Computers in
the Medical Office
Chapter 8:
Posting Insurance Payments and
Creating Patient Statements
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8-2
Third-Party
Reimbursement Overview
Fee schedule
 List of standard fees established by
provider
 Not necessarily the amount the provider is
paid
 Difference between amount in fee
schedule and amount paid is an
adjustment
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8-3
Remittance Advice Processing
Electronic Remittance Advice (ERA)
 X12-835P
Remittance Advice (RA)
 Paper format
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Remittance Advice Processing
Steps for Processing
 Verify that all procedure codes listed on
claim are represented on RA
 Review payment amount against expected
amount
 Identify reason for denials or payment
reductions
 Post payment information in practice
management program
 Bill secondary health plan (if appropriate)
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8-5
Entering Insurance Payments
Payments from
insurance carriers are
entered using the Enter
Deposits/ Payments
option on the Activities
menu
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Entering Insurance Payments
The Deposit List window lists deposits
for a specific date, or, all deposits can
be viewed
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Entering Insurance Payments
To enter a deposit, click the New
button, and the Deposit dialog box is
displayed
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Entering Insurance Payments
The type of payor—patient, insurance,
capitation—is selected from the Payor
Type drop-down list
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Entering Insurance Payments
Other information entered about the
deposit include:





Deposit date
Payment method
EFT Tracer
Check number
Description/Bank no.
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Entering Insurance Payments
Other information entered about the
deposit include:




Payment amount
Deposit Code
Insurance
Codes for payments, adjustments,
withholds, deductibles, and take backs
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Entering Insurance Payments
Once a payment is entered, it appears
in the Deposit List window
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Entering Insurance Payments
Once a payment is entered, the next
step is to apply the payment to patient
accounts
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8-13
Entering Insurance Payments
Payments
applied to
patient
accounts
using the
Deposit
feature
are automatically displayed in the
Transaction Entry dialog box
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Entering Insurance Payments
Capitation payments are entered but
not applied
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Entering Insurance Payments
Second “EOB Only” deposit is entered
Patient accounts adjusted to zero
balance
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Creating Statements
Statements are created in the Statement
Management area of Medisoft
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Creating Statements
When the Create Statements button is
clicked, the Create Statements dialog box
appears
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Creating Statements
The Create Statements dialog box contains
a number of filters, including
Transaction
Dates
Location
Chart Numbers
Provider
Billing Codes
Amount
Case Indicator
Statement Type
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Statement Types
Standard statements show all available
charges regardless of whether the
insurance has paid on the transactions
Remainder statements list only those
charges that are not paid in full after all
insurance carrier payments have been
received
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Creating Statements
Once statements have been created, they
are listed in the Statement Management
dialog box, with a status of Ready to Send
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Printing Statements
The Print/Send button is used to print
statements that are then sent out to patients
and guarantors
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Printing Statements
When the Print/Send button is clicked, a
statement method (paper or electronic) is
chosen
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Printing Statements
Next, the type of statement is selected from
the list provided
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Printing Statements
When the
Print/Send button
is clicked, paper
statements are
printed and
mailed by the
practice
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Editing Statements
If changes are necessary, highlight the
statement in the Statement Management
dialog box and click the Edit button
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