Welcome to the Health Office Management System (HOMS) Software and Procedures Handbook. This handbook has been designed to provide a healthcare office with useful information regarding all of the HOMS features and functions. Broadly defined, this software includes appointment scheduling, patient accounting, billing, and insurance processing. This document is not only a software manual. Special attention has been given to procedures for billing of, and collections for services rendered. We have designed this book to provide instruction for a client new to the pbs system and to serve as a reference guide for the more experienced user.

With pbs you have a partner that has been working for doctors in billing and collections for over 50 years. We are experts in billing, insurance, and the collection process. In this manual, we would like to share some of this expertise with you. We realize that the insurance and billing process is confusing and complex at times. At pbs, we work hard to create systems that ease your workload and maximize your office productivity. If you have any questions about the insurance and billing process or any suggestions on how we can improve this process, please contact our office for personal assistance.

The Health Office Management System

The Health Office Management System was created to assist healthcare offices in their daily office procedures. This includes scheduling appointments, managing patient accounts, submitting insurance, patient billing, and collections. The system works by connecting the computers in your office to the computer network at pbs via a SSL encrypted web browser connection so that we can assist with daily and monthly processing. The application supports both the mouse (point and click) and the keyboard function keys. As you enter information into the system, it is checked for valid procedure and diagnostic coding. Your insurance claims are processed by the pbs claims clearinghouse and transmitted for rapid payment. After cutoff (the last day in your billing period) pbs prints patient bills on statements personalized for your practice. These statements are mailed for you by pbs. By combining a direct connection to the claims clearinghouse with the pbs production and distribution facilities, you receive an integrated system to assist your office management.

Chapter Overview

This handbook will help you complete the procedures necessary to add, maintain, and process information using the HOMS. It is divided into chapters that explain the basic components of your system.

Chapter 1: Introduction

A brief explanation of how the system works.

Chapter 2: Fundamentals

Getting around the system and using help.

Chapter 3: Account Processing

Details the methods of recording billing, patient, and insurance coverage information. These records must be established before any transactions can occur.

Chapter 4: Patient Appointment Scheduling

Describes how to use the optional computerized scheduling functions.

Chapter 5: Code Processing

Describes the steps needed to add and maintain necessary codes. These codes must be in place for your system to function.

Chapter 6: Transaction Processing

Describes the recording of service rendered, payments received, or any adjustments to a patient’s account. This information is used to print the patient statements at the end of your billing period.

Chapter 7: Insurance Processing

Outlines the tasks and terminology associated with submitting insurance electronically and on paper. This chapter emphasizes the importance of understanding the insurance process and the necessary steps needed to ensure payment for services rendered.

Chapter 8: Billing Procedures and Reports

Explains the steps for cutting off and lists the reports you will receive as a result. It also explains how to manage accounts after billing is completed.

Fundamentals

In this chapter, you will learn how to navigate through HOMS.

Every computer application has some fundamentals you will need to learn in order to use the program. This chapter will help you become familiar with this application and explain some of the time saving features that can benefit you as you work with the system.

Entering and Exiting the System

Signing on is the process you will use to start the application on your computer. Go to the web address www.pbssite.com. Click Client Logon at the top of the screen.

Type your user name and password in the spaces provided.

The main menu will display when you press enter. Now you are signed on and the system is ready to use.

To sign off and close your HOMS session choose option 90 from the main menu. Then click the red “X” in the upper right hand corner to close your web browser if you wish.

Navigating The System Through Point & Click

There are options on the left side of each screen. This list of options is called the Side Options Bar. These options perform shortcuts or offer additional options for the screen they are associated with. It is important to become familiar with these options as they will simplify procedures and lessen time spent on the computer.

The function of the options will vary depending on which screen you have displayed. Two options that remain constant are the Exit option, F3, and the Cancel option, F12. Exit or F3 will take you out of the screen you are on, returning you to the main menu. Cancel or F12 takes you to the screen you were previously on.

There are three ways that you can use these options. The first way is the click on the option, on the Side Option Bar, located on the left side of your screen. The second way is to use the function keys at the top of your keyboard. The third and final way to use these options is the click on the arrow and X buttons on the top right side of your screen, which is show in the diagram below. The arrow button is your Cancel option and the X button is your Exit option.

Note: The command keys, F1 through F24, can also be used to perform the various functions. The actual command keys will vary depending on your keyboard. They will be F1 through F24 on some keyboards or F1 through F12 on others. If your keyboard has F1 through F12, use the shift key to perform the commands of the F13 through F24 keys. For example, if the command key is listed at the bottom of the screen is F15, press the shift key plus the F3 key. With many keyboards, key functions can be mapped to other keys, contact pbs for help.

On the Main menu, you are able to choose which option you want to select either by point and click or by entering the corresponding number in the option box on the bottom of the screen.

System Messages

Occasionally you will make an entry and the screen will display a message and not allow you to make another entry. The message may tell you that you have made an invalid entry, provide an explanation of an error, or give you a warning of possible errors. Entering valid information in the field will cause the error message to disappear.

Field Definitions - Guarantor Section

Account# This is the number assigned to the billing account by the system or by your office.

Flags These are two optional fields that allow you to flag a patient’s account for special handling. Some of the special handling functions that flag codes can be used for include: to sort the statements into various sequences at billing time, to not print a statement for the billing account, to not assess finance charges to the billing account, to print a special message on the statement, or to prevent a statement delinquency notice from printing on the statement for the billing account. For a list of flag codes and their meanings, see Appendix 1.

Title This is the title of the responsible party. For example; Mr., Mrs., Ms, or Dr.

First Name Enter the responsible party’s first name. If a business is the responsible party, enter the name of the business in this field.

Last Name Enter the responsible party’s last name. If the last name is a double name, use a hyphen between the names.

Sfx Enter the responsible party’s suffix. For example; Jr, DDS, or III

Bus? This field should be blank if the responsible party is a person, and should have ‘B’ or ‘C’ if the responsible party is a business. If ‘B’ is in this field, the system will alphabetize the billing account by the entry in the first name field. If a ‘C’ is in this field, the system will alphabetize the billing account by the entry in the first name field and print the name continuously, so there are no large spaces between words.

L.Acty This is the most recent date a statement was sent to the responsible party or was run, but not printed. This is determined by the system and cannot be manually added or changed.

LstChng. This is the date the last change was made to this account. This information is generated by the system and cannot be manually changed.

Address Enter the responsible party’s street address. Two lines are available. If the address will fit on one line, please use the top line.

City, State, Zip Enter the city, state, and ZIP code of the responsible party’s mailing address. You may wish to utilize the ‘quick key’ option for these fields. This would allow you to enter a single letter in the city field and the system would fill in the city, state, and zip (for single ZIP cities only). Call pbs to set up this option.

Home Phone Enter the responsible party’s home phone number. Please enter the phone number without any spaces or punctuation between the numbers.

Work Phone Enter the responsible party’s work phone number. Please enter the phone number without any spaces or punctuation between the numbers.

Cell Phone Enter the responsible party’s work cell number. Please enter the phone number without any spaces or punctuation between the numbers.

Agrd.Pmt If the responsible party has agreed to pay a certain amount until the bill is paid, enter that amount in this field. ‘Your agreed monthly payment is $XX.XX’ is printed on their statement.

Flag#1,2,3,4,5,6 These are optional fields that allow you to flag an account for special handling within your office. If the account will require special handling by pbs, please use the ‘Flags‘ fields to the right of the ‘Billing #’ field. If you would like to have the ‘Flag# X’ replaced with a more meaningful description, please call pbs.

Employer Enter the responsible party’s place of employment.

Notes These are three lines to enter any comments you need to make regarding this account. For example, you may enter the dates the responsible party was contacted for payment, a relative’s name and phone number, or anything that will help in the collection of the account. Press F6 for additional lines for notes.
Field Definitions - Patient Section

Patient Identifier

First Name This is the patient’s first name.

Last Name This is the patient’s last name.

Sfx This is the patient’s name suffix. For example, Jr, DDS, III.

Sex This is the patient’s gender (F=Female, M=Male, or B=Business).

Rel A code indicating the relationship of the patient to the guarantor.

1 - Patient is the insured

2 - Spouse

3 - Natural child, insured has financial responsibility

4 - Natural child, insured does not have financial responsibility

5 - Step child

6 - Foster Child

7 - Ward of the cournt

8 - Employee

9 - Unknown

A - Handicapped dependent

B - Organ Donor

C - Cadaver donor

E - Niece or Nephew

F - Injured plaintiff

G - Sponsored dependent

H - Minor dependent of a minor

I - Parent

J - Grandparent

Birth This is the patient’s birth date. Type the date without any spaces or punctuation.

MS This is the patients marital status, valid codes are: M-Married, S-Single, W-Widowed, D-Divorced, X-Legally Separated, U-Unknown.

Emp A code indicating employment status of the patient. F-Employed full-time, P-Employed part-time, N-Not employed, S-Self-employed, R-Retired, M-On active military duty, U-Unknown, D-Deceased.

Stu A code which indicates the student status of the patient if 19 years of age or older, not handicapped and not the insured. F-Full-time student, P-Part-time student, N=Not a student.

SocSec# This is the patient’s Social Security number. Type the number without any spaces or dashes between numbers.

Fee This is the fee schedule assigned to the patient. For example, it would be an ‘M: if the patient has Medicare as their primary insurance, ‘N’ if the patient is of Medicare age but does not have Medicare, blank for standard fees, or any other fee schedule designation that your office chooses.

Dr This is the doctor number of the patient’s primary care provider.

Insurance This is the code for the patient’s insurance carrier. Up to four codes may be entered. If left blank, the insurance form used for the patient will be the default form for your office.

Patient Insurance Setup

The ‘Patient Insurance’ screen is accessed from the main menu option 2 or F5 from the ‘Guarantor Information’ screen. The patient’s name is displayed at the top of the screen and all insurance companies the patient has coverage with are listed below.

Referring physician information can be added from the Patient Insurance screen as well. Select Referring Doctor (F10) to add this information.

HOMS stores the list of available relationship codes in regards to patient insurance. Place the cursor in the Rel field and enter F4 to display the relationship code list.

Side Option Bar Definitions

If the patient and the subscriber are the same person, you only need to fill in Insurance Company Name, ID number, Group number, and relation to patient as 1. Press enter and the computer will automatically fill the patient information in.

If the patient and the subscriber are not the same person, you are required to fill in the patient information as described above.

Field Definitions

On the very left column number 1 represents the primary insurer, numbers 2 through 8 represent secondary insurers and number 9 represents terminated insurance. All #9’s must have a date in the Terminated field of the insurance record.

ID# Patient identification number from insurance card.

Group# Group number from insurance card.

Subscriber First/Last Name/Address Information Subscriber name exactly as it is spelled or misspelled on the insurance card and their address information

Rel Relationship of the Patient to the Subscriber

1 - Self (Name must match patient record exactly)

2 - Spouse

3 - Child, insured has financial responsibility

4 - Child, insured does not have financial responsibility

5 - Step Child

6 - Foster Child

7 - Ward of the court

8 - Employee

9 - Unknown

A - Handicapped dependent

B - Organ donor

C - Cadaver donor

E - Niece or Nephew

F - Injured plaintiff

G - Sponsored dependent

H - Minor dependent of a minor dependent

I - Parent

J - Grandparent

Phone # Phone Number of subscriber

Birth Birth date of the subscriber.

