Table of contents:
Posting
error : charge with payment, wrong account
Posted
charge with wrong date of service
CPT
Codes- printing multiple based on billclass
Steps
to getting your electronic claims up and going
Handling
an EOB when patient has already paid at time of service
Post
charge, patient payed @ time of visit - receive an EOB
Changing
diagnosis code during an electronic claims submission
How
to check to see if a charge has been billed
Open
credit applied to different billclass
Posting
payment against and adjusted charge
Posted
charge to wrong doctor
Refund
insurance company
Refund
open credit
Insurance
claims printing out wrong place of service
Questions
& answers
Transfer
a billclass
"POSTING
ERROR : CHARGE WITH PAYMENT, WRONG ACCOUNT"
Scenerio:
Posted a $54.06 charge to primary BC (001). Primary then paid $43.25
on this charge leaving a balance of $10.81 in the self pay BC (008). Patient
paid the $10.81 leaving a $0.00 balance on their account. As it turns out,
the original charge was posted to the wrong account and now you need to
refund both the insurance company and the patient. Question: How do I refund
the insurance company and the patient so that my production reports are
accurate?
Answer:
It is important to keep in mind that along with refunding the insurance
and patient you must also correct the doctors production. This means that
since a charge has been posted (although in error) the doctors count for
that procedure has been incremented by 1 (i.e. Doctor 08 had a procedure
count of 20. This $54.06 posting incremented the count to 21). We will
first do an entry that brings the count back down to 20 so that the production
reports remains accurate. Then we will handle the refunds. Using the our
example do the following:
1) Start a CHARGE batch. On
the first screen, enter the guarantor and patient info. F2 to the second
screen. Enter the charge exactly as it originally was entered except key
the negative amount (in this case the amount coloum will have -54.06).
Reconsile and close batch. You just corrected the doctors production.
2) Start a PAYMENT batch. On
the first screen , the only fields you need to enter are : guarantor, patient,
billclass, and dates field. Enter the billclass that the charge is currently
in (in our example it would be 008). In the date field key from [01-01-01]
to [todays date]. Press ENTER. Space-Bar select the positive charge in
question. And press ENTER. You should now be on the second screen. Allowed,
%Paid, Payment & Disallowed = $0.00. Write off amount = -10.81. Use
the refund patient code. Now transfer the balance amount ($10.81) to the
primary billclass (001). F2 to save. Reconsile and close. You have just
refunded the patient, lets refund the insurance company.
3) Start a PAYMENT batch. On
the first screen , the only fields you need to enter are : guarantor, patient,
billclass, and dates field. Enter the primary billclass (001). In the date
field key from [01-01-01] to [todays date]. Press ENTER. Space-Bar select
both the negative & positive amount related to the charge (in our example
it would be the positive amount with a tent. balance of $10.81 and the
negative amount with a tent. balance of -$54.06). And press ENTER. You
should now be on the second screen. Allowed, %Paid, & Payment = $0.00.
Disallowed = -43.25 with a refund code. Write off amount = 54.06 with a
correction code. Transfer $0.00 balance to global corrections billclass.
Page down. Allowed, %Paid, & Payment = $0.00. Disallowed will be calculated
automatically (in our example, -$54.06) . Use correction code. And transfer
$0.00 balance to global corrections. F2 to save. Reconsile and close. You
have just refunded the insurance company & balanced the account.
"POSTED
CHARGE WITH WRONG DATE OF SERVICE"
Scenerio:
I posted a charge of $100.00 but put the wrong DATE OF SERVICE.
The batch is now closed and I need to correct that date for auditing purposes.
Answer:
1) Start a CHARGE BATCH.
2) Select ENTRY. Select and
ADD to this batch.
3) On the first screen, enter
the information as you did when you posted the charge incorrectly. You
DO NOT correct the date of service on this screen. Hit F2 to save. You
are now on screen 2 of 7.
4) Post the charge EXCATLY
as you did when it was posted incorrectly EXCEPT make the amount negative(-).
(In our example it would be -100.00).
5) On the second line post
the correct DATE OF SERVICE in the "FROM" and "TO" field. Re-enter the
charge using the positive(+) amount.
6) Close and reconsile this
batch. You will get a message:
WARNING! Charge Total is
0.00! Press any key to continue.
You will then be prompted
to OK the $0.00 amount . Enter YES.
* You have just corrected the
production in the system. You will now correct the actual charges.
1) Start a PAYMENT BATCH. Now
lets add to that batch.
2) On first screen, enter correct
information for fields: GUARANTOR, PATIENT, DOCTOR, LOCATION.
