Step 7 of 8
Read your claims, analytics and payers
How much you collect, why claims are denied, how each payer behaves, and what your own history says about a claim's codes.
These three pages are built from your files, not estimated. The money numbers need an A/R file; a denials report alone fills only the denial parts. Every rate shows how many claims it comes from, because 50% of 4 claims is not the same fact as 50% of 400.
Payers: the scorecard
Open Payers in the left menu. There is one row per payer.
- Claims, Billed
- What it tells you: How many claims and dollars this payer had in your latest A/R file.
- Denial rate
- What it tells you: Denied claims out of all of this payer's claims.
- Days to pay
- What it tells you: The typical (median) days from submitting a claim to getting paid, counting paid claims only.
- Top reason
- What it tells you: The reason code this payer denies for most.
- At stake
- What it tells you: Open denials on your worklist that you can still work, in billed dollars.
- Appeals won
- What it tells you: From the outcomes you recorded. It shows a rate only once there are enough decisions to mean something.
- Window
- What it tells you: The appeal window Yeam uses for this payer. A
~means it is assumed, not known.
| Column | What it tells you |
|---|---|
| Claims, Billed | How many claims and dollars this payer had in your latest A/R file. |
| Denial rate | Denied claims out of all of this payer's claims. |
| Days to pay | The typical (median) days from submitting a claim to getting paid, counting paid claims only. |
| Top reason | The reason code this payer denies for most. |
| At stake | Open denials on your worklist that you can still work, in billed dollars. |
| Appeals won | From the outcomes you recorded. It shows a rate only once there are enough decisions to mean something. |
| Window | The appeal window Yeam uses for this payer. A ~ means it is assumed, not known. |
Click a payer for the detail. The top line says how much you can still recover from them and how much closes within 14 days. Below it: Why they deny, How they pay, Appeals and Where to send.
How to use it
- A high denial rate with one top reason usually points to one fixable habit, like a missing modifier.
- Days to pay is also what decides when a sent appeal is worth a phone call.
- A reason code that keeps losing on appeal (look at Appeals) is a sign to stop writing those appeals and fix the claims up front.
Analytics
Open Analytics for the practice as a whole:
- Billed against collected, by month.
- Outstanding A/R by age: 0-30, 31-60, 61-90, 91-120 and 120+ days.
- Denial rate by month.
- Why claims are being denied: each reason code, what it needs, and how much is at stake.
- Recovery: how many denials sit at each stage, from to work through recovered.
Claims and code prediction
Open Claims to see every claim in your latest A/R file. Click one to open it. The sections are Why it was denied, Code review and Record your work.
Code review
For this claim’s payer and procedure code, Yeam shows which diagnosis codes that payer has actually paid on your past claims, and how many claims each figure rests on. A figure with fewer than 5 claims behind it is flagged as too few to rely on.
Predict from my history
On the Practice plan, Predict from my history gives four answers about the claim:
- Remedy: appeal, correct and resubmit, or write off.
- Diagnosis: the best-supported diagnosis code, or Leave as billed.
- If resubmitted as billed: the chance this payer denies it again.
- Worth working: whether fixing it is worth your time.
The diagnosis can only come from codes this payer has paid on this procedure in your own history, so it can never suggest a code you have not been paid for. The percentage beside an answer shows how much weight landed on that option. It is not the chance the answer is right. When there is no evidence for a question, Yeam says Not asked and why, instead of guessing.
A prediction is a second opinion from your own data. You decide what to change on the claim.
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