Sex Sex of the subscriber.

AOB By placing a Y or N for yes or no in this field you override the AOB setting on the Insurance Company Screen.

Subscriber’s Employer The subscriber’s employer.

Copay Copay amount.

GFD Gobal Field Date

Effective Date the Coverage began

Terminated (T) Date the Coverage ended

A referring physician’s name may be added if the insurance company requires it.

To add a referring physician’s name to the patient, choose F10 from the ‘Patient

Insurance’ screen. The ‘Add/Change Referring Physician’ screen will pop up.

Side Option Bar Definitions

A patient’s employer information may be added if the insurance company requires it.

To add an employer to the patient, select ‘Patient Employer’, F11, from the Side Option Bar on the ‘Patient Insurance’ screen. The ‘Add/Change Patient Employer’ screen will then pop up as shown below.

Patient Billing

Ideally, you should collect copay’s before the patient leaves the office. This improves cash flow and eliminates uncollectible accounts. Since this is not always feasible, patient billings are required. There are many different ways to bill patients. Each office must find a patient billing strategy that works best for their office. Some offices choose to bill patients immediately after a visit. The statements to the patients may include a message similar to, ‘Please do not pay amount at this time, insurance has been submitted.’ Other offices choose to wait until insurance has been processed to bill the patient. This prevents patients from sending in duplicate payments on charges that their insurance already covered.

Statement Processing

pbs uses a flag or notation code to indicate special treatment of a patient’s account at billing. Flag codes can sort statements into various sequences at billing time. They can hold a statement from printing or stop finance charges from being assessed to a particular billing account. You can apply flag codes to print a special message on the patient’s statement, or to not have a statement delinquency message printed on a specific billing account.

Statement groups work together with flag codes to include or exclude flagged accounts from billing functions. You may want all credit balance and small balance statements to be grouped in a ‘pull’ group that pbs sends back to you instead of mailing them to patients. The groups are sent back for review to your office because they may be lacking proper information or there is some other concern with the account. Once statements have been sorted by pull groups, the remaining statements are mailed by pbs.

Accounting Methodology

After determining when you are going to bill patients, your office should decide how to maintain billing accounts. At pbs, we offer two different accounting methods for you to use in maintaining your billing records, open item an previous balance. In the previous balance system, all charges are by default assigned to the patient or patient’s guardian as the responsible party. When payments are received, they are entered against the patients account balance, not against the individual charges. Conversely, an open item system allows charges to be allocated to a specific insurance company as the responsible party. Payments are allocated to individual charges and can be tracked by insurance payer. There are advantages to both types of systems. Procedures for billing under these systems are explained in the following two sections.

Open Item

Open item posting will track insurance payments by procedure, as well as provide more detailed information on account balance responsibility.

When a charge is entered for a patient, the entire amount of the charge is entered into insurance responsibility (primary insurance company). When the Explanation of Benefits (EOB) is received from the primary insurance company, the amount not covered is transferred to secondary insurance or the patient’s responsibility. For example, John had an office visit for $45. An insurance claim was submitted to Blue Shield. This puts the $45 in Blue Shield’s responsibility and John’s responsibility is zero. John will not receive a statement at this time. When the Blue Shield EOB is received, the payment ($30), deductible ($10), and write-off ($5) are entered against the appropriate claim number. The deductible amount of $10 now becomes John’s responsibility and he will receive a statement at the next billing cycle. John will continue to receive a statement that lists all unpaid charges that are his responsibility at each billing cycle. All unpaid charges and their dates of service will be listed on the statement until paid.

The advantages of the open item system are the separation of account balances between patient responsibility and insurance responsibility. Charges, payment, discounts and write-offs are applied to a specific insurance company or to the patient. This allows your office the ability to track an insurance company’s payment and write-off statistics. You will also be able to list ‘open’ claims for any insurance company.

Patient Appointment Scheduling

In this chapter, we describe how to schedule patient appointments, use the search functions of the software, and print billing and patient information from appointment scheduling software.

Patient Appointment Scheduling allows you to handle multiple providers’ schedules in one system while customizing recurring events to fit the providers’ needs. You may also use the system to schedule equipment and specific rooms. Using this automated scheduling allows for quick searches of open slots which leads to more efficient scheduling procedures.

The Patient Appointment Scheduling software is customizable to your office needs and uses. Templates can be designed to schedule reoccurring events and block out times that cannot be scheduled. pbs can also tailor printouts of daily schedules, patient information, and billing information from the Patient Appointment Scheduling software for your office. Patient Appointment Scheduling is an optional part of the HOMS software. If you would like to add Patient Appointment Scheduling to your system, please call pbs.

Daily Appointment Screen

This screen allows you to perform most of your scheduling functions. From this screen you can set up patient appointments, search for open appointments, view a specific date, view an entire month at a time, change or delete patient appointments and print schedules. The current days schedule will show when you first open this screen. Use option 11, Appointment Scheduling, from the HOMS main menu to access this screen. Access can be given or restricted on a per schedule basis.

The headings at the top of the screen are automatic. The current day and date are displayed. The number of scheduled appointments for the day is displayed on the right side of the screen at the top. On the far right of the screen the doctor, service, or location code is displayed along with a short description of that code.

Also displayed at the top of the ‘Appointment List’ screen are the following options.

A=Add Add an appointment.

V=View View or change an existing appointment.

C=Copy Choose an appointment to copy.

M=Move Choose an appointment to move.

H=Here Where you will either be copying or moving an appointment.

O=Out Mark an appointment time slot as out. This will close that time slot.

D=Delete Delete an appointment.

P=Print Print out a single super bill for the patient.

/=Cont Continues a patient’s appointment through additional time slots.

W=Window A window pops up allowing certain patient forms to be requested.

Side Option Bar Definitions

F12 Exit the current screen you are viewing and return to the screen you were previously viewing. This will cancel any pending add, delete or print commands.

F3 Exit without change, returns display to the main menu.

F10 Display the schedule one day in the future from the current schedule you are viewing.

F9 Display the schedule one day previous to the current schedule you are viewing.

F22 Displays the schedule one week in the future from the current schedule you are viewing.

F21 Displays the schedule one week previous to the current schedule you are viewing.

F2 Locates one or two appointment schedules by date and/or doctor/location.

F8 You may change the appointment schedule you are looking at by jumping ahead or back a specified quantity of days, weeks, months or years.

F4 List of doctors, locations and their codes.

F16 Find scheduled appointments by patient name and/or date range and/or doctor.

F17 Search for an open appointment.

F6 Add an appointment.

F7 Display calendar for a full month.

F11 The schedule can be viewed with or without the open appointments listed.

F5 The screen may be split, showing two daily appointment schedules, or full, showing only one daily appointment schedule.

F20 Displays, emails or prints the number of appointments for a date range determined by you. Appointments can be grouped by Type, Location, City, Zip or Referral.

F15 Print a copy of the schedule for the day you are currently viewing.

F14 Change the default information to display for the schedule.

Field Definitions

Doctor The doctor’s initials should be entered here. The program will default to the initials of the doctor you were viewing when you selected this screen. If you are unsure of what the doctor’s initials are, place the cursor in the field and then press F4. This brings up a list of doctors and then you can select the doctor with whom you want to schedule the appointment.

Date Enter the date of the appointment. The program will default to the date of the appointment schedule you were viewing before you selected this screen. The date should be entered as 6 digits. The slashes separating the month, date, and year are automatically added when the screen is entered.

Time This is the time of the appointment. If the time is not already filled in you will need to enter it using 3 or 4 numbers followed by AM or PM.

Min Enter the number of minutes the procedure will most likely take.

Check-In Initials of the staff member that checked the patient in.

Time Enter the time the patient checked in. (Note: Schedule preference must be ‘E’ to display this information.)

Type This is the type of appointment you are booking. It may be up to 5 characters in length. Examples are ‘NEW’ for a new patient or ‘OC’ for an office call.

Loc This is the location where the patient will be seen. It may be 3 characters in length. If you are not sure what the location abbreviation is, place the cursor in the field and then press F4. Then select the needed location. Examples are ‘OFC’ for office or ‘HOS’ for hospital.

By This is the initials of the person who scheduled the appointment. It may be 3 characters in length.

First Name The first name of the patient should be entered here.

Last Name The last name of the patient should be entered here.

Sfx This is the suffix of the patient’s name.

New? Enter ‘Y’ for yes, if this is a new patient or ‘N’ for no.

Account# The account number of an existing patient.

Reason for Appt You may enter up to 26 characters of description for the reason of the appointment. This field is shown on the previous screen. If you need more than 26 characters for this field you may enter additional information in the ‘Additional Information’ field.

Address Lines The patient’s address information.

Insurance This field shows patient insurance information that was entered on the patient’s insurance screen.

Referred by If applicable, fill in the referring physician’s number. If you are not sure of the physician’s referring number press F4 for the list. Fill in the first three letters of the physician’s last name on the ‘Position To:______’ line and press enter. The screen showing that physician’s referring number will display. Press F12 to go back to the Patient Appointment Data screen. Tab back to the ‘Referred By:______’ field and fill in the appropriate one-digit to five-digit number for the referring physician.

Primary Care Physician If applicable, fill in the primary care physician’s number. If you are not sure of the physician’s referring number press F4 for the list. Fill in the first three letters of the physician’s last name on the ‘Position To:______’ line and press enter. The screen showing that physician’s referring number will display. Press F12 to go back to the Patient Appointment Data screen. Tab back to the ‘PriCarePhys:______’ field and fill in the appropriate one-digit to five-digit number for the primary care physician.

PriDr# This is the patient’s primary doctor’s number.

REA Request Earlier Appointment. Would the patient like an earlier appointment? Y for yes or N for no.

Birth Enter the patient’s birth date in this field. The slashes separating the month, date, and year will automatically be added when you enter the screen.

Age The patient’s age is calculated from the birth date you entered. The only way to enter or change a person’s age is to change the ‘Birth’ field.

Sex This is the patient’s gender (F=Female, M=Male, or B=Business).

MS This is the patient’s marital status. Valid codes are S=Single, M=Married, W=Widowed, D=Divorced, X=Legally Separated, or U=Unknown.

Soc.Sec.No. Enter the patient’s social security number in this field. The dashes between the numbers will automatically be added when you enter the screen.

Home Phone The patient’s home telephone number.

Work Phone The patient’s work telephone number.

Cell Phone The patient’s cell telephone number.

Custom Field #1-5 These fields can be named anything. You can enter up to 26 characters in these fields. They are currently labeled ‘Additional Information’.

When adding an appointment the “Appointment Type” field has a pop-up window to display available Types. The user can define a specific color for the appointment, template, or both. Place the cursor in the Type field and select F4 to display available options and F6 to add another Type.

If needed an appointment can be scheduled to be repeated in the future. From the appointment schedule screen enter an “A” to add an appointment. Select F19 to display the Repeat Appointment window. Next, specify appointment criteria.

