HOW TO READ THE
LEDGER
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.
Ledger Tab
This screen is divided
into 3 distinct sections. The upper
section is essentially the “working” area of the screen. This area will display the history of
services and payments for this claim.
This is where you will reapportion the amounts due for a particular
service, or adjust off an amount no longer collectible. The middle area displays the TOTALS for this
ledger. The lower part of the screen
(grayed out so it is display only), displays a history of actions that make up
the detail lines in the upper section.
To see how this detail area of the ledger functions, highlight a service
line. The history that makes up that one
line of service, is displayed in the lower portion of the screen. You will see each individual entry that makes
up this line. This part of the screen
displays the visit date; the transaction; whether or not this part of the line
was for the patient or the carrier; how much of the service was charged to the
either the patient or the carrier; the User logged in when this action was done
and the date and time that it was completed.
As you can see, there may
be many entries in the detail area that make up one individual service line
from the upper area of this screen.
Amount of Patient Portion Amount Patient Paid
Upper (Working) Area of Ledger
There are several columns
in this area. These are defined as
follows:
Visit Date – This shows
the visit date of this transaction. The
visit date, when in the Services and/or Payment area will default to the date
of your computer, but may be changed to all for backdating information.
Description – This field
will display the description of the transaction. For example, the Service Description will
appear here, or, if this is a payment line, the payment type (and check or
credit card number if applicable) will be displayed.
Total - This field shows the total value of this
transaction. For a service, this would
be the normal price. For a payment, this
will display the total amount paid.
Carrier – This field
shows the total amount of this transaction that is the insurance carriers
responsibility. For example, if this
line was a service whose price was $45.00 and this patient has an 80/20 policy,
you would expect to see $36.00 in this field representing the amount you expect
the carrier to pay.
Car. Paid – This field
shows how much, if anything, has bee paid toward the carrier portion (as
represented in the previous field). If
there is an amount in the
Carrier field, and
nothing in this field, the carrier has not yet paid for their portion of this
service. Likewise, if the amount in this
field matches the amount in the Carrier field, the carrier has met his
responsibility for this service and you may assume that he will not be paying
anything further toward this line.
Patient - This field
shows the total amount of this transaction that is the patient’s
responsibility. For example, if this
line was a service whose price was $45.00 and this patient has an 80/20 policy,
you would expect to see $9.00 in this field representing the amount you expect
the patient to pay.
Pat. Paid - This field
shows how much, if anything, has bee paid toward the patient portion (as
represented in the previous field). If
there is an amount in the
Patient field, and
nothing in this field, the patient has not yet paid for their portion of this
service. Likewise, if the amount in this
field matches the amount in the Patient field, the patient has met his
responsibility for this service and you may assume that he will not be paying
anything further toward this line.
Discount – This field
will show whether or not any discount was applied toward this particular
service. A discount will reduce both the
carrier and the patient responsibility. A
discount will also appear on any HCFA billings.
Adjust - This field will show if any amount has been
adjusted off of this service line (rendered as not collectible). An Adjustment will reduce either the carrier
and/or the patient responsibility. An
Adjustment will not effect the amount that is printed on the HCFA billing.
Adj. Comment – This field
allows you to enter a note or “comment” regarding an amount that has been
adjusted off. This is an “enter” field
only. By that I mean that you may type
in your comment in this area, but the note itself will be displayed in lower
portion of the ledger screen, not on this line.
On Acct. – This field
reflects any activity with the On-Account credit for this claim. When a payment is made and has not been
applied directly to services, the amount will show in this field as a positive
number (you have, in essence, placed the amount in a “piggy bank” or holding
area for use later). When you then
transfer this amount to services (in the Services/Payment entry, the payment
method will be listed as Off Account, in the Payment/Refund entry this would be
a Transfer), you will see a negative amount in this field.
Business – This field
shows the business for whom this transaction belongs.
Doctor – This field shows
the doctor that was listed as having performed this service.
Qty. - This field will show the Days/Units
designation of service entries, or the Quantity of any inventory item.
