 TIME 11:50 AM REVENUE BY SERVICE AND CLASS PB0R59

FOR THE MONTH ENDING 7/31/11

SERVICE-CATEGORY/

DEPARTMENT MEDICARE MEDCAID DEAN CARE LANDS END ALLIANCE CONTRACTS OTHER *TOTAL*

.......................... ........ ....... .......... ......... ........ ........ ........ ......

.......................... ........ ....... .......... ......... ........ ........ ........ ......

-------------------------

INTENSIVE CARE UNIT

-------------------------

MEDICAL SURGICAL UNIT 815.00 .00 .00 .00 .00 .00 33415.00 34230.00

INTENSIVE CARE UNIT .00 .00 .00 .00 .00 .00 49895.95 49895.95

NURSERY .00 .00 .00 .00 .00 .00 11966.00 11966.00

URGENT CARE .00 28.80 .00 .00 .00 .00 .00 28.80

LABORATORY 561.91 1424.30 .00 .00 .00 .00 6336.55 8322.76

RADIOLOGY .00 .00 .00 .00 .00 .00 321.54 321.54

NUCLEAR MEDICINE .00 .00 .00 .00 .00 .00 1000.00 1000.00

CAT SCANNING 1104.20 .00 .00 .00 .00 .00 3064.90 4169.10

PHARMACY .00 5.10 .00 .00 .00 .00 .00 5.10

CARDIOPULMONARY SERVICES .00 210.05 .00 .00 .00 .00 946.00 1156.05

OCCUPATIONAL THERAPY .00 .00 .00 .00 .00 .00 133.00 133.00

MCF .00 160.00 .00 .00 .00 4216.00 21960.00 26336.00

EMPLOYEE HEALTH .00 .00 .00 .00 .00 .00 54.26 54.26

* SERVICE CODE TOTALS * 2481.11 1828.25 .00 .00 .00 4216.00 129093.20 137618.56

-------------------------

MEDICAL SURGICAL UNIT

-------------------------


NURSERY .00 .00 .00 .00 .00 .00 22860.95 22860.95

LABORATORY 407.50 .00 .00 .00 .00 2229.28 1192.52 3829.30

RADIOLOGY 392.70 .00 .00 .00 .00 143.65 331.32 867.67

RADIOLOGY CLINIC .00 .00 .00 .00 .00 .00 114.35 114.35

CAT SCANNING 4973.00 .00 .00 .00 .00 2775.70 1243.25 8991.95

PHARMACY .08 .00 .00 .00 .00 .00 .00 .08

CARDIOPULMONARY SERVICES 56110.95 .00 .00 .00 .00 198.90 210.05 56519.90

MCF .00 .00 .00 .00 .00 .00 4488.00 4488.00

* SERVICE CODE TOTALS * 65144.23 .00 .00 .00 .00 5347.53 31468.44 101960.20

-------------------------

OBSERVATION

-------------------------

OBSTETRICS 2036.92 .00 .00 632.00 .00 632.00 .00 3300.92

LABORATORY .00 .00 .00 238.95 .00 163.90 .00 402.85

* SERVICE CODE TOTALS * 2036.92 .00 .00 870.95 .00 795.90 .00 3703.77

-------------------------

.......................... ........ ....... .......... ......... ........ ........ ........ ......

** GRAND TOTALS** 74565.63 9566.35 1243.25 870.95 .00 10976.33 322266.94 419489.45


Example Revenue Service by Class Report: Year to Date

NPB0R59 ABC HOSPITAL PAGE 1

8/26/11 14:46:38 MONITOR PATIENT ACCOUNTING

REVENUE BY SERVICE AND CLASS * YEAR TO DATE *

PERIOD BEGINNING DATE 1/01/11 PERIOD ENDING DATE 7/31/11

MEDICARE MEDCAID DEAN CARE LANDS END ALLIANCE CONTRACTS OTHER *TOTAL*

____________________________________________________________________________________________________________________________________

......................... ........ ......... ...... ..... ....... ...... ....... .......

......................... ........ ......... ...... ..... ....... ...... ....... .......

CONVERSION INPATIENT

MEDICAL SURGICAL UNIT .00 .00 .00 .00 .00 .00 815.00 815.00

OBSTETRICS 872.36 .00 .00 .00 .00 .00 .00 872.36

LABORATORY .00 .00 .00 .00 .00 .00 897.08 897.08

RADIOLOGY .00 .00 .00 .00 .00 .00 160.77 160.77

CAT SCANNING .00 .00 .00 .00 .00 .00 3729.75 3729.75

* HSV CODE TOTALS * 872.36 .00 .00 .00 .00 .00 5602.60 6474.96

......................... ........ ......... ...... ..... ....... ...... ....... .......

INTENSIVE CARE UNIT


INTENSIVE CARE UNIT .00 .00 .00 .00 .00 .00 49895.95 49895.95

NURSERY .00 .00 .00 .00 .00 .00 11966.00 11966.00

URGENT CARE .00 28.80 .00 .00 .00 .00 .00 28.80

LABORATORY 561.91 1424.55 .00 .00 .00 .00 4853.90 6840.36

RADIOLOGY .00 .00 .00 .00 .00 .00 321.54 321.54

CAT SCANNING 1104.20 .00 .00 .00 .00 .00 1532.45 2636.65

CARDIOPULMONARY SERVICES .00 .00 .00 .00 .00 .00 946.00 946.00

MCF .00 160.00 .00 .00 .00 4216.00 21960.00 26336.00

EMPLOYEE HEALTH .00 .00 .00 .00 .00 .00 54.26 54.26

* HSV CODE TOTALS * 2481.11 1613.35 .00 .00 .00 4216.00 124945.10 133255.56

ICU INTERMEDIATE CARE


LABORATORY .00 .00 .00 .00 .00 .00 65.60 65.60

MCF .00 .00 .00 .00 .00 .00 2856.00 2856.00

* HSV CODE TOTALS * .00 .00 .00 .00 .00 .00 3736.60 3736.60

......................... ........ ......... ...... ..... ....... ...... ....... .......

NURSING HOME INPATIENTS


LABORATORY .00 384.75 .00 .00 .00 .00 228.25 613.00

MCF 680.00 3890.00 .00 .00 .00 .00 1330.00 5900.00

* HSV CODE TOTALS * 680.00 4274.75 .00 .00 .00 .00 2373.25 7328.00

......................... ........ ......... ...... ..... ....... ...... ....... .......

SWINGBED

NURSERY .00 .00 .00 .00 .00 .00 22860.95 22860.95

PHARMACY .00 .00 .00 .00 .00 .00 10.20 10.20

MCF .00 .00 .00 .00 .00 .00 8432.00 8432.00

* HSV CODE TOTALS * .00 .00 .00 .00 .00 .00 31303.15 31303.15

SWINGBED RESPITE


* HSV CODE TOTALS * .00 .00 .00 .00 .00 .00 25265.00 25265.00

......................... ........ ......... ...... ..... ....... ...... ....... .......

** FINAL TOTALS** 70243.72 5888.10 1243.25 870.95 .00 10195.53 313929.65 402371.20

SAMPLE REPORTS REVENUE REPORTS REVENUE Revenue/Usage Statistics Summary Page 3.1

Revenue/Usage Statistics Summary

Overview: This report summarizes the frequency and revenue by G/L

department. The frequency and revenue are listed in the following categories: inpatient current period and year to date, outpatient current period and year to date, and combined for the current period and year to date.

Access: Reports Menu III, Option 4 Program: PB0R33 - Month to Date selection NPB0R33 - Historical Data selection Selection: Month to Date Historical Data From and Thru Date

Statistics: None Use: This report can be used to compare and analyze revenue summaries. File: REVMAST

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SAMPLE REPORTS REVENUE REPORTS REVENUE Revenue/Usage Statistics Summary Page 3.2


RUN DATE 2/25/04 TIME 2:34 PM R E V E N U E U S A G E S U M M A R Y PB0R33

B Y D E P A R T M E N T

*********** INPATIENT *************** ************* OUTPATIENT ************ ************* COMBINED *****************

G/L CURRENT YEAR TO DATE CURRENT YEAR TO DATE CURRENT YEAR TO DATE

NUM FREQ REVENUE FREQ REVENUE FREQ REVENUE FREQ REVENUE FREQ REVENUE FREQ REVENUE

436 6208 76279 514 9159 6722 85438

67,198.50 846,626.75 13,693.75 132,435.25 80,892.25 979,062.00

437 336 3292 428 6426 764 9718

11,610.50 110,081.13 13,174.00 187,645.13 24,784.50 297,726.26

438 11 3 27 3 38

1,578.50 430.50 3,874.50 430.50 5,453.00

560 2 2

120.00 120.00

565 2 15 20 252 22 267

6.75 53.75 70.00 882.00 76.75 935.75

705 6 6

2,708.99 2,708.99

828 3 130 3 130

736.00 6,400.50 736.00 6,400.50

900 660 9376 660 9376

38,040.00 520,567.40 38,040.00 520,567.40

901 2364 27349 2364 27349

133,224.00 1,491,897.33 133,224.00 1,491,897.33

902 82 672 82 672

8,017.96 64,073.53 8,017.96 64,073.53

903 91 1658 91 1658

8,897.98 159,979.62 8,897.98 159,979.62

904 37 37

3,617.86 3,617.86

905 6 99 6 99

1,142.98 15,245.54 1,142.98 15,245.54

907 2 20 2 20

1,333.75 11,144.25 1,333.75 11,144.25

908 40 506 40 506

1,003.25 12,683.75 1,003.25 12,683.75

909 5 151 5 151

651.00 41,338.03 651.00 41,338.03

911 28 28

22,571.75 22,571.75

913 1 1

179.25 179.25

*** 22032 300106 13002 210716 35034 510822

*** 828,294.04 10,178,422.73 503,604.20 6,649,940.88 1,331,898.24 16,828,363.61

SAMPLE REPORTS REVENUE REPORTS REVENUE Revenue Detail (F/C – MTH, YTD) Page 4.1

Revenue Detail (F/C - MTH, YTD)

Overview: This report prints revenue for the month and year to date for each

charge code by financial class. This report prints in department number order and then in charge

code number order with totals for each department. This report can be automatically selected at Month End. Access: Reports Menu III, Option 5 Program: PB0R44 - Month to Date selection NPB0R44 - Historical Data selection Selection: Month to Date Historical Data From and Thru Date

Print Inpatient, Outpatient, or Combined Statistics: None Column Heading: Financial class column headings are based on the table defined by Option 7 on the Hospital Table File Menu. Use: This report can be used to determine usage by financial class for each charge code. File: REVMAST

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SAMPLE REPORTS REVENUE REPORTS REVENUE Revenue Detail (F/C – MTH, YTD) Page 4.2


RUN DATE 2/25/04 TIME 2:34 PM DETAIL REVENUE ANALYSIS BY FINANCIAL CLASS PB0R44

** COMBINED **

362 - EQUIPMENT RENTAL

MEDICARE MEDICAID BLUE CROSS PRIVATE NURS HOME ALL OTHER TOTAL

3751014-6 MTH .00 .00 .00 .00 .00 228.75 228.75

PULSE OXIMETER YTD .00 915.00 .00 274.50 .00 594.75 1,784.25

3751015-3 MTH .00 150.00 .00 .00 .00 .00 150.00

TRANSPORT ISOLETTE YTD 25.00 1,550.00 25.00 700.00 .00 250.00 2,550.00

3751016-1 MTH .00 .00 .00 .00 .00 .00 .00

VENODYNE YTD 940.00 80.00 380.00 20.00 .00 580.00 2,000.00

3751017-9 MTH 250.00 100.00 20.00 70.00 .00 120.00 560.00

WALL SUCTION YTD 1,990.00 640.00 320.00 250.00 .00 1,230.00 4,430.00

3751018-7 MTH .00 .00 .00 .00 .00 .00 .00

K-PUMP (HEAT PUMP) YTD 16.50 .00 .00 .00 .00 .00 16.50

3751020-3 MTH .00 .00 .00 .00 .00 .00 .00

ISOLETTE YTD .00 .00 .00 .00 .00 45.00 45.00

** DEPARTMENT TOTALS ** MTH 3,785.00 1,950.00 365.00 1,172.00 .00 2,538.75 9,810.75

YTD 49,666.50 21,633.75 7,465.00 11,774.25 10.00- 34,166.00 124,695.50



** COMBINED **

HOSPITAL TOTALS


MTH 453,544.51 175,503.85 70,117.58 113,830.98 193,926.38 324,974.94 1,331,898.24

YTD 5,535,380.12 1,977,553.25 1,052,735.19 1,429,359.51 2,365,219.37 4,468,991.38 16,829,238.82

SAMPLE REPORTS REVENUE REPORTS REVENUE Revenue/Usage Statistics Detail Page 5.1

Revenue/Usage Statistics Detail

Overview: This report summarizes revenue frequency and amount for each

charge code. The report lists the G/L department number, charge code, charge description, and the current period and year to date totals for both inpatients and outpatients.

This report prints in department number order and then in charge

code number order. This report can be automatically selected at Month End. Access: Reports Menu III, Option 9 Program: PB0R32 - Month to Date selection NPB0R32 - Historical Data selection Selection: Month to Date Historical Data From and Thru Date

Print departments on separate pages Department number Print by quantity or relative weight * * Relative weights are computed by multiplying the quantity of each

charge by the unit weight assigned to that charge in the charge master.

Statistics: None Use: This report can be used to analyze revenue by department and revenue code. Files: REVMAST, CHRGDESC

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SAMPLE REPORTS REVENUE REPORTS REVENUE Revenue/Usage Statistics Detail Page 5.2

NPB0R32 MEDHOST SAMPLE HOSPITAL PAGE 1


REVENUE USAGE DETAIL BY DEPARTMENT


----------------- CURRENT ----------------- ------------------- YTD --------------------

GL SERVICE INPATIENT OUTPATIENT INPATIENT OUTPATIENT

NO CODE DESCRIPTION QTY AMOUNT QTY AMOUNT QTY AMOUNT QTY AMOUNT

____________________________________________________________________________________________________________________________________

375 6920023 NUT CONSULT 1/4 HR 1.00 23.40

375 6920025 NUT REASSESS 1/4 H 1.00 23.40

375 6920026 NUT DX CHANGE 1/4 1.00 23.40

* DEPARTMENT TOTALS * 1.00 23.40 2.00 46.80

** FINAL TOTALS ** 1.00 23.40 2.00 46.80

SAMPLE REPORTS REVENUE REPORTS REVENUE Departmental Revenue (F/C) Page 6.1

Departmental Revenue (F/C)

Overview: This report summarizes revenue by department and financial class

group. The report prints the revenue for inpatient and outpatient for both the month and year to date.

