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Menu Path: MAINT/System Files/Company
A series of COMPANY screens requires certain information to be entered, for example company name and address, plus other screens that allow user-defined parameters to be selected in order to configure system operation per user preference.
Screen 1 - Extended Name allows an extra address line
Screen 1 - Authorized Signature Prints on HCFA1500 form in lieu of signature-generally, you need to sign an authorization form with insurance companies to so that they will accept a printed signature. Also transmitted National Standard Format as the submitter contact (can be blank-not required).
Screen 1 - Billing State From this field, the Medicare and Medicaid specific screens and data entry will be configured specifically for the state listed. Claims data, screens, data entry, etc. varies from state to state. Sometimes the (state) address of the provider is different from the state to which claims are submitted, for example, a provider on a state line transporting in two states with Medicaid provider numbers for each state this is an absolute necessity for Medicaid.
Screen 1 - Current Month -- The first month of your fiscal year is month 1, and the last month is month 12. The month number is automatically incremented by one each time a month is closed. Beware of closing more than once per month, and do not change the month by editing the company screen, except in unusual circumstances. Sometimes it is necessary to set the month back manually by editing this field so that retroactive changes can be made; potentially, this will invalidate end of month reports --- also, see MONTHLY menu.
Screen 1 - Medicare Carrier Code Some Medicare Carriers allow their (primary) insurance claims to be transmitted along with Medicare transmissions. The program will do this if and only if the code in this field is identical to the insurance company code in the insurance company file. In company screen 1, the example shown is BC-AL and refers to Blue Cross / Blue Shield Alabama. Thus, in Alabama, when Medicare claims are extracted for electronic claims transmissions, all primary pacode insurance (paycode 5) with insurance company code BC-AL will be extracted when extracting Medicare and transmitted along with the Medicare claims. It goes without saying that all crossover secondary payors will also be filed with Medicare, that is Medicaid and MEDIGAP insurance secondaries.
Screen 1 - Gramm Rudman Percentage -- Congress passed the Gramm-Rudman Budget Reduction Act which was a bill requiring budget reductions in the form of (Gramm-Rudman) percentages; these percentages are voted on by congress from time to time, and thus will change at these times. Historically, these percentages have been in the range of 0-3%. In late 1990, this percentage was 2.9%, but in late 1991, this percentage was zero. When the Gramm-Rudman percentage changes, EMS providers will be notified, at which times the new percentage must be entered into this field in company screen 1 in this format: for 2.9%, enter as 2.9. When posting payments from Medicare, the Gramm-Rudman percentage in this field is used to compute the required Medicare writeoff (see posting payments).
The effect of the Gramm-Rudman percentage is that it decreases the amount Medicare will pay, while at the same time adds a new and additional writeoff (required by federal law) such that what Medicare pays plus this new required writeoff totals 80% of the Medicare allowed amount. With this new required Gramm-Rudman writeoff, there are now three writeoffs:
write off the difference between the total charges and the allowed Medicare amount --- call this the overcharge writeoff.
Gramm-Rudman write off = 80% X GR% X MEDICARE ALLOWED AMOUNT
(GR% = Gramm-Rudman percent)
an attempt should be made to collect the remaining 20% of the MEDICARE ALLOWED AMOUNT from 2nd and 3rd party payors. The uncollected amount can be written off -- call this the uncollected writeoff.
From the above, it may be seen that accounting for total EMS charges includes:
Total Charges = Overcharge Writeoff + Medicare Payment + Gramm-Rudman Writeoff + Collection from 2nd/3rd Party Payors + Uncollected Writeoff
Note: taking away the Overcharge writeoff, the total of the remaining terms equals the MEDICARE ALLOWED AMOUNT.
The following table illustrates the effects of the Gramm-Rudman percentages, as well as relates charge/payment factors described above. Note that the Gramm-Rudman percentage that is used may not be realistic, but this value permits easy arithmetic.
