Account Notes and Encounter Billing Notes

Your practices receives many different electronic responses to claim submissions and billing. Read this article to learn the different EDI responses, which responses require attention, and how to use PCC's tools to review and respond.

Use the Claims tool to process and submit claims to insurance companies and other payers, work on claims that could not be submitted, and review a log of submissions.

PCC's insurance billing tools help you process and prepare claims, send them electronically or print them, review rejections and denials, fix problems and resubmit, and work down your insurance accounts receivable. You can maximize the use of your time as you pursue proper insurance reimbursement.

After you submit claims, your practice will receive clearinghouse and payor acknowledgements as well as ERAs and other electronic notifications from PCC, claim clearinghouses, and payors. You can use tools in PCC EHR to review these responses. When you need to do deeper research, you can use the EDI Reports (ecsreports) program.

While most claims are transmitted to payors electronically, sometimes you may need to generate a paper 1500 HCFA form.

How is a claim created, and what happens in the background to make sure your practice is paid? Read below to learn some of the "under the hood" workings of claims after you post charges into PCC EHR.

Learn how to use PCC's tools to turn an account's charges over to a collections agency.

Use the Bills tool in PCC EHR to generate personal bills for families. Use the Payments tool to print a single account statement.

PCC has a wide range of tools that help you keep your personal A/R under control. From collecting copays and generating bills, to bill follow-up and sending accounts to collections, PCC tools can make you more productive.

Every time you generate a batch of bills, Partner keeps a record in the Bill Log (billlog) program. You can use billlog to review details about your bill batches, find out who received a bill in each bill run, research why a family did not receive a bill, or examine a digital copy of any personal bill.

When you prepare and send personal bills, you can include a billing message customizable to the age of the balances on each family's account. Messages will appear on bills you print at your practice or send to an electronic billing service for printing.

Your practice can use automatic cycle billing to spread your bills out throughout a month or other period of time. With cycle billing, your revenue and billing workload will stretch throughout the month, and no family will accidentally receive more than one bill per cycle.

Unfortunately, not every family pays their bills on time. An address may be incorrect, a family may have questions about their balance, or they may be unable to pay. Following up on outstanding bills is a vital part of the billing process.

If your office has created duplicate patients or family accounts, you may need to merge them. Merging two patients combines data and saves a single set of basic demographic information. Merging two accounts combines the account billing and charge data so that it appears all of it occurred under one account.

Before you can schedule a patient, you need to create the patient and their family accounts on your PCC system. This article will guide you through a basic procedure for adding a new patient and a family account: try to find the patient, add the patient, and then add the family (if they are new to your practice).

Your PCC system keeps track of families and patients. Your practice's database stores information about every patient, with a patient chart for each one. PCC also stores a database of accounts, or "families." An account may be either a "Home" account for the patient or a "Billing" account. These are sometimes called the custodian and guarantor accounts.

How can you review a copy of an account's bill to verify what was sent to them on their statement? When your PCC system generates a bill, either for printing by a third-party printing service or in your office, it keeps a copy of the bill's contents.

Use the Demographics section of a patient's chart to review and edit patient and family demographics, such as patient information, contact information, insurance policies, and siblings.

If a secondary insurance requires the EOB from the primary, or any claim requires a certificate of medical necessity, discharge summary, or other clinical documentation, you need to send an attachment to the payor. You can edit the encounter and add an attachment code to an encounter, generate a unique attachment ID, and specify the attachment type and method. Attachment information will then be sent with the electronic claim.

Learn special techniques for searching for patient and account records.

Use the "Policies" component to add, update, and work with a patient's insurance policies and medicaid plans in PCC EHR.

Use PCC’s Sexual Orientation and Gender Identity components to securely record information in a patient’s chart. When a patient decides their gender identity is public, your practice can optionally display a patient’s pronoun and preferred name in the Appointment Book and elsewhere in PCC EHR.

When a patient or their caregiver indicates that they did not receive your latest text (SMS) message or broadcast email, you can easily determine if it is because they have opted out of communication from your practice.

If a family does not have insurance, or the family won’t be using insurance for an encounter, then a pediatric practices needs to provide a “Good Faith Estimate” for the cost of care when an encounter is scheduled more than 3 days in advance.

When your practice needs to prevent certain claims from being submitted, you can create a claim hold. A claim hold prevents claims from going out for specific dates of service, billing providers, places of service, and insurance plans. You can also configure your practice’s claim delay, which prevents any claim from going out until a certain number of days after the date of service.

You may wish to record details about an account or billing situation with a family. Read below to learn about Account Notes in PCC.

After you prepare and submit claims, you must deal with claims that could not be submitted or were rejected.

What kinds of pre-submission processing does your PCC system do on claims? What errors can it find, and how do you fix them?