Adding Patient Data

If the patient has a patient record already entered you do not have to manually fill in the patient information. Position the cursor on the patient’s first or last name and press F4.

Select the patient you would like to make an appointment for by clicking on the patient’s name. The patient demographic information will automatically be filled into the Patient Appointment screen. Use ‘Position To:________’ field to look up patients by last name.

X-Select Select a patient, press enter and the demographic information will automatically be filled into the ‘Patient Appointment’ screen.

C-Change Change the demographic information for a specific patient.

Position To: Type in part or all of the patient’s last name and press enter. The screen will position the list of patients to show patients with the specified name and other names below the specified name alphabetically.

Side Option Bar Definitions

Field Definitions

Last Name Enter the patient’s entire last name or a portion of it.

First Name Enter the first character of the patient’s first name.

Account Number Enter the patient’s account number.

Date Range Enter the dates the person could be scheduled within if known.

Doctor Enter the doctor’s initials if known.

Type Enter the type of appointment you need. For example, ‘NEW’ for a new patient or ‘ALL’ for all types.

Patient Tracking System

Press F5 while viewing a patient appointment to display tracking information. This window displays “Past”, “Complete”, “No Show”, “Cancelled”, “Rescheduled” and “Future” appointment totals. “Recall” appointments are also tracked.

To maintain patient appointment tracking data you must indicate a tracking event by populating the “NCR” data field with the appropriate event indicator. Possible indicators include “N” = no show, “C” = cancel, “R” = reschedule.

Monthly Calendar View

Use this feature to view the calendar month for a doctor or location. To see the calendar for a specific month click ‘Calendar’ on the Side Option Bar or press F7, and then the following screen will display.

The calendar will display prescheduled appointments, such as days the doctor will be out of the office or other pre-designed templates. The feature will also display the number of morning and afternoon appointments scheduled for a specific doctor or location. For example in this display, there are three morning appointments on the 1^st and no afternoon appointments scheduled.

Template Editor

F18 launches the template editor. A user may edit the doctors schedule template from this window. Enter the time you wish to insert at the bottom of the template. The program will automatically insert this in the correct order. A schedule can be modified for a single day or for the duration of the schedule. The template editor can be launched from the appointment schedule or calendar screen.

Side Option Bar Definitions

Field Definitions

Start Date: Enter the date for which you would like a schedule in MMDDYY form.

Ending Date: Enter the ending date of the schedules you would like to print. Leave blank if you only want to request one day.

Doctors: Enter doctor codes for the desired schedules or ‘All’ for all doctors’ schedules.

Locations: Enter location codes for the desired schedules or ‘All’ for all locations.

Print lab/ nurse schedule: To print a lab/nurse schedule place a ‘Y’ for yes in this field. If you do not want a lab/nurse schedule place a ‘N’ for no in this field.

Print open times: If you would like the schedule to print all possible times for appointments, place a ‘Y’ for yes in the field. If you only want scheduled times to be printed, place an ‘N’ for no in the field.

Print referring doctor information: Prints the patient’s referring doctor.

Print recent diagnosis: Prints the most recent diagnosis codes entered in the patient’s account along with the diagnosis code meaning.

Print patient insurance information: Prints patient’s insurance coverage along with their subscriber ID number.

Print additional information text: Prints additional information about the patient such as, insurance company and when the patient was last seen. If you would like to print additional information, choose ‘Y’ for yes in this field. If you do not want additional information to print, choose ‘N’ for no in this field.

Print Cell Phone: Prints patient cell phone number.

Print Account Balance: Prints the patient and insurance responsible balance.

Group by: Determines if the schedule is grouped by doctor or location. Place a ‘D’ in the field to group the schedule by doctor, or place an ‘L’ in the field to group the schedule by location.

Sort by: Determines if the schedule is sorted by appointment times or alphabetically by patient name. To sort by appointment times place a ‘T’ in the field, to sort by patient name, place an ‘N’ in the field, or to print both reports, place a ‘B’ in the field.

Print number of copies: Enter the number of copies you wish to print (1-9).

Orientation: This determines the paper orientation portrait or landscape. Enter a ‘P’ for portrait or ‘L’ for landscape.

Printer: Specify printer name or use *Printer to select your default printer. Enter *Email to deliver the report to your pbs email account.

Email: If you specified *Email in the Printer section enter your pbs email alias here. This field may be auto filled.

Print patient name labels? To print patient name labels, enter ‘Y’ for yes in this field. If you do not want patient name labels printed enter ‘N’ for no in this field.

Label Printer: Specify where you want to print patient labels. Use *PBS to print at PBS or enter the name of your label printer.

Other Appointment Scheduling Features

Press F19 from the appointment screen to show the Display Database Journal window. This can be used to show the adds/changes/delete history of a patient.

Appointment “Type” error message will be generated when appointment data is used with special “Types”. These “Types” include: NOTE, OUT, OFF, LUNCH, CONT. Patients should not be scheduled in a time slot with one of these “Types”.

Press F20 from the appointment screen to quickly display appointment counts for the days schedule. The counts can be broken down by Type, Location, No Show, Insurance or Sex.

Searching for Type Service Codes

To search for a specific code, type the code number and press enter.

If you need to make any changes to the information for a specific TSC, type in the TSC number to display the TSC information and then make necessary changes. Make sure that you press enter after making changes so that the information is entered into the system.

Remember to consult the most recent CPT manual and current Medicare fee schedule before making changes to the codes.

If the code is not on file, the TSC entry fields will display with blank fields and you can add a new code

Field Definitions

Description of Service The top line of this field is for the long description of the TSC. This description is for your information. The bottom line is for the short description of the TSC. This description is what prints on the statement.

CPT# The top box is for the current year, the box beneath it is for the prior year.

HCPCS# The top box is for the current year, the box beneath it is for the prior year.

(These field names change annually and the code files are updated each year.)

Md Md These are two optional modifiers used to explain special circumstances regarding a procedure. For example, the modifier for assistant surgeon is 80. To report ‘professional component only’ for diagnostic x-ray, diagnostic laboratory or radiation therapy, use modifier 26. To report ‘technical component only’ for x-ray (limited to specific circumstances), use modifier TC.

Please refer to the CPT or HCPCS manual for a list of valid modifiers and their usage.

PS This is the place of service code. Following is a list of valid PS codes:

1 – Pharmacy

3 – School

4 – Homeless Shelter

5 – Indian Health Service Free-standing Facility

6 – Indian Health Service Provider-based Facility

7 – Tribal 638 Free-Standing Facility

8 – Tribal 638 Provider-based Facility

9 – Prison-Correctional Facility

11 – Office

12 – Home

13 – Assisted Living Facility

14 – Group Home

15 – Mobile Unit

20 – Urgent Care Facility

21 – Inpatient Hospital

22 – Outpatient Hospital

23 – Emergency Room-Hospital

24 – Ambulatory Surgical Center

25 – Birthing Center

26 – Military Treatment Facility 31 – Skilled Nursing Facility

32 – Nursing Facility

33 – Custodial Care Facility

34 – Hospice

41 – Ambulance - Land

42 – Ambulance - Air/Water

49 – Independent Clinic

50 – Federally Qualified Health Center

51 – Inpatient Psychiatric Facility

52 – Psychiatric Facility - Partial Hospitalization

53 – Community Mental Health Center

54 – Intermediate Care Facility/Mentally Retarded

55 – Residential Substance Abuse Treatment Facility

56 – Psychiatric Residential Treatment Center

57 – Non-Residential Substance Abuse Treatment Facility

60 – Mass Immunization Center

61 – Comprehensive Inpatient Rehabilitation Facility

62 – Comprehensive Outpatient Rehabilitation Facility

65 – End-Stage Renal Disease Treatment Facility

71 – Public Health Clinic

72 – Rural Health Clinic

81 – Independent Laboratory

99 – Other Place of Service facility.

LAB? This field indicates if this is a clinical lab procedure. Enter ‘Y’ for yes, ‘N’ or blank for no.

#TM This field indicates the number of times a service is commonly billed. Normally this field will be blank to indicate 1 time.

INS Enter an ‘N’ in this field if you never want this TSC filed to Insurance.

NAR This field is used to define a narrative to be submitted on the insurance claim.

D – TSC description is used as narrative.

M – Transaction memo is used as narrative

B – Both TSC description and Transaction memo is used.

* This field is used to define how a TSC should be billed.

1 – Charge, 3 – Payment, & 4 – Write-Off

NDC This field is for the National Drug Code Assigned to billable drugs.

(Must be 11 digits)

DIAG This field is used if there is only One Diagnosis used for the procedure. This is normally blank.

To Add a Fee

To add a fee, type the code you want to add a fee to and press enter. Once your code appears, choose option ‘Add Fee’, F6. The following screen will then appear.

Field Definitions

Year The year the Fee is set up. The current year will display when you press F6.

Sched This is a single number or letter to designate the fee schedule. You may have up to eighteen different fee schedules for each TSC. For example, you would use an ‘M’ for the Medicare fee schedule. Leave this field blank for the standard fee.

Grp This is the code used for a certain group of doctors.

Mod This indicates the fee for a specific type service code modifier.

Std. Fee This is the default amount to be charge. You will need to enter this amount with decimals.

Referral Source Code

Referral source codes are three digit codes assigned by the system to each person, or other source, that refers patients to your office. These codes make it possible for the system to manage referral information. The system will keep a record of all referrals by that source. Referring providers are required on some procedures submitted to Medicare. For example, consultations require a referring physician. To add, search for, or change referring physician information choose option 43, ‘Referral Names’ from the main menu. The following screen will display.

Side Option Bar Definitions

Field Definitions

Code You define this code to represent this insurance company when you select this insurance company for patients and insurance processing.

Insurance Company Name and address information identifies this insurance company and prints on claims and labels for mailing.

Telephone & Fax Numbers You can track telephone and fax numbers to use when following up on insurance claims. There is a place to keep a contact name if you have someone at an insurance company who is helpful in resolving claim issues.

NAIC Code number routes electronic claims through claims processing centers much like a mailing address routes paper claims through the postal system. The insurance company can provide their number or pbs can look it up for you.

INS TYP Defines edit rules, B=Blue Cross Blue Shield, C=Champus, M=Medicare, O=Other Commercial Insurance, S=United Health Care, T=Tricare, U=Mutual of Omaha, W=Nebraska Medicaid.

Par ? Indicates your participation status with this insurance company. Y = Participate N=Do Not Participate

AOB ? Assignment of benefits, Y = Assign payment to the provider N or BLANK=Payment normally sent to the patient. (Claims processing rules for various types of insurance affect interaction of Participation and assignment of benefits.)

WC Y= to check the ‘related to employment’ or ‘workers comp involved’ box on the insurance form. N= to check the NO box, or leave field blank if neither box should be checked.

Med Gap A medigap policy supplements Medicare benefits by filling in some of the ‘gaps’ in Medicare coverage. If your patient has a medigap policy place an ‘M’ in the Med Gap field. Medicare also has a program to automatically crossover Medicare payment information for Medicare beneficiaries. If your patient has secondary insurance coverage with a company that participates in Medicare’s crossover program place an ‘X’ in the Med Gap field.

