Q & A Threshold Reports

Has there been any change to quarterly reports versus threshold reports? 

  • The source of data and how it is retrieved have not changed from previous years.  The frequency of reporting and the level of detail have changed.
  • In the past threshold reports were sent out 4 times a year.  The quarterly report included a subtotal for dollar billed per quarter.
  • Now reports are being sent monthly with a monthly dollar subtotal.  In addition to the montly report ARP physicians are also provided with a breakdown of the billing codes they have claimed per month.

Why is the total dollar amount wrong?

  • This is the result of the lag between when the service is completed, billing paperwork submitted, processed by the billing team, reviewed and approved by Alberta Health and Wellness, and then is available in the reporting system that we use.  Each time we run the report the data gets more up to date.

Why distribute a report if the data is not complete?

  • The data for all the ARP physicians across all of the divisions is downloaded at the same time.  Whatever data is picked as a cut-off will not be "perfect".  This is because there variation in how much time it takes for the data for a division to become available (as some are on electronic billing while others continue to do paper billing).  There is also variation physician to physician.  So whatever cut-off time we pick will not be "perfect".  The approach being taken is that it is better to provide regular reporting that constantly updates past months than it is to wait for the data for past months to be complete and then send a report.

Are the threshold reports run by the date of service or when the billing analyst enters the claim?

  • Threshold reports are run by the date of the service.

When do the threshold reports get generated?

  • The threshold report runs every third Monday of each month.

Who generates these threshold reports?

  • The Department of Medicine billing department has gone through numerous changes in the past few years without a Billing Team Lead.  The Department of Medicine is currently (September 2012) recruiting for a new Billing Team Lead.  Once a successful candidate has been hired, they will be responsible for generating these reports.  For the interim, Tim Bulger, Project Manager for the Department of Medicine will be generating and sending out the threshold reports monthly.

How will these reports get to the physician?

  • Physicians have the option to receive the monthly threshold report either by email or mail.  If the physician chooses to receive the report by email, they must fill out a form.
  • The physician will need to fill out the necessary information and send back either by fax (780-248-1611) or by hospital mail to the billing office Team Lead.  If no form has been sent in, the physician will get their threshold report my mail marked "Personal and Confidential".

Will the physician receive e-mails from their respective billing analyst to have their billings sent in each month?

  • Each physician is ultimately responsible for getting their billings in a timely manner.  Billing analysts will be vigilant in watching and reminding a physician regarding their outstanding billings and to contact the physician if no received billings are not in reasonable amount of time.

Who does the physician go to if they have questions about their threshold report?

  • The physician will need to contact their Divisional Director for any questions or concerns.