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The Insurance Payments form consists of three sections. In the first section, the Document/Check Information corresponds to the Payment tier. The Account information corresponds to the Payment Distributions tier. The second section allows the user to enter Payment Distributions to Charges. The final section allows the user to enter Payment Notes and Special Billing Messages.
The Payment Document/Check Information captured in MedSuite contains the following information:
Batch No
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Enter/Select the Batch to which the payment was applied. This defaults to the batch selected in the Payment Batch List
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Remit Date
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Date the payment was deposited into the bank. A warning will be issued if this is entered as a future date.
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Claim No
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Enter or Search (F9) for the claim that is making the Insurance Payment.
You may enter a claim number or patient name in the Claim No field. If a single entry is found that matches the information entered, the Claim information will be retrieved. If not match is found or if more that one match is found, you will be automatically taken to the Pick Distribution (Claim Search) form that will present a list of matching account entries.
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Division
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The Division associated with the claim is displayed
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Pmt Method
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Enter/Select the Payment Method (Check, EFT, Cash, etc)
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Charge Card
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Enter/Select the credit card type (VISA, MC, Amex, etc.) user-defined
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Doc./Check No
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Enter the Document or check number
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Pmt Type
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Enter/Select the Payment Type
This field may default from the payment calculation setups on the Plan Details Tab. If it is not setup on the Plan, then it must be manually entered in order to key in a payment amount.
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Adj Type 1
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Enter/Select the primary Adjustment Type
This field may default from the payment calculation setups on the Plan Details Tab. If it is not setup on the Plan, then it must be manually entered in order to key in a primary adjustment amount.
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Adj Type 2
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Enter/Select the secondary Adjustment Type
This field may default from the payment calculation setups on the Plan Details Tab. If it is not setup on the Plan, then it must be manually entered in order to key in a secondary adjustment amount.
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Reason 1
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Enter/Select the first Payment Reason
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Reason 2
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Enter/Select the second Payment Reason
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Reason 3
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Enter/Select the third Payment Reason
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Co-Payments / Co-Insurance
Co-Payment and Co-Insurance information may be added to the Payment Distribution. This data is informational only and will display in the Activity View of the Ledger.
Copay $
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Enter the Co-Payment amount
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Co-Ins $
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Enter the Co-Insurance amount
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Co-Ins %
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Enter the Co-Insurance percent (typically carrier-side)
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Automatic Payment Distribution
MedSuite is a line-item posting system. Payments must be applied to individual line items. Insurance payments generally provide line-item posting information. However, sometimes this information is not provided. In these cases, the insurance payment must be manually split to post to the individual line items and this process can be quite tedious. To streamline this process, you may enter the total approved, total deductible, total payment, total primary adjustment and total secondary adjustment and click on the Auto Distrib button (or press Alt-A). The totals entered will be distributed to the line-items on the claim as a percentage of the each line item's billed amount out of the total billed amount.
Approved
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Total approved amount.
Disabled if the Plan Details Tab Approved amount indicates that it is Not Used; otherwise it is enabled
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Deduct
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Total deductible amount
Disabled if the Plan Details Tab Deductible amount indicates that it is Not Used; otherwise it is enabled
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Payment
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Total payment amount
Disabled if the Pmt Type on this form is blank; otherwise it is enabled
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Adjust 1
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Total adjustment 1 amount
Disabled if the Adj Type 1 on this form is blank; otherwise it is enabled
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Adjust 2
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Total adjustment 2 amount
Disabled if the Adj Type 2 on this form is blank; otherwise it is enabled
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Auto Distrib
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Click this button to auto distribute the totals above to the line items
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Payment Distributions to Line-Items
All charges for the claim will be displayed in the grid. The fields below marked with an asterisk (*) may be automatically calculated of defaulted from the Plan Setup. If the user hits the Alt-5 the screen will hide the (Date and CPT fields) and display the (ASA, Units, and Minutes fields).
