Patient/Guarantor Payment Application

If you are applying a patient/guarantor payment, you will follow the same process listed above under Insurance Payment Application with one exception. You will not see a Complete box when applying patient/guarantor payments.


The purpose of the complete box is to allow billing of the next responsible party. The patient/guarantor is the last responsible party. There is nobody to move the balance to. For this reason, there is no complete box on the Apply Payment to Charges screen.

Patient/Guarantor Co-pay Application

If you are applying a patient/guarantor co-payment, the most important thing to remember is to choose a co-payment code and not a regular payment code. When applying the patient/guarantor co-payment, a new button will appear called Apply To Co-pay.


The Apply To Co-pay button will work similarly to the Apply To Oldest button. It will apply the co-payment to the oldest procedure code requiring a co-payment. In most cases, there should only be one procedure code requiring a co-payment, however if there was a missed co-pay for a previous visit, the Apply To Co-pay button will apply to the first record requiring a co-payment.

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Adjustment Entry

Adjustments are used to either increase or decrease the balance on a patients account. This can be done for many reasons.

  1. Refund – (Positive Adjustment) When a patient is in need of a refund, it is because they or their insurance carrier have paid more than is necessary. This causes that patient’s AR total to be smaller than it should be. When a refund is issued, the office is correcting that discrepancy. Refund adjustments will increase the patient’s AR total (and simultaneously decrease the practice accounts payable total).
  2. Disallowed Amount Adjustment – (Negative Adjustment) When billing insurance carriers, if you bill for an amount higher than the allowed amount, you will be required to write off the difference between the billed amount and the allowed amount. These write-offs are done using adjustments. Medisoft Advanced and Medisoft Network Professional will calculate and enter these adjustments automatically using the deposit list. Medisoft Original users must enter these adjustments through Transaction Entry. This process will lower the patient’s AR total.

    Courtesy Adjustment – (Negative Adjustment) If you want to write off a balance as a courtesy to your patients this is done using an adjustment. This process will decrease the patient’s AR total.

    Small Balance Write-Off – (Negative Adjustment) Many patients carry balances that are so small that it is not worth it to try and collect the balance. These balances are cleared using a Small Balance Write-Off. Medisoft Advanced and Medisoft Network Professional contain a utility that will automatically perform these write-offs. Medisoft Original users must manually enter these adjustments through Transaction Entry. This process will decrease the patient’s AR total.

    Error Correction – (Negative OR Positive Adjustment) During the billing process, you will find that data entry errors are made. Patients may be charged too much, or too little. A payment may be entered for the wrong amount. These corrections should generally be made using error correction adjustments. This gives you a complete record of what was originally entered, and the steps taken to correct the error. Deleting charges and payments is not recommended, as you will not have this record of what was previously entered.

    Takeback Adjustment – (Positive Adjustment) Takeback adjustments are used when insurance carriers have overpaid on a charge. Often these carriers will take the money back on a future EOB. The patient with the overpaid charge may not be on the EOB where the money was taken back. If a charge was overpaid by an insurance carrier, the balance on that charge is artificially low (it has been overpaid). Because the balance on the charge is lower than it should be, we need to RAISE the balance (and therefore the patient AR total). Medisoft Original users must do this through Transaction Entry. Medisoft Advanced or Network Professional users can enter these adjustments through the Deposit List.

    Withhold Adjustment – (Negative Adjustment) Withhold adjustments are usually used in conjunction with Takeback adjustments. When a provider receives an EOB that has had compensation withheld due to previous overpayment, they still need to pay the balances that would have been paid if not for the previous overpayment. This is done using withhold adjustments. Medisoft Original users must do this through Transaction Entry. Medisoft Advanced or Network Professional users can enter these adjustments through the Deposit List.

Adjustments are entered into the lower portion of the Transaction Entry screen. There are fields here that apply to adjustments, and there are fields that do not apply to adjustments. In this section, we will discuss only the fields that apply to adjustments.


Date: The date field functions the same way when entering adjustments as it did for charges.

