Bulk Insurance Payments is designed to enter in bulk insurance checks on a mass scale, rather than per patient account. The Bulk Insurance Payments feature also shows all bulk checks that have been entered into the system. This article covers the following topics:
- Locating the Insurance Company
- Bulk Insurance Payment Window
- Electronic Funds Transfer
- Use EOB Columns
- Additional Features
- Entering the Bulk Insurance Payment
- Refunding a Bulk Insurance Payment
- Handling a Bulk Insurance Takeback
Access Bulk Insurance Payments in Managers by selecting Bulk Insurance Payments from the sidebar.
In Bulk Insurance Payments, view all bulk checks that have been entered using the Bulk Insurance Payments feature. Search from the preset date ranges in the Show check payments from pop-up menu or manually enter a date range using the Start Date and End Date fields.
After locating the insurance company click the OK button and the bulk insurance payment window will display.
When entering a primary insurance payment, the Allowed amount from the primary must be entered. Fill in the appropriate columns for Deductible, Co-Insurance and Copay corresponding to the EOB from the primary payer.
You will need to enter a Reason Code on the primary insurance payment to correspond to the disallowed amount. The list of codes in MacPractice is HIPAA compliant and must be used. If the Primary payer does not use HIPAA codes, a matching code must be used from the list.
NOTE: For a complete listing of Reason Codes, go to the Internet ability and select Claim Adjustment Reason Codes from the sidebar or go to WPC's website.
CO-45 is the code for Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. This code should be used when appropriate and is not correct for all situations. If used incorrectly, it can cause rejections:
Explanation of Claim Adjustment Group Codes:
- CO - Contractual Obligations: This group code should be used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment. Generally, these adjustments are considered a write off for the provider and are not billed to the patient.
- CR - Corrections and Reversals: This group code should be used for correcting a prior claim. It applies when there is a change to a previously adjudicated claim. When correcting a prior claim, CLP02 (claim status code) needs to be 22. See ASC X12N Health Care Claim Payment/Advice Implementation Guide (835) section 2.2.8 for complete information about corrections and reversals.
- OA - Other Adjustments: This group code should be used when no other group code applies to the adjustment.
- PI - Payer Initiated Reductions: This group code should be used when, in the opinion of the payer, the adjustment is not the responsibility of the patient, but there is no supporting contract between the provider and the payer, i.e., medical review or professional review organization adjustments.
- PR - Patient Responsibility: This group should be used when the adjustment represent an amount that should be billed to the patient or insured. This group would typically be used for deductible and copay adjustments.
- Attach File...: This allows images to be attached to the Payment window. To attach a file, click the Attach File... box. A drop down box will appear so that an image can be attached.
- Filter All: This is a search field to locate a patient, code or unpaid amount easily.
Entering the Bulk Insurance Payment
Once the insurance payment amount is entered, check any additionally needed options, such as EFT, Use EOB Columns, attach an image, search for a particular patient, code, and so on. Next, post the insurance payment to the payment column by entering the insurance check amount and using the Tab key on your keyboard to activate the payment columns and open the Check amount changed box.
Tab down to the first column (Allowed), enter the allowed amount, and the Save Allowed column will automatically check, saving the information to the insurance plan when the payment is saved.
As the payments, write-offs, and/or negative adjustments are entered the remaining amount decrease and the Check amount changed area will start to track where the payments are being applied. If the EOB columns are being used the line items highlighted in red cannot be saved until the required fields to the far right of the payment window have been filled out. After all fields are entered the insurance payment can be saved.
After the payment is saved, an insurance payment line item will be added to each patient's ledger. The description will show the full amount of the Bulk Insurance Payment, but the Payment Amount column will show how much of this Bulk Insurance Payment has been applied to the selected patient.
Double clicking on the Insurance Payment line item will navigate to Managers > Bulk Insurance Payments and the Insurance Payment will open.
In the payment window locate the associated patient, charge, and dollar amount the insurance company is requesting for the refund. Double click the payment amount and change it to reflect the requested refund amount. After editing the payment information tab out of the payment column field. The change will be reflected in the Check amount changed area and the payment itself will have a Remaining amount.
Once all changes have been made click the Save button - this will display a warning stating "You have not applied all the amount, Continue to Save?" click OK to save the changes. The insurance payment window will close and a red line item appear in the bulk insurance payment list. In the associated patient's account the unapplied amount will be added back into the ledger balance, awaiting a new payment by the insurance company or the patient.
The red text indicates there is an unapplied amount for this insurance payment. This amount is also shown in the Remain column, indicating the amount that has not been applied. When this red line item is selected the Refund button will be activated - click the button to bring up the refund window.
Enter a description or check number for the refund in the Refund Reference/Desc field to assist in describing why this refund was created. The refund amount can be changed if only a portion of the unapplied amount needs to go back to the insurance company. After this information has been entered, click the Save button. A refund line item will appear in the bulk insurance payment list to indicate a refund was created for the insurance company. No indication will appear in the associated patients' accounts that a refund was created. This information will only appear in the bulk insurance payment list.
- Unapply the amount of the bulk insurance payment that needs to be taken back. This will remove that payment on the impacted patient ledger (presuming you unapplied the full amount of that patient's portion of the payment and not just part of their payment)
- In the Bulk Insurance window, select the bulk check, and then click the Refund Button.
After these steps are accomplished, you can then proceed to the normal Insurance Takebacks methods described in the article linked here, which will explain how you should proceed.