Visual Practice HOW TO
...Interpreting Reconciliation Reports
MRO RA - Reconciliation Advice - Introduction
Machine Readable Output (MRO) Reconciliation Advice (RA) are fancy acronyms for the file that is returned to you by OHIP once each month with comprehensive accounting responses to billings submitted through MRI submissions (Machine Readable Input). Depending on your method of communication with the Ministry of Health, this file can arrive by mail on diskette, or it can arrive by modem via EDT.
Visual Practice reads version 3.0 MRO RA files and imports them into its own accounting database. This enables you to run and re-run your RA accounting reports repeatedly anytime you want, without having to refer to the original OHIP MRO RA file.
There are nine main reports that can be produced using the Reconciliation Inquiry system. You can select each MRO RA file by name and date, select which reports you wish to view and select report formatting options. Depending on how you run your practice and reconcile your billings, some reports and options may be useful to you while others may be inapplicable. The Reconciliation Inquiry system was designed to appeal to the largest body of feature requests made by our customers for over 15 years.
Each report has its own purpose; some are summary views of accounting information, while others are very detailed breakdowns of billing rejections and other response conditions that the Ministry of Health wants to communicate to you. It is very important to pay special attention to rejections or adjustments that result in either adjusted payments or zero payments. In many cases, rejections are a result of mistakes in the billing process, and most of the time, these mistakes can be easily corrected, and the rejected bills resubmitted for payment.
A word of Caution...
Visual Practice is an excellent tool for catching rejections and adjustments and resubmitting your billings to OHIP. However, it is very important that you pay attention to the reports and follow up on claim errors in order to maximize your practice income. Because the Ministry of Health staledates claims over 6 months old from time of service, it is important that you submit claims and follow up on claim errors as quickly as possible. Visual Practice will not automatically resubmit rejected billings - you are required to review the rejections and either correct and resubmit your rejected claims, or write them off.
Visual Practice is not responsible for staledated claims. Staledated claims are an indication of a failure to bill and follow up on rejected billings within the 6 month window. This is a human failure, not a program or system failure. We are forceful about making this point because of the number of people performing OHIP billing who do not fully understand the OHIP billing process and who get caught in a staledate situation and usually call our support line looking for a way out. ACSL is not OHIP and does not have any authority to grant deadline extensions, nor is there any technical exception that will allow Visual Practice to recover staledated claims. You need to contact the Ministry of Health, explain the situation to them, and ask them to grant you an extension. If you call the ACSL support line asking for staledate claim submission information and extensions, you will be referred to this paragraph in our documentation.
The Reconciliation Inquiry Form enables you to run and re-run MRO RA reports. You can select which reports you wish to view prior to selecting to Preview or Print for the report output. There are two tabs in the Reconciliation Inquiry Form; the first shown below contains the 'Standard' reports:
The second tab contains "Advanced" reports, as shown below:
The Advanced tab contains special advanced reconciliation reports that customers have specifically requested over time. They may not be applicable to your type of billing; however, the best way to find out if they are useful to you is to try them.
Using the various Reporting Options
The Filename drop down combo box selection enables you to select current or past reconciliations to run reports for. They are dated because each year OHIP reuses the same filenames.
Sorting by Bill Number, Bill Date or Patient Name
The sort order for each claim detail report can be changed from Bill Number (default) to the Bill Date or the Patient Name, depending on which you use to reconcile bills when auditing your records using these reports.
Interpreting Reconciliation Inquiry Reports
MRO RA files contain a significant amount of information. There are nine main reports that can be selected, which help you to break down the response from OHIP into manageable, organized topical reports. These reports and their use are summarized below.
Standard Tab Reports
OHIP Remittance Advice Summary
The first report to appear is the OHIP Remittance Advice Summary. This report provides a summary categorization of the entire RA contents, and enables you to determine details such as the difference between what was billed on this reconciliation and how much OHIP actually paid. Also, adjustments and rejections are quantified and if any billings appear on this reconciliation which were billed on a different billing system.
