Essentials to Staffing a Medical Practice

As a physician setting up a new practice, there are many things to consider before seeing a patient. This includes but certainly not limited to office space, medical equipment and insurance. One of the most important things a doctor must select is the right office staff. This can literally make or break your practice and its reputation.

Well-qualified and friendly employees can enhance the patient experience making them feel welcomed and more apt to refer your services. Staff that is short with patients and not willing to hear their concerns will certainly drive patients away.

The four staff members a physician must have on his team include: an office manager, medical assistant, billing specialist, and a receptionist. Depending on the practice, some doctors may have a need for more than one person for each position. This does not include office manager. There should only be one manager per practice. Typically, an office can run smoothly with these four positions filled.

Office Manager – An office manager is essentially the eyes, ears, and voice of a practice. They oversee the office staff and attend to any situation that may arise. Managers tend to the business aspect of the office so doctors can concentrate on providing the best patient care possible. Many office managers have a nursing background so they are well-versed on both the clinical and business side.

Office managers also assist with billing questions, phone duties, and customer service. A manager is also the go-to person for staff members on such issues such as payroll, sick leave, vacation, and personnel issues.

Medical Assistant – These clinical professionals perform routine medical duties under the direct supervision of a physician. This includes taking, vitals, height and weight, as well as instructing patients about medications and special diets. They also prepare and administer medications, and authorize drug refills as directed. Medical assistants perform many administrative duties like answering telephones, greet patients, update and file patient medical records and forms.

Billing Specialist – This is a vital position in every medical practice. Billing specialists tend to have a background in medical coding and billing. However, many have also received on the job training. Day-to-day responsibilities include submitting claims to insurance companies, and working with insurance companies to get claims processed and paid. They also review denied claims, verify patient insurance coverage, and answer patient billing questions.

Receptionist – A warm, friendly and knowledgeable person usually fills this role. After all, this is most often the first person a patient encounters when contacting a practice. Receptionists are responsible for answering phone calls, checking patients in and out of the office, and initiating the billing process by giving patients the proper forms to fill. They must also have an understanding of how the office flows and have the ability to direct patients where they need to go during their visit.

As you can see, all of these positions tend to wear many hats. It is important to have dynamic individuals fill these positions. It is also important for the physician and office manager to set the tone for quality. Employees that are friendly, willing to be cross-trained and know their positions well, will help create a stable and thriving practice.

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Medical insurance billing software and EHR software has been in the limelight the past few years. It started with the proposal by President Obama’s stimulus plan to foot the bill for doctor’s offices to use EMR (electronic medical records) software. This software would include insurance billing software.

The long awaited software program had been the subject of much controversy.  But one this for certain, some aspects can be a timesaver.  This is innovative software developed for healthcare professionals as well as billing services employed by the medical profession.Using electronic claims for billing allows the least amount of mistakes, saves valuable office time if you use electronic statements and the rapid verification of eligibility for certain procedures. The time of approval is cut to a minimum and the documentation of the verification is on your computer.

Accounting becomes a snap when using medical insurance billing software. The software keeps track of what has been paid and what is still owed. The patient ledger will show you which patient’s insurance company has made a payment, how it was made and if there are adjustments needed to the account.

If you need a certain patient’s file on the screen, it is there. The time it took to hunt through file cabinets and fill out new patient billing information to add to a folder that was already too thick took up precious time. Now the information can be put into the computer, entered and it is at your fingertips when you need to find something.

When it comes to multi-tasking, medical insurance billing software will allow you to do several jobs at the same time. When you have entered the information in the billing section and prompted it to start, you can go on and do other tasks while this is in the process.

Making Office Time a Little Shorter With Medisoft Version 20

Everyone knows the majority of time you spend in an office is doing paperwork. If you could eliminate a major portion of this paperwork the time can be spent with patients. This includes time you spend on the telephone with insurance companies. Tracking down payments and charges by using medical insurance billing software will allow you more free time to get to the really important things.  With Version 20 of Medisoft, you can reduce the paper handling and shuffling by letting your patients fill in their demographic information on a tablet computer, then when they finish, your front office staff can verify the info, and with a click of a button, transfer that information to Medisoft, saving your staff the time consuming task of typing the  information into the Medisoft program themselves.  Not only that, the forms that patients sign off on , like HIPAA and other forms can be included on the tablet for approval from the patient, saving them time signing, and allows you to store the information digitally in Medisoft.Download a copy of Medisoft Medical Billing by clicking on this link.

