Computers in the Medical Office Chapter 8: Posting Insurance Payments and Creating Patient Statements McGraw-Hill Career Education

Third-Party Reimbursement Overview Fee schedule List of standard fees established by provider Not necessarily the amount the provider is paid Difference between amount in fee schedule and amount paid is an adjustment McGraw-Hill Career Education

Remittance Advice Processing Electronic Remittance Advice (ERA) X12-835P Remittance Advice (RA) Paper format McGraw-Hill Career Education

Remittance Advice Processing Steps for Processing Verify that all procedure codes listed on claim are represented on RA Review payment amount against expected amount Identify reason for denials or payment reductions Post payment information in practice management program Bill secondary health plan (if appropriate) McGraw-Hill Career Education

Entering Insurance Payments Payments from insurance carriers are entered using the Enter Deposits/ Payments option on the Activities menu McGraw-Hill Career Education

Entering Insurance Payments The Deposit List window lists deposits for a specific date, or, all deposits can be viewed McGraw-Hill Career Education

Entering Insurance Payments To enter a deposit, click the New button, and the Deposit dialog box is displayed McGraw-Hill Career Education

Entering Insurance Payments The type of payor—patient, insurance, capitation—is selected from the Payor Type drop-down list McGraw-Hill Career Education

Entering Insurance Payments Other information entered about the deposit include: Deposit date Payment method EFT Tracer Check number Description/Bank no. McGraw-Hill Career Education

Entering Insurance Payments Other information entered about the deposit include: Payment amount Deposit Code Insurance Codes for payments, adjustments, withholds, deductibles, and take backs McGraw-Hill Career Education

Entering Insurance Payments Once a payment is entered, it appears in the Deposit List window McGraw-Hill Career Education

Entering Insurance Payments Once a payment is entered, the next step is to apply the payment to patient accounts McGraw-Hill Career Education

Entering Insurance Payments Payments applied to patient accounts using the Deposit feature are automatically displayed in the Transaction Entry dialog box McGraw-Hill Career Education

Entering Insurance Payments Capitation payments are entered but not applied McGraw-Hill Career Education

Entering Insurance Payments Second “EOB Only” deposit is entered Patient accounts adjusted to zero balance McGraw-Hill Career Education

Creating Statements Statements are created in the Statement Management area of Medisoft McGraw-Hill Career Education

Creating Statements When the Create Statements button is clicked, the Create Statements dialog box appears McGraw-Hill Career Education

Creating Statements The Create Statements dialog box contains a number of filters, including Transaction Dates Location Chart Numbers Provider Billing Codes Amount Case Indicator Statement Type McGraw-Hill Career Education

Statement Types Standard statements show all available charges regardless of whether the insurance has paid on the transactions Remainder statements list only those charges that are not paid in full after all insurance carrier payments have been received McGraw-Hill Career Education

Creating Statements Once statements have been created, they are listed in the Statement Management dialog box, with a status of Ready to Send McGraw-Hill Career Education

Printing Statements The Print/Send button is used to print statements that are then sent out to patients and guarantors McGraw-Hill Career Education

Printing Statements When the Print/Send button is clicked, a statement method (paper or electronic) is chosen McGraw-Hill Career Education

Printing Statements Next, the type of statement is selected from the list provided McGraw-Hill Career Education

Printing Statements When the Print/Send button is clicked, paper statements are printed and mailed by the practice McGraw-Hill Career Education

Editing Statements If changes are necessary, highlight the statement in the Statement Management dialog box and click the Edit button McGraw-Hill Career Education