How to run a billing

This guide provides step-by-step instructions on how to run a billing process. It covers navigating to the Billing feature, filtering data, previewing and downloading claims, and submitting billing. By following this guide, users can efficiently manage and track their billing activities.

PENDING VISITS

1. Tu run a billing, go to the Billing section and click "Pending Visits". The billing process will have 3 steps:

  1. Select visits for billing
  2. Visits preview
  3. Claims preview

Step 1. Select visits for billing:

Start the process by selecting the visits you intend to bill

2. In this view, you will have access to all the visits of the agency that are pending for billing. You can easily identify the number of visits available for billing through this notification.

By default, only completed sessions are available for billing However, we can set up an alternative condition for you if needed.

3. By clicking on each visit you can see its details

* Filter the visits

4. You can use the "Filter" option to help you select the visits you want to bill. You can filter by client, insurance, therapist, procedure and "Visit Scheduled Date"

If you input only the end date of the current billing period and leave the start date field empty in the "Visit Scheduled Date" filter, you will view all visits from the current billing period as well as any visits that were overlooked in previous billing periods for any reason. This approach guarantees that you bill all ready visits up to the specified end date.

5. By default, visits with provisional approvals will not be displayed, but you can include them in the filter by checking the 'Include visits with provisional approvals' checkbox. Even if you include them in the filter, you won't be able to bill those visits until you add the PA number of the authorization.

* Send the visits to the next step

6. After filtering the visits, you can select those you want to bill

7. Then click "Add To Visits Preview" to send them to the next step: Visits Preview

8. After sending all the sessions you want to bill to the second step, click "Go to Visit Preview" to proceed

Step 2. Billing preview

9. From this view, you can check again the visits and remove any if you do not want to send it.

Click "Go to Claim Preview" to go to the next step

When a visit is removed from this view, it will be available again in the previous step

Step 3. Claims Preview

* Review the claim information

10. You can review all the information in each claim if you click "Download Preview"

11. This Billing preview report is an excel file.

12. In the first page of this report you can find the Summary page overview:

The summary page provides an overview of all clients selected for billing, with key information that includes:

  • client name
  • total hours and units ready for billing
  • total expected insurance payments, and a breakdown of payments per certification.
  • Detailed information about each visit, such as date, place of service, code, units, etc.

13. The billing preview report also includes a detailed page for each claim.

14. The Detailed Claim Page is especially handy for agencies using the clearinghouse integration. Here, users can check the exact details used to create claims before sending them to the clearinghouse.

With this feature, users gain clarity on the exact data being forwarded

* Submit billing

15. Once you review the information and decide to run the billing, just click "Submit Billing"

When you click "Submit Billing," there are two possible outcomes according to your billing configuration:

  1. By default, the billing process runs locally, meaning the information remains within the system. In this scenario, the user needs to use the billing report to manually input the necessary information into the insurance portal.
  2. The second option is the integrated billing, where the information is electronically transmitted to a clearinghouse (ClaimMD), and from there, users can forward the claim information electronically to the insurance company. If you want to enable this option you will need to create an account with the ClaimMD clearinghouse (you can contact us for more information)

* Billing report

16. When you submit a billing, regardless of the billing configuration (local or integrated), the system will generate a Billing report, which will be downloaded to your computer automatically.

The first page of this report will have general Billing information.

17. The report also contains a more detailed page for each client.

This is the report that agencies with local billing can use to manually input information into the insurance portal.

BILLING HISTORY

18. Under the Billing History section you'll find four tabs, with information about all the billings you have run in the agency:

  1. Billing
  2. ERA
  3. Claims
  4. Visits

1. Billing

19. Within the Billing section, you'll have access to a log detailing all billing groups that have been submitted in our system.

* Reports

20. You can download the PDF and Excel reports for each of those billings:

  • Click "Download PDF Report"
  • Click "Download Excel Report"

You can use the filter tool to locate a specific billing group. By specifying a date range, you'll be able to view all billing reports generated during that period

* Billing information (for Local Billings)

21. If the billing is local, the full billed amount will automatically be marked as paid.

22. In that particular billing group, all claims will be marked as fully paid

* Billing information (for integrated Billings)

The integrated billing allows you:

  • Reconciliation: Manage your accounts receivable by matching payments received from the insurance company.
  • Tracking Payments: You can easily keep track of which claims have been paid and their amounts by reviewing the ERA.
  • Denials and Adjustments: Identify any claims that were denied or adjusted, and understand the reasons provided by the insurance company."

