Create a Seamless Sickness Billing Format for Client for Management

Sickness billing format for client for Management

this training session will cover billing and therapy notes billing is the last step in the therapy notes workflow so this walkthrough will assume you've already entered a patient scheduled an appointment for them and wrote a note for that appointment if you need clarification on any of that check out our other walkthroughs or contact our support team if you'll be billing to either patients or insurance companies you'll first need to check your billing settings to find your billing settings go to the user icon click settings and then scroll down to practice billing to complete any billing and therapy notes make sure you have the box next to enable billing features checked likewise if you're going to be submitting any electronic claims make sure the box next to enable electronic claims in era is checked edi which is short for electronic data interchange allows therapy notes to submit your claims electronically to payers that you have added in your account electronic claims and therapy notes pass through change health care our clearinghouse partner who supports claim submission to over 2000 payers nationwide we'll explain eras later in this video in addition be sure to check the box next to enable real-time eligibility verification for the option to verify patient insurance information now under preferred billing methods select your default billing methods for in and out of network payers the billing method can also be adjusted per payer and per individual billing line item if desired even if you're out of network with a payer therapy notes can help you submit claims electronically on your client's behalf saving your client from the hassle of submitting on their own and having to wait for reimbursement when billing out of network you can even select how the out of network payers will be handled under out of network payment assignments if you're expecting out of network insurance to send payments directly to the practice select by default payments should be assigned to the practice if you're having the patient pay you in full up front then request that insurance companies send their payments to the patient by selecting by default payments should be assigned to the patient in therapy notes you can also select how many diagnosis codes you want to appear on your electronic claims with 4 being the max some pairs prefer to only have the primary diagnosis code while others prefer adding additional diagnosis codes for tracking information about co-occurring disorders justifying diagnoses associated with medical conditions or substance use and more you can always choose to override this setting before submitting an electronic claim regardless of which you choose if your practice is submitting cms 1500s or super bills you'll need to review your paper claim settings sometimes it's helpful to have the total amount paid to date on your paper claims like in the case of when a patient is submitting a super bill and the insurance company needs to know how much a patient has paid in order to reimburse them if this is something you'd like to do check the box next to include total amount paid to date on all paper claims therapy notes also allows you to choose whether you want to print your claims onto pre-printed red forms or if you want to print the red form background along with your claim information when payers require your paper claims to be on official cms 1500 forms you'll want to select the printing options looking below use the printer settings here to make sure the data you print lines up correctly with the pre-printed form in many cases insurance companies will want your signature on super bills in order to provide reimbursement you can easily include a spot for your signature by checking the box next to include a signature line on super bills the last option we're going to look at in this section is the alternate billing address which is used when you want your remittances and payments sent somewhere besides the physical practice location an important feature here is that you can include a po box which you cannot do in the practice information section once you've indicated that you'd like to use an alternate billing address you can click save billing settings to apply these changes to your account before we move on to actual billing services we're going to look at the user roles required for billing if we click staff at the top of the screen we'll see a user named practice biller this staff member is set up with the practice biller user role which is required for any practice member who will be submitting claims entering payments and accessing the practices billing reporting features be careful not to confuse this with biller for assigned patients only that user role is a supplemental role for clinicians which gives them the ability to record patient insurance information enter patient payments generate statements and perform other common tasks however this role doesn't allow them to submit insurance claims enter insurance payments or access the practices billing reports now that your users have been set up and you're sure you have the practice biller role it's time to set up your payers if you're not going to be submitting insurance claims you can skip this step for those who are submitting to insurance click payers at the top of the screen this screen provides you with a list of all the payers you've added if you aren't seeing a payer that you'd like to bill to you'll need to add that payer into your account to add a payer into your account click new payer the easiest place to start when adding a new payer is to fill in the payer's name in this example we're going to add aetna as a payer as we're entering this payer you'll see below that therapy notes has provided some name suggestions for us in this case we just want regular aetna so we're going to click on it to populate the payer's name please note the series of characters that appear in the payer id field since we'll be covering this in just a bit under insurance type you'll need to categorize the payer you're adding if the payer is a government payer select the program they're related to if the payer is commercial it's typically correct to select other insurance unless the name of the insurance company is one