Private Insurance Claims

Chapter 5
RECEIVABLES - PRIVATE INSURANCE CLAIMS

5.7.1. Add New Claim & Modify Existing Claims

The first two submenu items are identical in navigation and functionality. The only difference is that when adding claims, the system allows you to manage claims for all patients. While modifying, however, you may choose from a list of patients for which a claim already exists.
General - Pay close attention to tabs, buttons and menu options. For example, you may move to the next patient by using the navigational buttons provided on the right hand side of the screen.

Also note the information flow. Refer to the sample screen. Each row of information represents a service period (claim.) The "PATIENT" tab will display all claims for specific patient, either highlight or place the cursor on a row of information (one claim) and view claim detail in the other tabs.

Now you may begin to create new claims for the selected patient. Click on ADD NEW CLAIM button (or activate from menu) to begin. Enter service dates; designate a bill type for Private Insurance claims and OK. When you create a new claim, the software immediately prompts you to complete the "Claim" tab:

Enter the Admission Date.

To enter Admission Type, Admission source, and Patient Status at End of the Month double click on the blank box to reveal codes and click on your selection.

Total Days will be calculated based on claim service dates and status at end of the month.

Enter or edit a Rate.

To enter Diagnosis and Condition codes, double click on each box and click on your selection. Tab or hit Enter key to move to the next data entry field.

Enter Occurrence Codes & Dates.

To access Physician UPIN database, double click on the data box and click on your selection. Tab or hit Enter key to move to the next data entry field.

Add remarks specific to this claim.

Proceed to "CHARGES" tab.

Click on ADD CHARGE button and click on a revenue code to select. To select multiple revenue codes, hold down the Control (CTRL) key and click on desired items. Click on OK.

If revenue codes and their corresponding rates are in place (via MAINTENANCE), then the system will reflect those rates in Rate column. Additionally, if you preloaded Medicare designated revenue codes 110, 120 and 130 for accommodation charges, the software will calculate the number of days in the Unit column. Otherwise, you may manually enter or type over existing rates and units.

Enter "Y" for "Reimb." Column if the charge will be paid in addition to claim’s daily rate.

To delete a charge, highlight the charge and click on DELETE CHARGE button.

Proceed to RECEIVABLE tab to calculate the receivable and post to G/L, one claim at a time. To batch process calculation and posting, go to the RECEIVABLE menu, choose a payer, and select CALCULATE RECEIVABLE and/or POST TO G/L from the submenu.

Verify the claim information and mark it as complete. Locate the check box on the top right hand corner of each tab and click on the box to complete the claim. This means that the claim is ready for calculating receivable amounts, transmission, and posting to the General Ledger. The system will check certain data fields for completion, before accepting the claim.

Click on CALCULATE RECEIVABLE button. MedEasy will calculate the receivable amount.

Click on POST TO G/L button to post the claim. You are required to enter post date for the claim. Consult your accounting department regarding posting dates.

You can review all the claims created from the "PATIENT" tab.

To modify a claim, mark the claim as incomplete, enter changes and complete the claim. However, after the claim is already posted some information that will affect the receivable amounts cannot be changed. Refer to "Adjusting a posted claim" to make changes for those fields.

Changing Service Dates
To change service date, mark the claim as incomplete.

On the "Patient" tab, select the claim (click on the row of information you wish to change service dates.) On other tabs, proceed to next step.

Go to the menu bar and select CLAIM, then click on CHANGE SERVICE DATE submenu.

The current service dates will display in dialog box, you can type over the correct service dates and click OK.

Note that you need to mark the claim as complete once you are done.

Deleting Claims
To delete a claim:

On the "Patient" tab select a claim (click on the row of information you wish to delete.) On other tabs, proceed to next step.

Go to the menu bar and select CLAIM, then click on DELETE SELECTED CLAIM submenu.

MedEasy will prohibit deletions if:
1. Claim has been submitted for payment.
    Remedy: Delete the bill date.
2. A payment record exists.
    Remedy: After you verify the payment, you may decide that the payment was posted
    incorrectly. You may delete the payment and then return to this screen to delete the
    claim.
3. The claim is posted to G/L and the accounting period is closed.
    Remedy: Since accounting period is closed, we cannot delete the claim. However, if the
    claim has an error, after you reverse the claim (refer to Adjusting a posted claim), you
    can void the claim by entering zeros in all rate fields. Then re-calculate the receivable.
    All receivable amounts should become zero.
Adjusting Posted Claims
After consulting your accountant, follow these steps to make an adjustment to a posted claim.

On the "PATIENT" tab, select a claim (click on the row of information you wish to adjust.) On other tabs, proceed to next step.

Click on the ADJUSTMENTS menu. There is one option for Private Insurance claims.

REVERSE CLAIMS
Use reverse claim to reverse the entire claim (both revenue and receivable sides.) After you make changes to the claim, you need to CALCULATE claim before posting again. You need to enter the new post date. Consult your accounting department regarding posting dates and adjusting receivables.
5.7.2. Calculate Receivable
Before you calculate receivables, review all claims for the month and complete claims. Once you mark the claims as complete, you are ready to calculate accounts receivable for a batch of claims. From the RECEIVABLES menu, select CALCULATE RECEIVABLE. Enter the desired month and year. Click on OK. The system will confirm the total number of claims on the screen.
Note that the software does not require that you mark a claim as complete before calculating A/R for Private Insurance claims. Re-check and review all the claims on the screen.
5.7.3. Post Claims to G/L
After claims are calculated, you should use this option to post all the claims for specific month and year. From the RECEIVABLES menu, select POST CLAIMS TO GL. Enter the desired month and year, as well as posting date. Click on OK. The system will confirm the total number of posted claims on the screen.
5.7.4 Print UB92
Enter claim service dates, select either one patient or all patients for those service dates then click OK and the UB92 form will be printed. MedEasy does not require you to feed the pre-printed UB92 form.
Note: Private Insurance Claims have the option to print All charges or Reimbursible Only charges in addition to accomodation charges or No charges but accomodation charges will still print.
5.7.5. Print Ancillary Charge Log
Select this menu item to print claims ancillary charges for a given period. Enter the desired date parameter and click OK. If you requested a report for multiple months, note that each new month begins on a new page. Note that charges in charge master will not appear here. To view charges in charge master, use REPORT menu and then CENSUS reports.
5.7.6. Receivable Log
Select this menu item to print claims receivables log for a given period. Enter the desired date parameter and Click OK. If you requested a report for multiple months, note that each new month begins on a new page.