Pay/Adj Code: This is the field where you enter the adjustment code for the type of adjustment you would like to enter. Generally, these codes should have been set up previously. (See MED103: Getting Started) If the code is not already set up at this point, you can press the [F8] button with your cursor in the Pay/Adj Code field to create a new code. If the code is set up but you wish to edit the properties of this field, you can press the [F9] button with your cursor in this field.

Who Paid: This field is not necessary when entering adjustments.

Description: Enter any additional descriptions you wish to add to the adjustment you are entering.

Provider: If you want to be able to track adjustments by providers, enter the provider responsible for the amount being adjusted into the Provider field.

Amount: The Amount field is the key field when dealing with adjustments. Most adjustments are entered with the intent of lowering the balance. In order to accomplish this, you should enter a minus sign (-) and then the amount you wish to write off or adjust off. If you have set up your procedure codes properly, the minus sign will automatically be entered for you. In order for this to be automatically added, the field labeled Make Adjustment Negative must be checked within the adjustment code screen.

If this field is not checked, the minus sign will not be automatically added, and any number entered without manually typing the minus sign will be viewed as a positive adjustment.

Check Number: This field is not necessary when entering adjustments.

Unapplied: After entering an adjustment, it is important that you apply that adjustment to specific charges. The balance you need to adjust is attached to specific charges. If you do not apply your adjustment to those charges, your balance numbers could be incorrectly calculated. The Unapplied field shows you what portion of the adjustment has not yet been applied.

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

Adjustment Application

As stated, after entering your adjustments, you need to apply that adjustment to specific charges. This is done by clicking the Apply button in the lower left portion of the Payment/Adjustment entry section of the Transaction Entry screen.


Once you click the Apply button, the following screen will appear.


The charges that appear on this screen will be limited to the charges that appear on the Transaction Entry screen. This means you will only see charges for the selected chart number, case number, and possibly document or superbill number. If you are using document numbers or superbill numbers, you can see charges that are not linked to the specific document or superbill number by clicking the Show All field prior to clicking the Apply button.

The charges listed will show you the Date From (or date of service), the Document Number (or Superbill number), the Procedure Code, the original charge amount, and any remaining balance on that specific charge. You will only see one column that will allow you to make any entries. That column is the This Adjust column. In this column, you will enter the portion of the adjustment that will be applied to each individual charge. You can either apply the entire amount to one charge, or split the adjustment up and apply the same adjustment to multiple charges.

You should apply the adjustment until the Unapplied amount at the top of the screen shows 0.00.


Once you have completely applied the adjustment, click the Close button. You will return to the main Transaction Entry screen. Click the Save Transactions button. You have now entered and applied an adjustment.

 

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Taxable Transaction Entry

In most states it is illegal to charge tax on medical procedures. However, many offices and practices sell items directly to their patients. These could include equipment, vitamin supplements, and other similar items. The sale of these items is often subject to sales tax. In order to enter a taxable transaction and the charge for the sales tax, take the following steps:

  1. Set up a procedure code for the taxable item. (See MED103: Getting Started) When setting up this code, make sure you place a check mark in the field labeled Taxable.
  2. Set up a procedure code for the actual sales tax. (See MED103: Getting Started) When setting up this code, make sure you enter Tax as the procedure type and enter the tax percentage in the corresponding field.
  3. Open the Program Options screen. On the Data Entry tab you will see the following fields:


    The fields that affect the tax functionality are labeled Auto Create Tax Entry and Default Tax Code. If you would like to use the tax feature, the Default Tax Code is required. You should enter the tax code set up in step 2 into this field.

Tips and Tricks:

If the tax amount changes in your area, you should set up a new tax procedure code. This new code should have the new percentage. You would then need to change this code within the program options.

The Auto Create Tax Entry field determines exactly how taxes will be entered. If this field is checked, whenever a charge is entered using a procedure code that is marked as Taxable, a second line item will be entered automatically for the sales tax. The amount on that line item will be based on the tax percentage entered in the procedure code set in the Default Tax Code field, and the charge amount entered for the taxable charge.

