Why It Matters
Understanding these discrepancies is crucial for accurate financial reporting. Knowing exactly how patient responsibility (like coinsurance, deductibles, and copayments) impacts the final percentage ensures your team can correctly interpret the data, confidently answer billing questions, and avoid confusion when cross-referencing with external billing systems.
Understanding the Calculation Logic
The system uses two different calculation methods for displaying '% Collected' depending on the report context:
Simple Formula: Amount Collected ÷ Amount Billed
Enhanced Formula: (Amount Collected + Patient Responsibility) ÷ Amount Billed
(Note: Patient responsibility amounts include coinsurance, deductibles, and copayments that vary by claim and patient insurance policy).
Common Scenarios That Cause Discrepancies
Same Dollar Amount, Different Percentages You may see two claims with identical collected amounts (e.g., $540) showing vastly different percentages (e.g., 9.64% vs. 103%). This happens when:
One claim has high patient responsibility amounts (like $5,240 in coinsurance).
Another claim has minimal or no patient responsibility.
The system adds the patient responsibility to the numerator before calculating the percentage.
Percentages Over 100% When patient responsibility amounts are large relative to the amount billed, the calculation can result in percentages exceeding 100%. This is mathematically correct when using the enhanced formula that includes patient responsibility.
Example of the Enhanced Formula in Action:
Amount Collected: $540
Patient Responsibility (Coinsurance): $5,240
Amount Billed: $5,600
Calculation: ($540 + $5,240) ÷ $5,600 = 103%
Data Source Considerations
Patient responsibility amounts in Dazos may differ from what appears in your source billing system (such as CollaborateMD) for a few reasons:
Dazos may calculate patient responsibility based on real-time benefits verification.
The source system might not include certain patient responsibility components in its reporting.
Data synchronization may introduce patient responsibility values during the import process.
Tips & Notes
💡 Tip: Know which calculation method is being used in each report view. For comparative analysis, always make sure you are using the same report view or calculation method.
✅ Best Practice: When percentages seem unexpected, always check the patient responsibility. Review the specific coinsurance, deductible, and copay amounts, and cross-reference with your billing system to understand where the patient responsibility data originates.