Charges Entry
When a new invoice is created the screen below appears ready for you to enter the correct information. The screen is divided into several sections. They are:

• Top tabbed section 
• Facility, Provider, Insurance and Diagnosis selection
• Changing the billing order
  
• Charge entry
• Additional Dates and other info for a claim
• Payments collected
• Recall, claim processing and batching
  

The tab bar fields [top]

• The Invoice is unique for each claim. Some insurance companies call this the patient account number.  The number is used to easily retrieve the invoice for payments. When billing electronically this number is referenced on the Explanation of Benefits you receive.
• If you number your Superbills you can reference it in this field. The value in this field must be unique.
• The Patient and Chart are for the currently selected patient.
• The Copay, Disc% and FCs fields are those that actually belong to the selected patient. If you change the data in these fields here, it also changes the data in the patient’s record.
• Copay is the actual copayment assigned to the patient on their Billing info screen in the Patients Module. If you change the amount here it will also change the amount their, too!
• Disc% tells PracticeMaker® how much to discount a “discountable” procedure or product. The calculation occurs WHEN the procedure code is entered in the New Code field AND fee schedule A is used. The Disc% is a whole number like 20 NOT .2! For example, a product that costs $100 would be billed at $80 if the discount% is 20!
• FCs if checked "No" tells PracticeMaker® NOT to apply a finance charge to THIS invoice. You can also tell PracticeMaker® to NEVER apply a finance charge to ANY invoice for a particular patient (see the Patients Module chapter).

The Second Section [top]

• Facility is where the services on this claim were performed. When an invoice is created the patient’s default facility is used. To change the Facility click on the field’s drop down menu before charges are added. Changing the Facility after charges are added requires the use of a special dialog in which you select the "new" facility and click Update.
• The Off Doc is for the provider whose insurance numbers will appear on this claim.
• The Examiner is who examined the patient. Initially, this field and Off Doc are the same. It is easier to change them either of these fields before charges are added.
• Consult is the physician who wanted the patient consulted for service(s) about to be billed.  Medicare, and other insurances like Medicaid, require that this physician’s name and provider number/UPIN appear on the claim. If the procedure you try to add to a claim requires that a UPIN be associated with the claim, the claim is going to Medicare, and there is no UPIN, a dialog asks you to select a doctor that has one (Select) or use the office doctor’s UPIN (Fill)!
• Assigned to: is the entity responsible for the invoice.  Click Change to change the billing priority NOT who the bill will be reassigned to after the primary insurance has paid.  In other words, the primary insurance for a claim is NEVER changed unless it was incorrectly assigned to begin with.
• As of... is the date the invoice was assigned to this carrier.  You can change this date to any date within one year of today. This features is unique to PracticeMaker, the ability to change the Billing Date. For example, let's say you are seeing a Medicare patient on January 1st and you do not want to be the one has has to try and collect the deductible, you should change the Billing Date (As of...) to 6/1 instead.
• Location is a user defined value. The list grows as you add more values. You can sort reports by this field.
• If this service is considered an Emergency select Yes.
• Any Labs needs to be selected if you paid to have any of the services done on this claim for which you are now billing.  If you select "Yes" you must enter an Amount in the field after Yes. This is for Paper Claims only!
• Prior Auth is the referral number used on this claim, usually supplied by the managed care provider. It is carried over from the same field in the patient's record. It can be edited here without affecting the one in the patient's record.
• Precert Number is different from the Prior Auth as this usually comes from the insurance company.

Diagnoses for this claim only... (pink section) and Patient’s current diagnoses (blue section)

• The current CMS-1500 form allows 4 diagnoses per claim, here labeled Dx1 through Dx4.
• To have up to 4 of these fields filled automatically with all “current” diagnoses (not “99”) click Fills Dxs.
• You can also use “drag and drop” to fill these fields in any order. This does require that "Drag and Drop" is activated in FileMaker Pro (go to Preferences-->Application to check.)
• To add additional diagnoses, or to activate the Select Diagnosis wizard, click See More Dxs button. At that dialog you can navigate to the Diagnosis Module where you can search the diagnosis database of over 15,000 records for the proper diagnosis for the claim. To learn more click here.
  

Charge Entry [top]
PracticeMaker® uses temporary “data entry fields” for you to put a new charge item into before it is added to the claim. New charges can be added to any invoice that has not been paid. If you try to add a new charge to an invoice that has already been sent you will be notified but you can still add/edit a charge. A charge can only be edited if it was added to the invoice today.


To add a new charge do the following:

• Click in the field below New Code in the charge entry section, as shown above. This adds today’s date into the Date From field. However, if there is already a charge on the invoice (meaning the first listed procedure in the Charges List), its date will be used instead.
• Select the procedure code you want to use from the pop-up list or press the delete key and enter the code manually.
• If you want to search the Procedures Module for a procedure to use on this invoice, click the Procedures Selection tab  in the upper left hand corner. After finding the procedure in the Procedures Module you would click the Update Invoice button.
• The field Date To usually does not need to be filled unless you are doing hospital visits over several days. Then you would use one procedure code and the Units field has the number of visits you did in the DateFrom to DateTo time period.
• FS is for the fee schedule to be used on this charge. The fee schedule is assigned to the insurance carrier in the Insurances module. For patient-only changes, the fee schedule of A is used. However, if the Office Doctor has been assigned a fee schedule this will over-ride that assigned to the insurance or the patient!
  
  
• PracticeMaker® and fee schedules:
  The software allows you to have both patient and insurance charges on the SAME invoice with only non-patient charges appearing on the insurance claims.  Fee schedule “A” charges are assumed to be patient-only related.  If you will be posting both patient and insurance charges on the SAME invoice, change the letter code in the FS box to “A” as you enter each line charge that is for the patient only!  However, we strongly recommend that you have an “A” and another fee schedule to more clearly differentiate patient from insurance charges.
  