If this field is not checked, if a taxable charge is entered, you must click the Tax button in order to create the charges for the tax amount.


Following this process will allow you to enter transactions that include sales tax amounts.


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MultiLink Entry

MultiLink codes are used to enter multiple charge transactions at the same time. Many provider offices will find that they are entering the same groups of procedure codes for the same types of visit. An example of this would be a well-patient exam. MultiLinks allow you quickly enter all of those transactions.

MultiLink codes must be set up prior to clicking the MultiLink button in Transaction Entry. This is done by clicking the Lists menu and MultiLink Codes. You will see a list screen similar to the other list screens. Click the New button. The following screen will appear:


Code: The MultiLink Code field functions like the code fields in the other Medisoft list windows. The code is the value you will enter within transaction entry in order to enter charges for all the linked procedure codes.

Description: When entering the Description, it is important to make an entry that adequately describes the group of procedure codes. This will allow you to more easily determine when it would be appropriate to use this code.

Link Codes: The Link Codes are used to specify which codes will be entered into Transaction Entry when this MultiLink code is used. The transactions will be entered in the order they are entered into these fields. You can type the procedure code, or select it from the drop-down menu. If you need search capabilities, click the magnifying glass.

Tips and Tricks:

You can only enter charge type codes into MultiLinks. You cannot use MultiLinks to enter payments or adjustments.

Once you have finished setting up the MultiLink code, click Save.

After setting up your MultiLinks, they can be entered into Transaction Entry by clicking the MultiLink button.


Once you click the MultiLink button, you will see the following screen.


In the field labeled MultiLink Code, enter the code for the group of transactions you wish to enter. The Transaction Date field will automatically default to the program date specified in the lower right corner of the Medisoft screen. Once you are have selected the correct information, click Create Transactions. The desired charges will be listed in Transaction Entry. Click Save Transactions.

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Charge Entry and Edit

Once you have configured your data entry screen, you are now ready to enter charges. In this section we will discuss the methods of entering and editing charges. We will focus on the fields that default into the grid. We will also focus on issues that can arise during the charge entry process.

Column Sorting

To help practices manage your charges, you are able to click on any of the Grid Headers to sort by that column. Medisoft will remember your sort preferences.

Single Charge Entry and Edit

We will begin our discussion with the process for entering or editing a single charge. This process can be repeated in order to enter or edit multiple charges. In order to enter charges, click the New button at the bottom of the charge portion of Transaction Entry. (The top data entry section.) You will see a new line appear in the charge section.



Date: The Date field is the date of service for most charges. If you are entering a charge that requires a beginning and ending date, this field is where you would enter the beginning date.

Tips and Tricks

The Date field will default to the date listed in the lower right corner of the Medisoft screen. This date can be easily changed by clicking on the date. This will bring up the calendar. When you select a date, this will be the default transaction date for all new transactions.

Procedure: This field is where you would enter the actual procedure code for the charge. This code should have been entered into the Procedure/Payment/Adjustment List. Only codes with the Type field set to one of the 5 charge types or Tax can be entered in this portion of the screen. In the flow of office procedures, this should be specified on the superbill that the provider fills out during the patient’s visit.

Units: If multiple units of the same procedure were performed, enter the number of units in this field. After entering the Procedure Code, you may see that the units field automatically populate with a number. This is coming from the Default Units field of the procedure code setup. The Units field also corresponds directly to the Total field within Transaction Entry.

Amount: When entering Amounts you are specifying the amount you would like to BILL to the patient or insurance carrier. It is important to note that this amount is not the same as the amount of money you expect to be paid. This is especially true when dealing with insurance carriers. Most carriers base their payments on Allowed Amounts. We will discuss what an allowed amount is later.

You may see that the Amount field automatically populates with a default amount. This amount is calculated based on two fields:

  1. Case – Price Code: Within the patient’s case, you entered a letter from A to Z into a field labeled Price Code which is located on the Account tab.
  2. Procedure Code – Charge Amounts: On the Procedure Code Setup screen, you will see a tab labeled Amounts. This tab contains fields labeled A through Z. These fields contain default charge amounts that can be sent to Transaction Entry when this procedure code is entered. The amount that is sent will be determined by the value entered in the Case – Price Code field. If you entered the letter A for the Price Code, the value entered into field A on the Charge Amounts tab will be sent as the default charge amount.