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As far as medical practices go, the days of huge stacks of unwieldy paperwork and enormous amounts of claim forms is rapidly decreasing, thanks in large part to advances in modern technology. In the past, one of the most time consuming parts of running a medical office was processing all of the paperwork. As it was largely done by hand, errors were frequent. Thanks to medical practice management software, though, many of these irritating issues are becoming a thing of the past, and more offices than ever before are experiencing increased productivity and efficiency – as well as dramatically reduced costs.

Handling patients’ claims is a very integral part of any medical practice. Whether the patient uses a private insurance company or something like Medicaid or Medicare, making sure that the proper entity is billed the precise amount is very important. Equally important, of course, is that the patient is held responsible for the right amount and is billed accordingly. All too often, major errors in paperwork result in long, drawn out exchanges between a doctor’s office and a patient, wasting a great deal of time and causing a lot of frustration on both parts.

Medical practice management software solutions integrate many aspects of claims handling and patients’ records with the efficiency of an electronic medium. Rather than wasting a lot of money on stamps and postage – and having the long waits associated with “snail mail” – doctor’s offices can now file claims electronically. Most major insurance carriers accept this method of transmission, easing the incredible burden on the often limited staffs of private practices in the medical field.

By using medical practice management software, you can reduce the number of employees that you need to keep on hand. Or, you can lighten the load on the entire staff and free them up to accomplish more things during the course of a day. Records and claims will be far more efficiently organized by using this type of software. The hassle of keeping a slew of paperwork in order will greatly diminish as well – something that is sure to be welcomed by the office staff of any medical practice.

Many offices fear that training their staff to use this type of software might be difficult or too confusing. However, software has come a very long way and is generally surprisingly intuitive. Even people who profess to be rather unskilled with computers usually have no trouble at all in understanding how this software works. The training is quite simple, and your staff should be able to get on track with things in no time at all.

Patients also benefit when an office begins using medical practice management software. After all, their claims are usually processed and handled far more quickly, reducing the amount of time they have to sit and wonder about what is going on. Different aspects of their care and their diagnoses can be streamlined with this software, making it easier for them to understand how their individual case is being handled much more clearly.

There are so many great reasons for putting this type of software to use, it is little wonder that so many offices around the world have begun already. Faster processing times, better organization and increased staff efficiency are just a few of the excellent benefits to using these types of programs. In no time at all, your medical practice will begin reaping the benefits of switching to this type of software; it pays for itself quickly and can become a valued part of running your operation.

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Collections

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

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

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

Collection List Navigation

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

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

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

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

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

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

Tips and Tricks:

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

 

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

 

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


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


Tips and Tricks:

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

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


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


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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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Policy 1

The Policy 1 tab is where you enter the patient’s primary insurance information. Many of the fields included on this screen are similar to those included on the Policy 2 and 3 screens, with the difference being that they would apply to the secondary or tertiary insurance carriers if they were entered on those other screens.

Insurance 1: This field will be where you specify the Insurance Code for the primary carrier you wish to add to this case.

Policy Holder 1: Many people confuse the Policy Holder field with the Guarantor field. The Policy Holder field should contain the chart number of the patient or guarantor that holds the insurance policy.

Depending on circumstances, this may be a different person than the Guarantor that was specified on the Personal tab.

Relationship to Insured: The Relationship to Insured field corresponds directly to the Policy Holder 1 field. You will need to specify how the patient is related to the person listed as the Policy Holder 1.

Tips and Tricks:
The Policy Holder field for Medicare patients should always be the same as the patient Chart Number. Additionally, the Relationship to Insured field should always be set to self. Medicare does not offer family plans. Failure to accurately enter these fields for Medicare claims will result in claim rejections.

 

Policy/Group Number: You will find the patient’s policy and/or group number listed on their insurance card.

Policy Dates: These dates designate the policy effective dates. If these are applicable, they will also be listed on the patient’s insurance card.

Claim Number: Claim Number refers not to a standard Healthcare claim, rather a claim number that refers to a different type of insurance claim, such as an auto insurance claim, that is responsible for paying for the medical services being rendered. This field holds the claim number for that insurance claim.

Assignment of Benefits/Accept Assignment: This field determines who is going to receive payment for charges entered into this case. If you place a check mark in this field, that means the provider accepts assignment of the patient benefits, and the insurance carrier will send the payment directly to the provider. If you do not place a check mark in this field, the check will be sent to the Patient. The doctor’s office will be responsible for billing to and collecting from the patient in this situation. See Accept Assignment Handout.

Capitated Plan: Capitated plans pay a doctor or group of doctors a pre-negotiated amount of money per month to see a group of patients under a particular insurance carrier. These payments are not based on how many procedures are performed. The same payment will be made if no patients under that plan make a visit during the month. If this patient is part of a capitated plan, place a check mark in this box. See Capitated Plan Handout.