This report prints in department number order. This report can be automatically selected at Month End. Access: Reports Menu III, Option 10 Program: PB0R31 - Month to Date selection NPB0R31 - Historical Data selection Selection: Month to Date Historical Data From and Thru Date

Statistics: None Column Heading: Financial class column headings are based on the table defined by Option 7 on the Hospital Table File Menu. Use: This report can be used to analyze trends in revenue generated by each department. Files: GLKEYSR, RVSTATS

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SAMPLE REPORTS REVENUE REPORTS REVENUE Departmental Revenue (F/C) Page 6.2


RUN DATE 2/25/05 TIME 2:34 PM DEPARTMENTAL REVENUE BY FINANCIAL CLASS PB0R31


***** 310 ROOM & BOARD *****

MTH-IP 43,552.24 15,045.00 2,360.00 7,605.00 .00 .00 26,432.38 94,994.62

-OP .00 .00 .00 .00 .00 .00 .00 .00

**** 43,552.24 15,045.00 2,360.00 7,605.00 .00 .00 26,432.38 94,994.62

YR-I 643,411.67 188,793.75 83,736.75 96,905.00 .00 .00 366,781.50 1,379,628.67

-O 585.00- 195.00- .00 195.00 .00 .00 .00 585.00-

*** 642,826.67 188,598.75 83,736.75 97,100.00 .00 .00 366,781.50 1,379,043.67

***** 311 CRITICAL CARE UNIT *****

MTH-IP 7,429.00 1,748.00 437.00 .00 .00 .00 .00 9,614.00

-OP .00 .00 .00 .00 .00 .00 .00 .00

**** 7,429.00 1,748.00 437.00 .00 .00 .00 .00 9,614.00

YR-I 183,103.00 13,547.00 10,946.00 10,925.00 .00 .00 11,362.00 229,883.00

-O 1,269.00- .00 .00 437.00 .00 .00 .00 832.00-

*** 181,834.00 13,547.00 10,946.00 11,362.00 .00 .00 11,362.00 229,051.00

***** 312 SPECIAL CARE UNIT *****

MTH-IP 33,456.00 984.00 1,640.00 984.00 .00 .00 4,592.00 41,656.00

-OP .00 .00 .00 .00 .00 .00 .00 .00

**** 33,456.00 984.00 1,640.00 984.00 .00 .00 4,592.00 41,656.00

YR-I 328,984.00 20,664.00 19,352.00 13,776.00 .00 .00 61,992.00 444,768.00

-O 32.00 328.00 328.00 328.00- .00 .00 656.00 1,016.00

*** 329,016.00 20,992.00 19,680.00 13,448.00 .00 .00 62,648.00 445,784.00


RUN DATE 2/25/05 TIME 2:34 PM DEPARTMENTAL REVENUE BY FINANCIAL CLASS 0 PB0R31


***** TOTALS *****

MTH-IP 335,859.27 98,301.67 18,435.05 41,192.69 93,926.38 .00 140,578.98 728,294.04

-OP 117,685.24 77,202.18 51,682.53 72,638.29 .00 .00 184,395.96 503,604.20

**** 453,544.51 175,503.85 70,117.58 113,830.98 93,926.38 .00 324,974.94 1,231,898.24

YR-I 3,918,819.50 1,114,030.35 477,889.73 527,482.59 1,465,120.41 .00 1,775,080.15 9,278,422.73

-O 1,616,426.62 863,276.15 574,843.71 901,772.67 .00 586,060.75 2,107,560.98 6,649,940.88

*** 5,535,246.12 1,977,306.50 1,052,733.44 1,429,255.26 1,465,120.41 586,060.75 3,882,641.13 15,928,363.61

SAMPLE REPORTS REVENUE REPORTS REVENUE Revenue Detail (F/C-PD: Qty, $$) Page 7.1

Revenue Detail ( F/C- PD: Qty, $$)

Overview: This report summarizes in detail the revenue generated by each financial class in each department for each charge code. This report prints in department number order and then in charge code order. This report can be automatically selected at Month End. Access: Reports Menu III, Option 11 Program: PB0R58 - Month to Date selection NPB0R58 - Historical Data selection Selection: Month to Date Historical Data From and Thru Date

Print Inpatient, Outpatient, or Combined

Statistics: None Column Heading: Financial class column headings are based on the table defined by Option 7 on the Hospital Table File Menu. Use: This report provides a detailed basis to analyze revenue by major financial class groups at the individual charge code level by department. File: REVMAST

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SAMPLE REPORTS REVENUE REPORTS REVENUE Revenue Detail (F/C-PD: Qty, $$) Page 7.2



** COMBINED **

310 - ROOM & BOARD


3100000-3 QTY 269 8 74 30 0 155 536

PRIVATE ROOM AMT 55,155.00 1,710.00 15,170.00 6,150.00 .00 31,775.00 109,960.00

3100001-1 QTY 444 14 51 8 0 213 730

PRIVATE ROOM AMT 91,020.00 2,870.00 10,455.00 1,640.00 .00 43,665.00 149,650.00

3100002-9 QTY 1,223 764 242 344 0 876 3,449

SEMI-PRIVATE ROOM AMT 237,464.43 148,723.75 46,996.75 67,080.00 .00 170,444.00 670,708.93

3100003-7 QTY 1,325 181 57 114 0 216 1,893

SEMI-PRIVATE ROOM AMT 258,375.00 35,295.00 11,115.00 22,230.00 .00 42,120.00 369,135.00

3100004-5 QTY 3 0 0 0 0 245 248

PRIVATE SWING BED AMT 323.34 .00 .00 .00 .00 25,452.10 25,775.44

3100005-2 QTY 5 0 0 0 0 550 555

SEMI-PRI SWING BED AMT 488.90 .00 .00 .00 .00 53,325.40 53,814.30

** DEPARTMENT TOTALS ** QTY 3,269 967 424 496 0 2,255 7,411

AMT 642,826.67 188,598.75 83,736.75 97,100.00 .00 366,781.50 1,379,043.67



** COMBINED **

HOSPITAL TOTALS


QTY 193,829 62,909 35,266 43,373 40,644 134,841 510,862

AMT 5,535,380.12 1,977,553.25 1,052,735.19 1,429,359.51 2,365,219.37 4,468,991.38 16,829,238.82

SAMPLE REPORTS REVENUE REPORTS REVENUE Physicians Analysis (F/C) Page 8.1

Physicians Analysis (F/C)

Overview: This report summarizes admissions, registrations, discharges, patient

days, inpatient revenue, outpatient revenue, and total revenue generated by each physician.

This report prints in doctor number order. This report can be automatically selected at Month End. Access: Reports Menu III, Option 13 Program: PB0R56 - Month to Date selection NPB0R56 - Historical Data selection Selection: Month to Date Historical Data From and Thru Date

Statistics: None Use: This report can be used to review each physician's statistics by

financial class. File: STATDR

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SAMPLE REPORTS REVENUE REPORTS REVENUE Physicians Analysis (F/C) Page 8.2


RUN DATE 2/25/04 TIME 2:34 PM PHYSICIANS ANALYSIS BY FINANCIAL CLASS PB0R56

DOCTOR/

FINANCIAL CLASS ADM. REG. DIS. PAT. DAYS I/P REV. O/P REV. TOTAL REVENUE

---------------------- ----------- ----------- ----------- ----------- -------------- -------------- --------------

BARNES DONALD

EMPLOYEE DEDUCTION MTH 0 0 0 0 .00 .00 .00

YTD 0 0 0 0 .00 .00 .00

HOSPICE/HOME HEALTH MTH 0 0 0 0 .00 .00 .00

YTD 0 0 0 0 .00 .00 .00

NOTE MTH 0 0 0 0 .00 .00 .00

YTD 0 0 0 0 101.00- .00 101.00-

PLAIN STATEMENT MTH 1 9 1 3 5,107.09 7,295.41 12,402.50

YTD 10 75 11 27 30,663.60 42,269.75 72,933.35

NURSING HOME SKILLED MTH 0 0 0 0 .00 .00 .00

YTD 0 0 0 0 .00 .00 .00

SWING BED - SKILLED MTH 0 0 0 0 .00 .00 .00

YTD 0 0 1 14 3,321.50 .00 3,321.50

BLUE CROSS MTH 0 9 0 0 .00 3,655.23 3,655.23

YTD 6 78 6 19 22,360.55 44,862.00 67,222.55

MEDICARE MTH 0 3 0 0 .00 1,987.91 1,987.91

YTD 9 42 8 36 33,674.48 17,349.46 51,023.94

OTHER INSURANCE MTH 3 13 2 8 9,202.36 5,076.48 14,278.84

YTD 18 179 16 48 58,400.85 137,938.98 196,339.83

MEDICAID MTH 1 4 1 3 4,586.96 6,591.44 11,178.40

YTD 10 52 9 28 30,863.49 69,749.78 100,613.27

MEDICARE PRIVATE PAY MTH 0 0 0 0 .00 .00 .00

YTD 0 0 0 0 .00 .00 .00

*** DR. TOTALS MTH 5 38 4 14 18,896.41 24,606.47 43,502.88 *

YTD 53 426 51 172 179,183.47 312,169.97 491,353.44 **

*** GRAND TOTALS *** MTH 201 2,018 237 3,922 771,786.66 560,111.58 1,331,898.24 *

YTD 2,509 28,066 4,374 48,930 9,518,248.74 7,307,711.37 16,828,363.61 **

SAMPLE REPORTS REVENUE REPORTS REVENUE Physicians Analysis (Service – F/C) Page 9.1

Physicians Analysis (Service - F/C)

Overview: This report summarizes the revenue that each physician generates by

service within financial class. This report prints in hospital service code order and then in doctor

number order. This report can be automatically selected at Month End. Access: Reports Menu III, Option 14 Program: PB0R57 - Month to Date selection NPB0R57 - Historical Data selection Selection: Month to Date Historical Data From and Thru Date

Statistics: None Use: This report can be used to compare the revenue that each physician

generates by financial class and hospital service. File: STATDR

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SAMPLE REPORTS REVENUE REPORTS REVENUE Physicians Analysis (Service – F/C) Page 9.2


RUN DATE 2/25/04 TIME 2:34 PM PHYSICIANS ANALYSIS BY SERVICE/FINANCIAL CLASS PB0R57

DOCTOR/

FINANCIAL CLASS ADM. REG. DIS. PAT. DAYS I/P REV. O/P REV. TOTAL REVENUE

---------------------- ----------- ----------- ----------- ----------- -------------- -------------- --------------

AMBULATORY OUTPATIENT

BARNES LAWRENCE

PLAIN STATEMENT MTH 0 6 0 0 .00 322.00 322.00

YTD 0 54 0 0 .00 3,253.11 3,253.11

BLUE CROSS MTH 0 7 0 0 .00 579.25 579.25

YTD 0 59 0 0 .00 6,342.75 6,342.75

OTHER INSURANCE MTH 0 11 0 0 .00 2,830.73 2,830.73

YTD 0 113 0 0 .00 14,410.23 14,410.23

MEDICAID MTH 0 4 0 0 .00 6,591.44 6,591.44

YTD 0 30 0 0 .00 30,264.40 30,264.40

MEDICARE PRIVATE PAY MTH 0 0 0 0 .00 .00 .00

YTD 0 0 0 0 .00 .00 .00

*** DR. TOTALS MTH 0 28 0 0 .00 10,323.42 10,323.42

YTD 0 256 0 0 .00 54,270.49 54,270.49

BEAVERS CAROLYN

PLAIN STATEMENT MTH 0 2 0 0 .00 251.25 251.25

YTD 0 49 0 0 .00 8,049.90 8,049.90

BLUE CROSS MTH 0 3 0 0 .00 144.00 144.00

YTD 0 98 2 0 .00 10,620.76 10,620.76

MEDICARE MTH 0 0 0 0 .00 140.00 140.00

YTD 0 19 3 0 .00 2,307.75 2,307.75

OTHER INSURANCE MTH 0 14 0 0 .00 2,480.50 2,480.50

YTD 0 157 2 0 .00 24,399.55 24,399.55

MEDICAID MTH 0 19 0 0 .00 3,979.57 3,979.57

YTD 0 80 0 0 .00 20,516.69 20,516.69

*** SERVICE TOTALS MTH 4 0 9 70 18,030.36 .00 18,030.36

YTD 68 0 73 793 208,534.98 .00 208,534.98

*** GRAND TOTALS *** MTH 201 2,018 237 3,922 771,786.66 560,111.58 1,331,898.24

YTD 2,509 28,066 4,374 48,930 9,518,248.74 7,307,711.37 16,828,363.61

SAMPLE REPORTS REVENUE REPORTS REVENUE Revenue by Payor Page 10.1

Revenue by Payor

Overview: This report summarizes the revenue by inpatient and outpatient that

each payor has generated. This report prints in payor number order. Note: Be advised, this report does not tie (balance) to any other

revenue report in the MEDHOST system. This report only reflects revenue that was billed during the date range specified on the report.

