Payment Entry

The Payment Entry functions in MedSuite are divided into separate screens for entering Self Payments, Insurance Payments, and Bulk Insurance Payments. Each screen is specifically tailored to make the entry of each type of payment easier and more efficient.  In addition, there are features such as jumping to the ledger and returning right to payment entry, a payment search function to allow you to search for a previously entered payment, and special bill message and print Medigap options.

SELF PAYMENT ENTRY is used to enter payments sent by patients or account holders, or to enter refund adjustments for refunds being made to account holders.

INSURANCE PAYMENT is used to enter insurance checks that are sent to you with one patient on them.

BULK INSURANCE PAYMENT is used to enter payments that come to you on a "bulk EOB" from and insurance companies.  These EOBs and checks contain payments for many patients, such as payments received from Medicare, Medicaid, etc.  This Bulk Insurance option allows you to enter the amount of the entire bulk check, and then enter the individual payments for each patient listed on the bulk EOB.  The system will track the total payment and what you have entered for each patient so that you can easily see when you have entered the entire check and when you balance to the total.

SELF PAYMENT ENTRY

After creating a payment batch, batch, click on 1-Self and The Self Payment screen will be displayed.  As in other MedSuite data entry screens, TAB will move the cursor forward one field, and SHIFT-TAB will move it backwards.

Enter the Account Number for the payment that you are entering.  If you do not know the Account Number, you may enter a name.  The system will pull up the account matching the criteria you entered, or go to the Account Lookup Window displaying the results of the name search if there is more than one account that matched the criteria.  You may enter a last name followed by a comma and first initial to narrow the search.  Alternatively, you may press F9 to invoke the Account Lookup window.

The Batch No will default to the batch selected on the previous page.  The Remit Date will default if one was entered when the batch was created.  Otherwise, enter the remit date.

Select the PMT METHOD, such as Check, Cash, or Credit Card.

The PMT TYPE will default depending on what is set up on the Self Pay Plan in the Insurance Setup.  The cursor will proceed to the Adj Type 1 field.  If you do not enter an adjustment there, it will skip to the Payment field.  Enter the Payment amount and any adjustment amounts if applicable.  TAB to the Auto Disb field, and press the SPACE bar to have the system automatically disburse the payment to the charges.  The system will calculate the remaining Open amount.  Use the OK button (Alt+O) if you are done with the payment.

As a rule, the system displays only the open charges at the self pay level.  If nothing is displayed, click the SHOW ALL button to see any charges that are at a zero or credit balance or still waiting for payment from the insurance company.

The Payment Note option allows you to enter a free-form note regarding the payment that will display in the Activity View in the ledger and on the Memo tab of the ledger as a note.  The date beside the note will be blank as there may be multiple dates of service on a single Self-payment note.  The Self Payment Note will also appear in the body of the account statement if you indicate that it should.

The Special Bill Message allows you to select a pre-defined special message to be printed on the next patient statement, and you may indicate whether that message should be recurring.

You may enter a free-form special bill message in the box below.  You should not use a free-form special message if you have selected a pre-defined special message in the box above.  The system cannot print both messages on a patient statement.

The IMAGING button is not used at this time.

The SUSPENSE button allows you to "suspend" claims and/or statements, and enter the reason why you are doing so.        

Once the account is accessed after the SUSPEND is placed on an account a message will display showing that the account has been suspended.

The VIEW button allows you to jump to the patient ledger or to the account.

To go back to the payment screen, use the green Show Pay Entry button at the top right corner of the screen.

INSURANCE PAYMENTS

To enter individual Insurance Payments (as opposed to a Bulk Check from a Payor) select 2-Ins.  The Insurance Payment screen is displayed.  As in other MedSuite data entry screens, TAB will move the cursor forward one field, and SHIFT-TAB will move it backwards.

Enter the Claim No. for the insurance payment that you are entering.  If you do not know the Claim Number, you may enter a name.  The system will pull up the open claim matching the criteria you entered, or go to the claim search window and display the results of the name search if more than one open claim matched the criteria.  You may enter a last name followed by a comma and first initial to narrow the search.  Alternatively, you may press F9 to invoke the claim search window.

