Hi, my name is Ellen Patterson. Thank you for attending our webinar. I’d like to welcome you on behalf of iSALUS Healthcare. I will be showing you our Practice Management Suite which will include our scheduling and billing modules. If you have any questions I have unmuted you as far as the webinar, so please feel free to stop me and ask questions if I don’t go over something. And just so you’re aware, this webinar is being recorded. Thank you. I will go ahead and begin. You should be able to see my screen. It should be very colorful dials and graphs.
So where I am right now is our billing module home page. To give you different information about what’s going on both today and in the future. The top dials have to do with what’s happening today, so has any money been collected by the front desk, have any claims been created, patients checked out, things like that.
The graphs below them have to do with what’s going on over a longer period of time over the past 12 months. Rejected claims, when we receive the acceptance/rejection reports from the clearinghouse for both payer and clearinghouse rejections, we note those and we change the claim status to rejected so that those are able to be found and fixed and sent back out as quickly and as efficiently as possible to make sure that you are able to get clean claims out and collect as much money as you can.
Missing Data Claims are usually ones where the demographics haven’t gotten entered before the claim. These are very rare but do happen occasionally. Un-submitted Claims have to do with aging. So these are claims which are not aging, they haven’t been sent out. So it can be new claims that have been entered but not processed, claims that have been processed but not yet picked up by the clearinghouse, IMG may have on hold, rejected, etc.
So if we go back over to our scheduler, at this point we’re looking at a week for a single resource, we do also have the option of looking at more than one resource for a specific day so you can see multiple resources at a time. The active patient is loaded up at the top and we color code appointment statuses so in this case our patient has been marked as confirmed. When that patient is checked in it will change color and it will also open what we refer to as our quick-pay screen or our receipt window. You can set up various scheduling alerts. You also, once the patient is setup with a copay listed, that amount can be pulled into this screen so your front desk knows how much they need to collect. This screen is customizable. It can be set to be turned on at check in, checkout, both or neither depending on the type of practice you have and how you manage your patient payments. We do also include a notice at the top for what the patient’s current due balance is outstanding.
So in this case, if we are looking at, you know, this patient has a $20 copay, comes in, pays with his Visa, we apply that, and then this is sitting waiting for our claim to be created in order for us to go ahead and associate this payment with that claim. Once the patient is done, if you are using the EMR everything has been documented there, or if you are not using our EMR the provider has set up a charge slip along with the patient when they are checking out, you can check out the patient and then you have the option of entering the charges from this screen as well or you can take the written charge ticket if you are not using the EMR and enter those charges this way through our fully customizable electronic superbill. Once you save this information this actually creates the claim and this claim will now be available in billing for your billing staff to look at. The other thing you can do, particularly if you have gone ahead and scheduled a future appointment for this patient, once this is done if you print the receipt it will include what they have paid today, what was done and any future appointments as well as any outstanding balances. So this gives a lot of information and consolidates it all to one document so you don’t have to give them multiple documents with this information.
If it is a new patient that you are trying to schedule or any patient who’s not already on the schedule, what you can do is search for the patient, you can find the patient on the list if they’re an existing patient, go ahead and make them the active patient and then add the appointment on the schedule where it should be. So it’s very straightforward and easy to go ahead and schedule appointments. Also, for any patient who comes in you have access to any scanned documents to make it easy to scan if you’re wanting to scan insurance cards for that patients you can scan them directly into that patient’s chart very easily from here. You also have access to things like patient appointments, all their future appointments, any communications that have sent associated with this patient. You can send a communication. You can open the patient setup or anything else you might need to do regarding this patient.
If you’ve searched and it is a new patient and they do not appear on the list, you have the option of putting in a new patient via what we call our quick create, and all you would need to do here is go through and enter some very basic information, hit okay, and that has entered enough information for that patient to be able to be scheduled for an appointment.
Also the appointment types are fully customizable along with the duration so that you would be able to go through and set those up as are appropriate for each of your resources. So if you have multiple providers and one has an appointment where their standard is 30 minutes and another one has appointments where their standard is 45 minutes that can be adapted for and set up.
