HOW TO ENTER/EDIT PATIENT
CLAIM INFORMATION
From
the “Select a File to Open” menu choose Patient
Claim Information, or use the Navigation Bar Icons, click on the
A list of the current Patient Claims in your system will
popup. You may select from this list by
scrolling or using the arrow keys to move up and down through the list, or you
may click into either PAT CODE or NAME fields, and start typing. If you know the patient’s code for whom you
are seeking, click on a number in the PAT CODE field and type in that
code. TPS 2000 will take you to that
listing. If you know the patient’s name for whom you are seeking, click on a
name in the NAME field and type in all, or part of the patient’s name. TPS 2000 will take you to that area of the
list. When you have found the correct
patient, double click, hit enter or click on Select Record.
TO EDIT EXISTING PATIENT CLAIM DATA
Click on the TAB to find the fields that will be
changed. Type in your changes. As soon as you have left the field in which
you are working the data is saved. You
may either close this screen, or use the show list of records button to select
another claim.
TO ADD A NEW PATIENT CLAIM
To add a new claim to this patient’s account click on the
“+” Plus Sign on your navigation bar.
TPS2000 will ask you if you want to add a new record. Click on OK.
From here it’s as easy as typing.
1st Responsible Tab contains the basic
insured’s data.
When you add a new claim, TPS2000 will automatically
bring up the Carrier / Policy list.
Choose the Carrier and Policy that is correct for this claim. (Remember, deductible, maximums and co-pays
will be handled on another tab and should be part of the policy list).
There are 3 number fields available on this screen Policy #, Policy Group #, and Insured ID
#. Each claim could have 3 different
numbers that are needed. The patient’s
Insurance Card will list all the numbers that they require. The field Insured
ID # is the one that is set to print in
Policy
Group#/Medicaid# is the field that will print in
Policy
# is the field that is usually only used for Personal
Injury (Auto) type cases. This field is
not setup to print on any billing form.
It normally contains the auto policy number for the patient that is
needed on all correspondence to the insurance company.
NOTE: HCFA Red Med 1.7 format for paper billing to
Medicare is currently setup to me the Federal Medicare Standards. What that means specifically, is that there
will be no Carrier Name or Address printed at the top of the HCFA form. The word NONE will print in
Billing Start Date – Under normal circumstances, this field will not be
filled in. There might be a situation
where a patient has been cash, and now insurance will be billed. However, a new claim might not have been
established. In this case, you might
want to set a start date for billing so that no services older than this date
appear on carrier bills.
Coverage
Type – What ever selection is made here will determine which
box is checked in
Accept
Assignment -- If you Accept
Assignment, in other words, the insurance company mails the payment for
services to you instead of directly to the patient, then put a check mark in
this box. If this box is checked it will
put an “X” in the YES in
Primary
to Medicare – If there is an insurance that is primary to Medicare
(in other words Medicare is the secondary insurance) put a check in this
box. Medicare requires the word NONE to
be placed in
General Tab contains further information for this claim.
Claim
Name -- This field may
be edited by your office should you need further data available when in
services entry. If left alone, this
field will display the claim sequence for this patient (i.e. Claim 1, Claim 2,
etc.) and a history of each carrier selected on the 1st Responsible
tab.
Claim
Originated Date -- This is
the date that this patient first presented to your office for this particular
situation (claim).
Injury
Date -- If there was
an injury (i.e. Personal Injury claim, Work Comp claim) or if this insurance
company requires the onset date you fill in the date here. This field will print in
Similar
Illness Date -- If there was a
past claim for a similar situation or injury,
fill in the date here. This field
will print in
Injury
Description, Place of Injury, Complaint, and Acute Chronic
-- These fields, while not set to print
on any paper billing may be filled in so that they may be directly imported
into any notes or narratives for this patient.
(NOTE: The Acute Chronic field
is used in the 837 Electronic Billing format).
Ins
Claim # – This number is for internal use only. This field is not used for any notes or
narratives or on any carrier billing forms.
