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MedSuite's payment system is designed in three tiers:
Payment
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The Payment tier represents a check or an Explanation of Benefits (EOB). This tier only contains information specific to a check or EOB. It does not contain any information that identifies claims, subscribers, patients, etc.
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Payment Distribution
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The Payment Distribution tier represents a payment or adjustment on a claim or on an account. This tier contains information specific to a claim or account. Multiple Payment Distributions may exist for a Payment as would be the case on a bulk insurance payment such as a Medicare EOB.
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Payment Distribution to Charges
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The Payment Distribution to Charges tier represents the distribution of payment and adjustment amounts to individual charge line items. Multiple Payment Distributions to Charges may exist for a Payment Distribution.
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Payment Context
MedSuite provides two different contexts for payment entry:
Single
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Open a patient or an account and access the Payments List by using the Navigation bar or the Record Menu.
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Batch
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Select Payments from the Financials/Followup Section of the Navigation Bar or from the Financials/Followup sub-menu of the Navigation Menu
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This section concerns itself with the Batch Payment Entry context. There is a sub-context or style within payment entry that we need to understand as well. There are three "new" buttons on the Payments on Current Batch grid: Self, Ins, and Bulk..
The fundamental distinction between these styles is that Self Payment entry requires that the user post payments against and an account whereas the Ins and Bulk styles requires that the user posts payments against a claim.
Context
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Applied
To
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Style
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Payment Distribution Behavior
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Single
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Account or Patient
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Self
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The payment is applied to the account or patient that the user currently has "open".
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Claim
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Ins
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A claim search is performed when New Payment is selected. Therefore, we are searching for a claim for the patient or account that the user has "open"
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N/A
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Bulk Style is not available within Single Context
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Batch
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Patient or Account
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Self
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An account search is performed when New Payment is selected. Therefore, we are searching for any account meeting the search criteria
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Claim
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Ins
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A claim search is performed when New Payment is selected. Therefore, we are searching for any claim meeting the search criteria
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Claim
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Bulk
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A claim search is performed when New Payment is selected. Therefore, we are searching for any claim meeting the search criteria
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Payment Entry Styles
Self
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Self Payments are payments received from patients or accounts are applied in the Self Style. Self Style is available in both Single and Batch Payment Entry modes.
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Insurance
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Insurance Payments received from an insurance carrier are sometimes paid in a format that contains one claim per Explanation of Benefits (EOB). Insurance Style is available in both Single and Batch Payment Entry modes.
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Bulk
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Insurance carriers often pays multiple claims on a single EOB. This is referred to as a Bulk Payment. MedSuite contains check "balancing" logic that allows the user to track and balance Bulk Payments to the EOB. Since Bulk Payments usually contain payments for multiple patients and Single Payment Entry mode is only accessible when you are "inside" an account or patient, Bulk Style Payments are not available on Single Payment Entry mode. Bulk Style is only available in Batch Payment Entry mode.
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User Setup contains limit control information so that a specific user may be limited to a maximum amount that may be entered as Self Payments, Self Adjustments, Insurance Payments, or Insurance Adjustments.
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