Medical Billing 101: Getting Started With Billing

Getting Started With Billing

The drchrono platform revolves around patient appointments. It works this way since that's the way you interact with patients and in turn, get to bill them for your time.

To get started, fill out the schedule appointment prompt created through your scheduling portal (Navigation Bar > Schedule > Calendar > + New Event). Once you finished entering the basic details of the appointment, hit "Save" and the tabs on the top of the form will be able for you to click on. Note: You cannot navigate to other tabs without first completing and saving the basic information in the Appointment tab.

Once the appointment is saved, the "Billing" tab becomes available. Click on the billing tab to begin entering the billing information associated with the appointment.

  • Billing Status: Refers to how the payment is or has been processed
  • ICD Version: Refers to the ICD version your practice uses (9 or 10)
  • Patient Payment: Refers to the amount the patient has paid, including co-pay quantities
  • Payment Notes: A section you may add in any additional notes you think are relevant
  • Payment Posted Date: The date the payment was issued
  • Pre Authorization Approval #: The number provided by your insurance for pre-authorization. Insurance sometimes requires prior approval for procedures and will require a pre-authorization approval number for coverage
  • Referral Number: Insurance may require a referral from another physician for coverage. The referral number can be entered here.
  • Payment Profile: The type of payment obtained for the services you provide
  • Billing Profile: A drchrono convenience feature that allows you select from various profiles to pre-populate sections of the billing form that can be customized to your own needs.
  • Billing Pick List: Commonly used ICD and procedure codes used in your billing
  • Diagnosis Pick List: Previous diagnoses populated from the patient problems list
  • Employment/Auto/Other Accident: For insurance and legal purposes, select what kind of accident caused the patient condition (if applicable).
  • Onset Date Type: The type of event that caused the onset of the condition
  • Onset Date: The date of the condition onset.
  • Initial Visit Date: The first date the patient has visited your office for this condition
  • Last Related Visit Date: The last date the patient has visited your office for this condition

To add an item to charge to your patient, begin by adding the CPT (Current Procedural Terminology) code associated with the appointment procedures. Here, you can add a price or alternatively, if you have billing profiles already set up, you can pre-populate the CPT fields by selecting your billing profile through the drop-down menu. If a billing profile is used, additional CPT codes can be added to the appointment through the CPT Code search box.

Using the CPT Code Search:

Using a billing profile:

 

 

After populating the CPT Code section, you can make adjustments to the procedures. 

  • In the 'Price' box, price per unit is entered which will be multiplied by the quantity you enter. 
  • The 'Modifiers' option allows you to choose CPT modifiers to attach to the procedure (ie. AF: Specialty Physician"). Modifiers may describe if multiple procedures were performed, where the procedure was performed on the patient, how many people worked on the patient, and other information that may affect the claim's status with the insurance payer.
  • The 'Quantity/Minutes' box allows you to input a quantity to multiply by the rate determined by your entry in the 'Price' box (ie. Price =  $5, Quantity = 60 minutes will result in a $300 bill for a 1-hour procedure).
  • The 'Diagnosis Pointers' box is important for insurance purposes and refers to the primary ICD-9/10 code(s) the CPT procedure affects. The pointer format A:B:C:D points toward the order of the ICD-9/10 codes you may enter (see below). For example the format 2:1:0:0 means that the procedure primarily affects the SECOND item on the ICD-9/10 code list but also affects the FIRST item on the ICD-9/10 code list to a lesser extent than the second item and is not intended for anything else. By default, the pointer is set to 1:0:0:0 which means the procedure is intended to affect the first item of the ICD-9/10 code list.

In this example, the Diagnosis Pointer 1:0:0:0 refers that code 97602: WOUND CARE is intended to treat #1 of the ICD-10 code list (below), 'S01.501A: Unspecified open wound of lip' and indicates that it is not intended to treat anything else on the list.

To add ICD-10 codes to the list, search for the code by keyword or by ICD-9/10 code. If you selected ICD-9 on the ICD Version option in the earlier portion of this guide, the ICD-10 box will be replaced by the ICD-9 box.

 

If you are on an ICD-9 system and would prefer to use ICD-10, search for the ICD-9 code in conversion box below the ICD-10 code box and convert it to ICD-10.

 

HCPCS codes represent codes to represent medical procedures to Medicare, Medicaid, and third-parties. HCPCS is separated into three levels to represent different services. Level I HCPCS codes are used to bill Medicare or Medicaid and are identical to CPT codes. These CPT codes used for billing Medicare and Medicaid are actually HCPCS codes by definition. Level II and Level III HCPCS modifiers is where CPT and HCPCS really differentiate. You may add your HCPCS codes by searching by keyword or code in the HCPCS Procedure Code search box. Modifiers, Quantity, and Diagnosis pointers work in the same way as CPT codes.

The drugs you use in your procedures can be recorded for insurance billing purposes in the NDC Code box. Search for your drug by keyword or by the 10-digit NDC code. The price entered in the HCPCS section will show up as a line item in the NDC Code section. 

If you would like to charge your patients for any other items or services, you can add them by searching by keyword or custom code through the Custom Code search box. If you are unfamiliar with Custom Codes, please feel free to read our guide on inventory and service management.

Obtaining a Receipt

If you wish to provide a receipt to your patient for a payment, you can select the 'Receipt' button below the payment entry box. Note: The 'Receipt' button will only appear after you have hit save. 

When you hit the 'Receipt' button, a receipt in the form of a PDF will open in a new window. From here on, you can print or email the receipt to your patient.

 

The Patient SuperBill

For a more detailed receipt, click on the 'Patient SuperBill' button on the upper right hand corner of the billing form. The SuperBill is a receipt focused on the summary of charges. It details the visit information, diagnosis, insurance, treatment, charges, discounts, payments, and the remaining balance.

After clicking the 'Patient SuperBill' button, the following screen appears. By clicking on the arrow next to the button, you also get the option of sending the Patient SuperBill to onpatient.

 

Conclusion

Once you click save, if you selected to 'Bill Insurance' or 'Bill Secondary Insurance' under 'Billing Status', your claim will be batched with all your other claims and transmitted at 7:00 PM PST (-0800) to Emdeon or Trizetto, our clearinghouses. You will receive an electronic remit that is viewable in the drchrono EHR. From that point onward, you can track the payments your patients make and the collections you receive from their insurance. 

 

 

 

 

 

 

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