NOTE: This tutorial is Extremely Important – This is the place to go to when you have questions about why a claim is not printing or sending; why an item is or is not printing on a claim form; why a procedure charge or claim is or is not printing on a report; why medisoft charges are showing or not showing on a statement. It all depends on how Medisoft “sees” the status of a charge item, whether when it was billed, was a primary and secondary responsible? If so, were they billed? If billed, has it been paid? And if it has been paid, has it been marked “Complete”? If an item was NOT responsible for insurance 1, then it would not print on a claim. If a charge was billed, and paid, but not marked as complete, then next responsible party will not be billed until it is marked as complete. One common example is a patient tells you they have only one insurance, you enter charges and bill, then when they get a statement, they call you and tell you they have a secondary policy. It is common then to go into the medisoft case for that patient, and add a secondary policy and policy #, but then that’s all. And then you still have problems. The reason for the problem is that the system still thinks there is only one policy and there is no secondary (even though the info is in the Policy #2 tab in the case)- the solution to this situation is to click on the UPDATE ALL button at the bottom of the transaction entry screen AFTER you enter the policy #2 info, when you do that (and you can do that at any later time if you forget), you will see in the Charge Reference Information, that the Insurance 2 box will be checked, once it is checked, you can bill a secondary insurance company. The other common scenario is questioning why a patient is not getting a statement (or why a secondary is not printing) even though there is payment from the insurance company and you see a dollar amount in the AMOUNT PAID section, but the box is not checked (note, when you enter a insurance payment in medisoft, there is always a COMPLETE box , make sure it is always checked if payment is complete for that insurance company y). If the box is not checked , and it should be, go back to the transaction entry screen for that payment; highlight the line, and click APPLY, and then find the payment and mark it complete if it is indeed complete), and then the next responsible party will be billed.

Charge Reference Information

Along the upper right side of the Transaction Entry screen you will see two tabs. The first tab is labeled Totals. This tab is automatically selected when transaction entry is opened. It contains all the fields discussed in the previous section. The second tab is labeled Charges. This tab contains fields that relate to the currently selected charge.



Responsible: The fields located in the Responsible portion of this screen will indicate which payers are responsible for payment for the currently selected charge. The Guarantor field should ALWAYS be checked. The Insurance fields will show a check mark if the corresponding insurance carrier is responsible for payment on the selected charge. Additionally, the Insurance fields will be affected by data entered into both the case screen and the procedure code setup screen. Fields that will affect whether or not an insurance carrier is responsible include the following fields:

  1. Procedure Code – Patient Only Responsible: If the Patient Only Responsible field is checked within the procedure code setup – that procedure code will NEVER list an insurance carrier as responsible for the charge.
  2. Procedure Code – Don’t Bill To/Only Bill To: If values are entered into either of these two fields, it is possible that the procedure code will not list particular insurance carriers as responsible for the charge.
  3. Procedure Code – Billing Charge: If the procedure code type is set to Billing Charge instead of Procedure Charge, the insurance carrier would not be responsible for the charge.
  4. Case – Cash Case: The Cash Case field appears on the Personal tab of the case setup. If this box is checked, transactions entered into that case will not show insurance carriers as responsible parties.
  5. Case – Insurance 1, 2 or 3: In order for an insurance carrier to be responsible for a charge, the insurance carrier must be entered into the case. If the insurance carrier is not entered, the check mark will not appear in the responsibility for that carrier.

Another thing that can affect the responsible fields is the order of entry. The responsibility for each transaction is determined at the time the transaction is saved. If you change or add information into any of the fields listed above after the transaction has been entered and saved, those changes will not automatically affect the responsibility. In order for those changes to take affect, you will need to press the Update All button at the bottom of the Transaction Entry screen.


