WinMedStat Practice Management



WinMedStat

Practice Management

The Beginners Basics

Handbook

Provided by WinMedStat

5232 Village Creek Drive, Ste 201

Plano, Texas 75093

Phone: (972) 818-6116

Fax: (972) 818-8974

Support Hours: Mon-Fri, 8:15a-5:15p CST

Beginners Basics Training

Hardware Orientation

1. What is a Server?

A server is the computer that stores your practices data and allows many workstations to access that data at the same time.

a) Startup/shutdown

- exit all applications

- go to the start button in the bottom left corner

- choose the shutdown option

- choose the shutdown option and then turn the power off once you see the “ok” on screen

OR

- choose the restart option and let the computer reset itself and wait for the desktop to return

b) Backup tapes

c) Show components

2. What is a workstation?

A workstation is the computer that you might use to access the data stored on the server. It is also used to run applications separate from the server.

a) Startup/shutdown

b) Keyboard

c) Mouse

3. What is a printer?

a) Power on/off

b) Loading paper

c) Opening printer for jams

Mouse Basics

1. How to use the mouse

a) Right vs. Left Click

b) Dragging

Windows Basics

1. How to login to Windows

2. Start Button

3. Navigation

4. How to run:

a) WinMedStat

b) Word

Windows Mechanics

1. How to check / cancel print jobs

2. Control Panel

3. Windows Explorer

4. Finding things in Windows

Appointment Scheduling

[pic] Click on the Appointment Scheduler Icon from the WinMedStat toolbar.

You will then be prompted to choose your facility and resources. Choose your facility by using the drop down menu pictured below. To choose you resources; highlight the resource you would like to select. Then click the [pic] button to add your resource. If you wish it add all of the resources listed then you may use the [pic] button. To remove a resource, highlight the resource and use the [pic] button. As well as, if you want to remove all selected resources use the[pic] button.

[pic]

[pic]

Scheduling an Appointment:

1. You may select the desired date by clicking on the calendar.

2. Select the desired time by clicking on the colored line next to the appropriate time slot.

3. Right click then choose Add New Appointment.

A. For a new patient or temporary patient:

I. Click on the [pic] button.

II. Fill in the appropriate information.

III. Click the “OK” button.

B. For established patients:

I. Click on the “New Search” button.

II. Click on the first few letters of the patient’s last name in the “Select Criteria” box.

III. Click on the[pic] button.

IV. Click on the correct patient’s name from the list that appears at the bottom of the screen.

X. Click on the [pic] button.

4. The “Add New Appointment” window will now appear with the patient’s information entered in the appropriate fields.

5. Now choose your reason and location for the appointment by clicking on the pull-down arrows and making the appropriate selections.

6. Enter appropriate notes relating to the patient’s visit, this is a free text box. (Maximum allowable is 75 characters).

7. After everything is entered, click on the “OK” button.

Editing/Rescheduling an Appointment:

1. If at a later date, you need to edit an appointment already scheduled, just double-click on the appointment and this will bring up the “Edit Appointment” window (pictured below). You can change the time, date, or any of the information shown here.

[pic]

2. When finished, click on the “OK” button and the appointment will reflect the changes made.

Canceling an Appointment:

1. If after an appointment has been scheduled and the patient calls wishing to cancel, select the appropriate appointment by clicking of it. Once it is selected right click on the line, then scroll down to choose delete appointment.

2. The system will flag you to make sure you want to delete the appointment. Click on the “Yes” button.

3. The system will then prompt you to give a reason for the “deletion”, enter the reason and then click on the “OK” button.

Other Features:

The Icons pictured below are found on the toolbar in the appointment scheduler:

[pic]

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1. Send a letter: You can click on the patient’s name and then click on this icon.

This allows you to pick from a variety of template letters (i.e. traveler, recall letter, labels) and merges the patient’s information from demographics.

2. Preview selected day’s appointments.

3. Daily notes

4. Jump to current day

5. Go to specific date

6. Search for a particular appointment

7. Patient demographics

8. Check a patient in

9. Add a new appointment

10. Delete appointment

11. Change facility/resources

12. Expand column

13. Shrink column

14. Refresh the scheduler

You can also have a full screen view by clicking on the [pic] button located to the left of your resources.

To shrink the screen back, simply click on the [pic] button.

