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Ledger - Charge Window

The Charge window allows users to enter multiple procedures into a patient's chart. Most fields can be set to pull information forward to save time for the clerical staff. While most fields in the Charge window are universal across MacPractice products (MD, DDS, 20/20 and DC), a few fields are unique. Fields that are not consistent across MacPractice products are labeled in the description.

You can access the Charge window by selecting the Charge menu at the top of the ledger, or use the Command + N keyboard shortcut instead. You also have the option to bring procedures forward from a Treatment Plan.

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Charge Fields

The top left portion of the Charge window is dedicated to the Charge Fields. A majority of these fields pull directly from the Fee Schedule within References. 

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Fee Schedule

The Fee Schedule is a list of codes and fees. Almost all information in the Charge window can be defaulted within the Fee Schedule.

The Fee Schedule field will list the Fee Schedule selected in the Patient tab, if applicable. Otherwise, it will pull the first Fee Schedule alphabetically. You will want to be sure that the correct Fee Schedule is selected before entering the desired procedure.

For more information on creating and configuring Fee Schedules, please click Here.

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Procedure Date

This is the date in which the procedure was performed (or started, if it spanned multiple days). By default, it will list the current date, but this can be manually overridden.

To Date
*Not present in MacPractice DDS*

If a procedure spans multiple days, an end date for the procedure may be entered here.ProcedureDate.png

Code

A Code is a series of letters, numbers, or symbols assigned to something for the purposes of classification or identification. Codes in MacPractice are usually used to indicate a specific procedure, product or diagnosis.

A user can enter the Procedure Code or Alias in this field.

If a code entered does not match the selected Fee Schedule, a prompt will appear asking if the user would like to add the Code to the Fee Schedule.

Search Button
Click the magnifying glass to bring up a search window to search the selected fee schedule by code, Supercode, short description, or alias.

The search field is a smart search, so if a user begins to type something, any relevant or matching fields will appear in the window. Clicking on an item in the results will highlight that item. It is possible to select multiple items by holding down shift and clicking (if they are all in a row) or by holding down command and clicking multiple items.

Selecting items and clicking OK populates selected charges into the Code field. If multiple codes are selected, then each code will appear as a line item in the Procedure Table.

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Modifiers

If the code has any modifiers, they can be entered here. A modifier is a two digit code added to the end of a procedure code to give more specific information for the processing of a claim. There can be up to 4 two digit modifiers per charge on a claim.

A user can also enter modifiers in the code itself (for example, 12345.67), and when they press Tab, if the code with the modifier exists in the Fee Schedule, the modifiers will apply appropriately to the Modifiers field.

The user may get a prompt asking to add the code if it does not exist. Click the Add Code button if this is the case.

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Procedure Description

This is the procedure's short description, as entered in the Fee Schedule Reference. ProcDescription.png

Tooth & Surface

*Not present in MacPractice DC or 20/20*

These fields allows you to enter the number of the tooth/surface, the numbers reflected here should also be reflected on the Restorative Chart graphic under the Dental tab.

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Alias

An Alias is a unique office designated code that can be input in place of the official Code. Once entered, the proper Code will appear in the Code field and the Alias will appear in the Alias field.

Aliases may be set in the Fee Schedule Reference.

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Fee Calculations

The Fee Calculations menu determines how the fee for the procedure is calculated.

  • Fixed: The Total Fee will equal the Unit Fee. The Unit field cannot be edited.
  • Units: When you select Unit, a Unit Type window will appear, and the Unit field will become editable. The Total Fee will be the Unit Fee multiplied by the number of units.

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Unit Type

The Unit Type classifies how the charge associated to the Code is going to be calculated. This can be based off hours, minutes, sessions or other.

Minutes should ONLY be used with anesthesia billing.

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Area of Oral Cavity

*Not present in MacPractice DC or 20/20*

This allows a user to select the area of the mouth affected by the procedure. This is necessary for some ADA claims.

It is in a different location in MacPractice MD. It is possible to make any code as requiring an Area of Oral Cavity in the Fee Schedule Reference.

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Units

The Units field is directly related to what has been selected in the Fee Schedule Calculation menu.

  • If the Fee Calculations menu is set to 'Fixed', this field will be dimmed.
  • If the Fee Calculation menu is set to 'Units', a user can enter the number of units used in conjunction with the procedure.

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Unit Fee

The Unit Fee is the cost of a procedure depending on what is selected in the Fee Calculations area.

