1. Computers in the Medical Office
Chapter 8:
Posting Insurance Payments and Creating Patient Statements
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2. 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
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3. Remittance Advice Processing
Electronic Remittance Advice (ERA)
X12-835P
Remittance Advice (RA)
Paper format
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4. 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)
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5. Entering Insurance Payments
Payments from insurance carriers are entered using the Enter Deposits/ Payments option on the Activities menu
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6. Entering Insurance Payments
The Deposit List window lists deposits for a specific date, or, all deposits can be viewed
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7. Entering Insurance Payments
To enter a deposit, click the New button, and the Deposit dialog box is displayed
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8. Entering Insurance Payments
The type of payor—patient, insurance, capitation—is selected from the Payor Type drop-down list
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9. Entering Insurance Payments
Other information entered about the deposit include:
Deposit date
Payment method
EFT Tracer
Check number
Description/Bank no.
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10. Entering Insurance Payments
Other information entered about the deposit include:
Payment amount
Deposit Code
Insurance
Codes for payments, adjustments, withholds, deductibles, and take backs
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11. Entering Insurance Payments
Once a payment is entered, it appears in the Deposit List window
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12. Entering Insurance Payments
Once a payment is entered, the next step is to apply the payment to patient accounts
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13. Entering Insurance Payments
Payments applied to patient accounts using the Deposit feature are automatically displayed in the Transaction Entry dialog box
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14. Entering Insurance Payments
Capitation payments are entered but not applied
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15. Entering Insurance Payments
Second “EOB Only” deposit is entered
Patient accounts adjusted to zero balance
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16. Creating Statements
Statements are created in the Statement Management area of Medisoft
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17. Creating Statements
When the Create Statements button is clicked, the Create Statements dialog box appears
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18. 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
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19. 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
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20. Creating Statements
Once statements have been created, they are listed in the Statement Management dialog box, with a status of Ready to Send
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21. Printing Statements
The Print/Send button is used to print statements that are then sent out to patients and guarantors
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22. Printing Statements
When the Print/Send button is clicked, a statement method (paper or electronic) is chosen
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23. Printing Statements
Next, the type of statement is selected from the list provided
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24. Printing Statements
When the Print/Send button is clicked, paper statements are printed and mailed by the practice
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25. Editing Statements
If changes are necessary, highlight the statement in the Statement Management dialog box and click the Edit button
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