Access: Reports Menu III, Option 15 Program: PB0R07 Selection: Report from and thru date Payor selection - All or selected companies Up to 10 payors may be keyed. Statistics: None Use: This report can be used to compare the revenue that each payor

generates. Files: INSMAST, PACOST


PB0R07 EXAMPLE HOSPITAL 4/14/03

REVENUE BY PAYOR 10:08:19

FROM 1/01/08 TO 1/31/08 PAGE 1

PAYOR I/P REVENUE O/P REVENUE TOTAL REVENUE

----------------- -------------- -------------- --------------

000 SELF-PAY 23,763.65 1,303.00 25,066.65

100 MEDICARE/ BC OF MS 94,015.61 .00 94,015.61

200 MEDICAID/ FIRST HEALTH 68,234.50 .00 68,234.50

300 BLUE CROSS/ MS 9,857.25 .00 9,857.25

301 BLUE CROSS/ TN 5,587.50 .00 5,587.50

302 BLUE CROSS/ OTHER 1,080.50 .00 1,080.50

400 AETNA 16,099.95 5,817.25 21,917.20

410 SHELTER INSURANCE 1,016.20 .00 1,016.20

420 HEALTHMARK 4,049.63 .00 4,049.63

435 BMA 1,060.00 .00 1,060.00

500 CHAMPUS-WPS 13,544.60 .00 13,544.60

570 PAN AMERICAN LIFE 4,688.24 .00 4,688.24

600 COMMERCIAL INSURANCE 4,455.90 .00 4,455.90

616 PROVIDENT INSURANCE 4,442.70 .00 4,442.70

705 MAILHANDLERS 3,548.04 .00 3,548.04

720 CIGNA 2,448.25 .00 2,448.25

730 MET LIFE 385.50 .00 385.50

735 EMPLOYERS HEALTH 938.25 .00 938.25

785 CONFEDERATION LIFE .00 1,526.00 1,526.00

-------------- -------------- --------------

REVENUE - FINAL TOTAL 259,216.27 8,646.25 267,862.52

SAMPLE REPORTS REVENUE REPORTS REVENUE Departmental Revenue By Service Page 11.1

Departmental Revenue By Service

Overview: This report summarizes the number of charges and revenue by each

type of service. The types of services that are shown on this report are Inpatient,

Outpatient, Clinic, Home Health, Industrial Billing, One Time Visit, Pharmacy, Inpatient Rehab, and Invalid.

This report only prints YTD revenue numbers. This report prints in department number order. Each department will begin on a new page. Access: Reports Menu III, Option 16 Program: PB0R73 Selection: Beginning and Ending Date

Statistics: None Use: This report can be used to compare the revenue that each type of service generates. Files: ACCUMCHG, INDACCL1, SYSCTL, GLKEYSM, STATHD

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SAMPLE REPORTS REVENUE REPORTS REVENUE Departmental Revenue By Service Page 11.2

DATE: 2/14/05 MEDHOST MEMORIAL HOSPITAL PAGE 1

TIME: 16:07:52 DEPARTMENTAL REVENUE BY SERVICE PB0R73

FROM 1/01/05 TO 1/31/05

DEPT: 431 EEG/EKG

SERVICE QUANTITY REVENUE

------- -------- -------

INPATIENT 79 12,744.00

OUTPATIENT 161 28,428.50

CLINIC

HOME HEALTH

INDUSTRIAL BILLING

ONE TIME VISIT 30 5,124.00

PHARMACY

INVALID

IRF Med. Patients

DEPARTMENT TOTALS: 270 46,296.50

SAMPLE REPORTS REVENUE REPORTS REVENUE Physician Profit and Loss Report Page 12.1

Physician Profit and Loss Report

Overview: This report summarizes the profit and loss amounts for each physician

for the entered date range. The report prints the physician number, physician name, total

revenue, contractual amount, bad debt writeoff amount, net revenue, calculated expenses, physician profit/loss amount, and number of admissions and registrations.

The net revenue is calculated by subtracting the contractual amount

and bad debt writeoff amount from the total revenue. The calculated expenses amount is produced by multiplying the

entered calculated percentage by the total revenue. Access: Reports Menu III, Option 17 Program: PA0R60 - Physician number order PA0R62 - Profit/loss amount order Selection: Period beginning and ending date Calculated expenses percent Sort by - Physician # or Profit/loss amount

Statistics: None Use: This report can be used to compare each physician's profit or loss

amounts and the components that comprise each profit or loss. Files: RVSTATX3, PASTATX3, PHYMAST, ARDESC, GLKEYSM, YTDPL, SYSCTL

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SAMPLE REPORTS REVENUE REPORTS REVENUE Physician Profit and Loss Report Page 12.2

PA0R60 EXAMPLE HOSPITAL PAGE 1


PHYSICIAN PROFIT AND LOSS REPORT


CALCULATED

AMOUNT AMOUNT EXPENSES PHYSICIAN

NO. PHYSICIAN NAME TOT REVENUE CONTRACTUAL BAD DEBT W/O NET REVENUE (.2000) PROFIT/LOSS ADMITS REGSTRN

____________________________________________________________________________________________________________________________________

001 BAKER CHARLES MD 68,093.50 68,093.50 13,618.70 54,474.80 2 7

002 LOCKHART RICHARD MD 1.50 2,640.00 2,638.50- .30 2,638.80-

004 CRAIG TIMOTHY MD 5,440.00 2,640.00- 8,080.00 1,088.00 6,992.00

006 ROGER KENNETH E MD 6.00 6.00 1.20 4.80

009 MCLIN RONALD MD 7,000.00 184.82- 7,184.82 1,400.00 5,784.82

010 MILLER DONALD M DO 8,981.00 100.00- 9,081.00 1,796.20 7,284.80

011 YATES GENE MD 44.00 44.00 8.80 35.20

013 FELD MARK MD 344.00 344.00 68.80 275.20

015 HAMILTON GREG MD 2,640.00 2,640.00 528.00 2,112.00 1

018 TRYDE JOHN MD 4,880.00 4,880.00 976.00 3,904.00

025 SMITH SCOTT MD 2,640.00 2,640.00 528.00 2,112.00 1

078 KATZ MICHAEL MD 6,300.00 6,300.00 1,260.00 5,040.00 1

* FINAL TOTALS * 106,370.00 2,640.00 21,274.00 3

2,924.82- 106,654.82 85,380.82 9

SAMPLE REPORTS REVENUE REPORTS REVENUE Critical Access I/P 96 Hr. Report Page 13.1

Critical Access I/P 96 Hr. Report

Overview: This report is used by Critical Access Hospitals to support the

Medicare requirement of the 96 hour average length of stay for all inpatients.

Critical Access is a category of Medicare Reimbursement which allows

small rural hospitals that meet certain requirements to elect to change from Prospective Payment (DRGs) to cost based reimbursement.

The report prints the patient number, patient name, admit date,

admit time, discharge date, discharge time, and total hours stayed. The following information prints at the end of the report: total hours

stayed, average hours stayed, minimum hours, maximum hours, and patient count (total patients).

Access: Reports Menu III, Option 18 Program: PA0R75 Selection: Discharge Dates - From and To Hospital service code - Enter or leave blank for all

Statistics: Average Hours Minimum Hours Maximum Hours Use: This report can be used as a patient log to support the 96 hour

average length of stay requirement for all inpatients and can be filed with associated cost reports to Medicare.

Files: PATIENTS, STATHD, SYSCTL

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SAMPLE REPORTS REVENUE REPORTS REVENUE Critical Access I/P 96 Hr. Report Page 13.2


USER: ANNA MONITOR CRITICAL ACCESS HOSPITAL 96 HOUR REPORT DATE: 6/11/06

HSV CODE: ALL FROM DATE 1-01-2006 TO DATE 1-15-2006 TIME: 10:30:00

ADMIT ADMIT DISCHARGE DISCH TOTAL

PAT # PATIENT NAME DATE TIME DATE TIME HOURS

103017 ANDERSON GARETH A 2005-12-19 15:22 2006-01-13 11:25 596.05

103027 ELVERD ANNA ROSE 2006-01-02 5:05 2006-01-05 13:00 79.91

103028 ELVERD SHELLIE RAY 2006-01-02 8:09 2006-01-05 13:00 76.85

103030 STIER RAYMOND L 2006-01-03 10:24 2006-01-06 13:15 74.85

103031 MILLER RANDAL C 2006-01-03 10:38 2006-01-08 14:25 123.78

103035 WILLEMS INFANT FEMALE 2006-01-05 7:46 2006-01-06 12:30 28.73

103037 SPENCER RITA 2006-01-05 17:10 2006-01-08 17:27 72.28

103038 THOMAS DALLAS R 2006-01-05 19:35 2006-01-07 20:30 48.91

103039 PHILLIPS VERA A 2006-01-07 1:55 2006-01-09 11:45 57.83

103040 PHILLIPS MARIE C 2006-01-07 1:55 2006-01-09 11:45 57.83

103041 WILLIAMS VAUGHN 2006-01-08 15:10 2006-01-09 14:35 23.41

103043 HAGMAN HENRY 2006-01-09 20:58 2006-01-15 16:10 139.20

103044 AYRES THOMAS D 2006-01-10 14:35 2006-01-12 16:15 49.66

103045 HARDING ANNA H 2006-01-11 18:45 2006-01-13 12:56 42.18

103046 TERRY FORD A 2006-01-11 10:40 2006-01-13 9:20 46.66

103048 LARSEN HARRY ROBERT 2006-01-11 12:37 2006-01-14 12:06 171.48

103049 HARDING JERRY R 2006-01-11 18:45 2006-01-13 12:56 42.18

3089695 STIER RAYLENE P 2000-12-27 19:38 2006-01-03 10:23 158.75

3089738 BLACK MARIA NICOLE 2000-12-28 8:10 2006-01-02 11:15 123.08

3089997 PECKINPAUGH GEORGE S 2000-12-31 9:45 2006-01-04 11:05 97.33

3090071 LITTLE SAMUEL B 2006-01-02 54 2006-01-02 10:15 9.35

3090072 SCHEIDEGGER TONY C 2006-01-01 23:26 2006-01-05 15:05 87.65

3090074 CRAWFORD JIMMY R 2006-01-01 23:29 2006-01-02 20:40 121.18

3090305 HOWELL DILLON A 2006-01-03 19:55 2006-01-06 11:20 63.41

3090337 WILLEMS SUSAN R 2006-01-05 8:25 2006-01-06 12:30 28.08

3090447 CRIAG JR EDDIE C 2006-01-04 23:25 2006-01-09 10:01 106.60

3090454 THOMAS CAITLIN S 2006-01-05 19:35 2006-01-07 20:30 48.91

3090535 AYRES HAROLD D 2006-01-05 17:55 2006-01-10 14:34 116.65

3090536 KIESER MICHAEL 2006-01-05 16:51 2006-01-10 18:00 121.15

3090572 BEIER BRENDA 2006-01-06 11:00 2006-01-07 13:00 26.00

3090574 HAWHEE PETER R 2006-01-06 11:05 2006-01-06 20:30 9.41

3090597 SIMPSON KEVIN L 2006-01-06 19:11 2006-01-08 15:40 144.48

3090602 HAGMAN UTLEY 2006-01-06 20:56 2006-01-09 20:57 72.01

3090631 TERRY OLENA B 2006-01-07 20:53 2006-01-11 10:39 185.76

3090639 EIGEL BENJAMIN 2006-01-08 37 2006-01-11 16:01 87.40

3090743 REED JANE ANNE 2006-01-08 14:05 2006-01-13 13:30 119.41

3090806 VAUGHN POLLY KAY 2006-01-09 1:15 2006-01-09 18:30 17.25

3090848 HARRISON TURNER L 2006-01-09 13:30 2006-01-14 12:06 118.60

3090875 SNYDER SPENCER 2006-01-09 17:15 2006-01-13 10:05 188.83

3090890 CROWE EVITA 2006-01-09 22:51 2006-01-13 10:00 83.15

3090941 HOHMAN BRANDON 2006-01-10 11:38 2006-01-11 9:10 121.53

Total Hours : 3,987.76

Average Hours: 97.26

Min Hours : 9.35

Max Hours : 596.05

Patient Count: 41

********* E N D O F R E P O R T *********

SAMPLE REPORTS REVENUE REPORTS REVENUE RVU Analysis Report Page 14.1

RVU Analysis Report

Overview: This report is used to analyze the RVU units for each physician by

month and year. The report prints the CPT code, modifier, CPT description, selected

RVU (Total, Work, Expense, or Malpractice), base rate, volume (count), percentage of the total count, and RVU units.

The base rate on the report is Price 1 from the Charge Master for the

charge code to which the CPT is attached. Total breaks print for each department code, physician, and facility. The report prints in physician number order. Summary by Physician and Procedure will print at the end of the

report. Access: Reports Menu III, Option 19 Program: PA0R87 Selection: From Date Thru Date Date Selection - S = Service Date P = Period Ending Date Report RVU - 1 = Total RVU 2 = Work RVU 3 = Expense RVU 4 = Malpractice RVU Physician Number - Enter ALL, a physician number, or press F4 to select a physician.

Statistics: Volume = Unit count of charges % = Percentage of the total units

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Use: This report can be used as a tool to determine the amounts charged

for procedures, expense analysis, physician productivity analysis, and physician compensation.

