Insurance billing is a critical and complicated process to receive the maximum insurance payout for each claim. Our Revenue Cycle Management software (RCM) seamlessly complements the workflow of billers and coders. It helps billers eliminate time-consuming, repetitive tasks so they can focus on maximizing revenue for their practice.
The billing process is triggered when the provider commits a procedure or chart note in the Remedly EHR, causing the billing details to automatically populate in the RCM for claims management.
In this article, you'll learn to:
- Set up your Generic Provider account for Eligibility Check
- Set up your Provider's account for insurance billing
- Insurance treatment setup
- Appointment scheduling with Billing Type as Insurance
- Add patient insurance information
- Check patient's insurance eligibility
- Document Copay
- Commit a procedure/chart note with charge to insurance
- Create invoice with charge to insurance and apply Copay
- Apply insurance payment and collect Patient Responsibility in the EHR
How to Set Up a Practice Generic Provider Account for Eligibility Checks
To enable the seamless workflow from EHR to RCM, you first need to set up your practice's Generic Provider account as well as your actual provider(s) account(s) (see the below instructions).
To get started, follow these steps:
1. Log in as Generic Provider, which is your practice's core account for making practice configurations.
2. Go to the Main Menu>Practice Account> Account Settings.
3. Select Name and Login information.
4. Fill in all required fields, including NPI used for credentialing, if you wish to verify patients' insurance eligibility, and hit Update.
IMPORTANT:
- The NPI must be the same NPI used for enrollment with your clearinghouse (TriZetto or Claim.MD) for eligibility checks.
- All users, regardless of their role in the EHR, can check eligibility under the main provider's account NPI if the above steps are completed.
To learn more about the capabilities of the Generic Provider Account, check out the following article:
How to Set Up a Provider's Account for Insurance Billing
After setting up the Generic Provider account, the same settings need to be made for each provider for the correct NPI to be shared with the RCM when a note is committed.
Each provider should:
1. Log in to their account. If it's there first time to access Remedly, they'll be prompted to login from an email invitation.
2. Go to the Main Menu>Practice Account> Account Settings.
3. Select Name and Login information.
4. Fill in all required fields, including NPI in order to submit claims via the RCM, and hit Update.
How to Set Up a Treatment for Insurance Billing in the EHR
Before you start scheduling appointments and seeing patients, we recommend that you complete your treatment setup.
To learn more about this functionality, read the following article:
Treatments can be configured to default as insurance-related when invoicing and charting. With these configurations in place, users will be prompted to input medical codes while charting which will auto-populate into corresponding invoices and claims.
IMPORTANT: procedure/chart notes and copay collected upfront synchronize with your RCM when the notes are committed, NOT when you create invoices. So, always double-check that you've included all necessary medical codes and recorded copayments BEFORE committing your notes.
1. Navigate to Treatment Setup from the Calendar: Practice Account>Treatment Setup.
2. Locate the desired procedure and click on Edit.
3. Scroll down to Assign Location Attributes and click on the arrow to open configuration options.
4. For Charge to Patient or Insurance, select the option which is appropriate for the majority of your appointments for this treatment.
Note: Charge to Insurance or Patient can be overridden when invoicing.
Scheduling with Billing Type as Insurance
When scheduling appointments where the majority of services performed will be billed to insurance, select Billing Type as Insurance to help billers target these bills for processing. This will enable reports to be run identifying all appointments using insurance billing.
To learn more about how to create appointments, please see the following article:
For a report on which appointments may be billable to insurance, please see the following article:
How to Add Patient Insurance Details
When adding a patient who plans to apply for insurance reimbursement, it is important to capture their insurance information in patient demographics in the Remedly EHR. Insurance details can be added for primary, secondary, and tertiary insurance programs.
IMPORTANT: By adding insurance details, you can run eligibility checks to determine your patients' insurance qualifications even before their appointment. Once a procedure/chart note is committed, the insurance section of the patient chart will transfer to your RCM module. Additionally, it will automatically populate into a bill and claim upon creation. Electronic eligibility checks and electronic claim submission are not possible if you add custom insurance details!
1. Locate a patient and open their chart. Then click on the Pencil icon at the top of the left-hand tile.
2. Scroll down to the Insurance Details fields and fill in the required fields.
Note: you can search both by the Payor ID and by the insurance company name.
IMPORTANT: When searching, ensure you choose a legitimate insurance company rather than a custom one. Opting for genuine payors improves data accuracy and workflow efficiency. Selecting a custom option may necessitate manual claim submission and eligibility checks via phone or fax, leading to increased administrative workload and potential delays.
If a custom insurance company has been previously added, it will appear at the top of the search list like this: [custom-503] Cigna. DO NOT choose custom! Instead, scroll down the search list to locate the legitimate payor based on the patient's insurance card details. The preferred method of search is by the Insurance company ID (Payor ID).