We do also have the ability to run eligibility checks through our clearinghouse. In this case all I did was right click and go to eligibility. When it is run it will come back and show you active coverage for various things. It will also show you specific services including coinsurance amounts, limitations, in-network versus out of network, deductible, out of pocket, etc. We even provide a benefits document which can be very nice since patients often do not know what their benefits are. It will provide a lot of information including more detail on the information that comes back in the quick screen.
We also add the ability to search for future appointments so if I am looking to find appointments with a resource our more than one resource, I can go ahead and search for those. I can determine where that appointment should be if I need to and I can set a time period, say six weeks, and what the system will do is it will go out six weeks and it will find open appointment slots plus or minus seven days from that six weeks to show what is open. So I can then go ahead and go out to that date and determine where there are open appointments and go ahead and schedule my patient.
Some claims have been created, I can update to show what’s happened, that we collected some money, there have been claims created. Of course, in any case you can always enter claims manually, you are not required to use the electronic superbill to enter claims.
Our main billing screen is the billing query. So this gives you a lot of different items because you can work from this screen or you can do reporting from this screen. We give you the option of several search boxes so that you can search for claims that have particular issues and get those addressed as quickly as possible to get those claims out. You can even search by patient information, payers, claim, submission dates, etc. However, if I am looking for claims that have been entered using the electronic superbill I am looking for closed electronic superbill claims, so I am going to select that as my claim status and search. What this does is it brings me back a list of claims where all of the claims meet that criteria. It’s going to give me some basic claim information as far as my claim numbers, dates of service, status, etc., patient information, guarantor information, insurance, providers, locations, but you can also turn it on so that you can see the procedures, modifiers, diagnosis codes, etc., which will help an experienced biller substantially because they will be able to go over and look at those claims and determine if modifiers need to be added to any of those line items. If they find any claims where items need to be added they could certainly do so manually and save that information. If there is information missing for whatever reason, it will be flagged in red. You can then go into that claim and rather than having to go out to a separate demographics area you can from the claim simply open the patient setup and go to, in this case, go to the insurance screen and add an insurance if needed. You can also go into any other section of patient setup to make any changes or modify or add a comment, etc.
Once we have reviewed the claims and determined that they are ready to go, we have our “submit claims” so I’m going to go ahead and do that. The system will automatically batch the claims into a group and split the claims between electronic and paper claims. It will also flag if there are claims that are in statement mode that need to be sent out as statements instead. It then notifies us that the batch has been created and we go to our claims submission area. Now the thing that’s nice about this is this now gives you another chance to take a look at those claims and make corrections before they go out to the clearinghouse. If anything is here marked as failed, then you would be able to go in and fix that. Anything that’s marked as passed is ready to go out. So in this case there are some claims that need to be fixed. All of those have kind of popped up to the top here and you can go ahead and open the claims from here and fix whatever might need to be fixed. In this case there’s no diagnosis code. So you can send a message, you can notify the provider or whatever else it is you might need to do. If everything is okay, you can hit process and the claims will go out. Anything that’s still in a failed status will go on to the rejected claims list to be fixed at a later time and these would be filed. In this case everything would go out. This is our claims submission process. It’s fairly straightforward. You do not have to upload any files to the clearinghouse yourself. We take care of all of those interactions for you.
Now the next step, of course, would be getting paid by the payers. This is our payment posting area. This area handles batch insurance payments, whether they’ve come to us through an electronic remittance or they are being manually entered because you received the EOB on paper or they can also take care of patient statement payments. If this were an ERA, the ERAs again you don’t have to go to the clearinghouse or a payer to download a file, those are brought in and they’re automatically added to a user’s worklist. The claims associated with that are added to the batch and the payments are posted out. Now these are not yet showing on the patient’s account and they will not until you have gone through and checked them. So you can make sure that you are not writing off anything that you shouldn’t write off, that you can refile with a modifier, anything like that. It can be taken care of very easily from here, you can open the claim itself, you can open the patient setup, and you can make any changes you need to. We do have a spot for comments if there’s something you need to note on here. The status is automatically updated based on the claim and the patient’s setup. In this case our patient does not have a secondary insurance, so since there’s still a balance it’s set to ready to send statement. If there were a balance left and they had a secondary it would be marked to ready to send secondary. If they were zeroed out this would be marked done. So again we take care of that for you to save you some steps. In addition, if an electronic remittance comes in, we do have this Display ERA checkbox and what this will do is this will put the paper version of the EOB so to speak down here so it can be compared against what has been posted. So that’s insurance payments.