of the listed options under insurance type next look at the network option if you have a contract with this payer check this box otherwise leave it blank the default billing method is determined by the payer that's been selected but you can manually adjust the billing method using the drop down menu also keep in mind that you can always adjust the billing method for an individual service as well moving down the payer id is a series of characters that act like a payer's digital address this means that as long as the payer id is correct the claim will go to the payer the easiest way to find a payer id is using the method we just demonstrated search for the payer's name then click on one of the suggestions to populate the payer id if entering the payer's name doesn't provide what you're looking for it's possible that the payer you're looking for doesn't have a contract with our clearinghouse if a payer doesn't have a payer id our clearinghouse can still submit your claims for you if you'd like to do that set the billing method to edi leave the payer id blank and include the address the claim would need to be mailed to from here this payer's claims are handled like an electronic claim except that when a claim is submitted it will be mailed to the payer and the claim will cost 49 cents instead of 14 cents if a payer id populates when you add the payer adding a physical address isn't required unless therapy notes specifically asks for it if an eligibility id appears your practice can run eligibility checks on patients with this insurance before saving take a look under clearinghouse services the claims section lets you see if you are able to submit claims electronically to this payer through therapy notes a green check mark next to claims means that you can submit claims to this payer without any further enrollment a yellow triangle next to claims means that this payer requires an enrollment before you submit claims to begin the enrollment check the box next to begin edi claims enrollment underneath you'll see an era option eras short for electronic remittance advice act as electronic versions of a paper explanation of benefits routed directly into your therapy notes account therapy notes also offers an assisted era payment posting feature which pulls information from your era to help you post the payment into therapy notes quickly to enroll in eras for a certain payer check the box next to begin era enrollment to gain access to the claims and era enrollment paperwork for this payer make sure the appropriate boxes have been checked then click save new payer and enroll after saving the payer you can download the instructions by clicking the pdf links each payer has slightly different instructions so please refer to each payer's specific instructions for completing the enrollment please note that even if you are credentialed with a payer you may still need to complete the enrollment paperwork to submit claims to them through therapy notes being credentialed means that you have a contract with the payer for providing services to patients with that insurance being enrolled means that you have received permission to submit to payers through a clearinghouse or a medical record software that uses one for the purpose of this demonstration the payers will be using do not require any enrollment for submitting electronic claims if there is a green check mark next to eligibility verification you can verify insurance information for patients with this insurance now we're going to look over the billing settings section for a patient which we access by going to patients clicking the patient's name and then clicking the billing settings tab before we build to a patient's insurance we need to record their insurance information so it will be included with each of their claims since they have insurance we'll need to check patient has insurance we're going to select the payer we just added into the system then note that the patient or guardian signature is on file this signature refers to a patient or guardian giving permission for having their information released in order to bill their insurance if you are in network with this patient's insurance you may record the patient's copay if the copay is recorded it will automatically be listed as the patient's responsibility for their appointments if you're out of network with the patient's insurance you can still record the patient's copay but it will not be applied to any services when working with an out of network insurance you'll also have an additional field called payment send to this allows you to select if you'd like payment from this patient's insurance sent to the patient sent to the practice or if you want to use the default practice setting out-of-network payments are typically sent to the practice if you plan to use balance billing to charge the patient for what insurance doesn't cover in contrast you can have the patient pay you up front then have the patient's insurance send any payment to the patient switching back to the payer we started with you can note the patient's deductible in the deductible field the patient's deductible doesn't count down in therapy notes since the deductible can be reduced from other sources but you can use this field for reference below you may complete the fields for member id policy group employer or school and plan name of these fields the only one that is absolutely required is the member id while the others can be left blank but should be included if they are on the patient's insurance card on the right you'll need to select the relationship the patient has to the insured party if the patient has their own insurance leave the relationship as self when you have a patient who has their insurance through another party select that party using the drop down menu then fill out their information it's a good idea to have a copy of the patient's insurance card handy in case you get an insurance claim rejection to add the card scan a copy into your computer then click upload insurance card select the file from your computer then upload the card on occasion you'll have a patient that has secondary insurance to record a patient's secondary insurance check the secondary insurance box then fill in their information once a patient's insurance information is saved you can also submit an eligibility request to see if the