The system will display open/unpaid claims that match the search criteria you entered.  If you do not have a name, TAB to go to the Search All field.  You may enter a visit date (in the format mm/dd/yyyy) or a policy #, SS# (in the format 999-99-9999), or plan name.  You may enter the full policy# or SS#, or just a portion of the #.  Note that you should select the "Show Closed Claims" box if you need to post a payment or adjustment to a claim that has already had a payment entered on it.  After selecting the claim from the claim search, the Insurance Payment screen is displayed again.

The Batch No will default to the batch selected on the previous page.  The Remitted date will default if one was entered when the batch was created.  Otherwise, enter the remit date.  Enter the Payment Method.  This would probably be Check for an Insurance Payment.

Enter the Doc No, which is usually the check number.

The Pmt Type and Adj Types default from the Insurance Plan setup.  These may be overridden if you are posting a Refund, for example.  In that case, you may blank out the Pmt Type and change the Adj Type to Refund. Payment Reasons are entered to indicate why a payment was denied or a payment amount was different than the expected amount. Enter Co-Pay, Co-Ins, and Co-Ins% if applicable.  Select the link for detail on where to setup the system to enable or disable these fields in Payment Entry Insurance.  Anything entered in these fields will display in the patient ledger.  These fields are not used to perform any calculations.

The cursor will move down to the charges.  Enter the payment information, for each charge, including the Approved Amount, Deductible, Payment, and Adjustments, if applicable.  The system may calculate some of these fields automatically, depending on the current insurance plan setup.  For example, a Medicare payment and adjustment may be calculated and displayed automatically.

The system will calculate the remaining Open amount.

If you are unable to post the payment to each line-item charge because the payor did not indicate the payment for each line-item, use the Auto Disb button.  Instead of keying the amounts on each line item charge, enter the payment/adjustment amounts in the fields available on the Copay line on the screen.  Then TAB to the Auto Disb field, and press the SPACE bar to have the system automatically disburse the payment to the charges.

The Status will default to Paid if there is a paid amount.  If DO NOT want the secondary claim to be filed, (for example, if the primary plan has paid in full and you want to drop the charges to the self-pay level), select SELF.  This will prevent the secondary claim from filing and will bill the account for any remaining balance.  Use the HELD Status if you would like to prevent the secondary claim from filing and hold the charges at the current level.  This option is typically used if the payor has not paid the claim correctly and you are going to send an appeal.

Selecting the Disputed status will keep a claim "open" instead of "closing" it like a Paid status would.  This is typically used when a payor approved amount is different from the expected approved (allowed) amount. The claim would be sent to the FollowUp Manager if a Payment Reason code has been entered that is flagged to send a claim to the Manager.  The adjustment can be calculated using the Adjustment Type 2 payment calculation on the Plan Setup, and would be set up as the Allowed – Approved, and a special adjustment code for Disputed Amounts would be used.  It becomes "disputed A/R," and this adjustment type and amount can be reported on.  A special message is usually entered on the patient statement to let them know that there is a problem with the insurance payment, and that all or some of the amount in dispute may become the patient's responsibility.

Tab through the remainder of the fields.  Use the check-box to indicate whether a Medigap claim should be printed.

The Payment Note option allows you to enter a note regarding the payment that will display in the Activity View of the ledger and on the Memo tab.  The date beside Insurance payment notes are posted and displayed with the Visit date of the claim the note was entered on.  The Insurance payment note will also appear in the body of the account statement if you indicate that it should.  This is a free-form field where you could put a note regarding an appeal, for example.

The Special Bill Message allows you to select a pre-defined special message to be printed on the next patient statement, and you may indicate whether that message should be recurring.

You may enter a free-form special bill message in the box below.  You should not use a free-form special message if you have selected a pre-defined special message in the box above.  The system cannot print both messages on a patient statement.

