computers in the medical office
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Computers in the Medical Office. Chapter 8: Posting Insurance Payments and Creating Patient Statements. Third-Party Reimbursement Overview. Fee schedule List of standard fees established by provider Not necessarily the amount the provider is paid - PowerPoint PPT PresentationTRANSCRIPT
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
Chapter 8:Chapter 8:Posting Insurance Payments and Posting Insurance Payments and
Creating Patient StatementsCreating Patient Statements
Computers inComputers inthe Medical Officethe Medical Office
8-8-22
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
Third-PartyThird-PartyReimbursement OverviewReimbursement Overview
Fee scheduleFee schedule List of standard fees established by providerList of standard fees established by provider Not necessarily the amount the provider is paidNot necessarily the amount the provider is paid Difference between amount in fee schedule and amount paid is an adjustmentDifference between amount in fee schedule and amount paid is an adjustment
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McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
Remittance Advice ProcessingRemittance Advice ProcessingElectronic Remittance Advice (ERA)Electronic Remittance Advice (ERA)
X12-835PX12-835P
Remittance Advice (RA)Remittance Advice (RA) Paper formatPaper format
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McGraw-Hill Career Education
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Remittance Advice ProcessingRemittance Advice ProcessingSteps for ProcessingSteps for Processing
Verify that all procedure codes listed on claim are represented on RAVerify that all procedure codes listed on claim are represented on RA Review payment amount against expected amountReview payment amount against expected amount Identify reason for denials or payment reductionsIdentify reason for denials or payment reductions Post payment information in practice management programPost payment information in practice management program Bill secondary health plan (if appropriate)Bill secondary health plan (if appropriate)
8-8-55
McGraw-Hill Career Education
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Entering Insurance PaymentsEntering Insurance PaymentsPayments from insurance carriers Payments from insurance carriers
are entered using the Enter are entered using the Enter Deposits/ Payments option on the Deposits/ Payments option on the Activities menuActivities menu
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McGraw-Hill Career Education
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Entering Insurance PaymentsEntering Insurance Payments
The Deposit List window lists deposits for The Deposit List window lists deposits for a specific date, or, all deposits can be a specific date, or, all deposits can be viewedviewed
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McGraw-Hill Career Education
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Entering Insurance PaymentsEntering Insurance Payments
To enter a deposit, click the New button, To enter a deposit, click the New button, and the Deposit dialog box is displayedand the Deposit dialog box is displayed
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McGraw-Hill Career Education
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Entering Insurance PaymentsEntering Insurance Payments
The type of payor—patient, insurance, The type of payor—patient, insurance, capitation—is selected from the Payor capitation—is selected from the Payor Type drop-down listType drop-down list
8-8-99
McGraw-Hill Career Education
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Entering Insurance PaymentsEntering Insurance PaymentsOther information entered about the deposit include:Other information entered about the deposit include:
Deposit dateDeposit date Payment methodPayment method EFT TracerEFT Tracer Check numberCheck number Description/Bank no.Description/Bank no.
8-8-1010
McGraw-Hill Career Education
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Entering Insurance PaymentsEntering Insurance PaymentsOther information entered about the deposit include:Other information entered about the deposit include:
Payment amountPayment amount Deposit CodeDeposit Code InsuranceInsurance Codes for payments, adjustments, withholds, deductibles, and take backsCodes for payments, adjustments, withholds, deductibles, and take backs
8-8-1111
McGraw-Hill Career Education
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Entering Insurance PaymentsEntering Insurance PaymentsOnce a payment is entered, it appears Once a payment is entered, it appears
in the Deposit List windowin the Deposit List window
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McGraw-Hill Career Education
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Entering Insurance PaymentsEntering Insurance PaymentsOnce a payment is entered, the next step is Once a payment is entered, the next step is
to apply the payment to patient accountsto apply the payment to patient accounts
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McGraw-Hill Career Education
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Entering Insurance PaymentsEntering Insurance PaymentsPaymentsPayments
applied toapplied topatientpatientaccountsaccountsusing theusing theDepositDepositfeaturefeatureare automatically displayed in the Transaction Entry dialog boxare automatically displayed in the Transaction Entry dialog box
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McGraw-Hill Career Education
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Entering Insurance PaymentsEntering Insurance Payments
Capitation payments are entered but Capitation payments are entered but not applied not applied
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McGraw-Hill Career Education
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Entering Insurance PaymentsEntering Insurance Payments
Second “EOB Only” deposit is enteredSecond “EOB Only” deposit is enteredPatient accounts adjusted to zero balancePatient accounts adjusted to zero balance
8-8-1616
McGraw-Hill Career Education
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Creating StatementsCreating Statements
Statements are created in the Statement Statements are created in the Statement Management area of MedisoftManagement area of Medisoft
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McGraw-Hill Career Education
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Creating StatementsCreating Statements
When the Create Statements button is clicked, When the Create Statements button is clicked, the Create Statements dialog box appearsthe Create Statements dialog box appears
8-8-1818
McGraw-Hill Career Education
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Creating StatementsCreating Statements
The Create Statements dialog box contains The Create Statements dialog box contains a number of filters, includinga number of filters, including
Transaction Transaction DatesDates LocationLocation
Chart NumbersChart Numbers ProviderProvider
Billing CodesBilling Codes AmountAmount
Case IndicatorCase Indicator Statement TypeStatement Type
8-8-1919
McGraw-Hill Career Education
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Statement TypesStatement Types
StandardStandard statements show all available statements show all available charges regardless of whether the charges regardless of whether the insurance has paid on the transactionsinsurance has paid on the transactions
RemainderRemainder statements list only those statements list only those charges that are not paid in full after all charges that are not paid in full after all insurance carrier payments have been insurance carrier payments have been receivedreceived
8-8-2020
McGraw-Hill Career Education
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Creating StatementsCreating Statements
Once statements have been created, they Once statements have been created, they are listed in the Statement Management are listed in the Statement Management dialog box, with a status of Ready to Senddialog box, with a status of Ready to Send
8-8-2121
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Printing StatementsPrinting Statements
The Print/Send button is used to print The Print/Send button is used to print statements that are then sent out to patients statements that are then sent out to patients and guarantorsand guarantors
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Printing StatementsPrinting Statements
When the Print/Send button is clicked, a When the Print/Send button is clicked, a statement method (paper or electronic) is statement method (paper or electronic) is chosenchosen
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McGraw-Hill Career Education
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Printing StatementsPrinting Statements
Next, the type of statement is selected from Next, the type of statement is selected from the list providedthe list provided
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McGraw-Hill Career Education
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Printing StatementsPrinting Statements
When the When the Print/Send button Print/Send button is clicked, paper is clicked, paper statements are statements are printed and printed and mailed by the mailed by the practicepractice
8-8-2525
McGraw-Hill Career Education
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Editing StatementsEditing Statements
If changes are necessary, highlight the If changes are necessary, highlight the statement in the Statement Management statement in the Statement Management dialog box and click the Edit buttondialog box and click the Edit button