3) In the DATE RANGE enter
FROM: [010101] TO: [todays date] . Hit the ENTER key to bring up charges.
SPACE BAR select BOTH the negative and positive charges that have the INCORRECT
date of service. Do not select the entry with the corrected date of service
4) Hit enter to bring you to
the next screen. Enter ZERO amount in ALLOWED and ZERO amount in PAID field.
Notice that your Disallowed amount has been calculated. Accept this amount,
Use the CORRECTION CODE that is appropriate.
5) In the XFER field, enter
the code for GLOBAL CORRECTIONS.
6) Use the PAGEDOWN key to
go to the next selected charge. Do steps 2-5
7) Close and reconsile. YOUR
DONE!
"CPT
CODES - PRINTING MULTIPLE BASED ON BILLCLASS"
Scenerio:
You have two cpt codes for misc. supplies. If the billclass is different
can you have it print out different cpt codes based on the billclass?.
For example : For Billclass 01 you want it to print code 99070 and for
Billclass 02 you want it to print 78222.
Answer:
1) From Main Menu. Go to menu
TPV. Select procedure code in question.
2) Using our example, nder
INSURANCE CODES field type : 01=99070; 02-78222
3) For billclass 01 the code
99070 will print etc...
4) YOUR DONE!.
"STEPS
TO GETTING YOUR ELECTRONIC CLAIMS UP AND GOING"
Now that ESI has set you
up with EMC what do you do now? Well, below are some of the steps needed
to make that push to a paperless office.
Answer:
1) GET REGISTERED. Call the
medicare (or other) office in your area. Tell them you are going to be
sending electronic claims and need to register. Ask them for the correct
forms and procedures.
2) REVIEW PAYERS LIST. Check
list for all payers that can be sent electronically from the payor list
( you should have this participating payers list - if not you can request
one). Take note of Payer Name and ID #
3) SET UP BILL TYPE. For electronic
claims you will need to set up a bill type in your system.
4) CHANGE PLANS. Be sure to
change the plans over the the new electronic type codes.
5) TRANSFER DETAIL. This is
the most time consuming part but only has to be done once. Run a report
to give you detail of all accounts with charges that can now be sent electronically.
You will have to transfer these charges to the new type.
6) FINAL PREPARATIONS. Set
up your modem. If you need help call technical support. For NEIC claims
you can now begin sending them. For others that require agreement forms
you will have to send test data to ESI so we can make sure all is well.
7) JOIN ESI CLAIMS SERVICE.
Now that your company is sending claims regularly you may wish to get on
ESI's claim rejection service. For a small fee, this service will notify
you of rejected claims within a day or two of submitting them. This will
minimize your rebill time dramatically and help manage you A/R more effectively.
"HANDLING
AN EOB WHEN PATIENT HAS ALREADY PAID AT TIME OF SERVICE "
Scenerio:
Posted a charge for $395.00 to the primary billclass. Patient payed
$300.00 at the time of service which was applied to the $395.00 leaving
$95.00 open in the primary billclass. You receive an EOB from the insurance
company that says the disallowed is $120.83 and you need to apply $274.17
to the deductable. The problem is the patient already payed $300.00.
Answer:
How do you take the disallowed and refund the patient the refund?
1) Start a PAYMENT BATCH. Add
to the batch.
2) In the first screen : Enter
Gaurantor and Patient info. PAYMENT amount = 0.00, Enter the BILLCLASS
code for the primary insur. F2 and select the $395.00 amount. You should
now be on the second screen.
3) Allowed = 274.00, %Paid
= 0.00, Payment = 0.00, Disallowed = $120.83. Use the correct adj. Code
for insurance disallowed.
4) WRITEOFF -25.83 using refund
code which should leave the balance at 0.00
5) F2 . YOUR DONE.
"
CHANGING DIAGNOSIS CODE DURING AN ELECTRONIC CLAIMS SUBMISSION "
Scenerio:
A claim got rejected and I need to rebill that individual; But,
before I rebill I need to change the diagnosis on one of the charges. Question:
How do I do an individual rebill & how do I change that diagnosis?
Answer:
1) Main menu of Merlin. ACCOUNTS,
PATIENT, select patient, ESC, PATIENT, FORMS, ELECTRONIC, select patient,
HCFA, select PRIMARY (i.e.), select BILLCLASS, select DATE, select CHARGE.
2) Select EDIT. Select Account.
3) Now use the PAGE DOWN key
to page down FIVE (5) time. You should now be at CLAIMS INFO screen.
4) You can alter the diagnosis
codes located on this screen.
5) YOUR DONE.
