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Appendix A - Billing Procedures

The intent of this section of your EMS Fast Cash instruction manual is to familiarize you with billing procedures that are vcompatible with the program as well as accounting practices.  Departures from these procedures will cause problems, either with accounting audits, as well as incorrect historical reports and databases.

Daily Procedures
These procedures may be done less frequently for small services, but the procedure should be followed periodically so that the program functions properly as designed. The following procedure must be repeated in its entirety for each company (if multiple companies are used).

tVerify all invoice information for the complete day, normally the previous day -- see page 4 of this section for tips on collecting and verifying trip data.

tEnter all invoices (Menu Tree = FILES/Invoice/A-Add). As soon as a new invoice is posted, immediately post charges.

tPost all charges and writeoffs immediately after adding each new invoice (C-Post Charges).

tPost all payments (Menu Tree = FILES/Invoice/P-Post Payments), and at the same time post contractual and other appropriate writeoffs. You may consider advancing due dates at this time based on the payment date; this will soften statement messages due to late payments by insurance companies, etc. for example.

tPost Charges to all invoices not posted (Menu Tree = FILES/Invoice/N-Not Posted List). From the main invoice screen, display all invoices for which charges HAVE NOT BEEN POSTED. Be sure to post charges to all invoices displayed. Normally this is step is not needed, since charges should be posted immediately after entering a new invoice.

vOPTIONAL -- Add/Edit Memos to invoices, patients, etc. as necessary (Menu Tree = FILES/Invoice/M-Memo) -- Comments may be attached to an invoice by highlighting the invoice in the main invoice screen and pressing the M key. If a memo is already attached to an invoice, an asterisk (*) will appear beside the invoice (in the main invoice screen). Rules for entering/editing memo notations for an invoice are found on the last page of this section. Similarly memo fields can be attached to records in other files, such as Patients, Doctors, Employers, Insurance Companies, and Subscriptions.

vOPTIONAL Print Transaction Log (Menu Paths = PRINT/Transaction Log). Note that when the end of month closing is done, the currently accumulated transaction log is deleted, and a new one will begin to be accumulated for the new month.

 

At The End of The Day

(Transmit to Medicare (Menu Path = TELECOM/Medicare/Extract Claims/Transmit Claims). Note that the 14-day payment floor begins the day you transmit.

(Transmit to Medicaid (Menu Path = TELECOM/Medicaid/Extract Claims/Transmit Claims --- if implemented in your state).

tPrint Medicare forms Menu Path = PRINT/Medicare/Select the applicable form. After transmitting, there may be Medicare claims that do not qualify for filing electronically, and these remaining claims will be printed.

tPrint Medicaid forms Menu Path = PRINT/2-Medicaid/Select the applicable form. After transmitting, there may be Medicaid claims that do not qualify for filing electronically, and these remaining claims will be printed.

tPrint all insurance forms (Menu Path = PRINT/Forms/Insurance/Select the proper form from the menu/Print All). Then print refiles

tPrint All Refiles (Menu Selection = Print All Refiles). Refiles are printed if insurance forms filed more than 45 days ago have neither been paid nor rejected. If you require mailing labels proceed with next step.

vOPTIONAL -- Print Mailing Labels For All Forms (Menu Selection = Print Mailing Labels). Mailing labels will be printed for all forms printed (above), including refiles. Remember to replace forms in the printer with mailing labels. Use of windowed envelopes precludes the need to print labels

tPrint all invoices not printed (Menu Path = PRINT/Invoices/All Invoices Not Printed). All invoices should be mailed daily. You may want to get a red rubber stamp for certain invoices: "This is not a request for payment, only a notification of services performed". There are messages to this effect, but even so, some patients mistake the invoice for a request for payment. In some cases (Private Pay, e.g.) the invoice is a request for payment as it should be. In these cases, patients may be prompted to call and provide insurance information.

tPrint balance due statements unless the normal end of month statements will be printed in a few days -- (Menu Path = PRINT/Statements/Statements: Balance Due After Insurance-Medicare Payment/Print All). Note that balance due statements should mailed daily, except near the end of the month when monthly statements are mailed. Note that when monthly statements are mailed that has the same effect as printing this report, and these will not be printed subsequently. Balance due statements are sent to patients whose insurance has either paid of rejected.

tBackup Data Files (Menu Path = MAINT/Backup/Save Data files). For each company (if more than one company is on the system) use a diskette for each day of the week to insure maximum backup protection. On Monday, use the diskette labeled MONDAY, on Tuesday, use the TUESDAY diskette, etc.

vOPTIONAL- Print Payments Posted to Balance Bank Deposits (Menu Path = PRINT/ Reports/List Payments By Invoice). For each company (if more than one company is on the system

 

15th to 18th of Each Month

tPrint payment pending list (Menu Path = PRINT/Files/Invoice (Payment Pending)/Medicare through Secondary Insurance). With this list, contact all insurance companies which you have not heard from for two months prior services. Follow-up on insurance is important.

tPrint patients 31-60 days past due (Menu Path = PRINT/Patient List/Patients With Selected Past Due Invoices/Patients With Active Invoices Past Due 31-60 Days). With this list look up each invoice and decide whether or not to call either the responsible party or the insurance company concerning payment. If extenuating circumstances are the reasons for non-payments, you may want to extend the due date by one or two months by advancing the due date at this time; otherwise, patients will receive FINAL NOTICE messages on subsequent statements.

t Print patients more than 60 days past due (Menu Path = PRINT/Patient List/Patients With Selected Past Due Invoices/Patients With Active Invoices Past Due Over 60 Days). This is the list of

patients who received Final Notice statements on the first of this month, and have not responded with any type payment. These patients have reached the end of the billing cycle, and should not continue as Active invoices. Each patient's record should be reviewed, and one of the following three options selected:

ŒSend to a collection agency: If this option is chosen:

tIn the detail invoice screen, change the invoice status to C (for Collections)

tIn the main invoice screen, select R-Report to print all information about this invoice to send to the collection agency.