Screen 1 - Finance Charge/Month -- Enter the monthly percent finance charge, for example 1.5% per month is the same as 18% per year. Note that there is a Y/N field in the patient file that selects which patients are assessed finance charges. Also note that a menu selection ASSESS FINANCE CHARGES must be selected to effect the assessment, at which time a finance charge record is added to the CHARGE.DBF file for the respective invoices, and this will show up on the POST CHARGES screen.
Screen 1 - Minimum Finance Charge -- When assessing finance charges, either the percent charge (see above) or the minimum dollar amount stored in this field will be used; whichever is higher.
Screen 1 - Cleanup Time -- This field specifies the retention time of invoices after zero balance (paid up). During monthly file cleanup, all invoices paid up longer than the number of days stored in this field will be removed from the system (along with associated charges, payments, and paycode records).
Screen 1 - Insurance Refile Time -- This specifies the number of days that allows Medicare/Medicaid/Insurance claims to be refiled (only via forms-not electronic), and is the number of days past due. In other words if the field contains 30, then after the claim is 30 days past due, refiles will be enabled, and when refiled claims are selected from the PRINT/FORMS/REFILES menu chain, then claims that qualify will be printed (refiled).
Screen 1 - ALS/BLS Billing Method -- As defined by Medicare, beginning January 1, 1995, New HCPCS codes will be optional until April 1, 1995, and mandatory thereafter. There are 4 billing methods , and this may vary from carrier to carrier. Consult with your carrier as to which method(s) are in use in your state. These methods and HCPCS codes are elaborated in the section accessed via the menu selection MAINT/System Files/Supplies.
Screen 2 - Print Company Name on Statements and Invoices -- N(o) if you are using pre-printed forms with your company name and address.
Screen 2 - Print Statements for Patients with Zero Balance -- Print statements for paid up accounts.
Screen 2 - Print Statements for Patients with Negative Balance -- There is a patient report that list overpaid accounts. From this a check can be sent to the patient, Medicare, Medicaid, Insurance Company that overpaid rather than send a statement. Periodically, go to the PRINT/Patient List/Patients With Negative Balance Invoices, and from this printed list reimburse the overpaid party, and post a negative payment in the amount of the reimbursement so that the invoice will show zero balance.
Screen 2 - Print Statements for Medicare/Medicaid Patients -- Per preference of the EMS provider. It is recommended to print these for Medicare, but not Medicaid so that when payment (in some cases Medicare copay) becomes the patient responsibility, then prior statements shall have been received stating some thing to this effect "We have filed with Medicare and awaiting payment currently due from you $0.00). You may not want a global lockout on sending either a Medicare or Medicaid patient a statement by setting N(o) here, but may want instead to individually prevent specific invoices to be included in statements. This can be done by setting the invoice status to H(old). Note that a rejection by either Medicare or Medicaid considers that the invoice is no longer these payors, but becomes private pay at which time your selection here is overridden.
Screen 2 - Print Statements for Insurance Pending and Invoice < 31 Days Past Due -- Per preference of the EMS provider to print statements not overdue and insurance payment pending.
Screen 2 - Print Aged Totals on Statements -- Either print one total due line or four lines plus total due line; the four lines are the due amounts listed by time overdue (0-30 days, 0-60 days, etc.).
Screen 2 - Print Invoices with Inactive, Collection, .......... Status -- normally not done
Screen 2 - Print Invoices with Subscription Status -- Invoices are simply a notification of service, not necessarily a request to pay. This will enable/disable notification of services for subscribed patients.
Screen 2 - Print Invoices for Medicare/Medicaid Patients -- normally not done for Medicaid, normally done for Medicare. An invoice is not a request for payment (except for private pay), but simply details of services performed, and is the only time a patient receives a line item by line item listing of all charges. As with statements (above) you may want to globally lock out printing invoices to these payors, but do it on an individual basis.
Screen 2 - Print Company Name on HCFA 1491/1500 Forms -- Some forms may already have your name and address printed.