You do have the ability to manually change any value that defaults into the Amount field.

Total: You do not have the ability to manually change the value that appears in the Total field. This field will be the amount that is billed for this line item on a claim. The value that is displayed here is based on the numbers entered into the Units field and the Amount field, as well as a setting within Program Options. Within Program Options, if the field labeled Multiply units times amount on the Data Entry tab is checked, the Total field will contain the result of multiplying the Units by the amount. If the program option field is not checked, the Total field will contain the same amount that is entered in the Amount field.

Diag 1 – 4: The Diag 1 – 4 fields are where you specify which diagnoses were identified during the patient’s visit. These codes will be identified on the superbill filled out by the provider during the patient’s visit. Within these fields you should enter ALL the diagnosis codes that were identified during the visit. These fields determine what will print in box 21 of a CMS-1500 form.

1-4: The fields labeled 1-4 are fields known as Diagnosis Pointers. These fields correspond directly to the Diag 1 – 4 fields. These fields indicate which of the diagnosis codes apply to this particular transaction. Place a check mark under the numbers that correspond with the correct applicable diagnosis codes entered in the Diag 1 – 4 fields.

Tips and Tricks:

If you are entering multiple charges, it is critical that you enter exact same diagnosis codes in the exact same order in the Diag 1 – 4 fields. Failure to do so will cause the transactions to appear on different claims. If a diagnosis code doesn’t apply to a particular charge, simply uncheck the corresponding Pointer field.

Additionally, if you change the diagnosis codes for a transaction that has been previously placed on a claim with other transactions, that transaction will be removed from the claim.

Provider: The Provider field in transaction entry is where the attending provider (or provider who performed the procedure) is entered. This field will automatically populate with the provider who was entered into the case as the Assigned Provider. When you are creating claims for transactions entered, if you create based on Attending Provider, the claim will include provider information for the provider entered in this field within Transaction Entry.

Tips and Tricks:

If you enter multiple transactions with different Attending Providers, pay attention to how claims are created. If you create based on Attending Provider, you will get a different claim for each different provider listed on eligible transactions.

POS: POS stands for Place of Service. This field is used to specify where the service was performed. There are specific place of service codes that must be entered. A list of eligible codes is available in the Medisoft help file. You may also find information defaulting into this field. You have the ability to set default place of service codes both in the Procedure Code Setup, and the Program Options.

TOS: TOS stands for Type of Service. Similar to the POS field, this field requires entry of one code from a list of specific type of service codes. A list of eligible codes is available in the Medisoft help file. This field may also default a value. These defaults are set in the Procedure Code Setup screen. There is not a program option to default this value.

Allowed: Allowed amounts are only required when an insurance carrier is responsible for a charge. This amount is used by the carrier to calculate the amount of compensation that will be made for that charge. See Allowed Amounts Handout.

M1: The M1 field is used to enter modifiers. Modifiers give the insurance carrier more information regarding the charge. This can affect the amount of compensation. In some instances you will need more than one modifier. If this is the case, you will need to add the additional modifier fields to the grid.

Once you have entered your transaction(s) including all pertinent information, click the Save Transactions button at the bottom of the transaction entry screen.


If you want to edit a charge that has been previously entered, you simply need to make the necessary Chart, Case, Document, and Superbill number selections, and then editing the fields you need to change. Once you have made your changed, you will need to click the Save Transactions button.

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Personal


Case Number: You will not be able to edit the case number field. This field will automatically increment by 1 for each case that is created within your practice. The incrementing is done on a practice level and NOT on a patient level. This means that any case number will only exist once within the practice. This number will be the number used to refer to the case from within Transaction Entry, Deposit Entry, and Office Hours.

Description: The description field is a required field for each Case. You will not be able to save a case without entering in a description. The description should accurately describe the transaction set that will be contained within the case. For example, if you are creating cases on a yearly basis, you would want to assign the year as the case description.

