medisoft-statement-management-overview

Introduction

After receiving payment from the insurance carriers, the next step in the billing process is to bill patients for any remaining amounts. This process often includes the need to collect from patients on balances not paid. This chapter will discuss the different methods of billing statements, as well as the ways Medisoft can enable your office to better collect outstanding debts owed by patients. Additionally, we will discuss the process for collecting charges owed but not paid by insurance carriers.

Types of Balances

When billing patients for their outstanding balances, it is crucial that you have an understanding of the different types of balances. Within Medisoft, there are two types of patient balances. There are also 3 insurance balances

  1. Patient Reference Balance: The patient reference balance contains all charges in the patient’s ledger that have any outstanding balances. As soon as a charge is entered it is reflected in the patient reference balance. If a transaction is set to be billed to an insurance carrier, the patient reference balance is the only balance it resides in until the claim is billed. When looking at the Transaction Entry screen, the field labeled Account Total will show you the patient reference balance.
    Standard patient statements will include patient reference balances.

  2. Patient Remainder Balance: Patient remainder balances contain charges for which no insurance carrier is responsible AND charges that have been complete payments made by all responsible insurance carriers. By “complete” we mean that the payments entered for the insurance carriers and that payment has been applied and marked “complete” in the payment application screen.
  3. Primary Insurance Aging Balance: When dealing with primary insurance aging balances, we are looking at the amount that is owed by all primary insurance carriers. A charge enters this balance at the point it is billed to the primary insurance carrier. A charge leaves this balance at the point a payment is applied from the primary carrier AND that payment is marked complete.
  4. Secondary Insurance Aging Balance: This balance functions similar to the primary insurance aging balance. A charge enters this balance when the primary insurance carrier makes a complete payment AND when the secondary claim is billed. A charge leaves this balance at the point a payment is applied from the secondary carrier AND that payment is marked complete.
  5. Tertiary Insurance Aging Balance: The tertiary insurance aging balance functions like the secondary insurance aging balance. A charge enters this balance when the secondary carrier makes a complete payment AND when the tertiary claim is billed. A charge leaves this balance at the point a payment is applied from the tertiary carrier AND that payment is marked complete.
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MultiLink Entry

MultiLink codes are used to enter multiple charge transactions at the same time. Many provider offices will find that they are entering the same groups of procedure codes for the same types of visit. An example of this would be a well-patient exam. MultiLinks allow you quickly enter all of those transactions.

MultiLink codes must be set up prior to clicking the MultiLink button in Transaction Entry. This is done by clicking the Lists menu and MultiLink Codes. You will see a list screen similar to the other list screens. Click the New button. The following screen will appear:


Code: The MultiLink Code field functions like the code fields in the other Medisoft list windows. The code is the value you will enter within transaction entry in order to enter charges for all the linked procedure codes.

Description: When entering the Description, it is important to make an entry that adequately describes the group of procedure codes. This will allow you to more easily determine when it would be appropriate to use this code.

Link Codes: The Link Codes are used to specify which codes will be entered into Transaction Entry when this MultiLink code is used. The transactions will be entered in the order they are entered into these fields. You can type the procedure code, or select it from the drop-down menu. If you need search capabilities, click the magnifying glass.

Tips and Tricks:

You can only enter charge type codes into MultiLinks. You cannot use MultiLinks to enter payments or adjustments.

Once you have finished setting up the MultiLink code, click Save.

After setting up your MultiLinks, they can be entered into Transaction Entry by clicking the MultiLink button.


Once you click the MultiLink button, you will see the following screen.


In the field labeled MultiLink Code, enter the code for the group of transactions you wish to enter. The Transaction Date field will automatically default to the program date specified in the lower right corner of the Medisoft screen. Once you are have selected the correct information, click Create Transactions. The desired charges will be listed in Transaction Entry. Click Save Transactions.

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Reference Items, Account Aging, and Account Totals

At the top of the Transaction Entry screen, you are going to see various fields that reference different items in the patient’s account. These items can help you with various parts of the billing process. In this section we will discuss those fields and the information that can be found by using them. The items referenced on the default screen relate to the case that is selected. They do not relate to one particular transaction.

Reference Items


Last Payment Date: This field shows you the last time a payment was made to this patient’s chart. This field will be the same for each case a patient has. Additionally, this field is referring to any payment made to the account. It does not matter whether the payment came from the insurance carrier or from the patient.