Screen 2 - Participating Medicare Provider -- First, a definition of what a participating provider entails, and then the pro's and con's of being one (and this may vary from state to state, as well as locality-to-locality). To become a participating provider requires that in November/December, proper application is made so that the application can become effective beginning January 1st. This is binding for 12 months, and if it is desired not to participate, the following Nov/Dec, the application must be made to get out. After becoming a participating provider, you must accept assignment on all claims. Additionally, Medicare will crossover secondary insurance claims via Medigap; approved Medigap codes must be included in the insurance company records. This means that Medicare will file with secondary insurance companies for you. In some states, Medicare automatically files with Medicaid for you, whether you are a participating provider or not, and this may vary from state to state. One advantage of being a participating provider is that Medicare checks are mailed to you. One disadvantage is that you must accept the "Medicare Allowed" amount which may be considerably less than your charges, and the difference between what is charged and what Medicare "Allows" must be written of as a Medicare Contractual Writeoff, and by law is uncollectable by any means. Medicare will pay 80% of the allowed amount, and it is your responsibly (and obligation) to collect the remaining 20% from secondary co-pay sources (insurance, Medicaid Private Pay, etc.). In non-participating cases, you can collect the full amount from the patient, whereupon you file for them, but the check is mailed to the patient. Whether or not being a participating provider is advantageous is strictly on a case-by-case basis, and best determined by each provider. If you are in a locality with more than one provider, you may be at a competitive disadvantage if the other provider is participating and you are not, since the financial obligation may be less for the patient using the participating provider. There is a HCFA mandate in the works that all providers MUST be participating.
Screen 2 - Print A/R Balance at end of G/L Transaction Period -- At the end of each transaction period (usually daily), G/L transactions are printed for journal entry into an independent G/L system. The computed balance can either be printed or not by the Y/N entry into this field, The down side of printing this balance is the compute time required, but in most cases is not objectionable.
Screen 2 - Medicaid Accepts Crossovers From Medicare -- If Medicaid is secondary to Medicare, in some states Medicare will file automatically with Medicaid for you. If selected, the secondary date filed field in the invoice file will be automatically set to the date filed with Medicare: ACCEPTED: Alabama, Florida, Georgia, Mississippi, North Carolina, Tennessee. NOT ACCEPTED: Kentucky. Note that this is subject to change, and you should check with Medicaid.
Screen 2 - Ask Signature On File Question if Medicare Paycode -- If N(o), the phrase "Signature On File" will be printed on HCFA1491 forms, and the Medicare paycode window in the invoice screen will not have this message and field. If Y(es), this question is displayed each time a Medicare paycode is selected in an invoice paycode window: Sign. On File Y/N
Screen 2 - Enable Writeoff Classification Option -- If N(o), All writeoffs will have the same classification. If Y(es), the operator can classify writeoffs when posting payments and these classifications are printed in the TRANSACTION LOG and OPERATIONS report. Additionally, if Enabled, then you will have an adjusted collection efficiency (bottom half of OPERATIONS report that gives you credit for contractual writeoffs. Recommend enabling with Y(es).
Screen 2 - File Secondary Insurance Even if Invoice Balance is Zero -- Preference of the EMS provider whether or not to file secondary insurance after the invoice has been paid. Normally not done.
Screen 3 - Billing For Non-Ambulance Etc. -- A separate company can be created to allow billing for Non-Ambulance services (fire inspection, e.g.). Statement and Invoices will have no reference to patients. Additionally, all services of this type must be on a separate company, not mixed with normal EMS services.
Screen 3 - Medicaid Uses Multiple Insurance Carriers -- If this flag is set to Y, the insurance company (carrier) code entry will be required when a Medicaid paycode is entered (in the invoice), with subsequent data entries as though an insurance company paycode had been entered. The insurance company name is printed at the top of the HCFA1500 form. , with the only exception being when Medicaid is secondary to Medicare. If MEDICAID IS SECONDARY TO MEDICARE, the insurance company code will not be required, and this is the only exception. Only a few states are using multiple insurance carriers for Medicaid claims; examples are Tennessee and Arizona.
