Posting - Carrier Payment Application

  Permissions! Clinic Staff must have Administrator, Billing Manager, Billing Assistant, or Operations Manager Permissions assigned in order to manage Postings.

Fusion Enterprise understands that billing is a critical function of any practice. As such, we have ensured that you can run all of your practices billing through Fusion Enterprise and make it as easy as we can. This series of introductory articles will cover the important aspects of managing Postings with Fusion Enterprise.

Posting - Carrier Payment Application

When applying a carrier payment the screen will appear as follows:

The top portion of the dialog is the Payment Detail. This is the payment you will be applying. In order to apply a carrier payment, you need to know which case to apply the payment. The EOB will provide you with the Claim ID and/or the Patient Name.

Payment Detail

Identifier	Identifier of the payment that is being applied.
Amount	Amount of the payment that is being applied.
Carrier	Carrier from which the payment was made.
Applied	Amount of the payment that has been applied.
Claim ID	Entry box for the Claim ID. Used to determine to which case to post the payment.
Go	Instructs Clinic Controller to look up the Claim ID and find the Case.
Search	Searches for a Case manually by bringing up the Select Case dialog.

Entering the Claim ID from the EOB and pressing Go in the Payment Detail area will load the patient into the Selected Case area. If the Claim ID is not known, the search button may be pressed, and the Select Case dialog will show, allowing you to manually locate the patient. Selecting a case will load that case’s visits and charges information into the Selected Case Area, where you can start to apply monies from the payment.

NOTE: If a check spans multiple patients, you can keep selecting additional cases by entering their Claim ID’s or searching for them. This can continue until you have completely applied the payment. If there is money remaining, it will show in the Posting dialog as not being fully applied. There is also a report called ‘Unapplied Money,’ which will help you later find any partially applied payments.

Once the patient is selected, either by manually searching for them or by entering the Claim ID, the Selected Case area will populate with information from the selected case.

Selected Case

Visits	List box showing all qualifying visits.
Charges	List of charges that are attached to the selected visit in the Visits list box.
Invoice State	The Invoice State of the selected visit. Right-clicking the invoice state will allow you to select the desired invoice state.
Charge	Total charge amount for the selected charge in the Charge list box.
Balance	Balance of the charge selected in the Charge list box.
Doc Level	Allows you to set a Documentation Level for this visit. This Doc Level will show up in the Claims list the next time claims are generated for this visit.
Contract Delta	The difference in the fee schedule and the amount posted for this particular charge and carrier.
Contract Rate	Contracted rate for this charge and carrier combination as taken from the Contract. For more information on contracts see Chapter 16: Contracts.
Carriers	Displays a list of carriers associated with this visit.

The Visit list box will populate with any qualifying visits. For a visit to qualify, it must be waiting for a payment from the same carrier as is listed on the payment.

Selecting a Visit from the visit box will populate the Charges list box with charges for that visit, and the summary information on the right will also update.

Once the Visit has been selected, right-click and select Add Transactions from the menu. The entire right-click menu will be discussed later in this chapter.

The Add Transactions screen will now appear with the charges for the currently selected visit. This screen is designed to look much like an EOB.

Multiple Transaction Entry

Charge	Charge code of the line item.
Payment	Amount of the payment to apply to the line item.
Adjustment	If listed on the EOB, enter the Adjustment amount.
Allowed	If listed on the EOB, enter the Allowed amount.
Adjustment Reason	Reason for any adjustment.
Original Charge	Original Charge amount of the line item.
Balance	Balance remaining.
Contract	Amount the carrier is contracted to pay. This will only show if a contact is entered for this particular carrier.
Add $0 Pmt / $0 Adj Transactions	When checked, the $0 payment and $0 adjustment transactions will be entered rather than discarded.

The Multiple Transaction Entry dialog will allow you to tab between fields and quickly enter the information as it is found on the EOB. EOB’s will list adjustments in one of two ways, either as an adjusted amount or an allowed amount. For example, the original charge may be $100.00, but the insurance company says that reasonable and customary is only $79.28. The EOB will list either a

$20.72 adjustment or a $79.28 allowance. Either of these numbers may be entered, and the other will automatically be calculated for you.

Carriers may also specify more than one adjustment and may also specify the patient responsibility amount. To add additional adjustments or payments to a single line, right-click on the charge line and select ‘Add,’ and a new line will appear for the line item.

In the above example you can see that the 97001 has a $50.00 payment and a $10.00 adjustment marked as R&C (Reasonable and Customary). There are also two additional lines for the 97001. The first one has a $15.00 Out of Network adjustment, and the second one has a $25.00 CO 119 adjustment.

You can add as many additional lines as are required as well as delete any lines you do not wish to add.

To facilitate rebilling a partial claim, you can use the Suppress Carrier Billing feature, which is also available by right-clicking on a charge line. This allows you to prevent specific codes from being rebilled on the next billing cycle. If this feature is enabled for a code, the code will not appear on the claim. Once the claim is billed, however, Suppress Carrier Billing is removed, to allow the code to appear on subsequent claims. If Suppress Carrier Billing is enabled for a charge code, the code will appear in purple text in the dialog.

After all the line items are entered, you press OK to enter the transactions. Cancel will close the dialog and will not save any entered items.

Once back to the Payment Application dialog, any transactions that were entered will show in the Transaction grid at the bottom. Note that the grid only shows transactions for the currently selected charge. The grid will also show transactions from previously entered payments. For example, if you are entering transactions for a secondary payment, the primary payment transactions would also be listed for that charge. This allows the poster to see the complete picture for this charge line. After entering transactions, the Invoice State for the visit is automatically bumped to Bill Next. Right-clicking the Invoice State reveals the following choices:

Invoice States

Rebill Current	Sets the invoice state to rebill the current insurance carrier.
Hold Billing	Sets the billing state to wait for payment from the current carrier. This is not to be confused with 'Hold Billing' as found in the case dialog.
Bill Next	Sets the invoice state to bill the next entity involved. This could be the next carrier, such as a secondary, or the patient.
Wait for Next	Sets the invoice state to wait for payment from the next entity involved. This is useful when the primary forward the remittance to the secondary on behalf of the clinic.
Billing Complete	Sets the billing state to Bill Complete.
Send to Collections	Sets the billing state to Send to Collections.

Even though the invoice state is automatically moved to the next level, the invoice can be set to any of the choices listed. Selecting Rebill will set the visit to rebill the current carrier the next time claims are generated. Bill Next would bill the next entity in line to receive a bill; this may be a secondary carrier or the patient.

The other item of interest is the Doc Level. The Doc Level is a notice that can be placed onto a visit to indicate that some sort of documentation is required. There are three settings for Doc Level: None, Level 1, and Level 2. When claims are created, they are stamped with one of these Doc Levels, and the person sending claims will know what documentation needs to be printed to accompany the claims. What these document levels represent and how they are used is at the discretion of the clinic using them. Fusion Enterprise is only providing a method of communication between the poster and the person generating and sending claims.