Global Coverage Until: If a Global Surgical Procedure was entered into Transaction Entry for this case, Medisoft will calculate out the number of Global Period days indicated in that procedure’s record and input that expiration date in this field. All transactions entered within this period will default to a zero dollar amount. If the procedure code entered is outside of the global coverage period, the standard charge amount will appear.

Cash Case: If you place a check mark in the field labeled Cash Case, it will be impossible for you to bill any insurance claims for transactions entered into this case. It will prevent all transactions from ever appearing on an insurance aging report. Transactions will immediately appear on a remainder statement without waiting for payment from the insurance carrier. This field should be used ONLY if the patient has no insurance or if the transactions entered into the case will definitely not be covered by an insurance carrier.

Print Patient Statement: If this field is not checked, the charges entered into this case will NEVER appear on a Patient Statement. If you never wish to bill a patient for certain charges, you would want to set up a case this way.

Guarantor: The simplest definition of the Guarantor field is that it defines the person who will receive the patient statement. The drop down menu will give you access to all patients and guarantors that have been entered into the Patient List. This will also be the person listed as the Guarantor for the patient when their Ledger is pulled up within the Quick Ledger.

Marital Status: It is important that you fill out this field to the best of your ability. It is possible that some Electronic Claims will not process properly if this field is not properly filled out.

Student Status: Because most private insurance companies base their coverage for dependants on student status, you will need to enter an appropriate student status for those patients who could be affected by their student status designation. Usually these patients are from 18 to 24 years old.

Employer Information: The employer information is going to automatically populate based on what was entered into the Patient entry screen. Any time a patient changes employers, you should create a new case, and modify the information entered into the Patient entry screen.

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Medisoft Case Setup Overview and Definitions

Medisoft utilizes an accounting system known as Case Based Accounting. Case Based accounting groups transactions together based upon the case they are entered into. Different offices have different methods of using cases. Cases include large portions of the information that will appear on a claim. Within the case, you will assign Insurance Carrier and Guarantor values to transactions. These values will be used to determine how and where claims and statements are sent.

Definition of a Case: A case is a unique condition or situation for which a patient seeks treatment or services. There can be multiple visits for service related to a single case and all services related to that malady or condition are contained in the same case.

There is not one “right” way to create new cases but we will give you a few general guidelines for when to create a new case.

In general, you may need or want to create a new case whenever:

1. The number of transactions entered into that case reaches 650. The transaction limitation includes charges, payments, adjustments, and comments as well as any sub-set of these transaction types.

2. The insurance carrier information for that patient changes. You do not want to simply change the insurance carrier information within the existing case, in order to maintain your record of the patient’s insurance history. The transactions entered into that case under the original insurance carrier should not be associated with a case containing a different insurance carrier.

3. Employer information changes. Within the patient setup, you can set up a default employer for use whenever a new case is created. If a patient changes their employer, generally that change will also include a change in benefits, which will change the insurance carrier associated with them. These changes need to be reflected in a new case.

4. Time period changes. Many offices create a new case for a specific time period. You may want to create a new case for each quarter or for each year. This allows you to group transactions together based on when they occurred. The only limitation you will need to note with this is that payments must be entered into the same case as the charge to which the payment will be applied.

5. Visit based cases. Some offices choose to create a new case for each visit a patient makes to the office. This allows you the most detail in grouping transactions together. However, this option is not necessary if the office uses the Document Number or Serialized Superbill features properly.

6. Variations in the billing process for the same patient. If there are different guarantors for different charges for the same patient, you will need to set up a different case for each guarantor. Similarly, if there are charges that you never wish to bill on a patient statement, those transactions will need to be entered into a separate case.

7. Specialty field changes. There are many specialty fields included within the case screen. Whenever any of these fields change, you will want to create a new case. For example, if the patient was a student, and the student status changes, you will want to create a new case for transactions entered since the student status changed.

