Family Billing


Medisoft Patient Accounting prints one statement per guarantor. A guarantor is the person listed as financially responsible for charges on a patient account. The guarantor is set on a case by case basis on the Personal tab of the case screen.

If a guarantor has multiple patients with balances eligible to print on a statement, all of those patients and charges will appear on one statement sent to the Guarantor.

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There are two types of patient statements.

  1. Standard Statement: This type of statement will show all charges that have a balance on them. The balance shown on this statement is the Patient Reference Balance. If you print or send standard statements, your patients will get statements showing a balance that may not reflect the amount the patient will need to pay. For this reason, we recommend that you do not use standard statements for patient billing purposes.
  2. Remainder Statement: Patient remainder statements will show the charges that make up the patient remainder balance. This means that charges that have not yet been paid by responsible insurance carriers will not appear on these statements. We recommend that you use remainder statements for patient billing purposes.
  3. Missed Co-pay Remainder Statement: The only difference between this and the Remainder Statements is that this statement will include missed copays in the total amount due. In order for this statement to work properly you must turn this function on in Program Options by checking the Add Copays to Remainder Statements field in the Billing tab. This statement function is only available using Statement Management.
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As you prepare for your transition to the new ICD-10 diagnosis codes, you will need to work closely with different partners.  In today’s blog post, we are going to look at the role of working with your clearinghouse and how they can help you prepare for the new diagnosis code implementation.  At the bottom of the blog post are some questions you should ask your clearinghouse.

Planning for ICD-10: Working with Clearinghouses


As we move towards the ICD-10 transition, CMS reminds practices that clearinghouses can be a valuable resource for testing ICD-10 preparedness. For instance, clearinghouses can help providers look at the reasons for rejection and analyze their claim problems during the transition. However, providers should not expect clearinghouses to offer the same level of assistance for ICD-10 transition as they did when HIPAA Version 5010 was implemented, since ICD-10 is based on provider data and clinical documentation.

The Role of Clearinghouses in the ICD-10 Transition
Practices preparing for the October 1, 2014, ICD-10 deadline are looking for resources and organizations that can help them make a smooth transition. It is important to know that while clearinghouses can help, they cannot provide the same level of support for the ICD-10 transition as they did for the Version 5010 upgrade. ICD-10 describes a medical diagnosis or hospital inpatient procedure and must be selected by the provider or a resource designated by the provider as their coder, and is based on clinical documentation.

During the change from Version 4010 to Version 5010, clearinghouses provided support to many providers by converting claims from Version 4010 to Version 5010 format. For ICD-10, clearinghouses can help by:

  • Identifying problems that lead to claims being rejected
  • Providing guidance about how to fix a rejected claim (e.g., the provider needs to include more or different data)

Clearinghouses cannot, however, help you identify which ICD-10 codes to use unless they offer coding services. Because ICD-10 codes are more specific, and one ICD-9 code may have several corresponding ICD-10 codes, selecting the appropriate ICD-10 code requires medical knowledge and familiarity with the specific clinical event.

While some clearinghouses may offer third-party billing/coding services, many do not. And even third-party billers cannot translate ICD-9 to ICD-10 codes unless they also have the detailed clinical documentation required to select the correct ICD-10 code.

As you reach out to your clearinghouse or billing service, you may want to ask:

  • Are you prepared to meet the ICD-10 deadline of October 1, 2014? Where is your organization in the transition process?
  • Can you verify that you have updated your system to Version 5010 standards for electronic transactions? (Only systems with Version 5010 can accept ICD-10 codes; systems with the older, Version 4010 standards cannot accommodate ICD-10.)
  • Who will be my primary contact at your organization for the ICD-10 transition?
  • Can we set up regular check-in meetings to keep progress on track?
  • What are your plans for testing claims containing ICD-10 codes? How will you involve your clients, such as my practice, in that process?
  • Can my practice send testclaims with ICD-10 codes to see if they are accepted? If so, when will you begin accepting test claims?
  • Can you provide guidance or training on how my clinical documentation will have to change to support ICD-10 coding?
  • Do you anticipate any pricing changes for your services due to the switch to ICD-10?

