Billing and Insurance FAQ

Start with the Aged Outstanding Claims Report to see what has been billed to insurance that has not been paid. Then follow up with the Aged Patient Receivables and Aged Payor Receivables reports to view out-of-pocket monies uncollected and overall view of insurance monies owed and for how long. Then run the To-Sec/Disputed Charges NOT Waiting to be Billed report to view charges that have been disputed or sent for secondary billing and not set for re-bill.

Post a negative insurance payment to reduce the primary paid amount by the refund amount. If you are using bulk posting, place that negative amount into the paid column to offset the originally paid amount.

On the Insured's/Other Insured's Information tab, enter the policyholder's information below "Insured's Information".

Enter the billed dollar amount that is allowed in the current year out of the total dollar amount allowed per calendar.

The frequency type is defined by the claim itself. It can be an Initial Claim (1), a Replacement of Prior Claim (7), or a Voided Claim (8). To trigger a replacement of prior claim, you would create a "corrected claim". This is done by finding the original claim in accounting (under EDI claims), highlighting it, and choosing "correct" at the far right. To trigger a voided claim, you would do the same, but choose VOID. All other claims will be listed as initial claim.

Medicare requires SBR-04 (plan/group name) to be blank.

Check in the patient info whether the correct fee schedule is selected. Also, make note of whether the fee schedule was set up after the charges had already been posted. If this is the case, the fee schedule won't apply retroactively. You would need to manually adjust it on each ledger line item, or you could remove the charges and repost them once the fee schedule is associated with the patient. As the fee schedule acts as a filter with which the charges sift through on the way to posting in the ledger, the fee schedule amounts will then apply correctly.

In order to avoid this redundancy, it is ESSENTIAL that fee schedules are set up correctly and in place prior to charges being added to the ledger.

Care packages can be retroactively applied; however, you must use update patient balance to do so. Be sure the care package totals (and insurance deductible left, etc.) are accurate as of the date you are updating patient balance to before you do, and it should count from there moving forward. If it still seems off, you can enter a "?" into the visits used field to have it manually recalculate.

Also remember, if a charge has already been billed to the insurance, update patient balance will not affect the transaction itself.

The reset date. This will reset the annual limit visit count, monetary total, and deductible left fields. It will also automatically update itself to one year out. The reinstate date will create a new instance of said policy with that as the effective date and will archive that policy.

In the patient's ledger, click Print > Claim Form and follow the prompts. Print for more information.

If you are trying to re-print a claim form that has already been billed but no payment or denial has been posted on the charge, Insurance. You will not be able to re-print a claim form from the patient’s ledger until it has been posted.

The PQRS macro set and tool will help apply the proper "G CODE" on the CMS 1500 to show meaningful use. Go to the MyChiroTouchPQRS page for more information.

You can find box 19 on the Condition tab of the Patient Information page. If you have questions about where to access other HCFA form fields in ChiroTouch, HCFA Form 02/12 for detailed instructions.

It is a contractual obligation for you to collect the patient’s full copay at the time of their visit, even if the total for the services you provide is less than the copay amount. In some instances, this will cause a temporary ledger imbalance. Once you receive your EOB from the insurance, you may then reduce patient responsibility on that ledger line, which will produce a credit on their ledger.