Sel DME Durable Medical Equipment, controls whether the claim should contain the following charges, D=DME only, N=Non-DME only, and Blank=all charges, DME and non-DME.

Mult Dr/Clm Y= allow multiple doctor charges on the same claim. N= file separate claims for multiple doctors.

Bch Ins? Y= create insurance claims for this insurance company when processing automated batch insurance. N= do not include this insurance company when processing batch insurance.

Ntc TSC Notice Transaction Service Code determines the transaction that is generated when insurance processing runs. This transaction displays on the patient detail screen and statement.

Fee Sch To use a standard fee leave field blank, enter a fee schedule code for fee lookup.

CPT Ver Blank is default to use current year CPT code verification. Enter the year to use for verification if the insurance company does not use the current year CPT codes.

Auto Flag Not Used

Form Type Type of claim form that will be used when printing paper claim. NF = No form, C1 = CMS1500 form, C2 = CMS1500 form plus duplicate, X1= ADA2006 Dental form, X2 = ADA2006 Dental form plus duplicate

XBox 1-7 Corresponds to box 1 of the HCFA 1500 form, 1=Medicare, 2=Medicaid, 3=Champus, 4=Champva, 5=Group Health, 6=FECA BLK Lung, 7=Other

Pat Sig? Y= print ‘PATIENT SIGNATURE ON FILE’ in box 12 on the HCFA1500 form. N= leave box 12 blank.

Dr. Sig? Y= to print ** AUTOMATED SIGNATURE ** along with the doctors name in the doctors signature area on the insurance form.

Bx25 S/E Controls which number prints in box 25 Fed Tax ID #, S=Social Security number, E= Fed ID number.

Bx33 C/P Controls which address prints in box 33 C = Clinic, P=Provider.

Prt 0? Controls printing the zero amount charges in the detail section of the insurance form. Y= yes, N= no.

Prt Grp Sorts the printed insurance forms by this character. All insurance codes that you want sorted in the same group must have the same ‘sort group’ value. Blank is a valid sort group code.

Prt Seq Defines the sequence that the insurance forms and labels will be printed within each sort group. Z=zip sequence A=alpha by patient name N=numeric by patient number.

ICo Lbl? Insurance company mailing label, Y= print insurance company mailing label for each paper claim.

Pat Lbl? Patient mailing label, Y= print patient mailing label for each paper claim.

EMC ? Electronic Claim submission, Y= submit claims electronically for this insurance company, N=Print paper claims only.

EMC Rcv Controls which electronic receiver pbs sends claims to. A=Ameritas, B=BCBS of Nebraska, C=Noridian, D=WebMD, E=Emdeon, F=United Concordia, G=Clearconnect, K=BCBS of Kansas, M=Medicare, N=KS Medicare, R=Railroad Medicare, T=Tricare, U=Mutual of Omaha, W=Medicaid.

EMC TSC Transaction Service Code that will display on the patient screen and statement when an electronic claim has been processed for this patient.

EC HCFA Y= Prints a ‘file copy’ insurance claim for claims submitted electronically to this company.

Pmt TSC# Transaction Service Code that will display on the patient transaction history screen and on financial reports when payments are entered for this insurance company.

WrtOff TSC# Transaction Service Code that will display on the transaction history screen and on financial reports when write-offs are entered for this insurance company.

Field Definitions

Batch# This is the number that is used to identify the batch. A simple numbering plan you may use is ‘mmdd-1’ The last number can be 1- Charges, 3-Payments.

Dr This is the number of the doctor who performed the procedure.

TSC# This is the type service code.

C Charge codes designate whether a transaction is a payment, charge, or adjustment. The valid charge codes are: 1-Charge for procedure performed, 2-Miscellaneous income or cash payment at time of service, 3-Payment on account, 4-Miscellaneous credits, 8-Additional diagnosis or additional modifiers, 9-No charge item. A ‘no charge’ entry in this C will print ‘no charge’ on the patient’s statement.

TranDate This is the date of the transactions.

Memo This is the name of the patient or other relevant information.

BillgYM This is the year and month the transactions will be billed in.

PS This is the place of treatment code.

Note: The default settings can be overridden when typing information into the batch. For example, if you set your default charge code at 2, but type in a charge code 1 in data entry, the charge code 1 will override the default charge code 2.

Batch Entry

After setting the default information for the batch press enter and a data entry screen will display. The following screen is an example of a data entry screen. There are other data entry screens that can be accessed by pressing F11. The alternate screens allow you to enter payments, charges, miscellaneous adjustments and mixed entry. The following screen should be used when you want to enter charges.

As each screen is completed press enter and this will bring up the default values that you entered at the start of entering. You will then need to press enter again so that a blank screen is displayed. Once you see the blank screen the transactions that you entered are saved to the system and you can continue entering transactions. Make sure your default data has not changed before you begin entering on a new screen. When all charges are entered, press F4 to view the batch and the totals. If you need to make additional entries press F6 to return to the entry screen.

Each line has three fields for modifier codes and diagnosis codes. If additional diagnosis codes need to be entered for a charge fill in the next entry line with the same information as the previous line, with two exceptions. Use C8 in the ‘C’ column and leave the ‘Amount’ column blank. This allows you to enter additional diagnosis codes without entering additional charges.

Side Option Bar Definitions

Field Definitions

Patient# Enter the billing account number and single digit patient number for this patient. The patient number is only used for family billing

F.Name/Memo Enter the patient’s first name or other information. If you need to enter a referral doctor, enter the referral doctor’s number in the first three positions of this field. If you are entering a transient patient (#99999), enter the patient’s first initial and last name.

TranDate This is the transaction date. If the transaction took place on a single date, enter the date in MMDDYY format. If the transactions took place over several consecutive days, enter the dates in MMDDDDYY format with the first ‘DD’ as the first transaction date and the second ‘DD’ as the last transaction date. If entering a patient recall, enter the recall month as MM00YY. If the charge code is ‘8’, the transaction date must be the date the procedure was performed.

Dr# This is the doctor number of the doctor who performed the procedure.

PS This is the place of treatment code. If there is a place of treatment defined for this procedure in your TSC master file, you may leave this field blank.

TSC This is the type service code for the procedure performed, or the recall TSC

Md Md Md These are three optional TSC modifier codes. Additional modifiers will be entered on a separate line with a CC8 ‘no charge,’ and the date the procedure was performed.

Amount This is the amount charged for the procedure. Do not enter the decimal point. If you do not use a fee schedule, you must enter the total amount of the charge. For example, if a patient has two of the same procedures on the same day, you would enter a ‘2’ in the #TM field and the total for both procedures in the amount field. If you use a fee schedule, the system will enter the total charge for you.

#Tm This is the number of times the procedure was performed on the same day or consecutive days. Leave blank if the procedure was performed only once.

Diag Diag Diag You can enter up to three diagnosis codes for the TSC here. Additional diagnosis codes will be entered on a separate line, with a CC8, ‘no charge’, and the date the procedure was performed.

C The charge code.

A second method for entering charges is to post transactions one at a time to a specific account. This method allows you to immediately view the patient’s services for the day. Select option 6, ‘Transaction History with Balance’, from the main menu. Enter the account number or name of the patient. Once you have selected the patient, the transaction history screen will appear. Now select option ‘Enter Charge’ or F18, to add a charge and the following screen will display.

The date will default to today’s date but once changed the new date becomes the default date until it is changed again. The Batch # defaults to today’s date with a modifier of 1. This can be changed and the new information will become the default for future entry until changed again.

Enter appropriate data from the encounter form and press enter. You have room to enter four procedures at one time. You will need to repeat the process if you have more than four procedures.

Side Option Bar Definitions

Field Definitions

Account# This shows you the account number you are entering charges for.

P# Patient number.

Date This will default to today’s date but can be changed to reflect the date the patient was seen by the physician.

CPT #

Md Md Md These are three optional TSC modifier codes. Additional modifiers will be entered on a separate line with a CC8 ‘no charge,’ and the date the procedure was performed.

#Tm This is the number of times the procedure was performed on the same day or consecutive days. Leave blank if the procedure was performed only once.

Memo Enter the patient’s first name or other information. If you need to enter a referral doctor, enter the referral doctor’s number in the first three positions of this field. If you are entering a transient patient (#99999), enter the patient’s first initial and last name.

PS This is the place of treatment code. If there is a place of treatment defined for this procedure in your TSC master file, you may leave this field blank.

Batch# This will default as the date but can be changed to different batch number.

Bilg.YM This is the current billing year and month that you are entering charges into.

Viewing a batch

After you have entered a batch you may want to view your entries for accuracy or to make additional changes. To view your batch, press F4 ‘Batch List’ from your ‘Charge Entry’ screen. The following screen will display.

You can make additional changes to a specific entry in a batch by placing a ‘C’ next to the entry you want to change. You can also change multiple entries in a batch by placing a ‘G’ next to the entries you wish to change.

Option Definitions

C - Change To change the information for a specific entry place a C next to the entry you want to change.

D - Delete To delete an entire entry place a D next to the entry you want to delete

G - Gangchng This function changes every entry selected. For example, if you typed in the wrong batch number for the entries you could place a G next to each entry that is in the incorrect batch. A new screen will display that allows you to make changes to all the selected entries.

L - LckupFee To add the predetermined fee for the procedure place an L next to the entry you would like the fee to be added. The fee is based on TSC information entered in the TSC/Fee Master option 41 on the main menu.

T - TrnInq This option brings up the ‘Transaction History’ screen for that patient. Place a T next to the entry that you would like to view.

A new transaction screen will display for the entry that allows you to make your changes.

Tab to the field that needs to be changed and enter the correct data. Press enter after the necessary changes have been made. On the Batch Transaction screen, the line you changed will be highlighted in white. Verify the change was entered correctly.

Side Option Bar Definitions

After entering you EOB Payment information, press enter and the ‘Verify Totals’ screen will appear.

If you have only one claim for the patient you will not see the ‘Verify Totals’ screen it will go straight to the ‘Transfer Balance’ screen.

After you verify your totals, press enter and the ‘Transfer Balance’ screen will appear. This allows you to allocate the remainder of a charge to the patient, or a secondary insurance company.

Unapplied Credits - Open Item

Unapplied credits occur when a payment entered into the open item system is not associated with a specific charge. The system does not link the specific payment with any charge and the payment will be displayed in red on the transaction detail screen. To redistribute unapplied credits to a specific charge, you should first run the ‘Unapplied Credits Report.’ To run this report select option 59 ‘Other Reports/Printer Options’, from the main menu. At the report menu, select option 410 ‘Unapplied Credits.’

To redistribute the patients listed in the unapplied credits report, choose option 6, ‘Transaction history with balance’, from the main menu and enter the patient number. The unapplied credit should be displayed in red as shown below.

Place an ‘R’, for Redistribute, next to the unapplied credit. A screen will then ask you to ‘Distribute Dollar Amount’. You may then select the correct charge. Make sure to verify that the dates of the unapplied credit and the charge are the same. Following is an example of the ‘Distribute Dollar Amount’ screen.