Billed To: The fields located in the Billed To section will give you information about where in the billing process the highlighted transaction is. The Claim field will let you know what claim the highlighted transaction is on. The Insurance 1, 2, and 3 fields indicate which carriers have been billed. These fields relate closely to the Responsible fields. If a carrier is not responsible for a transaction, it will not show that it has been billed. The only carriers you will be concerned with are the ones listed as responsible for the transaction.


Amount Paid: The Amount Paid fields are related closely to the Responsible and Billed fields. These fields will show you the amounts that have been paid by the various responsible parties. Additionally, there is a check mark field next to the payment amount. This check mark shows that the payment from that carrier has been marked complete. In this example, we can see that the primary insurance carrier has made a payment that has been marked complete. The secondary carrier has not yet paid. The tertiary carrier has a check mark. This is due to the fact that the tertiary carrier is not responsible for this charge. Based on this example, you would expect to see this charge on a Secondary Insurance Aging report. You would NOT expect to see this charge on a Primary Insurance Aging report because the primary carrier has made a completed payment. You would not expect to see this charge on a Tertiary Insurance Aging report because the tertiary carrier is not responsible. You would NOT expect to see this charge on a Remainder Statement because all responsible insurance carriers have not made completed payments.


Date Created: The Date Created field tells you on which date the charge was entered into the program.

Last Statement Date: This field tells you the last date a statement was printed for this particular charge. This can be useful when looking at individual open charges, and trying to figure out why they have not yet been paid.

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Reference Items, Account Aging, and Account Totals

At the top of the Transaction Entry screen, you are going to see various fields that reference different items in the patient’s account. These items can help you with various parts of the billing process. In this section we will discuss those fields and the information that can be found by using them. The items referenced on the default screen relate to the case that is selected. They do not relate to one particular transaction.

Reference Items


Last Payment Date: This field shows you the last time a payment was made to this patient’s chart. This field will be the same for each case a patient has. Additionally, this field is referring to any payment made to the account. It does not matter whether the payment came from the insurance carrier or from the patient.

Last Payment Amount: Similar to the Last Payment Date field, this field is chart specific. It will show you the amount of the last payment made into the patient’s account.

Last Visit Date: Medisoft will automatically track visits for you. A visit is defined as a calendar day for which one or more CHARGES have been entered for a case. Visits are tracked on a case by case basis, meaning each case will have a different date. This field shows the date of the last visit for the selected case.

Visit: When setting up the patient case, you had the opportunity to specify the number of visits that were authorized by the insurance carrier. Certain carriers will authorize a certain number of visits for certain circumstances. These are done using what is known as authorizations. Each authorization would require a separate case. The visit field automatically tracks how many visits have occurred in that case (and therefore under that authorization). It uses the same definition of a visit that was previously given under Last Payment Date.

This field can prevent the office from seeing patients who have met or exceeded their authorized number of visits, and therefore will not have coverage for that care. Additionally, the office can then let the patients know that they are getting close to their limit, and then let the patients take appropriate action to either obtain another authorization, or find an alternative means of care.

If this field is for some reason showing the wrong number of visits, you can manually change it from this screen. Simply double click the word Visit. The following screen will appear.


You will be able to increase or decrease the Visit Number as needed. Once the changes are made, click OK. This process will change the visit series number listed in the patient’s case information.

Global Coverage Until: If you enter a Global Surgery code for this case the Global Coverage Until field will automatically calculate the date by taking the date that the global procedure was entered and adding the number of days entered in the procedure code.

Account Alerts: Account Alerts are red, two letter codes that are designed to alert you when the customer meets certain conditions. In order to receive some or all of these account alerts you must check them in Program Options, in the General tab, at the bottom in the Account Alert Settings area.

Account Aging

        

Account Aging: Depending on the tab being viewed, it will show the aging of the insurance carrier or the patient. The total will indicate the total amount from the insurance carrier’s or the patient’s aging. On the Patient’s tab it will indicate if there is any copay overdue. On the insurance tab TNB stands for Total Not Billed indicating that the claim needs to be created and sent.