3. Hit +Add button as shown on the screen above. Insurance details are added.
REMEMBER: The updated patient information is not saved yet. Hit the Save button to enable changes in the patient.
We also suggest uploading photos of the insurance cards and storing them in the Forms section for reference.
How to Conduct Eligibility Check
To verify your patient's insurance eligibility, please double-check if your main insurance provider saved their NPI in the Generic Provider's account settings of the EHR (see instructions here).
If this is done, all your providers and staff will be able to check eligibility under that provider's NPI in the EHR.
Eligibility checks in the EHR are enabled with a current date.
Eligibility checks in the RCM can be conducted with any service date. However, there needs to have been at least one chart/procedure note already committed for a patient since this establishes the patient's account in the RCM.
You can learn more about eligibility checks both in the EHR and RCM in the following articles with detailed guidance:
How to Document a Copay in the EHR
How to Collect Copay Upfront
If you collect a copay upfront, here are the steps to make sure it's recorded as a payment in the RCM. This helps your billers who primarily use the RCM to know that the copay has been collected, saving them time.
1. Collect the Copay as an actual payment in your EHR from the Create Appointment window by clicking on the Record a Payment button.
2. Make sure to enter copay details in the Payment Notes. This will help identify this specific copay and apply it to the relevant invoice upon its creation.
3. Unselect the Select All tick box if you have any outstanding invoices not associated with your appointment. Hit Apply Payment.
4. Click on OK in the Payment success popup.
You'll be redirected back to the Create Appointment window.
The copay you've just collected will be added up to a patient's credit in the Payments & Refunds section of the Individual Patient History:
If you expand the section, you'll see the copay collected.
5. But for this copay to display in the RCM, you have to click on the bottom right corner of the appointment tile on the Calendar, input copay amount, and select the Apply Payment button.
6. Click on OK in the success window.
IMPORTANT: Even though the message indicates that the copay is applied, keep in mind that the Apply payment button only documents the copay, NOT effects any payment in the EHR. Therefore, make sure you complete steps 1-4 before officially registering it with the associated appointment.
All the above steps ensure that when a procedure/chart note is committed, the copay will be registered as as a payment in the RCM and as an actual payment in the EHR.
See instructions how to commit a procedure/chart note below.
How to Collect Copay After Remittance Received
If you didn't collect a copay during the visit because you didn't know the exact amount or the patient wasn't ready to pay upfront, you can collect it after receiving remittance from the insurance company.
This is known as part of the Patient Responsibility.
1. Locate a patient, expand the Invoices section in the Individual Patient History, and hit Add New Invoice.
2. Select the desired appointment and click on Edit at the end of the invoice line item.
3. Make sure to select Charge to Insurance, if not preselected during charting. Add diagnosis and CPS/HCPCS codes for the same reason. But if your procedure/chart note had been set to Charge to Insurance before the invoice was created, then you can skip these step and proceed to the next one.
You can record Insurance Adjustment, Copay, and Patient Responsibility in the invoice. In our scenario, we must bill and collect the copay along with any other patient responsibilities.
Within our EHR system, you have the option to enter all patient responsibilities, including copays, in the Patient Responsibility field. Alternatively, you can input copays and other patient responsibilities separately if needed.
4. Let's record and collect copay and other patient responsibility as a single amount being $50.00 and hit +Update Charge.
5. The Patient Responsibility will be added as a separate line to the invoice. Hit Create Invoice & Record Payment.
6. Either select the Payment Method and hit Apply Payment
OR
Select Credit and Apply Payment.
In the first case we can, for instance, select one of the Credit Cards on File and hit Apply Payment.
7. Click on OK in the success window.
You'll be redirected to where you started - the Individual Patient History, where you can expand the Invoices and the Payments & Refunds sections to see all payments made and invoices due.
How to Commit a Procedure/Chart Note with Charge to Insurance
To set up an insurance billing charge, follow these steps:
1. In the Create Appointment window, hit Write a Procedure Note.
2. When identifying the diagnosis in the chart/procedure note, make sure to choose Charge to Insurance in the Treatment section. This step is crucial for indicating that the appointment will involve insurance billing.
Note: If you've already configured your treatment (visit reason for appointment) as Charge to Insurance in the Treatment Setup before beginning a note (refer to instructions here), the Treatment section of the note will automatically default to Charge to Insurance. This ensures you won't overlook adding medical codes, which are essential for creating an insurance charge in the RCM.
3. Use the keyword search for codes or diagnosis names to facilitate your diagnosis selection.
4. Select the CPT/HCPCS code as facilitated by keyword search. Add CPT modifiers if necessary and input appropriate units (standard default is 1).
