Change Status

If you would like to change the status or follow up date for a group of ticklers, click the Change Status button. The following window will appear.

You can utilize this window to change the status for all ticklers in the list, or you can change the status for ticklers that have been previously selected using the Windows multi-select function.

Status From: The Status From field will specify the status that ticklers must have in order to be affected by this change.

Status To: This field is used to designate the new status you wish to assign to the affected ticklers.

Change Follow Up Date To: Use this field to change the follow up date. This is very useful if you do not finish your collection work for a particular date.

Once you have made your selections, click OK.

 

 

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Collections

After billing your patients and assigning them to payment plans, you need to be able to collect on balances that go unpaid. Offices have a few options for doing this. They could hire a collection agency. In general, this is a fairly easy way for the doctor to take care of the outstanding debt. The downside to collection agencies is that they generally receive a high percentage of the collected debt as a fee for collection.

Another option for performing collections is to utilize the Medisoft collections module to collect your debts from within the office. The collections module is called the Collection List. The Collection List can contain collection information for outstanding patient and insurance balances. The Collection List is designed to allow you to quickly move down the list making phone calls to the parties responsible for the outstanding debt.

To access the Collection List, click the Activities menu and Collection List.

Collection List Navigation

By default the Collection List will only display collection tasks that are scheduled to be performed on the current date.

You do have the ability to specify the range of dates you wish to see listed by specifying a beginning and ending date in the upper left corner of the screen.

If you want to see all items regardless of date, place a check mark in the field labeled Show All Ticklers. You will notice that the date fields are now unavailable to you.

By default, any ticklers for charges that are eventually paid in their entirety will be marked as deleted. If you only want to see the deleted ticklers, place a check mark in the field labeled Show Deleted Only.

If you would like to exclude deleted ticklers from your list, place a check mark in the field labeled Exclude Deleted.

If you would like to see all ticklers regardless of status, only the top box (Show all Ticklers) should be checked.

Tips and Tricks:

If you are using the Collection List to perform the collections process, you would not want to see deleted items. If an item is automatically being assigned the deleted status, that item does not have a remainder amount, and you would not want to contact that patient or guarantor as part of a collections process.

 

There are a few ways you can create a new tickler. Older versions of Medisoft utilized the aging reports to create tickler entries. These versions also allowed the creation of multiple ticklers for the same balance. Medisoft v11 and v12 are different. You must create new ticklers from within the Collection List.

 

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Change Status

Pressing the Change Status button will allow you to change the status for a group of statements. Pressing this button will bring up the following screen.

The first thing you will need to specify is which statements you wish to change. This can be done by selecting the Batch option or the Selected Statement(s) option.

Batch: Selecting Batch will allow you to specify a certain batch number, and change the status for all statements within that batch.

Selected Statement(s): This option will allow you to change the status for a statement or group of statements regardless of batch number. In order to select multiple statements, you will need to hold the [CTRL] button down and click on the statements you wish to change. This must be done PRIOR to pressing the Change Status button.

After selecting which statements you wish to change, you will need to specify the current status of the statements you wish to change. The Status From field will allow you to only change statements that have a certain status. You also have the ability to change all selected statements regardless of status. This is done by selecting the Any status type field.

Once you have selected the current status you wish to change, you will need to select the new status you wish to assign to the statements.

If you would like, you can change the billing method from paper to electronic or vice versa. This is done using the Billing Method From and Billing Method To fields.

The process is completed by clicking the OK button.

 

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Editing a Patient Statement

Once your statements are created, you can view and edit those statements from within Statement Management. To edit a statement, simply double-click the statement you wish to print. The following screen will appear.

The upper portion of the screen will be available regardless of which tab you have selected. This section of the screen will tell you the statement number, who the guarantor is, the remainder balance, and the date the statement was created.

General

On the general tab, you will see general information regarding this statement.

Status:  The Status field tells you where in the billing process this statement is.  When a statement is first created, it has a status of Ready to Send.  When a statement is first billed the status is changed to Sent.  Once the balance of all transactions on the statement reaches 0, the status is changed to Done.  The other status fields are used for your own purposes.  If you wish to use these other codes, you must manually set the statements to these status codes.

Billing Method:  The Billing Method field lets you specify whether you want to print out a paper statement or whether you want to send the statement electronically.

Type:  The Type field specifies whether the statement is a standard or remainder statement.  As you can see, this field is not one you can modify.  If you need to change this for any reason, you MUST delete the statement and recreate it.

Tips and Tricks:If you create standard statements and wish to change them to remainder statements, you will not be able to create statements for all of the patients originally listed in statement management.  This is because standard statements look for any charge with a balance, while remainder statements only look for charges making up the patient’s remainder balance.

 

Initial Billing Date:  This field specifies the first date the transactions attached to this statement were actually billed on a statement.

Batch:  The batch number is updated the first time a statement is printed or sent.  All statements billed at the same time will be assigned the same batch number.

Submission Count:  The Submission Count field tracks how many times the transactions attached to this statement have been billed to the guarantor

Billing Date:  The Billing Date field will tell you the last time these transactions were billed to the guarantor.