If you have several patients with the same claim number, this field may
be filled in with that number. Then you
may use the
[Show Claims for this #] button to see the list of all
claims that contain the exact same entry in this field.
Prior
Authorization # – If you have an authorization number that needs
to be shown on the carrier bills fill that number in this field. This will print in
Auth. #
of Visits – This field is used to display the number of visits
that have been authorized.
Outside
Lab Work and Charges -- If you
put a check mark in the box for Outside Lab, then fill in the amount that is
being submitted for the lab work that was sent outside of your office. If there is data in these fields, they will
print in
Claim
Type – This field is for your use. If you need more specific classification
(more than the carrier type), this field is available.
Severity – This
field, while not set to print on any paper billing may be filled in so that it
may be directly imported into any notes or narratives for this patient.
Subluxation
Level – This field, while not set to print on any paper
billing may be filled in so that it may be directly imported into any notes or
narratives for this patient.
Marital
Status – The choices available here are Single, Married and
Other. The option chosen will determine
which box contains and “X” in
Employment
Status – The choices available here are Employed, Full Time
Student, Part Time Student. The option
chosen will determine which box contains and “X” in
Unable
to Work From and To -- If
there is or was a period of time during this claim that this patient was unable
to work due to injuries, put the dates in these fields. If there are dates in these fields, they will
fill in
Hospitalization
From and To -- If there is or
was a period of time during this claim that this patient was hospitalized due
to injuries, put the dates in these fields.
If there are dates in these fields, they will fill in
HCFA
HCFA
Signature
on File
Signature
on File Box 13 – If you have obtained your patient’s signature
authorizing you the insurance company to send the payment for services directly
to you instead of to the patient, put a check mark in this box. If there is a check mark in this box the
words “Signature on File” will print in Box 13 of the Red HCFA form.
Electronic
Billing Info The
information in this section will be used with the 837 Electronic Billing Form
Gov’t Assigned – Used for Medicare only. If your patient has assigned their benefits
then
select “Assigned”; There are also the settings of “Assigned except for
Clinical”,
“Not Assigned”, and “Patient Refuses to Assign Benefit”.
Compl. Case – Place a checkmark in this
box if this claim is classified as a
complicated
case.
Vision Condition – Select the correct assignment for the patient’s
purchase of
replacement
vision products.
Info Release – Select the appropriate
entry that describes the release of information
for
this claim or case.
Symptom Indicat. – If appropriate,
select the entry
Release of Info – Select the date of
that you received the Release of Information.
Patient’s
Condition Related To – If the patient’s claim or situation was related
to either an accident at work (Employment), an auto accident, abuse or some
other accident check the appropriate box here.
If there is a check in one of these boxes an “X” will be placed in the
appropriate YES in Box 10 of the Red HCFA form.
All other areas of Box 10 of the Red HCFA form will contain an “X” in
the NO fields. There is also an entry
for Another Party Responsible. Mark
this, in the case of an Auto Accident or Other Accident if someone other than
the patient was the “at fault” party.
State – If any of the fields in the Patient’s Condition Related To fields
have been selected, select the state in which the accident occurred.
Country – If any
of the fields in the Patient’s Condition
Related To fields have been selected, select the Country in which the
accident occurred.
Amb.
Patient Grp. – If this patient
is part of a Amb. Patient Group enter
that information here.
[Print Patient/Claim Data] This button is used to print a hard, paper
copy of the patient and claim information, including diagnosis and payment plan
information.
Visit Info/Misc. contains information on
maximums, deductible, visits and special billing settings for this claim.
Insurance
Coverage – If this insurance policy has a maximum amount that it
will pay, you have the ability to enter this amount in the Maximum Amount/Total
column. TPS2000 will then track the
Insurance portion expected on services.
When this expected amount (Amount Used column) meets or exceeds the
amount in the Maximum Amount/Total column, TPS2000 will stop billing the
insurance company for services. It will
also make any services added after this amount has been met the responsibility
of the patient. When the year rolls
over, TPS2000 will reset the Amount Used, again start tracking this amount, and
billing the insurance company appropriately.