Last Payment Amount: Similar to the Last Payment Date field, this field is chart specific. It will show you the amount of the last payment made into the patient’s account.

Last Visit Date: Medisoft will automatically track visits for you. A visit is defined as a calendar day for which one or more CHARGES have been entered for a case. Visits are tracked on a case by case basis, meaning each case will have a different date. This field shows the date of the last visit for the selected case.

Visit: When setting up the patient case, you had the opportunity to specify the number of visits that were authorized by the insurance carrier. Certain carriers will authorize a certain number of visits for certain circumstances. These are done using what is known as authorizations. Each authorization would require a separate case. The visit field automatically tracks how many visits have occurred in that case (and therefore under that authorization). It uses the same definition of a visit that was previously given under Last Payment Date.

This field can prevent the office from seeing patients who have met or exceeded their authorized number of visits, and therefore will not have coverage for that care. Additionally, the office can then let the patients know that they are getting close to their limit, and then let the patients take appropriate action to either obtain another authorization, or find an alternative means of care.

If this field is for some reason showing the wrong number of visits, you can manually change it from this screen. Simply double click the word Visit. The following screen will appear.


You will be able to increase or decrease the Visit Number as needed. Once the changes are made, click OK. This process will change the visit series number listed in the patient’s case information.

Global Coverage Until: If you enter a Global Surgery code for this case the Global Coverage Until field will automatically calculate the date by taking the date that the global procedure was entered and adding the number of days entered in the procedure code.

Account Alerts: Account Alerts are red, two letter codes that are designed to alert you when the customer meets certain conditions. In order to receive some or all of these account alerts you must check them in Program Options, in the General tab, at the bottom in the Account Alert Settings area.

Account Aging

        

Account Aging: Depending on the tab being viewed, it will show the aging of the insurance carrier or the patient. The total will indicate the total amount from the insurance carrier’s or the patient’s aging. On the Patient’s tab it will indicate if there is any copay overdue. On the insurance tab TNB stands for Total Not Billed indicating that the claim needs to be created and sent.

Policy Copay: When entering the information into the case, you have the ability to enter a copay amount. The amount entered into that field will appear in this field. Medisoft will not automatically enter the copay for you, but it will help track missed copays. There is a new report call Outstanding Co-payment Report.

OA: OA is an abbreviation for Other Arrangements. This is a field in the case setup screen that will allow you to enter 4 characters. Whatever is entered into that field will appear in this portion of the screen.

Annual Deductible: Similar to visits, deductibles are handled on a case by case basis. You can enter the annual deductible into the insurance carrier tab of the case screen.

YTD: If you enter deductible type codes into a patient’s account, the amount field is filled out with the amount of the charge that was applied to a deductible. When this is done the accounts receivable for the patient is not affected. You simply move the balance responsibility from the insurance carrier to the guarantor. The amounts entered into deductible type transactions are totaled for the case and displayed in the YTD field.

Tips and Tricks

Medisoft will track deductibles for you on a case by case basis. It is important to note that the only party whose calculation matters is the insurance carrier.

Simply because Medisoft states that the deductible has or has not been met, does not mean it is true. If the patient has been seen by any other providers for any reason during that year, they will have made payments that were applied to the deductible. These transactions will not be in your providers system.

Totals


Charges: Shows the total number of charges that appear on the currently displayed Transaction Entry screen. If you are utilizing the Superbill or Document Number fields, this will be the total number of charges that have been entered into that specific superbill or document number.

Adjustments: Shows the total number of adjustments that appear on the currently displayed Transaction Entry
screen.

Subtotal: This field displays the sum of the Charges and Adjustments fields. The reason we state that it displays the sum is because the Adjustments field can contain either positive or negative values.

Payment: Shows the total number of payments that appear on the currently displayed Transaction Entry
screen.

Balance: The Balance field shows the total balance for the transactions currently displayed. These transactions are specific to the case that is currently selected. If you are utilizing the Superbill or Document Number fields, this will be the balance on the transactions entered specifically for that superbill or document number.

Account Total: This field is different from the other total fields that have been previously explained in one very important way. The Account Total field shows the entire balance for that patient’s account. This balance does NOT filter based on Case, Document, or Superbill.