Deductible Met: This field is used to indicate whether the patient has met his or her annual deductible. When the deductible is met, click this box. The amount of the deductible paid is displayed in the Transaction Entry window. When the full amount has been paid, the program reflects the amount entered in the Annual Deductible field in this window in the YTD field in Transaction Entry. In other words, if the patient has a $250 deductible and the Deductible Met check box is checked, then the YTD field also reflects $250. This field is reset annually.


Annual Deductible: The Annual Deductible field is a reference field that will be displayed within Transaction Entry. If you know the amount of your patient’s annual deductible, enter it here.

Copayment Amount: Copayment Amount allows you to enter in the amount of the copay that this patient has for each visit. This field will display within transaction entry as the Policy Copay. This field is a reference field only. It will not automatically enter a copay for you. You will not be able to bill a patient for a missed copay until after the insurance carrier has paid. You will not be able to enter the copay reference as a percentage. It is strictly a dollar amount copay.

Insurance Coverage By Service Classification: The main function of Service Classifications is to provide a more accurate division of the patient and insurance portions when transactions are totaled. It is based on the premise that all similar procedures are reimbursed at the same percentage rate by the majority of carriers.

Because a carrier doesn’t normally pay the same percentage for every type of procedure, it is essential that procedures be divided into service classifications in order to assign the proper percentage to each class. These are set up at the time the procedure codes are created and, although they can be changed, they cannot be deleted.

A common example of the variation is the difference in percentages paid for office visits and those paid for lab work. Normally, office visits are paid at 80%, while lab work is covered at 100%. To handle this difference, when the procedure codes are created, office visits are put in service Class A (paid at 80%) and lab work is put in Class B (paid at 100%). In the Case (Policy 1, 2, and 3) windows, in the Service Classification fields, A shows 80% and B shows 100%. These classifications are used in calculating allowed amounts (Apply Payment/Adjustments to Charges window).

In the Insurance Coverage Percents by Service Classification fields, indicate the percentage amount of coverage indicated in the applicable insurance policy. There are eight fields to enter Service Classifications. You assign the fields. Field A is generally used for common procedures, and Field B could be for surgery or lab charges. Field C could be those services that are not covered by most insurance policies, etc.

The Service Classification fields in this window are completely separate from the 26 Charge Amount fields (A – Z) provided for in the Procedure/Payment/Adjustment edit window, Account tab.   The values for the Service Classification fields can be anything between 0% and 100%. Place a zero default for procedures not covered by the insurance carrier. Any of these figures can be changed by typing over the number, and the dollar amount charged can be overwritten in Transaction Entry.

Policy 2

Crossover Claim: The Crossover Claim field is the only field that is different in functionality from the Policy 1 tab. This field designates transactions entered under this case as crossover transactions. This means that the Primary insurance carrier will be forwarding the claim to the Secondary carrier. If this is the case, you will not want to print or send a secondary claim manually, as it would be a duplicate claim. If this box is checked, secondary information will be included on Medicare claims (for Medigap crossovers). Additionally, you will not be able to print or send the secondary claim for these transactions.

Policy 3

There are no fields on this tab with different functionality than the fields listed for Policy 1 or Policy 2.

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Medisoft Case Setup Overview and Definitions

Medisoft utilizes an accounting system known as Case Based Accounting. Case Based accounting groups transactions together based upon the case they are entered into. Different offices have different methods of using cases. Cases include large portions of the information that will appear on a claim. Within the case, you will assign Insurance Carrier and Guarantor values to transactions. These values will be used to determine how and where claims and statements are sent.

Definition of a Case: A case is a unique condition or situation for which a patient seeks treatment or services. There can be multiple visits for service related to a single case and all services related to that malady or condition are contained in the same case.

There is not one “right” way to create new cases but we will give you a few general guidelines for when to create a new case.

In general, you may need or want to create a new case whenever:

1. The number of transactions entered into that case reaches 650. The transaction limitation includes charges, payments, adjustments, and comments as well as any sub-set of these transaction types.

2. The insurance carrier information for that patient changes. You do not want to simply change the insurance carrier information within the existing case, in order to maintain your record of the patient’s insurance history. The transactions entered into that case under the original insurance carrier should not be associated with a case containing a different insurance carrier.

3. Employer information changes. Within the patient setup, you can set up a default employer for use whenever a new case is created. If a patient changes their employer, generally that change will also include a change in benefits, which will change the insurance carrier associated with them. These changes need to be reflected in a new case.

4. Time period changes. Many offices create a new case for a specific time period. You may want to create a new case for each quarter or for each year. This allows you to group transactions together based on when they occurred. The only limitation you will need to note with this is that payments must be entered into the same case as the charge to which the payment will be applied.