Screen 3 - Print Payment Description on Statements -- When posting payments, a payment description can be entered, and if this option is enabled here, this description will be printed on statements, and is helpful for the patient to understand the statement. For example, the description next to a Medicare payment may read "$100 deductible, $53.92 patient copay". With such a message, the patient should understand why they owe $153.92. However, some patients do not read, and thus use of a highlight pen is helpful to point out certain areas such as this where you would like to attract their attention.
Screen 3 - Allow Posting Payments Invoices, Charges and Payments to Future Periods -- If the month has not been closed and you are in the next month, enabling here will allow entering/posting in a month that is future to the current period (month). This will create accounting discrepancies (amounts) on statistical reports by month, and is not recommended.
Screen 3 - Include ....................On Invoice Report -- In the main invoice screen, the R-Report option will print all information about the highlighted invoice so that this report can be turned over to a collection agency, legal authorities, etc. Certain options here will determine what data to exclude/include from this report.
Screen 3 - Enable Minimum Partial Payment Option -- For private pay where a monthly payments have been established, a payment lower than minimum will not be considered as adequate so as to eliminate past due statements (see PAYCODE7 records per section Fi.9 (menu tree FILES/9-Paycode 7 Private Pay).
Screen 3 - Include Diagnosis Information on Invoice Normally not done
Screen 3 - Electronic Claims Used to File Medicare, Medicaid or Insurance Y if either of these are electronic
Screen 3 - Statements/Invoices Use Right Windowed Envelopes Y = right window, N = left window
Screen 3 - Statements/Invoices Use Double Windowed Envelopes Prints both Mail-to and return addresses in windows
Screen 3 - HCFA1500 Forms Use Right Windowed Envelopes The mailing address will print on the left or right side (in the envelope window position) depending upon your choice here. Y = right window, N = left window. Some vendors supply laser forms with a bar code in the left window, and thus right windows are required.
Screen 4 - No. Days for Collection Level 1 -- Extraction of collection letters has programmable features. The number of days is the elapsed time since the last letter was extracted before the next letter is eligible for extraction. For example, 15 days (minimum) must lapse from the time collection letter 1 is extracted before collection letter 2 is eligible for extraction; then 20 days until collection letter 3, etc. The data path is simply the disk directory where the collection data is stored. Select N(o) for word processor mail merging and (Y)es) for EQUIFAX -- No=take out space-filled characters that could result in unwanted spaces, between first name and last name, e.g.
Screen 4 - Data Path for Collection Letter -- Each time collection letters are extracted, the files LETTER1.DAT, LETTER2.DAT, etc. are written to disk drive C, subdirectory COLLECT, with a series of records, one for each patient, and each record has the data format as shown below. Note that the drive and subdirectory can be specified, and the ones shown here are for example only. If collection letter 1 is being extracted, the system erases the file C:\COLLECT\LETTER1.DAT, and then rewrites a new C:\COLLECT\LETTER1.DAT (if any are extracted), otherwise there will be no existing LETTER1.DAT. This ensures that specific collections letters (letter 1, 2, etc.) are only sent one time.
Screen 4 - Fixed Width Data Fields Yes for EQUIFAX, No for all other.
Screen 4 - Data File Version As data the extracted data files are changed, added to, etc. as time goes on, new data versions are generated so that users of data 1, 2, etc. who do not choose to change to newer versions so as not to disrupt your current usage (word processors, collection agencies, etc.) will not need to be changed.
Extraction Data Format for Collection Letters -- The different data versions are discussed in more detail under the menu COLLECT. Shown below is data version 2, for example:
"M1 -10002","MURPHYJS","10/22/92","John","S","Murphy","John","S","Murphy","Rt. 2, Box 231M","Green Mountain","CA","62813-9523","(555)","555-1212","256-09-3044","193.00","0.00","193.00", "Y"
Note that the computer converted from all CAPITAL (Upper Case) to Upper and lower case-this is because collection letters do not look good in all CAPS. You may recognize the data as: Invoice Number, Patient Code, Service date, Patient Name, Responsible Party, Address, Phone, Social Security Number, Charges, Payments, Balance due. Note that the N(o) option was chosen for the example. See Section D-Collect for more details