Date
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Service date is displayed
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CPT
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Procedure code is displayed
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Bill
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Charge amount billed is displayed
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M1
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Charge Modifier 1 is displayed
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Allow
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The line-item amount allowed is displayed
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Open
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The line-item amount open is displayed
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Approved*
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Enter the line-item amount approved
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Deduct*
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Enter the line-item amount deduct
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Payment*
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Enter the line-item amount paid
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Adj1*
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Enter the line-item amount primary adjustment
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Adj2*
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Enter the line-item amount secondary adjustment
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Status
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The line-item payment status may be selected from the drop-down list displayed. The values available for selection in this field are defined as follows:
| • | Blank - Attempt to go through the Payment Status Defaults described below |
| • | Paid - The balance will drop to the "next" level of insurance. If no insurance exists after the current level, any balance remaining will drop to Self Pay. |
| • | Denied - The balance will drop to the "next" level of insurance. If no insurance exists after the current level, any balance remaining will drop to Self Pay. |
| • | Disputed - The balance will drop to the "next" level of insurance. If no insurance exists after the current level, any balance remaining will drop to Self Pay. |
A new billing record for the amount in dispute will be created with the original claim number.
Use of the "Disputed" status combined with a contractual write-off in Adj1 that you agree with and a disputed write-off in Adj2 that you do not agree with will allow you to create a patient statement that matches the payer's EOB.
| • | Held - The balance is held (open) at the current level |
| • | Self - The Claim is paid or denied and the user wants to skip any remaining levels of insurance and have the billing proceed to the self-pay level |
| • | Refile - The balance will be held (open) at the current level and will be refiled to the payer |
A new claim for the amount refiled will be created with the original claim number.
Payment Status Defaults
Zero/Credit Balance Defaults
MedSuite may automatically select one of the Default Payment Status values from Practice Setup - Claims Tab as follows:
| • | Zero Balance - The charge is paid in-full and the status will default to the practice setup. It is often useful to set the default to "Self" in this situation. |
| • | Credit Balance - The charge is overpaid and the status will default to the practice setup. It is often useful to set the default to "Held" or "Self". |
Paid/Denied Defaults
Assuming that the Zero Balance or Credit Balance defaults either were not invoked or were blank in Practice Setup, MedSuite may automatically select one of the values from the drop-down list as follows:
| • | Paid - If the Payment column is not equal to $0.00 |
| • | Denied - If the Payment column is equal to $0.00 |
Payment Reason Defaults
Other values are automatically selected by entering Payment Reason Codes that have been configured to set the line-item payment status:
| • | Held - Held at the current claim level |
| • | Denied - The claim is denied and proceeds to the next billing level displayed |
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Refile Secondary Claim
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Forces a refile of the secondary claim (if one has already been created). This is used primarily in Medigap situations where the Medigap claim was created by MedSuite, but Medicare failed to send the claim to the Medigap Carrier.
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Payment Notes
You may enter a free-form payment note regarding the payment that will display in the account ledger. The note will show in the Activity View and Memo tab of the ledger with the Visit Date of the claim that the payment note was applied to. If you select
Print Payment Note on Statement, the note will not only go in the ledger but show on the patients statement as well.
Print Payment Note on Statement
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Indicates if the note typed in the box should be printed on a statement.
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Note
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Text of the note to be added to the account ledger. If "Print Payment Note on Statement" is checked the note typed will also print on the statement.
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Special Bill Message
Sometimes, you want to convey information to the account holder or patient. This can be done via the Special Billing Message. The message can be a "canned" of pre-defined message or it may be free-format text. The Account Billing Tab will be updated with the selected/entered message and the recurring flag.
(Blank)
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Enter/Select the "canned" special billing message that will be set on the account.
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Recurring
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Indicates if the message is recurring or a one-time message
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Message
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Text of the message. Up to four lines of 60-characters of text per line may be entered.
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Buttons
Sec Info
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When Medicare is secondary (MSP), You must enter information about the adjudication of the primary claim in order to file the MSP claim electronically
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Suspense
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You may suspend claims or statements for the account and add a memo indicating why this was done. The Suspend Claims and/or Suspend Statement flags on the Account Billing Tab will be updated
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View
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You may select this button to view the account demographics or ledger
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Imaging
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Displays images indexed to the payment.
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Ok
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Saves the payment as entered
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Cancel
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Cancels the payment changes made and closes the Insurance Payment form
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