Checking a Patient in through the Appointment Scheduler:

Checking a patient in accomplishes two tasks:

1. Prints the traveler if it was not printed in advance.

2. Adds the patient to the check out list.

You can check a patient in though the scheduler by highlighting the appointment, then single clicking on the desired patient. Right click on the patient, and then scroll down to select patient check in.

-If this is an established patient WinMedStat pulls the appropriate information from the Patient Demographics automatically.

-If this is a new patient, WinMedStat will take you to the Patient Demographic screen. Enter all the appropriate information and then click on the “OK” button.

Adding a New Schedule Template

You have the option to create schedule templates within the schedule. These templates can be used for any of the resources that the user wishes. They are not Doctor specific. On the General Schedule the field templates are listed. The user can choose either existing templates (via the drop down menu) or create a new one.

[pic]

• Open the General Schedule for editing and on the bottom right the templates are listed. Choose Add.

• You will then be prompted to name the new template.

[pic]

NOTE: You can name the template anything that you want. It might be a good idea to choose very descriptive names. If the template is for every Monday you might want to name it Monday.

At this point the new template will open.

[pic]

Appointment Template Icons:

[pic]

• [pic] Add an Appointment Type to the template.

• [pic] Deletes an Appointment Type from the template.

• [pic] Manage the Appointment Types.

Adding Template Categories to the template:

• Choose a beginning time slot by clicking the box next to the corresponding time.

• Click on the page icon to add an appointment type to the template.

• Click ok.

NOTE: The new button on the template creates a new template.

APPOINTMENT SCHEDULING SHORTCUTS

[pic]

SCHEDULING AN APPOINTMENT

1) Choose the doctor (or other resource) for which you wish to schedule.

2) Select the desired date by clicking on the calendar.

3) Select the desired time by clicking on the colored line to the right of the gray time slot.

4) Click on the Add New Appointment [pic] icon.

A. For a new patient or temporary patient:

I. Click on the [pic] button.

II. Fill in the appropriate information.

III. Click on the “OK” button.

B. For established patients (patients who have already seen your doctor before)

I. Click on the “New Search” button.

II. Type in the first few letters of the patient’s last name in the “Select Criteria” box.

III. Click on the [pic] button.

IV. Click on the correct patient’s name from the list that appears at the bottom of the screen.

X. Click on the [pic] button.

5) The “Add New Appointment” window will now appear with the patient’s information entered in the appropriate fields.

6) Now choose your reason and location for the appointment by clicking on the pull-down arrows and making the appropriate selections.

7) Enter appropriate notes relating to the patient’s visit, this is a free text box (Maximum allowable is 75 characters).

8) After everything is entered, click on the “OK” button.

[pic]

EDITING/RESCHEDULING AN APPOINTMENT

1) If at a later date, you need to edit an appointment already scheduled, just double-click on the appointment and this will bring up the “Edit Appointment” window. You can change the time, date, or any information that is shown here.

2) When finished, click on the “OK” button and the appointment will reflect the changes made.

CANCELLING AN APPOINTMENT

1) If after an appointment has been scheduled and the patient calls wishing to cancel, single click on the appropriate line, which will then turn blue. Then you will single click on the “Delete” icon [pic].

2) The system will flag you to make sure you want to delete the appointment. Click on the “Yes” button.

3) The system will then prompt you to give a reason for the “deletion”, enter the reason and then click on the “OK” button.

PATIENT CHECK IN

Checking in a patient accomplishes two tasks:

1) Prints the traveler if it was not printed in advance.

2) Adds the patient to the check out list.

CHECKING IN THROUGH THE APPOINTMENT SCHEDULER

1) Highlight the appointment by single clicking on the desired patient.

2) Single click on the [pic] icon.

a. If this is an established patient WinMedStat pulls the appropriate

information from the Patient Demographics automatically.

b. If this is a new patient, WinMedStat will take you to the Patient

Demographic screen. Enter all of the appropriate information, then click on the “OK” button.

CHECK IN ICON

This method is used if the patient was seen without an appointment, or a walk-in, and

is for existing patients only.

1) Click on the patient [pic].

2) Select the patient using the [pic].

3) Verify that the patient and provider information is correct, if not change it.

4) Click on the “OK” button.

