Account Information: Replaces account Setup and Billing Tab
The intake information should come from an intake coordinator. The account creation may be completed by the coordinator, front office staff, billing tech or Clinician. This procedure also applies to patients who have not had an appointment for more than a year.
The initial account set up requires entering the patient demographic information to start the account. This process can be started from the appointment calendar when the appointment is scheduled. Best practice is to first check for the patient information in the system before creating a new account. Required items are:
· Patient first and last name
· Date of Birth
· Gender
· Address and zip code
· Phone number
The second phase of entering a new patient account is to enter the payment “Case” information. This will be “Insurance Case” and “Self-Pay”. When creating a case, ensure that the patients proper insurance company is selected and that the proper insurance plan is selected. If the insurance company and plan are not already in the system, they may be added by a billing technician. When entering insurance case information, the option to select “Payer Scenario” is available (also under the case tab). This should be “Commercial” unless the insurance is BCBS, then select “BCBS” and if Medicare select “Medicare”. Copay and deductible information may be entered under the insurance case. All standard benefits information will be recorded in the notes section of the insurance case plan. After creating an insurance case, also create a self-pay case with no insurance information attached. This is created for items such as no-show fees, testing and consults that are not billed to insurance.
Coinsurance information for each CPT code should be entered as a note under the “General” tab of the patient account (PM module) in the “Notes” section. The format will appear as follows: Coinsurance by CPT code: 90837: $25.00 || 90834: $22.00 || 90875: $2.00
Account alerts: create account alerts for any account that has collectibles other than copays, such as Coinsurance, deductible amounts or specific cash rates assigned to the account. Select all of the options on the alert setting page so the alert is seen at all stages of the patient account. This information will guide the clinician or front office staff in collecting the appropriate fees for an account. Coinsurance by cpt code can be found under the patient account tab (EHR module) by selecting “type” Notes from the drop down menu.