5. Payment and Adjustment Screen
After finding a patient and selecting charges, pip displays the Payment and Adjustment screen. On this screen, you can enter payment and adjustment amounts for each charge that you selected. You can also specify how the payment or adjustment should be labeled, and you can select a responsible party for the remainder due.
The charges you selected will be listed with their date of service, procedure code, amount charged, and the contractually "allowed" amount (if known). Press Tab or Enter to move among the Payment and Adjustment fields. Review and edit the payment type and responsible party fields at the bottom of the screen. Press [F1 -- Save Payments] to save and post payment and adjustment amounts.
Adding Insurance Payment Notes and Reasons For Denial: Practices use different Payment and Adjustment Types, which are located in the "Payment Types" table in ted, to add a note to the account history explaining payment or lack of payment. If an adjustment amount is $0.00, however, you must turn on an option in ced for the adjustment type to be recorded in the history.
Withhold, Payment, and Adjustment Columns: The Post Insurance Payments program supports a third "Withhold" column, which would allow you to record even more information. You can activate the Withhold column by running pip -w instead of pip. Contact PCC at 1-800-722-1082 for help configuring and using different columns in pip.
Print a Claim When Finished: If your office always prints time-of-service HCFA forms, pip will ask if you need a new paper HCFA. The question will only appear if the payments or adjustments posted result in the charge pending a secondary insurance company.
5.1. Working with Allowed Amounts
The Allowed column displays the contractual reimbursement amount for the fee. The amount will only appear when the responsible insurance has an assigned allowable schedule in the Insurance Table in the Table Editor, and when that assigned schedule has a fee entered for the date of service of the charge.
The assigned allowable schedule for the responsible insurance is displayed in the lower-left corner of the screen, if available.
You can jump directly into the Contract Fee Schedule Editor (allowedit) for a given procedure by pressing [F8 -- Config Allow].
5.2. Payment Type, Check Number, and Responsible Party Fields
Use the fields at the bottom of the screen to modify the label and behavior for the payment:
Payment Type: This is the label that will be attached to the payment. Whenever you review the account's history, this is what you will see next to the payment. In most cases, the name of the insurance carrier will be appended to the Payment Type once you post it. Practices use different payment types to indicate why a payment was $0 or to simplify reporting on different kinds of payments. Enter an asterisk (*) in the field to see payment types your office uses. The default value for this field is "Ins Pmt".
Adjust Type: This is the label that will be attached to the adjustment. Whenever you review the account's history, this is what you will see next to the adjustment. In most cases, the name of the insurance carrier will be appended to the Adjustment Type once you post it. Practices use different adjustment types to indicate special adjustment circumstances. Enter an asterisk (*) in the field to see adjustment types your office uses. The default value for this field is "Ins Adj".
Current Insurance: The Current Insurance field shows the current responsible party for these charges. The payments and adjustments you enter will be recorded as coming from this carrier. In almost every situation, the EOB and check you have received will match the Current Insurance field.
If you have received payment from a different carrier, double check that you have selected the correct patient, date of service, and charges. You may want to press [F2 -- View Account] and review the account history before continuing. You can enter an asterisk (*) in this field to see available carriers on your system and change who the payment is from.
Next Insurance: If the payments and adjustments you enter do not fully pay off the charges, then the remaining amount will be pended to the next responsible party or "Next Insurance." You should always review the Next Insurance field as it determines what will happen to the remaining charge once you press [F1 -- Save Payments].
Partner fills the Next Insurance field in for you: if the account has a secondary insurance, it will appear in the field. If the account does not have a secondary insurance, the word "Personal" will appear. If there is no secondary insurance but the charge in question can also be covered by Medicaid, then "Medicaid" will appear. If you need to change who the next responsible party should be, you can Tab to this field. Enter an asterisk (*) to see a list of choices for this account.
Medicaid Status: A charge is a Medicaid charge if the patient had a Medicaid status flag assigned when the charge was posted or the charge was later marked as Medicaid in oops.
Check Number: This number will be recorded with the payment. If you consistently enter a check number when you post payments, you will have an advantage when dealing with payment mistakes across multiple accounts. You will also be able to list all patients to whom a particular check was posted.
5.3. Function Keys on the Post Payments Screen
If you need to check account information or history, press [F2 -- View Account] or [F3 -- View Patient]. You can also view a quick demographic synopsis by pressing Page Down.
If you wish to edit the Allowed amount or review the allowable schedule for an amount, press [F8 -- Config Allow] to run the Contract Fee Schedule Editor.