Insurance Billing Overview
PCC’s insurance billing tools help you prepare claims, send them electronically, review rejections and denials, fix problems and resubmit, and work down your insurance accounts receivable. PCC’s Practice Management suite helps you maximize the use of your time as you pursue proper insurance reimbursement.
You can break the task of collecting insurance balances into these steps:
Ensure All Charges Were Posted
Before you bill insurance, your practice can use PCC’s tools to post charges and then to ensure that all charges were posted.
Generate and Submit Claims
Run the “Prepare and Submit” claims programs in Practice Management (preptags and ECS) to scrub outgoing claims for errors, generate claims, and send them. As PCC processes your claims, you will see errors and warnings right on the screen, such as when patient or account information is incomplete. Later, if you need to print any claims, you can use the HCFA program.
Read EDI Reports to Verify Claim Submission
You will receive electronic reports detailing your claim submissions, including logs of any errors or submission problems. Your office should use e-mail and the ecsreports program to review the “Billing Error”, “Bad Claims”, and “Payor Response” reports. Understanding all of the different reports will give you more tools for dealing with an unpaid claim. All electronic reports (whether they are printed or sent to your e-mail box) are stored in the ecsreports program for easy access.
Post Insurance Payments and Adjustment (and Submit Remaining Charges to the Next Responsible Party)
When your practice receive ERA 835s (or paper EOBs), post the payments and adjustments in the Autopost and Post Insurance Payments programs (autopost, pip). Post the payment information and link payments and adjustments to each of the referenced charges. When payments and adjustments do not cover the full amount of the charge, you can use pip to fix account problems and resubmit the charges, send them to a secondary policy, or bill the family.
Work on Outstanding Claims
Use PCC’s reporting features to track your accounts receivable and follow-up on old claims. While Partner has hundreds of reports, a good place to start is the “Insurance Accounts Receivable Summary” (insaging) report. It provides an overview, by insurance group, of your outstanding balances. You can then use the “Insurance Accounts Receivable Detail” (inscoar) report to analyze specific claims based on insurance company, provider, or other criteria, and contact the carrier about unpaid claims.
Correct Mistakes and Recreate Claims
During any of the above steps, or even before you first submit a claim, you may need to fix a problem with a charge and recreate the claim. For example, if you find the account has a new insurance plan or was responsible for a larger copay, you can use the Correct Mistakes (oops) program to change the details of the charge and then re-batch the claim to the new payer. In rare cases, you might use the maketags program to re-prepare a large batch of claims based on a date range, a provider, or other criteria.