Insurance Statements and Insurance Payment Methods

Abstract

If Insurance Statements are printing incorrectly (too many visits appear on the statement, and there are payments on the file that should be covering them), refer to this article.

Underlying challenge

In the original version of Capable 21C, there was no way to distinguish between payments from a private source (eg the patient), and payments from an insurance source (eg an insurance cheque or HICAPS payment). As Capable 21C was further developed, it began to distinguish between insurance charges and private charges to support Gap Payments often recovered from patients. Because there was no way to distinguish where the payments were coming from, Capable 21C would produce statements that applied private gap payments to older insurance visits, and produce incorrect statements.

This defect was corrected in version 1.5.206 on 17th November 2003 by allowing each payment method to be flagged as either private or insurance. /p>

Subsequently, all insurance statements would only print insurance chargeable services and products, and would only print insurance payments. This has caused some problems for existing files where significant payments had already been received on a private payment method. The payments are present on the file (making the overall balance appear correct), but they are listed as private payments. This results in statements that show visits that have been paid.

Resolution

To resolve this issue, a number of steps should be performed.

  • Create a new payment method for insurance payments.
  • Alter existing payments on existing insurance accounts so that they use the insurance payment method; or Close off existing insurance accounts and recreate them under a new case number.

    • Please read the detailed instructions in their entirety before commencing this procedure.

    Detailed Information

    To create a new payment method for insurance payments, follow these steps:

  • Select Setup|Setup Payment Methods
  • Create a new payment method by clicking the New Payment Method button.
  • Assign an appropriate name to the new payment method (eg Insurance Cheque)
  • Tick all four check boxes on the General Tab of the Payment Method Properties window. In particular, ensure that the ‘Payment is normally received from insurers’ check box is ticked. /li>
  • Close the properties window for the new payment method.
  • It is advisable to review other payment methods to ensure that the ‘Payment is normally received from insurers’ check box is not ticked for private payment methods (eg Cash and Cheque).
  • Close the Payment Methods window.

    • To Alter existing payments, follow these steps:

  • Click the Patient Info button on the Appointment Book.
  • Enter the patient case number or surname, press ENTER and select the required patient as needed.
  • Click the Visits & Financials button on the Patient Information window.
  • Click on any historical visit that includes an insurance payment.
  • From the fly out menu, select Alter Receipt.
  • On the Receipt Alteration window, select the payment that was made from the insurer by clicking on it.
  • Click the Alter Type button.
  • Select the new Insurance Cheque (or other insurance payment method).
  • Close the Receipt Alteration window. /li>
  • Repeat steps 4-10 for all historical payments from the insurer.
  • Close the Visits & Financial window.
  • Close the Patient Information window.

    • Some patient files may have many insurance related visits and payments. Altering all historical payments may be particularly time consuming. Two alternative tools may be of use in these situations:

    To close an existing file and create a new one:

  • Go to the Visits & Financials window and note the details of all outstanding visits.
  • Note the case number of the old file.
  • Create a new patient file (using the File|Client Data Entry option).
  • Make the new patient file exactly the same as the old file, with the exception that the case number should be different. /li>
  • Go to the Visits & Financials window for the new patient file.
  • Click in the empty area for historical visits.
  • Choose the menu option to Add an invoice for a specific date.
  • Enter the details as they are requested for one of the outstanding visits on the original file.
  • Repeat steps 6-8 for all outstanding visits.
  • Close the Visits & Financials window.
  • Go to Patient Information, locate the original file, and go to Visits & Financials.
  • Click on one of the outstanding visits and choose Receipt Alteration.
  • Select the insurance service by clicking on it. Click the delete button to delete the service.
  • Repeat step 13 for each insurance service. Close the Receipt Alteration window.
  • Repeat steps 12-14 for all remaining outstanding insurance services (these should have been recreated on the new file in steps 6-9).
  • Close the Visits & Financials window.
  • Update any manual/paper based documentation to ensure that they refer to the new case number instead of the old.

    • To fix all payments on a file en-masse:

  • Go to Visits and Financials for the patient file.
  • Click on any historical visit. Choose the Review Payment Allocation option from the fly out menu.
  • Click the Convert Insurance/Private button.
  • Answer each question in turn.

    		• This knowledge resource is designed for use on a Windows (tm) XP system operating at a screen resolution of 1024x768 or better. Windows Media Player must be installed for this training resource to operate correctly.

    Copyright 2008 Capable Software Pty Ltd

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