Send to an attorney or file a lawsuit: If this option is chosen:

tIn the detail invoice screen, change the invoice status to L (for Legal)

tIn the main invoice screen, select R-Report to print all information about this invoice to send to the attorney.

ŽWrite off the account. You may choose to write off some accounts for the poor and elderly. Note that if neither the invoice status is changed from A (Active) nor the due date extended, this patient will continue to get FINAL NOTICE statements each month.

tPrint past due private pay statements (Menu Path = PRINT/Statements/Statements: Past Due 31-60 Days, Private Pay Pending/Print All).

tPrint past due statements after insurance or Medicare (Menu Path = PRINT/Statements/Statements: Balance Due After Insurance/Medicare Payment/Print All).

 

End of Month
vOPTIONAL – Assess finance charges -- (Menu Path = MONTHLY/Assess Finance Charges). Note that minimum and percent finance charges are defined in COMPANY SCREEN 1.

tRefund Overpayments (Menu Path = PRINT/Patient List/Patients With Negative Balance Invoices). Refund the appropriate party (Patient, Insurance Company, etc.) and post a negative payment in the amount of the refund – this should result in a zero balance for the invoice. Add an appropriate note to the payment, e.g. Refund to Insurance Company.

vOPTIONAL-- COLLECTIONS  – Extract collection letter 2, and send this file to your collection agency. Extract collection letter 1 and send your collection letter. Edit invoices with the freeform code fields with F; manually change all status fields to C.

tIf you put some accounts on hold to prevent printing statements – Print this report to insure that none have developed into private pay and are still on hold (or inactive) status. Menu tree: PRINT/Files/Invoice (Selected Payor and Invoice Status/All/Hold

tPrint monthly statements (Menu Path = PRINT/Statements/Print All/Patients With Active or Contract Invoices). Print after all invoices up to and including the 25th are entered,

Set the statement date to the 1st of the NEXT month

For example, on March 26th, set the statement date to April 1.

After printing, use a highlight pen to emphasize certain descriptions, messages, etc. For example, if a Medicare payment was made with a payment description $32.41 patient copay, then mark this wording with a highlight pen, and also at the bottom of the statement, highlight $32.41 currently due from you. The use of payment descriptions for deductibles, copays, etc. will enable some patients to better understand the reason they owe. Additionally, review the messages. If you choose to soften the tone of the message, edit the invoice, advance the due date, and reprint that particular statement.

 

vOPTIONAL--COLLECTIONS   – Extract collection letter 2, and send this file to your collection agency. Extract collection letter 1 and send your collection letter. Edit invoices with the freeform code fields with F; manually change all status fields to C.

proper message. Review the statement messages for reasonableness, especially final notice messages, and one of two actions as follows:

  1. Some of these may be due to late payment by Medicare, Insurance, etc., and possibly this is the first time payment is the patient’s responsibility, i.e. the first statement with patient responsibility is a harsh final notice. Edit the invoice and set a more reasonable due date and reprint the statement with a less-harsh message.
  2. If this is an appropriate message, edit each invoice and add the letter F in the freeform code field. Mail the statement as is. Here, we are setting the stage for putting accounts on collection status at a later time.

     

After (and only after)

all invoices and payments for the month have been entered

 

tPost write-offs (Menu Path = FILES/Invoices/P-Post Payments).

vOPTIONAL -- Print the G/L transaction log (Menu Path = PRINT/Transaction Log). After printing, the message is displayed ERASE TRANSACTION FILE Y/N?. Use this printed report to check the work you have just completed. If the report is correct, enter Y to erase the transaction file, otherwise select N, make corrections as necessary, reprint the file, etc. until finally the printout is correct, after which you should erase the file. Note that on network systems, this log can be printed for individually by workstation. At the end of month cleanup, this file is automatically erased.

vOPTIONAL -- Print aged report(s) (Menu Path = PRINT/Aged Report/All Patients). Print for each patient status (as desired). Three dates must be entered, and these are: Date 3 --- last day of the previous month; Date 2 ---last day of month preceding Date 3; Date 1--- last day of the month, preceding Date 2. These are listed in the reverse order as on your screen in order to simplify date definitions.

vOPTIONAL -- Print patient lists (Menu Path = PRINT/Patient List/All Patients). Print the selectable categories as desired.

vOPTIONAL -- Print statistical reports (Menu Path = PRINT/Statistical Reports/All menu options). You may want a hard-copy backup of reports.  Note that these end of months reports can also be printed by restoring the end of month backup diskette

tBackup data files (Menu Path = MAINT/Backup/Save Data Files). Physically make the diskette read-only to prevent inadvertently changing the data at a later time. If you are using 3-1/2 diskettes, open up the second hole in the end of the diskette moving the small tab with a pencil point; if you are using 5-1/4 diskettes, sue the write-protect tape supplied with the diskettes and cover the notch in the side of the diskette. Mark this diskette for end of month.

SAVE THIS DISKETTE IN A SAFE PLACE, THIS IS YOUR PERMANENT COPY OF THESE FILES

tClose out the current month (Menu Path = MONTHLY/Close Out Month).

vOPTIONAL -- Close out the year (Menu Path = MONTHLY/Close Out Year). IF this is the last month of your FISCAL year, and this is not necessarily the end of the CALENDAR year. Also make the diskette read-only.

tCLEANUP SHOULD BE RUN EVERY MONTH (Menu Path = MONTHLY/Cleanup Data Files).