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• Recent Medical Billing Software Posts
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  • Medisoft Version 21 of Practice Management Software
  • Oct 1, 2016 is the end of ICD-10 Grace Period For Billing Claims
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  Last updated by admin at May 4, 2015.

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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.

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Here’s a good article to get you going…

http://www.physicianspractice.com/icd-10/creating-icd-10-action-plan-possible-effects-and-office-awareness

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Editing a Patient Statement

Once your statements are created, you can view and edit those statements from within Statement Management. To edit a statement, simply double-click the statement you wish to print. The following screen will appear.

The upper portion of the screen will be available regardless of which tab you have selected. This section of the screen will tell you the statement number, who the guarantor is, the remainder balance, and the date the statement was created.

General

On the general tab, you will see general information regarding this statement.

Status:  The Status field tells you where in the billing process this statement is.  When a statement is first created, it has a status of Ready to Send.  When a statement is first billed the status is changed to Sent.  Once the balance of all transactions on the statement reaches 0, the status is changed to Done.  The other status fields are used for your own purposes.  If you wish to use these other codes, you must manually set the statements to these status codes.

Billing Method:  The Billing Method field lets you specify whether you want to print out a paper statement or whether you want to send the statement electronically.

Type:  The Type field specifies whether the statement is a standard or remainder statement.  As you can see, this field is not one you can modify.  If you need to change this for any reason, you MUST delete the statement and recreate it.

Initial Billing Date:  This field specifies the first date the transactions attached to this statement were actually billed on a statement.

Batch:  The batch number is updated the first time a statement is printed or sent.  All statements billed at the same time will be assigned the same batch number.

Submission Count:  The Submission Count field tracks how many times the transactions attached to this statement have been billed to the guarantor

Billing Date:  The Billing Date field will tell you the last time these transactions were billed 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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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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Comment

The comment tab will allow you to enter various comments regarding this statement. These comments will not be included on any printed or sent statements. They are for internal use only.

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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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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.
   

   
   

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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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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Medisoft Version 19 System Requirements

Note; the requirements have not been officially released, so we are including the current requirements and will change when officially released..

MEDISOFT V18  Technical Requirements

Medisoft V18 is a 32-Bit application.  On a supported 64-Bit platform, the application will run in a 32-Bit mode.

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