Medical Manager Unit 6 ICBS 170

Medical Manager  Billing Routines Generation of bills and statements sent to guarantors and insurance companies Patient billing Patient statements Insurance billing worksheet Trial insurance billing Insurance billing process Electronic media claims

Medical Manager  Insurance companies require specific preprinted forms Most insurances accept the CMS 1500 Some may want it completed in a slightly different way.  Medicare requires a physician's Medicare provider number  Other insurance companies require a Worker’s Compensation #, Medicaid #, or state identification number

Medical Manager  CMS 1500 Could have as many as 99 different formats

Medical Manager  Insurance Billing Worksheet Allows you to verify that information was entered correctly Procedure charges assigned to proper primary and secondary insurance companies Procedure codes, diagnosis codes and ailment information matches Last opportunity to edit insurance related information

Medical Manager  The health insurance claim form must be accurate and complete  If improperly filled out Returned unpaid Placed in a suspense file  Can be resubmitted, payment will take longer

Medical Manager  Posting Payments and Adjustments Payments may be posted three ways  Posting payments from the Procedure Entry screen  Posting payments from the Payment Entry screen  Patient Check-out Payments

Medical Manager  Payment entry screen Used whenever a payment, adjustment or refund is to be posted to the patient’s account Transferring financial responsibilities Produce a claim for another insurance plan or for the patient Payments for procedures can be split between patient and insurance carrier

Medical Manager  Partial Payments Transfer responsibility to same or secondary insurance plan Transferring responsibility to patient Accepting partial payment as settlement of an account

Medical Manager  Open Items The apostrophe(‘) following the insurance plan # on a line indicates that a secondary insurance plan shares responsibility for the payment but has not yet been billed

Medical Manager  Status Codes Last column on the payment entry screen Shows who is responsible for payment  Study the status codes on page 273 These will be on your Unit Test