"HOW
TO CHECK TO SEE IF A CHARGE HAS BEEN BILLED "
Scenerio:
You have a hunch that a charge that was posted in the past has not
been paid on.
Answer:
How can I find out if a particular charge has been billed?
1) From MAIN MENU select ACCOUNTS,
select PATIENT. Enter the correct patient number.
2) From the patient screen
hit the ESC (escape) key. Select TRANSACTIONS. Select VIEW.
3) Enter a date or 010101 for
the beginning of time.
4) The report the is generated
has a INS BILL field that show that particular charge was billed. If the
date is 99-99-99 then that charge has not been billed yet.
5) YOUR DONE.
Note: If you are sure that
the charge is not getting billed even after you have run insurance for
that billclass then run an individual rebill.
"OPEN
CREDIT APPLIED TO DIFFERENT BILLCLASS "
Scenerio:
An open credit is in Billclass 02. You want to apply this open credit
to a charge in Billclass 03.
Answer:
1) Start a PAYMENT batch. Transfer
charge to BC 02 (see TRANSFER BILLCLASS reference sheet). Close batch.
Charge should now be in BC 02.
2) Start PAYMENT batch. Apply
open credit amount to the charge.
3) Xfer the balance back to
BC 03. Close Batch.
4) YOUR DONE!.
"POSTING
PAYMENT AGAINST AN ADJUSTED CHARGE "
Scenerio:
$70.00 was adjusted off an account. You then received a payment
for that charge for the amount of $30.79. Question: How do I post payment
to the adjusted charge amount?
Answer:
1) Start a PAYMENT BATCH.
2) Enter GUARANTOR & PATIENT
information. Accept PAYMENT DATE default. Arrow key down to AMOUNT field.
Enter payment amount (i.e. $30.79)
3) Enter BILLCLASS of the adjusted
charge. (if you do not know, use the F12 key)
4) Arrow key down to DATE RANGE
fields. Enter FROM: 010101, TO: (what ever todays date is). Hit the enter
key to bring up charges. Select charges. You are now on the second screen.
5) ALLOWED = ZERO, PAYMENT%
= ZERO, PAYMENT AMOUNT = 30.79, DISALLOWED = -30.79
6) Be sure to put the negative(-)
amount in the disallowed field. Your balance should now be zero. F2 to
save.
7) YOUR DONE!
"POSTED
CHARGE TO WRONG DOCTOR "
Scenerio:
Posted a charge of $600.00 to the wrong doctor. The batch has already
been closed. Question: How do a correct the posting so that the charge
does not effect the production information.
Answer:
1) Start a CHARGE BATCH. Give
it a discription that helps to identify its use. You do not need to enter
any other infromation in this Batch Screen so hit F2 to save.
2) Select ENTRY. Select this
Batch. Enter information on this screen as you did when you posted the
charge incorrectly. Hit F2. You should now be on the line item screen.
3) Post the charge EXACTLY
as you did when it was posted incorrectly (date of service, doc code, cpt...)
EXCEPT put the negative(-) amount ! ( in our example it would be -600.00)
4) On the second line post
the charge to the correct doctor as you normally would.
5) Close and reconsile the
batch.
*You have just corrected the
production in the system. You now will correct the actual charges.
1) Start a PAYMENT BATCH. Now
lets add to that batch.
2) On first screen enter correct
info for fields: GUARANTOR, PATIENT, DOCTOR CODE, LOCATION.
3) In the DATE RANGE enter
FROM: 010101 TO: . Hit Enter. Space bar select BOTH the negative
and positive charges. Hit Enter to bring you to the next screen.
4) Enter ZERO amount in ALLOWED.
Enter ZERO amount in PAID. Notice that your Disallowed amount has been
calculated. Accept this amount, use the CORRECTION ADJ. CODE.
5) In the XFER field, enter
the code for GLOBAL CORRECTIONS.
6) Hit the PAGEDOWN Key to
next charge. Do 2-5.
7) Close and reconsile batch.
YOUR DONE!
note: This will prevent anyone
from accidently billing this charge.
"REFUND
INSURANCE COMPANY "
Scenerio:
Insurance Company paid on a patient charge. For some reason (rejection
etc...) You need to refund that money back to the insurance company and
bill the patient. Question: How do I refund the insurance company and bill
the patient?
Answer:
1) Start a PAYMENT batch.
2) Enter Date range 010101
to and spacebare select the charge in question.
3) In the WRITEOFF field enter
the negative(-) amount of the refund. (Use proper correction codes). You
should now have a positive(+) amount in the balance field.
4) You can now transfer this
amount (xfer) to the self-pay bill class..
5) F2 to save. YOUR DONE!.
