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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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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Procedure/Payment/Adjustment Setup

When talking about Procedures, Payments, and Adjustments, we are talking about items that are going to affect your Accounts Receivable in some manner. This chapter will discuss the different types of transactions, the effects they will have on your accounts receivable, and how to accurately set up the different types of codes.

To access the Procedure/Payment/Adjustment list, click the Lists menu and Procedure/Payment/Adjustment Codes.


To create a new code, click the New button.

We will now discuss the different types of codes you will set up, and how each is done.

Charges

Charges are codes that will increase the accounts receivable, AND will be billed to either the patient or the insurance carrier or both. Codes that are billed to insurance carrier are also known as CPT codes (Current Procedural Terminology).

The most critical field when setting up any entry into this screen is going to be the Type field. The fields available to you on this screen will vary based on the different types selected. We will now discuss each charge type available, and when you would use each type.

Procedure Charge

Procedure charges are the most commonly used codes used in the Medisoft program. Procedure charges are used to charge patients for services rendered in the office.

General Tab


Code 1: The Code 1 field is unlike the other code fields within Medisoft in that it does not automatically populate for you. This is generally the code that will be submitted to the insurance company on either a paper or electronic claim. Unless the service is one you will never be submitting to an insurance carrier, you need to make sure that the code you are entering is a valid code. Valid codes are available through the Codes on Disk and Encoder Pro programs. There are also books that contain listings of all valid codes.

Alternate Codes 2 and 3: These are the alternate codes that are available to be sent on claims to certain insurance carriers, as discussed in the Insurance Carrier setup.

Tips and Tricks:
If an insurance carrier has a 1 in the field Procedure Code Set, claims sent to that carrier for this procedure code will transmit or print the code entered into Code 1. If a 2 or 3 is entered into the Procedure Code Set field, claims sent to that carrier will transmit or print the code entered into Alternate Code 2 or 3.
If you receive reports of procedure codes not printing or incorrect codes printing, this is the first place you should look.

 

Description: There are official descriptions available through the Codes on Disk and Encoder Pro Products, as well as the books. Codes that will be sent to insurance carriers should utilize these descriptions, even though the description is not generally sent on electronic claims or printed on paper claims. The description does, however, print and send on Patient Statements. For this reason, it is important to enter accurate and good descriptions of the codes, in order to prevent some patients from calling about their statements.

Account Code: Enter the Account Code from your office’s accounting program (such as Quicken or Quick Books) for recording charges and/or payments. This code is used for grouping procedures in the Practice Analysis report.

Type of Service: This type of service code will set the value that will default into the TOS field in transaction entry when this procedure code is entered. There are standard type of service codes that are available in the Knowledge Base and Medisoft Help Files.

Place of Service: The place of service code in the procedure code setup will set the value that will default into the POS field in transaction entry. Similar to the Type of Service codes, there are standard Place of Service codes that are also available in the Knowledge Base and Medisoft Help Files.

Tips and Tricks:
The Type of Service and Place of Service fields within the procedure code setup screen are only fields that will set default values for transactions entered into Transaction Entry using these codes. If you receive a rejected claim for either of these two fields, correcting it in the procedure code setup will not correct the rejection. You must correct the values that are entered into Transaction Entry.

 

Time To Do Procedure: In the Time To Do Procedure field, enter the average time, in minutes, required to perform this procedure, if applicable. This is usually determined by the provider. This information is displayed when creating an appointment for this procedure, to help determine the appointment length required.

Service Classification: The Service Classification field is where you designate under which service classification this code belongs. The Medisoft Basic program offers only one option (A), whereas Medisoft Advanced and Medisoft Network Professional offer eight options (A-H). The classifications are established in the Case window, Policy tab, Insurance Coverage Percents by Service Classification field.

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%.

 

Tips and Tricks:
Service Classification is also used when automatically calculating the allowed amounts. This will be discussed in the Payment Application chapter.

 

Don’t Bill To Insurance: This field allows you to exclude transactions entered using this procedure code from claims being sent to a particular insurance carrier. If you wish to utilize this feature, enter the insurance code of the insurance carrier you wish to exclude for.

This feature is also based on pre-HIPAA standards, when different insurance carriers used different codes for the same procedure. If you enter anything into this field, you will likely exclude this procedure code from claims. This can result in lower compensation amounts. For this reason, we do not recommend using this feature.