If you delete transactions in the day to day operation of the program, this amount may show an incorrect balance total. In order to recalculate the amount, simply double-click on the amount.

Calculate Totals: The Calculate Totals field is located in the lower left corner of the Transaction Entry screen. If this field is selected, the totals will appear. If it is not checked, the only value that will appear is the Account Total field.

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Medisoft Practice Setup

Introduction

Once the Medisoft program has been installed, the office will need to go through and do a large amount of preliminary data entry before they will be able to begin the billing process.

Medisoft is a flexible program that offers many different ways of doing things.  As a Value Added Reseller, your success will depend on your ability to familiarize yourself with the options that are available within the program, and identify which setup will be most beneficial to a particular office.

This workbook follows the recommended order in setting up a new user’s system.

Tips and Tricks:If you have questions regarding any portion of the Medisoft program, you can press the [F1] button with that screen open.  The help files will open to the section regarding the window you have open at the time.

Practice Setup

The first thing an office would set up after installing Medisoft would be a practice.  A practice is defined as a group of data files related to the operations of one office or group of offices.

A practice shares a common list of patients, insurance carriers, procedure codes, diagnosis codes, and other data files.  A practice also shares a common Accounts Receivable total, although you do have the ability to report on each provider or doctor Accounts Receivable total.  All data files for a particular practice reside in the same sub-directory of your root data directory. (Example:  C:\Medidata\medisoft)

Tips and Tricks:Most medical offices will only need to create one practice.  The most common instance where multiple practices are created is in a Billing Service.  A Billing Service generally has multiple offices as clients, and therefore they need to create separate practices for each office.

 

In the previous section, we briefly discussed creating a practice.  We will review this process and expand the explanation of it.

Practice Creation

In order to create a new practice, take the following steps:

  1. Click the File menu and New Practice.  There is also a New button on the Open Practice screen.  Either of these options will bring you to the same process.
  2. You will see the “Create a new set of data” window.  Enter the name of the practice as you would like it to appear in the practice list.  You will also be asked to enter the data path.  The first portion of the path will be defaulted to the value you entered when initially connecting to the Advantage Database Server.  You will simply need to enter the name of the sub-directory within Medidata that you would like to hold the data for this practice.  Once entered, click Create.

 

  1. You will need to repeat this process for any additional practices you wish to create.


Practice Settings

Practice Tab

After you create a practice, the following screen will appear:

 

This screen is the first place you will begin entering information that will affect the billing process.  We will discuss each field that will have an effect, and what that effect is.

Practice Name and Address:  The Practice name and address information must be entered properly, as this information will be sent on electronic claims.

Type:  There are three options available under the type field.  If you do not choose a type, Medical is the default practice type and does not add any additional fields.

  1. Anesthesia:  This option will enable the ability to bill transactions for a specified number of minutes.  This is only necessary for Anesthesiologists.
  2. Chiropractic:  This option will cause certain fields required for Chiropractic billing to appear within the program.  These fields are as follows:

 

Level of Subluxation

Treatment Months/Years

Nature of Condition

Date of Manifestation

Complication Ind.

  1. Medical:  This setting should be used for all other practice types.

Federal Tax ID:  Enter the Tax ID number assigned to the Practice in this field.  This field may affect electronic claims for group practices.

Tips and Tricks:When entering a Tax ID number, do not enter any formatting such as spaces, dashes, or any other symbols.  Simply enter the 9 digit number. 

 

Extra Fields:  Do not enter anything in these fields unless expressly told to do so by your Electronic Claims Module Documentation.

Practice Type: If you are a solo (individual) provider select the Individual button. If you are a member of a group and use an Organizational NPI, select the Group Practice button.

Entity Type:  This field offers you the option to select either Person or Non-Person.  Select Person if the office is a solo practitioner.  Select Non-Person if the office is a group practice or billing under a company name such as Dr Johnson LLC.


Practice IDs Tab

 

This grid houses practice billing information such as group or individual NPI, taxonomy, tax IDs, claim filing status (group or individual) and connects this information to insurance carriers and the doctors in your practice as a series of rules.  You will want to set up at least one entry (rule) on the grid.  You could associate IDs and codes to all providers, insurance carriers and facilities or you could associate different IDs and codes to each provider, carrier or facility or any combination of these.  Click the Help button and read important information regarding this tab and assigning rules.  Proper configuration of this tab is critical for billing.  Also, be aware that there is a similar grid in provider setup that works in conjunction with this tab which is discussed later in this document.

