Billing Patient Statements

After creating your statements, you are now ready to bill them. When a statement is first created, it is not marked as either a paper statement, or an electronic statement. This gives you the option of sending the statement either way.

Printing Paper Statements

In order to print your paper statements, take the following steps:

  1. Create your statements using the process outlined previously.
  2. Click the Print/Send button.


  3. The following window will appear. Select Paper. You will also see a field labeled Exclude Billed Paid Entries. This field will cause the statements to ignore any transactions that have a balance of zero, regardless of whether the entire statement has been paid or not. We recommend that you check this. Once you have made your selections, click OK.


  4. You will now be asked to select a format for your patient statements. Medisoft comes standard with the formats listed. You also have the ability to modify these formats in order to create your own. If the statements you have created are remainder statements, you MUST select a remainder statement format. If the statements you have created are standard statements, you MUST select one of the other formats. After making your selection, press OK.


  5. The program will now prompt you to select where you would like to output your statements. In order for the statement to be marked as billed, you must select either the option to Print the report on the printer or Export the report to a file. Make your selection and click Start.


  6. You will see the Data Selection Questions screen. This screen will allow you to filter your statements. The Statement Total Range will default to 0.01 to 99999. This means that you will only get statements with a total between 1 cent and $99,999. If you want zero or negative balance statements, you will need to modify this value. You will also see a Statement Number Range. This filter will default to a range including the entire range of statements in statement management. Do not change this filter. Make any other selections you wish to filter on and click OK.


  1. The statements will be sent to the output device previously specified.

You will note that Statement Management works in a much different manner than Claim Management. The statements printed are NOT limited to those statements with a status of Ready to Send and a batch set to 0. You will get any statements that have charges with outstanding balances on them.

Additionally, if the same patient or guarantor has multiple statements created in statement management, those statements will NOT print out on separate forms. They will be combined into one statement when printed. There is one exception to this condition. If you have created statements in both the standard and remainder formats, the statements will not merge with other statements with a different type.

Tips and Tricks:

It is possible that charges appear on a remainder statement prior to being paid by the insurance carrier. This has to do with the allowed amount settings. See the Allowed Amount handout for more information.

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Transactions

The Transactions tab will show you which charges are attached to this statement.

You will also have the same options on this tab as you did on the corresponding tab within Claim Management.

Add: Clicking the Add button will allow you to add eligible transactions to this statement. In order for a transaction to be eligible for addition, it must meet the criteria required for the type of statement you are editing. This means that all conditions discussed during the Troubleshooting Creating Statements must be met.

Split: If you click the Split button, you will be able to split transactions off of the existing statement and onto a new statement.

Remove: Clicking the Remove button will take the highlighted transaction off the statement. That transaction will then be subject to addition to another statement if it remains eligible.

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Statement Management

There are two methods for actually printing your patient statements. The first method we will discuss is Statement Management. Statement Management handles statements in a similar manner to the way Claim Management handles claims.

Statement Management
allows you to integrate your statements into your collections module (Collection List). Additionally you will be able to utilize the cycle billing feature.

This section will examine the different processes you will use within Statement Management to effectively bill your patients.

To open Statement Management click the Activities menu and Statement Management.

Statement management is ONLY available in Medisoft Advanced and Medisoft Network Professional.

Creating Statements

In order for a transaction to print on a patient statement, that transaction must be created on a statement. In order to create statements, take the following steps from within Statement Management:

  1. Click the Create Statements button.


  2. The following window will appear. Here you will be have the ability to filter which transactions are created on statements. Leaving these filters blank will look for any ELIGIBLE transactions that have not been placed on a previous statement, and place them on a new statement.


  3. In the Statement Type section you have the option to create either Standard or Remainder
    Statements. If you select Standard, you will create statements for all eligible transactions regardless of the party that is currently responsible for the remaining balance. If you select Remainder, you will create statements for all eligible transactions with balances that are currently part of the Patient Remainder Balance.
Tips and Tricks:

When creating statements, each transaction can only be placed on one statement. If you create a standard statement, you will not be able to create a remainder statement for the same transaction unless you delete the original standard statement.