Only Bill To Insurance: Similar to the Don’t Bill To Insurance Field, this field allows you to specify one insurance carrier which will be the only carrier to receive claims with this procedure code on them. Enter the insurance code of the insurance carrier into this field.

Again, this feature is based on pre-HIPAA standards. For the same reasons, we do not recommend using this feature.

Default Modifiers: Certain procedure codes have modifiers that can change the meaning of the code, and therefore the amount of compensation that will come back from the insurance carriers. Lists of these modifiers are available in Encoder Pro as well as in the CPT Code Books.

Tips and Tricks:
Similar to the Type of Service and Place of Service fields, the Default Modifiers simply set which modifiers will be entered by default when this procedure code is entered into Transaction Entry. If you receive a rejection on a claim for a missing or invalid modifier, you will need to correct it in Transaction Entry in order to correct the rejection. Changing this field will not affect any claims.

 

Revenue Code: This field is only for use with a UB form. UB forms have a field labeled Revenue Code. This is where you should enter the value you wish to print in this field.

Default Units: If no value is entered into this field, each procedure code will default to 1 unit. If you want this procedure code to default to a larger number of units, enter the number you would like to set as default here.

Most procedure codes should default to 1 unit.

If you receive a rejected claim for a missing or invalid number of units, this is not the field you should modify. You will need to change the number of units in Transaction Entry.

National Drug Code: The National Drug Code (NDC) is used for billing prescribed drugs on electronic claims.

NDC Unit Price: The unit price of the drug is applicable when billing prescribed drugs on electronic claims.

NDC Unit of Measurement: The unit of measurement of the drug is applicable when billing prescribed drugs on electronic claims.

Code ID Qualifier: The Code ID Qualifier tells the insurance carrier what type of code is being sent for electronic claims. This should typically be left blank.

Taxable: If the service you are performing is taxable, check this box in order to charge tax when this procedure code is entered.

Tips and Tricks:
In most states, it is illegal to charge taxes on medical services. This field is used more often for items that are sold through the office such as crutches or vitamins.

 

HIPAA Approved: The HIPAA tab of the program options screen contains an option labeled Warn on Unapproved Codes. If that option is turned on and you enter a procedure code that does not have the HIPAA Approved box checked into Transaction Entry, you will receive a warning stating the following:

If you click Yes, the code will be saved. If you click no, you will be returned to the Transaction Entry screen and you can make any necessary changes.

Tips and Tricks:
Simply marking a code as HIPAA Approved does not necessarily mean it is truly a HIPAA Approved code. You will still get rejected claims if you submit codes that are not officially HIPAA Approved.

 

Require Co-pay: Beginning with Medisoft v12, you are able to track missed co-pays. When a procedure code is entered into Transaction Entry where Require Co-pay is marked and a co-pay amount is entered into the patient’s case, Medisoft expects a co-pay payment to be applied to that procedure code. If co-pay payment has not been applied to the procedure code, then the patient will appear on the Outstanding Co-Payment Report with the amount due.

Patient Only Responsible: If you check this box, this procedure code will never appear on any insurance claims. It will also cause the charge to increase the patient’s remainder balance as soon as it is entered.

Purchased Service: The Purchased Service box, when checked, indicates that the procedure code is used only in connection with a service that the practice purchases; usually from a lab.

Amounts Tab

Charge Amounts A-Z: Medisoft Basic only contains the first Charge Amounts field (A). In Medisoft Advanced and Medisoft Network Professional, you will have access to A-Z. Here you have the ability to set up different amounts that will be defaulted into Transaction Entry. This allows you the ability to charge different amounts for the same procedure code based on the value entered into the Price Code field in the Patient’s case. One example of a situation where you may want to bill a different amount would be for cash patients.

These fields will simply default the amount that will be entered into Transaction Entry whenever this procedure code is entered. You will still have the ability to change that amount when entering the charge.

 

 

 

Tips and Tricks:
An alternative to charging different amounts for different types of patients is to use write-offs. This will allow you to document the exact reason someone was charged less than someone else. This will protect you if you are ever audited.

 

Cost of Service/Product: Enter the amount that it costs you to perform the procedure into this field. This will allow Medisoft to report on the profitability of different procedure codes, if desired.

Medicare Allowed Amount: This is a reference field only that will let you know what Medicare’s allowed amount for this procedure in your area is. This is not to be confused with the Allowed Amounts fields in the Allowed Amounts tab. This field will not affect payment application.