You should print the unapplied credits report at least once a month and redistribute unapplied credits. Make sure and complete this process before billing to prevent statement errors.

Payment Entry – Previous Balance

Choose menu option 21 ‘Enter Transactions by Batch.’ Before you begin entering information you must determine the default information for the batch. The default data remains constant through all entries until it is changed. Enter the default information and press enter. If a charge entry screen appears, press F11 until the payment entry screen displays. Remember, you do not have to retype the default data for the batch in the payment entry screen.

Fill in the required information in the payment entry screen. As each screen is completed press enter and this will bring up the default values that you entered at the start of entering. You will then need to press enter again so that a blank screen is displayed. Once you see the blank screen the transactions that you entered are saved to the system and you can continue entering transactions. Make sure the default data has stayed the same before you begin further entry. Press F4 to review the payments you have already entered for the batch. It is often useful to put the date of service in the Memo column. This allows you to keep track of claims if you should need to correct or review an entry.

While previous balance software does not automatically link payments to charges or insurance companies you can utilize TSC numbers to summarize payment and write off amounts for various insurance companies if you want more detailed monthly reporting. Payment service codes include: insurance payments, insurance write offs, interest charges on past due accounts, patient payments, and small balance write-offs. For example, a Medicare payment could be a service code 32 and a Medicare write-off could be service code 42.

If you group your payments in batches corresponding to your bank deposits you can print a deposit report to match your bank deposits. The deposit report is requested with the daily proving report. It lists all the payments in the batch, as well as the total, in alpha order.

Side Option Bar Definitions

Additional Entry Instructions

While most data entry consists of entering charges and payments, there are certain entry procedures that you may not use often. These include handling returned checks or refunds, reversing errors, entering income, collection accounts and write-offs, and recording traffic. The following is a list of these items and their specific entering instructions.

Reversing Entries

If an error occurs after billing is already done, you can still reverse the entry in the current month. To reverse a payment, an adjusting entry, or charge, go to the ‘Transaction History’ Screen, option 6, and type a ‘field minus’ in the box to the left of the entry line that you want to reverse. Be sure to back date your entries or add the original date in the Memo field.

Professional and Non-Professional Income

To enter professional and non-professional income use the following data, account #99999, C2, and TSC 998 (non-professional income) or 999 (professional income). Enter a brief explanation in the ‘Memo’ field.

Refund Checks

To record a refund check, where you wrote the patient a check, to a patient’s account use a TSC 20 (refund) and a ‘field minus’ after the amount in C3.

Returned Checks

To record a returned check, use a TSC 2 (check returned) and a ‘field minus’ after the amount in C3.

Collection Accounts

There are three ways to handle collection accounts using the HOMS software.

You can mark the patient account with a flag code, you can move all collection accounts into a single account, or you can write off the accounts when you turn them over to collections. Each method is explained in detailed instructions below.

1. Flag code method

To turn a patient over to collections, mark the patients account with a flag code CA for collection agency. To record a payment from a collection agency, enter it as a normal payment entry on the collection account. Enter the fee kept by the collection agency as TSC 993 (collection expense) on the collection agency account in C4. You may wish to write off any remaining balance on the patient’s account.

2. Collection account method

On the patient’s account use a TSC 994 (collection credit memo) and C4. Enter the patient’s balance in the amount field. This entry requires an offsetting TSC 995 entry. You would use your collection agency’s account number with a TSC 995 (collection charge memo) and post the patient’s balance with a ‘minus’ sign after the amount in C4. To record a payment from a collection agency, enter it as a normal payment entry on the collection account. Enter the fee kept by the collection agency as TSC 993 (collection expense) on the collection agency account in C4. You may wish to write off any remaining balance on the patient’s account.

3. Write-off method

You may want to reduce your Accounts Receivables when turning patient’s over to collection agencies. If you decide to write off all accounts turned over to collections you can record payments on these accounts by entering them as 992 (collection income) with a C2.

Write Off

To write off, as uncollectible, all or part of a balance, use a TSC 996 (uncollectible) and C4.

Traffic

To record the number of patients seen in your office over a specific time period, use traffic. At the end of each session or day enter traffic by using TSC 997 (traffic) and a C2. Enter the number of patients in the ‘#Tms’ column. You will not enter an account number. You may create a separate batch for traffic entries or enter traffic as the last line in each batch you enter.

Proving a Batch

The printout of the batch information is titled the ‘Detail Proving Report.’ Proving is extremely important to ensure all data entry was completed correctly. There are several ways to print proving. Proving can be printed from the batch entry screens by selecting ‘Print Batch’ or F15, from the ‘Transaction Batch Balancing’ screen, option 25 from your main menu, and from the ‘Display Current Month Batches’ screen, option 23 from your main menu.

After printing the batch, carefully compare the detail proving report to the source information to make sure everything is correct. An error list will also print with the proving if certain incorrect information was entered. (e.g. invalid account number, invalid TSC or diagnosis code). Careful attention to proving can correct most data entry mistakes at this point. For a sample proving report, see Appendix 3.

When all errors are corrected and the batch totals verified, press F9 to indicate the batch is balanced. These totals will now be automatically transferred to the control log, option 25 from the main menu. It is important to keep a control log of your batch totals to compare with proving before cut-off. A control log is designed to keep you informed of your month to date totals. Use option 25 ‘Control Log Balancing’ to keep the control log on the HOMS system. You may also want to keep a paper control log for your use as well.

To view the control log select option 25, ‘Control log balancing’ from the main menu and the following screen will display.

In this screen you can view the totals for each batch. From this screen you can also print detail proving reports and submit insurance. Keeping the control log up to date will make it easier to balance at the end of the month when you are ready to ‘close out’ the month.

If you made any adjustments to batches since they were balanced press F5 on the control log to recalculate the totals. You should make sure all adjustments made to the balanced batches are correct. Use an ‘R’ to replace the old totals with the correct totals.

Option Definitions

C - Change Place a C to the left of a batch you would like to edit.

D - Delete Delete an entire batch.

V - View View the batch.

L - Lock Lock the batch so that further changes should not be made.

U - Unlock Unlock the batch.

P - PrtPrv Print a detail proving report for the batch.

R - Replace To replace a changed batch with the new correct totals. Must first recalculate all batches.

I - InsSbm Submit insurance for the batch.

Side Option Bar Definitions

Transaction History

The Transaction History option allows you to view a patient’s medical and financial history. The ‘Transaction History’ screen shows all of the transactions that have been added to a patient’s account. The batch number, doctor number, TSC, memo information, description, place of treatment code, date, diagnosis code, and amount for each transaction is displayed. The ‘Transaction History’ screen also shows some of the information from the patient’s ‘Billing Information’ screen and an aged account balance.

You should become extremely familiar with the ‘Transaction History screen because it contains useful information about a billing account and provides access to many other patient screens.

Transaction History - Open Item

The ‘Transaction History’ screen for the Open Item system has the same functions as the previous balance system. The two are different because the open item system separates account balances between patient responsibility and insurance responsibility.

Selecting option 6, from the main menu, ‘Transaction history with balance’, accesses the transaction history screen. A patient search screen is displayed. Search for the patient you would like to view. Select the corresponding letter for that patient and the following screen will display.

Several options may be selected from the ‘Transaction History’ screen. The Patient’s ‘Notes’, F5, and the ‘Patient Profile’, F7, screens may be displayed, a payment from the patient or responsible party may be recorded, or the billing account may be deleted from the ‘Transaction History’ screen.

The ‘Alt View’, F11 will display the transactions by line item. All transactions posted to a line item will be grouped together to provide a mini snapshot of how a claim was processed.

When viewing the ‘Transaction History’ screen the entries are color-coded as follows:

Pink - Open claims (charges). A claim is considered open until all payments and any applicable adjustments have been made against the claim bringing it to a zero balance.

Black - Charges that are completely closed. Payments and .00 entries are also displayed in black.

Red – Unapplied credits. Any credits that are displayed in red should be correctly applied so that a claim does not remain open.

Option Definitions

C - Change To change the information for a specific entry place a ‘C’ next to the entry you want to change.

D - Dlt To Delete and entire entry place a ‘D’ next to the entry you want to delete.

I - InsDsp Show a detailed insurance distribution for this entry.

P - PmtIns Place a ‘P’ next to an entry to bring up the ‘Claim Payment Entry’ screen. From this screen you can enter payments.

A - AsgnClm Place ‘A’ next to an entry to assign a claim number to the entry.

R - Redst Place ‘R’ next to an entry to redistribute the dollar amount for the entry.

S - ShwDst Show a detailed distribution of the entry.

J - COB

Z - PrtIns To print insurance for an entry place a ‘Z’ next to the entry.

- - Rev To reverse an entry.

U - Unapply Place a ‘U’ next to an entry to unapply a payment distribution for that entry.

Field Definitions

Date This is the transaction date.

Claim # This is the claim number

Dr This is the doctor number of the doctor who performed this procedure.

TSC# This is the type of service code.

MD This is the modifier of the type service code.

Memo This is the information from the F.Name/Memo field when the transaction was entered into the system.

Description This is the description of theTSC.

Diag This is the diagnosis of the transaction

Batch This is the number of the batch were this transaction was entered.

Amount This is the amount of the transaction.

Ins.Bal This is the total amount owed by (or credited to) the insurance company.

Pat.Bal This is the total amount owed by (or credited to) the patient.

0-30 This is the amount of the patient’s balance that is over 0 days past due but less than 30 days past due.

30-60 This is the amount of the patient’s balance that is over 30 days past due but less than 60 days past due.

60-90 This is the amount of the patient’s balance that is over 60 days past due but less than 90 days past due.

Over90 This is the amount of the patient’s balance that is over 90 days past due.

Balance This is the total amount owed (or credited to) the account.

Side Option Bar Definitions

Insurance Processing

In this chapter, we outline the tasks and terminology associated with filing and collecting on insurance claims. While we will focus on the aspects of this process that pbs is directly involved with, please note that there are many internal, practice specific issues involved with insurance processing as well.

Insurance Processing – How the System Works

Your practice will use internal procedures and pbs software to establish insurance coverage for patients, enter charges for your patients, request claims for those charges, and enter payments from the insurance company. Behind the scenes, pbs will run payor specific edits against your claim requests, submit electronic requests or print claims, and communicate to your office regarding necessary claim corrections and statistics associated with your claim filings. Several factors affect the insurance processing cycle including the following:

§ Batch insurance, single requests and electronic secondary claims

§ Electronic or paper claims

§ Verification

§ Participation status and assignment of benefits

§ Insurance company specific procedures

§ Secondary insurance coverage

Batch Insurance, Single Requests and Electronic Secondary Claims

In an effort to speed up the insurance processing cycle, pbs provides an option to process claims for multiple patients using batch processing functions. A batch is a grouping of multiple patients and their charges in a single set of data. Once the information for the batch is entered, the insurance for the batch can be automatically run for all patients in the batch. This greatly speeds up the insurance filing process by eliminating the need for making individual insurance requests. This works well if you have several patients with similar charges. Many clients put office visits into one batch and hospital visits in another so that they can use batch insurance processing for the office visits. Please note that batch insurance should only be submitted once, resubmits will cause duplicate data.