Note: to input more than one CPT code, click Additional CPT. This is useful when submitting claims for the patient visit, procedure, prescriptions and/or injections in a single note.
Note: If the provider is not familiar with the billing process or does not have time to complete all details, they can partially complete the inputs and leave the rest for the biller to complete.
5. Inventory should also be identified as insurance if appropriate.
6. Once all information has been inputted as desired, the provider can click Commit. This will populate the charge in the RCM together with the preliminary registered copay, if any.
7. Click OK in the success popup.
Note: if the provider saves the note instead of committing it, the biller can add the necessary details to the note then commit the note.
How to Add an Addendum to a Procedure/Chart Note
You can always include an addendum to the procedure or chart note to make sure any missed or crucial info gets across to your biller or for other needs. Addendum details will be included in the RCM note. You can create as many addendums as needed.
To accomplish this, you can follow the next steps:
1. In the Create Appointment window, hit Write an Addendum.
2. Input your notes and hit Commit for the addendum to populate into the RCM.
How to Create Invoice in the EHR with Charge to Insurance and Apply Copay
In order to create an invoice with charge to insurance in the EHR, follow the next steps.
1. Hit the Create Invoice button in the Create Appointment window.
2. Invoice with Charge to Insurance will be created. If you collected Copay upfront, you can apply this patient credit to the invoice even before insurance remittance is received. Click on Edit at the end of the desired invoice line item.
3. Input previously collected copay amount in the relevant field and hit +Update Charge.
This action will add a line to the invoice indicating that copay is a patient-related charge.
4. Scroll down the page to click on Create Invoice & Record Payment.
On the New Payment page, you'll get to see your invoice preselected to apply the payment as well as Select Credit option that we need in order to distribute the collected copay.
5. Click on the Select Credit and scroll down the list of credit options to locate the desired prepayment. Check the appropriate tick box.
6. The selected credit amount will be added to the Total Payment field to reflect the copay. Next, click on Apply Payment.
7. Click on OK in the success window.
You'll be redirected to the Create Appointment window, where you can have a capability to Edit Invoice, if you wish.
How to Apply Insurance Payment and Collect Patient Responsibility in the EHR When the Remittance Received
How to Apply Insurance Payment
When the Remittance Received, you can register insurance payment as well as collect patient responsibility in the EHR.
To accomplish this, follow the next steps. If you collected copay upfront in the EHR on the day of the appointment, and the remittance includes copay as a patient responsibility, make sure that you don't collect it twice in your EHR.
1. Locate a patient, expand the Payments & Refunds section in the left-hand tile of the Individual Patient History and hit +Payment to register insurance payment.
2. In Payment Method, select Insurance Payment.
The payment amount will be calculated automatically based on the outstanding amount of the selected invoice. So, make sure you selected the desired invoice.
3. If the insurance payment amount you input instead of the automatically calculated amount is less than outstanding amount, suppose insurance paid only $50.00 instead of $80.00, the system will prompt you to adjust the amount in the selected invoice after you select the desired invoice in the checkbox.
To enable the Apply Payment button, click on the arrow at the end of the relevant invoice line.
This action will expand the invoice line items, granting access to the field where you can adjust/modify the payment amount.
4. Modify the payment amount to be equal to the insurance paid amount ($50.00 in our example) and hit Apply Payment.
5. Click on OK in the Payment success window.
You'll be redirected to where you started the payment - Individual Patient History in our case.
If you expand both the Invoice and the Payment and Refunds sections, you'll see that the insurance payment has been registered in the EHR and the invoice Due amount has been updated to $30.00.
How to Collect Patient Responsibility
After insurance payment has been distributed to the invoice, you can collect the Patient Responsibility part due.
In order to accomplish this:
1. Locate the desired invoice in the Individual Patient History and click on Edit.
2. Click on Edit at the end of the invoice line item for which the patient is responsible to pay.
3. Input the due amount ($30.00) in the Pt.Resp. field and hit +Update Charge.
Note: if the Copay was paid upfront during the visit, it will be auto populated in the Copay field.
The Patient Responsibility line will be added to the invoice:
4. Hit Update Invoice & Record Payment.
5. On the payment page, the invoice will be preselected with all its line items.
5.1 You can either apply Select Credit to apply it to the payment if a patient paid you before their responsibility was added to the invoice and then hit Apply Payment.
OR
5.2 You can select Payment Method at the beginning of the New Payment page.
Next, hit Apply Payment.
6. Click on OK in the success window.
You'll be redirected to where you started - Individual Patient History. You can expand the Invoice section there and see that the invoice was Paid in Full when both insurance and patient payment were registered and collected.
The Invoice will look like this:
The Payment Receipt of the patient will look like that: