Advanced billing question about when payments should be applied


(Sherwin Gaddis) #1

Here is the scenario:

In OpenEMR there seems to be confusion within the system as to who owes what and why. When the girls are checking in patients they have the demographics page up and at the top, it gives an overview - if the patient has a balance or a credit and what is still pending with insurance. Unfortunately, this is never correct. Here is an example of what is happening:

The patient is seen on 3/12/19 pays a $35.00 copay and the encounter is created. Because that encounter is sitting with insurance the demographics screen is showing that the patient has a $35.00 credit and the insurance has a balance of $265.00 when in fact I billed this encounter out at a total of $300.00. I file this claim on 3/13/19 and it sits with insurance until I get a remit that states how much has been paid to Dr. Haggerty and how much to bill the patient. Let’s say that I do not receive this remit until 4/20/19 but we see this patient again on 4/15/19. The girls don’t know if they should collect a copay for the current visit because OpenEMR is telling them that the patient has a credit of 35.00 because the march encounter is still with insurance. So they don’t collect and now the demographic page shows a patient credit of $35.00 and an insurance balance of $565.00 or they do collect and now it shows a patient credit of 70.00 and an insurance balance of 530.00. But if they don’t collect because OpenEMR reads that there is a $35.00 patient credit and then on 4/20/19 I post the remit that left a $35.00 copay to the patient the patient is going to be VERY confused on there May visit when the girls have to tell the patient that they have a $35.00 balance from April and to pay there current $35.00 copay but the patient remembers being told that they had a credit. This gets overwhelming for the girls if insurance comes back and only pays one of CPT codes that were filed on this claim and I have to force the entire claim back to insurance responsibility or OpenEMR will bill the patient for the amount that the insurance did not pay for that I am fighting.

When an encounter is created and a patient pays on that encounter, even though that claim is sitting with insurance, it should not be giving the patient a credit until the insurance has paid for this encounters in full and the entire encounter has been turned to patient.

Help unconfuse us.

Should the patient balance on the be blank until after the insurance has been paid/posted to the system?

@zhopenemr @jagan.visolve @stephenwaite

(Stephen Waite) #2

It should accurately reflect the credit. It’s confusing when you have to combine it into 1 line stating amount due; it’s more properly read as 2 lines, ins due and pt due.