Insurance
Deductible -- If this
patient has a deductible amount due before benefits begin, place this amount in
the Maximum Amount/total column. TPS2000
will then track the amount of services applied toward deductible in the Amount
Used column. Until this deductible
amount has been meet or exceeded, TPS2000 will make the patient responsible for
all service amounts. However, TPS2000
will also make sure that these deductible services are billed to the insurance
company so that they may be properly credited as deductible amounts. Once the deductible has been met, TPS2000
will start splitting the amount due for each service as the policy has been
setup.
NOTE: If you have
a special or customized policy setup for this insurance company (i.e. you have
a contract with them and must adjust off a portion of the service amount),
TPS2000 tracks the allowed amount toward the deductible.
Deductible
Rollover Month – If the patient has a deductible amount setup, you may
pick the month in which this deductible is again due. For the majority of policies this will be
January, however, there are policies that roll over in other months.
Per
Visit Copay – If this patient has a per visit copay that must be paid,
fill in the amount of the copay here.
TPS2000 will place the first $10.00, or $20.00 or whatever the copay
amount is, of the day’s charge as the patient’s responsibility. It will then ‘split’ the balance of the
services delivered per the policy setup.
Maximum
# of Visits – If this insurance policy has a maximum number of
visits for which it will pay, you have the ability to enter this amount in the
Max # Visits. TPS2000 will then track
the number of visits for this claim..
When this number meets or exceeds the Max # Visits, TPS2000 will stop
billing the insurance company for services.
It will also make any services added after this point has been reached
are the responsibility of the patient.
When the year rolls over, TPS2000 will reset the visit counter, again
start tracking the number of visits, and billing the insurance company
appropriately.
Visit
Counters / Message to Display --You have the ability to
setup messages that will automatically print on your Startup Message Listing
from the individual Claims screen. You
have the ability to add a special message that will appear after so many
visits. For example, if you want to see
the message "Patient needs a re-exam" to print after the patient's
12th visit, you will put the number "12" in the field "Display
Message on Visit #" and you will print the message you wish to see
displayed in the field "Message to Display". You could add a different message to a
special Month To Date visit and/or Total Visits as well.
Last
Exam Date, Last Xray Date, Last Report Date – In your Service
Master Entry you may categorize your services.
If a service has been marked with the Production Category noted as an
Exam, or Xray and Report, when you enter a service for your patient that has
one of these designations, TPS2000 will automatically update these fields with
that service date.
Across from these fields are the Next Exam Date, Next Xray Date, Next Report Date. For your tracking only, you may fill in the
appropriate dates here is you wish.
Attorney – If
there is an attorney for this claim or case, select them from your list of
attorneys.
Referring
Physician– If there is a referring physician for this claim or
case, select them from your list of referring physicians. TPS2000 will automatically fill in the ID#
and state automatically. If there is a
referring physician, remember to fill in the Date that you received the
Reference.
There are several small check boxes on this screen –
Bill Secondary/Tertiary – If you need to physically
print a HCFA form for your
secondary
carrier – put a check mark in this box.
Send Patient Statements – If you do not
want this patient to ever receive a patient
statement,
uncheck this box (this is not normally recommended).
Bill Attorney instead of Insurance – If
you want the HCFA form to go to the
Attorney INSTEAD of to the
insurance company, put a check mark in this box.
Bill Carrier For – All Services > $0.00 --
This box is not normally needed for a
HCFA form to be produced. If there is any amount of a service that is
due on the insurance side of the ledger, a HCFA will be produced. If the insurance is not responsible because a
deductible was setup, a HCFA form will still be produced. However, if you need to FORCE TPS2000 to
create a HCFA form put a check mark in this box. For example, a patient was setup as CASH
originally, after you have processed several services for this patient, they
then tell you that they have insurance and want them to be billed. Change the CASH carrier in the claim file to
the Insurance company that has been provided, put a check mark in this box and
do an ALL CARRIER bill batch.
Bill Carrier For – No Charge Services - This will not normally be used. If you have
a situation where you have
bundled codes and are required to list all services in that bundle at a $0.00,
then you would check this box.
