A HCFA DIDN’T PRINT FOR A PATIENT

What to look for and how to correct this

You did your normal carrier billing and noticed that there was not a HCFA form for 1 or more patients that should have billed. There are several things that can stop TPS! from creating a HCFA for a patient. Let me give a few scenarios and maybe this will help you review each of these cases and see if any of these apply...

1. You want to bill as a courtesy, but patient is responsible for the bill and policy has total service due on the patient side.

You are always capable of creating a courtesy billing for a patient. The only additional step needed in this scenario is to be sure that on the Visit Info./Misc. tab in Claims is that the line item "Bill Carrier for All Services > 0.00" is checked.

2. You have a patient that has been with you for some time, no change in insurance companies it just suddenly stops creating HCFAs.

Go to that Visit Info./Misc. Tab of claims again and check to see if either a "Visit maximum" or an "Insurance $ Paid Maximum" has been set, and then whether or not it has been reached. In either case, when a patient has a set maximum in one of these fields, as soon as this maximum has been reached TPS! will stop billing the insurance company and put the entire portion due on the patient side until the roll-over month listed on this same page. When that roll-over happens, TPS! will again start recalculating this maximum and again creating HCFAs.

3. Patient started off as either Cash or an Insurance company that you have found was not correct, you have corrected the Insurance carrier in the claims area, but nothing billed or, you have a patient that has been billing and now, suddenly, is not.

There could be several scenarios that result in the above situations. Correcting the insurance carrier on the first claims screen is the correct first step, next go Visit Info./Misc. Tab in Claims, to the line item "Bill Carrier for All Services > 0.00" and be sure you have put a check mark in this box. Now, when you do an "ALL CARRIER" billing, TPS! will pickup these first services that had been put through on the wrong carrier and bill them to the new carrier in the file. Please remember that if you do an "All Carrier Billing" nothing will be skipped, however, under this circumstance, if you try to bill carrier by selected patient (for example) it won't bill the services dates that don't belong to the new carrier. The other alternative to All Carrier Billing is Selected Carrier Billing. Just tag both the "old carrier" that was in the patients file originally and the "new carrier" that is in there now. It could also be more difficult than that. If you have tried the above solution and you still cannot bill these service dates, we need to look a little deeper. Be sure that the Billing Provider for the Provider that provided the services has not changed.

4. Your TPS! system printed the top half of a HCFA form , but didn't fill anything in the services area.

This scenario is very specific. Check the Maximum billing amount you have listed for that bill batch, next, check the patients ledger. You have a single service amount that is greater than the maximum billing amount. TPS! cannot split a single service into 2 billings. In a sense you have just totally confused your TPS! system, it knows it has services in the ledger that need to be billed, but you told it it couldn't bill for any amount greater than $x.xx. The partial HCFA is TPS!'s way of saying, I have a/ problem. Simply do another bill bat/ch with a maximum amount large enough to allow TPS! to bill.

There is one more possible reason for a HCFA to not print. If you entered an insurance carrier into TPS, gave this carrier to a patient or patients and entered services for these patients, you would, and should, expect to receive a HCFA form for these services. However, if, for whatever reason, prior to billing you DELETE this particular insurance carrier, these services will not bill.

Remember, if you are doing a “clean up” of your insurance carrier file to remove duplicated entries, be certain that no services have been left unbilled prior to removing these carriers. We suggest you first change the name to avoid using this carrier again, then delete in 3-6 months. (NOTE: Try something like this for the name change Do Not Use – Delete on 09/18/20XX.)