© 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Chapter 8: Posting Insurance Payments and Creating Patient Statements Computers in the Medical Office

8-2 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Third-Party Reimbursement 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

8-3 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Remittance Advice Processing  Electronic Remittance Advice (ERA)  X12-835P  Remittance Advice (RA)  Paper format

8-4 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education 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)

8-5 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Entering Insurance Payments  Payments from insurance carriers are entered using the Enter Deposits/ Payments option on the Activities menu

8-6 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Entering Insurance Payments  The Deposit List window lists deposits for a specific date, or, all deposits can be viewed

8-7 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Entering Insurance Payments  To enter a deposit, click the New button, and the Deposit dialog box is displayed

8-8 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Entering Insurance Payments  The type of payor—patient, insurance, capitation—is selected from the Payor Type drop-down list

8-9 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Entering Insurance Payments  Other information entered about the deposit include:  Deposit date  Payment method  EFT Tracer  Check number  Description/Bank no.

8-10 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Entering Insurance Payments  Other information entered about the deposit include:  Payment amount  Deposit Code  Insurance  Codes for payments, adjustments, withholds, deductibles, and take backs

8-11 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Entering Insurance Payments  Once a payment is entered, it appears in the Deposit List window

8-12 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Entering Insurance Payments  Once a payment is entered, the next step is to apply the payment to patient accounts

8-13 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Entering Insurance Payments  Payments applied to patient accounts using the Deposit feature are automatically displayed in the Transaction Entry dialog box

8-14 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Entering Insurance Payments  Capitation payments are entered but not applied

8-15 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Entering Insurance Payments  Second “EOB Only” deposit is entered  Patient accounts adjusted to zero balance

8-16 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Creating Statements  Statements are created in the Statement Management area of Medisoft

8-17 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Creating Statements  When the Create Statements button is clicked, the Create Statements dialog box appears

8-18 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Creating Statements  The Create Statements dialog box contains a number of filters, including Transaction Dates Location Chart Numbers Provider Billing Codes Amount Case Indicator Statement Type

8-19 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education 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

8-20 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Creating Statements  Once statements have been created, they are listed in the Statement Management dialog box, with a status of Ready to Send

8-21 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Printing Statements  The Print/Send button is used to print statements that are then sent out to patients and guarantors

8-22 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Printing Statements  When the Print/Send button is clicked, a statement method (paper or electronic) is chosen

8-23 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Printing Statements  Next, the type of statement is selected from the list provided

8-24 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Printing Statements  When the Print/Send button is clicked, paper statements are printed and mailed by the practice

8-25 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Editing Statements  If changes are necessary, highlight the statement in the Statement Management dialog box and click the Edit button