Now that the codes have been added, let’s cover how to insure the visit!
In this lesson we’ll cover the following insurance topics:
- Insuring a Visit
- Deductibles, Co Pays & Co Insurance
- Remove, View or Edit an Insurance Claim
- Adding Insurance Information to a Paid Visit
- Secondary Policies
If you have not done so already, please go through the US Insurance Set Up Steps first.
In the previous lesson, we added CPT & Dx codes to Victoria’s appointment.
In this case, let’s say Victoria has insurance coverage. To add a claim to the visit, press the Add button in the Insurance Info section:
Select the primary coverage insurance claim from the list. You can select an existing claim or “Add New Claim.”
Clicking the “Add” button gives you the option to add an existing claim (if Victoria has one saved to her profile) or a new claim to the visit.
Let’s say the provider selects Victoria’s existing claim. Once he does that, the visit becomes insured and Jane generates an invoice for the insurer.
An insured visit will look like this in the Appointment window:
And like this on the Schedule:
To edit the insurance information for this visit, say to add in a $20 co-pay, we can press the insurer name (in blue text) to open up the claim details:
Patient responsibility is typically entered into the following fields: Co Pay, Co insurance, Deductible.
Once the visit is insured, you’ll be able to accept payment if the patient has any time of service responsibility!
If you’d like to collect payment from an insurance patient at the time of service, then you can add a patient responsibility to the purchase claim panel.
Once you’ve added the policy to the visit, click on the claim (in blue text) to open up the claim panel.
Once you’ve opened the panel, you’ll have a couple options.
If a patient is working to pay off a deductible, you’ll want to enter the full deductible or the known remaining deductible amount in the deductible field. This tells Jane that insurance won’t be paying anything towards the patient’s insured visits until that amount is reached. This will push the full amount billed (assuming the deductible is higher than what was billed) down to the patient.
It’s the beginning of the year and our patient Ann has a $1000 deductible.
Let’s say Ann comes in for an insured visit and we bill out a single code that totals $100.
As Ann’s deductible is higher than the amount billed, Jane will push the entire amount billed down to the patient:
On Ann’s next visit, Jane will reduce the deductible by the amount paid on the previous visit, in our example, $100:
Note: Jane does not communicate externally to check for up to date deductible information. If you are treating a patient and then they have gone elsewhere for treatment, the deductible in Jane would need to be manually altered.
If you don’t want the full amount billed to insurance to be passed down to the patient at the time of service, you can add in an eligible amount equal to what the patient is paying at the time of service:
If the patient has a Co Pay or Co Insurance responsibility, you can enter the $ amount per visit in the claim panel. Jane will push only that amount down to the patient:
If you have added an insurance claim to a visit in error, or maybe you have selected the wrong insurance claim, here’s how it can be removed:
- Head to the patient’s appointment and click on it
- On the right hand panel scroll down to Insurance Info
- Under Primary Policy, click the drop down arrow to remove the claim
This Claim Menu also gives you the ability to View the claim, or Edit claim information:
If you need to add billing codes and/or an insurance claim to a paid appointment, you’ll want to use the Allow Editing toggle to make the needed changes!
Start by clicking on an appointment to view the Appointment window, and scroll down to the Insurance Info section.
Toggle on Allow Editing:
With Allow Editing turned on, you can now click to add any needed insurance information.
Once you have added the billing codes and/or claim, Jane displays a button that allows you to Update Invoices.
When you click the Update Invoices button, behind the scenes, Jane is re-applying the client’s original payment. If there is a balance outstanding Jane will show that as the amount owing on the patient’s account. Or if the client’s original payment exceeds the amount of the regenerated invoice, Jane will generate a credit on the patient’s profile.
Secondary and Tertiary Insurers can be added to a visit by navigating to the Insurance Info area, and by selecting the “Add” button next to the Secondary Policy section:
Please note that Jane currently doesn’t have a feature that allows you to submit to a patient’s secondary insurance via EDI file or CMS-1500 (as we only have that option for the patient’s primary which can include info about the secondary coverage if both are added to a purchase).
The EDI (for the primary) includes some information from the secondary policy (i.e. Secondary Insured’s ID and Insurance Program), but there isn’t (yet!) a way to produce an EDI to send to secondary.
📘 Continue learning the insurance billing workflow in Start Billing 4 - Claim Management