The IMAGING button is not used at this time.

The SUSPENSE button allows you to "suspend" claims and/or statements, and enter the reason why you are doing so.        

The VIEW button allows you to jump to the patient ledger or to the account, and then come back to the payment.  To go back to the payment screen, use the green Show Pay Entry button at the top right corner of the screen.

BULK INSURANCE PAYMENTS

To enter Bulk Insurance Payments select 3-Bulk Ins. The Payment screen is displayed where the information about this bulk check is entered.  As in other MedSuite data entry screens, TAB will move the cursor forward one field, and SHIFT-TAB will move it backwards.

The Batch No will default to the batch selected on the previous page.  The Remit Date will default if one was entered when the batch was created.  Otherwise, enter the remit date.  Enter the Payment Method.  This would probably be Check for an Insurance Payment.

Enter the Doc No, which is usually the check number.  Enter the Amount of the bulk payment on this check.

When you select NEW to add a payment distribution for this bulk payment, the Insurance Payment screen is displayed.  As in other MedSuite data entry screens, TAB will move the cursor forward one field, and SHIFT-TAB will move it backwards.

Enter the Claim No. for the insurance payment that you are entering.  If you do not know the Claim Number, you may enter a name.  The system will pull up the open claim matching the criteria you entered, or go to the claim search window and display the results of the name search if more than one open claim matched the criteria.  You may enter a last name followed by a comma and first initial to narrow the search.  Alternatively, you may press F9 to invoke the claim search window.  If you do not have a name or claim number, TAB to go to the Search All field.  You may enter a visit date (in the format mm/dd/yyyy) or a policy #, SS# (in the format 999-99-9999), or plan name.  You may enter the full policy# or SS#, or just a portion of the #.  Note that you should select the "Show Closed Claims" box if you need to post a payment or adjustment to a claim that has already had a payment entered on it.

After selecting the claim, the Insurance Payment screen is displayed.  Notice in this insurance payment screen that the Bulk Payment Amount is displayed along with the amount that has already been applied and the amount remaining that is still un-applied.  This will be updated after each payment that you key, until the up-applied amount reaches 0.00.  Note that a batch with funds still unapplied may NOT be released.  As in other MedSuite data entry screens, TAB will move the cursor forward one field, and SHIFT-TAB will move it backwards.

The Batch No will default to the batch selected on the previous page. The Remitted date will default if one was entered when the batch was created.  Otherwise, enter the remit date.  Enter the Payment Method.  This would probably be Check for an Insurance Payment.

Enter the Doc No, which is usually the check number.

The Pmt Type and Adj Types default from the Insurance Plan setup.  These may be overridden if you are posting a Refund, for example.  In that case, you may blank out the Pmt Type and change the Adj Type to Refund. Payment Reasons are entered to indicate why a payment was denied or a payment amount was different than the expected amount. Enter Co-Pay, Co-Ins, and Co-Ins% if applicable.  Select the link for detail on where to setup the system to enable or disable these fields in Payment Entry Insurance.  Anything entered in these fields will display in the patient ledger.  These fields are not used to perform any calculations.

The cursor will move down to the charges.  Enter the payment information, for each charge, including the Approved Amount, Deductible, Payment, and Adjustments, if applicable.  The system may calculate some of these fields automatically, depending on the current insurance plan setup.  For example, a Medicare payment and adjustment may be calculated and displayed automatically.

The system will calculate the remaining Open amount.

If you are unable to post the payment to each line-item charge because the payor did not indicate the payment for each line-item, use the Auto Disb button.  Instead of keying the amounts on each line item charge, enter the payment/adjustment amounts in the fields available on the Copay line on the screen.  Then TAB to the Auto Disb field, and press the SPACE bar to have the system automatically disburse the payment to the charges.