23. In integrated billings, you'll notice that the claims appear as Outstanding and the Paid amount remains empty until the Electronic Remittance Advice (ERA) is made available in your ClaimMD account

Claims overview:

By clicking on any billing group you can view quick information about the claims, such as:

  • Latest message
  • ICN: you can see the Internal Control Number (ICN) once the ERA has been made available in your ClaimMD account.
  • Paid amount

24. Latest message: you have access to the latest interaction regarding the claim transmission, such as:

  • "Claim.MD Acknowledged": Indicates that the ClaimMD clearinghouse has accepted the claim

25. You can see the Payer ICN once the ERA is made available in your ClaimMD account

26. You can see the Paid amount for each claim once the ERA is made available in your ClaimMD account.

Fully paid claims will have this green checkmark:

If the insurance pays a claim partially, we'll highlight that claim with a red alert. This allows you to review the transmission messages and see the reason for the adjustment

Claims information: By clicking on any claim, you can view it's information

27. Aside from the claim overview within each billing group, you can see the claim information by clicking on a particular claim:

28. From this view you can see all the messages during the transmission process, adjustments and extra information

You have the option "Set as Paid" to manually mark outstanding claims as paid. This feature is particularly useful for claims where an ERA is not available in your ClaimMD account. It allows you to manage and reconcile claim information by updating the payment status for such claims.

2. ERA

29. Under the ERA tab you will see a record of all the ERAs made available in your ClaimMD account. By clicking on any of those ERAs you can view the details

30. You can download the PDF version of ERAs (as shown in your ClaimMD account)

You can filter by Payer ID and received date of the ERA, and you will see all ERAs within the applied selection.

3. Claims

31. Beneath the Claims tab you will have a compilation of all claims that have been processed through the system. From this section you have access to:

  • ICN
  • Latest message: you have access to the latest interaction regarding the claim transmission

32. From here you can Set claims as paid

You can filter by Billing reference number, clients, first day of service or billing date, and you will see all claims within the selection applied.

4. Visits

33. Under the visits section you will see all visits billed using the system, and you will have access to:

  • ICN of those visits whose ERA has been made available in your ClaimMD account

You can filter by Billing reference number, clients, therapists, insurance, procedure, visits dates (scheduled, available for billing or billing), and you will see all visits within the selection applied.

DENIED CLAIMS

34. If you use the Billing Integration, you can view all denied claims under the Denied Claims section. A notification next to the tab will indicate the number of claims denied.

35. By clicking on a denied claim, you can view basic information about the reasons it was not accepted

* Handling Denied Claims

36. When dealing with denied claims, you have three options to address and resolve the issues:

  1. Fix the issue in the Insurance Portal and Set as Paid in our system:
    • From the insurance portal you can correct the necessary information
    • Once the information is corrected and the claim is accepted by the insurance, mark the claim as paid in our system.
  2. Fix the issue in ClaimMD and Set as Paid in our system:
    • Access your ClaimMD account and make the necessary corrections to the claim information.
    • After making the corrections and ensuring the claim is accepted, set the claim as paid in our system.
    • As with the insurance portal, update the information in our system to avoid recurring issues.

  1. Fix in our System and Resubmit:
  • Correct the claim information directly in our system.
  • Once the information is updated, resubmit the claim directly from our system.
  • The system will send the corrected claim to your ClaimMD account.

Each option ensures that your claims are properly addressed and resubmitted, helping you maintain accurate records and reduce the likelihood of future denials.

37. You can also archive a claim.

BILLING REPORTS

38. You will also have access to billing reports, such as "Accounts Receivable Aging Report", to know how long insurance claims have been outstanding:

39. By default you will see outstanding claims for 21 Days or More.

40. Click "Filter" to use different parameters, like:

  • Days outstanding
  • Insurance

41. You can also export the aging report

VISIT UPDATES AFTER BILLING

After a visit has been sent to billing, only office staff members can change the date, time, or Place of Service (POS). These changes can affect the billing process. Here’s how the system handles these updates based on the timing of the changes.

1. Changes Before Billing

42. Pending Visits

If the date, time, or POS is changed while the visit is still in the pending visits stage (before the session is actually billed), the updated information will be reflected in the system without any additional steps.

2. Changes After Billing

43. Post-Billing Updates

If any changes are made after the visit has been billed, the system will generate a billing update.

44. Billing updates are easily identifiable within the system as they will be highlighted with a different color.

45. Updates will have an icon on the right side of the visit. Hovering over the icon will display a notification indicating why the visit looks different.

46. Comparison: To compare the original visit information with the updated information, click the arrow next to the visit. This feature allows you to view both versions to understand what has changed.

47. Depending on the nature of the change, this update can take two forms:

  • Update: Generated if the date, time, or POS is changed.

  • Void: Generated if the visit is deleted.

48. Special Considerations for Billing Integration Users

For those using the billing integration feature, billing updates cannot be processed until the ERA has been made available in your ClaimMD account. Once the ERA has been made available in your ClaimMD account, you can proceed to bill the updated visit information.

Before Billing:

  • Navigate to the pending visits.
  • Make any necessary changes to the date, time, or POS.
  • The system will automatically update the visit information.

After Billing:

  • Access the visit that needs to be updated.
  • Make the required changes to the date, time, or POS.
  • The system will generate an update or void based on the changes.
  • If using billing integration, wait for the ERA before proceeding with billing the update.

This process ensures that all visit information is accurately maintained and billing updates are properly managed to reflect the changes made by staff members.