  • If Fee Calculation is set to 'Fixed', the Unit Fee will equal the Total Fee.
  • If Fee Calculation is set to 'Units', the Total Fee will equal units multiplied by the Unit Fee.

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 Total Fee

The Total Fee is the overall cost a user will charge the patient for a Procedure. It takes into account both the Unit Fee field as well as the Units field in the New Charge window.

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Schedule Units

This field displays the Schedule Units associated with the procedure. Any number here will appear in the Time column in the Ledger.

The Schedule Units numbers are for reference only, and have no bearing on scheduling.

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Taxable Checkbox

When the Taxable box is checked, the Tax will display in the Charge window to the right of the "Emergency" checkbox, right above the "Items" tab.

With the Taxable box checked, you can also select a Tax Rate as defined in References - Tax Rate & Tax Type. You can also configure Fee Schedule Codes to automatically assign a tax to them.

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Tax Rate

If the Taxable checkbox is checked, a Tax Rate pop-up menu will appear. A user can select the tax rate they wish to use for this procedure.

Information on setting up the Tax Rate can be found Here.

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Emergency Checkbox

When enabled, this checkbox makes it so the procedure will be marked as an Emergency Procedure on an insurance claim.

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Patient Responsible Checkbox

When checked, Patient Responsible ensures that the procedure will be omitted from all insurance claims.

If Insurance Estimating is used, the entire fee will go to the Patient Portion.

If this option is grayed out, this would indicate that there is a closed claim attached to the charge. 

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Charge Copay Checkbox

When checked, the copay amount will be allocated to the patient portion, and a copay field will appear in the Procedure Table below.

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Charge via Contract

Always select the Charge via Contract checkbox when posting a procedure to the contract so that the negative adjustment is automatically applied. If Charge via Contract is not selected when charges are entered, or if the negative adjustment on the procedure is deleted, the patient will be charged twice for the same procedure.

For more information on this, visit our Contract Billing article. 

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Charge Tabs

The lower left side of the window house several different tabs.

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Diagnosis

This is where a user can associate diagnosis codes to a procedure.

If a code is added to the procedure in the fee schedule, it will pull into the Charge window automatically.

If the patient has checked diagnosis codes listed in the Problem List in the Clinical tab, they will also pull into this window.

A code may be manually entered. As numbers or words are typed in, a menu of possible matches will display. At least 3 characters must be entered first.

Clicking the magnifying glass will bring up the Universal Code Selector.

Any changes made to diagnoses in the New Charge window will be reflected in the codes Reference.

Only diagnosis codes that are checked will be displayed on the claim with a maximum of 12.

If a user would like to save the diagnosis codes listed in the Charge window back to the patient's problem list, go to the MacPractice menu and select Preferences > Ledger > New Charge tab > Add Diagnosis Code From New Charge Checkbox. Check this box and MacPractice will automatically add any diagnosis codes from the New Charge window to the patient's Problem List. This is a local preference, so it must be set on each computer in the office individually.
Note: Per guidelines received from the NUCC, only 4 diagnosis codes per charge are allowed. The mandate states there can be up to 4 diagnosis codes per CPT code and up to 12 unique diagnosis codes per claim.

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Notes

This is a free notes field, where a user can enter notes associated with the procedure.

In MacPractice DDS, there is a checkbox, "Print As Remarks on Claim (Box 35)", that will include the notes in box 35 of the ADA claim form.

Note regarding Medical eClaims: The character limit for eClaims is 80 characters. Anything beyond the 80 character limit will not pull into the eClaim. Please also make sure that no special characters are added and that only alphabetical and numerical values are being saved in this field as special characters can cause rejections.

Notes added to this field will not pull onto Dental eClaims per charge. Notes.png

Specialty

*Not present in MacPractice 20/20*

In MacPractice MD, this is where the Tooth, Surface and Tooth Quad (Area of Oral Cavity) fields are located.

In MacPractice DDS, this tab contains the Brand, Kind, Size and Type fields. These fields are simply for the office's reference, and are not used in reports or claims.

In MacPractice DC, this tab is present but empty.

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RX

This is where a user can enter medication/prescription information that can be pulled to the insurance claim.

A medication/prescription may be entered by clicking the Green Plus Sign button under the Rx tab.

A window will open listing all medication/prescription records for the selected patient.

Select the appropriate information, click Select. If you wish to create a new prescription, you can do so from this window by clicking the green plus button in the upper right corner. Any added prescription will be added to the patient's Active Meds list in the Rx Ability, and will pull any associated National Drug Code (NDC) number onto a claim form (Typically Box 24a in a CMS form) and/or an eClaim. For more information, refer to CMS 1500 (02/12) Interactive Form Box 24a and Adding NDC Numbers to Claims.

