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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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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New mobile ipad, iphone apps for Medisoft in version 18 sp2 to be released soon. Now enter superbills and appointments on your ipad or iphone and the info will show up on the office database. To be available soon, stay tuned…

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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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Program Options

After creating a practice, you will need to set up the program options for that practice.  The program options will govern how the Medisoft program will react in certain situations.  It is usually good to set the program options once, and then only modify them if specific situations require that change.

In this chapter, we will not cover all of the program options, rather the more basic ones.  We will cover the more complex options in the chapters covering the affected portions of Medisoft.

The program options are accessed by clicking the File menu and Program Options.

 

 

Tips and Tricks:The program options settings are specific to the practice that is open when you adjust the settings.  This means that multiple users accessing the same data will be functioning under the same program options.  It is not possible to make these settings user specific, unless each user is accessing a different practice’s data.

 

 

General

 

 

 

 

 

 

 

 

Remind to Backup on Program Exit:  This field will enable or disable the Backup Reminder window that appears when closing the Medisoft program.

 

 

 

 

 

 

 

 

Tips and Tricks:It is generally recommended that you leave the Backup Reminder window enabled.  Backups are extremely important for any office.One possible instance when you might want to disable this reminder is if the office is using the Medisoft Backup Scheduler or another automated backup program such as a tape drive backup.

 

Backup Program:  By default this field is set to mbackup.exe.  This is the executable file that runs the Medisoft Backup Program.  We do not recommend that you change this field.

Command Line:  If you decide to use a third-party backup program, the Command Line field is used to pass parameters to this program.  Refer to the manual for the program you choose for a list of valid parameters.

Show Windows on Startup:  Once you have completed your preliminary data entry, you will spend most of your time in Medisoft within 1 or 2 windows.  These windows are Transaction Entry and Patient List.  Selecting either of these options will cause the windows selected to open automatically when Medisoft is launched.

Show Hints:  This option enables pop up help hints when your cursor is held above an icon for a few seconds.

 

 

 

 

 

 

Show Shortcuts:  If you select the option to Show Shortcuts, the available shortcut keys for the active window will display along the bottom bar of the Medisoft program.

 

Use Server Time:  This option helps you maintain the integrity of your data by ensuring that all computers are working off a central date (the system date and time on the server).

Calculate Patient Remainder Balances:  You can see the Patient Remainder Balances in various places throughout the program.  This field must be recalculated every now and then in order to ensure accuracy.  This option allows you to specify exactly when this amount will be recalculated.

Data Entry

 

 

 

 

 

 

Use Enter to move between fields:  This option changes the function of the Enter key to mirror the Tab key and move the cursor to the next field.

Use zip code to enter city and state:  If this option is enabled, the city and state fields of any address within the program will populate automatically if a zip code is entered which has previously been entered in conjunction with a particular city and state.

Tips and Tricks:If the Zip Code feature is enabled, the tab order of most screens containing an address will be changed.  The tab will move from the street fields to the zip code field.  Once the zip code is entered, if the city and state fill in, the tab will never move to those fields.  If the city and state do not populate, the next time you press tab, the cursor will move to the city field.


HIPAA

 

 

 

 

 

 

Auto Log Off:  This field is designed to help the practice maintain HIPAA compliance.  If you have set up your security profiles, a locked screen will prevent viewing and modifications to the program after the allotted number of minutes go by without activity in Medisoft.

Tips and Tricks:The timer for this feature is timing the use of the actual Medisoft Program.  If you are using other programs on the computer, but Medisoft sits idle for the specified amount of time, the program will lock down.

 

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Network Setup

While this course will not go through specifics of network setup and configuration, we will introduce you to some preliminary setup tools and troubleshooting tips that will help you identify whether a network is set up properly for use with the Medisoft program.

Network Hardware

Network hardware must meet certain requirements for use with the Medisoft program. NOTE: WE HIGHLY RECOMMEND GIGABIT SPEED NETWORKING, and Under NO CIRCUMSTANCES DO WE SUPPORT WIRELESS NETWORKS AS PACKETS CAN DROP.

Cables: All network cables must be CAT5 or better.

Network Interface Cards (NIC): All NICs must have the capability of data transfers at a rate of 100 Mbps or higher.

Hubs, Routers, and Switches: Whether you use a Hub, Router, or Switch will depend on your individual situation. Whichever device you choose must also have the capability of data transfers at a rate of 100 Mbps or higher.