Bill Carrier For – Fully Adjusted or Discounted Services –
Again, this will not
normally
be used. If you have a capitation situation
that requires a special
handling
(i.e. services to be adjusted off but billed anyway), then check this
box.
Bill Carrier For – Sales Tax – Sales Tax, by law, is the
responsibility of the End User.
However,
there are some situations where tax should be billed to the carrier.
If this
is what is needed, put a check mark in this box.
EB
Sublux 1 & 2 – If you are a chiropractic office and you are
using the 837 Electronic Billing Form, fill in the subluxation level for this
claim or case.
EB
Narrative – If you are
using the 837 Electronic Billing Form, fill in any narrative needed for this
case or claim.
EB
Acute/Chronic – If you are
using the 837 Electronic Billing Form, fill in the status needed for this case
or claim.
Discharged – Once you have discharged this patient for
this case or claim, enter the date here.
Active – If
this claim is no longer Active (scheduling appointments, adding new services)
then remove the check mark from this box.
Inactive claims are still capable of being billed and recording
payments.
2nd Resp. Same basic fields as is found on the 1st
Resp screen. However, these will reflect
the information for the person who is responsible for the Secondary Insurance.
3rd Resp. Same
basic fields as is found on the 1st Resp screen. However, these will reflect the information
for the person who is responsible for the Teritiary Insurance.
User Definable Fields -- This screen is for your office use.
You may alter the names of each of these fields. If there
are special dates, hobbies, or memo type items that you would like to see in
your practice management, you may do so with this entry. On this screen you will see 4 date fields, 5
single line entry fields and 2 memo fields.
From the Basic System Information Screen you may
establish the labels for these fields.
For example, one of the date entries might be labeled "IME
EXAM". One of the memo fields might
be "Past History". Once these
fields are renamed, the names you have chosen will be seen on each patient's claim
screen.
Diagnosis Tab contains the current diagnosis
for this patient.
To select a diagnosis for this claim, you may sort and
search either by ICD9 Code or by Name.
Place a ‘bullet’ (click in the dot) of which option you wish to use to
search. Now click in the list and start
typing. To select, either hit enter,
click on [Add Item] or double click on the item.
You may move the diagnosis entries around by changing the
number to the left of the ICD Code. If
you wish to delete a diagnosis from this claim, click on the small box [] found
to the left of the D.# column. When this
small box shows black, it has been deleted.
As soon as you changes tabs or claims then return, your screen will
refresh and you will no longer see this entry.
$ Plan Tab is where you will set up any special payment
plans that you have made with your patient.
If you have a program that includes Care Plans this field
will be invaluable. Essentially, if you
layout a plan of care for your patient over a specified period of time (i.e. a
year is most common) you may fill in the start and end dates of the plan on
this screen. You may then note the
Payment Frequency, the Usual and Customary amount of this care, if you are
placing a cap on this amount, if you offer a one time savings amount and the
cost, if any for any additional family members on this plan. TPS2000 will then calculate the total savings
that this patient is getting and show you what the payment amount should be
(based on what was checked in payment frequency). You also have the ability to set Plan
Alerts. These alerts will generate
messages based on either a set date, dollar amount that the patient has paid
toward this plan, or dollar amount of services that have already been rendered.
Ledger Tab will display the history of services and payments
for this claim.
Each line on the ledger also contains a history of
actions. When you highlight a service
line, for example, the history displayed in the lower portion of the screen will
show the visit date, the services, how much of the services was charged to the
patient, how much of the service was charged to the carrier, if any of the
services has been adjusted off (either during the services entry as a policy
write off or after it was posted). It
also notes the User logged in when this action was done and the date and time
that it was completed. There are also
cumulative totals displayed on this screen making it easy to see the total of
services or patient payments that have been applied to this claim. (For more information about the Ledger Tab,
see the write up “How to Read the Ledger”).
When you are done you may pick another Patient Claim to
work on or you may close the entry by clicking on the “X” in the upper right
hand corner of the Claim Screen.
HCFA GUIDELINES
