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 income. For a more detailed view of income, many providers choose to use the Day Sheet as a broader and more understandable view.

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 (ERAs) 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 Date 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 from when the appointment is first scheduled. 

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To navigate the live claims, you have access to several filters to narrow the range you are examining.

Claim Status Filter:

  • ERA Received: A response has been received via ERA from the payer, however, at least 1 item on the claim that needs manual review.  Additional details can be found within the actual appointment by clicking on the green words ERA Received.
  • In Process at Clearinghouse: The claim has been received at the clearinghouse and is being scrubbed prior to sending to the payer.
  • In Process at Payer: The payer has received the claim from the clearinghouse and is conducting an upfront scrub of the claim prior to accepting it into their system for processing.
  • Payer Acknowledged: The payer has accepted the claim into their system for processing.
  • Coordination of Benefits: The claim has been processed by the patient's primary insurance and is now with the patient's secondary insurance for consideration.
  • Other: These are claims that are in other statuses, including Paid in Full, Faxed/Mailed Claim or Appeal, Balance Due, Pending Info Practice among others.  Details for these claims can be found under Billing St, just to the right of the Claim St.  Billing > Live Claims Feed > Billing St
  • Rejected: Upfront rejection.  If you click on the blue Rejected Payer within the appointment, you will be able to see additional information regarding the denial.  This claim has not made it into the payer's system for processing.
  • ERA Denied: The claim has been processed by the payer, however, there is a portion(s) that has been denied.  Details on the denial can be found on the actual ERA posting within the appointment.
  • Not Submitted: These are appointments for which there is no status.  Claim has not billed to insurance.  This could include appointments from the current or future dates.
  • Missing Information: Upfront rejection for information that is imperative to submit the claim.  Additional information on the rejection and clarity on what information is missing can be seen by clicking on the blue missing information words within the appointment.

 

Day Sheet

The day sheet is designed to provide a day to day snapshot of your finances, detailing charges, payments/credits, and adjustments. Since the day sheet provides sums for the time period, the day sheet can also be used to summarize daily, 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 Charges), Credits (Amount Collected From Insurance), Adjustment (Insurance Adjusted Amount),  and Patient Payments (Paid By Patient).

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Accounts Receivable

Accounts Receivable tracks the total amount of money outstanding from previous appointments/transactions. 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 by clicking on the respective tab.  If you click on the blue word Total on the right of the screen, the system will resort the items for you from highest dollar amount to lowest.

 

Fee Schedule 

The fee schedule is where you can add prices for the services you offer. These services can be added as  CPT/HCPCS code or a custom procedure.  NDCs can also be added to any drug codes you bill out to assist during the billing process.  This NDC would need to be updated if anything changes (i.e. multi use vial to single use) that would result in a change in NDC.

During an appointment, you can attach any of the CPT/HCPCS/custom codes to the appointment and they will reflect the price that is currently listed in the fee schedule. You can add items such as modifiers, taxes, expected reimbursement by payer, and picklist information to further customize your fee schedule.

 

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