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Billing Module Overview
The Billing Module is an add-on to the main software charting module which allows you to simply and quickly bill patient charges, indicate payments collected and manage the overall Accounts Receivable (AR) for your practice.
The following terms will be used extensively:
Ledger - analogous to the "chart" on the EHR side of things, the Ledger is a complete record of the patient's financial transactions with the practice.
FeeSlip - analogous to the "encounter", the FeeSlip represents a single discreet set of billing charges, usually corresponding to a patient encounter visit or possibly to a optical sale.
Claim (or Insurance Claim) - is the portion of charges that are submitted to an Insurance Plan (e.g. BlueCross/BlueShield, Aetna, Medicare or other carrier). The claim is represented visually by the onscreen CMS-1500 form (previously called the HCFA-1500). Note that all insurance claim information discussed here applies ONLY to the United States. If you are practicing in another country, you will use the FeeSlips to create charges, but will have to manually create and bill your insurance claims.
Statement - a printed version of the FeeSlip. Note that the current version of the software does not create a cummulative statement; you must print out the statements for each outstanding FeeSlip.
Post Payment - means to mark a patient account as paid (either fully or partially) by some method (e.g. by patient payment with a credit card or by a check from the insurance company).
Electronic Claim Submission - means the submission of your claim directly to a clearinghouse which converts your claim to the X12 standard and sends in on to the various insurance companies.
Export Claim - instead of printing a claim for mailing to an insurance company, you can send the claim electronically but you must first "export" the data so that all your claims can be batched together.
Upload Claims - this step involves converting individual claims into a single batch file, ready to be uploaded to the clearinghouse. Uploading is a manual step whereby you go to the clearinghouse site (e.g. www.officeally.com) and select "Upload Claims" to transmit securely over the internet.
The basic use of the Billing Module is threefold:
(1) Open a patient Ledger and create a new FeeSlip for that patient's charges. You create the FeeSlip and enter the appropriate codes to indicate procedures done and the corresponding diagnosis. The charges pre-fill based on your default settings, but you can manually adjust onscreen.
(2) Create insurance Claims and/or statements for the patient.
(3) Post any payments. This can be done at the time of service or at a later date when actual payment is received.