Deductible Entry

Many patient health plans include deductibles. Deductibles are amounts that must be paid by the patient before the insurance carrier will begin to make payments for medical care. Generally deductibles are calculated annually. The annual deductible amount is entered into the patient’s Case screen on the Policy 1 tab.

In addition to showing the Annual Deductible, Medisoft has the ability to track the portion of the deductible that has been paid in that particular office. Medisoft and other POMIS systems cannot track the total amount paid towards the deductible because some care could be performed in other offices such as insurance carriers and specialists. The amounts paid by the patient in these offices would be applied to the deductible as well, yet we would have no record of these payments. For this reason, the insurance carrier and the EOB should be the only indicator used by the office to determine whether or not the deductible has been met.

This does not mean that the deductibles should not be tracked in the office. Medisoft offers a procedure code type for deductible entries. These codes should be used to identify which charges were applied to the deductible. This type of code will not increase or decrease the balance for any outstanding charges; it will simply allow the program to bill the patient/guarantor for charges that were applied to the deductible.

Medisoft Basic users must enter these deductible codes through Transaction Entry. Medisoft Advanced and Network Professional users can enter these codes through the deposit list.

To enter a deductible code through Transaction Entry, take the following steps:

  1. Open Transaction Entry to the chart, case, and document or superbill number that contains the transaction(s) applied to the deductible.

    In the Payments, Adjustments, and Comments portion of Transaction Entry, enter a procedure code that has been previously set up as a deductible type code. (See MED103: Getting Started)

    In the Who Paid field, select the primary insurance carrier.

    You will notice that you are not able to enter any amount into the Amount field. This is because the deductible code is not actually affecting the AR total.

    Click the Apply button.

    You will see a payment application screen identical to the Insurance Payment Application screen. All functionality is the same as an insurance payment application except the Amount column. The amount entered into this column will not lower the balance of the charge at all. You are simply specifying the amount that would have been paid if the patient had met their deductible. This amount will them be added to the YTD field within the patient’s Case screen.

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