Of course, you may also request individual claims throughout the day. These requests are known as single requests. You may want to request claims individually when additional information must be added to the claim, such as, accident dates or hospital admission dates. Once single requests are submitted they will be processed and reported to you by the pbs clearinghouse. Single claims are also used by clients who wish to print a claim for a patient at the time of the patient’s visit.

To send a claim electronically to a secondary payor the explanation of benefits (EOB) must be entered into the insurance request. This greatly reduces turn around time for payment and eliminates errors or loss of submitted documentation that can occur from manual claim processing by the insurance carrier.

Electronic Claims

There are two means of submitting insurance claims to the insurance company, paper or electronic filing. At pbs, we are directly connected to most insurance companies. This allows us to directly submit most of your claims electronically. Electronic filing is the preferred method for requesting reimbursement because it accelerates the insurance process significantly. When a claim or set of claims is requested for electronic submission, the following process will occur.

1. Requests are transferred to pbs via our data communications network. Your requests are then printed on an Insurance Request Log and returned to your office the next day for review. After receiving the log, review it to make sure all claims you submitted were received by pbs. For more information on the Insurance Request Log and a detailed explanation of its contents, see Appendix 4.

2. Pbs runs Payor specific edits against all claims. We refer to these edits as ‘first level’ edits. Claims that do not pass first level edits are not transmitted but are listed on an EC Reject Log and returned to you along with error messages to help you correct the errors. You have the option of printing a nearly completed paper claim along with the EC Reject Log. Paper claims may print for the patients with errors to help you see what information needs to be corrected. Paper claims will only print if the insurance master is set to do this, so please notify pbs if you would like this option. We recommend that you correct the data in your system and resubmit a claim electronically. Please note that no claim has been submitted to the insurance company for the patients that appear on the EC Reject Log. For more information about the EC Reject Log see Appendix 5.

3. Claims that pass pbs first level edits are transmitted electronically to the payor or the payor’s Designated Claims Clearinghouse (DCC). This is done using internal pbs software and is transparent to you.

4. When transferred claims are initially received by the payor or DCC, an initial verification is performed accepting or rejecting the claims. This acceptance or rejection is transferred back to pbs as a confirmation of the transmission. This is known as a ‘second level’ edit. Claims that are rejected on the second level edit are generally because of Doctor NPI#, or Subscriber # issues. If a claim or batch of claims for your practice does not pass the second level edit, you will receive a reject report from pbs stating the reject reason and how to correct it. In some cases, we may be able to correct the problem directly with the payor. If so, you will receive a call from pbs explaining what happened and how it was corrected. To view the memo you would receive if a claim were rejected under a second level edit refer to Appendix 6.

5. After passing the second level edits, your claims will be processed by the payor where a final set of edits will be applied to the claims. Claims will be rejected if they do not pass the insurance companies specific edits and rules under what we refer to as, ‘third level’ edits. You will learn of the rejection on an EOB sent to you by the payor and pbs will not be notified of the reject. Since the third level reject notice from the payor is not provided to pbs, we are not aware of these rejected claims and you will have to resubmit the claim after correction.

6. Please note that it will be your responsibility to correct and resubmit any rejected claims. We always suggest that you correct and resubmit these claims electronically unless paper submittal is required. At pbs, we are working together to maximize your reimbursement. Please contact pbs if you have any questions regarding the insurance process or rejected claims.

7. Claim is paid.

Paper Claims

Sometimes filing insurance claims on a paper claim form is the only choice. Paper claims may be necessary so that you can attach a narrative. Also, secondary insurance typically requires attachment of an explanation of benefits from the primary insurance when you file a claim. We can print labels for mailing paper claims, or in some cases mail them directly from our office. You may process paper claims as part of your regular batch. When a paper claim is requested the following process will occur.

1. Requests are transferred to pbs via our data communications network. Your requests are then printed on an Insurance Request Log and returned to your office the next day for review. Along with the Insurance Request Log your completed claim forms will be returned. For more information on the Insurance Request Log and a detailed explanation of its contents, see Appendix 4.

2. Payor specific edits are run by pbs against all claims. We refer to these as ‘first level’ edits. Claims that do not pass first level edits are listed on an EC Reject Log. Claims that do not pass pbs internal edits because of missing or incorrect data are listed on this report along with error messages to help you correct the errors. Along with the EC Reject Log, the incorrect paper claims will be returned to you with any insurance reject codes printed on the left bottom corner of the insurance form. This allows you to correct claims, avoiding delayed payments from data entry errors.

3. Paper claims that have no error codes are ready to mail to the insurance company. Claims that have errors should be corrected before filing. Errors will be explained on the reject memo accompanying the claim. We can also print address labels for the insurance company or mail the claims directly from our office if you prefer.

4. After receiving the paper claim, the payor will then run a set of ‘third level’ edits before approving the claim for payment. If a claim is rejected under a third level edit you will learn of this on an EOB and pbs will not be notified of the reject. Please note, we are working together to maximize your reimbursement. We can help you with this if you contact us, however we are not notified of rejects at this level.

5. Claim is paid.

Verification

Verification is an important step in the insurance processing cycle. Verification is the process of checking your records with the records pbs generates about your insurance claims. In order to verify that pbs has received the claims you submitted, it is important to print daily or batch proving reports. Compare the insurance request log with the previous days proving reports to make sure all claims have been filed. Claims that have not been filed because they did not pass first level edits will be listed on the EC Reject Log. Claims listed on the EC Reject Log have not been submitted and must be corrected before filing again.

Participation Status and Assignment of Benefits

A provider may complete a participation agreement with a given insurance company or plan. The insurance company then refers patients to the provider but pays for services based on the plan's fee schedule. Participation agreements affect whether the provider can bill the patient for amounts beyond the insurance company fee schedule or have to write off the remainder of those fees. Participation status is indicated in box 27 Accept Assignment (CMS1500 form) and is not indicated on the ADA Dental Form. Some medical insurance companies read box 27 on the CMS1500 form while many rely on internal records to verify participation status.

Usually participating insurance companies send payment directly to the provider. Box 13 Insured's or Authorized Persons Signature on the CMS1500 form or box 20 on the ADA Dental Form requests payments of benefits are made to the provider. Most providers keep patients signatures on file to authorize payment to the provider regardless of participation status with the insurance company. The claim is then filled out and submitted with SIGNATURE ON FILE.

The software provided by pbs has two places where settings are made regarding participation and assignment of benefits. The insurance company record and the insurance claim request. These records provide the flexibility for each service provider to process insurance to meet their unique requirements as well as the requirements of different insurance companies. When you file an insurance request the insurance company record can provide the default information. You can also override the settings on a per claim basis. For example, Sara had an office visit yesterday; she only has Medicare insurance. Your office does not participate with Medicare, but you would still like to accept assignment for patient Sara. You can do this by accepting assignment of benefits on the insurance claim request screen. The insurance claim request then overrides the insurance master and you will receive payment directly from Medicare for Sara’s visit. In doing this you are accepting Medicare’s fee schedule for payment on patient Sara.

Insurance Company Specific Procedures

Individual insurance companies use various procedures for paying providers. In addition to the claim editing rules, other procedures such as electronic payment reporting and time windows for paying claims will vary from company to company. Even within one insurance company, different plans will receive claims and pay under different procedures. For an example of how participation status and assignment of benefits may vary for each company, see Appendix 7.

Secondary Insurance Coverage

Secondary insurance coverage applies to many patients, especially those patients with Medicare. Many Medicare patients carry secondary insurance policies to cover medical costs that Medicare does not pay for. In most cases, the secondary policy will cover these expenses.

Secondary insurance companies require attachment of an EOB from the primary insurance provider with the claim form. For this reason, some secondary insurance cannot be sent electronically. To make the process of filing secondary insurance easier pbs has created several ways to help you file secondary claims. First, you can have the insurance master set to print a claim form along with the original primary claim when a patient has secondary insurance. After you receive an EOB from the primary insurance attach it to the paper claim and send it to the secondary insurance company. You can also wait until the EOB from the primary insurance provider is received, then request a paper claim for the secondary insurance provider.

Currently, secondary claims can be sent electronically to the following insurance companies: Medicare (required), Nebraska Medicaid, BCBS of NE and Tricare.

For patients with Medicare as their primary insurer, Medicare has a cross over feature with most large insurance companies. When Medicare crosses over with an insurance company, the transfer of Medicare payment information occurs automatically. Medicare sends an electronic EOB to the secondary insurance company. The Secondary insurance bases their payment on this EOB and submits payment to the provider along with their EOB. Often, secondary insurance companies pay before Medicare. When setting up insurance companies in your system, there is an appropriate field to mark Medicare cross over. If this field is marked, the computer will not print a secondary claim, as an electronic EOB will be sent from Medicare.

Field Definitions

Patient No. The patient number that you want to process insurance claims for. Use F4 to prompt for valid patient account numbers.

Ins. Code The code for the insurance company that you want to process claims for this patient. You can leave it blank if you want to process both primary and secondary insurance.

From Date The starting date of service that you want to include on the claim.

To Date The ending date of service that you want to include on the claim.

FAC Cd Enter the facility code for the place of service if other than the office.

Admit Date The hospital admission date if charges are related to hospitalization.

Dschg Date The hospital discharge date if charges are related to hospitalization and the patient has been discharged.

Acc Date The accident date if the charges are related to an accident.

Acc Ind Accident Indicator, A=auto accident, N=no accident, 1=injure at home, 2=injured at school, 3=injured at recreation, 4=work injury, self-employed, 5=auto injury, non-collision, 6=motorcycle injury, O=other (NSF).

AA ST The state the auto accident occurred.

AOB ? Leave this field blank to use the default setting from Patient Insurance for Medicare or Insurance Master for other insurance. Y or N to override the insurance master.

Prior Auth. No. Used if you have received a prior authorization number from the insurance company for the charges.

EC? Electronic Submission of claim. Blank= use normal setting in Insurance Master record N= if you want to over ride the Insurance Master to print a claim so that you can attach additional information and mail it to the insurance company.

Single Request Insurance Processing – Open Item

You may also process an insurance claim from the Transaction History screen. This may be more convenient when you are working with a single patient record and have the transaction detail on the screen. Place a Z in the blank next to the charge you want to request a claim and the ‘Request Insurance Claim’ screen will pop up over the transaction detail. You can then enter additional information related to the claim. A claim request will then be processed after you press enter.

Electronic Secondary Claim Request

You must first enter the Coordination of Benefits (COB) from the primary insurance carrier. This information will come from the explanation of benefits (EOB) provided when the primary carrier processed the claim.

From the ‘Transaction History’ screen, place a ‘J’ in the box next to the charge that you want to request a claim on. The following screen will display.

Side Option Bar Definitions

F12 Exit the current screen you are viewing and return to the screen you were previously viewing. This will cancel any pending add, delete or print commands.

F3 Exit without change, returns display to the main menu.

F4 Place cursor in a field and press F4 to provide a list of available data.

F10 Submits the Secondary Claim.