Most wireless networks do not have data transfer rates of 100 Mbps or higher. Because of this, it is not recommended that you attempt to install and run the Medisoft program on a wireless network.

Network Components

Network components are items that must be configured within the network setup portion of your operating system. The following components are required on BOTH the server machine and any client machines.

Client for Microsoft Networks

File and Printer Sharing for Microsoft Networks

Internet Protocol (TCP/IP)

It is possible or likely that an office will have other network components installed. Generally, these additional components will not cause problems with the functionality of the Medisoft program. However, there are certain items that could possibly cause a problem.

The most common conflict comes with the installation of a Protocol other than TCP/IP. Usually, the protocol that will be installed is NetBEUI. NetBEUI is a protocol that requires very little setup or configuration. For this reason, people with less experience in setting up networks will set one up using NetBEUI as the protocol. Unfortunately, the Advantage Database Server does not support NetBEUI functionality. If you see both NetBEUI and TCP/IP installed in the network components, the system is probably running on NetBEUI, and therefore the Medisoft program will not be able to connect to the Advantage Database Server.

 

Tips and Tricks:
If the network is running on the NetBEUI protocol instead of TCP/IP, Medisoft will usually return the error 6420.
If you see both TCP/IP and NetBEUI installed on the same system, it often indicates that the person setting up the network was not able to successfully configure the TCP/IP protocol, and installed NetBEUI as a quick way to get network functionality. If removing NetBEUI causes the network to stop functioning, you know that TCP/IP is not set up properly.
Medisoft will not install onto Novell Networks.

Server Name

All computers on a network are given a name that will be used to identify that computer on the Network. The Medisoft Program uses this network name to connect to the data over the network. You can find the name of your server by right-clicking the My Computer icon and clicking Properties. If you click the tab labeled Computer Name, you will be able to identify the name of this computer on the network. It is imperative that you note the computer name, as it will be required in order to set up your Medisoft program.

 

Copyright 2012 www.medicalbillingsoftware.com

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Referring Provider Entry

To access this screen, click on LISTS: Referring Providers.  This window contains important information about the referring providers associated with your practice.  Each referring provider needs to have his or her own record set up in the database.

Referring Provider Entry – Address Tab

Code: The referring provider code can contain up to five alphanumeric characters and identifies the referring provider in the program.

Inactive: To mark this Referring Provider as inactive, check this box.

Last Name, First Name, Middle Initial: Enter the provider’s demographic information.  A referring provider can be a doctor, nurse, technician, or physician’s aide who deals with patients.  Enter the referring provider’s name in the name fields and his or her address and phone numbers in the correct fields.

Credentials: Credentials gives you seven spaces to enter characters indicating the referring provider’s credentials, such as MD, Ph.D., RN, DO, DC, etc., or whatever applies.

Street, City, State, Zip Code: Enter the provider’s demographic information.

NOTE: When entering an address, the focus of the program moves to the Zip Code field after the Street field.  Enter the zip code.  If that code has already been entered in the program database, the city and state information is automatically entered in their respective fields.  If the zip code is not found in the database, the focus of the program returns to the City and State fields for your input.  This information is then saved to the database and available the next time the zip code is entered. For more information on this feature.

After entering a Zip Code and auto populating the City and State fields, if you then go back to the Zip Code field and change the value entered without first saving it, the system will not change the City and State value previously entered, producing an inaccurate record. Use care when changing an auto populated City and State field without first saving the initial entry.

E-Mail/Phone Numbers: Enter the referring provider’s E-Mail and other Phone Numbers in the spaces provided.

Medicare Participating: This check box should be clicked if the referring provider is committed to working with Medicare.

License Number: Enter the referring provider’s license number.

Specialty: If you are sending electronic claims, select the referring provider’s special field of practice.  If you need to use a specialty code that is different than the usual code, select “Not Listed” and enter your specialty code in the data entry box that appears next to the Specialty field.

NOTE: This field is not used for sending paper claims unless you have modified your claim form to include this information.

Entity Type: The Entity Type field is to identify whether the entity is a Person or a Non-person.  This is for sending electronic claims.

Referring Provider Entry – Default PINs Tab

SSN/Federal Tax ID: Enter the referring provider’s Social Security or Federal Tax ID Number.  This number prints in Box 25 of the insurance claim form.  Choose the radio button to indicate whether the number entered is the Social Security Number or the Federal Tax ID.  If you select Federal Tax ID, an X prints in the EIN box of Box 25 on the insurance claim form.  If you select Social Security Number, an X prints in the SSN box of Box 25 on the insurance claim form.

