We need to make it so that when the front office posts a patient’s copay and or payment that it does NOT pull to the encounter form. When this happens the insurance will refund the patient the over payment and not pay us.
Example:
Patient has a 20.00 copay but has a balance of 60.00. The patient pays 80.00 dollars. We file the insurance and it shows that the patient paid 80.00. The insurance would have paid us 90.00 for the office visit and would leave 20.00 for the patient to pay. With the claims going the way they are right now the insurance would pay us 10.00 still leaving 20.00 to the patient and the insurance would then write a check to the patient for the amount that they see as the patient over paying us of 60.00. Still leaving the patient with a 60.00 balance with us since we did not get our payment from the insurance company.
This creates a lot of confusion for the patients and with deductible season next month this is going to cause a mess on patient balances.
Copay-1.png is missing data in the Insurance & Required Co Pay columns. Presently it’s “saying” that insurance paid nothing, therefore the remaining balance is the responsibility of the patient.
See attachment for what Checkout should look like.
I can’t tell from the image what you did wrong in the simulation. Did you fail to press the Generate Invoice button?
Provide the corresponding EOB Posting - Invoice (Fees/Billing/EOBs) for more clues.
The description you give above by Demi seems more like a procedural issue than an programming problem. If the patient gives the front desk $80 on a $20 copay?
How is the front desk instructed to handle the over payment for the visit?
If the front desk did as I did in the image below. I took the same $80 and spread it across the outstanding encounters as a $20 copay instead of putting all of it on one encounter creating the over payment you describe. What do you think?
Notice that the insurance balances do not change when I did it that way.
I finally got what Demi was talking about. There are times when there is too much information. If she had simply said that copayments were being added to the amount paid that is being printed on the HCFA printout. It would have made more sense to me. She noticed that if the front desk takes a copay, that amount is added and printed in box 29 and it should not be.
So, I commented out the lines that fill box 29.
I have to find out from her when box 29 is suppose to have a value in it.
I’ve attached 3 documents which should help you navigating this stuff.
If a claim is being sent to the secondary insurance, Box 29 would be the total paid by the primary insurance, plus any amounts paid by the patient for covered services.
I would strongly advise against commenting out Box 29 of the gen_hcfa_1500.inc.php because it will create a billing nightmare if a patient has more than one insurance.
Ask Demi to follow the procedure you outlined in your second attachment. If there is a new wrinkle, describe it in details so that we can arrive at a solution.