12. We will now focus on the columns used to apply the payments and adjustments as listed on the EOB.
Payment: In the payment column, enter the actual amount paid by the insurance carrier. An entry here will cause a payment type transaction to be entered into the patients ledger in the amount entered.
Deductible: If a charge or portion of a charge was applied to the patient deductible, it will be listed on the EOB. Enter that amount here. The balance on the charge will not be affected by this amount.
Withhold: If the EOB states that an amount was withheld from the payment for this patient’s visit, enter that amount in this field. The most common use of this is when the insurance carrier had previously overpaid on this or another patient’s account. This will lower the balance on the charge by the amount entered.
Allowed: Allowed amounts are the amounts the insurance carriers will base their payments on. This field will automatically populate with the allowed amount entered for this combination of procedure code and insurance carrier. These values can be entered through either the procedure code entry screen or the insurance carrier entry screen. If the value defaulting in this field is 0, you can enter the allowed amount in the column on this screen, and it will automatically update the value in the procedure code and insurance carrier setup screens. Additionally, for the purposes of this particular payment application, you can change the value that is defaulting in this field and have it affect that transaction only.
Adjustment: The adjustment field is normally used to enter the disallowed amount adjustments. If you have entered your allowed amounts properly, this field CAN automatically calculate the adjustment amount for you. In order for this to happen, you must first make a selection within Program Options. On the Payment Application tab, place a check mark in the field labeled Calculate Disallowed Adjustment Amounts.
Takeback: If the EOB states that an amount was withheld for a previous overpayment, it will also indicate the patient who was overpaid. The Takeback column is used to take the money back from the previously overpaid patient. This will increase the balance on the charge by the amount entered.
Complete: The complete field is the most important field on this screen. This field is indicating that the payment from this insurance carrier is complete and that no more money is expected from the insurance carrier. If you will be appealing the amount, do not place a check mark in this field. If you do not expect any more payment on that line item, place a check mark. The check mark indicates that the aging and billing should move on to the next responsible party. You can automatically check insurance payments as complete by selecting the program option on the Payment Application tab labeled Mark Paid Charges Complete. This field will only be available if your deposit type was set to Insurance.
Rejection: The rejection field is used to create notes that will appear on a patient’s statement indicating the reason the charge was not paid by the insurance carrier. This is included on this screen because the EOB will indicate the reason it was not paid, and this is the screen used to enter the EOB. These messages must be set up prior to payment application. This is done through the Lists menu and Claim Rejection Messages. New Rejection Messages can also be added from the Deposit List by right clicking in the rejection area and select New Rejection Code (F8) or Edit Rejection Code (F9).
- Provider: You will not be able to edit the value in the Provider field. This simply indicates the attending provider, or provider who performed the medical services.
Once you have entered all applicable values for this patient, click the button labeled Save Payments/Adjustments. At this point you will create up to 5 types of transactions in the patient’s ledger. This process will also update your mwtrn.adt and mwpax.adt files. At this point, these transactions will appear on your accounting reports.
- Change the chart number field to the next patient on the EOB, and repeat this process for each subsequent patient until the entire amount has been applied.
Following this process will allow you to quickly enter 5 different types of insurance transactions for multiple patients.
NOTE: This feature is only available on Medisoft Advanced and Medisoft Network Professional.