Although MD HQ does not directly interface with any clearing houses, you can track patient responsibility versus insurance share, generate billing paperwork (to be submitted directly to insurance or ), and track insurance reimbursements within the EMR.
Allocating the Total Due Between the Patient and Insurance Responsibility
First, you will want to make sure that we have turned on the ability for you to allocate a charge between patient responsibility and insurance share. If you do not see patient/insurance allocation options when adding a charge for which "Add to Insurance Invoice" is checked, contact us at email@example.com to set it up.
When assigning any given charge to a patient, you can allocate the total amount due between the amount the patient is responsible for (e.g., a co-pay) and the insurance share/obligation. Make sure to check the box for "Add to Insurance Invoice" when you are adding the charge to see allocation options - if this box is checked for the item you are adding in your charge list, it will automatically be checked when you go to add the charge to the patient's account. When you edit the patient responsibility, the insurance share will automatically adjust to account for the remainder of the charge.
In the image above, the "Pt Billing Note" shown at the top comes from any notes entered in the Billing Notes field of the Billing tab of the Patient Information pop out. The Billing Notes space appears at the top of any Add Charge or Add Payment window, and so is a great place to make a note of the patient's co-pay or co-insurance obligation, so that you can easily view this information whenever adding a charge or a payment to the patient's account.
When you add a charge that you've allocated between insurance share and patient responsibility to an encounter note, the balance due on the note will be the amount you allocated to the patient, with the insurance share shown as an "Insurance balance". The total balance for the patient shown in the yellow Billing block and on the Patient Portal will reflect only the patient's responsibility. The insurance balance for each charge that have an insurance balance outstanding will be shown on an Insurance Payments tab in the Billing Portal that you access by clicking on Billing -> Go to Billing Portal.
Submitting Claims to Insurance
Once you have added the charge and allocated between patient responsibility and insurance share, there are several approaches you can take to submitting the claim:
1. For practices that will be submitting claims manually (versus via an external billing service), you can generate a HCFA 1500 form (under Reports -> Generate HCFA 1500 Claims Form). You would mail the HCFA 1500 claims form directly to the insurance company for reimbursement.
2. For practices that use an external billing service, you can create a faxable/printable summary to send to the biller at the end of a day/week/month. To do this, go to Billing -> Go to Billing Portal and click on the Generate Reports tab, then on the report called "Insurance Billing Summary". This will generate a printable/faxable list of all encounters during the designated period, along with a breakdown of all information necessary for the biller to submit claims.
Alternately, you can have us set up a limited-access account for your biller to be able to log in directly and see only the information necessary to submit claims and record insurance payments and write-offs. Contact firstname.lastname@example.org to set this up.
Managing Claims and Recording Amounts Reimbursed by Insurance
When payments come back from the insurance company, you would record the payment in the Insurance Payment tab of the Billing Portal by clicking on the relevant charge, and recording the amount reimbursed in the "Modify Existing Charge" pop up that appears (see image below).