New Invoices

Converted prospective invoices will automatically move to the New Invoice snapshot. This allows users to know which invoices need to be worked so they can be billed to insurance or assigned to the patient.

Navigation

To access new invoices, you can click on the New Invoice snapshot or filter by the New status in the Clinic Overview screen.

Filters sit at the top of the page to narrow down the view of patients listed. Once you have filtered the various areas, click Search to display filtered content.

Click on the name of the patient to open the invoice for that date of service.

A new screen will appear displaying details of the new invoice.

1. Coverage - this hyperlink allows you to update the primary insurance of the patient.

2. Invoice Summary - this button will bring you into the full invoice summary for the patient.

3. Apply Payment - payments and adjustments can be made via this button.

4. The date of service will expand to show the line items being billed. 

The purple header bar provides important information:

• Date of Service (DOS)

• Appointment Type - if the invoice is attached to an appointment, the appointment type will reflect. If this area is blank, then the invoice was created using the Billing quick tool.

• Invoice Status - the invoice status can be changed manually or automatically depending on the action of the user.

• Provider

• Location

• Patient Responsibility - balances assigned to the patient on the invoice

• Insurance Balance - balances being sent to insurance

• Balance - total of the insurance and patient responsibility balances

If you need to add another line item, click on the (+) plus sign in the grey header bar. 

This will populate a blank line item for you to complete.

Items that are editable will have a purple box around them. Click inside the box to update the following areas: 

• CPT/Procedure code

• ICD/Diagnosis code

• Units

• Terms

• Billing Instructions

• U&C percentage.

Procedure Code

To update the procedure code, click on the arrow icon to change the procedure code by description.

To search by CPT code:

1. Click on the sort icon

2. Double-click on the description of the procedure so it highlights purple.

3. Type the CPT code and then select the appropriate description.

Adding a Modifier

To add a modifier to a CPT code, click on the (+) plus sign icon for that specific procedure.

The above box will appear with 3 buttons:

1. Edit CPT Modifier - access the CPT modifier library to add new modifiers to the list

2. Add Modifier - select the modifier you want to add to the CPT code

3. Save Modifier - save the modifier to the CPT code.

Edit CPT Modifier

1. Select a modifier from the list to edit the modifier and/or notes. Type the updated information and it will autosave. 

2. If you do not see the modifier in the library, click Add New Modifier.

1. Enter the modifier code

2. Enter the modifier description

3. Click Save.

The modifier has been added successfully to the CPT Modifier Library.

Adding a Modifier to a Procedure Code

After clicking on the + plus sign, click Add Modifier.

Select the modifier from the dropdown list. If you want to enter details of the modifier, enter that into the Notes field.

Click Save Modifier.

In the above example, the modifier was added to line item 99213. 

1. A purple ‘i’ icon indicates that a modifier has been added to the CPT code. 

2. Hovering over the ‘i’ icon provides details of the modifier.

Deleting a Modifier from a Procedure Code

Click on the (+) plus sign icon for the CPT code with the modifier.

Click on the grey ‘x’ to remove the modifier.

Click Save Modifier.

The ‘i’ icon has been removed from the CPT code.

Diagnosis Codes

Adding a diagnosis code is a similar process to adding a procedure code.

To update the diagnosis code, click on the arrow icon to change the diagnosis code by description.

To search by ICD-10 code:

1. Click on the sort icon

2. Double-click on the description of the diagnosis so it highlights purple.

3. Type the ICD-10 code and then select the appropriate description.

Adding Secondary Diagnoses

To add an additional diagnosis code for that line item, click on the (+) plus sign icon for that specific procedure.

Click Add New Diagnosis.

To search by description, click on the magnifying glass icon or type the name of the diagnosis in the search bar.

Click on the diagnosis description.

To search by the ICD-10 code, click on the magnifying glass icon or type the ICD-10 code in the search bar.

Click on the diagnosis description.

Click Save Diagnosis.

Units

To change the number of units for a line item, click inside the units box. 

For this example, we will be changing 1 unit at $260 to 2 units.

1. Change the units to the desired number. In the example, we can see that the charge has been updated to $520 for 2 units.

2. Click Save.

A green banner will appear indicating that the “Invoice saved successfully”

The invoice has been updated to reflect 2 units for 99213.

Billing Terms and Instructions

Billing Terms

Terms selected will label and determine the actions against the charges of the service line. Users may select from three options:

• Fee for Service (F) - this is the office's standard fee for that CPT code.

• Package  Plan (Pkg) - selecting this term will associate the line item with a package plan recorded in the patient's escrow of their financial chart. Based on how the package plan is set up, the charges will either zero out or move money over from that package plan to satisfy the balance.

• No charge (N/C) - this term will automatically zero out the charges of the service line; if selected, billing instructions are not necessary to select. 

Billing Instructions

This field directs the office staff regarding the party (patient vs. insurance) that is responsible for the charge and provides instruction as to how the billing should be handled.

In conjunction with billing terms selected (see above):

• BI: bill insurance

• BP: bill patient

• BIO: bill insurance only - this is used when you wish to write off copays or any other portion of the charge that is not covered by insurance.

• BPO: bill patient only - do not submit a charge to insurance.

• BIR: "bill insurance and I will review" - instructs the billing office to bill the patient's insurance and review the EOB with the physician for disposition of any residual balance. This may be used if the physician wants the option of writing off a portion of a charge after it has been paid by the insurer.

• C: contracted insurance - used for patients that have contracted insurance. Instructs the system to bill for copays only for that service on the encounter date.

 

In conjunction with the Package Service Plan (Pkg) billing terms:

Patients that have prepaid for a global service may be billed with one of two options:

• GPt: "Global, bill for patient recovery" - instructs the office to create an invoice for the patient to submit to their carrier for reimbursement.

• GPR: "Global, bill for practice recovery" - in some instances the patient's insurance will have reimbursed the patient with funds that equal her cash global payment to the practice. GPR instructs the billing department to bill the patient's insurance for practice recovery.

Please Note: We recommend only using either the ‘BI’ or ‘BP’ billing instructions.

 

 

Once you have filled in your first line item with the Billing Term and Billing Instructions click on the AutoFill Billing Terms/Instructions for the system to fill in the rest of the line items.  You are able to override them if necessary. 

 

 

U&C

%U&C or Percent of the Usual and Customary Charge is used to provide a discount for a service that the patient is being directly charged for. The default value is "100" - which represents "100%". Users may enter any value between 0 and 100 to discount an individual line item. 

Click in the box to make the change. 

For example, if we want to provide a 15% discount, type 85 to make the user responsible for 85% of the charge. In the above example,the $300 charge has been adjusted by 15% for a total of $255.

 

Patient Responsibility

If the patient is responsible for all line items in the invoice (BP billing instruction):

1. Click on the Invoice Action button.

2. Select Change Status

3. Click on Patient Responsibility

The invoice status has now changed to Patient Responsibility and will fall off of your New Invoice list.

 

If you decide to push a statement to the patient at this time, please refer to the Print & Send Patient Account Statements manual. 

 

Upload a Claim to Change Healthcare

For further information on how to upload a claim to the Change Healthcare clearinghouse, please see the manual Upload a Claim to Change Healthcare.

 

 

**All manuals are compliant with HIPPA regulations.  No patient information has been released.  All screenshots above were taken from a test clinic with fake patient information.