F11 Toggles through the patient’s insurance coverage.

Enter the information from the explanation of benefits into the appropriate fields. The Copay box is used for Copay and Co-Insurance information. The adjust(ment) box is for entering contractual obligations only. All other denial reasons must be entered in the three boxes directly below. The first two fields have a ‘Prompt’, F4 list that will display the claim adjustment reason codes. (The Washington Publishing Company’s web-site is a resource for this information and can be accessed at http://www.wpc-edi.com/custom_html/claimadjustment.htm)

Press enter to have the system validate your entries. If correct press F10, ‘Submit Sec Claim’ and the ‘Request Insurance Claim’ screen will appear. Enter any additional information related to the claim. A claim request will be processed after you press enter and a ‘~‘ will appear next to every CPT code that was electronic ally sent to the secondary payor.

Electronic or Paper Remittance Advice Posting

Insurance companies will pay providers with a check and an explanation of benefits (EOB). The check is taken to the bank and the EOB is used to enter payments for specific charges, or claims. You can enter these payments using your software, or for the larger insurance payors, pbs will get an electronic file of the EOB and use an automated process to apply these payments. Applying payments automatically eliminates the need to enter each account payment; instead, the payments are automatically posted to all of the correct patient accounts. This greatly reduces the time your office must spend on data entry. The Remittance Advice Posting screen (option 33) is shown below.

Remittance Advice screen functions are described below.

P Post remittance advice automatically to proper account.

R Prints report containing remittance advice details.

D Deletes remittance advice from the system.

X Displays additional information about the remittance advice.

V View posted batch details.

Q Query.?????

Fixing Claim Rejections from the Insurance Claims Reject Screen

This option allows you to view rejected insurance claims, correct the errors, and resubmit the rejected claim. From the Main Menu, select option 35 to display the Insurance Rejects screen.

An Overview of Using the Insurance Claims Rejects screen

From the Main Menu, select option 35. The Insurance Claim Rejects screen will be displayed.

The default information that is first displayed are all claim rejects that we have sent to your system that (1) are up to one year old, (2) have a balance due, and (3) have not had a claim filed since the reject was sent to your system. These are both the rejects that we send to you in a memo and the rejects that are printed on the Claim Error Log. These are claims that need to be corrected and resubmitted.

The first step is to display the Rejected Claim Detail screen. To display the Rejected Claim Detail screen, click on the patient account number or put an “F” next to the reject and press enter. The reason for the reject is displayed at the bottom of the screen.

The next step will be to correct the cause of the reject. From the Rejected Claim Detail screen you can correct most of the errors that cause claim rejects.

Then you will want to resubmit the claim. You can resubmit the claim from the Rejected Claim Detail screen by selecting the Submit Claim option on the left of the screen. Or you can resubmit the claim by selecting the Z option from the Insurance Claim Rejects screen.

You can return to the Insurance Claim Rejects screen by pressing Enter or by selecting Enter from the left of the screen.

The cursor will be to the left of the claim reject you corrected and resubmitted. Enter an “M” and press enter. This will mark the claim as fixed.

Repeat these steps until you have corrected and resubmitted all of the rejects.

Options on the Insurance Claims Rejects Screen

F FixReject. Selecting the F option will display the Rejected Claim Detail screen. From this screen you will be able to correct many claim problems and then resubmit the claim.

V ViewDetails. Selecting the V option will display the View/Change Reject Details screen. This will display more information on the reject sent from the insurance company.

I PatientInsurance. Selecting the I option will display the Patient Insurance screen.

P PatientProfile. Selecting the P option will display the Guarantor Information screen.

Z SubmitClaim. Selecting the Z option will display the Submit Insurance Claim screen.

M MarkAsFixed. Selecting the M option will change the status of the reject to Fixed.

D Delete. Selecting the D option will change the status of the claim to Deleted.

Filter With this screen you can change the date of rejects, the EDI receiver displayed, if zero balance claims are displayed, if fixed or resubmitted claims are displayed, and if deleted claims are displayed.

Options on the Rejected Claim Detail screen

Adding or changing patient demographics or patient insurance. The top of the screen (fields InsID# through ReferBy) contains information from the Patient Information screen and the Patient Insurance screen. Adding or changing information in these fields will change the Patient Information or Patient Insurance screens and will be included on the claim when you resubmit it.

Adding claim submission information. The fields PreAuth# through Disch are for claim submission information. This will be included on the claim when you resubmit it.

Adding notes. The Notes field is used to add notes to the claim reject. These notes can be viewed with the V option on the Rejected Claim Detail screen.

Changing transaction detail. You can change transaction detail by selecting the transaction or putting the cursor to the left of the transaction, entering a C, and pressing enter. This will display the Transaction Detail screen.

Displaying additional rejects. The system will display the reason for the latest reject at the bottom of the screen. If there a earlier or additional rejects, they will be displayed with “Claim Reject” in the Description of Service column. Selecting “Claim Reject” will display the reason for that reject at the bottom of the screen.

Refiling the claim. After you have corrected the errors, you can resubmit the claim by selecting Submit Claim at the left side of the screen.

Billing Procedures and Reports

This chapter explains the steps for cutting off and lists the reports you will receive as a result. It also suggests ways to help manage accounts after billing is completed.

‘Billing’ is the term used for the process at the end of your billing cycle which includes cutting off, printing the statements and reports, processing the statements, and putting together your billing package. Billing usually occurs at the end of the month and is started by the cut-off process.

End of Month

It is recommended to close the month as close as possible to the same date each month. This keeps revenue and production reports consistent from month to month. This date can be set in the middle of the month or any time that fits your schedule best on an ongoing basis.

When you have completed monthly entry call pbs to ‘cut-off’ which starts the billing process.

Cut-Off

Use this procedure on the last day of your billing cycle, when all transactions have been entered for the billing period. This is the prelude to statements and billing reports being printed.

1. Request proving for all batches not yet proven. If corrections need to made make corrections before cutting-off. To learn more about proving, see chapter 5 or Appendix, page 3 for a sample detail proving report.

2. If your office does ‘batch’ insurance, be sure you have requested the insurance for the last batch entered.

3. Add your totals for the month for charges, cash calls, payments, miscellaneous credits and patient traffic.

4. Print a control log out to verify the totals in the system match your totals.

5. Any errors still pending will also need to be corrected before billing is run.

6. Call pbs with these totals. Pbs will verify these totals with the system. Any discrepancies will need to be corrected at this time.

During the billing process the monthly batches are posted to patient accounts and closed to further editing. Several processes run at cut off including aging accounts, adding interest charges, automatic write-offs of small balances, and printing or e-mailing reports. Statements are printed and pbs staff complete the mailing process. Statements that are flagged for special attention are returned to your office for review.

Billing Package

Listed are the reports you will receive from pbs after your billing has been run, printed, and processed. You will have the option of having these reports printed or and electronic PDF version emailed to you through our secure email or a combination of both. It includes the following items.

1. PSA: Professional Services Analysis - This report includes:

Supplementary Schedule – It lists total activity, accounts receivable, and previous years’ activity. If your practice has more than one doctor, there is also a ‘supplementary schedule’ for each individual doctor.

Month by Month Report – It lists monthly activity for the current year as well as the previous year. If your practice has more than one doctor, there is an ‘month by month’ for each individual doctor.

Services and Receipts – A statistical breakdown summarizing services, income and adjustments for the current month, as well as year to date totals.

TSC Breakdown Report - It lists all TSCs used, with descriptions, average fees, number of times used, as well as year-to-date activity.

2. Summary of Accounts Receivable: This is a list of all accounts with a balance. It also ages balances in 30-day increments. Alpha or numeric sort is available.

3. Hold Bill Summary: Lists accounts with balances that were flagged not to print a statement.

4. Statements: These are your patient’s statements that require special attention. They include; 03 flag codes, NA (insufficient address), credit balances, small balances, past due statements (which is any month increments that you would like set up, such as 60 days past due) and any other specially requested statements

5. Other special reports requested by your office:

a. Credit Balance List - Shows accounts with credit balances.

b. Small Balance W\rite-Off list - If the system automatically writes off small balances for you, you will receive a list of the ones written off for the billing month.

c. Agreed Monthly Payment List – Shows accounts with an agreed monthly payment, the agreed payment and the accounts current balance.

d. Unpaid Claims List – A summary of the unpaid claims group by Insurance Company.

e. Insurance Payment Summary – This report provides reimbursement information by Payor for each procedure paid or written off with the billing period.

f. Flag Code Summary - This is a summary of accounts receivable for specific flag codes.

g. Doctor Summary – This is a summary of accounts divided into sections by doctor.

h. Financial Class Summary by Insurance Company - This is a summary of accounts receivable by insurance company.

i. Past Due Summary - This is a summary of accounts receivable showing accounts that have reached a pre-specified age

j. Transaction List - this is a list of all accounts that had activity during this billing period. It lists all transactions for each account.

k. Special Transactions Lists - You may want a transaction list of all your Medicaid patients, all your Medicare patients, or other specific group.

l. Payment Breakdown and Balance Breakdown - These reports list payments and balances, by doctor, for each billing account.

Year-end reports can be produced on CD-ROM to simplify archival storage and record access.

Account follow-up procedure

Once billing has been done and insurance has been filed, you will need to follow up on patient accounts with past due amounts. Each month use your accounts receivable aging report to identify overdue accounts. At pbs, we can provide you with summaries displaying accounts that are 60, 90, 120, and 150 days overdue. These reports allow you to accurately track your overdue accounts.

You can use the information on the Unpaid Claims List to contact the insurance company about outstanding claims and determine if there is a way to speed up the payment process. The accounts receivable summary may be sorted several ways for your office needs. It is also possible to get patient information on the Accounts Receivable summary such as, address and telephone number. This information is useful when making calls to patients about their accounts. For more details about the Summary of Account Receivable Report, see Appendix 8 and 9.

After identifying overdue accounts, your office should contact patients about their accounts. This can be done over the telephone or by mail. When contacting patients use common sense and a straight, truthful approach. Promptly and thoroughly, investigate any complaints from patients about their monthly statements. Be courteous and try to resolve disputes or conflicts before they become a problem.

Monthly collections procedure

The following guide is a month-by-month schedule for managing patient accounts. Again, every office must find what procedures work for them. This schedule is a starting point; your office should develop its own monthly collections procedures to accommodate your needs and the needs of your patients.

1 month

Make sure that all charges have been entered on the patients account. Check to see that the account has been entered with your specific codes to indicate Workman’s Compensations, Medicaid, Medicare, Blue Shield, PPO or other special handling of the account. Once the charge is the patient’s responsibility, send the first statement to the patient.

2 months

Once the first bill has not been paid, a dating message should appear on the next statement, for example, ‘Your balance is past due. Please pay your previous balance or make arrangements with our office.’ You can decide what message you would like printed on your statements or pbs can generate nine statement delinquent notices to choose from. Please contact pbs if you would like statement delinquent notices printed on your statements. At this point, call and check with the patient to determine if there are any problems with their bill.

3 months

You may want this message printed on the statement, ‘Your previous balance is 60 days past due. It is necessary for you to pay this balance now.’ At this point, the accounts manager should generate a collection letter to the patient. For an example letter, see Appendix 18.