Policy Copay: When entering the information into the case, you have the ability to enter a copay amount. The amount entered into that field will appear in this field. Medisoft will not automatically enter the copay for you, but it will help track missed copays. There is a new report call Outstanding Co-payment Report.

OA: OA is an abbreviation for Other Arrangements. This is a field in the case setup screen that will allow you to enter 4 characters. Whatever is entered into that field will appear in this portion of the screen.

Annual Deductible: Similar to visits, deductibles are handled on a case by case basis. You can enter the annual deductible into the insurance carrier tab of the case screen.

YTD: If you enter deductible type codes into a patient’s account, the amount field is filled out with the amount of the charge that was applied to a deductible. When this is done the accounts receivable for the patient is not affected. You simply move the balance responsibility from the insurance carrier to the guarantor. The amounts entered into deductible type transactions are totaled for the case and displayed in the YTD field.

Tips and Tricks

Medisoft will track deductibles for you on a case by case basis. It is important to note that the only party whose calculation matters is the insurance carrier.

Simply because Medisoft states that the deductible has or has not been met, does not mean it is true. If the patient has been seen by any other providers for any reason during that year, they will have made payments that were applied to the deductible. These transactions will not be in your providers system.

Totals


Charges: Shows the total number of charges that appear on the currently displayed Transaction Entry screen. If you are utilizing the Superbill or Document Number fields, this will be the total number of charges that have been entered into that specific superbill or document number.

Adjustments: Shows the total number of adjustments that appear on the currently displayed Transaction Entry
screen.

Subtotal: This field displays the sum of the Charges and Adjustments fields. The reason we state that it displays the sum is because the Adjustments field can contain either positive or negative values.

Payment: Shows the total number of payments that appear on the currently displayed Transaction Entry
screen.

Balance: The Balance field shows the total balance for the transactions currently displayed. These transactions are specific to the case that is currently selected. If you are utilizing the Superbill or Document Number fields, this will be the balance on the transactions entered specifically for that superbill or document number.

Account Total: This field is different from the other total fields that have been previously explained in one very important way. The Account Total field shows the entire balance for that patient’s account. This balance does NOT filter based on Case, Document, or Superbill.

If you delete transactions in the day to day operation of the program, this amount may show an incorrect balance total. In order to recalculate the amount, simply double-click on the amount.

Calculate Totals: The Calculate Totals field is located in the lower left corner of the Transaction Entry screen. If this field is selected, the totals will appear. If it is not checked, the only value that will appear is the Account Total field.

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Medisoft Mobile – Medisoft iPhone App Released (via SBWire)

Medical iPad App allows users to enter medical electronic superbills and check schedules from iPhones. Tampa, FL — (SBWIRE) — 04/01/2013 — http://www.MedicalBillingSoftware.com today announced the release of Medisoft Mobile – A Medisoft iPhone App available for Free, now from the iTunes store. The…

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Transaction Entry Display Configuration

Now that you understand the reference fields at the top of transaction entry, you are ready to configure the transaction entry portion of the screen to meet your needs.

Screen Size and Proportions

The transaction entry portion of the screen is divided into two parts. The upper portion is used to enter charges. The lower portion is used to enter payments, adjustments and comments. You have the ability to change the size of the charge and payment portions of the screen. Hold the cursor between the two portions until it shows two arrows pointing up and down. While holding your left mouse button down, drag the window until the proportions meet your needs.

If do not like any changes you have made to the display of your screen, you can click the Window menu and Clear Window Positions. It is important to note that this will clear any custom display settings that have been made anywhere within Medisoft.

Custom Grid Settings

Both the charge and payment portions of Transaction Entry come with fields that default into the display. These fields may meet your needs, or they may not. You have the ability to customize the grid to include or exclude fields according to your needs.

In order to modify the grid settings, take the following steps:

  1. Select a Chart and Case Number. You do not have the ability to modify the grid unless these are selected.
  2. Click the small black dot on the far left of either the charge or payment portion of the screen.