5. Visit based cases. Some offices choose to create a new case for each visit a patient makes to the office. This allows you the most detail in grouping transactions together. However, this option is not necessary if the office uses the Document Number or Serialized Superbill features properly.

6. Variations in the billing process for the same patient. If there are different guarantors for different charges for the same patient, you will need to set up a different case for each guarantor. Similarly, if there are charges that you never wish to bill on a patient statement, those transactions will need to be entered into a separate case.

7. Specialty field changes. There are many specialty fields included within the case screen. Whenever any of these fields change, you will want to create a new case. For example, if the patient was a student, and the student status changes, you will want to create a new case for transactions entered since the student status changed.

8. Global Coverage is used. If a Global Surgical Procedure is entered into Transaction Entry for a case, an automatic calculation is done to determine the end date for that Global Surgery. If more than one Global Surgical Procedure is used for the same case, the Global Coverage Until date will change to the latest date.

There are many other reasons to create new cases. You will need to figure out what works best for your office.

Tips and Tricks:
When browsing through the case screen, you may find that you have fields that are “hidden” without the scroll bar that allows you to access the fields. If documentation such as the Knowledge Base, Help Files, or Training Documentation refers to a field that you cannot see, you may have to expand the size of the case screen in order to make the field visible.

 

You will be able to see some of the Patient demographic information at the bottom of the case window. You will also be able to check the eligibility and print a Face Sheet using the buttons available along the right side of the screen.

If you want to switch your case screen to a different case for that same patient, you can do so using the case field in the lower right corner of the screen.

You may find that the Tab labels are missing from your case screen.

This is due to your display settings being set to use large fonts (large size DPI). In order to correct the issue, you must set your font setting (DPI setting) to Normal.

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Payments

Payments are used to lower the practice’s Accounts Receivable amount, while registering a positive cash flow into the office. Like charges, there are different types of payments that will be used for different reasons.

Insurance Payment

Insurance Payments are used to register any payments coming from insurance carriers.


Code: The Code 1 field is slightly different for Payments than it is for charges. There are no standard codes that must be entered for payments. You can create codes that are easy for you to remember, or easy for you to enter. There is also no need to enter or utilize Alternate Codes.

Prepayment: This box will allow you to enter this payment code without applying it. This is necessary, because payments are usually applied to specific charges. If the payment is a prepayment, the applicable charges have not been incurred.

Tips and Tricks:
In order to function properly, you will only need one insurance payment code. Some offices, however, like to report on payments coming in from individual insurance carriers. One easy way to do this is by creating different payment codes for each insurance carrier. For example, the code MP could be used for Medicare payments.

Cash Copayment

Cash Copayments include all the same fields as Insurance Payments. All fields have the same functionality as well. This code is used to enter co-payments that have been made using cash. Copayments will only be made by patients, guarantors, or any party that is not the insurance carrier. For this reason, when entering a Cash Copayment code into Transaction Entry, the Who Paid field should always be the Guarantor.

Check Copayment

Check Copayments have the same functionality as Cash Copayments, but are designed to be used when entering copayments made by check.

Credit Card Copayment

Credit Card Copayments have the same functionality as Cash and Check Copayments, but are designed to be used when entering copayments made with a credit card.

Tips and Tricks:
It is not critical that you set up codes for all three types of copayments. The billing process will function properly if you simply use the same code for each copayment.
However, you will not be able to get the same level of reporting on your copayments. Additionally, you will not have the ability to print accurate bank deposit slips if you do not utilize the different copayment types. Medisoft v12 introduced the ability to track missed copays. This will be discussed in more detail in the Payment Application section.

Cash Payment

Cash payments include all the same fields as the other payment types. This code is used to enter payments that are NOT copayments, that are made using cash. This type of payment code is usually used after the insurance carrier has paid, and the patient still owes money. It is also used for cash patients who have no insurance carriers, and therefore have no copayments due (because they will be responsible for paying all charges in full.)

Check Payment

Check Payment codes contain the same functionality as Cash Payments, but are used to enter subsequent payments made by check.

Credit Card Payment

Credit Card Payment codes are used to enter subsequent payments made by Credit Card. The functionality, as expected, is the same as that for all other payments.

 

Tips and Tricks:
Similar to the Copayment codes, it is not necessary that you create codes for each of the three types of payments. The most important thing for you to do is to make sure that these payment codes are only used for patient payments, and not for insurance payments.
If you wish to be able to report on the different types of patient payments coming in, you will want to create codes for each of these three types of patient payments. This will also allow you to print accurate bank deposit slips.

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