CPT Code - This field shows the CPT Code that has been
entered for this service. For inventory
items, this will be the HCPCS code.
SL - This field shows the
source location that has been setup for this service and/or inventory
item.
ST - This field shows the
source type that has been setup for this service and/or inventory item.
Activity/Inventory - This
field shows the service and/or inventory item.
Unlike the Description field, only service or inventory types will be
listed here, payment, transfer, refund lines, etc. will show no description in
this area.
Diag. Key – This field
lists the unique code that represents the diagnosis entry attached to this
service line. To see the actual
diagnostic codes, click once on the Diag. Key field and a window will open up
to show the ICD Code and Description. (NOTE:
Items that have different Diag Key numbers, even if delivered on the
same day, will appear on separate billing forms).
YTD Visits - This field
shows the Year To Date visit number that was designated for this service at the
time it was entered.
# In Series - This field
shows the number in series visit number that was designated for this service at
the time it was entered.
Visit # - This field
shows the Total visit number that was designated for this service at the time
it was entered.
Auth. Num – This field
reflects the Prior Authorization number that is specific for this service or
inventory item. You enter the number on
the General Tab of Claims, but, like the diagnosis, it may change through out
the care of this patient. This field may
be edited here if needed. (NOTE: Items
that have different Prior Authorization Numbers, even if delivered on the same
day, will appear on separate billing forms).
Deductible Used - This
field shows if this service was calculated as being part of the patient’s
deductible. It will reflect the amount
that was added to the Deductible Used field. (NOTE: An amount appearing in this
field will ensure that this service, even if patient is fully responsible and
the service is fully paid, will appear on a carrier billing form).
Copay Used - This field
shows if this service was calculated as being part of the patient’s Per Visit
Copay. (NOTE: An amount appearing in
this field will ensure that this service, even if patient is fully responsible
and the service is fully paid, will appear on a carrier billing form).
Car. Billed - This field
shows whether or not this service has ever been billed to the primary
carrier. If this field shows a date,
that is the date in which it was billed.
Bill # - This field shows
the bill number assigned to this service.
If there is a bill date in the previous field, this is the bill number
of the batch on which you will find that this service has been billed.
Batch # - This field
shows the batch number in which this service has been billed. If there is a bill date in the Car.
Billed field, this will reflect the
batch number in which this service has been billed.
Current Balances On Account Credit Total
Middle (Totals) Area of Ledger
There are several fields
in this area. These are defined as
follows:
On Acct. - This field
shows the current credit available to this patient. (NOTE:
this field should always reflect a positive number, if you ever see a
negative number in this field, please print the ledger and fax to EON Technical
Support for assistance in correcting this error.
The following fields
reflect the totals of columns shown above.
These are the cumulative totals (everything to date).
Total - This field
reflects the cumulative total of Total Column.
This is the total value of all services delivered to date.
Carrier - This field
reflects the cumulative total of the Carrier column. This is the total amount, to date, that we
said was insurance carrier responsibility.
Car. Paid - This field
reflects the cumulative total of the Car. Paid column. This is the total amount, to date, that we
have said that the insurance carrier has paid.
Patient - This field
reflects the cumulative total of the Patient column. This is the total amount, to date, that we
said was patient responsibility.
Pat. Paid- This field
reflects the cumulative total of the Pat. Paid column. This is the total amount, to date, that we
have said that the patient has paid.
Discount - This field
reflects the cumulative total of the Discount column. This is the total amount, to date, that has
been discounted from services delivered.
Adjust - This field
reflects the cumulative total of the Adjust column. This is the total amount, to date, that has
been adjusted (rendered as not collectable) from services delivered.
Car. Bal. - This field
reflects the current outstanding amount owed by the insurance carrier.
Pat. Bal. - This field
reflects the current outstanding amount owed by the patient.
