Editing Existing Ticklers

The purpose of the collection list is to allow you to quickly move through the collections process. Each tickler has a Responsible Party attached to it. This field will display either the Guarantor or the Insurance Carrier responsible for the outstanding balance represented by that tickler. If you click the + sign next to that party, you will see all applicable information necessary for making a collection call.

You can also double-click the tickler to open it. You will see the following screen:

Here you can edit many of the values associated with this tickler. Most importantly, you can specify the date this issue was resolved. Usually the entry of this date corresponds with the receipt of payment on the outstanding debt. This payment could be for the entire amount, or for any other amount agreed upon by both parties. If the issue is resolved, you should also change the status of the issue to either Resolved or Deleted.

You would repeat this process for each subsequent tickler

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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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12. We will now focus on the columns used to apply the payments and adjustments as listed on the EOB.

Payment: In the payment column, enter the actual amount paid by the insurance carrier. An entry here will cause a payment type transaction to be entered into the patients ledger in the amount entered.

Deductible: If a charge or portion of a charge was applied to the patient deductible, it will be listed on the EOB. Enter that amount here. The balance on the charge will not be affected by this amount.

Withhold: If the EOB states that an amount was withheld from the payment for this patient’s visit, enter that amount in this field. The most common use of this is when the insurance carrier had previously overpaid on this or another patient’s account. This will lower the balance on the charge by the amount entered.

Allowed: Allowed amounts are the amounts the insurance carriers will base their payments on. This field will automatically populate with the allowed amount entered for this combination of procedure code and insurance carrier. These values can be entered through either the procedure code entry screen or the insurance carrier entry screen. If the value defaulting in this field is 0, you can enter the allowed amount in the column on this screen, and it will automatically update the value in the procedure code and insurance carrier setup screens. Additionally, for the purposes of this particular payment application, you can change the value that is defaulting in this field and have it affect that transaction only.

Adjustment: The adjustment field is normally used to enter the disallowed amount adjustments. If you have entered your allowed amounts properly, this field CAN automatically calculate the adjustment amount for you. In order for this to happen, you must first make a selection within Program Options. On the Payment Application tab, place a check mark in the field labeled Calculate Disallowed Adjustment Amounts.

Takeback: If the EOB states that an amount was withheld for a previous overpayment, it will also indicate the patient who was overpaid. The Takeback column is used to take the money back from the previously overpaid patient. This will increase the balance on the charge by the amount entered.

Complete: The complete field is the most important field on this screen. This field is indicating that the payment from this insurance carrier is complete and that no more money is expected from the insurance carrier. If you will be appealing the amount, do not place a check mark in this field. If you do not expect any more payment on that line item, place a check mark. The check mark indicates that the aging and billing should move on to the next responsible party. You can automatically check insurance payments as complete by selecting the program option on the Payment Application tab labeled Mark Paid Charges Complete. This field will only be available if your deposit type was set to Insurance.

Rejection: The rejection field is used to create notes that will appear on a patient’s statement indicating the reason the charge was not paid by the insurance carrier. This is included on this screen because the EOB will indicate the reason it was not paid, and this is the screen used to enter the EOB. These messages must be set up prior to payment application. This is done through the Lists menu and Claim Rejection Messages. New Rejection Messages can also be added from the Deposit List by right clicking in the rejection area and select New Rejection Code (F8) or Edit Rejection Code (F9).

  1. Provider: You will not be able to edit the value in the Provider field. This simply indicates the attending provider, or provider who performed the medical services.
  2. Once you have entered all applicable values for this patient, click the button labeled Save Payments/Adjustments. At this point you will create up to 5 types of transactions in the patient’s ledger. This process will also update your mwtrn.adt and mwpax.adt files. At this point, these transactions will appear on your accounting reports.


  3. Change the chart number field to the next patient on the EOB, and repeat this process for each subsequent patient until the entire amount has been applied.

Following this process will allow you to quickly enter 5 different types of insurance transactions for multiple patients.

NOTE: This feature is only available on Medisoft Advanced and Medisoft Network Professional.

 

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Transaction Entry Buttons

Transaction Entry has various buttons at the bottom of the screen.


These buttons perform the following functions:

Update All: The Update All button is used to update the displayed transactions to include changes made to either the Case setup or the Procedure Code setup. These changes would affect which payors are responsible for the particular charges, or the type of transaction.

Quick Receipt: If you click the Quick Receipt button, Medisoft will print out the walkout receipt format that is selected on the Billing tab of the Program Options screen under the Receipt field. This receipt is usually given to the patient on their way out of the office. The receipt details what procedures and payments were entered during that visit.

Print Receipt: Clicking the Print Receipt button will allow you to select a walkout receipt format for printing. These receipts will have the same properties as the receipt printed under the Quick Receipt button.

Tips and Tricks:

Walkout receipts will never contain insurance payments. These receipts are only designed to show which transactions were entered on the day of the visit. Insurance payments are not received in advance.

Print Claim: The Print Claim button will look at the transactions listed on the screen, and print claims for the transactions that have insurance carriers listed as eligible, responsible payors, AND have not previously been placed on a claim. This process will create a claim or claims in claim management for these transactions.

View eStatements: Select this button to open the BillFlash eView page for the guarantor associated with the case. See the BillFlash section of the eStatements chapter of the EDI documentation for more details.

Close: Clicking Close will close the Transaction Entry screen. You will need to apply any payments before clicking this button. If you have not saved your transactions before clicking this button, you will be prompted to do so.

Save Transactions: This button is used to save any new or edited transactions.

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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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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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EDI Notes – New to Medisoft

There are circumstances where transaction level notes are required on your electronic claims. Use this window to manage such notes that need to be attached to individual line items. Items added to the EDI Notes List will generate additional ANSI segments in the 2300 and/or 2400 loops. Items in the EDI Notes list are specific to each line item or charge entry. You should refer to each Insurance Carrier for assistance in determining the necessity of these notes.

You can add the following segments:

  • Line Note (NTE)–usually used for special instructions or notes not entered anywhere else in the claim.
  • Test Results (MEA)–usually used to specify physical measurements or counts, including dimensions, tolerances, variances, and weights.
  • Contract Information (CN1)–used to specify basic data about the contract or contract line item. This information is required when the submitter is contractually obligated to supply it on post-adjudicated claims. You can also enter claim-wide contract information on the EDI Note tab of the Claim window.
  • Line Supplemental Information (PWK)–used and required when attachments are sent electronically but are transmitted in another functional group rather than by paper; or required when the provider deems it necessary to identify additional information that is being held at the provider’s office and is available upon request by the payer (or appropriate entity), but the information is not being submitted with the claim.

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


    You will see the following screen:


    Click New to add as many EDI notes as required by carrier.

    Claim Level EDI Notes should be entered in the Comments tab within the Case.

    Details: Click this button to add national drug code (NDC) information to the charge.


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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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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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Free Download of Medisoft Billing Program:

One of the most popular medical billing software programs is Medisoft Advanced and Medisoft Network Professional.  You can download a free 30 day, fully functional demo of medisoft for free.  Of course the program itself is not free, only the demo period; after the 30 day demo of this popular medical practice management software is up, you may decide you want to purchase the program for your medical billing service or internal medicine practice, mental health clinic, physical therapy management solution, or for your physician office.

After you download medisoft billing software for free , and the 30 day free demo expires, you can purchase our insurance billing software program, or delete it from your computer.

Free Medical Practice Management Software Demo Download

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