The Status will default to Paid if there is a paid amount.  If DO NOT want the secondary claim to be filed, (for example, if the primary plan has paid in full and you want to drop the charges to the self-pay level), select SELF.  This will prevent the secondary claim from filing and will bill the account for any remaining balance.  Use the HELD Status if you would like to prevent the secondary claim from filing and hold the charges at the current level.  This option is typically used if the payor has not paid the claim correctly and you are going to send an appeal.

Selecting the Disputed status will keep a claim "open" instead of "closing" it like a Paid status would.  This is typically used when a payor approved amount is different from the expected approved (allowed) amount. The claim would be sent to the FollowUp Manager if a Payment Reason code has been entered that is flagged to send a claim to the Manager.  The adjustment can be calculated using the Adjustment Type 2 payment calculation on the Plan Setup, and would be set up as the Allowed – Approved, and a special adjustment code for Disputed Amounts would be used.  It becomes "disputed A/R," and this adjustment type and amount can be reported on.  A special message is usually entered on the patient statement to let them know that there is a problem with the insurance payment, and that all or some of the amount in dispute may become the patient's responsibility.

Tab through the remainder of the fields.  Use the check-box to indicate whether a Medigap claim should be printed.

The Payment Note option allows you to enter a note regarding the payment that will display in the Activity View of the ledger and on the Memo tab.  The date beside Insurance payment notes are posted and displayed with the Visit date of the claim the note was entered on.  The Insurance payment note will also appear in the body of the account statement if you indicate that it should.  This is a free-form field where you could put a note regarding an appeal, for example.

The Special Bill Message allows you to select a pre-defined special message to be printed on the next patient statement, and you may indicated whether that message should be recurring.

You may enter a free-form special bill message in the box below.  You should not use a free-form special message if you have selected a pre-defined special message in the box above.  The system cannot print both messages on a patient statement.

The IMAGING button is not used at this time.

The SUSPENSE button allows you to "suspend" claims and or statements, and enter the reason why you are doing so.        

The VIEW button allows you to jump to the patient ledger or to the account, and then come back to the payment.  To go back to the payment screen, use the green Show Pay Entry button at the top right corner of the screen.

As you continue to enter payment distributions for the bulk payment, the Payment Information screen is updated.  The system will track the total payment and what you have entered for each patient so that you can easily see when you have entered the entire check and when you balance to the total.  Note that a batch with funds still unapplied may NOT be released.

PAYMENT SEARCH

If you need to locate a payment, click on the PAYMENT SEARCH tab.  The system will go back and search all payments to find ones that meet your criteria, such as a $200.00 payment as in the example below.  The search criteria are listed under the SEARCH EXAMPLES tab.  You may search by document number (check #), payment amount, payment date, name, etc. to locate "lost" payments.

PAYMENT DEBITS / RECOUPMENTS / RETRACTIONS

To add money back on to an account, (to debit the account) enter a NEGATIVE payment.  That is, enter a "-" in front of the amount that you are debiting back onto the account.  As a rule, when you enter an amount in the payment field, it lowers the account balance.  To raise (debit) the account balance, you do the opposite of what you normally do, by entering a negative payment.

If the amount needs to be added back on because of an insurance recoup or retraction, enter the negative payment via the Insurance Payment screen and post it to the insurance claim.  When you are searching for the claim, you may need to use the "Show Closed Claims" option in order to locate it.

Negative payments should be used and NOT adjustments to perform this function.  Negative payments are used to transfer an incorrectly posted payment from one account to another, or from one claim to another on the same account if it was posted to the incorrect claim, or from one procedure to another on one claim on one patient if it was posted to the incorrect procedure on a claim.

The following steps should be taken to transfer an incorrectly posted insurance payment from one claim to another.

Access the Insurance Payment entry screen.  Press F9 to invoke the claim search window.  Enter the patient's name or the claim number of the claim you wish to remove the payment from.  Select the "Show Closed Claims" to access a claim that has already had a payment entered on it.  After selecting the claim from the claim search, the Insurance Payment screen is displayed again.

The Batch No will default to the batch selected on the previous page.  The Remitted date will default if one was entered when the batch was created.  Otherwise, enter the remit date.   THE DATE ENTERED HERE SHOULD BE THE DATE OF THE ORIGINAL PAYMENT.