patient is covered please keep in mind that each report you send is 14 cents to do this click verify eligibility select the providers and the date of coverage then click submit request it may take up to two minutes to receive your eligibility verification report but you'll receive most reports within a few seconds when you receive a new report a green new report available link will appear next to the eligibility field in the client's primary insurance or secondary insurance information on their billing settings tab a review eligibility verification reports link will also appear on your to-do list when there are new reports ready each eligibility verification report contains details about the eligibility verification request that you submitted as well as any information therapy notes receives from the payer including errors with the request provider information subscriber and dependent information eligibility and benefit information and any associated benefit details after you have reviewed the report click the mark as reviewed button in the upper right corner of the report while on this screen we're also going to look at a few additional billing features used for patients if you have a patient that needs to use pre-authorization codes you can add those codes into the patient's chart to record a pre-authorization code select the service code pre-authorization code the code's parameters and comments when you bill for this service code electronically or by cms 1500 the pre-authorization code will be applied and the uses remaining will be reduced by 1. to remove a pre-authorization code click the corresponding x button in some cases you may need to include additional information before submitting your claims if you need to do so check the box next to additional claim information then add what you need if you've enabled credit card processing you can securely save credit cards for later use with the enter card and swipe card buttons saving cards is a great way to ensure that you're paid for your services even if your client knows shows their appointment moving down the page you can select the responsible party for billing this person can be anyone listed in the patient's contacts list if the responsible party listed for this claim is anyone besides the patient the party's name will be listed in place of the patient's name on statements if you have negotiated a custom cash rate for a client and the rate has been documented in their services contract click the add rate info button to enter the client's cash rate per service code after you've reviewed your settings and ensure that they align with how you want to bill for this patient click save changes now that we've gone over the basics of setting up billing and therapy notes we're going to go over direct billing edi billing paper billing and external billing for more specific examples visit the therapy notes youtube channel starting with direct billing we can see here that we have a service where the billing method is direct looking over a little further we can see that the patient balance for this service is greater than zero which means we are owed funds for this date to let a patient know that they need to pay for the services you provided them you can generate a statement to generate a statement click create statement adjust the parameters to fit the information you need add a comment if you'd like then click download statement or print statement once your patient has paid for their services stay on top of your bookkeeping by recording the payment as soon as possible click enter patient payment then select your payment method to reflect how you were paid if you've enabled credit card processing you can choose to swipe a patient's card enter a patient's card details manually or select card information that has already been saved with one of these options selected saving the payment will charge the card as well as record the payment before doing that you'll need to enter the payment date payment amount and the check number or transaction id depending on the payment method after entering the payment amount the funds will automatically be allocated to the earliest open dates you can click onto the allocation boxes and change the allocations if required you may also check the write-off boxes on a specific service to record that you were paid less than what you were expecting and are confident you're not going to collect those funds once the information you've entered reflects the payment you've received click save payment just as you accept payment from patients you may also need to issue refunds under various circumstances before issuing a refund you'll need to have an unassigned credit in the patient's chart to generate an unassigned credit the amounts entered in the payment allocation column must equal a value less than the payment amount after editing the amounts in the payment allocation column the unallocated portion of the payment will be recorded as an unassigned credit once the payment is saved to enter a refund from the patient billing page click enter refund then list the refund amount assign clinician and comments you'd like to add if you have patient credit card processing enabled the method field will give you an option to have the refund paid back to the patient's card otherwise select record refund only note the date of the refund then click add refund please note that deleting a payment will not issue a refund if you would like to delete a payment from the patient billing screen click the payment from the search billing transactions table click delete this payment and confirm your decision by clicking delete payment next we're going to cover electronic billing which is the easiest and most cost effective way to bill through therapy notes we can tell that we have a pending edi claim by finding a number next to submit edi claims or the green pending edi under insurance status you can also find a prompt to submit edi claims within your to-do list to submit the electronic claim click submit edi claims check the box next to the date of service click review claim details and double check that the claim information is correct then click submit claims after you've submitted the claim you can check on its status by going to edi claim history then clicking on the claim number on this screen you can view the claim history which