Getting started with Insurance Billing

This tutorial will provide the basic steps to follow in setting up your database to create and track CMS-1500 insurance billing. This process is vital to ensuring that your CMS-1500 forms are completely and accurately filled out for you when the time comes to print or submit the forms.

The first step will be to Add insurance companies you will be working with. More insurance companies may be added at any time.

To begin, Click on Maintain | Insurance Carriers.

Next, click New to enter an insurance company into the database. When you are finished, click Save (or Save & New to add a new record). You can add in as many insurance carriers as you need initially. Later (when entering Patient information), you will be given a chance to select a Primary Insurance carrier and add in other specific information.

Now, close the Insurance Carrier window. If you are working with a Referring Physician, now is a good time to enter the physician information. Click on Maintain | People | Physicians click New to add the physician. If not working with a referring physician, you can skip this step.

Click New to add the physician. If not working with a referring physician, you can skip this step.

Next, click on the Maintain Patients icon. Choose the patient you wish to setup insurance billing for. Of course, you may need to add that client, and if so, just click on New and enter the client information. When you need to change or add additional data to the Client, click on the Edit button. Then click Save to retain any changes made.

note the bottom-left area where the Primary Insurance information is stored.

This section is where you will enter specific information about your client’s Primary and, when needed, Secondary insurance. See the following example:This information will transfer to the CMS (HCFA)-1500 for billing insurance.

Once the client’s Primary Insurance data is saved, click on the Insurance Billing button. This will bring up the Maintain Events window. It is necessary to create an “Event” in order to create the CMS-1500 billing. The Event keeps billing segregated for each accident, illness, etc.

Click New to enter a new Event, using the Date of CURRENT as the Event date. You will need to choose the Event type. Description is optional for internal reference. You should see the client’s Primary Insurance carrier displayed, if one was selected on the Maintain Client window. When needed, you can click in the Referring Physician box to select the proper name.

Additionally, this is where you will enter any Claim Number needed for your CMS-1500 form. Along with the Prior Authorization Number, choose any required Insurance and Signature Dates. Click Save button when ready and you will see the Date of CURRENT shown in the listbox. This serves as the Event Date and will keep all billing done for this Event associated with it.

Now we can move into actually creating the CMS-1500 forms. While there are a few different ways to produce the CMS-1500 within the software, there is one method that we deem a “best practice” and should be right for most users. Starting from the Maintain Clients window, click on the Session button. This will bring up the Maintain Sessions window where you will create Sessions (Appointments)

As you will note, the box (on the left side of the window) displays a listing of all session dates/times that have been booked for this client. Review the bottom portion of the window shown and you will see the Status: OPEN. This is important to note because as long as any session is OPEN, you may make changes to the session (e.g. Start time). You can also Delete a session that is in OPEN status.

Once the session has been completed, you may choose Create Invoice. This action will display the window below for you to confirm finalizing the session or appointment.

After pressing OK to Finalize the session, the session information will be pushed forward to the Billing screen.

The screen below shows the date of service for the session under the Charges area (in the pale green highlight). Should you need to adjust any of the units or pricing information, you can do so by clicking on the Price (e.g., $27.25) field. Just highlight the amount and type in your change. Press your Tab key or click out of that field, and you should see the adjustment. This works the same way with the Units column (e.g., 2).

After verifying the data is correct, click on the Post Billing button. This will “lock-in” the invoice data so that you can create a CMS-1500, as indicated in the window below.

Because everything has been setup for us, click on the Create CMS 1500 button and you will encounter this box. Choose the correct Event date (if more than one exists), and then you will see the CMS-1500 form appear.

When the CMS-1500 appears, verify that the information is accurate. If there are any additions or changes that need to be made, you may do this right on the form. You may also choose to Queue the form for electronic submission rather than printing. Click Save when finished.

Now the CMS-1500 form is available to be printed using the pre-printed forms. Click on the Print button and then the Start button to preview the form.

Load the blank CMS-1500 forms in your printer and click the printer icon at the top of the screen to print.

This concludes the basics of creating CMS-1500 insurance billing

If you research all of the software available for our industry and

compare the features, ease of use and

price, there is only one clear choice.

Healthcare Office Professional!

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