Transcript ERA Processing April 23, 2015 & April 25, 2015 Presented
ERA Processing
April 23, 2015 & April 25, 2015 Presented by: Melissa Holmes
T
raining Manager 2015 User Conference
PM Session
ERA Processing…What is it?
2015 Office Practicum User Conference
Objectives
● ● ● ● ● ● ●
Different Match Status’s HIPAA code table Sending a Balance to a Secondary Sending a Balance to the Statement Queue Force Pay Date Handling Insurance Re-Coupments on an ERA Processing a Secondary Payment
2015 Office Practicum User Conference
2015 Office Practicum User Conference
Open the Billing Center
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Click on Adjudications
2015 Office Practicum User Conference
Auto Approve Boxes
Example A: Box is checked
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Example B: Box is not checked
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Default Statement Type
2015 Office Practicum User Conference
Force Pay Date
Force Pay Date
The deposits are not made until Monday, 08/13/2012, so the user will force the pay date here to match the date of deposit.
8/13/12 2015 Office Practicum User Conference
Ready to Fetch New Adjudications
2015 Office Practicum User Conference
2015 Office Practicum User Conference
Ready to Process New Adjudications
2015 Office Practicum User Conference
2015 Office Practicum User Conference
Processed Claims Now Show in Adjudications
2015 Office Practicum User Conference
2015 Office Practicum User Conference
Open the ERA Tab
Select the ERA Check You Wish to Post
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Isolating a Single Check Payment
813037490003708 2015 Office Practicum User Conference
2015 Office Practicum User Conference
Review Payments
What’s a Match Status?
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What Action Does OP Take With Each Match Status When I Press Post Payment?
•Unmatched OP will take no action on an unmatched status. Any CPT with this status will remain in the queue until it is manually changed to a Discard status.
•Matched OP will post the adjudication in the patient’s account.
OP will take any Insurance or Patient Actions •Review or Appeal OP will take no action on Review or Appeal statuses. Any CPT with one of these statuses will remain in the queue until it is manually changed to a Matched or Discard status.
•Paid, Repriced or Discard OP will throw the adjudication away. There is no Recycle Bin.
2015 Office Practicum User Conference
2015 Office Practicum User Conference
Posting ERA Payments
Review ERA Payments Totals
100124 Test, Victoria 3/29/2012 73..64 12.39 1495 1495 99213 OFFICE/OUTPATIENT 2015 Office Practicum User Conference 73..64
12.39
Document Completion of ERA Payment
1/14/2015 JMN Balanced 123456789 4569715313548646178 1336988456300125 120326544 12015649864650 501684 210648940 1231465749865 1352156479 45674894231 564651897 1324165 326547890 01210567498 000001265489 001654987460 2015 Office Practicum User Conference
Additional Places for Balancing ERA Payments
▪ ▪ ▪
Current Receipts Standard Reports Billing Transaction Analysis
2015 Office Practicum User Conference
2015 Office Practicum User Conference
Let’s Try It!
Matched vs. Unmatched Tabs
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Why Would a CPT Claim be Listed in the Unmatched Tab?
•The claim adjudication is listed under the name of the insured as opposed to the patient
Example: newborn claims
•The claim adjudication is for a CPT/claim that no longer exists
Example: a CPT was deleted or edited to a different code
•The claim adjudication is slightly different than the original claim
Example: the adjudication contains a modifier that did not exist on the corresponding claim in OP
2015 Office Practicum User Conference
How Do I Match Unmatched Claims?
Test, Sally Test, Sally Test, Sall Test, Sally Test, Joe Test, Joe Test, Megan Test, Nick 2015 Office Practicum User Conference
How Do I Match Unmatched Claims?
2015 Office Practicum User Conference
How Do I Match Unmatched Claims?
2015 Office Practicum User Conference
How Do I Match Unmatched Claims?
2015 Office Practicum User Conference
How Do I Match Unmatched Claims?
2015 Office Practicum User Conference
How Do I Delete Unmatched Claims?
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Discarding Manually Posted Payments (or already processed Adjudications) Before After
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Change Match Status Based on Adjustment Code Reason
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Editing Adjudications
At times, an adjudication will apply the incorrect settlement information for a claim, based on payment information received from the payer. If this problem occurs, you can manually edit the adjustment fields on the Adjudication Table to correct the adjustments. Again, this can happen if an adjustment is applied to the incorrect CPT and/or if a CPT is being adjusted on the insurance side when it is actually due by the patient based on the CPT rejection reason. For example, a CPT may be adjusted as a non-covered service that is actually due by the patient but is not listed this way on the incoming adjudication.
2015 Office Practicum User Conference
Insurance Action Insurance Action
- In all selections below, the insurance balance (as identified in the the insurance and the next action will depend on your choice of the following options:
Ins Bal
column) will be listed as due by
1.
Hold on Account
- No further action will be taken at this time. You would select this option if the insurance balance is to be held as outstanding pending claim appeal, review, or reprocessing.
2.
Xfr Sec
- The referenced insurance balance will be transferred to the insurance you select for submission as a secondary claim. Once selected, the corresponding claim will be automatically sent to the
Claims Queue
with its stage set to Secondary.
3.
Xfr Prim
- The referenced insurance balance will be transferred to the insurance you select for submission as a primary claim. Once selected, the corresponding claim will be automatically sent to the
Claims Queue
with its stage set to Primary. 2015 Office Practicum User Conference
Patient Action Patient Action
- In all selections below, the patient balance (as identified in the
Pat Bal
column) will be transferred to the patient and the next action will depend on your choice of the following options:
1. Hold on Account
- No further action will be taken at this time. You would select this option if the patient responsibility is a significantly small amount and you do not want to generate a patient statement at this time.
2. Create Statement
- The referenced patient balance will be sent to the Statement queue awaiting printing by your office.
3. Autopay with PC ($x.xx)
- The referenced patient balance will be paid with the patient's available credit. If there is an available credit, this selection will identify the amount of the available credit.
4. *Autopay with CC only
- OP will attempt to utilize a pending credit card on file to pay the referenced patient balance.
5. *Autopay with PC + CC
- OP will attempt to pay the balance with any available Patient Credits first then proceed to pay any remaining balance with a saved Credit Card on file *only applicable if user is signed up with Instamed Merchant Services and a Credit Card is saved on patients account.
2015 Office Practicum User Conference
Posting Interest Payments Option #1 - Posting to Generic Account
1. Change the match status of this adjudication to matched and approve for posting.
Option #2 - Posting to Specific Patient Account
1. Enter an interest charge for the payment amount on the specified account.
2. Manually post the Insurance Payment for the interest payment to the specified account and claim created in step 1 above. 3. On the Adjudications tab of the e-Billing center, change the match status of the interest adjudication (as assigned to an account by the name of Provider Adj. E-Billing) to
Discard
, approve and post the transaction. 4. Go to the
Account
of -5, Provider Adj. E-Billing 5. Click on the
Claims
tab. 6. Locate and click on the claim with the interest payment so that it appears
highlighted
. 7. Click on the
minus Void
button to delete this "claim" 8. Click
Yes
when prompted "This action will delete the entire claim, Are you Sure?" Aetna 0069456 2015 Office Practicum User Conference
Manually Adding a Credit for an Overpayment
2015 Office Practicum User Conference
2015 Office Practicum User Conference
Let’s Try It!
2015 Office Practicum User Conference
Questions ?
2015 Office Practicum User Conference