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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Capitation Payments

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

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

  1. Click the New button.


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


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

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

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



 

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

12. Highlight the payment and click Apply.


  1. The following screen will appear.


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


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


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


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

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

  1. Click the New button.


  2. The following screen will appear.


  3. The Deposit Date field specifies the date of payment and adjustment that will be listed in the patient ledgers. This date will default to the computer’s system date. You can manually change this date in order to enter payments that were received on previous dates.
  4. The Payor Type field will default to Insurance. Change it to Patient. You will see the window display change.


  5. When selecting the Payment Method, you will have the option to select Check, Cash, Credit Card, or Electronic. Make your selection according to the method the patient used when making the payment.

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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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Insurance Payments

To enter an insurance payment from an EOB, take the following steps from within the Deposit List.

  1. Click the New button.


  2. The following screen will appear.


  3. The Deposit Date field specifies the date of payment and adjustment that will be listed in the patient ledgers. This date will default to the computer’s system date. You can manually change this date in order to enter payments that were received on previous dates.
  4. The Payor Type field will default to Insurance. This is the value you want here for a non-capitation insurance payment.
  5. Enter the entire amount listed on the check in the field labeled Payment Amount.
  6. In the field labeled Insurance, enter the insurance code for the carrier making the payment.
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ERA Adjustment Posting

ERA (Electronic Remittance Advice) Adjustment Posting is an option that works in conjunction with Revenue Management. Revenue Management automatically reads the electronic EOB format returned by the insurance carrier, and applies the payments to the appropriate charges. This is the most efficient way to post payments. The process for posting an electronic EOB will be discussed in the blog posts covering EDI.

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