Allowed Amounts Tab

This tab will allow you to see the allowed amounts for this procedure code and every insurance carrier in your insurance carrier list. You can also change the allowed amounts here in the procedure code as well as in the insurance carrier list. If the Update Allowed Amount is checked in Program Options under the Payment Application tab, this will let the allowed amounts entered from within Transaction Entry or the Deposit List to update these lists every time. We will cover allowed amounts more extensively in the Payment Application chapter.

Add on Products

Medisoft offers two add-on products that can assist you in quickly and accurately enter in your Procedure Charges.

Codes on Disk: Codes on Disk offers you a quick way to import thousands of codes at one time into your Medisoft Program. This will prevent you from having to manually enter your codes, and helps insure that the proper codes are entered. This is an inexpensive option for someone who wants to simply and quickly avoid a large amount of preliminary data entry. Codes on Disk does not, however, assist you with proper BILLING of the codes entered.

 

Encoder Pro: Encoder Pro is a program designed to replace the CPT Code book. It will allow you to look up any valid procedure code by code or by name. It will list out what the procedure is for, as well as list any modifiers or special conditions that go along with that code. You can also merge individual codes into your procedure code list. You do not have the option to merge all codes or sets of codes into your data.

Encoder Pro is accessed by clicking the Encoder Pro button on your Procedure Code Entry screen.

Product Charge

For product charges and any subsequent charges, we will only discuss the items that are different from Procedure Charges.

Product Charges are generally used to differentiate between products that are sold and services that are rendered by an office. Product Charges will transmit on insurance claims, but unless the product charge is a valid charge from either Encoder Pro, or a CPT Code Book, you will want to check Patient Only Responsible.

You will also want to check your local laws to see if any products you sell are subject to sales tax. If they are, check the Taxable field.

All other fields within this type of code have the same meaning as those within Procedure Charges.

Inside Lab Charge

Inside Lab Charges are meant to separate Lab charges that are performed in your office, from the other types of charges.

All other fields function as previously mentioned.

Tips and Tricks:
If a code is set as an Inside Lab Charge, it will by default not appear on patient statements if they have been entered into a case with Medicare as an insurance carrier. This is determined by looking at the insurance type. If the type is Medicare, Inside Lab Charges will not print on Patient Statements.
If you need these charges to print on patient statements for Medicare patients, you will need to select the Billable to Medicare Patients field.

 

Outside Lab Charge

Outside Lab Charges are meant to separate Lab charges that are performed outside your office, but are billed for by you, from the other types of charges. When billing Outside Lab Charges, it’s often necessary to check the Purchased Service field. Outside Lab Charges do not have the same effect on Medicare Patient Statements as Inside Lab Charges.

All other fields function as previously mentioned.

Global Surgical Procedure

This feature is new in Medisoft v14. Global Surgery includes all necessary services performed by the physician before, during, and after a surgical procedure. When a Global Surgical Procedure is entered into Transaction Entry, all other procedures entered subsequently will default to a zero dollar amount if it falls within the global coverage period. If the procedure code entered is outside of the global coverage period, the standard charge amount will appear. Once the Code Type of Global Surgical Procedure is chosen, the Global Period ___ Days field appears.

Billing Charge

Billing charges are used to create interest charges for overdue accounts. It is also used for charges such as no-show charges. Generally, you cannot bill interest or other Billing Charges to insurance carriers. For this reason, you will want to check the Patient Only Responsible field. This also makes most of the other fields irrelevant.

Tips and Tricks:
One common mistake made when entering data into Medisoft is to assign Procedure Charges to the type Billing Charge. This will cause processing errors with both your paper and electronic claims.

Tax

When the Code Type field is set to Tax, many of the fields will no longer be available to you. The fields that remain the same will have the same functionality as they did in the other code types.

One different field you will see is the Tax Rate field. Here you can specify the sales tax amount in your area. You will also note that the Patient Only Responsible field will default checked. This is because in most states, it is illegal to charge insurance companies for sales tax.

 

 

 

 

 

Tips and Tricks:
You will need to specify the procedure code you wish to use for taxes on taxable transactions within the Program Options on the Data Entry tab.
You will not specify anything in the Amounts tab for taxes, since the amount of the charge will be based on the amount charged to taxable transactions, and the tax rate specified on the General tab.
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Free Download of Medisoft Billing Program:

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

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

Free Medical Practice Management Software Demo Download

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