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Computers in the Medical Office. Chapter 8: Posting Insurance Payments and Creating Patient Statements. Third-Party Reimbursement Overview. Fee schedule List of standard fees established by provider Not necessarily the amount the provider is paid
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Computers inthe Medical Office Chapter 8: Posting Insurance Payments and Creating Patient Statements
Third-PartyReimbursement 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
Remittance Advice Processing • Electronic Remittance Advice (ERA) • X12-835P • Remittance Advice (RA) • Paper format
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)
Entering Insurance Payments • Payments from insurance carriers are entered using the Enter Deposits/ Payments option on the Activities menu
Entering Insurance Payments • The Deposit List window lists deposits for a specific date, or, all deposits can be viewed
Entering Insurance Payments • To enter a deposit, click the New button, and the Deposit dialog box is displayed
Entering Insurance Payments • The type of payor—patient, insurance, capitation—is selected from the Payor Type drop-down list
Entering Insurance Payments • Other information entered about the deposit include: • Deposit date • Payment method • EFT Tracer • Check number • Description/Bank no.
Entering Insurance Payments • Other information entered about the deposit include: • Payment amount • Deposit Code • Insurance • Codes for payments, adjustments, withholds, deductibles, and take backs
Entering Insurance Payments • Once a payment is entered, it appears in the Deposit List window
Entering Insurance Payments • Once a payment is entered, the next step is to apply the payment to patient accounts
Entering Insurance Payments • Paymentsapplied topatientaccountsusing theDepositfeatureare automatically displayed in the Transaction Entry dialog box
Entering Insurance Payments • Capitation payments are entered but not applied
Entering Insurance Payments • Second “EOB Only” deposit is entered • Patient accounts adjusted to zero balance
Creating Statements • Statements are created in the Statement Management area of Medisoft
Creating Statements • When the Create Statements button is clicked, the Create Statements dialog box appears
Creating Statements • The Create Statements dialog box contains a number of filters, including
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
Creating Statements • Once statements have been created, they are listed in the Statement Management dialog box, with a status of Ready to Send
Printing Statements • The Print/Send button is used to print statements that are then sent out to patients and guarantors
Printing Statements • When the Print/Send button is clicked, a statement method (paper or electronic) is chosen
Printing Statements • Next, the type of statement is selected from the list provided
Printing Statements • When the Print/Send button is clicked, paper statements are printed and mailed by the practice
Editing Statements • If changes are necessary, highlight the statement in the Statement Management dialog box and click the Edit button