As you prepare for the October 1, 2014, ICD-10 deadline, clearinghouses are a good resource for testing that your ICD-10 claims can be processed—and for identifying and helping to remedy any problems with your test ICD-10 claims.

Keep Up to Date on ICD-10:
Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline.

Article Resource:
The Role of Clearinghouses in the ICD-10 Transition” located on the CMS website.
Planning for ICD-10: Working with Clearinghouses and Billing Services” located on the CMS website.

For more resources or information on Medisoft ICD-10 readiness, please visit www.medicalbillingsoftware.com/medisoft-icd-10.htm

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medisoft-statement-management-overview

Introduction

After receiving payment from the insurance carriers, the next step in the billing process is to bill patients for any remaining amounts. This process often includes the need to collect from patients on balances not paid. This chapter will discuss the different methods of billing statements, as well as the ways Medisoft can enable your office to better collect outstanding debts owed by patients. Additionally, we will discuss the process for collecting charges owed but not paid by insurance carriers.

Types of Balances

When billing patients for their outstanding balances, it is crucial that you have an understanding of the different types of balances. Within Medisoft, there are two types of patient balances. There are also 3 insurance balances

  1. Patient Reference Balance: The patient reference balance contains all charges in the patient’s ledger that have any outstanding balances. As soon as a charge is entered it is reflected in the patient reference balance. If a transaction is set to be billed to an insurance carrier, the patient reference balance is the only balance it resides in until the claim is billed. When looking at the Transaction Entry screen, the field labeled Account Total will show you the patient reference balance.
    Standard patient statements will include patient reference balances.

  2. Patient Remainder Balance: Patient remainder balances contain charges for which no insurance carrier is responsible AND charges that have been complete payments made by all responsible insurance carriers. By “complete” we mean that the payments entered for the insurance carriers and that payment has been applied and marked “complete” in the payment application screen.
  3. Primary Insurance Aging Balance: When dealing with primary insurance aging balances, we are looking at the amount that is owed by all primary insurance carriers. A charge enters this balance at the point it is billed to the primary insurance carrier. A charge leaves this balance at the point a payment is applied from the primary carrier AND that payment is marked complete.
  4. Secondary Insurance Aging Balance: This balance functions similar to the primary insurance aging balance. A charge enters this balance when the primary insurance carrier makes a complete payment AND when the secondary claim is billed. A charge leaves this balance at the point a payment is applied from the secondary carrier AND that payment is marked complete.
  5. Tertiary Insurance Aging Balance: The tertiary insurance aging balance functions like the secondary insurance aging balance. A charge enters this balance when the secondary carrier makes a complete payment AND when the tertiary claim is billed. A charge leaves this balance at the point a payment is applied from the tertiary carrier AND that payment is marked complete.
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Capitation Payments

Capitated plans are a different type of insurance plan. This type of plan pays the doctor or group a specific amount of money to see a group of patients each month. This amount is paid regardless of how often these patients are seen. This means that the payments are not related to specific charges.

To enter a capitated payment, take the following steps from within the Deposit List:

  1. Click the New button.


  2. In the Date field, enter the date you received the capitation payment.
  3. Select Capitation in the field labeled Payor Type.
  4. The screen display will change. You will note that the code fields will no longer be available to you.


  5. In the field labeled Payment Amount enter the amount of the capitation payment you received.
  6. The Insurance field should contain the insurance code for the carrier making the payment.
  7. Enter any other fields as necessary.
  8. Click Save.

You will see the capitation payment listed on your deposit list. You will not be able to apply it. Because the payment is not for specific charges, you do not need to apply it. Any charges that were entered into capitated accounts should have been written off at the time of entry.

Neither capitation payments nor charges have any affect on your practices AR. Because you cannot apply the payment, it will never appear on most of your accounting reports. The only report that will show capitation payments is the Deposit List report. The only file affected through this process is the MWDEP.ADT file.