PIN Fields: In the PIN (Personal Identification Numbers) fields, enter all applicable PINs assigned by each of the major insurance types, e.g., Medicare, Medicaid, Tricare, Blue Cross/Blue Shield, Commercial, PPO, and HMO carriers.

UPIN: If the referring provider is part of a group practice which has been assigned a group number by Medicare, that number is entered in the UPIN field.  The UPIN is necessary for designating a referring provider on the insurance claim form.

EDI ID: This field may be required when sending electronic claims.

National Identifier: Enter the provider’s National Provider ID.  This 10-digit number is a standardized identifier that provides each provider with a unique identifier to be used in transactions with all health plans.

CPO Number: This field is for electronic claims. Enter the provider’s care plan oversight number.

Extra 1/Extra 2: These fields may be required when sending electronic claims.

Referring Provider Entry – PINs Tab

Depending on the type of claims you file, you could have separate PINs from each insurance for this referring provider.  This tab provides a PIN matrix where you can store these additional PINs.

PIN

Depending on the type of claims you file, you could have separate PINs from each insurance for this referring physician.  Enter the appropriate PIN for the insurance company.

Qualifier

If you send electronic claims, you may also be required to enter qualifiers for the PINs.  These qualifier codes indicate the type of PIN being sent.  Refer to the implementation guide for your insurance carrier if you are not sure which qualifier to use.  This is not provided by Medisoft but by your carrier.

NOTE: If you converted data from Medisoft 10 or previous, the qualifiers may have been converted as well.  Verify that the qualifiers are correct for each PIN and/or Group ID.

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Practice Information Setup;
Go to the File menu and select Practice Information to open the Practice Information window.

The window has two tabs and each is divided into three sections.

Practice Tab
Unless noted below, enter the information as requested.  Note that special characters cannot be used in these fields (such as a slash).

Zip Code: When entering an address, the tab stop moves to the Zip Code field after the Street field.  If you enter a zip code that has already been entered, the city and state information automatically populates.  If the zip code has not been entered, enter the city and state in their respective fields.  This information is then saved to the database and available the next time the zip code is entered. For more information on this feature, see Program Options – Data Entry Tab.

After entering a Zip Code and auto populating the City and State fields, if you then go back to the Zip Code field and change the value entered without first saving it, the system will not change the City and State value previously entered, producing an inaccurate record. Use care when changing an auto populated City and State field without first saving the initial entry.

Type: Click the down arrow to select your practice type: Medical, Chiropractic, and Anesthesia.  When you choose Chiropractic or Anesthesia, other areas in the program change accordingly. Medical is the default practice type and does not add any additional fields.

Chiropractic

When you select Chiropractic, the Level of Subluxation field appears in the Diagnosis tab of the Case window for entering the level of subluxation. See Case (Diagnosis) .

In addition, five treatment fields are displayed in the Miscellaneous tab of the Case window electronic claims: Treatment Months/Years, No. Treatments-Month, Nature of Condition, Date of Manifestation, and Complication Ind.. See Case (Miscellaneous) .

Anesthesia Selecting Anesthesia causes the field Minutes to be added next to the Units field in the Transaction Entry window.

Extra 1 and Extra 2: These are option fields that may be used if a carrier requires extra data on a claim.  They can hold up to 30 characters.

Entity Type: The Entity Type field is used to identify whether the entity is a Person or a Non-person.  Choose Person or Non-Person depending on whether the practice name consists of a practice name or an individual’s name.  For example, if the practice name is Best Western Clinic, you would choose Non-Person.  However, if the practice name is Dr. I. M. Best, you would choose Person.

Billing Service Tab
This tab is nearly identical to the Practice tab.  It is provided for those occasions when both practice and billing service information is needed.  Fields in the Billing Service tab are used for sending electronic claims in the ANSI format.  This tab also makes billing service information available in reports (designed through the Report Designer).

Multiple Practices
You can set up more than one practice in Medisoft, each with its own Practice Information window.  With separate practices, you have separate data files, i.e., patient information, procedure codes, diagnosis codes, insurance companies, providers, etc.  The bottom line is that you can have one set of the Medisoft program files from which you can access different sets of data files.

When you enter Medisoft Insurance Billing Software, the program selects the same database that was last in use when the program was shut down.

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