As far as patient payments, those copays that have been collected at the front desk, it’s a two-piece process. Basically, we do have a report and this can be used by the billing staff or the front desk and what this will do is this will give us the monies that have been collected on whatever date, show who collected them, where they were collected, etc., also the payment methods used, and then you can open and see which patients those apply to. It is very straightforward here and really well used for balancing a drawer at the end of the day to make sure that what’s in the drawer corresponds with what’s been entered into the system.
When you’ve balanced on that, we do have also what we call our receipt posting area and this is to help with when you are collecting many copays at the front desk, rather than having to open each patient’s account separately and apply those payments we allow you a way to do it as a group so you can create a new batch for the date of service and the system is going to go out and find claims with that date of service that match the receipt and it’s going to auto apply that money for you. If everything checks out, you can simply hit post and you’re done and it will apply to all patients in that batch. If, for some reason, you need to make changes, you have access to that patient’s claim history and you can apply payments elsewhere.
Next thing I’ll show you is our aging report. This is the report that’s designed for following up on your claims. You can choose how you would like to organize that report. You can choose the aging buckets you would like to look at. And when you run the report you will see a list broken down however you arranged it, insurance due and the patient due payments under each category. You can then drill in for detail and this is going to give you that payer, the claims that are outstanding for that payer. Again, with even further detail, you can hover to get some information or you can click in and it will show you what’s been done, it will show you any payments that have been received, the current status of the claim and anything underlying can be opened from here. So you can open a comment, you can open a claim itself or you can open the patient setup so that while you are on the phone with the payer any changes or notes you need to make can be made. It is possible to export and print this report also.
Patient payments work basically the same way except you’ll have the patient or responsible party and then the outstanding claims for that patient.
Some other feature reports that we have are our Charge and Payment Analysis Reports. These are looking at things more specifically. Our Charge Analysis you can run for whatever date range you’d like, however long you want to run it. So if run it for a date range what this is going to show us, there’s the total charges that have been entered into the system in that date range and the procedures. It’s take all the same data and broken it down into multiple formats for you to view based on what you find most useful for you. You may have a circumstance where you’re wanting to see by provider. You may have a circumstance where you want to financial class or payer, etc. When you go in you would see a list of procedures, the number of them and then the total expanded charge on that. So this is going to give you a lot of good information regarding those charges. The payment analysis does basically the same thing except you can search by payments that have been received also.
The practice summary is a good overview report. We do not have in OfficeEMR what is referred to as a hard close. There are not specific tasks you must perform in order to either send statements or close out your month. Everything in our system is live in real time so many of our clients use this as their month-end report because you can run it by a number of different date options. You can run it by charge date or you can run it by payment dates. I’m going to go ahead and run my charge dates. So again, this is giving us different breakdowns of information. So it’s breaking you down by provider, financial class, etc. And what it’s showing you here is that you have your total charges that were billed out during the month, the payments against those charges and the adjustments on those charges, broken out so you can see what’s going on under each circumstance. Of course, you can also run by payment information to see the payments without regard for dates of service.
The last thing I’m going to show you is what we refer to as our Practice Aging Report. This report is very useful for a full practice overview. You can run it for anywhere from one to twelve months. You can select different information to be included and what this will give you in this case is a two-part report. This top part is showing you the charges for each individual month with the payments against those charges, the total adjustments on those charges and your total remaining balance or your outstanding AR for those charges. And, of course, you have accumulative totals. At the bottom it’s looking for money that came in in that month with a deposit date of that month so this money may have come in in May, however, it could be for a March claim it could be for a May claim, it could have been for a January claim. So it’s looking for money that’s actually been collected in that month instead. So this is very nice to give you both sides of what’s going on. It’s very useful for trending information to see how things are going there so it’s a very useful report to have and I think fairly unique to our system.
We do also have a full authorization tracking system if you’re a specialist. You can actually even start with that at the scheduler point where you can go ahead and check for authorizations or add an authorization for a patient. You can update dates, you can set warning levels, how many visits have been used, if it’s for specific codes, etc. You can absolutely do that. It can be associated with an appointment and then that information will follow through onto the claim and the appropriate authorization or referral information will be transmitted on the claim. And then, of course, that is fully accessible in billing on any claim to be associated with that.