Understanding Scheduled and Actual Production Calculations

The document provides information regarding the calculations for scheduled and actual production (gross and net).

Calculations

Gross scheduled production

Gross scheduled production is the sum of the Scheduled Charges for the scheduled procedures.

If the scheduled procedure has a Planned status, the Provider is the rendering provider (according to the insurance defaults); otherwise, if the scheduled procedure has an Other status, the Provider is the scheduled provider (the provider assigned to the appointment).

If the Provider has a fee schedule, the Scheduled Charge comes from that fee schedule; otherwise, the Scheduled Charge comes from the preferred fee schedule of the location where the procedure is scheduled.

Gross actual production

Gross actual production is the sum of the Procedure Charges for the completed procedures. The Procedure Charge is the charged amount for a posted procedure (with a Complete status) on a patient's ledger.

Net scheduled production

Net scheduled production is the sum of the Scheduled Charges for the scheduled procedures, minus any discounts or insurance adjustments that are applied to those procedures. Remaining benefits and deductibles are excluded from the calculation.

The Provider and Procedure Charge are determined according to the following criteria:

The Scheduled Charge is determined according to the following criteria:

Net actual production

Net actual production depends on patients' insurance coverages:

The Procedure Charge is the charged amount for a posted procedure (with a Complete status) on a patient's ledger.