Remittance (ERA)

The Electronic Remittance function in MedSuite allows automated payment posting of electronic files received from PerSe or Emdeon for payors such as Medicare.

Electronic Remittance files are automatically received from PerSe during the PerSe transmission if they exist.  They are then processed for each practice during the next Close Out if that option is selected.  This process creates unreleased payment batches and enters the payments and adjustments to the patient claims in MedSuite.  Several reports are generated and displayed in the Task Viewer.  A Remittance Error report is created for payments that it is unable to post, and a Remittance Listing Zero Paid report lists rejected claims.  Users are then able to work the rejected claims, handle the errors, and release the batches of payments that were created.

REMITTANCE SETUP

Before beginning to process remittance files, the Payment Type and Adjustment Type that are to be used should be set up on the Plan.  If they are not set up, MedSuite will use a generic payment and adjustment code such as "Remit Payment" and "Remit Adjustment."   This is the only setup that needs to be completed prior to starting Electronic Remittance.

PROCESS REMITTANCE FILES (DURING CLOSE OUT)

Electronic Remittance files are automatically received from PerSe during the PerSe transmission if they exist.  They are then processed for each practice during the next Close Out if that option is selected.  If your Close Out is set up as a Scheduled Task, you will need to re-schedule it with the PROCESS REMITTANCE option selected.  The Close Out will generate several reports that will be listed in the Task View after it is finished.

REPORTS IN TASK VIEWER:

Several reports are generated by the Close Out and displayed in the Task Viewer with the other Close Out reports.  The REMITTANCE LISTING ZERO PAID and the REMITTANCE ERROR reports are ones that should be printed because they will require some action to be taken.

REMITTANCE LISTING

The Remittance Listing shows in an EOB format all the payments included in the remittance file.  There may be several different checks contained in the remittance file and on the listing.  The check number, amount, and remit date are listed at the top of each page.  Patients are listed in alphabetical order, and the list shows the amount paid and adjusted for each charge, along with Reason Codes, CoInsurance amounts, Crossover Insurance, etc., just as an EOB would show.

This report will also print an error for any payment that the system was unable to apply.  A typical error is **Claim not applied please see the Error Listing.**  This occurs when the system cannot match the claim on the remittance with a claim in MedSuite.

It may not be necessary to print this report at this time.  You will have an opportunity later to print a new EOB as needed after the errors have been corrected.

REMITTANCE LISTING ZERO PAID

The Remittance Listing Zero Paid report lists rejected claims, and any claims where the payment amount was zero, such as denials for duplicate claims.

This report provides a more efficient way of locating problem claims by printing them all in one place on one report, instead of having to search through pages and pages of correctly paid claims in order to find the ones with problems.  These are claims that should be investigated to determine whether they should be appealed or disputed.

REMITTANCE ERRORS

The Remittance Errors report lists patients that were contained in the remittance file but that MedSuite was unable to locate the correct claim to post the payment to.  A typical error on this report is “Could not find the Patient in the MedSuite system.”  This could occur when a claim for this patient was filed from a previous system; the payment cannot be posted into MedSuite and would need to be posted in the old system instead. This report provides a more efficient way of locating problem claims by printing them all in one place on one report, instead of having to search through pages and pages of correctly paid claims in order to find the ones with problems.  These errors will correspond to any on the Remittance Listing that say **Claim not applied please see the Error Listing.**  Again, these are payments that will need to be investigated so that the payments can be posted correctly.

PAYMENT ENTRY SCREENS

You may find that you need to correct some errors in the Remittance File.  TO do this, go to Batch, Payments.  Go to Batch, Payments.  You will see that batches have been created for each check contained in the remittance file.  The Batch No will be Remit, the User will be Remit, and the Check No. is contained in the Description so that you can match it up to the Remittance Listing.  The Date Remit is the date the electronic remittance was issued” by the payor.  In addition, you will see the amount of the check in the Bulk Payment at the bottom, along with the amount applied and amount still unapplied, if there were remittance errors on that check.  Clicking the + next to the Bulk Payment will display the payments on that check in that batch.

Double-click on the Bulk Payment, or select Edit.  The Bulk Payment information screen is displayed.  If you need to change the Remit Date to the date of the deposit, rather than the date the remittance was issued by the payor, edit the Remit Date on the Bulk Payment Information screen, as well as on the Batch List as displayed above by editing the Batch.

If there were errors on this remittance, the Remit Errors button will be displayed at the bottom of the screen.  It will not display if there were no errors.  If the Remit Errors button is showing, select it.  A list of the payments that had errors is displayed.  These are the ones on the Remittance Listing that said **Claim not applied please see the Error Listing.**  These were also listed on the Remittance Error Listing, usually with the error that “Could not find the Patient in the MedSuite system.  These payments may need to be posted manually, or they may need to be deleted.  If you need to delete a payment because it is a payment for a patient on your previous system, or a zero payment/denial for a duplicate payment, use the Delete button.

To post one of these payments, select a patient, and then select New.  The Insurance Payment screen is displayed, with the information for the patient you selected.  The cursor is in the Claim Number field.  Search to find the claim that this payment should be posted to.  Start by keying in the Claim No. displayed in the bottom left corner of the screen.  This is the claim number that came back from the payor in the remittance file.  This may or may not produce the desired results.  If you get no results, try clicking on the Show Closed Claims option.  Again, this may or may not produce the desired results.  It may find some closed claims; these could be claims that have had payments already posted to them, claims that were closed because the billing was reset for some reason, etc.  If one of these is the claim the payment should be posted to, click on it and then OK.

The Insurance Payment screen will be displayed with the claim information of the selected claim.  Proceed through the screen to enter the payment.  The bottom of the screen shows the payment information received in the remittance file.

If you cannot find a claim to post the payment to, it may need to be posted to a Suspense Account.  The dollars need to be applied somewhere, as a batch cannot be released while it still has unapplied payments.  If you are going to post it to a Suspense Account, you will need to edit the amount of the payment on the Bulk Payment Information screen and change the total to reflect the payment that you are removing from this batch.  You might create a new batch to be used for payments you are putting on the Suspense Account.  You might also need to edit the amount of the Bulk Payment if you remove payments that belong to patients in a different system, such as patients in a previous billing system on which you are still receiving some payments.

After all the Remit Errors have been posted, the Remit Errors button will disappear.  The Print EOB button is used to print a new Remittance Listing that will no longer have the errors listed on it.  Once the errors have been corrected and there is no more unapplied dollars, enter the Release Date on the batch so that it will post during the next Closeout.