Files: ACCUMEXT, ACCUML8, CPTCODE, GLKEYSM, PA0001F, PA0086W, PA0087W, PHYMAST, SYSCTL


● Total RVU

PA0R87 EXAMPLE HOSPITAL Hosp# 001 Page: 7

Report Period: 06/01/02 Thru 06/30/02 RVU Analysis by Physician Date: 6/30/02

Selecting by Service Date TIME: 11:17:15

Physician: 12345 WILLIAMS TERRY A

Total --Month-to-Date-- --Year-to-Date--

CPT Code Mod CPT Code Description RVU Base Rate Volume % RVU Units Volume % RVU Units

10120 REMOVE FOREIGN BODY 2.62 154.00 3 4.10 7.86 3 4.10 7.86

12001 REPAIR SUPERFICIAL WOUND( 2.27 204.00 2 2.73 4.54 2 2.73 4.54



12034 LAYER CLOSURE OF WOUND(S) 5.96 405.00 1 1.36 5.96 1 1.36 5.96


24600 TREAT ELBOW DISLOCATION 10.95 567.00 1 1.36 10.95 1 1.36 10.95

26770 TREAT FINGER DISLOCATION 7.73 337.00 1 1.36 7.73 1 1.36 7.73

99281 EMERGENCY DEPT VISIT .42 51.00- 1- 1.36- .42- 1- 1.36- .42-




99281 EMERGENCY DEPT VISIT .42 51.00 1 1.36 .42 1 1.36 .42






99282 EMERGENCY DEPT VISIT .71 79.00 8 10.95 5.68 8 10.95 5.68


99283 EMERGENCY DEPT VISIT 1.60 145.00 15 20.54 24.00 15 20.54 24.00


Totals for ER PHYSICIAN 43 58.79 90.91 43 58.79 90.91

45330 DIAGNOSTIC SIGMOIDOSCOPY 2.77 208.50 1 1.36 2.77 1 1.36 2.77

99212 OFFICE/OUTPATIENT VISIT, .95 42.00 1 1.36 .95 1 1.36 .95

99212 OFFICE/OUTPATIENT VISIT, .95 57.00 3 4.10 2.85 3 4.10 2.85


99213 OFFICE/OUTPATIENT VISIT, 1.33 63.50 4 5.47 5.32 4 5.47 5.32







99391 PREV VISIT, EST, INFANT 1.98 131.00 1 1.36 1.98 1 1.36 1.98

99396 PREV VISIT, EST, AGE 40-6 2.73 177.50 3 4.10 8.19 3 4.10 8.19

Totals for PROVIDER REVENUE 30 40.97 48.16 30 40.97 48.16

Totals for WILLIAMS TERRY A 73 100.00 139.07 73 100.00 139.07

Facility Total: 73 139.07 73 139.07


● Work RVU





Work --Month-to-Date-- --Year-to-Date--



12001 REPAIR SUPERFICIAL WOUND( .17 204.00 2 2.73 .34 2 2.73 .34






















45330 DIAGNOSTIC SIGMOIDOSCOPY .94 208.50 1 1.36 .94 1 1.36 .94











99391 PREV VISIT, EST, INFANT 1.00 131.00 1 1.36 1.00 1 1.36 1.00




Facility Total: 73 139.07 73 139.07


● Expense RVU





Expense --Month-to-Date-- --Year-to-Date--







12052 LAYER CLOSURE OF WOUND(S) .03 390.00 1 1.36 .03 1 1.36 .03


















45330 DIAGNOSTIC SIGMOIDOSCOPY 1.78 208.50 1 1.36 1.78 1 1.36 1.78











99391 PREV VISIT, EST, INFANT .95 131.00 1 1.36 .95 1 1.36 .95




Facility Total: 73 139.07 73 139.07


● Malpractice RVU





Malpractice --Month-to-Date-- --Year-to-Date--


10120 REMOVE FOREIGN BODY .01 154.00 3 4.10 .03 3 4.10 .03






24600 TREAT ELBOW DISLOCATION .46 567.00 1 1.36 .46 1 1.36 .46

26770 TREAT FINGER DISLOCATION .25 337.00 1 1.36 .25 1 1.36 .25

99281 EMERGENCY DEPT VISIT .02 51.00- 1- 1.36- .02- 1- 1.36-

.02-


.02-


.02-


.02-







.03-






45330 DIAGNOSTIC SIGMOIDOSCOPY .05 208.50 1 1.36 .05 1 1.36 .05











99391 PREV VISIT, EST, INFANT .03 131.00 1 1.36 .03 1 1.36 .03

99396 PREV VISIT, EST, AGE 40-6 .05 177.50 3 4.10 .15 3 4.10 .15



Facility Total: 73 139.07 73 139.07


● Summary by Physician



SUMMARY by Physician TIME: 11:17:15

--Month-to-Date-- --Year-to-Date--

Physician Volume % RVU Units Volume % RVU Units

WILLIAMS TERRY A 73 100.00 139.07 73 100.00 139.07

Facility Total: 73 139.07 73 139.07

● Summary by Procedure



SUMMARY by Procedure TIME: 11:17:15

--Month-to-Date-- --Year-to-Date--

Procedure Volume % RVU Units Volume % RVU Units

10120 REMOVE FOREIGN BODY 3 4.10 7.86 3 4.10 7.86

12001 REPAIR SUPERFICIAL WOUND( 2 2.73 4.54 2 2.73 4.54



12034 LAYER CLOSURE OF WOUND(S) 1 1.36 5.96 1 1.36 5.96

12052 LAYER CLOSURE OF WOUND(S) 1 1.36 2.91 1 1.36 2.91

24600 TREAT ELBOW DISLOCATION 1 1.36 10.95 1 1.36 10.95

26770 TREAT FINGER DISLOCATION 1 1.36 7.73 1 1.36 7.73

45330 DIAGNOSTIC SIGMOIDOSCOPY 1 1.36 2.77 1 1.36 2.77

99212 OFFICE/OUTPATIENT VISIT, 8 10.93 7.60 8 10.93 7.60




99281 EMERGENCY DEPT VISIT 2 2.73 .84 2 2.73 .84

99282 EMERGENCY DEPT VISIT 11 15.06 7.81 11 15.06 7.81



99391 PREV VISIT, EST, INFANT 1 1.36 1.98 1 1.36 1.98

99396 PREV VISIT, EST, AGE 40-6 3 4.10 8.19 3 4.10 8.19

Facility Total: 73 139.07 73 139.07

SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS A/R Accounts On Hold Report Page 1.1

A/R Accounts On Hold Report

Overview: This option is used to print a listing of A/R accounts which have beenplaced on hold using Hold/Release Accounts to Purge, Option 1 on the Period Processing Menu. These accounts will not be purged in the Year End Processing which is done during Month End Processing if the month being closed is the last month of the fiscal year.

Totals will be printed for the number of bad debt accounts and active A/R accounts that have been placed on hold.

There is no prompt screen displayed after the option selection.

Access: Period Processing Menu, Option 2

Program: AR0P73

Selection: None

Statistics: None

Use: This listing is used to verify the accounts which will not be purged.

File: ARMAST

SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS A/R Accounts On Hold Report Page 1.2


TIME 8:24:28 ACCOUNTS RECEIVABLE NONPURGE LIST AR0R93

ACCOUNT ACCOUNT NAME CURRENT WRITE OFF WRITE OFF

NUMBER BALANCE DATE AMOUNT

------- ------------ ------- --------- ---------

1395201 NICHOLS SHIRLEY MARY .00 7/27/02 1,247.00

1395821 OWENS IMA RUTHIE 504.96 9/28/02 127.76

6009187 HOLMAN CYNTHIA LISA .00 4/16/03 76.00

SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS A/R Accounts To Purge Report Page 2.1

A/R Accounts To Purge Report

Overview: This option is used to print a listing of accounts which will purge

during the Year End processing based upon the date keyed. Year End Processing is done during Month End Processing if the month being closed is the last month of the fiscal year.

This report is subject to change based on any A/R activity that may

occur after the report is printed. Access: Period Processing Menu, Option 3 Program: AR0R93 Selection: Purge Date Statistics: None Use: This listing is used to verify the accounts which will be purged. File: ARMAST

SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS A/R Accounts To Purge Report Page 2.2

AR0P73 ACCOUNTS RECEIVABLE PURGE LIST PAGE 58

FOR 7/31/94

ACCOUNT ACCOUNT NAME WRITE OFF WRITE OFF CURRENT

NUMBER DATE AMOUNT BALANCE

------- ------------ --------- --------- -------

7445679 STONE BEATRICE EATON 0/00/00 .00 .00

7446016 BUSH WILLIAM MATTHEW 0/00/00 .00 .00

7446107 ADAMS PAMELA JEAN 6/31/02 150.00 .00

7446131 HATT ZETTIE ARA 0/00/00 .00 .00

7446206 HAYNES PAUL J 5/15/02 500.00 .00

7446248 COOK JOSEPHINE HUDSO 0/00/00 .00 .00

7446255 STALLON JACK EUGENE 0/00/00 .00 .00

7446651 HYATT EUGENE B 8/01/02 20.00 .00

7446669 DAVIS TAMMY ANNETTA 0/00/00 .00 .00

7447006 DEMAR EDITH DEES 0/00/00 .00 .00

7447154 LATTE MARGARET MCLEA 0/00/00 .00 .00

7447162 STUARTS TERESA ANN 0/00/00 .00 .00

7447253 HARRISON ANGELA DAWN 0/00/00 .00 .00

7448749 CHAPIN GERI LEATHEM 7/01/02 557.00 135.00

7511454 LAWRENCE VICKIE JEAN 0/00/00 .00 .00

7511470 BYRNS KIMBERLY ROCHE 0/00/00 .00 .00

7511496 HOLLEY SHIRLEY JOYCE 0/00/00 .00 .00

7511520 CLAYTON RICHARD ANTH 0/00/00 .00 .00

7511652 COPE TIMOTHY RAY 2/15/02 258.55 300.00

7511694 BUCHANAN PATRICK C 0/00/00 .00 .00

7511702 RAY KRISTI LYNETTE 0/00/00 .00 .00

7511785 LOWE JOEY KEVIN 0/00/00 .00 .00

7511819 YOUNG ERNEST DALE 0/00/00 .00 .00

6929954 NOBBITT WILMA HAZEL 5/01/02 784.25 75.00

6920383 HILKINGTON B D 0/00/00 .00 .00

7068166 SHELTON CAROLYN KATH 0/00/00 .00 .00

7086705 SHELTON CAROLYN KATH 0/00/00 .00 .00

1445287 TIDFORD ANNE ELLIS 7/31/02 145.00 .00

7302144 THOMASON DAVID MICHA 0/00/00 .00 .00

7171564 WILBANKS MAGGIE ANN 0/00/00 .00 .00

7274384 WILLIAMS MARK ANTHON 0/00/00 .00 .00

** TOTAL BAD DEBT ACCOUNTS: 136 **

** TOTAL ACTIVE A/R ACCOUNTS: 2,934 **

SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS Guarantor Purge Report Page 3.1

Guarantor Purge Report

Overview: The Guarantor Purge Report prints the guarantors that were purgedduring Year End processing which is done during Month End Processing if the month being closed is the last month of the fiscal year.

The Guarantor File is purged based on the number of days since last admission/registration for a guarantor. The number of days is specified in the Purge Guarantor File field in the A/R Control Record, Option 3 on the System Control File Menu.


Program: PB0R38

Selection: None

Statistics: None

Use: This listing is used to identify the guarantors which have been purged. This listing should be retained for reference.

Files: GUARANT, GUARPRG, EMPLOYER, SYSCTL

SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS Guarantor Purge Report Page 3.2

REPORT DATE 4/05/2005 EXAMPLE FACILITY FAC# 001 PAGE 1

RUN DATE 4/05/2005 TIME 9:19:33 AM GUARANTOR PURGE REPORT PB0R38A

GUARANTOR NAME GUARANTOR ADDRESS EMPLOYER INFORMATION *-------------------OTHER------------------*

BUTLER RAY MARTIN 208 SOUTH BUDDING AVE WENDY'S DATE OF LAST A/R STMT

APT 101 DATE OF LAST ACTIVITY (REG OR ADMT) 3/31/00

GUARANTOR NUMBER CURRENT BALANCE IN A/R

29 VIRGINIA BEACH, VA A/R COMMENTS

23452 NUMBER OF STATEMENTS

PHONE # 804-340-5866 PHONE # GUARANTOR SEX CODE M

OCC GUARANTOR FINANCIAL CLASS E

YEARS EMPLOYED # BAD DEBT WRITE OFFS

BAD DEBT AMOUNT

DATE OF LAST PAYMENT 3/21/00

GUARANTOR SOC SEC # 228-80-0155

GUARANTOR NAME GUARANTOR ADDRESS EMPLOYER INFORMATION *-------------------OTHER------------------*

BROWN PATRICE A 1113 CRAFTSMAN DRIVE UNKNOWN DATE OF LAST A/R STMT

DATE OF LAST ACTIVITY (REG OR ADMT) 3/31/00

GUARANTOR NUMBER CURRENT BALANCE IN A/R

33 VIRGINIA BEACH, VA A/R COMMENTS

23464 NUMBER OF STATEMENTS

PHONE # PHONE # GUARANTOR SEX CODE F

OCC GUARANTOR FINANCIAL CLASS E

YEARS EMPLOYED # BAD DEBT WRITE OFFS

BAD DEBT AMOUNT



SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS Purged A/R Account Listng Page 4.1

Purged A/R Account Listing

Overview: The Purged A/R Account Listing prints the accounts that were purged

during Year End processing which is done during Month End Processing if the month being closed is the last month of the fiscal year.

The A/R files are purged based on the number of days after an

account becomes a zero balance. The number of days is specified in the Purge Accounts Receivable field in the A/R Control Record, Option 3 on the System Control File Menu.

The bad debt files are purged based on the number of days since the

last transaction or write-off date. The number of days is specified in the Purge Bad Debts field in the A/R Control Record, Option 3 on the System Control File Menu.

Access: Period Processing Menu, Option 5 Program: AR0R15 Selection: None

Statistics: None Use: This listing is used to identify the A/R accounts which have been

purged. This listing should be retained for reference. File: ARMAST

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SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS Purged A/R Account Listng Page 4.2

RUN DATE- 8/12/04 D E L E T E B A D D E B T B A L A N C E A C C O U N T AR0R15

TIME 11:23:28 EXAMPLE FACILITY PAGE 1

PATIENT PATIENT F/C ADM/REG DISCHARGE DATE LAST ZERO BAL BAD DEBT

PATIENT NAME NUMBER TYPE 1 2 3 DATE DATE WRITE OFF PAYMENT AGE PURGED

PEOPLES ERWIN 9000038 I S C 2/11/00 2/13/00 6/18/00 3/20/00 911 1,168.30

MINDA CHARLES 9000077 I S C 3/03/00 4/04/00 6/18/00 6/19/00 861 22,736.31

SMITH MATTHEW 9000159 I S 4/14/00 4/16/00 6/18/00 6/19/00 849 1,654.08

BOWMAN HAMILTON 9000181 I S B 5/02/00 5/05/00 8/14/00 7/12/00 830 604.02

BAD DEBT ACCOUNTS DELETED 4 26,162.71

RUN DATE- 8/12/04 D E L E T E Z E R O B A L A N C E A C C O U N T R E P O R T AR0R15

TIME 11:23:28 EXAMPLE FACILITY PAGE 1

PATIENT PATIENT F/C ADM/REG DISCHARGE DATE LAST ZERO BAL GUARANTOR GUARANTOR

PATIENT NAME NUMBER TYPE 1 2 3 DATE DATE BILLED PAYMENT AGE NAME NUMBER

CHISOLM TONYA 9000005 I S C 1/12/00 1/29/00 2/14/00 6/15/02 925 CHISOLM EMILY 60002

HELMS LYDIA 9000016 I S C E 1/25/00 1/29/00 2/01/00 0/00/00 925 THOMAS WILLIAM 73788

INPATIENT ACCOUNTS DELETED 2

OUTPATIENT ACCOUNTS DELETED

*** TOTAL ACCOUNTS DELETED 2



SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS A/R Status Reports For Purged Acct Page 5.1

A/R Status Report for Purged Accounts

Overview: The A/R Status Reports for Purged Accounts prints a detailed account

status for accounts that were purged during Year End processing which is done during Month End Processing if the month being closed is the last month of the fiscal year.