Adjusted Billing Lines
The Adjusted (Changed) Billing Lines by OHIP report lists claim lines within the reconciliation which the computer could not match to the original source line. This is due to the fact that OHIP changed the actual billing code within the bill from its original submitted code. OHIP does not supply a line reference when reconciling bills with multiple OHIP code lines, so the computer can match the lines only using the OHIP code billed, number of units and date of service. If these do not match and the line cannot be found, the reconciliation line appears in this report.
No Matching Bill Numbers - Other Systems
An RA (reconciliation advice file) is a monthly response by OHIP to a single provider or group's submitted billings from all points of submission. While this distinction may not seem meaningful, it is important when you have OHIP billings being submitted from another computer and/or software program, to prevent claim lines from overlapping, so that when you process your single RA on both systems, the billing numbers match to their original claim lines.
Bills that do not have matching numbers will appear in detail on this report. Since the billings were not originally done on this copy of Visual Practice, there is no way to include details such as the original patient name and original claim line submission information for these claim lines in any report. The information that is provided by OHIP is printed on this report so that you can at least reconcile these lines by hand, or determine how much of this reconciliation contains billings outside your system's original billings and if there are any errors.
This is especially useful when first converting to Visual Practice from another system. This report can be used to rebill rejections from the original system, provided that you can determine the original patient and enter them into Visual Practice first. Many new customer opt to import the basic patient information from their old systems, making this approach even easier. They usually then look up the old billings in the old system to determine the original patient and then rebill it under Visual Practice.
Rejected Billing Lines by OHIP
The Rejected Billing Lines by OHIP report is very important for error follow up. While you can use the "View Only Rejected Bills" option under the Records menu when you have an open OHIP Bills Form to view rejected claim lines, this report provides you with rejection details on a line by line basis within a reconciliation. At the end of the report is a summary of the number of claim lines rejected, how much was billed, and how much was paid.
You will notice an option to include or exclude claim lines rejected on a '35'. Error 35 indicates that the claim line was paid on a previous submission. Under some circumstances (such as full resubmission) error 35 replies are understood and since 35's are marked as Accepted (as they have been paid by OHIP) there is no need to adjust the original claim line in any way. Error 35's are therefore optional to include in an error report.
OHIP Message and Cumulative Statistics
Included with the MRO RA file is a message section. OHIP uses this section to provide general announcements as well as information specific to the provider or group of the reconciliation, such as billing threshold status and other important information.
We have observed many customers who simply file this report without reading it. It is recommended that you review it, as in many cases in the past, very important Ministry announcements are made through this message system first.
Billing Lines Paid as Billed by OHIP
This report simply details each claim line in the RA file that was paid as it was originally billed. Some customers find it useful to have a full print out of this information on paper, so it is included in Visual Practice's Reconciliation Inquiry system.
Remittance Detail List
This report simply details each claim line in the RA file regardless of its billing status. Some customers find it useful to have a full print out of this information on paper, so it is included in Visual Practice's Reconciliation Inquiry system.
OHIP Summary Totals
This final report is similar to the OHIP Remittance Advice Summary, except it summarizes all payment information and provides adjustment details for the entire RA.
The total payment is taken directly from the RA file, while Total Paid is calculated based on line adjustments and billing totals. The cheque number and date paid indicate the method of payment and the date of payment from OHIP. Normally, payment is done through direct deposit, although in some cases, cheques are still issued to some providers under special circumstances.
Advanced Tab Reports
Group Income Summary
This report is useful to customers who manage billing for provider groups. Provider Groups are billing providers who have been assigned a four digit group number and bill under it through the Ministry of Health MRI/MRO system. This report will enable Provider Groups to break down income by provider, based on the MRO RA.
Income Summary by Department
If you use the Department field in OHIP billing, you can use this report to break down your reconciliation by Billing Department. This report is useful when you need to know how to allocate income, when allocating income by Billing Provider doesn't reflect the income sharing or distribution arrangement you may have.
Technical/Professional Income Summary
This report is for practices that engage in Technical/Professional split billing that need to separate technical and professional income. This report only reports on codes that have been billed using the 'Type' field designation indicating a professional or technical component service. The Ministry of Health also supports a set of combined codes that have both professional and technical services in one code. This report will not split these combined codes, as the program has no way of knowing if the code is combined and what the ratio of professional to technical fee is.