Payer Register
Adding a new Entry to the Payer Register
You can record an Insurance payment using the Patient register or directly in that payer’s register. You can also use the payer register to post electronic remittances.
The Payer Register can be shown in 3 different views.
1. Insurance Pending. This view only shows claims and matching payments/adjustments that are pending payment or have not received a response from the payer. The totals for this view will match the aging totals for this payer assuming that all payments have been applied to claims.
2. Ins/Patient Pending. This view will show all claims that have not been paid in full or still have a balance regardless of whether it is the payer or the patients’ responsibility. This view is best used when you need to locate a single item from a claim that may have received payments on other items of the claim.
3. Show All. This view will show all claims from all patients.
To record payer payments directly in the payer register, select a Payer, then click the Register tab. To record a payment or adjustment, select the charge using your mouse, then right click or press the Enter key.
In the Payer register, you can record the following types of transactions:
1. Insurance Payment/Adjustment
2. Comment
Insurance Payment and Adjustment
For each charge line, MDC allows you to record the payer adjustment and the payer payment at the same time.
The payment entry screen will show each line of the claim. Enter the amount that was allowed for each charge on the claim along with the payment that was made. Some payers show an actual adjusted amount rather than an amount allowed. To enter the adjustment as an actual adjustment, click the ALLOWED (+) label. The label changes to ADJUSTED (-). Now you can enter the actual adjusted amount. For example, on a $20 charge, if the payer allowed $14, you would enter $14 if the label is ALLOWED (+). If the label is changed to ADJUSTED (-), then you would enter -6.00. After the adjustment is recorded, the patient register will always show the adjusted amount (-6.00).
Enter the entry date, payment method, and check number (if applicable). You can also enter a check date. By default, the check date is set to the entry date. If the check date field is not visible on your system, and you wish to enter a separate check date, you need to enable the check date field using the Preferences screen.
Always use the tab key to progress though the payments and adjustments screen. The cursor will move logically from one field to the next. When recording an adjustment and a payment, the payment field will automatically receive the result of the amount allowed times the percent covered.
Payment = Allowed * %covered
If you are not showing the percent covered field, then 100% is assumed the first time the cursor is moved to each payment field. On each re-entry of the cursor into the payment field, the payment field is unchanged from the previous amount.
To show or not show the percent covered field, see the Preferences screen.
Primary and Secondary Payers
If the patient has secondary, then the claim responsibility can be changed to the secondary payer after the primary makes a payment or adjustment on the claim. When you post a primary payment (or adjustment) to a line item of a claim and the claim was created with a secondary payer, then the following prompt will appear:
MDC will check if payments/adjustments have been applied to all the line items of the claim. If each line item has at least one payment/adjustment, then the prompt will suggest that the claim responsibility is changed to secondary. When you click OK to this screen, the claim will no longer be the responsibility of the primary payer and the claim will now appear in the secondary payers register. You also have the option to have this claim put back into the print queue so that it can be re-printed for the secondary payer.
If at least one item has not received a primary payment or adjustment, then the prompt will still appear but the ‘Send claim to secondary payer’ check box will be un-checked.
When you click OK to this prompt, the claim will remain the responsibility of the primary payer. The claim will still exist in the primary payers register. You can manually control this as each primary payment is made by checking or un-checking the ‘send claim to secondary payer’ check box.
If afterward you need to check which payer is responsible for the claim, you’ll need to go to the particular claim and see what payer has the ‘Send Claim Form’ button checked.
Marking a Claim as ‘Responded’
As soon as an Insurance payment or adjustment is applied to an item of a claim, the claim is automatically marked with an ‘R’ indicating that the claim has been responded to by the payer. In cases where the patient has Secondary insurance, the claim will not be marked Responded until both Primary and Secondary have had a payment or adjustment applied. You can view the Responded flag by exposing the far right column of the patient register. Use your mouse and drag the far right column to the right.
MDC provides a method of forcing the Response flag on or off. To enable this functionality, see the File Menu – Practice Information – Defaults. With the response forcing enabled, you can select a charge line and manually force the response by selecting ‘Force Response/Aging Date’
To force the response, click the Force Response button then select the Primary Response and/or Secondary Response. When the response flag of a claim is forced, the Patient register will indicate ‘RF’ instead of ‘R’. The F indicates the claim response is Forced on.
The Response column of the Patient register can contain the following items:
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The importance of the Response flag is that it is used to determine who is responsible for payment of the claim. Initially when a claim is filed the patient is not responsible for the claim balance and the claim amounts will not show on the Patient Statement nor will the amounts be included in the Patient Aging. As soon as the claim is marked ‘Responded’, the claim balance becomes the patients’ responsibility. Similarly, the Payer balance will not include the claim charges after the claim is flagged as ‘Responded’.
A claim will automatically be marked Responded if the claim balance is $0.00. At the same time, the claim is marked as Cleared and will no longer appear in the patient register (unless Show All is selected).
If you want to make the Patient Responsible for a claim regardless of the payer response, see File – Practice Information – Defaults. Uncheck the option to wait for payer response before the patient is made responsible.
Comment
Use this selection to post a comment or message to the patients’ account. The message will appear on the patients’ statement.
Modifying a Payment or Adjustment
To modify a payment, adjustment, or comment select the item you want to modify, then press the Enter key and select Edit from the pop up window.
When modifying a payer payment or adjustment make the necessary changes then click the OK button.
If you change the check number, check date, or memo, any other payments that have been recorded using this payer and this check number will be updated to reflect the changes. For example, suppose you’ve applied a payer payment and the payment was applied to multiple charges. If after recording the payment, you realized that the check number was incorrect, you only need to update one of the payments with the new check number. The other payment check numbers will be updated automatically.
Posting Electronic Remittance
You can post your electronic remittance directly from the payer register. To enable posting from the payer register select the Edit Menu – Preference – MDC Settings. Check the box that says Show ERA summary in MDC home. This option essentially tells MDC that you are using electronic remittance files.
If there are un-posted remittance files, the MDC Home section will show the files that need to be posted.
If you click on one of the items under ERA’s to Post, MDC will move directly to the payer that sent the ERA. The Payer register then provides an additional section at the bottom of the screen that will show the remittances received for the selected payer.
To automatically post a payment, select an item in the lower list. The upper register will automatically scroll to the charge that this payment will be applied to. Press the Enter key or double click your mouse on the payment.
To record the payment click the Record button.
After the payment has been posted, you can click the Archive Posted button in the lower right of the screen. This will remove the downloaded transaction from the payers list. Since you have posted the payment, the downloaded transaction is no longer needed.
Last Update: 2/17/2009