Medical Billing 101: Introducing Your Core Billing Tools

Billing Summary

The billing summary is separated into two sections: Income Analysis and Payment Speed. The Income Analysis section is a simple graph which gives you a basic picture of your incomes. For a more detailed view of incomes, many providers choose to use the Day Sheet as a broader and more understandable view of your incomes. Payment Speed lets you know the fastest, slowest, and average speed in which you get paid. The Payment Speed section only works for electronic remits (payments) and not paper EOBs. Performance Indicators gives you a few key metrics to measure the health of your practice operations. Here you can view the quantity of procedures, amount of charges, amount of adjustments, amount allowed by insurance,  If you notice, there are the letters 'A' and 'P' next to some of the items in the Performance Indicator list. These stand for Appointment and Posted Date respectively.

Live Claims Feed

The Live Claims Feed is a convenient and comprehensive way to keep track of all your claims starting all the way from day one. If you selected 'Bill Insurance' in the Billing Status field of the New Appointment form (New Appointment > Billing > Billing Status > Bill Insurance > Save), your claim will appear in the claims screen of the Live Claims Feed. Here you can view the amount billed, allowed, adjustments, balances, and statuses. 

 

To navigate the live claims, you have access to several filters to narrow the range you are examining, the most important of which is the Claim Status Filter.

Claim Status Filter:

  • ERA Received: The ERA was transmitted to the drchrono system and the payment was posted.
  • In Process at Clearinghouse: The clearinghouse is processing your claim in preparation of transmission to payer.
  • In Process at Payer: The clearinghouse has approved of your claim and has transmitted the claim to the payer.
  • Payer Acknowledged: When the payer acknowledges receipt of the claim, the status changes to payer acknowledged. This indicates your claim has transferred to the main system.
  • Coordination of Benefits: Medicare only. If a patient has medicare as primary and another insurance as secondary, Medicare must pay the secondary insurance. Once the claim passes from Medicare to the secondary insurance, the claim status will change to 'Coordination of Benefits'.
  • Other: Other statuses that you might encounter.
  • Rejected: There are two types of rejection: clearinghouse rejection and payer rejection. A clearinghouse rejection means that a clearinghouse has kicked back your claim for missing information. A payer rejection indicates that the claim has been rejected at the front-end when a payer scrubs the claim and finds missing information, then the payer rejects the claim.
  • ERA Denied: The claim has made its way to the payer and then denies it.
  • Not Submitted: The insurance status is 'Not Submitted', meaning the claim was never submitted to be billed.
  • Missing Information: There is missing information in your claim.

 

Day Sheet

The day sheet is designed to provide a day to day snapshot of your finances, detailing charges, claim credits, and adjustments. Since the day sheet provides sums for the time period, the day sheet can also be used to summarize week to week and monthly finances (max 31 days). The day sheet provides a more macroscopic view of your practice. It allows you to keep track of your debits (Total Billed Out), Credits (Amount Collected From Insurance), Adjustment (Insurance Adjusted Amount),  Patient Payments (Paid By Patient), and Charges. 

Accounts Receivable

Accounts Receivable tracks the total amount of money you can possibly collect from your past activities. Here you can organize your claims by claim type, submission status, age, and date. You can also view your accounts receivable by insurance or patient types.

 

Fee Schedule 

The fee schedule is where you can add prices to the services you offer. These services are referred to as procedures and can be a CPT/HCPCS procedure or a custom procedure including inventory charges. During an appointment, you can attach any of the fee schedules to the appointment and have them show up in your patient's bill. You can add modifiers, taxes, payer, and other features to your procedures. On the fee schedule page, you can add new procedures or manage your existing procedures.

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