While Cerbo does not connect directly to a clearinghouse so that you can submit claims via the EHR, there are various tools for insurance billing built in, and several options for how practices that bill insurance directly would submit their claims. Note that you also always have the option to generate an insurance invoice/ superbill for patients to submit for reimbursement if you do not bill insurance directly, but want patients to have that option.
Regardless of the way you will be submitting insurance claims, the first step within Cerbo is that the provider or front desk staff adds the relevant charges and payments to the patient's encounter note, in the Charges/ Payments box at the right of the note text area. If a charge is marked as being an insurance-billable charge (checkbox) AND insurance versus pt allocation is enabled for your build, you will be able to specify the patient's responsibility (co-insurance or co-pay, for example) versus the insurance company responsibility for each individual charge. The patient's balance on the note would include only the amounts allocated to patient responsibility.
For practices that allocate between patient and insurance responsibility, the amount due from insurance is tracked on a practice-wide level under Billing > Go to Billing Reports > Insurance Payments tab.
For submitting claims to insurance, there are several options:
- Billing option 1 – manual entry/ submission. The biller will log into the EMR and go to the Billing Tab > Generate Report > then Insurance Billing Summary where they will be able to see the insurance billing info and generate HCFA's as needed. Then, when payments come in from insurance companies, they would apply those payments to patient accounts in Cerbo via the Insurance Payments billing tab (no need to go into each patient chart individually).
- Billing option 2 – EDI electronic download/upload. The biller would log into the EMR and go to the Billing Tab > Insurance Payments, and export/ download an electronic claims file. They would then log into a billing clearing house that accepts EDI files (like Office Ally, but there are many others), and upload the EDI file to automatically populate and generate HCFA forms that can be submitted via the clearinghouse’s interface. Then, when payments come in from insurance companies, they would apply those payments to patient accounts in Cerbo via the Insurance Payments billing tab (no need to go into each patient chart individually).
- Billing option 3 – automatic sync of charges billed to insurance. We have an AFT/DFT bridge with Open Practice Solutions, meaning that if you use OPS for your insurance billing, we can set it up so that charges that are entered into Cerbo automatically sync over to OPS, who submits the claims to insurance. This option may be set up so that the charge amounts for insurance-billable charges that are added to patients' charts in Cerbo are $0 in the EHR, then OPS applies the appropriate charge in their system. In this setup, there would not be any need to manually apply payments received from insurance to outstanding balances in Cerbo.
Regardless of the option used, insurance payment information does not sync back into Cerbo.