Apply Remittance

 

The Remittance screen is where you apply payments received from the insurance companies. The Explanation of Benefits (EOB) document lists all of the treatments for a specific date range and indicates whether a treatment is paid, denied, or a deductible. As you make entries in the table, ClinicSource automatically calculates the Write Off (W/O) amount.


On the top part of the screen, you enter the amount remitted. The Running Balance field subtracts payments from the total amount and displays the information in the field.


Add Remittance Amount and Documentation


The top portion of the screen is where you identify the insurer, information about the payment and add any other documentation.



Follow these directions to add the remittance amount.


  1. From the Payments screen, click the New Remittance button. The Remittances screen appears.


  1. From the Insurer drop-down list, select the appropriate insurer. (NOTE: You can select the Insurer from the Remittances tab then click the New Remittance button.)


  1. In the Date field, type the EOB remittance date or use the calendar control to select the date.


  1. In the Amount field, type the check amount. The Running Bal. displays the check amount.


  1. In the Check/EFT # type the check number or the Electronic Funds Transfer (EFT) tracking number.


  1. From the drop-down beside the Check/EFT # field select how the funds were submitted. Options are Direct Deposit, Check, Cash, and Credit Card.


  1. In the Documents table, upload documents you want to save. See About Documents for directions. This is optional.


  1. In the Payment Notes table, add a new note.


    • Click the New Payment Note button. The Payment Note dialog box appears.


    • Type your note.


    • Click the Save button. Your note appears in the Payment Notes table.


9.Process the remittance.


Apply Payment


One of the process options is to apply the payment. Before you begin adding information, review the EOB to match treatment dates and CPT codes. In the following image, the treatment dates (2/3/2013) and the CPT codes (97110) in the Treatment Charges table and on the EOB match. As you read across the EOB, the amount the insurance company paid to the provider is listed in the Paid to Provider column. In this case, you apply the payment.



Follow these directions to apply a payment.


  1. In the Treatment Charges table, click the checkbox in the column and the appropriate row to indicate you are applying a payment. The W/O (Write Off), Pat Resp (Patient Responsibility), Ins Resp (Insurer's Responsibility), and Pmt Amt (Payment Amount) cells become editable.


  1. In the Pmt Amt column, type 50.00 which is the amount the insurance company paid. Notice the following:


    • Amount charged by the provider is $75.


    • Amount allowed for the service by the insurance company is $60. (This is added in Setup/Insurers/Insurer Name).


    • The patient has a $10 copay.


    • The remaining amount is $15.00 after applying the $50 payment and the $10 copay which appears in the W/O column. The W/O amount is automatically calculated by ClinicSource.


  1. In the RC1, RC2, and RC3 fields type any reason codes or remarks that apply.


  1. Click Apply or continue to the next item.



Deny Treatment


Sometimes the insurance company denies a payment and will not pay anything for the treatment. Those denials must be accounted for in the system as well. In the EOB, the denied payment is for treatment on 2/5/2013. The Paid to Provider column indicates that the insurance company is not paying for the treatment.



Follow these directions to apply a denied payment.


  1. In the Treatment Charges table, click the checkbox in the Dny column on the appropriate row. The PMT AMT is automatically set to 0. Notice the following:


    • Amount Charged by the provider is $120.00.


    • Amount Allowed by the insurance company is $67.13


    • The W/O amount is $52.87.


    • The patient is still responsible for the $10.00 copay.


  1. In the RC1, RC2, and RC3 fields, type any reason codes or remarks that apply.


  1. Click Apply or continue to the next item.



Deductible


Some payments are refused by the insurer because the patient is responsible for meeting a deductible. When the patient meets the deductible, that is when the insurance company will begin paying for treatments, unless the claim is denied.



Follow these directions to apply a deductible.


  1. In the Treatment Charges table, click the checkbox in the Ded column on the appropriate row. The PMT AMT is automatically set to 0 and the Pat Resp field is set to $60. Notice the following:


    • Amount Charged by the provider is $75.00.


    • Amount Allowed by the insurance company is $60.00


    • The W/O amount is $15.00.


  1. In the RC1, RC2, and RC3 fields, type any reason codes or remarks that apply.


  1. Click Apply or continue to the next item.



Treatments Applied to Remittance


Each time you click apply, an item from the from the Treatment Charges table is moved to the Treatments Applied to Remittance table. The information for several patients can appear in the table.




Delete Information in the Treatments Applied to Remittance Table


From the table you can do delete everything in the table, delete all information for a patient or delete a single row. Follow these directions to delete information.


  1. Do the following to delete information:


    • To delete all content in the table, click the Delete button in the Treat column heading.


    • To delete all patient information, click the Delete button beside the patient's name.


    • To delete a row, click the Delete button on the row.


A confirmation dialog box appears.


2.In the dialog box, click the OK button. The information is removed from the table.



Edit Content in the Treatments Applied to Remittance Table


If you need to make a correction after you click the Apply button on the Treatment Charges table, you can make the changes in the Treatments Applied to Remittance table. Follow these directions to make changes:


  1. In the Treatments Applied to Remittance table, click the row with the information you need to change. The W/O, Pat Resp, Ins Resp, and AmtPaid cells become active.


  1. Make your changes.


  1. Click the Save button. The information is saved.

 

 

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