When you send a claim to an insurance company, and the insurance company adjudicates the claim, they will reply with an Explanation of Benefits (EOB) or Payer Claim Summary (PCS). A typical EOB or PCS will list the sessions you billed to the insurance company along with the amount you charged them, any adjustments they applied (i.e. contracted rate adjustments) with remark codes (standard codes indicating the reason for the adjustment), the amount they are paying you along with the patient responsibility. Therabill has a batch insurance payment entry page that you can use to quickly enter both the payments and the adjustments that are shown for each session on the EOB or PCS.
NOTE: This article refers to manually entering payments. This is not Electronic Remittance Advice. You can receive electronic remittance advice from many payers and have them delivered directly to you in Therabill for easy posting of payments. Please click here to find out more.
Entering Batch Insurance Payments & Adjustments
Follow these steps to get to the batch payment entry page.
- Click Payments on the top navigation bar.
- At the top of the Payments page, click the Ins Pmts w/ COB button.
- Payment Information: At the top of the page, you can enter information about the entire payment (for example, check number, check date) (see image to the right, in red square).
- Applying Payments to Services: At the bottom of the page (highlighted by a blue rectangle in the image to the right), Therabill will list all sessions that are considered open to the insurance company that you entered at the far top right of the page. In this section, you can apply payments and adjustments to specific service codes.
At the top of the page (highlighted by red rectangle in image), you enter information about the entire payment.
- Total Amount (optional): This is the total payment amount. You can leave this blank. If you enter a value here, then when you apply the payment, Therabill will perform an error check to make sure the total of the individual payments applied to the service codes (see section below labeled Applying Payments and Services) is equal to the total amount that you enter here. If the two values do not equal, Therabill will stop you from entering the payment.
- Pmt Method: You can indicate how the insurance company paid you. Values available are Check, or EFT/ACH. EFT/ACH refers to direct deposit in to your bank account.
- Received Date: This is also referred to as the post date. The current date will be pre-entered for you. If you leave the received date blank, then Therabill will automatically post to the current date (today's date).
- Check Date (optional): You can enter the check date here (even EFT/ACH payments have a check date associated with them).
- Check Number (optional, but strongly recommended): It is strongly recommended that you enter check numbers. This will give you the ability to use the payment search to find payments by check number as well as using various reports that use check numbers.
- Deposit Date (optional): If you would like to record a deposit date, you can do so here. This is completely optional.
Applying Payments to Services
- Pmt Amt: Enter the amount that the insurance company paid you for that session.
- Class: If you are using payment classes, you can choose a payment class to assign to the payment amount. For information about payment classes, please see: http://www.youtube.com/watch?v=6XPG6U3-mEs
There is usually an adjustment amount listed on the Explanation of Benefits for each service. An adjustment is not a payment. An adjustment is the insurance company saying that a portion of your charge amount is not being paid by them and they feel it should not be payable by the patient. Often times, this is a contracted rate adjustment. If it is a contracted rate adjustment, then you usually must apply (or post) this adjustment to adjust down the balance due for the service line. Some adjustments do not need to be posted. However, you still want to enter them as they may be needed to report to secondary insurance.
IMPORTANT: Some payers list deductibles and copay amounts as 'adjustments'. Do not enter these types of adjustments as an adjustment in Therabill. Instead, enter these types of adjustments in the patient responsibility section (see section below labeled Patient Responsibility).
- Amount: Enter any adjustment amount the insurance company applied.
- Remark: Each adjustment on the EOB will also have a remark code. The remark code (or reason code) is often referenced on the service line of the EOB and a description of the remark code is given elsewhere on the EOB. The remark code indicates the reason why they are adjusting down the balance. You must enter this remark code. More and more insurance companies are requiring it for secondary insurance claims submissions and entering it here will keep you prepared.
- Post: You do not always want to post the adjustment to the session in Therabill. If you post the payment (by checking this checkbox), then the balance due on the session in Therabill will be reduced due to the adjustment. If it is a contracted rate adjustment, then you most likely do want to post the adjustment. If you do not check the post option for a service line, then the adjustment will simply be entered as a reference for coordination of benefits. The balance due on your service will not be reduced if you do not check the post checkbox for the service line. There are many reasons not to post an adjustment. One example is if they are denying your claim. Denial of a claim does not necessarily mean that you want to adjust the balance due on the session. Most likely, you will want to bill the patient for the service.
The EOB will usually show a patient responsibility. The patient responsibility is the charge amount - payments - adjustments. On the EOB they will also tell you if the patient responsibility is due to copay or deductible.
- Copay: If the reason given for the patient responsibility is listed as copay, then enter the patient responsibility in to the copay text box.
- Deductible: If the reason given for the patient responsibility is listed as applied to deductible, then enter the patient responsibility in the deductible text box.
- Other: This is a 'catch all' for any other type of patient responsibility (it is not copay nor deductible).
- Resubmit: This will send that service line back to the bill insurance area. You can then go back to your bill insurance area and send the service line out on another claim.
- Close session: This does not mean that the session balance is automatically adjusted to zero. Closing a session means that the balance due on the session is now due by the patient. That is, when you bill a service to insurance in Therabill, the session is considered open to insurance. An open session will show up as a pending insurance charge on the client statement (when you bill your patient). Closing the session (closing it to insurance) means that any balance due is now due by the patient and it will show up as a finalized charge on the client statement. If there is one instructional video we want everyone to watch, it is this one (click here).
- Bill remainder to client: This is deprecated. You should really use close session. However, if you happen to be using the old client invoicing system (that Therabill is no longer supporting or maintaining) instead of the new billing statements system, then you will need to use bill remainder to client in order to send the service line in to the client invoicing system. If you are still using the old client invoicing system, we strongly recommend transitioning in to the new client statements system.
- Bill remainder to agency: If you are using agency statements, then choosing bill remainder to agency will cause this service line to show up on the agency statement.
- Keep current status: This performs no action on the service line. The current status (open to the insurance company will be maintained).
- Crossover: Some insurance companies are capable of crossing over claims amongst each other. This is also referred to as coordination of benefits. This refers to the primary insurance automatically submitting the claim to secondary insurance after they adjudicate the claim. If you know that the insurance company you are entering payment on already submitted the claim to secondary insurance, then choose this crossover option and enter the secondary insurance in the select menu that appears. Therabill will then internally mark the service line as open to the secondary insurance. By doing this, your accounts receivable and aging reports will correctly reflect which insurance company is currently responsible for payment.
Once you have entered all of the information, click the Apply Payments button at the top right (see image above, in the red rectangle).