We suggest that you select one type of statement and ALWAYS create statements using that type.

 

  1. Once you have made your selections, click Create.


  2. If the following screen appears, no eligible transactions were found within the parameters set.


  3. If eligible transactions were found, you will see new statements created on the main statement management screens. These statements will have a Status of Ready to Send and a Batch number
    of 0.
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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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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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Transaction Entry

During the recent blog posts discussing the Transaction Entry interface, we discussed the process used for entering payments and adjustments through the Transaction Entry screen. This process must be followed for entering insurance EOBs as well.

It is important to note that when entering payments through transaction entry, you will only have access to one patient and case at a time. This means that you will need to break out the EOB into multiple payments in order to apply it to each patient. Additionally, you will need to manually create each type of necessary adjustment.

If you are using Medisoft Original, you have no choice but to enter your payments through Transaction Entry.

Quick Ledger

(Please Note: The Quick Ledger is a feature only available in Medisoft Advanced and Medisoft Network Professional.)

Medisoft has the ability to change the current responsibility for a charge through the Quick Ledger. When doing this, you can only use the Quick Ledger to move the responsibility to a subsequent party. An example of this would be to move the responsibility from the primary insurance carrier to the guarantor. When using this feature, the program will automatically enter a payment with a 0 amount and mark it complete. This will effectively move the balance to the designated party.

This is done by simply right-clicking on a charge, clicking Responsibility, and then selecting the party you want to make responsible for a charge.

Tips and Tricks:

Insurance carriers will not be listed as the responsible party until a claim has been billed to them. Until the primary carrier has been billed, the responsibility will be listed as Patient Responsible.

If you want to undo this process, you will not be able to simply right-click and change it back.

The only way to undo this process is to open Transaction Entry to the screen including the payment that was created. You should then highlight the payment and click Apply. You will then have the opportunity to remove the Complete checkmark. This will take the responsibility back for that payor. If you have multiple 0 payments that were created, you will need to repeat this process for each carrier’s payment. If you wish, you can then delete the 0 payments. It is IMPERATIVE that you uncheck the Complete box PRIOR to deleting the payment.

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Deposit List Automation Options

When entering payments through the deposit list, there are automated features which allow you to better navigate the billing and collections process. We will examine those features here. These fields are available on the payment application screen.

Alert When Claims Are Done: If you apply COMPLETE insurance payments to all charges that are on the same claim in Claim Management, that claim will be automatically marked as done. If this field is checked you will be notified when the claim is marked done.

Alert When Statements Are Done: If you apply payments that bring all charges on a statement to a zero balance that statement will be marked as done. If this field is checked, you will be notified when the statement is marked done.

Bill Remaining Insurances Now: If you apply COMPLETE insurance payments to all charges that are on the same claim in Claim Management, this feature will cause Medisoft to bill the next responsible insurance carrier automatically.

Print Statement Now: After receiving insurance payments, the next step in the billing process is usually to print patient statements. If this field is checked, the patient statement will print after clicking Save Payments/Adjustments.

Write off Balance Now: Medisoft has the ability to do small balance write-offs. This allows you to write off balances that are too small to be worth collecting. In order for this option to be available, you must have your program options configured in advance. On the Payment Application tab in the Program Options screen, you will see a section labeled Small Balance Write-Off. You must have an adjustment code entered in the field labeled Patient Write-off Code and the maximum amount you wish to be written off in the field labeled Maximum Write-off Amount.

If the Write off Balance Now is checked, the current payments and/or adjustments are created and applied, prior to recalculating the Patient Remainder Balance. After the Patient Remainder Balance is recalculated for the patient listed in the For box, the Patient Remainder Balance is compared with the Maximum Write-off Amount that was entered in Program options. If the write-off conditions are met, then the write-off adjustment is created and applied to this patient’s ledger.

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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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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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