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Troubleshooting Creating Statements

It is possible that you expect specific transactions to be created on a statement, and they are not appearing on your new statements. If you are encountering this problem, it could be due to any of the following issues:

  1. The transactions have already been placed on a previous statement. This can easily be checked from within
    Transaction Entry. If you modify the grid, you will have the ability to add a field that shows the Statement Number for each transaction.


  2. The transactions were entered into a case not eligible for patient statements. Open the case containing the transactions and make sure the field labeled Print Patient Statement is checked.


  1. If you are trying to create remainder statements, the transaction has not been paid and marked as complete for all responsible insurance carriers. You can quickly check which carriers have not yet paid on the Transaction Entry window. Highlight the charge in question and click the Charge tab at the top of the screen. There is a section labeled Amount Paid. If this section does not have a check mark next to all 3 insurance carriers, the charge will not appear on a remainder statement. Any carriers without a checkmark need to have a complete payment entered prior to that charge creating on a remainder statement.


If the balance on the charge reaches 0 before the responsibility moves to the guarantor, it will not be created on a statement

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  1. The fields labeled Payment Code, Adjustment Code, Withhold Code, Deductible Code, and Takeback Code. These codes represent the 5 types of transactions that can be entered into a patient’s ledger through the deposit list. These codes MUST be entered prior to applying the payment. You can set up default codes to be used for payments from each insurance carrier. This is done on the Options and Codes tab of the insurance carrier setup screen.


  2. Click Save. At this point you have updated the mwdep.adt table, but have not yet updated the mwtrn.adt or mwpax.adt tables.
  3. You will now see the payment listed on the main page of the deposit list. Highlight it and click Apply.


Tips and Tricks:

If you see EOB Only in the amount column, that indicates that there was not an actual payment made, and that the EOB indicates the reason payment was not made.

  1. You will see the following screen. In the For field enter the chart number for the first patient listed on your EOB. Any charges that have not yet been paid by that insurance carrier will be displayed. If there are charges on the patient ledger that do not appear on this screen, you may want to try unchecking the field labeled Show Unpaid Only.


  1. The first step is to locate the charges that were paid and to which you need to apply the payment. The EOB should list the date of service, the procedure code, and the amount billed. These fields are available to you on the left side of the window. You will need to find the charges using these fields. Additionally, you will see the balance remaining on each charge in the column labeled Remainder.


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Adjustment Definitions

As stated in the introduction, adjustment entry is closely related to payment entry. When applying an EOB from an insurance carrier, you will not only create and apply payments, but you will also create and apply various types of adjustments. We will examine the types of adjustments that can be posted, and when each type should be used.

Disallowed Amount Adjustment: Allowed amounts are defined as the amount insurance companies will base their compensation on. Disallowed amount adjustments are used to reduce the balance on charges that were billed at a rate higher than the allowed amount. If you are using Medisoft Advanced or Higher, this adjustment can be automatically calculated for you through the deposit list. If you are using Medisoft Original, or if you are applying your payments through Transaction Entry, you will need to manually calculate and enter this adjustment amount. The calculation used in determining the amount is (Billed Amount – Allowed Amount) x (-1). If your billed amount is lower than the allowed amount, it is definitely in your best interest to raise your prices.

Withhold Adjustment: Withhold adjustments are used to decrease the AR total on a patient’s account due to money being withheld by the insurance carrier on a previous EOB. Insurance carriers may withhold money due to prior overpayments. These overpayments do not necessarily need are not necessarily going to be for the same patient(s). For this reason, withhold adjustments are often combined with takeback adjustments.

Takeback Adjustment: Takeback adjustments are used to increase the AR total on a patient’s account due to money being withheld by the insurance carrier on a previous EOB. This type of adjustment is applied to the patient(s) who has charges that were overpaid by the insurance carrier. Takebacks are usually entered in conjunction with a withhold adjustment.

Deductible: Deductible entries are used to move the responsibility for a particular charge to the next responsible party without lowering the AR total. If a charge has been applied to a deductible, the patient is responsible to pay for the charge. For this reason you do not want to change the AR amount. You simply want to make sure the charge shows up on the remainder statement.

 

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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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Transaction Notes

You have the ability to enter notes specific to a certain transaction. When viewing the Transaction Entry screen with the default grid settings, the first field along the left side of the screen is the note indicator.

This field appears blank if there is no note attached to the transaction. If there is a note attached to the transaction, you will see a sheet of paper occupying this field and indicating that a note is attached.


If you would like to view or enter a note for a specific transaction, highlight that transaction and click the Note button.


You will see the following screen:


In the Type field you will need to select the type of note you wish to add. The type of note you select will depend on what you want to do with the note. If you want the note to appear on a patient statement, you would need to select the type labeled Statement Note.

Once you have entered the Type, enter the note into the field labeled Documentation/Notes. When finished, click OK.

If you are simply viewing a previously entered note, the screen will appear with the Type and Documentation/Notes displaying the previously entered values.

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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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