    Earlier versions do not have a black dot. Click the small square button that looks like part of the header.


    The following screen will appear. This screen will allow you to modify the fields and captions that appear in that portion of Transaction Entry. The Field column will give you a list of all the data fields that are currently displayed on that view. The Caption column lists the labels that will appear at the top of that particular column. The Width column indicates how many characters will display in the currently set column width.

    The fields are listed in the order they appear on the display. The first field listed will be along the far left of the display screen, and as you move down, each subsequent field will be directly to the right of the previous field.


Tips and Tricks:

It is important to note that you can change the Caption for any particular field that is being displayed. Use this feature with care. Mislabeling a field could lead to improper data entry and rejected claims.

If you would like to change the order of the fields, you can simply click on a field name and drag it to the position you want it to occupy, or you can use the and buttons to help you set the order for your fields.

If you would like to add fields that are not currently listed, click the Add Fields button. The following screen will appear. The Add Fields screen will give you a list of all fields that you can add to the display. Fields that are already displayed will not be listed on this list. Additionally, it is not possible to add fields to the list. Highlight the field(s) you wish to add, and click OK.

Note: The Windows multi-select functionality will work on this screen. Simply hold the [CTRL] button while clicking the fields you wish to add.


If you would like to remove unneeded fields from the list, highlight the field you wish to remove and click Remove Field. This feature will not work with the Windows multi-select functionality. You must remove the fields one at a time.

If, at any time, you want to restore the defaults for that particular window, click the Restore button.

Once all needed changes have been made, click OK.

Certain fields are used more often than others. The following is a list of the fields that are most often added to the Transaction grid, and the purpose the fields fill.

Claim Number: The claim number field is used to quickly tell the user which claim each transaction is on. This information is also given in the charge tab of the referential information at the top of the screen; however you can only see one transaction at a time in this view. Adding the Claim Number to the grid allows a complete overview of the claims containing the displayed transactions.

Date Created: Many reports are run using the date the transaction was created. This is especially true for the aging and analysis reports. Adding this field to the grid can allow you to quickly see which report filters will cause the displayed transactions to print.

Date To: Some procedures may be performed over the course of more than one day. These procedures require two dates, the beginning and the ending service dates. This field allows you to enter the ending date.

Statement Dates: These fields will allow you to quickly see the dates that statements including this charge were sent to the guarantor.

Document Number: The Document Number field is helpful when using the Serialized Superbills or Document Number features. If you are using these features and you select the Show All field, you will be able to see all transactions regardless of document or superbill number. Adding the Document Number field to the grid will allow you to see the document and serial numbers when multiple numbers are being displayed.

Facility: Adding this field allows you to specify a different facility for each transaction. It is important to note that transactions with different facilities will never create on the same claim. This field will default to include the value entered into the Facility field of the case. Additionally, changing the facility for a transaction that has already been placed on a claim with other transactions will remove that transaction from the claim. It will be added to a new claim the next time claims are created. This information affects box 32 of a paper claim, and loop 2310D.

Tips and Tricks:

If you are printing paper claims, the default formats pull the facility information from the patient case. If you want the forms to print the facility information from the Transaction Facility field, you will need to customize the form to do so.

Minutes: The Minutes field will automatically be added to the grid if the Practice Type field in the Practice Information screen is set to Anesthesia. This field is only necessary for anesthesiologist billing.

Modifiers: Medisoft only defaults one modifier field into the grid. There are some circumstances when more modifiers are needed. You can add the modifier fields 2 through 4 in order to accommodate the necessary additional modifiers.

Remainder: The remainder field indicates how much money is still owed on that particular transaction.

Copay: When checked, this field indicates that the patient copay should be applied to this procedure. This field is automatically checked if the Require Co-pay field is checked in the procedure code.


Copayment Expected Amount: Adding this field will show the copayment amount expected by the patient according to what was entered in the copayment amount field of Policy 1 in the patient’s case.