Tips and Tricks:If converting from a version older than Medisoft 16, it is likely that multiple Legacy IDs will be converted into this grid as Group Provider IDs.  This will not be desirable as most Insurance Companies will reject if these IDs appear on claims.  There is no “NPI Only” setting in Medisoft 17.  Many VARs are careful to delete Group Provider IDs from the older version prior to converting to Medisoft 17.If needed, you can quickly delete all items in this grid by holding down the Ctrl button and then pressing the Delete button.  Once deleted, the action is not reversible.

 

 

 

 

Click New to enter Practice IDs.

 

 

National Provider ID:  The NPI is the standard unique health identifier for health care providers.  It consists of a 10 digit identifier (9 numbers followed by a check-digit) that standardizes one number for each provider used by every insurance carrier.  This standard was part of the HIPAA legislation to establish a unique identifier to improve the efficiency and effectiveness of electronic health information.  Once established, the provider’s NPI will not change regardless of job or location changes.

Taxonomy Code:  Taxonomy Codes are a 10 character provider specialty code used for electronic billing.  There will be circumstances when submitting electronic claims where you will be asked to supply a Taxonomy Code.  Enter this code here.  Refer to your electronic claims documentation for more information regarding this field.

Tax Identifier:  If the practice name is a business or organization, it would be appropriate to select this radio button and enter the 9 digit Tax ID.

Social Security Number: If the practice name is a person’s name, it would be appropriate to select this radio button and enter the 9 digit Social Security Number.

Legacy Identifiers:  The Legacy Identifiers available on this screen are rarely used.  If an Insurance Carrier requires a legacy ID, it may be input here.  If these IDs are input, they should be specific to one Insurance Carrier or Class.

 

Practice & Statement Pay-To Tabs

 

 

These tabs are identical. Use these tabs when both practice and billing service information is needed.  Practice Pay-To is used for electronic claims.  Statement Pay-To is used for electronic statements.  Use these tabs to create a separate pay-to address location such as a PO Box instead of a physical address.

Open Practice

After setting up multiple practices, you will need to be able to switch between these practices.  This is done by clicking the File menu and Open Practice.

The following screen will appear and will give you a few options:

 

Opening a Practice:  To open a practice on the list, simply highlight the practice and click OK.  You can also double-click the practice you wish to open.

Tips and Tricks:Medisoft will remember the last practice that was opened.  When you start the Medisoft program, it will automatically open this practice.

 

Deleting a Practice: You have the option to delete a practice from the open practice screen.  If you would like to remove the practice from the list, highlight the practice and press the Delete button.

Tips and Tricks:When viewing the open practice window, you are actually viewing the contents of a data file.  The name of that file is mwdblist.adt.  This file is located in your root data directory (usually Medidata).When you delete a practice, you are not actually deleting the data files for that practice.  You are simply deleting the reference to that practice from the mwdblist.adt file.  The name of the practice that appears on the Open Practice window is also stored in the mwdblist.adt file.  If the name is spelled wrong, you will need to delete the practice and create a new one that points at the same data path.

 


Finding the Data Path: Find the data location of any practice by clicking and holding the cursor over the name of any practice on the Open Practice window.

****Remember to do a daily, weekly, monthly, quarterly, yearly backups to multiple locations including a local offsite backup *********

For Medisoft Support Call us at 888-691-8058 or 941-743-6666.

How to start a new practice in medisoft

How To Setup Medisoft

 

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Provider Entry – Default Group IDs Tab
This tab is where you store default group numbers assigned to this provider from various sources.

Provider Class: You can assign a provider to a class or group.  First set up provider classes in the Provider Class List.  Then click the down arrow in this field to select a class for the provider.

Group Number: Enter the provider’s group number.

Medicare Group ID: Enter the provider’s Medicare group number.

Medicaid Group ID: Enter the provider’s Medicaid group number.

BC/BS Group ID: Enter the provider’s Blue Cross/Blue Shield group number.

Other Group ID: Enter the provider’s group number for other insurances.

We hope you appreciate our information concerning setting up our practice management software program.  Please Contact us at 888-691-8058 or 941-743-6666 for all your technical support or medisoft training needs.

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