 

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Comment

The comment tab will allow you to enter various comments regarding this statement. These comments will not be included on any printed or sent statements. They are for internal use only.

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Patient Co-payment

When posting a Patient Co-payment, you will follow the same process listed for Patient Payment with the following differences.

Change Payor Type to Patient.

  1. The Copayment Code should correspond to the Payment Method chosen. In the example below, the Payment Method chosen is Cash; therefore the Copayment Code is COPAYCASH.

    

  1. When applying the payment, there is a new button available called Apply to Co-pay. This works exactly the same as when you apply a co-payment in the Transaction Entry screen. Notice on the example below that all the fields under the Co-pay column are grayed out except for the field where the procedure code still requires a co-payment.



 

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  1. The Show Unpaid Only field does not have any effect on patient payments.
  2. The Payment Procedure Code fields will automatically populate with the codes that were entered during the creation of the deposit. These are the codes that will be listed on the line item entries within the patient ledger after the applicable charges and adjustments are applied. You do not need to change these fields.
  3. At the top of the screen you will see a field labeled For. This field is used to designate the patient for whom the payment(s) and adjustment(s) are being entered. This field will default to the same chart number that was entered when creating the deposit. You do have the ability to change the chart number. If you select a patient that does not have the person making the payment listed as the guarantor, you will see the following message. Clicking Yes will allow you to apply the payment anyways. Clicking No will force you to select a different patient before proceeding.


  4. Once you have selected the chart number of the patient to whom the payment will be applied, you are ready to actually apply the payment. The first step in applying the payments (and adjustments) is to identify which charges are being paid or adjusted. You can identify the specific charges by using the Date, Procedure, Charge, and Remainder fields. The remainder field tells you the balance on each charge.


  5. Once you have identified the charges you wish to pay or adjust, enter the amount of the payment that will be applied to each charge in the column labeled Payment, and the amount (if any) that you wish to adjust off each charge in the Adjustment column.


Tips and Tricks:

If you apply a payment amount greater than the remainder amount, you are indicating that an overpayment was made on that charge. The patient is usually due a refund in this instance. The refund should be entered as a positive adjustment.

  1. After entering your payment and adjustment amounts, click Save Transactions. At this point, we are making line item entries into both the mwtrn.adt and the mwpax.adt tables.


  2. If the payment was made for multiple patient accounts, you can now change the chart number in the For field to the next patient to whom you wish to apply the payment.
Tips and Tricks:

Normally you would want to apply the entire payment before leaving the payment application screen. If you do this, the unapplied amount field will show 0.00.

If you do not apply a payment completely, the balance and AR totals will only be affected by the amount you apply.

  1. After applying and saving the payments and adjustments, click Close.

Following this process will allow you to enter and apply patient payments from the deposit list. It is important to note that copays entered through Office Hours into the deposit list will be listed as unapplied payments until you go through and manually apply them to the charges.

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11. You will now see the payment listed on the main screen of the deposit list.

12. Highlight the payment and click Apply.


  1. The following screen will appear.


  1. You will see various fields that are grayed out. These fields do not apply to patient payments.
  2. By default, the only charges you will see are charges that have a remainder balance (meaning charges that have been paid by all responsible insurance carriers). If you would like to see charges with balances, regardless of remainder status, uncheck the box labeled Show Remainder Only.


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  1. Enter the Payment Amount.
  2. In the field labeled Chart Number, enter the chart number of the patient or guarantor who made the payment. This is NOT always the patient’s chart number. If the payment was made by anyone other than the patient, you should specify that person’s chart number in this field.
  3. The Payment Code, Adjustment Code, and Copayment Code fields determine which procedure codes will be listed in the patient ledgers for payments and adjustments applied through this deposit. These codes will default with values entered into the Program Options window. These fields are located on the Payment Application tab. The default payment code will be determined by your selection made in step 5.


  4. Once you have entered all applicable fields, click Save.


  5. At this point, we have only affected the mwdep.adt file. There are not yet any entries in the patient’s ledger, nor have we changed the patient balance in any way.
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