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Attachments

Attachments may be submitted here for use with NEA FastAttach

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Items

Inventory items can be added to a charge here.

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Charge References

The right side of the Charge window can be manually set per charge, or you can setup a specific code to pull a majority of the information from the Fee Schedule as well. Some of this information will be more specific to the patient and their procedure than other areas of the window, so setting up some of these fields with defaults may not be an option. 

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Provider & Office

These fields designate the Provider and Office that will be credited with the production for the charge.

If the code in question has a provider and office set in the Fee Schedule, that data will be used.

If there is not a Provider and Office set in the Fee Schedule, it will pull the Patient Provider.

If the Patient does not have a provider selected in the Patient tab, the Provider and Office menus will be set to None, and must be selected manually.

Note: A user can access the Provider dropdown by either clicking on the dropdown, or hitting the Tab key. Once you access the menu, you can navigate through the list of Providers by clicking on a name, using the arrow keys and selecting a name with the spacebar, or by simply typing a name while the dropdown is selected. (If the Tab option does not work, a user can turn on the OS Preference on your computer by going to Preference > Keyboard > Shortcuts > Full Keyboard Access > All Control).

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 Provider Shown on Claim

The Provider Shown on Claim drop down menu controls which Provider's name and information will be printed in Box 31 of a CMS Claim Form, or Box 48/53 of an ADA form containing this charge. 

There are several ways to set this up depending on your office's unique billing situation. By default, the provider in this dropdown will pull from the corresponding field in the charge provider's User Reference.

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Recall/Follow-Up Type

This field is labeled Recall in MacPractice DDS, and Follow-up in MacPractice MD, DC and 20/20.

They function the same way, and allow a user to select a particular type of recall/follow-up to associate to the charge, such as, see patient again in 3 days, 6 months, or a year, and so on.

For more information on Recalls/Follow-ups, please click Here.

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Procedure Type

The Procedure Type dictates what kind of Procedure is being performed. This can be defined in the Reference.

This will determine percentage coverage for Insurance Estimating.

If the office do not use Insurance Estimating, users may still find this useful for tracking production within the office using the Production by Type Report.

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Procedure Category

This displays the Category for the Procedure. These are designed to help track Procedures in certain Reports. Procedure Categories are created in References.

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Place of Service

The Place of Service indicates the location in which the procedure was performed. Generally, it will be defaulted to Office (11). This will affect information on claims.

A new Place of Service can be created in the Reference.

In MacPractice MD, fields will appear for the Admitted Date, Discharge Date & Time and LOS Days.

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Type of Service

*Not present in MacPractice DDS*

The Type of Service indicates the type of procedure that was performed. This will affect information on claims.

Older builds of MacPractice (Builds 6.1 and earlier) users can view a list of Types of Services in References. In New Builds (7.0+) the Reference has been removed, but the list can be viewed in the Fee Schedule or New Charge window. 

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Referral & Referral Type

The Referral field is where a Referral, set in the References, may be selected.

The Referral Type designates which type of Referral is selected in the Referral field.

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Facility

This is the place in which the procedure was performed.

Depending on the Place of Service, a Facility may be required.

This information will print in Box 32 on the CMS-1500 form, and Box 56 of the ADA form.

The Facility displayed ensures that all of the relevant information for the Facility will pull into claims claims appropriately. The information may be edited by double clicking on the name of a Facility inside the selector window and unlocking the record. Utilizing the selector window is similar to using the Facility Reference.

New Facility may be created by clicking the green plus in the Facility selector window. Creating a Facility here is the same as adding a Facility Reference.

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Discharge Status 

The Discharge Status is the reason for which the patient was Discharged. This may be selected from the pre-set list of Discharge Statuses.

Additional Discharge Statuses can be added in References.

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Admitted Date and Time

*Not present in MacPractice DDS*

This date indicates when the patient was Admitted to the selected facility, as well as the time in which they were Admitted.

The Admitted date will pull into the Hospital Admission and Discharge Date on Insurance Claims associated to the charge.

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Discharge Date and Time

*Not present in MacPractice DDS*

This date indicates when the patient was Discharged from the facility, as well as the time in which they were Discharged.

This information will pull into the Hospital Admission and Discharge Date fields on a claim.

