In case of insurance payments, patients provided in the EOB are to be selected, in order to post the payments to the corresponding charges. Manual posting screen permits cash posting one patient at a time.
1. Select Payments from the main menu and click on Manual Posting.
2. Create a new payment by providing payment information and generate the payment number or search for a payment using appropriate search parameters.
3. Select a patient by providing either MR # or patient name in the Patient field. The patient field is a smart search field. To know more about smart search, click here. Click the Search button to the far right to list all the charges for the patient, for the selected insurance. You can also search for encounter lines using claim# instead of Patient field. Charges are displayed as in Image 1.
3a. Auto Populate Paid Amount checkbox is disabled for insurance payments.
3b. Process Secondary INS First checkbox is to be selected in cases the claim status is still in Claim_Sent_to_PR and the secondary insurance pays you before the primary does.
3c. Show Closed Lines is used to display the lines already closed ,i.e., WO_CLOSE or PAID_CLOSE.
4. Enter the Allowed, Paid, and Adjustments (if any, along with the adjustment reason). The balance will be auto calculated by the system based on the Allowed, Paid and Adjustments entered. If a balance remains (Allowed-Paid is non-zero), you can choose to leave the balance to the Patient (Bill to PT) or bill it to secondary (Bill to SE) or write it off using the status WO_CLOSE by providing adjustments. If there is no balance (Allowed-Paid is zero), the system sets the Next action to PAID_CLOSE.
The following are the important columns in the Encounter Lines for Insurance payments.
|Code||The charges will be listed against each line with the codes.|
|Claim#||The claim number against which the line has been billed.|
|Charge||This is the original billed charge.|
|Rem||This displays the Remaining charge for the line.|
|Allowed||Enter the Allowed Amount in this box. The Allowed amount will be highlighted in red color if the amount entered is less than the amount specified in the Fee Schedule.|
|Paid||Enter the Paid Amount in this box.|
|To Copay||Enter the Copay amount if any here.|
|To Ded||Enter Deductibles if any here.|
|Adj||Enter the Adjustment amount here (optional)|
|Reason||If Adj. amt. is entered, the reason is mandatory.|
|With Hold||Enter the amount to be withheld if any here.|
|Balance||The Balance is automatically calculated and displayed here.|
|Next Action||The Next Action box indicates the action that has to be taken on a particular line. The Next Action for each line has to be selected before clicking the Post button. The explanation for the Next Action abbreviations is given below.
WO_CLOSE :- WRITE OFF CLOSE (When Allowed Amt.-Paid Amt. -Adj. is zero)
PAID_CLOSE :- PAID CLOSE (When Allowed Amt.-Paid Amt. is zero)
BILL_TO_PT :- BILL TO PATIENT
BILL_TO_GR :- BILL TO GUARANTOR
RE_BILL_TO_PR :- RE-BILL TO PRIMARY INSURANCE
|Reverse||The Reverse option allows you to take back any amount that has been wrongly posted against a line.|
|Notes||To enter any notes, click on the Notes icon.|
7. When the payment is posted, it can be verified in the Posting Log, as in Image 2. The image shows a fully applied payment. On-account Amt will be zero and the Posting Log shows the patients and the DOS’s for which the payment was posted.
Payer remarks are important in the case of denials. If the line was denied, set the Line Sub Status as Denied, provide Remark and choose the Category Code. You can also enter remarks to be entered in the Patient Statement in the Remark To Pat. Stmt field. EOB Page# is the page number in the EOB that contains the selected patient info; see Image 3.
Line activity shows all the activities performed so far on the selected line; refer to Image 4.
Enter details of other adjustments made here (see Image 5). Choose Other Adj. Reason and enter the amount in the Other Adj. Amt box.
If the EOB provided by the insurance has only denials, create a zero check payment and save it in the system. If the EOB has a mix of payments and denials, perform the following.
A. Select the patient in the posting screen as in the case of normal payment posting.
B. In the open charge line which is denied by the payer, set the next Action to the appropriate one.
C. In the Payer Remark tab, set the line sub status to DENIED and select appropriate category code from the Category code drop-down.
D. Click on Post.
E. Repeat Steps A to D for every patient whose claim is denied.