The A/R files are purged based on the number of days after an

account becomes a zero balance. The number of days is specified in the Purge Accounts Receivable field in the A/R Control Record, Option 3 on the System Control File Menu.

Access: Period Processing Menu, Option 5 and Option 7 Program: AR0R10 Selection: None Statistics: None Use: This listing is used to identify the accounts that have been purged.

This listing should be retained for reference. File: ARMAST, ARSUMMRY, ARACCUM, COMNTFIL

NOTE: This report is sent to the printer output queue and eArchive divided into the following reports with the ending letters referring to the starting letter of the patient’s last name: AR0R10A_C AR0R10D_F AR0R10G_H AR0R10I_J AR0R10K_L AR0R10M_O AR0R10P_R AR0R10S_T AR0R10U_W AR0R10X_Z

SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS A/R Status Reports For Purged Acct Page 5.2

REPORT DATE 6/05/12 FAC# 250 PAGE 1 RUN DATE 6/05/12 QA MEDICAL CENTER - BILLING MASTER LIB AR0R10

ACCOUNTS RECEIVABLE STATUS REPORT ** DELETED ** ACCOUNT NO. --> 0503700 TYPE: E GUARANTOR NO. --> 0210143 DOTSON DOTTIE HOSP SRV CODE: ERE HISTORY NO. --> 000151802 DOTSON DOTTIE FINANCIAL CLS: B DOTSON DOTTIE 5900 CAPERS STREET SSN: 645-67-8904 5900 CAPERS STREET NASHVILLE TN ADMITTED ----> 3/30/05 NASHVILLE 37214 DISCHARGED --> 3/30/05 37214 PHONE: 615-678-9045 PHONE: 615-678-9045 DATE BILLED ------> 6/01/06 NO. OF PAYMENTS -------> TOTAL CHARGED ----> .00 DATE OF LAST PAYMENT --> 0/00/00 CURRENT DUE ------> .00 LAST PAYMENT AMOUNT ---> .00 NUMBER OF STMTS. ------> 03 PHYSICIAN: BAKER ANNE R DATE LAST STATEMENT ---> 5/15/08 LAST STMT. AMOUNT -----> .00 LAST LETTER NUMBER ----> 00 PAYOR 1 000 PLAN 1 000 POLICY# PAYOR 2 000 PLAN 2 000 POLICY# PAYOR 3 000 PLAN 3 000 POLICY# ---------------------------- TRANSACTION HISTORY ------------------------------ CYC# DATE TRANS CDE REF# DESCRIPTION AMOUNT ------------------------------- BILLING HISTORY ------------------------------- CYC# DATE PAYOR 1 PAYOR 2 PAYOR 3 PATIENTS 01 6/01/06 ----------------------------------- COMMENTS ---------------------------------- CMNT: 01 TYPE: D NEXT FOL-UP: 7/13/06 FOL-UP ON: 10/19/06 COLTR: BRIDGET

SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS Purged Patient History Listing Page 6.1

Purged Patient History Listing

Overview: The Purged Patient History Listing prints the patient demographic

information that was purged during Year End Processing. The Patient History file is purged based on the number of days since

the last admission/registration for a patient. The number of days is specified in the Purge Patient History File field in the A/R Control Record, Option 3 on the System Control File Menu.

Access: Period Processing Menu, Option 5 Note: If the month being closed is the last month of the fiscal year,

the Year End Processing will automatically be performed which will produce this report.

Program: PB0R39 Selection: None

Statistics: None Use: This listing is used to identify the Patient History records which have

been purged. This listing should be retained for reference. File: PATHIST

|

|

SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS Purged Patient History Listing Page 6.2

PB0R39 EXAMPLE FACILITY

DATE 8/12/02 PATIENT HISTORY PURGE LIST PAGE 1

PATIENT NAME/MED REC. # ADDRESS EMPLOYER INFORMATION *----------------------OTHER-----------------------*

BOYD JULIA 238 GOLF STREAM DRIVE RECORD STATUS D BIRTHDATE 8/11/56

BIRTHPLACE SOC SEC # 411-76-4476

ELIZABETH CITY NC SOC SEC ALPHA SEX F

000000007 27909 RACE W RELIGION O

PHONE # 919-338-5464 PHONE # 000- MARITAL STATUS M MAIDEN NAME

OCC FAMILY DOCTOR

HOW LONG EMP 00 MOTHER DOB 0/00/00 FATHER DOB 0/00/00

MOTHER MAIDEN NAME

FATHER NAME

*----------------ADMISSIONS HISTORY----------------*

EMERGENCY CONTACT I EMERGENCY CONTACT II *----PREVIOUS-------* *------CURRENT---------*

BOYD, WILLIAM GUAR # GUAR # 985

SAME AS ABOVE PAT # PAT # 1000004

FIN CLASS FIN CLASS C

ADM DATE 4/16/01

PHONE # 919-338-5464 PHONE # DISC DATE 4/16/01

BUS PH# 000-0000 BUS PH# ICD-9 DIAG CODE

RELATION TO PAT 02 RELATION TO PAT 00 LAST TRANSACTION 5/12/01

SPOUSE DOB 8/11/56

*----------------ALLERGIES---------------* *---------MEDICATIONS----------*

PATIENT NAME/MED REC. # ADDRESS EMPLOYER INFORMATION *----------------------OTHER-----------------------*

MAYS KEVIN TEST RECORD STATUS D BIRTHDATE 9/25/65

BIRTHPLACE SOC SEC # 000-00-0000

TEST TN SOC SEC ALPHA SEX M

000000008 37211 RACE W RELIGION C

PHONE # 000- PHONE # 000- MARITAL STATUS S MAIDEN NAME

OCC FAMILY DOCTOR

HOW LONG EMP 00 MOTHER DOB 0/00/00 FATHER DOB 0/00/00

MOTHER MAIDEN NAME

FATHER NAME

*----------------ADMISSIONS HISTORY----------------*

EMERGENCY CONTACT I EMERGENCY CONTACT II *----PREVIOUS-------* *------CURRENT---------*

GUAR # GUAR # 1551

PAT # PAT # 4444444

FIN CLASS FIN CLASS M

ADM DATE 4/16/02

PHONE # PHONE # DISC DATE 4/16/02

BUS PH# BUS PH# ICD-9 DIAG CODE

RELATION TO PAT 00 RELATION TO PAT 00 LAST TRANSACTION 5/14/02

SPOUSE DOB 9/25/65

*----------------ALLERGIES---------------* *---------MEDICATIONS----------*

SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS Purged A/R Trans Code Listing Page 7.1

Purged A/R Trans Code Listing

Overview: The Purged A/R Transaction Code Listing lists the transaction codes

which were purged during the Year End processing. The transaction codes are marked for deletion through A/R

Transaction Code File, Option 3 on the File Maintenance Menu. Access: Period Processing Menu, Option 5 Note: If the month being closed is the last month of the fiscal year,

the Year End Processing will automatically be performed which will produce this report.

Program: PA0P22 Selection: None

Statistics: None Use: This listing is used to identify the transaction codes which have been

purged. This listing should be retained for reference. File: ARDESC

SAMPLE REPORTS PERIOD PROCESSING PERIOD PROCESS Purged A/R Trans Code Listing Page 7.2

PA0P22 EXAMPLE FACILITY PAGE: 1

DATE: 8/12/02 MONITOR DELETED A/R TRANSACTION CODES LISTING TIME: 7:23:37

CODE DESCRIPTION

187 ABC PAYMENT

251 ABC CONTRACTUAL

SAMPLE REPORTS PERIOD PROCESSING PERPRS Recurring Outpt Auto. Report (Prelim) Page 8.1

Recurring Outpt Automation Report (Preliminary)

Overview: The Recurring Outpt Automation Report (Preliminary) is an

on-demand report of recurring outpatients who have been automatically discharged and re-admitted through implementation of the automatic discharge/re-registration option. No prompt screen appears when you select this option—the report is generated when you select the option.

Note: Operation of this option requires setting a flag in the System Control Menu, Option 26: Admissions Control Record, as explained in the documentation for that option.

The preliminary report is used to assess which accounts will be affected when the month-end production version of the report is run (refer to the documentation for Recurring Outpt Automation Report (Production)). The preliminary version of the report is subject to change when the month-end report is run.

For each patient who has been automatically discharged and readmitted, the Recurring Outpt Automation Report (Preliminary) lists the Patient Number, Medical Record Number, Name, Service Code, Financial Class, Account Balance, Discharge Status, and Admit Date.

An example report is shown in the section, “Example Recurring Outpt Automation Report (Prelim).”


Program: PB0P102

Use: This report prints a list of the outpatients with a Patient Type R=Recurring who have not been discharged. The report is sorted by Hospital Service Code.

File: PAADMCTL, PATIENTS

SAMPLE REPORTS PERIOD PROCESSING PERPRS Recurring Outpt Auto. Report (Prelim) Page 8.2

EXAMPLE RECURRING OUTPT AUTOMATION REPORT (PRELIM)

PB0P102 ABC HOSPITAL Page: 1

Recurring Outpatient Automation Preliminary Report Date: 11/04/11

Time: 09:57:38

No Patient Medical Svc Fin Account Dischg Admit

Activity Number Record# Name Code Class Balance Status Date

* 250063 111279 ARTHUR HAROLD J CA B .00 30 2011-11-01

* 250064 1422 BLABAUM BEAUFORD J CA 9D .00 30 2011-11-01

* 250065 100569 ERICKSON FORREST J CA B .00 30 2011-11-01

* 250066 106950 GLEICHAUF THOMAS L CA B .00 30 2011-11-01

* 250067 117594 HALMA MARTIN P CA B .00 30 2011-11-01

* 250068 104150 HYING EUGENE J CA B .00 30 2011-11-01

* 250075 107799 JEWELL DONNA J CA B .00 30 2011-11-01

* 250069 143751 JOHNSON JOSEPH L CA B .00 30 2011-11-01

* 250070 7892 MARTIN WILLIAM R CA B .00 30 2011-11-01

* 250071 147142 MILLER KAREN J CA B .00 30 2011-11-01

* 250072 4311 NELSON MILTON W CA B .00 30 2011-11-01

* 250073 113517 RADTKE HELEN A CA B .00 30 2011-11-01

* 250074 114622 RUZICKA JAMES R CA B .00 30 2011-11-01

* 250080 151926 SMITH REOCCURING CA W .00 30 2011-11-01

Patients for CA 14



Time: 09:57:38



* 250079 152134 TEST JOEY B CAR C .00 30 2011-11-01

Patients for CAR 1



Time: 09:57:38



* 250081 152051 TEST IE LAB A .00 30 2011-11-01

Patients for LAB 1

......................................................................................................................................

......................................................................................................................................



Time: 09:57:38



* 250076 7152 SCHAFER JUNE E PT E .00 30 2011-11-01

* 250077 110867 STURZ ALVINA D PT M .00 30 2011-11-01

Patients for PT 2



Time: 09:57:38

Total patients 19

* denotes no activity for current month

SAMPLE REPORTS PERIOD PROCESSING PERPRS Recurring Outpt Auto. Report (Prod) Page 9.1

Recurring Outpt Automation Report (Production)

Overview: The Recurring Outpt Automation Report (Production) is generated on

the last day of the month after the Day-End processing has been completed. For each patient who has been automatically discharged and readmitted, the Recurring Outpt Automation Report (Production) lists the original Patient Number, Medical Record Number, Name, Service Code, Financial Class, Account Balance, Discharge Status, Admit Date, Discharge Date, and new Patient Number. With the appropriate settings, the program will also print labels, wristband labels, and facesheets for new patient numbers. The report is organized by Hospital Service Code. An example report is shown in the section, “Example Recurring Outpt Automation Report (Prod).”

A preliminary version of this report may be generated on-demand from the Period Processing Menu, Option 18: Recurring Outpt Automation Report link. For more information, refer to the documentation for Recurring Outpt Automation Report (Preliminary) in the PA Sample Reports manual.

Note: Implementation of the Recurring Outpt Automation Report (Production) requires setting a flag in the System Control Menu, Option 26: Admissions Control Record and setting report specifications in Period Processing Menu, Option 13: Recurring Outpt Automation Maint. Refer to the documentation for each option for more information about the automatic discharge/re-registration option.

Access: Period Processing Menu, Option 13: Recurring Outpt Automation Maint

Note: If the month being closed is the last month of the fiscal year, the Year-End Processing will automatically be performed which will produce this report.

Program: PB0P102

Use: This report prints a list of the outpatients with a Patient Type R=Recurring who have not been discharged. The report is sorted by Hospital Service Code. This listing should be retained for reference—it will be especially useful for verifying that charges are entered on the correct patient number.

