How to bill Patient Co-Pays

Transcription

1 How to bill Patient Co-Pays There are 3 ways to handle patient co-pays in HAS depending on the billing scenario. The co-pay can be transferred to the Self Pay insurance after the primary payer has been billed, it can be set up to automatically deduct from the primary payer billed amount at the time of Billing Audit posting, or when the primary payer is PPS a co-pay charge will be used. To bill patient co-pays, a default Self Pay insurance should be listed in File > File Maintenance System Settings on the ID-Numbers tab or entered for the patient in the Patient > Insurance file (Clinical users should enter in their clinical system). METHOD 1: BILLING CO-PAY AFTER PRIMARY PAYER PAYS One-Time Setup Go to the File>File Maintenance>System Settings ID- Numbers tab. Select a Default Self-Pay Insurance from the dropdown. Process In A/R > Payments/Transfers, the co-pay balance due can be transferred to Self Pay after the primary insurance payment amount has been applied. Click the Detail tab at the top of the window. Check Allow Transfer and enter the To Bill Date (defaults to Today's Date). The To Insurance should be set to Self Pay. 716 Newman Springs Road Lincroft, NJ Tel Page 1 of 6

2 In the Transfer column for each visit, enter the per visit co-pay amount. If the charge Net amount is the same as the co-pay amount, you can click XFer All Chgs and the Xfer button and then press Save. Select Yes on the confirmation window if all data elements were entered properly. Performing the Transfer creates a bill record for the Self Pay insurance for the co-pay amount. Running a billing audit is not needed for this process. Charges can also be transferred with a $0 amount if you wish them to appear without a due amount on the patient statement/claim. After the Transfer is complete, you can generate Patient Statements (AR>AR Reporting, set Report Type to Statements) or print a patient pay claim (Billing>Printed Claims>Custom Invoices). Using Patient Statements is recommended since it will reflect prior payments whereas Custom Invoice shows co-pay charge co-pay amounts only. METHOD 2: BILLING CO-PAY AT TIME OF BILLING AUDIT One-Time Setup Go to the File>File Maintenance>System Settings Reporting tab. Check Auto Post CoPays to Self Pay. 716 Newman Springs Road Lincroft, NJ Tel Page 2 of 6

3 Process On the Patient > Insurance tab (or in your Clinical System) enter the Self Pay insurance. Select the patient s primary insurance and enter the Co-Pay Amount in the corresponding field. When running the Billing > Billing Audit for the primary payer, confirm the co-pay amount is posting to the Self Pay Insurance. After posting the Billing Audit that has co-pay amounts posted to Self Pay, you can generate Patient Statements (AR>AR Reporting, set Report Type to Statements) or print a patient pay claim (Billing>Printed Claims>Custom Invoices). Using Patient Statements is recommended since it will reflect prior payments whereas Custom Invoice shows co-pay charge amounts only. 716 Newman Springs Road Lincroft, NJ Tel Page 3 of 6

4 METHOD 3: BILLING CO-PAY WHEN PRIMARY PAYER IS PPS Dollar amounts greater than zero cannot be transferred to or from a PPS payer. When handling copay for a PPS primary insurance a co-pay charge code will be used to bill the co-pay amount to Self Pay. The Co-Pay should be billed after the RAP and Final. One-Time Setup Go to the File>File Maintenance>System Settings, Modality tab and add a new modality for Co-Pay. The Is-Visit box should be unchecked and the Care-Type set to Other. Go to the File>File Maintenance>Charge Code and add a new co-pay charge code. 716 Newman Springs Road Lincroft, NJ Tel Page 4 of 6

5 In the Bill-Rate tab add a Bill-Rate with a 0.00 Net amount: Process Make sure the primary insurance is setup to not cover the Co-Pay Charge Code. This can be done at the Insurance level under File > File Maintenance > Entity, Insurance type on the Ins-Rate tab. In Charge > Enter/Maintain, enter the patient in the Patient dropdown and add a row for the Co-pay Charge Code. Specify a Date within the Admit/Discharge Date range. In the Price-Ovr field, enter the amount of the Co-pay for the episode. (Note, If the Price-Ovr column is not visible, go to the Preferences tab and check the Chg Price Ovride box on the left under the Visible Grid Columns settings.) Example: 716 Newman Springs Road Lincroft, NJ Tel Page 5 of 6

6 After the Co-Pay has been entered, run the Billing > Billing Audit for the Self Pay insurance. After posting the Billing Audit that has co-pay amounts posted to Self Pay, you can generate Patient Statements (AR>AR Reporting, set Report Type to Statements) or print a patient pay claim (Billing>Printed Claims>Custom Invoices). Using Patient Statements is recommended since it will reflect prior payments whereas Custom Invoice shows co-pay charge amounts only. If you wish to include all the services provided to the patient in addition to the co-pay charge, the charges from the patient s other insurance(s) can be transferred from the Payment menu with a net amount of $0 to the Self Pay insurance selecting the same Transfer: To Bill Date used on the Self Pay Billing Audit. 716 Newman Springs Road Lincroft, NJ Tel Page 6 of 6