Enter the Payment Method.  This would probably be Check for an Insurance Payment.  Enter the Doc No, which is usually the check number.

The Pmt Type and Adj Types default from the Insurance Plan setup.  These may be overridden.  The cursor will move through the fields and down to the charges.  Since the claim has already had a payment made on it, the system will not calculate any of these fields automatically like it might be set up to on a new insurance payment.

When you get to the payment amount field, enter a NEGATIVE payment.  That is, enter a "-" in front of the amount that you are debiting back onto the account.  As a rule, when you enter an amount in the payment field, it lowers the account balance.  To raise (debit) the account balance, you do the opposite of what you normally do, by entering a negative payment.  You will notice that the system will display the amount that you entered within parentheses.  The Open amount will be increased by the amount that you entered.

The Payment Note option allows you to enter a note regarding the payment that will display in the Activity View of the ledger and on the Memo tab.  The date beside an Insurance payment note is both posted and displayed with the Visit date of the claim the note was entered on. The Insurance payment note will also appear in the body of the account statement if you indicate that it should. This is a free-form field where you could put a note as to why you are posting the negative payment amount.

Then you would post the payment to the correct claim by searching for it and posting the payment as you normally would.  The only difference would be that you must be careful with the Remitted Date and put the correct date of the original payment.

The procedure to move an incorrectly posted insurance payment from one procedure to another on the same claim would be the same as above, except that after entering the negative payment on the incorrect procedure, you would stay on the same claim, same screen, and proceed to enter the payment on the correct procedure.

The procedure to move an incorrectly posted patient payment from one patient to another patient would also be the same as above, except that you would enter the transaction through the Self Payment Entry screen instead of the Insurance Payment screen.

REFUNDS

Patient/Account refunds should be posted through Self Payment Entry.  You will need to use the "Show All" function in the Self Payment Entry screen in order to see the charges that are at a zero or credit balance.

Insurance Refunds should be posted through Insurance Payment Entry, and applied to the claim that was overpaid.  When you are searching for the claim, you may need to use the "Show Closed Claims" option in order to locate it.

SUSPENSE ACCOUNT

You may want to set up a "Suspense Account" where you can post payments that you don't know where else to put them, i.e. you cannot locate the patient and/or claim to post the payment to.  A zero charge should be entered to which payments can be posted.  Payments that you are posting to the Suspense Account are entered via Self Payment Entry.  You will need to use the "Show All" function in the Self Payment Entry screen in order to see the charge to post the payment to, since it will be at a zero or credit balance.  When the funds are to be removed from the suspense account and applied to a patient or refunded to a carrier, payment and/or adjustment transactions to accomplish this are entered.  A refund adjustment would be posted to issue a refund.  Payment codes should be used to post the payment to the correct account.  This can be accomplished by entering a negative payment on the Suspense Account to un-do the original payment, and entering a normal payment on the correct account (both of these should be entered with the original remit date).  These will zero each other out so that you are still in balance.  Using Payments to transfer the funds instead of adjustments will ensure that payments are reported correctly.

You may create suspense accounts for other functions if you would like.  Many practices use other suspense accounts to handle prepayments and collection payments.

PREPAYMENTS

PrePayments can be posted to a "dummy charge" that has been entered on a patient or on to a "PrePay Account," which is much like the Suspense Account above.  When the service is rendered and the visit is entered, then the payment must be moved and applied to the visit in order for the payments to be reported correctly.  This is accomplished by entering a negative payment on the "dummy charge" to un-do the original payment, and entering a normal payment on the new visit (both of these should be entered with the original remit date).  These will zero each other out so that you are still in balance.  Using Payments to transfer the funds instead of adjustments (or not moving the prepayment at all) will ensure that payments are reported correctly.  If the prepayment is not applied to the new visit, the system will try to bill that visit.  Therefore, it is important to post the prepay to the visit when it is entered.