"REFUND
OPEN CREDIT "
Scenerio:
You have an open credit that needs to be refunded
Answer:
1) Start an ADJUSTMENT batch.
The open credit will automatically be brought up.
2) Use correct code for refund.
F2 to save.
3) YOUR DONE!
"INSURANCE
CLAIMS PRINTING OUT WRONG PLACE OF SERVICE "
Scenerio:
You ran paper claims and the PLACE OF SERVICE is incorrect. Question:
How do I check/correct the POS?
Answer:
1) From the Billing menu select
View
2) Select EMC control file
and select View again.
3) Select the sequence # in
error.
4) PAGE DOWN Three(3) times.
You should now be on claim lines 1-4.
5) check to see if the POS
TOS COD fields are correct.
6) F2 to save. YOUR DONE !
"QUESTIONS
& ANSWERS "
Q: We ran a production report
and the number of charges is less than what was actually keyed. The report
was ran for the month of April. Some of the charges had a key day of May
with a date of service of April?
A: This report is generated
by the date keyed. If the procedure has a date of service of April but
a keyed date of May that charge will show up on Mays productions report.
Note: The reason this report
is generated by date keyed can be understood by the following example :
If a charge that was suppose to be posted in April was posted in May and
the report was generated by date of service you would have to run Aprils
month end processing again to reflect the change.
Q: How do I know if an account
has been billed?
A: Look up the account
in question and run a transaction report. Look at the INS BILL field that
represents the date that insurance was billed. If this field is 99-99-99
then that charge has not been billed.
Q: I ran a transaction report
and noticed that several of the reference fields where blank. I know I
had entered something in those fields when I was posting payments.(i.e.
"Check number is 323"). Why is it not showing up in the transaction report?
A: Where you posting adjustments
with a zero payment amount? If the payment amount was zero the the reference
field will not show. The reference field is used to explain payment entries
not adjustment entries.
Q: We are not opening a posting
cycle today but will want to key detail for todays date. Can we open the
cycle tomorrow with todays date and do all our posting?
A: Yes. You can open and
close for the posting cycle with yesterdays date and then open for the
current date.
Q: I was closing the day and
received a message that the program has found an ORPHAN BATCH. What do
I do?
A: Go to BILLING and reconsile/close
the batch. Orphan batches are caused by batches not closing all the way
(network error, electrical spikes, etc...) Your batch report will be off
but your original report will be correct.
Q: I did a FULL TAPE BACKUP
but accidentally forgot to except the report. Do I have to do the whole
backup again?
A: Most likely NO. You
will need to call an ESI technical support representative to check the
backup for errors. If the backup looks good the representative will have
you run the backup again without the tape in the machine. This will cause
you to error out of the backup and again ask if you want to accept the
report. At this time you can select YES and begin your day.
Q: Why is it when I put an
E in the plan style field under the Insured screen I can't get to the plan
code?
A: Employer # is missing.
Q: In a charge batch, the alternate
code is not showing up on the screen.
A: That is ok. It will
be logged into the system with the original code.
Q: How many patients can be
on a single account?
A: Eight (8).
"TRANSFER
A BILLCLASS "
1) Start a PAYMENT batch. Go
to ENTRY and select this batch. Now ADD to this batch.
2) Enter the GUARANTOR and
PATIENT information. Enter the BILLCLASS that the charge is currently in.
(Note: do not enter infromation in the the payment field!). Enter the DATE
range of [010101] to [todays date] . Press enter and select the charge
in question. Enter to the next page.
3) All fields on this page
should be $0.00, leaving the balance at the bottom respectfully. In the
XFER field, select the BILLCLASS you want this charge transfered to. Be
sure to press enter on this field so MERLIN accepts the changes. F2 to
save. Reconsile and Close batch. Your done!
"POST
CHARGE, PATIENT PAYED @ TIME OF VISIT - RECEIVE AN EOB "
Scenerio:
Posted a charge for $395.00. Patient payed $395.00 at time of visit
leaving a $0.00 balance. You receive an EOB for $216.00 in benefit and
$79.00 provider discount. The patient is responsible for $100.00. Question:
How do you post this check and refund the patient $295.00?
Answer:
1) Start a PAYMENT batch. On
the first screen enter GUARANTER, PATIENT, & PAYMENT amount of $216.00.
Use the proper payment code. Enter the bill class that the charge is currently
in. In the DATE range field enter 010101 to . Select
the $395.00. Enter to next screen.
2) Second screen should look
like figure below (except your disallowed code might be different and the
patient is probably not me )
3) F2 to save. Reconsile and
close. Hey, Your done!