File: PAADMCTL, PATIENTS

SAMPLE REPORTS PERIOD PROCESSING PERPRS Recurring Outpt Auto. Report (Prod) Page 9.2

EXAMPLE RECURRING OUTPT AUTOMATION REPORT (PROD)


Recurring Outpatient Automation Production Report Date: 11/30/11

Time: 23:59:00

No Patient Medical Svc Fin Account Dischg Admit Discharge New Patient

Activity Number Record# Name Code Class Balance Status Date Date Number

* 250063 111279 ARTHUR HAROLD J CA B .00 30 2011-11-01 2011-11-30 250090

* 250064 1422 BLABAUM BEAUFORD J CA 9D .00 30 2011-11-01 2011-11-30 250091

* 250065 100569 ERICKSON FORREST J CA B .00 30 2011-11-01 2011-11-30 250092

* 250066 106950 GLEICHAUF THOMAS L CA B .00 30 2011-11-01 2011-11-30 250093

* 250067 117594 HALMA MARTIN P CA B .00 30 2011-11-01 2011-11-30 250094

* 250068 104150 HYING EUGENE J CA B .00 30 2011-11-01 2011-11-30 250096

* 250075 107799 JEWELL DONNA J CA B .00 30 2011-11-01 2011-11-30 250097

* 250069 143751 JOHNSON JOSEPH L CA B .00 30 2011-11-01 2011-11-30 250098

* 250070 7892 MARTIN WILLIAM R CA B .00 30 2011-11-01 2011-11-30 250099

* 250071 147142 MILLER KAREN J CA B .00 30 2011-11-01 2011-11-30 260000

* 250072 4311 NELSON MILTON W CA B .00 30 2011-11-01 2011-11-30 260001

* 250073 113517 RADTKE HELEN A CA B .00 30 2011-11-01 2011-11-30 260002

* 250074 114622 RUZICKA JAMES R CA B .00 30 2011-11-01 2011-11-30 260003

* 250080 151926 SMITH RANDY CA W .00 30 2011-11-01 2011-11-30 260004

Patients for CA 14



Time: 23:59:00



* 250079 152134 TESTA JOEY B CAR C .00 30 2011-11-01 2011-11-30 260005

Patients for CAR 1



Time: 23:59:00



* 250081 152051 TESTA IZ LAB A .00 30 2011-11-01 2011-11-30 260006

Patients for LAB 1



Time: 23:59:00



* 250076 7152 SCHAFER JUNE E PT E .00 30 2011-11-01 2011-11-30 260007

* 250077 110867 STURZ ALVINA D PT M .00 30 2011-11-01 2011-11-30 260008

Patients for PT 2



Time: 23:59:00

Total patients 18

* denotes no activity for current month

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Leave Of Absence List Page 1.1

Leave Of Absence List

Overview: This option generates a listing of the patients who are on leave from

the hospital. The listing prints the patient number, patient name, leave of absence

code, leave of absence description, leave date, expected return date, and leave of absence days.

Access: Reports Menu I, Option 21 Program: PB0R43 Selection: The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the


Site Location - Enter a site location, press F4 to search for a site location, or leave blank for all

Note: This selection will only be displayed if the field Site Location Processing is answered 'Y' in the Admission Control Record, Option 26 on the System Control File Menu.

Statistics: None Use: This listing can be used to verify the patients on leave and identify their expected return date. Files: PATHIST, ADMEG, SYSTABFL


FIELD DESCRIPTION

Print Indicate if the report should be printed. Yes = The report should be printed. No = The report should not be printed.

Copies Indicate the number of copies of the report to be printed 1-99.

Outq Enter the printer outq name. The field will default to the outq for the user that is running the report.

Archive Select Yes if the report should be saved to optical disk (archive). Otherwise, select No.


PB0R43 FAC# 100

DATE 3/31/05 EXAMPLE HOSPITAL PAGE 1

Site 100 LEAVE OF ABSENCE REPORT

PATIENT PATIENT NAME LEAVE OF ABSENCE LEAVE EXP. RET LOA

NO. CODE DESC. DATE DATE DAYS

0000027 BAKER CHARLES T OFF SITE TESTS 3/04/05 3/12/05 27

6000010 BOYD JOHN D H HOME 2/24/05 2/28/05 35

6000011 YOUNG VAUGHN F HOSPITAL 2/17/05 2/19/05 42

6000068 HUDSON HANNAH H HOME 2/08/05 2/25/08 51

6000070 CHECKER FAYE F HOSPITAL 2/22/05 2/25/05 37

TOTAL ON LEAVE - 5

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Admission Register Page 2.1

Admission Register

Overview: This option generates a listing of all the patients that have beenadmitted to the hospital during the entered date range.

This listing prints the patient number, admission date, admission time, quick admit date, quick admit time, days of stay, physician number, hospital service code, age, admission type, admission source, financial class, history number, patient name, and advance directive.


Program: PB0R23


Note: This selection will only be displayed if the field Site Location Processing is answered 'Y' in the Admission Control Record, Option 26 the System Control File Menu.

Date range - From date and To date Print order - Patient Number, Financial Class, Admission Date, Hospital Service Code, or Patient History Number

If Hospital Service Code order is selected, all HSV codes can be printed or only selected codes. If selected HSV codes are to be printed, enter up to ten codes.

The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Distribution – Y or N Archive - Y or N

Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the System Control File Menu. The Archive field will default to 'N'. Be sure to change it to 'Y' to archive the report.


Statistics: None

Use: This listing can be used to identify admitted patients for a specific date range of financial class.

Files: ADMREG


RUN DATE 8/13/04 TIME 13:46:05

EXAMPLE HOSPITAL

FAC# 100 PAGE 1

ADMISSION REGISTER

PB0R23

FOR THE PERIOD 3/01/04 TO 3/04/04

PATIENT ADMISSION ADMISSION QKMNT QKMNT DAYS PHY HOSP ADM ADM FIN HISTORY

ADVANCE

NUMBER DATE TIME DATE TIME STAY NO. SERV AGE TYP SRC CLS NUMBER PATIENT NAME

DIRECTIVE

------- --------- --------- -------- ----- ---- ----- ---- --- --- --- --- --------- -------------------------- -----------

--

1039609 3/01/04 16:55

3 99 MED 33 1 7 B 34768 WHITE MARY Q

N

1039629 3/02/04 23:45 3/02/04 21:00 4 99 MED 26 1 7 Q 48815 ROGERS SUE Q

N

1039645 3/03/04 17:45

1 184 MED 11 1 7 C 41841 JONES JOHN A

N

1039648 3/03/04 20:35

2 179 MED 1 1 7 C 53741 BAKER JOHN A

N

2134427 3/02/04 7:10

3 104 SUR 33 2 1 B 44477 WHITE JAMIE Q

N

2134640 3/04/04 6:55

2 99 SUR 82 3 1 M

4074 BAKER BILLIE T

N

2134954 3/01/04 11:26 3/01/04 9:00 3 55 MED 48 3 1 P 28023 ODONNELL JOHN A

N

2134963 3/01/04 12:30

5 179 MED 86 3 1 M

1791 RODRIGUEZ MATTHEW Q N

2134964 3/01/04 12:34

3 108 MED 69 3 1 M 33155 ODONNELL PAT R

N

2134997 3/02/04 8:20

3 257 MED 39 1 7 A 56476 GREEN LUKE Q

N

2135012 3/01/04 18:20

2 257 MED 50 2 1 P 58722 DOE BILLIE R

N

2135063 3/02/04 9:51

2 108 MED 95 2 1 M 22474 JACKSON LUKE G

N

2135089 3/02/04 11:35

1 184 MED 82 3 1 M

9692 ROBERTSON GEORGE Q

N

2135106 3/02/04 14:45

1 184 MED 41 3 1 M 58804 UNDERWOOD BART A

N

2135158 3/02/04 23:20 3/01/04 8:00 3 99 MED 74 3 1 M

8643 PARKER LUKE G

N

2135170 3/03/04 7:50

10 127 MED 90 3 1 M 57605 ROBERTSON BILLIE T

N

2135224 3/03/04 13:00

4 257 MED 44 3 1 B 52741 FITZGERALD MARY Q

N

2135277 3/03/04 19:07

6 257 MED 92 1 7 M 55871 BROWN GEORGE G

N

2135281 3/04/04 1:50

5 179 MED 84 3 1 M

440 BLACK JANE Q

N

2135288 3/04/04 7:21

163 184 MED 41 3 1 M 58804 UNDERWOOD BART A

N

2135346 3/04/04 14:30

1 187 ICU 64 2 1 M 44655 FITZGERALD MARK G

N

2135350 3/04/04 15:52

4 187 MED 21 2 1 P 46181 WHITE MATTHEW A

N

2135380 3/04/04 20:30

2 178 MED 2 2 1 H 38826 NORRIS MARY T

N

GRAND TOTAL - ADMISSIONS

23

GRAND TOTAL - PATIENT DAYS 233

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Discharge Register Page 3.1

Discharge Register

Overview: This option generates a listing of all the patients that have beendischarged from the hospital.

This listing prints the patient number, admission date, discharge date, days of stay, financial class, hospital service code, age, history number, physician number, physician name, patient name, race, and discharge status. The patient's address and phone number can be selected to print.

The days stay on this report is the difference between the discharge date and the admit date. It does not reflect the number of room charges or any leave of absence (LOA) days.


Program: PB0R24



Note: This selection will only be displayed if the field Site Location Processing is answered 'Y' in the Admission Control Record, Option 26

on the System Control File Menu.

Date range - From date and To date Print order - Patient number, Financial class, Date order, or HSV If HSV is selected, the following selections are displayed:

1 - All HSVs 2 - Selected HSVs Up to 10 HSV codes may be entered.

Include address and phone - Y or N

The Printer/Archive Options window will be displayed to allow the following selections to be entered: Print - Y or N Copies - Number of copies Outq - Printer outq name Archive - Y or N

Note: The archive selection will only be shown if HMS Archive is installed in the Hospital name/addr/id# record, Option 1 on the System Control File Menu. The Archive field will default to 'N'. Be sure to change it to 'Y' to archive the report.

Statistics: None

Use: This listing can be used to identify discharged patients for a specific date range or financial class.

Files: ADMSTATJ01, ARMAST, PAADMLOC, PATHIST, PATIENTS, PHYMAST


RUN DATE 1/15/04 TIME 9:20:28

EXAMPLE HOSPITAL

FAC# 100

PAGE 1

Site 100 EXAMPLE HOSPITAL

DISCHARGE REGISTER

PB0R24


PATIENT ADMISSION DISCHARGE DAYS FIN HISTORY PHY

DISCHARGE

NUMBER DATE DATE STAY CLS HSV AGE NUMBER NO. PHYSICIAN NAME PATIENT NAME

RACE STATUS

------- --------- --------- ---- --- --- --- -------- ----- -------------------- ------------------------- ---- ---------

170 8/13/03 8/13/03 1 M EMR 3 46117 1 BAKER ROBERT BABY SMITH

W

01

EMR:

1

1032419 2/17/03 8/27/03 191 M ICU 78 9491 179 PARKE

R P

FORREST ELWOOD D

W

01

14 2/18/03

9/30/03

224 P

ICU

34 23945

222 DAWSON KRISTA

JORDAN MELISSA

H

01

184 2/20/03 8/15/03 176 C ICU 44 46080 503 GLEASON D

HENRY VAUGHN

W

01

1 7/22/03 8/27/03 36 S ICU

1783 1 BAKER ROBERT

GILBERT AMY

O

00

5000034 8/28/03 8/28/03

1 S ICU 43 10450 501 FLINT TIMOTHY

TURNER BEA

W

01

5000145 10/15/03 10/15/03

1 S

ICU

43 46860

503 GLEASON D

ONEILL ANITA

W

01

ICU:

6

110 8/05/03 8/13/03 8 P MED 38 39749 476 ALBERTA MARIA

CARTER AMY A

W

01

111 7/29/03 8/13/03 15 S

MED

62

5106 116 MCCORMICK A

GRANT RITA R

H

01

163 8/11/03 8/12/03 1 M MED 58

5785 1 ROBERT BAKER

EDWARDS STACY

O

01

183 8/15/03

8/27/03 12 S

MED

33

7389 222 DAWSON KRISTA

GEORGE WILMA

W

01

206 8/15/03

8/15/03 1 B

MED

27

8951

105 BUTLER CARTER

ROGERS DAVID M

W

01

247 8/27/03 9/30/03 34 M MED 43

9673 501 FLINT TIMOTHY

DAVENPORT A R

W

01

229 9/02/03

9/30/03 28 B

MED

59 38286 476 ALBERTA MARIA

HATLEY DENNY

O

01

216 8/27/03 9/30/03 34 M MED 20 36489 55555 BAKER JOHN

GABRIEL ASHLEY P

W

01

2105732 4/14/03 10/15/03 184 M MED 93 46870

501 FLINT TIMOTHY

UTLEY PAUL

W

06

5000053 9/16/03 9/30/03 14 M MED 43 46871 501 FLINT TIMOTHY

JOYNER JERRY

W

01

5000059 9/16/03

9/30/03 14 M MED 43 46848

501 FLINT TIMOTHY

DANES CARLA

W

01

MED: 11

161 8/06/03 9/30/03 55 F NUR 13 46115 503 GLEASON D

WALKER A G

I

01

71 8/12/03 10/15/03 64 C

NUR

37 46085

503 GLEASON D

JONES NINA

W

20

201 8/15/03

8/15/03 1 P

NUR

38 39749

476 ALBERTA MARIA

CARTER MICHAEL

W

01

NUR:

3

100 8/01/03 8/01/03 1 C SUR 33 17156 318 BAKER JUANITA

DILLINGHAM HARRIET

W

01

119 8/05/03 8/27/03 22 M SUR 4 41759 476 ALBERTA MARIA

FRENCH BONITA R

W

01

134 8/06/03

8/15/03 9 P

SUR

20 3876

222 DAWSON KRISTA

CLANTON NATALIE

W

01

222 8/27/03

9/30/03 34 C

SUR

82 12628

476 ALBERTA MARIA

ADAMS MONA

W

11

SUR:

4

SITE TOTALS: DISCHARGES

25

PATIENT DAYS

1161

GRAND TOTAL - DISCHARGES

25

GRAND TOTAL - PATIENT DAYS

1161

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Pre-Admission Register Page 4.1

Pre-Admission Register

Overview: This option generates a listing of all the patients that have been pre-admitted to the hospital.

This listing prints the patient number, expected date, expected time, physician number, admission type, admission source, financial class, hospital service code, history number, current balance, and patient name.

The listing prints in expected date order.

If Room and Bed assignment by site location is not used, there is no prompt screen displayed after the option selection.