Copayment Paid: Indicates when a copay has been applied to the procedure code.

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Introduction

After entering appointments and printing superbills, the office is now ready to enter the procedures that were performed during the various patient visits. This process is done through Transaction Entry.

Within transaction entry, you have the ability to enter charges, payments, adjustments, and comments. The first three types of procedures generally have the effect of changing the patient’s and practice’s accounts receivable totals. They can also be used to change the party who is currently responsible for payment on a particular charge. Comments will generally not affect accounts receivable totals for either party.

Transaction Entry is the screen where most time is spent during the use of Medisoft. Because of this it is important that you have an understanding of the various options available to you on this screen. We will discuss some of the various billing scenarios you will deal with. We will introduce Transaction Entry as a tool for entering payments. When discussing payments, we will focus on copays. We will discuss insurance payments in the payment entry chapter.

You can open Transaction Entry by clicking the Activities menu and Enter Transactions.

Patient, Case, Document, and Superbill Selection

When you first open Transaction Entry, the screen will look like this:


The first fields you will need to enter are the Chart and Case numbers.

Chart: In this field you should enter the chart number of the patient for whom you need to enter transactions. If you do not know the chart number, you have a few options.

Click the down arrow next to the Chart Number field. This will give you a list of all patient chart numbers that currently exist within your database.

Click the magnifying glass button. This will bring up the Patient Search window.


From the Patient Search window you can sort the list of patients by clicking on the heading of the field you wish to use to sort.

You can also click the magnifying glass button. This will bring up a detailed search window. You will be able to use the options available to you on this screen to search the entire patient database for specific values.


Case: The Case field will not be available to you until you have entered the Chart Number. Once you have entered the Chart Number, the drop down menu for this field will include all cases that have been entered for that Chart Number. In order to help practices with patients with numerous cases, the case numbers are listed with the newest cases at top.


As you can see, the case Number, Description, and Annual Deductible will appear on this drop down menu. For this reason, it is important that you assign your cases descriptions that would allow you to quickly determine which case would be appropriate for that particular visit.

Tips and Tricks:

If you need to add a patient chart number or a case number to the list, simply press [F8] with your cursor in the corresponding field.

If you need to edit the information in either the patient setup or the case setup, press the [F9] button

Document Number: The Document Number field will only be available to you if you have selected the Force Document Number field on the Data Entry tab of the Program Options screen. Additionally, you cannot have the Use Serialized Superbills option checked on that same screen.


Document numbers are used to further group transactions together. Some offices create a new case for each visit. In this circumstance, there is not a benefit for the office in using the Document Number feature. If you do not create a new case for each visit, document numbers allow you to more closely link payments and adjustments to the charges they were applied to.

It is important to note that if this feature is turned on, by default you will only see transactions for the document number that is selected. There is a field on the Transaction Entry screen labeled Show All. This field will allow you to see all transactions entered into that case regardless of document number.

Tips and Tricks:

If you properly utilize the document number feature, your patient statements will group transactions together by document number. This will make them more understandable to patients who want to know exactly where their payments went.

Superbill: The Superbill field functions similar to the Document Number field. It is only available if the Force Document Number field has been selected as well as the Use Serialized Superbills field within Program Options.


In addition to properly setting up the program options, you must be using Office Hours or Office Hours Professional in order to use the Serialized Superbills feature.

Superbill numbers are used like a Document Number to group all transactions related to a specific visit together. Additionally, they are used to link transactions to the appointments entered into Office Hours.

Because the billers are using the superbills in order to complete their data entry for charges, the Superbill field can be entered prior to entering the Chart and Case fields. The office would simply need to enter the serial number from the top of their superbill, and the applicable Chart and Case numbers would automatically populate.

Similar to when using the Document Number field, the only transactions that will be displayed will be those transactions that have been entered under that particular Superbill number field. If you want the ability to see all transactions regardless of superbill number, place a check mark in the Show All field.

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