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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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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Deductible Entry

Many patient health plans include deductibles. Deductibles are amounts that must be paid by the patient before the insurance carrier will begin to make payments for medical care. Generally deductibles are calculated annually. The annual deductible amount is entered into the patient’s Case screen on the Policy 1 tab.

In addition to showing the Annual Deductible, Medisoft has the ability to track the portion of the deductible that has been paid in that particular office. Medisoft and other POMIS systems cannot track the total amount paid towards the deductible because some care could be performed in other offices such as insurance carriers and specialists. The amounts paid by the patient in these offices would be applied to the deductible as well, yet we would have no record of these payments. For this reason, the insurance carrier and the EOB should be the only indicator used by the office to determine whether or not the deductible has been met.

This does not mean that the deductibles should not be tracked in the office. Medisoft offers a procedure code type for deductible entries. These codes should be used to identify which charges were applied to the deductible. This type of code will not increase or decrease the balance for any outstanding charges; it will simply allow the program to bill the patient/guarantor for charges that were applied to the deductible.

Medisoft Basic users must enter these deductible codes through Transaction Entry. Medisoft Advanced and Network Professional users can enter these codes through the deposit list.

To enter a deductible code through Transaction Entry, take the following steps:

  1. Open Transaction Entry to the chart, case, and document or superbill number that contains the transaction(s) applied to the deductible.

    In the Payments, Adjustments, and Comments portion of Transaction Entry, enter a procedure code that has been previously set up as a deductible type code. (See MED103: Getting Started)

    In the Who Paid field, select the primary insurance carrier.

    You will notice that you are not able to enter any amount into the Amount field. This is because the deductible code is not actually affecting the AR total.

    Click the Apply button.

    You will see a payment application screen identical to the Insurance Payment Application screen. All functionality is the same as an insurance payment application except the Amount column. The amount entered into this column will not lower the balance of the charge at all. You are simply specifying the amount that would have been paid if the patient had met their deductible. This amount will them be added to the YTD field within the patient’s Case screen.

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Patient/Guarantor Payment Application

If you are applying a patient/guarantor payment, you will follow the same process listed above under Insurance Payment Application with one exception. You will not see a Complete box when applying patient/guarantor payments.

The purpose of the complete box is to allow billing of the next responsible party. The patient/guarantor is the last responsible party. There is nobody to move the balance to. For this reason, there is no complete box on the Apply Payment to Charges screen.

Patient/Guarantor Co-pay Application

If you are applying a patient/guarantor co-payment, the most important thing to remember is to choose a co-payment code and not a regular payment code. When applying the patient/guarantor co-payment, a new button will appear called Apply To Co-pay.

The Apply To Co-pay button will work similarly to the Apply To Oldest button. It will apply the co-payment to the oldest procedure code requiring a co-payment. In most cases, there should only be one procedure code requiring a co-payment, however if there was a missed co-pay for a previous visit, the Apply To Co-pay button will apply to the first record requiring a co-payment.

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Taxable Transaction Entry

In most states it is illegal to charge tax on medical procedures. However, many offices and practices sell items directly to their patients. These could include equipment, vitamin supplements, and other similar items. The sale of these items is often subject to sales tax. In order to enter a taxable transaction and the charge for the sales tax, take the following steps:

  1. Set up a procedure code for the taxable item. (See MED103: Getting Started) When setting up this code, make sure you place a check mark in the field labeled Taxable.
  2. Set up a procedure code for the actual sales tax. (See MED103: Getting Started) When setting up this code, make sure you enter Tax as the procedure type and enter the tax percentage in the corresponding field.
  3. Open the Program Options screen. On the Data Entry tab you will see the following fields:

    The fields that affect the tax functionality are labeled Auto Create Tax Entry and Default Tax Code. If you would like to use the tax feature, the Default Tax Code is required. You should enter the tax code set up in step 2 into this field.

Tips and Tricks:

If the tax amount changes in your area, you should set up a new tax procedure code. This new code should have the new percentage. You would then need to change this code within the program options.

The Auto Create Tax Entry field determines exactly how taxes will be entered. If this field is checked, whenever a charge is entered using a procedure code that is marked as Taxable, a second line item will be entered automatically for the sales tax. The amount on that line item will be based on the tax percentage entered in the procedure code set in the Default Tax Code field, and the charge amount entered for the taxable charge.

If this field is not checked, if a taxable charge is entered, you must click the Tax button in order to create the charges for the tax amount.

Following this process will allow you to enter transactions that include sales tax amounts.

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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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Over the next several blogs, we are going to be providing you info on How To Setup a New Insurance Company, To Get Started, Open Medisoft Medical Billing Software Program, Click on the Blue Cross icon, or click on LISTS: INSURANCE COMPANY.

Medisoft Insurance Carrier Entry – Address Tab
This tab is where you enter this insurance carrier’s demographic information.

Code and Inactive: Each carrier is assigned a unique code. You can assign the code or allow the program to assign it automatically. Click the Inactive check box to mark the insurance carrier inactive.

Name and Address: Enter the insurance carrier’s name and address. Following the name, type the street, city, state, or zip code that helps you identify the right carrier.

Phone, Extension, and Fax: Enter the insurance carrier’s phone and fax numbers.

Contact: Enter a contact person at the insurance carrier. This is for reference only and doesn’t print on a claim form.

Practice ID: Enter the ID assigned to the practice by the insurance carrier.

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Over the next several blogs, we are going to be providing you info on How To create a new Referring Provider, To Get Started, Open Medisoft Medical Billing Software Program, Click on the referring provider icon, or click on LISTS: REFERRING PROVIDERS.
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.

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.

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.  For a list of valid qualifiers, click here.

0B = State License

1A = Blue Cross Provider Number

1B = Blue Shield Provider Number

1C = Medicare Provider Number

1D = Medicaid Provider Number

1G = Provider UPIN Number

1H = Champus Identification Number

1J = Facility ID Number

B3 = Preferred Provider Organization Number

BQ = Health Maintenance Organization Code Number

EI = Employer’s Identification Number

FH = Clinic Number

G2 = Provider Commercial Number

G5 = Provider Site Number

LU = Location Number

N5 = Provider Plan Network Identification Number

SY = Social Security Number

U3 = Unique Supplier Identification Number

X5 = State Industrial Accident Provider Number

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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Over the next several blogs, we are going to be providing you info on How To create a new Referring Provider, To Get Started, Open Medisoft Medical Billing Software Program, Click on the referring provider icon, or click on LISTS: REFERRING PROVIDERS.

Medisoft 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.

Note: if you want only the NPI number to transmit, please do not type anything in the following fields except the “National Identifier” field.
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(NPI): 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.

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Over the next several blogs, we are going to be providing you info on How To create a new Referring Provider, To Get Started, Open Medisoft Medical Billing Software Program, Click on the referring provider icon, or click on LISTS: REFERRING PROVIDERS.

Medisoft 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: For information on the Inactive check box, click here.

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, 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.

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. Read more

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