Access: Reports Menu I, Option 11 Admission Menu, Option 8

Program: PB0R25


Note: This selection will only be displayed if the field Site Location Processing is answered 'Y' in the Admission Control Record, option 26 on the System Control File Menu.

Statistics: None

Use: This listing can be used to identify patients that are expected to be admitted to the hospital on specific dates.

Files: ADMREG, PAADMLOC, PATHIST, PATIENJ01, SYSCTL

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Pre-Admission Register Page 4.2

PB0R25 MEDHOST SAMPLE HOSPITAL PAGE: 1

HOSPITAL: 245 MONITOR: PRE-ADMISSION LIST DATE: 9/11/13

USER: ANNA Site 241 HOSPITAL LOCATION TIME: 7:36:00

PATIENT EXPECTED EXPECTED PHY ADM ADM FIN HOSP HISTORY CURRENT

NUMBER DATE TIME NO. TYP SRC CLS SERV NUMBER BALANCE PATIENT NAME

------- -------- -------- --- --- --- --- ---- -------- ------------- -------------------------

503643 8/17/05 646 3 1 C MSU 151382 .00 FLETCHER TONYA L

503649 8/19/05 29 3 1 U MSU 124096 .00 UBECK MARY J

600022 5/08/13 11:50 1039 1 2 U ICU 101679 .00 WAGNER MICHAEL P

600023 5/08/13 11:53 1039 1 1 U ICU 122428 .00 RAMEY NEIL JANICE L

600025 6/30/13 13:39 1016 2 1 3 ICU 151970 .00 TANNER GINNYU

600027 6/30/13 14:25 1140 1 1 C MSU 151932 .00 SMITH APRIL

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Pre-Registration Register Page 5.1

Pre-Registration Register

Overview: This option generates a listing of all the outpatients who are pre-registered for service on a specific date.

This listing prints the patient number, expected date, expected time, physician number, admission type, admission source, financial class, hospital service code, history number, current balance, and patient name.

The listing prints in expected date order.

If Room and Bed assignment by site location is not used, there is no prompt screen displayed after the option selection.


Program: PB0R50 PB0R50S – By site location


Note: This selection will only be displayed if the field Room and Bed assignment by site location is answered 'Y' in the Admission Control

Record, Option 26 on the System Control File Menu.

Statistics: None

Use: This listing can be used to identify patients that are expected to be registered in the hospital on specific dates.

Files: ADMREG

||

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Pre-Registration Register Page 5.2

PB0R50

ABC HOSPITAL

PAGE: 1

HOSPITAL: 100

MONITOR: PRE-REGISTER LIST

DATE: 12/23/03

USER: ANNA

TIME: 1:57:15

PATIENT EXPECTED EXPECTED PHY ADM ADM FIN HOSP HISTORY CURRENT

NUMBER DATE TIME NO. TYP SRC CLS SERV NUMBER BALANCE

PATIENT NAME

------- -------- -------- --- --- --- --- ---- -------- ------------- ------------------------

292 12/11/03 13:00 488 1 3 S EMR 39792

.00 PERKINS AMBER

289 12/13/03 12:06 488 9 9 S RAD 879632147 100.00 SAMUEL GINA

303 12/13/03 12:42 100 1 1 B OP 14843

.00 WILBANKS KAREN

304 12/14/03 12:44 488 1 1 S OHP 14272

.00 WATERS SHAUN B

320 12/14/03 14:21 343 9 9 S OP 17022244

.00 TURNER BILLY

324 12/17/03 12:22 338 3 3 M EMR 17022251

50.00 QUINN ROBERT

332 12/19/03 7:00 25 3 1 M RAD 17022254

75.00 LANDON REGIS

339 12/19/03 8:06 488 1 3 S OP 46107

.00 VINCENT MARY E

350 12/21/03 1:00 100 3 1 B SDS 34109

.00 OCONNOR DORIS

352 12/21/03 12:16 369 1 3 N OP 17022224

.00 HITE KENNER

378 12/24/03 14:09 488 1 1 M MIN 9096

.00 YATES RANDALL W

442 12/24/03 15:54 987 3 3 B MIN 17022316 100.00 INGALLS MARY FRANCES

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Outpatient Registration List Page 6.1

Outpatient Registration List

Overview: This option generates a listing of all the outpatients and emergencyroom patients.

The listing prints the patient number, registration date, registration time, quick admit date, quick admit time, physician number, hospital service code, admission type, admission source, age, financial class, patient name, how the patient arrived, chief complaint, advance directive, and chart number.


Program: PB0R23



Date range - From and To Print order - Patient Number, Financial Class, Registration Date, Hospital Service Code, or Chart Number

If Hospital Service Code order is selected, all HSV codes can be printed or only selected codes. If selected HSV codes are to be printed, enter up to 10 codes.



Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id#record, Option 1 on the


||


Statistics: None

Use: This report is used to identify outpatient and emergency room patients that are registered.

Files: ADMREG


RUN DATE 3/10/04 TIME 11:48:48

EXAMPLE HOSPITAL

FAC# 100 PAGE 1

REGISTRATION LIST

PB0R23


PATIENT REG REG QKMNT QKMNT PHY HOSP ADM ADM F HOW ADMITTING ADV CHART

NUMBER DATE TIME DATE TIME NO. SERV TYP SRC AGE C

PATIENT NAME

ARRIVED CHIEF COMPLAINT DIR NUMBER

------- ------- ----- -------- ----- ----- ---- --- --- --- --- -------------------------- ------- ------------------- ----- --------

1039602 3/01/04 2:57

431 EMR 1 7 24 C FITZGERALD JOANNE A

VAN VOMITING

N 12345

1039603 3/01/04 8:58 3/01/04 8:00 315 EMR 1 7 92 M BROWN JOHN H

COUGH VOMIT

N 55512

1039604 3/01/04 9:12

315 EMR 1 7 36 W JACKSON PAT A

CAR FB LFT EYE

N 123145

1039605 3/01/04 10:55

184 EMR 1 7 39 D DOE MARK T

AMBULANCE RT BREAST CYST N 88551

1039606 3/01/04 12:32

315 EMR 1 7 34 S HARRIS BART A

BOTH EYES IRRITATED N 55541

1039607 3/01/04 13:30

315 EMR 1 7 41 S UNDERWOOD BILL

CAR ABD PAIN

N 65654

1039608 3/01/04 14:04 3/01/04 14:30 315 EMR 1 7 25 S ROGERS PAT T

LFT SIDE FACE PAIN N 85858

1039610 3/01/04 15:45

55 OBV 1 7 84 M ROBERTSON JOAN R

CHEST PAIN RO MI N 22221

1039611 3/01/04 15:59 3/01/04 15:00 315 EMR 1 7 57 M ROGERS SANDRA

N 54545

1039612 3/01/04 17:44

315 EMR 1 7 44 P BAKER SANDRA T

R HAND SWELLING N 45454

1039613 3/01/04 18:14 3/01/04 17:30 315 EMR 1 7 85 M DOE LANCE

N 14010

1039614 3/01/04 22:36

315 EMR 1 7 24 S GREEN BART E

CAR COUGHING

N 78787

2132721 3/01/04 8:00

127 SDS 3 1 80 M NORRIS MARIE W

ABN FIND-STOOL CONT N 123454

2133273 3/01/04 8:40

127 SDS 3 1 36 P UNDERWOOD JUAN Q

WALKED STOMACH FUNCTION DI N 345411

2134089 3/01/04 10:35

127 SDS 3 1 30 C MARTIN PETER G

AMB ESOPHAGEAL REFLUX N 721112

2134648 3/01/04 7:13

127 OBV 3 1 41 B FULLER WILLIAM A

LFT ING HERNIA REPA Y 212144

2134649 3/01/04 11:01

127 SDS 3 1 88 M DOE GLENN G

EKG N 998811

2134650 3/01/04 9:35

127 SDS 3 1 34 P FULLER SAM R

HEMRRHOID NOS W COM N 556611

2134651 3/01/04 10:40

127 OBV 3 1 36 W WHITE MARK A

BING HERNIA REPAIR N 457889

2134718 3/01/04 15:30

187 ORC 3 1 78 M JONES MARILYN R

CAD

Y 656565

2134720 3/01/04 16:10

187 ORC 3 1 80 M HARRIS LUKE G

CAD

N 232321

2134722 3/01/04 10:30

187 ORC 3 1 53 B BAKER BILLIE R

AMB CHEST PAIN

N 405000

2134724 3/01/04 10:45

187 ORC 3 1 64 B JACKSON MATTHEW G

S/P MI ENTRY CARD R N 515124

2134726 3/01/04 5:22

99 SDS 3 1 72 M JACKSON PAT Q

CAR HEARTBURN

N 141414

2134728 3/01/04 5:22

800 OHO 3 9

Y EDWARDS PETERS

N 787111

2134757 3/01/04 8:05

179 OP 3 1 41 C FITZGERALD JANE Q

XRAY

Y 653211

2134758 3/01/04 9:20

399 OP 3 1 26 P PETERSON SANDRA R

N 787112

2134759 3/01/04 12:40

127 OP 3 1 40 P ROGERS JOAN R

XRAY

N 472181

2134760 3/01/04 13:20

142 OP 3 1 44 B RODRIGUEZ SUE R

XRAY

N 352177

2134761 3/01/04 12:42

232 OP 3 1 72 M GREEN PETER G

NUMBNESS TINGLING Y 982414

2134764 3/01/04 8:20

267 OP 3 1 34 C ROBERTSON BILLIE R

BACK PAIN

N 405121

2134765 3/01/04 8:50

187 OP 3 1 79 M RODRIGUEZ MATTHEW G

N 657114

2134826 3/01/04 8:55

55 REC 3 1 31 W NORRIS MARK G

PHYSICAL THERAPY N 403511

2134828 3/01/04 15:30

267 REC 3 1 10 B JACKSON ANNE Q

PHYSICAL THERAPY Y 123887

GRAND TOTAL - REGISTRATIONS 34

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Recurring Outpatient Listing Page 7.1

Recurring Outpatient Listing

Overview: This option generates a current listing of the patients who areclassified as recurring outpatients.

The report prints the patient number, patient name, site location (if applicable), hospital service code, financial class, periodic billing code, registration date, date of last bill, current balance, and amount of unbilled charges.

The report is broken down by hospital service code with totals for each hospital service code.


Program: PB0R85

Selection: Site Location - Enter a site location, press F4 to search, or leaveblank for all

Note: The Site Location selection will only be displayed if the field Site Location Processing is answered 'Y' in the Admission Control Record, Option 26 on the System Control File Menu.



Note: The archive selection will only be shown if MEDHOST Archive is installed in the Hospital name/addr/id# record, Option 1 on the System Control File Menu. The Archive field will default to 'N'. Be sure to change it to 'Y' to archive the report.

Statistics: None

||


Column Heading: PER BILL - Periodic billing code

Use: This listing is used to verify the outpatients that return to the hospital for ongoing treatment such as physical therapy.

File: ADMREG


RUN DATE 4/15/03 TIME 14:09:58

MEDHOST TEST FACILITY

FAC# 001

PAGE 1

R E C U R R I N G O U T P A T I E N T L I S T I N G

PB0R85

PATIENT

SITE

PER REGISTRATION DATE OF

CURRENT

UNBILLED

NUMBER

PATIENT NAME

LOC HSV F/C BILL DATE

LAST BILL

BALANCE

CHARGES

-------

------------

--- --- --- ---- --------- ---------

---------

-------

5807382 GREEN BETTY J

W01 HHH A 1/15/03

2/15/03

150.00

.00

5808255 SMITH JOSEPH

W01 HHH C 1/20/03

2/15/03

75.50

50.00

** SITE/HSV TOTALS ** # OF ACCOUNTS

2TOTAL BALANCE

225.50

50.00

** FINAL TOTALS ** # OF ACCOUNTS

2TOTAL BALANCE

225.50

50.00

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Treatment Worksheet Page 8.1

Treatment Worksheet

Overview: This option generates a treatment sheet listing all patients byroom/bed.

This report lists the room/bed number, patient name, sex, age, smoking indicator, hospital service, doctor, and diagnosis.


Program: PB0R01

Selection: Site Location - Enter a site location, press F4 to search for a sitelocation, ore leave blank for all


Statistics: None

Use: This report can be distributed daily to the nursing stations to be used to record notes regarding patients' vital signs, diet, activity, or treatments.

Files: PATIENTS, PHYMAST, RMBED

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SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Treatment Worksheet Page 8.2

DATE: 7/21/04

D A I L Y T R E A T M E N T S H E E T

PAGE: 2

ROOM| |S| |S| |

|

| | | |

NO. | PATIENT'S NAME

|E|AGE|M|HSV| DOCTOR

| DIAGNOSIS

|V/S |DIET |ACTIVITY |TREATMENTS

----|-------------------------|X|---|K|---|--------------------|-------------------|----|-----|---------|---------------------------

|

| | | | |

|| | |

|

XHN5|KANATZER WANDA

|F| 2| |MIP|BLOCK, CLEMENT MD |CHEST PAIN

| | |

|

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|

XHN6|YADEN GENE NEYLAND |M| 1| |MIP|BLOCK, CLEMENT MD |

| | |

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|

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|| | |

|

XHN7|STEPHENS AARON RALPH |M| 30| |MIP|BLOCK, CLEMENT MD |PNEUMONIA

| | |

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XHN8|

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|

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|

XHN9|SACKETT CHARLES

|M| 79| |MIP|BLOCK, CLEMENT MD |CONGESTIVE HEART F | | |

|

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XH10|FEND ELMER

|F| 93| |MIP|BLOCK, CLEMENT MD |

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XH11|

| | | | |

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XH12|SWAFFORD BARBARA

|F| 31| |GIP|BURRESS, ROGER MD |DIABETES

| | |

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XH13|SMITH ALICE

|F| 31| |GIP|BURRESS, ROGER MD |ASTHMA

| | |

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XH14|JONES ALANA RENEE |F| 28| |MIP|BLOCK, CLEMENT MD |

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XH15|SALTSGIVER GEORGINA |F| 22| |MIP|BLOCK, CLEMENT MD |BRONCHITIS

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XH16|STEVENS ROGER

|M| 30| |MIP|BURRESS, ROGER MD |

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XH17|STEPP ADAM

|M| 30| |MIP|BLOCK, CLEMENT MD |

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XH18|STEPHENS CORY

|M| 30| |MIP|BLOCK, CLEMENT MD |

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XH19|BROWN APRIL

|F| 11| |MIP|COFFEY, BRUCE MD |

| | |

|

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Periodic Billing Report Page 9.1

Periodic Billing Report

Overview: This option generates a listing of all patients set up as periodic billingpatients.

