Entering PPO Insurance Claims

[Nate]

When we upgraded a few months back to ver 6.1 we lost the ability to enter claim payments by total and must only do by procedure. This becomes very frustrating in those cases where we receive a check as total payment and not broken up into individual procedures. It seems to happen with almost every PPO patient that has secondary insurance and the secondary insurance will send a total payment not broken down by procedure. Does anyone know why it was changed and the idea behind removing the ability to enter as total payment? We did not overly use it or abuse it! In fact it seems odd that a great feature was removed when growing the software usually means adding features. If others do not use it much or at all they could just not click on it. It is still present, takes up space, but we can not use it.

Let me know if maybe it was Reactivated in a more recent update, as maybe others found it to be an annoyance and have got it running again.

Thanks

[jordansparks]

The manual says, "you MUST itemize by procedure in order for your writeoffs to show properly in reports." Since my memory gets fuzzy about complex situations like this, I'm going to depend on that explanation. I think that means that it causes big problems if you enter a writeoff that is not attached to a procedure. Now if that is the only problem, then it may be ok for us to turn it back on for situations where there is no writeoff. The writeoff box would then be blocked if it was a total payment. How would this suggestion impact your routine? This is my best explanation at the moment without further research.

[Nate]

I think that would be great. I guess it changed because of the change in the account module and to improve the accuracy of writeoffs. It would certainly make things easier for us if we could do a total payment and if there is an insurance writeoff involved I imagine we could simply enter that by way of the adjustments outside of the claim.

Thanks

[jordansparks]

I guess you should submit a request.

[Nate]

I will add a request to allow PPO insurance to payments to be added by total payment.

Can you explain the way your office or others handle a patient that has 2 insurances and the second insurance often sends a total payment and sometimes even the first will send a total payment. Im just looking for a work around as we have not really come up with one.

Thanks

[nathansparks]

If you enter payments by total, rather than by procedure, for primary insurance there are problems with reporting, as jordan indicated. The whole point of having the PPO type is to keep track of the difference between the UCR and the PPO fee (called discount in tp module, writeoff in account module and reports). For secondary insurance we should allow payment by total, please do request it as a feature. But in the meantime, you might try either making the the secondary insurance 'category percentage' type, or splitting the payment by procedure ad hoc (guess). I know these are not ideal solutions, but if you are not writing off by procedure anyway, cat % should work fine.