1. Computers inthe Medical Office Chapter 8: Posting Insurance Payments and Creating Patient Statements

2. Third-PartyReimbursement Overview • Fee schedule • List of standard fees established by provider • Not necessarily the amount the provider is paid • Difference between amount in fee schedule and amount paid is an adjustment

3. Remittance Advice Processing • Electronic Remittance Advice (ERA) • X12-835P • Remittance Advice (RA) • Paper format

4. Remittance Advice Processing • Steps for Processing • Verify that all procedure codes listed on claim are represented on RA • Review payment amount against expected amount • Identify reason for denials or payment reductions • Post payment information in practice management program • Bill secondary health plan (if appropriate)

5. Entering Insurance Payments • Payments from insurance carriers are entered using the Enter Deposits/ Payments option on the Activities menu

6. Entering Insurance Payments • The Deposit List window lists deposits for a specific date, or, all deposits can be viewed

7. Entering Insurance Payments • To enter a deposit, click the New button, and the Deposit dialog box is displayed

8. Entering Insurance Payments • The type of payor—patient, insurance, capitation—is selected from the Payor Type drop-down list

9. Entering Insurance Payments • Other information entered about the deposit include: • Deposit date • Payment method • EFT Tracer • Check number • Description/Bank no.

10. Entering Insurance Payments • Other information entered about the deposit include: • Payment amount • Deposit Code • Insurance • Codes for payments, adjustments, withholds, deductibles, and take backs

11. Entering Insurance Payments • Once a payment is entered, it appears in the Deposit List window

12. Entering Insurance Payments • Once a payment is entered, the next step is to apply the payment to patient accounts

13. Entering Insurance Payments • Paymentsapplied topatientaccountsusing theDepositfeatureare automatically displayed in the Transaction Entry dialog box

14. Entering Insurance Payments • Capitation payments are entered but not applied

15. Entering Insurance Payments • Second “EOB Only” deposit is entered • Patient accounts adjusted to zero balance

16. Creating Statements • Statements are created in the Statement Management area of Medisoft

17. Creating Statements • When the Create Statements button is clicked, the Create Statements dialog box appears

18. Creating Statements • The Create Statements dialog box contains a number of filters, including

19. Statement Types • Standard statements show all available charges regardless of whether the insurance has paid on the transactions • Remainder statements list only those charges that are not paid in full after all insurance carrier payments have been received

20. Creating Statements • Once statements have been created, they are listed in the Statement Management dialog box, with a status of Ready to Send

21. Printing Statements • The Print/Send button is used to print statements that are then sent out to patients and guarantors

22. Printing Statements • When the Print/Send button is clicked, a statement method (paper or electronic) is chosen

23. Printing Statements • Next, the type of statement is selected from the list provided

24. Printing Statements • When the Print/Send button is clicked, paper statements are printed and mailed by the practice

25. Editing Statements • If changes are necessary, highlight the statement in the Statement Management dialog box and click the Edit button