includes when the claim was generated when it reaches the clearinghouse and typically when it reaches the payer likewise most payers also send an alert into this section if a claim is rejected to submit a paper claim make sure you have a number next to create cms 1500 a number next to create cms 1500 and a green pending paper indicates that you have a paper claim ready to submit if you click on create cms 1500 you can generate a cms 1500 by clicking include on cms for services you'd like to bill for the document format determines how the pdf you're about to generate will look if you're printing onto an official cms 1500 select pdf for printing onto a pre-printed form if you're printing onto a blank piece of white paper select pdf with form background included with your options selected you can now click download cms 1500 then build a form as needed marking a claim as externally submitted doesn't actually submit the claim but allows you to keep track of what claims have been submitted along with recording the insurance payment and therapy notes to mark claims as externally submitted click mark external items next click the method drop-down menu then select pending external submission pending edi submission and pending paper submission should only be selected if the billing line items method is either edi or paper and you do not need to use therapy notes to generate or submit the claim after you have submitted the service manually via a method outside of therapy notes click the mark submitted button next to the corresponding service regardless of the billing method you use you can record your insurance claim payments by going to the patient billing screen then clicking enter insurance payment when entering an insurance payment the first item you'll select is if the patient was from an in-network or out-of-network payer and which payer the payment was from after that select the payment method payment date payment amount and the check number transaction id if applicable insurance companies may cover multiple patients with a single payment in that case uncheck the box next to this payment covers items for this patient only if the services you're trying to submit for are still not appearing use the menu options to adjust the visible items and date range as long as the items you'd like to include are visible use the allocation boxes to list how much you were paid for each service if the amount you list in the allocation box is less than the amount you are expecting you can write off the remainder of the balance by checking the adjustment box when you're expecting a payment from secondary insurance or additional funds from the primary insurance leave this box unchecked once all services being paid have been accounted for you can add the payment into your account by clicking save new payment if you've enabled eras in your account you can post your payment even faster to access era payment posting go to billing era and click on the era number for the one you'd like to post if you've already recorded this payment click mark as process to remove it from your to-do list to post the payment click post payment confirm that the information is correct then click post payment again on occasion a payer may require a refund or submit a negative payment in the event of overpayment penalties or other adjustments recording an insurance refund is very similar to entering an insurance payment the key difference is that the payment amount as well as any resulting allocations need to be recorded with negative numbers a negative value can be entered with a minus sign or surrounded by parentheses if you're expecting insurance to pay for this date eventually leave the adjustment box unchecked otherwise record the refund by clicking save new payment the last items we're going to talk about today are the billing reports all of the reports you can access are found under the billing tab at the top of the page first we're going to look at patient aging and batch statements patient aging and batch statements helps you determine which patients still have a balance or a credit using the filtering options you can define the information you're looking for then click create report to produce the data from here you can use the check boxes on the right to produce a statement for a single patient or multiple patients if you want more information on any of these amounts simply click on them for greater detail as with most reports in therapy notes you can export this report as an excel spreadsheet or a pdf file if you would like to see how much your insurance payers owe your practice click insurance aging report just like with the previous report you can click on any amount to see the transactions that led to it as well as export the entire report as an excel spreadsheet or pdf file under more reports you can access the revenue report which lets you see all of the revenue the practice has earned all revenue is counted by the date of payment and you can use the filtering options to look for specific types of revenue likewise you can see how much the practice has written off using the write-off report this report has similar mechanics to the revenue report to see how many notes have been written in the practice click no count report then adjust the filter options as needed before clicking create report keep in mind the no count report is based on the date of service not when the note was written to stay on top of pre-authorizations in your practice use the pre-authorization report the pre-authorization report allows you to gather data about all pre-authorizations for your clients in your therapy notes account and easily see which codes may need to be renewed for any other billing information you're searching for we recommend using the search billing transactions section this is especially handy for finding appointments that are missing a note as well as looking for appointments with a specific service code that concludes our billing training session if you enjoyed this training session subscribe to our youtube channel and enable notifications to make sure you can see all of our latest feature announcements tutorials and more to try therapy notes free for 30 days visit therapynotes.com for one-on-one support at no additional cost contact our support team by phone or email we hope to hear from you soon thanks for watching