  
• You can have both patient and insurance charges on the same invoice. To do this just enter the procedure you want the patient to pay for and just change the default insurance fee schedule (i.e. H, M, P or 11 thru 15) to "A". This will them lookup the correct Amount.
  
  
• The DXs field is used to “point to” which diagnosis fields are being linked to the procedure being entered. For example, if there are two diagnoses on a claim filling fields Dx1 and Dx2, then you would enter 12 in this field (not 1,2 or 1-2).
• The Units field defaults to 1 unit. Change if needed. There can be up to 99 units.
• The field Item$ fills in with the amount for the entered procedure for the selected fee schedule.  This value is multiplied by the number in units to give the Total$ amount.
• There are four modifier fields, M1 through M4. You can select a modifier from a pop-up list or enter your own! There is a separate chapter on modifiers and what they can do for you.
• Use the fields Dr and Ex to associate a different Office Doctor and/or Examiner than that listed in top section of the invoice for this charge. This should only be done for group practices, not solo providers sharing the software.
• The field Reserved 24K gives you control over what will print in block 24K of the CMS-1500 or sent electronically (field FA0.23 for example in NSF), which is the provider number of the performing physician.
• UR is the user who either created the charge line or lasted altered it.
• TOS is the type of service. You can edit this field if you wish.

When you have completed all the necessary fields for this charge click the green down arrow  on the left end of the temporary fields. This will check for any errors and add the charge to the invoice!

Editing a Charge
If you need to re-do a charge the same day you posted it click the red up arrow and that charge is brought back up into the temporary fields. When you have made your changes click the green down arrow again to re-check this charge. If you want to discard the changes you made click the trash can icon in the temporary section.

Claim Data (previously called "Extra Dates") [top]
Occasionally, additional information is required to process a claim.  These dates and other fields are accessed by clicking the tab on the top of the screen to get the dialog below.



This separate database now contains information required to correctly process claims. As HIPAA requirements change, this database is easier to update than the main Billing database.

[click here to enlarge above image]

 
The screen above will be the most commonly used and add specific date information to a claim. The column Patient's Record shows you what it currently in the patient's record on the Dates tab. To use a date click its button. To clear a date click its >>move>> button. The clear a date click its X button. To fill the field from its calendar, click its button. To enter data into other other sections, just click on the appropriate tab. When you are done, click Return.

Payment Entry [top]
This section is for adding payments that were collected at the time of the patient’s visit, such as copayments or self payments. Do not use this section to add insurance payments or payments received after the initial charges are created. It is important that you read the Payment Type Section of PickList, so you can get a better understanding of all the different "payment types".

Only three payments are allowed here. Also, payments posted here come under less scrutiny than those posted on the Payments screen.
 

To add a payment do the following:

• Click in the field just below PT, which stands for Payment Type. A list of many selections appears. Though this list can be customized in the PickList Module, most users have the following selections:

• 0- Memo: Use this to add a memo to an invoice even after it has been paid off!
• 1- Patient Resp. Use this to reassign part of an insurance balance to the patient. Once the patient pays this record is deleted before the real payment is posted!
• 3- Copay-chk/chg is used when the patient pays for part of an insurance charge using either a check or a charge card. A reference is required and you must select what type of credit card it was, if applicable.
• 4- Copay-cash is for a cash payment given as a copayment
• 7- Self-chk/chg is used when the patient pays by check or credit card for a charge NOT being sent to insurance (i.e. contact lenses, vitamins, glasses). A Reference is required (check number).
• 8- Self-cash is basically same as “7” but paying cash
• 15- Courtesy-Insur designates a courtesy adjustment against an insurance charge or charges
• 16- Courtesy-Pat designates a courtesy adjustment against a patient charge or charges

After selecting your PT above its description appears and today’s date is put in Date.

• Amt$ is for the amount of this payment or adjustment
• In Reference put the check number or other reference, even a memo
• The Source field will be filled in automatically based on the source of a payment. However, if the patient is using a charge card, select either AX (for American Express), DC (for Discover card), M/C (for MasterCard) or VI (for Visa).
• UR represents the user ID of the person who made or last altered this record.

Correcting a Payment Line
If you noticed an error after a payment has been posted (but before the invoice has not been totally paid off), you can correct the payment by clicking on the arrow. This refills the temporary entry fields.

Note- If the invoice has been paid off or the error was not posted today then these errors can only be corrected by the administrator.

You will be given a message telling you exactly what you are doing, just like with changing a charge lineitem!  Once any errors have been corrected, you can “accept” the payment by clicking the down  button.

The field Invoice comment allows you to put a memo in box 19 of the CMS-1500. There is an editable pop-up list associated with this field.

There is a built in calculator to help you if needed. Click on its icon next to Amt$ . If there is an amount in the Amt$ field already, it will be placed into the calculator for you to work with. Use the mouse to click the buttons or use the keypad on your standard keyboard. If you want the result placed back into the Amt$ field click the DONE button, otherwise just click the close box on the calculator.


5. The Bottom Section [top]
This section allows you to update the patient's Primary Recall Information. This is the Recall Date 1 field on the patient's Visits screen. Just enter the recall date and then select a Visit from the pop-up list.


The EClaim related section allows you to change the ECS# if needed. For example, if a claim is usually sent electronically, the ECS# would be 1 or higher. However, let's say you need to send a paper claim instead because you need to attach an operative note, you would change the ECS# to zero.

Batching tells you if the invoice is set to be processed in the next batch of Claims, or in the case of a patient statement, say for an unpaid copay, Statements. Your choices for both these pop-ups are Batch, Hold and Collect.