This listing prints the patient number, patient name, admission date, date of last bill, inpatient/outpatient, financial class, payor/plan, hospital service code, total charges, unbilled amount, and billing code.

The listing is subtotaled by billing code.


Program: PB0R60



Periodic billing codes - Enter up to 5 codes or leave blank fo all codes.

Statistics: None

Use: This listing can be used to determine what periodic billing accounts the hospital should review.

File: PATIENTS

||

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Periodic Billing Report Page 9.2

PB0R60

DATE 6/03/04

EXAMPLE HOSPITAL

PAGE 1

TIME 3:08 PM

PERIODIC BILLING REPORT

PATIENT ADM DTE LST BILL I/O F/C PAYOR HSV TOTAL CHARGES UNBILLED AMT BILLING CODE

------------------------- -------- -------- --- --- ------- --- -------------- -------------- -------------------

0000015 BAKER ANNE Q

4/06/04 0/00/00 I C 104/001 MED 645.50

645.50 M - MONTHLY BILLS

2135940 BLACK JOHN A

3/11/04 0/00/00 O W 939/002 OHP

40.00


2136443 BROWN BILLIE T

3/18/04 0/00/00 O W 944/002 OHP

50.00


2136686 BROWN BILLIE T

3/22/04 0/00/00 O W 944/002 OHP

.00

.00 M - MONTHLY BILLS

2136023 EDWARDS BART Q

3/12/04 0/00/00 O W 933/002 OHP

40.00


2136368 GREEN JOAN T

3/17/04 0/00/00 O W 998/002 OHP

.00


2136181 GREEN MARY R

3/15/04 0/00/00 O W 910/002 OHP

.00


6000068 HUDSON LESLIE

4/07/04 0/00/00 I C 001/001 ICU

.00


6000076 MILLER LOWELL

4/14/04 0/00/00 I C 001/001 ICU

.00


2131537 ODONNELL JAMES Q

1/19/04 0/00/00 O S 000/000 OHP

.00


2136393 PARKER BART G

3/17/04 0/00/00 O W 942/002 OHP 173.50


2136698 PARKER BART G

3/22/04 0/00/00 O W 942/002 OHP

.00


2135933 RODRIGUEZ ANNE T

3/11/04 0/00/00 O W 941/002 OHP 171.50


2131539 UNDERWOOD MARK Q

1/19/04 0/00/00 O S 000/000 OHP

.00


BILLING CODE SUBTOTAL 1,120.50 1,120.50

GRAND TOTAL

1,120.50 1,120.50

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Billing Cycling Summary Report Page 10.1

Billing Cycle Summary Report

Overview: This option generates a summary report listing cycle billing accounts.

This listing prints the patient number, cycle number, patient name, total balance, payor #1 balance, payor #2 balance, payor #3 balance, patient balance, date billed, and financial class.


Program: PB0R48

Selection: All patients or a specific patientPrint zero balances - Yes or No

Site Location - Enter a site location, press F4 to search for a sitelocation, or leave blank for all

Note: This selection will only be displayed if the field Site Location Processing is answered 'Y' in the Admission Control Record, Option 26 on the System Control File Menu and only if a Patient Number is entered.

Statistics: None

Use: This listing can be used as a history of billings for cycle bill accounts.

Files: ARMAST, ARSMSTATJ1, PATHIST, PATIENTS, SYSCTL

||

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Billing Cycling Summary Report Page 10.2

DATE 3/01/05

EXAMPLE FACILITY OF AMERICA

PAGE 1

Site 100

BILLING CYCLE SUMMARY REPORT

PATIENT CYCLE

PATIENT

CURRENT BALANCE

DATE F/C

NUMBER NO.

NAME

TOTAL

PAYOR #1 PAYOR #2 PAYOR #3 PATIENT BILLED

2581189 1 SMITH MARY JANE

77.71-

77.71- .00

.00

.00 1/31/05 M

282.00

82.00

.00

.00

.00 1/31/05 M

2455181 1 YANCEY SCOTT

50.00

50.00

.00

.00

.00 1/31/05 C

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Guarantors Not To Receive Statements Page 11.1

Guarantors Not To Receive Statements

Overview: This option generates a listing of guarantors who are not to be sentstatements.

Note: Guarantors may be selected to not receive statements through Guarantor History Maintenance.

This report lists the guarantor number, guarantor name/address, phone, current balance, date of last statement, date of last payment, writeoffs, bad debt balance, and comments.

There is no prompt screen displayed after the option selection.

Access: Reports Menu II, Option 20

Program: AR0R63

Selection: None

Statistics: None

Use: This report is used to identify the guarantors who are not sent statements and the balances for these guarantors.

File: GUARANT

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Guarantors Not To Receive Statements Page 11.2

PB0R63

EXAMPLE FACILITY

DATE: 4/05/

05

GUARANTORS NOT TO RECEIVE STATEMENTS

TIME: 15.58.05

PAGE 1

GUARANTOR

GUARANTOR

CURRENT DATE OF DATE OF WRITE BAD DEBT

NUMBER

NAME/ADDRESS

PHONE

BALANCE LAST STMT LAST PMT OFFS

BALANCE

COMMENTS

0000004 BRICKALL, GARY

615-442-8168

18.25

01/02/05

12 CYNTHIA TRAIL

NASHVILLE

TN 37210

0000005 JACKSON, FRANK

615-524-7920

1,752.75

12/31/04 1

58.25

PAY FROM TAX RT

147 MARGIN ST

NASHVILLE

TN 37212

0000006 BARTIN, HUGH

125-125-2541

1,083.50

01/15/04

PAY FROM TAX RT

RT 4 BOX 11

SHADOWBOX

AZ 24561

TOTALS:

NO. GUARANTORS

3 *

$2,854.50 *

$58.25 *

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Readmission List Page 12.1

Readmission List

Overview: This option is selected to print the patients that have been readmittedwithin the number of days prior to the report date.

For example, to list the patients that were admitted more than once during the last 90 days of 2005, enter 123105 as the report date and 90 as the number of days.

This report lists the patient number, chart number, patient name, admission date, discharge date, financial class, and hospital service code.

Totals are printed for the number of patients and the number of readmissions.


Program: PA1R71

Statistics: None

Selection: Admission dateNumber of days previous to admission date to look for readmissions Inpatients, Outpatients, or Both Same DRG - Yes or No

If answered Yes, the report will print only the readmissions for a patient in which the patient had the same DRG for all readmissions.

Same Diagnosis - Yes or No If answered Yes, the report will print only the readmissions for a patient in which the patient had one or more of the same diagnosis codes for all readmissions.

Patient Class - F4 to search or leave blank to select all classes

Files: ADMREG, PATHIST, PATIENTS, PATEXT, ABSTRACT, ADMREGC

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Readmission List Page 12.2

PROG: PA1R71

EXAMPLE FACILITY

PAGE

1

TIME: 16:45:01

READMITTED PATIENTS OCCURRING THE LAST 90 DAYS

DATE: 12/04/

05

PATIENT CLASS: G

AS OF 10/30/05

PATIENT

CHART

ADMISSION DISCHARGE FIN HOSP

NUMBER

NUMBER

NAME

DATE

DATE

CLASS SERV

5701960 088861248 TAYLOR WILLIAM T

10/28/05 10/28/05 L EOP

5702024 088861248 TAYLOR WILLIAM T

10/30/05 10/30/05 L DOP

5701749 000049825 GRANT KERMIT R

10/26/05 10/26/05 M HHC

5701722 000049825 GRANT KERMIT R

10/26/05 10/29/05 M MIP

5701748 000055658 REDDEN WILLIAM

10/26/05 10/26/05 M HHC

5702083 000055658

REDDEN WILLIAM

10/30/05

10/30/05

M EOP

5701648 000059485 WALKER SHERRY K

10/26/05 10/26/05 N DOP

5701007

000059485

WALKER SHERRY K

10/28/05

10/31/05

N ROP

5701624 000056286 DURGIN CLARA T

10/25/05 10/27/05 N MIP

5701977 000056286 DURGIN CLARA T

10/29/05 10/29/05 N DOP

5701677 000058744 WHITLEY DIANE

10/25/05 10/25/05 L EOP

5701965 000058744 WHITLEY DIANE

10/28/05 10/28/05 L EOP

5701645 000054721 SPENCE BETTY J

10/25/05 10/25/05 L EOP

5701857

000054721

SPENCE BETTY J

10/27/05

10/27/05

L EOP

5701841 000055185 DILLARD MORGAN E

10/28/05 10/28/05 K DOP

5702016 000055185 DILLARD MORGAN E

10/30/05

10/30/05

K DOP

5702095 000057023 LEFFEW ROBERT H

10/30/05 10/30/05 M HHC

1237982 000057023 LEFFEW ROBERT H

10/30/05 11/01/05 M MIP

TOTAL NO. PATIENTS:

9

TOTAL NO. READMISSIONS:

9

****** E N D O F R E P O R T ******

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Expired Member Listing Page 13.1

Expired Member Listing

Overview: This option generates a listing of deceased patients grouped by VIPcode.

The VIP code is entered for a patient during the Admission/ Registration process and can be maintained through Patient Maintenance.

This listing prints the medical records number, patient name, patient address, city, state, zip, and deceased date.

Each VIP code begins printing on a new page.

The patient information is sorted by medical records number.


Program: PB0P91B

Selection: Expired From and To DateSelected VIP codes or all VIP codes

Statistics: None

Use: This listing can be used to determine deceased patients for each VIP code.

Files: ADMREG, MRABMASTR, PATHIST, PAVIPS, SYSCTL

||

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Expired Member Listing Page 13.2

RUN DATE 4/05/2005 TIME 09:19:33

MEDHOST TEST FACILITY

FAC# 001

PAGE

1

EXPIRED MEMBER LISTING

PB0P91B

FROM 1/01/05 TO 1/31/05

VIP Code: S Description: SENIOR

Med. Rec. # Patient Name Patient Address

Patient City State Zip

Deceased Date

____________ ____________________ ____________________ __________________________ _________

_____________

287 SMITH FLORA A

4444 BELL BRANCH RD NUNNELLY

TN 37137

2005-01-06

3817 HENRY MADISON L

104 ELM STREET

CENTERVILLE TN 37033

2005-01-07

9870 ONEILL LOREENA

45 ROSE CIRCLE

NASHVILLE

TN 37210

2005-01-20

10335 ROBERTS GINGER C 0555 EAST FIRST

MEMPHIS

TN 38030

2005-01-13

12142 DAWSON STUART

1433 MAPLE ROW

NASHVILLE

TN 37215

2005-01-02

17644 WILLIAMS TED R

123 OLD RICHARDSON NASHVILLE

TN 37205

2005-01-12

18244 VAUGHN PAULA

345 GREENWAY DRIVE NASHVILLE

TN 37210

2005-01-27

SAMPLE REPORTS MISCELLANEOUS REPORTS MISC Leave Of Absence History Page 14.1

Leave Of Absence History

Overview: This report is used to list the patients who have had a leave ofabsence recorded on their account.

The report prints the patient number, patient name, leave of absence code, leave of absence description, financial code, financial code description, discharge/transfer status code, discharge/transfer status description, and number of leave of absence days.

Totals print for the number of patients and leave of absence days.

If printing by site code, site totals will print for the number of patients and leave of absence days.

Access: Reports Menu III, Option 20

Program: PA0R26


Selection: Sort by - Patient name, Patient number, LOA code, or LOA Days LOA date range - From and Through or Blank for all LOA number of days - From and Through or Blank for all Discharge/Transfer status - Enter up to 5 codes or Blank for all Financial class - Enter up to 5 codes or Blank for all LOA code - Enter up to 5 codes or Blank for all Site code - Enter up to 4 codes or Blank for all Note: This selection will only be displayed if the field Site Location

Processing is answered 'Y' in the Admission Control Record, Option 26 on the System Control File Menu.



Note: The archive selection will only be shown if MEDHOST Archive is

installed in the Hospital name/addr /id#record, Option 1 on the System Control File Menu. The Archive field will default to 'N'. Be sure to change it to 'Y' to archive the report.

Statistics: Average LOA Days Use: This report can be used to track the historical LOA data for patients

that have been transferred from the hospital. Also, the number of patients and total number of interrupt days (LOA) can be determined from this report.

Files: LOAHIST, DSSTAT, FCDESC, SYSTABFL


PA0R26

MEDHOST HOSPITAL

PAGE 2

SITE 070 070

LEAVE OF ABSENCE HISTORY

DATE 3/10/08

FAC# 070

TIME 8:37:30

*List of patients on leave: With LOA codes (A) Sort by patient name

PATIENT

PATIENT NAME

LEAVE OF ABSENCE FINANCIAL CLASS

DISCHARGE/TRANSFER STATUS

LOA

NO.

CODE DESC. CODE

DESC.

CODE

DESC.

DAYS

7071372 CALDWELL SUZANNAH M

A LTAC TO ACUTE B BLUE CROSS

02 SHORT-TERM GENERAL HOSPITAL

000

6000104 DORAN JAMES JEFFERY

A LTAC TO ACUTE F MEDICAID

30 STILL PATIENT OR WILL RETURN AS OP 000

6000069 PITTMAN DARRELL LYNN

A LTAC TO ACUTE F MEDICAID

62 DISCH/TRNSF FROM ACUTE PCH TO SWING 002

6000165 WOODYARD WILMA BELLE

A LTAC TO ACUTE

F MEDICAID

01 HOME/SELF CARE

002

Site Totals

Total Patients-

4

Total LOA Days-

4

Average LOA Days- 1.00

Total Patients-

10

Total LOA Days-

4

Average LOA Days-

.40

MEDHOST Enterprise Patient Accounting Sample Reports · REPORT MENU/TAB OPTION F Final Census...

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