Things start getting complicated with discounted FFS reimbursement. Some practices post the full fee, the payment and a contractual adjustment to account for the difference. Others post the approved amount rather than the physician's usual fee, so when the payment arrives, no adjustment is required. Both methods, especially the second one, distort the collection ratio. Things get worse when managed care plans withhold portions of FFS payments and, months later, refund withholds or pay bonuses.
Capitated arrangements add more complications, since they pay a fixed amount per member per month.
The problem, though, is not the collection ratio but how you calculate it. The problem is not the collection ratio but how you calculate it. Give the plan codes descriptive names so you can distinguish among different plans offered by the same company. Next, set up payment codes corresponding to each plan code. Use the appropriate payment code when recording payments received from the patient, the plan or other sources for services covered by that plan.