4 months

Another dating message should appear on your statement. For example, ‘Your previous balance is over 90 days past due. As much as we regret it, we will take further action if you do not pay your account in full or make arrangements with our office.’ At this point, another collection letter should be generated by the accounts manager and signed by the physician. It is necessary for the physician to be included in the decision making process, since they may know something you don’t. For an example letter, see Appendix 19.

5 months

Write the account off, or transfer it to a separate file of inactive accounts and turn it over to a collection agency.

Collection Agencies

Collection agencies ordinarily retain one-third of any balance collected. Consequently, turning an account over to a collection agency should be done only as a last resort. The agency should have a proven track record and preferably specialize in medical accounts. They should be instructed not to pressure patients facing true financial hardship. If after a reasonable amount of time, the agencies have not been able to collect, the accounts should be written off.

If a patient files bankruptcy, the collection agency should be notified at once and all collection proceedings should cease.

If your office would like a complete Accounts Receivable policy guide, please call pbs and we will customize one for you. If you would like to see a sample accounts receivable policy guide, see Appendix 10.

Accept Assignment, 87

Account Aging, 74, 75, 76, 79

Account Processing, 40

Accounting Methodology, 52

AOB, 87

Appointment Scheduling, 7

Add an Appointment, 10, 13

Calendar View, 22

Display Schedule, 8

Printing, 23, 24

Search for Appointment, 20

Search for Open Appointments, 15, 17

Assignment of Benefits, 87

Batch Entry, 54, 71

Add, 55

Change, 60

Control Log, 62, 72, 73

Delete, 60

Editing, 54

Gang Change, 60

Proving, 54, 72

View, 59

Batches, 54

Billing, 40

Timing, 52

Billing account

Search, 41, 42, 44, 75

Billing Account

Add, 44

Change, 44

Delete, 44

Dependents, 44

Search, 41, 42, 44, 75

Billing accounts

Overdue, 99

Billing Package, 98

Billing Refund, 81, 82

Charge Ticket Entry, 57

Codes

Diagnosis, 33

Procedure, 26, 27, 28, 34

Treatment, 26, 27, 28

Collection Agencies, 101

Command Keys, 4, 5, 60, 81

Control Log, 62, 72, 73

Credits, 64, 69, 80

Cut-Off, 97

Default data, 55, 57, 58, 63, 64

Demographic Information, 13, 40, 44

Electronic Claims, 85, 99

Electronic or Paper Remittance Advice Posting, 89

Error Messages, 5

Face Sheet, 23

Fee schedule, 28, 30, 37, 47, 58, 87, 88

Flag codes, 45, 46

Guarantor, 40, 42, 43, 44, 45, 46, 52, 67, 76, 77, 79

HCFA Common Procedure Coding System, 29, 34

HCPCS Codes, 34

Help, 5

ICD9-CM, 33

Insurance Processing

Batch insurance, 84

Electronic Claims, 85, 99

Overview, 84

Paper Claims, 86

Secondary Coverage, 88

Submit Claims, 90, 91, 94, 96

Insurance Reports

EC Reject Log, 85, 86, 87

Insurance Request Log, 85, 86, 99

Reject Memo, 86

Insurance Setup

Add Insurance Record, 36

Change Insurance Record, 36

Patient Record, 48

Referring Physician, 48

Invalid Entry, 5

Keyboard functions, 4

Keyboard operations, 4

Medicaid, 37, 38, 99, 100

Medicare, 28, 30, 32, 34, 37, 38, 47, 64, 88, 95, 99, 100

Medicare Cross Over, 88

Miscellaneous Adjustment Entry, 57

Non-Professional Income, 71

Open Item, 52

Overdue Accounts, 99, 100

Paper Claims, 86

Patient Accounts, 26, 40, 82, 89, 98, 99, 100

Patient Appointment Scheduling, 7

Add an Appointment, 10, 13

Calendar View, 22

Printing, 23

Search for Appointment, 20

Search for Open Appointments, 15, 17

Patient Information Screen, 44

Patient Insurance information

Change Referring Physician, 50

Patient Insurance Information, 48, 66, 81, 96

Add Insurance, 48, 66, 81, 96

Add Referring Physician, 50

Change Insurance, 48, 66, 81, 96

Delete or Terminate Insurance, 48, 66, 81, 96

Patient Number, 11, 38, 40, 41, 58, 69, 94, 95

Patinet Appointment Scheduling

Display Schedule, 8

Payment Entry, 57, 63, 65, 80, 84, 89

Entry from EOB, 65

Open Item, 64, 65, 69

Previous Balance, 63

Unapplied Credits, 69

Previous Balance, 52

Procedure Code, 26, 29, 34

Adding, 26, 27, 28

Changing, 26, 27, 28

Description, 26, 27, 28

Modifiers, 26, 27, 28

Professional Income, 71

Professional Services Analysis, 98

Proving, 72

Proving Report, 72

PSA, 98

Referring Physician, 30

Add, 30

Change, 30

Refferal Code, 30

Refund Checks, 81, 82

Returned Checks, 71

Reverse Charge, 71

Reverse Entry, 71

Reverse Payment, 71

Secondary Carrier, 88

Secondary Insurance Coverage, 88

Summary of Accounts Receivable, 98

Superbill, 23

System Messages, 5

Transaction History

Entry, 75

Open Item, 79

Previous Balance, 74, 75, 76, 79

Transaction History, 74, 75, 76, 79

TSC, 26, 30, 56, 58

Add, 26, 27, 28

Change, 26, 27, 28

Description, 26, 27, 28

Modifiers, 26, 27, 28

Type Service Code, 26, 29, 30, 34, 56, 58

Add, 26, 27, 28

Change, 26, 27, 28

Description, 26, 27, 28

Modifiers, 26, 27, 28

Search, 28

Unapplied Credits, 69

GLOSSARY

Accept assignment- accepting the payment of insurance companies as full payment for services.

Account processing the method used to record patient billing information.

Accounts receivable- the balance of the amount owed for services rendered but not collected.

Arrow/cursor keys- the set of four keys, with arrows, that move the cursor one space at a time in whatever direction you wish. They do not add or delete text.

Batch- a group of entries to be processed.

Batch entry- the process that actually posts information to an account.

Billing- process at the end of your billing cycle which includes cutting off, printing the statements and reports, processing the statements, and putting together your billing package.

Billing account-set up in the name of the person or company responsible for paying the account (the guarantor).

Carrier-insurance company which carries a policy or benefit package for a patient.

Charge Code- a number used to indicate the type of transaction, 1-charge, 2-miscelaneous income, 3-payment, 4-credit, 8-additional diagnosis or modifiers, or 9-no charge.

Charges- the amount of the fee, determined all or in part by the current Medicare Fee Schedule.

Command/Options- the group of keys on the keyboard that begin with ‘CF’ or ‘F’ or ‘CMD’.

Control log- a report designed to keep you informed of your month to date totals

Collection agency- an agency that collects money for services your office rendered for a fee.

CPT (Current Procedural Terminology)- created by the American Medical Association, a system of listing and coding procedures and services performed by providers.

Cursor- the symbol, often an illuminated box or blinking line, that indicates where the next entry will appear on the screen.

Custom Diagnosis Code (CDC)- individualized code that allows you to enter complicated ICD9-CM codes that your office uses with a simplified custom code.

Cut-Off- the procedure at the end of your billing cycle to get statements and reports printed.

Demographic- information used to set up and collect on billing accounts.

Deposit slip report- a list of money collected and entered via batch entry, used to include with your checks in your daily deposit, or as a record for your office of payments included on each deposit.

EC- Electronic Claim.

EOB- Explanation of Benefits.

Error message- indicates an invalid entry, or provides and explanation of the error.

Face sheet- A form given to patient’s where they fill out the personal and insurance information to be used in the billing process.

Fee Code- this determines the amount billed to the patient.

Field- an area on the screen shown as a blank line or shaded area where information may be typed.

Flags- optional fields that allow you to flag a patient’ s account for special handling of the statement.

Guarantor- The person or company financially responsible for paying the bill.

Group- optional field for insurance group number if applicable.

Health Insurance Portability and Accountability Act (HIPAA). A federal law that outlines the requirements that health insurance companies must satisfy in order to provide health insurance coverage in the individual and group healthcare markets. This includes protecting health insurance coverage for those who lose or change jobs, regulating security and privacy of health care data, instituting national standards for health care transactions, and encouraging electronic data interchange.

Help- provides you with on-screen help.

ICD9-CM- International Classification of Diseases, 9^th Revision, Clinical Modification- listing of diagnosis codes.

Insurance company code- code set up by your office for an insurance company.

Lab- laboratory procedure.

Long description- gives more detail for the type service code, strictly for the operator’s help.

Menu screen- lists procedure options. The user directs the system by pressing an option letter or number.

Mode- tells you what operation you are involved in. If you are adding a new account or code, the mode will be ‘Add’.

Modifier- a two-digit code used to provide a more accurate description of procedures performed. Consult the CPT manual for more information

Password- a code established at the time of installation to restrict usage of the system for security purposes. These passwords are changed periodically.

Patient number- the one digit suffix to the billing number, used to identify each patient within the billing account, when family billing is used.

Proving report- used to check the entries you have made.

Referring source- source code used to indicate the source that referred the patient to your office.

Relation- relationship of the patient to the guarantor.

Screen- the portion of the system displayed on the monitor.

Short description- of the type service code, prints on statements.

Sign off- the process used to close the application at the end of the day, or if you are leaving your system unattended for a period of time that could allow unauthorized usage.

Sign on- the process used to bring the system up on your screen, ready to use.

Selection screen- offers a list of possible information and the user chooses the information required.

Super Bill- a form complete with medical procedures and their corresponding diagnosis and CPT codes and their fees.

Transaction processing- is the recording of services rendered, payments, adjustments, or insurance requests.

Type Service Code (TSC)- can be up to five digits, used to identify service performed. It may indicate a treatment procedure, such as a CPT code, or an office procedure, such as a payment on account or a cash discount. It may also be customized to indicate a procedure only your office uses.

UPIN- Unique Physician Identification Number.

WC- Workers Compensation.

Write-Off- amount of a bill that will not be paid by the insurance company or the patient.

Entering and Exiting the System

Navigating The System Through Point & Click

Guarantor/Patient Information

Guarantor Information Screen

Patient Form System

Adding an Appointment

Adding Patient Data

Using the GoTo Screen

Patient Tracking System

Press F5 while viewing a patient appointment to display tracking information. This window displays “Past”, “Complete”, “No Show”, “Cancelled”, “Rescheduled” and “Future” appointment totals. “Recall” appointments are also tracked.

Monthly Calendar View

Template Editor

Type Service Codes

Viewing Type Service Codes

Searching for Type Service Codes

Referral Source Code

ICD9-CM Codes

Insurance Company Codes

Payment Entry - Open Item

Enter Payments from EOB - Open Item

Transaction History

Transaction History - Open Item

Billing Refund

Insurance Processing – How the System Works

Batch Insurance, Single Requests and Electronic Secondary Claims