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LOS Days

LOS, or Length of Stay, is calculated from the dates entered and is just for informational use.

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Lab Name

This field is used for off-site tests, such as a Lab for blood tests. This may be required, depending on the Place of Service and Require Lab settings.

This will print in box 32 of the CMS-1500 form, if there is not a Facility associated to the charge.

This will also display the Lab ID number (this number is provided by the Lab).

The Lab displayed ensures that all of the relevant information for the Lab will pull into claims claims appropriately. The information may be edited by double clicking on the name of a lab inside the selector window and unlocking the record. Utilizing the selector window is similar to using the Laboratory Reference.

New Labs may be created by clicking the green plus in the Lab selector window. Creating a Lab here is the same as adding a Laboratory Reference.

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Lab Costs & Material Costs

These fields are used to show the costs associated to the Laboratory and Materials charged to the office.

The Lab Costs and Material Costs will display on the Production Reports.

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Required Lab Checkbox 

When checked, a user will have to enter the Lab Name for the procedure in order to save it.

A user can check this box by default in the Fee Schedule Reference, and associate a Lab to pull into the Charge window by default. ReqLab.png

 

Procedure Table

At the bottom of the New Charge window there is a table that will display a summary of information related to the Charge.

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Users can also click the green plus on the right to add another charge in the window without having to close the Charge Window. Alternatively, clicking the red minus will remove any charge information line by line. 

A majority of the information shown in this table is pulled directly from the information selected above. This information includes the Code, Pr/Of (Provider and Office), Fee, and Copay. In MacPractice MD and DDS, a user will also see a Tooth and Surface column. Many of the fields within the Procedure Table can be edited by selecting it, then pressing the Tab key on the keyboard, or by changing the information in the charge window above the table.

There are also additional fields in this area that will display some Insurance Estimating information:

Pri/2nd Allowed

These columns will include the primary and secondary allowed amounts. This information will pull if the user has selected a plan and if the Allowed Amount have been entered for the selected procedure code under References > Insurance Companies > Plans tab > Procedures sub-tab.

If no allowed amount is set in the Reference, and Insurance Estimating is used, this amount will default to $0.00.

Allowed.png Pri/2nd WrtOff

These fields will display the amount that will be written off due to primary and secondary insurance. The formula MacPractice uses to calculate a write off is:

Fee (-) Allowed (=) Write Off

This shows that if the total fee is more than the amount that is allowed, then any amount over the allowed will not be charged to the patient. If Insurance Estimating is set up with the Insurance Company Reference, the write off will match the information entered.

If the office does not use Insurance Estimating, it may be helpful to review the Write Offs Without Insurance Estimating documentation.

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Pri/2nd Ins %

This is the percentage that Insurance will cover based on the percentage set in the Insurance Companies Reference > Plans tab > Coverage sub-tab for the Primary and Secondary insurance.

If no percentage is set in the Reference, and Insurance Estimating is used, this amount will be assumed to be 100%.

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Pri/Sec Ins Portion

This is the Portion that primary and secondary insurance are expected to pay based on the percentage entered in the Insurance Companies Reference > Plans tab > Coverage sub-tab. The formula MacPractice uses to calculate Insurance Portion is:

([Allowed Amount] - [Deductible] - [Copay]) x [Insurance %] = [Insurance Portion (up to the patient's remaining coverage)]

If nothing is set in the Reference and Insurance Estimating is used, this amount will default to $0.00.

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Pat Portion

This will reflect the remaining amount that the patient is expected to pay based on the percentage entered in the Insurance Companies Reference > Plans tab > Coverage sub-tab

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Pri/Sec Deduct.

This is the Deductible that Insurance will charge based on if "Deductible" is checked within the Insurance Companies Reference > Plans tab > Coverage sub-tab for each Procedure Type.

If no Deductible is set in the Reference, and Insurance Estimating is used, this amount will default to $0.00.

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Enter Payments After Saving Charges 

This checkbox ensures that after entering the charge information, the payment window opens.

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Insurance Estimating Indicator

This blue text will indicate whether or not Insurance Estimating has been turned on within the MacPractice Menu > Preferences > Insurance > General tab. 

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Summary Table

On the far right side of the Charge Window, MacPractice will provide a basic summary the of insurance that has been entered into the Patient chart, and the Charges currently being displayed.

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Insurance

The Insurance Table displays all of the insurance information that can be found in the Patient ability > Primary/Secondary tabs.

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Charge

This box will show the arithmetic behind the charges, the insurance estimate and the patient portions.

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