Chapter 8:
Posting Insurance Payments and
Creating Patient Statements
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Third-Party
Reimbursement Overview
 Fee schedule
 List of standard fees established by provider
 Not necessarily the amount the provider is paid
 Difference between amount in fee schedule and amount paid is an adjustment
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Remittance Advice Processing
 Electronic Remittance Advice (ERA)
 X12-835P
 Remittance Advice (RA)
 Paper format
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8-4
Remittance Advice Processing
 Steps for Processing
 Verify that all procedure codes listed on claim are represented on RA
 Review payment amount against expected amount
 Identify reason for denials or payment reductions
 Post payment information in practice management program
 Bill secondary health plan (if appropriate)
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Entering Insurance Payments
 Payments from insurance carriers are entered using the Enter
Deposits/ Payments option on the Activities menu
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Entering Insurance Payments
 The Deposit List window lists deposits for a specific date, or, all deposits can be viewed
8-6
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Entering Insurance Payments
 To enter a deposit, click the New button, and the Deposit dialog box is displayed
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Entering Insurance Payments
 The type of payor —patient, insurance, capitation —is selected from the Payor
Type drop-down list
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Entering Insurance Payments
 Other information entered about the deposit include:
 Deposit date
 Payment method
 EFT Tracer
 Check number
 Description/Bank no.
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Entering Insurance Payments
 Other information entered about the deposit include:
 Payment amount
 Deposit Code
 Insurance
 Codes for payments, adjustments, withholds, deductibles, and take backs
8-10
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Entering Insurance Payments
 Once a payment is entered, it appears in the Deposit List window
8-11
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Entering Insurance Payments
 Once a payment is entered, the next step is to apply the payment to patient accounts
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8-13
Entering Insurance Payments
 Payments applied to patient accounts using the
Deposit feature are automatically displayed in the
Transaction Entry dialog box
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Entering Insurance Payments
 Capitation payments are entered but not applied
8-14
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Entering Insurance Payments
 Second “EOB Only” deposit is entered
 Patient accounts adjusted to zero balance
8-15
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Creating Statements
 Statements are created in the Statement
Management area of Medisoft
8-16
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Creating Statements
 When the Create Statements button is clicked, the Create Statements dialog box appears
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8-18
Creating Statements
 The Create Statements dialog box contains a number of filters, including
Transaction
Dates
Location
Chart Numbers Provider
Billing Codes Amount
Case Indicator Statement Type
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8-19
Statement Types
 Standard statements show all available charges regardless of whether the insurance has paid on the transactions
 Remainder statements list only those charges that are not paid in full after all insurance carrier payments have been received
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Creating Statements
 Once statements have been created, they are listed in the Statement Management dialog box, with a status of Ready to Send
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Printing Statements
 The Print/Send button is used to print statements that are then sent out to patients and guarantors
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Printing Statements
 When the Print/Send button is clicked, a statement method (paper or electronic) is chosen
8-22
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Printing Statements
 Next, the type of statement is selected from the list provided
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8-24
Printing Statements
 When the
Print/Send button is clicked, paper statements are printed and mailed by the practice
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Editing Statements
 If changes are necessary, highlight the statement in the Statement Management dialog box and click the Edit button
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