8. Global Coverage is used. If a Global Surgical Procedure is entered into Transaction Entry for a case, an automatic calculation is done to determine the end date for that Global Surgery. If more than one Global Surgical Procedure is used for the same case, the Global Coverage Until date will change to the latest date.

There are many other reasons to create new cases. You will need to figure out what works best for your office.

Tips and Tricks:
When browsing through the case screen, you may find that you have fields that are “hidden” without the scroll bar that allows you to access the fields. If documentation such as the Knowledge Base, Help Files, or Training Documentation refers to a field that you cannot see, you may have to expand the size of the case screen in order to make the field visible.

 

You will be able to see some of the Patient demographic information at the bottom of the case window. You will also be able to check the eligibility and print a Face Sheet using the buttons available along the right side of the screen.

If you want to switch your case screen to a different case for that same patient, you can do so using the case field in the lower right corner of the screen.

You may find that the Tab labels are missing from your case screen.

This is due to your display settings being set to use large fonts (large size DPI). In order to correct the issue, you must set your font setting (DPI setting) to Normal.

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Hurricane Charley hit us full force. I remember hunkering down with my wife in the bathroom of our house. The wind was blowing fiercely, we could see little minin cyclones spinning grass and debris in our backyard. I remember getting all suited up and running out to the barn to try to call in the horses to the barn for safety. They didn’t want to come in, instead they were content with sticking their huge “rumps” to the wind (they are quarter horses), and waiting out the storm outside in the pasture. Then suddenly I heard an “explosion” and turned around to see a plastic shed in the bar flying in pieces all over. I considered that a much needed encouragement to head back to the house and hunker down some more, I ran to the front door and as I entered the house, my wife said “Harry look at the barn”, I looked and saw it “flying away”, obliterated with chunks of metal roofing and wood spinning wildly in the air, pelting the path I had used to run back to the house.

From personal experience, I know the damage natural disasters can bring. Luckily, at my office, we had put all the equipment up on the desks from the floor (for floor standing computers), made backups, took backups off site, and survived with minimal interruption to business (we did cart the server to a staff members house down south in Fort Myers florida, where they had internet access and electricity). I can remember doctors offices in Punta Gorda, that received the brunt of the storm, wading around the streets picking up paper medical charts, (talk about HIPAA violations! lol)

Look at what happened with Hurricane Sandy in the northeast. Even fortune 500 firms had damages they were not expecting because of all the consequences of what a hurricane could do.

What can we learn? Here are some suggestions for preparing for natural disasters:
1- Always backup your data on a regular basis.
2- Always “rotate” your backup media (this means if you are backing up to tapes; memory sticks; CD’s or DVD’s or other media, don’t put all your eggs in one basket. Diversify, spread your risks to multiple media). We suggest a media for monday; tuesday; wednesday; thursday; and 5 or so fridays (one for each week, and on week 6, you would rotate and use media #1 again); 3 or 4 minimum monthly media; and yearly media backups.
3- Take backup media offsite in case of robbery; fire, or other disaster destroys your office and everything inside.
4- We learned that communications and power are two very important aspects in a disaster. We had voicemail on our phone lines, and thought we were still receiving messages from customers and clients after the storm. We were wrong, the phone companys “voicemail” was in town and was damaged in the hurricane, and we had no way to communicate with our customers since the phone lines were down. I remember driving every day for a few hours up to Sarasota FL, to FedEx Kinkos, to hookup my laptop to check emails, and use the cell towers in Sarasota to call customers. Later we hooked up a generator so that the office could function on a limited basis when phone service was restored.
5- Think in advance of alternate locations to setup your office in case of disaster. One of the most busiest businesses thriving in the Hurricane Sandy disaster are temporary office locators who find locations for clients on a temporary basis.

Do you have any suggestions for preparing for disasters in your home or business?

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Participate in our new medical billing software discussion forum. Post questions on medisoft billing software or post questions about medical billing or coding issues. Medisoft Medical Billing Software Discussion Forum

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Medical Billing Software is what this blog is all about.  Got questions about medisoft medical billing software, or about what it can do, or what reports it has, or who’s the best place to purchase from, or anything else medical billing relalted- just ask!

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