Tot. Bal. - This field
reflects the current outstanding amount owed for this claim. The Tot. Bal. (or outstanding claim balance)
is calculated by adding the Car. Bal. and the Pat. Bal.. Then reducing that amount by anything in the
On Acct. field. EXAMPLE:
Car.Bal. $432.00
Pat. Bal. 0.00
Subtotal $432.00
On Acct. < 18.00>
Tot. Bal. $414.00
There are an additional
three buttons found in this middle section these work as follows:
[Beg. Balances] - When
you click on this button, it brings up a list of all of the doctor’s entered
into your TPS 2000 program. For the
first doctor, enter the date that you want for this beginning balance. Next enter any outstanding patient amount in
the Pat. Balance column. Enter any
outstanding carrier amount in the Carrier column. If there is a credit on this account, enter
it in the On Account column. Repeat this
for any other doctor’s as necessary.
When you are done, click on Save Beginning Balances. NOTE:
There is no need to enter a Beginning Balance if this patient’s balance
to bring forward is $0.00.
[Total] – This button
allows you to “Subtotal” at any point on the ledger. For example, say that you wanted to see the
outstanding amounts and cumulative totals as of December 31, 1999. In the upper part of the ledger screen. Arrow to the last transaction delivered for
the year 1999. Click once on this line
to highlight (select) it. Now click on [Total] you will see the Totals readjust them selves
to show you the picture of this claim at that point in time. You will also see the following message to
the right of the [Total] field “until 12/31/99”.
[Auto Adjust] – This
feature allows you to adjust off amounts “in mass”. Let’s say that you have a personal injury
claim for which you agreed to settle.
The settlement amount is less than what is owed. You could apply the payment automatically,
then you will need to adjust off the remaining balance. If there are multiple services remaining, you
won’t want to do these one service line at a time. Go into the ledger and click on [Auto
Adjust]. This will bring up the
following screen:
You may select only a
specific date range to be adjusted, or you may select up to a specific amount,
you may also design whether carrier, patient or both sides are to be
adjusted. After you make your
selections, type in your explanation then click on [Auto adjust unpaid items]. This action will then automatically be carried
out.
Lower (Totals) Area of Ledger
This area of the ledger
will display the detail. What I mean by
this is if you click on a service line in the ledger above, you will see each
action that made up this service. For
example, if you have a service line that reads:
Visit
Date Description Total Carrier
CarPd Patient PatPd Disc Adj
01/05/01 EP OV Min $45.00
33.00 0 10.00
10.00 0 2.00
If you click on this
line, you would see each action that made up this charge. For example:
Date
Transaction Source Amount
User Date/Time Entered
01/05/2001 Charge
Carrier $35.00 Jenny
01/05/2001 9:22AM
01/05/2001Charge
Carrier - 2.00
Jenny 01/05/2001 9:22AM
01/05/2001Adjustment - 2.00
Jenny 01/05/2001 9:22AM
01/05/2001Charge Patient $10.00 Jenny
01/05/2001 9:22AM
01/05/2001Payment Patient
-10.00 Jenny 01/05/2001 9:22AM
You may also see the
detail of any payment line by the same method.
You also have the ability
to make notes on any of the above actions.
For more information on notes, see the How To Help for Adjustments
Comments and Ledger Notes.
Printing the Ledger
In the Middle section of the ledger, between the On
Account Balance and the Beginning Balance Button you will see a small printer
icon. Click on this icon to print the
patient ledger. You have the following
choices:
To Print Entire Ledger: Leave the From Date field
blank. This will print all entries in
the ledger up to the To.
To Print a Date Range: Fill in the From
Date and To fields with the appropriate dates.
(NOTE: The ledger report will
print from the day FOLLOWING the date filled in for From Date and up to (but
not including) the date filled in for To).
3 Different Layouts: This
area is preset to print a “Default” layout.
You may, however, choose from 2 other layout styles.
Highlight Balances: This
layout will mark unpaid services with either a highlight or a circle (depending
on whether or not it is a carrier or a patient balance). This is an excellent tool when auditing a
patient’s account.
With Car. Billing Dates: This layout may be used to show the date the
primary carrier was billed for a specific service date. (NOTE:
this layout has been successfully used to show “timely filling” with
insurance companies).