PATIENT DEMOGRAPHICS

This is the section of WinMedStat that contains all the information about each of your patients, including name, address, employer, insurance information, referrals, and prescriptions. Patient demographics can be accessed by either the icon at the top of the screen, or by checking in a new patient through the appointment scheduler. The only required fields to create a Patient Demographic record are: name, gender, and primary doctor. All other data can be entered at a later date,

[pic]

TO ADD A NEW PATIENT FROM PATIENT ICON

1) Click on the Patient Demographics icon.

2) Single click on the “Add New Patient” icon.

3) The system will ask you if you would like to use the data from the previous patient. Click “Yes” or “No”, depending on the new patient being entered.

4) Use the tab key to fill in the open fields.

PATIENT TAB

1) Guarantor Same As Patient box

a. If the patient is the guarantor, leave as defaulted in system.

b. If the patient is not the guarantor, uncheck the box. This will allow you access to the Guarantor Tab, where you will enter the guarantor information for this patient. Each guarantor entered is stored in your database and can be accessed for future access for other patients in the same family.

2) Needs Referral box

a. If the insurance does not require a referral, leave the field blank.

b. If the insurance does require a referral to treat, the checkbox will flag this patient requiring a referral to be entered before an appointment can be scheduled. This will also cause the system to look for active referrals when making an appointment, as well as if there is no referral a warning box will appear when booking an appointment. These warnings will also appear when in patient demographics and charge entry.

3) To choose the employer, click on the icon to pull up the “Find Employer”

screen. Type in the employer in the “Select Criteria” box and click on “

Find Now”, this will display any employer that has been entered

previously that meets that criterion.

a. If employer is listed:

i. Highlight the appropriate line, and click on the “Select” button.

b. If employer is not listed:

ii. Click on the “New” button at the bottom and add the employer information, then click “OK” to add it to the database.

iii. Once the information has been added, the screen will refresh to show the new information.

iv. Highlight the appropriate line, and click on the “Select” button.

4) Primary Doctor is the doctor who will be the primary caregiver of this patient. Select the primary doctor by using the pull down menu and click on the appropriate doctor from your list.

5) Referring Doctor is the doctor that has referred this patient to your practice. To choose a referring doctor:

a. Click on the “Select A Referring Doctor” icon.

b. Enter the doctor’s last name in the “Select Criteria” field and click on the “Find Now” box.

i. If the doctor is already in your database, highlight the appropriate line and click on the “Select” button.

ii. If the doctor is not listed, you will have to add “New”, just like the employer field. Once all required information has been added, click on “OK”, this will refresh your search criteria so that you can select the doctor in question.

6) Co-Pay is used only if the patient has an actual co-payment ($5, $10, $15,etc.). This field will automatically print on the patient traveler when checking in, and also displays on the charge screen and on the appointment schedule with details for this patient.

7) Bill Code is a way of grouping your patients. You can run reports, patient lists and statements by bill code. It is all user defined, so you can call it whatever you like. Some examples would be PPO, HMO, POS, Cash only, Capitation, etc. The bill code itself must be two digits, but allows for a written description.

8) Fee Code is a list of your fee schedules. You have the option of setting up several fee schedules within the system. When you enter a fee schedule here, it will automatically pull up that fee schedule and pricing when you enter charges for this patient. All patients must have a fee code assigned to their account.

9) Notes field is a free form text box. This information will print directly to the traveler. Do not put confidential information in this area! This field can be used to note if a patient is required to go to a specific lab, or they have a certain percentage of the bill they pay instead of a co-payment, or any information that would be helpful to the doctor/nurse or the checkout person would go here.

10) Balance and Insurance fields are for display only for your convenience.

GUARANTOR TAB

This field is only accessible if the “Guarantor Same As Patient” has been

unchecked on the Patient Tab.

1) Use the binoculars to look up a guarantor.

a. If the guarantor is listed, highlight the name and click on the “Select” button.

b. If the guarantor is not listed, you will have to add as new.

i. Click on the “New” button

ii. Fill out appropriate fields.

iii. Click on the “OK” button, which will bring you back to the binoculars criteria field from which you can then select.

Once a guarantor is added to the database, it can be associated with any patient in your system. The guarantor’s billing address will carry over to the insured information screen.

INSURANCE TAB

[pic]

1) To add a new insurance policy

a. Click on the “Add” button, this will display the insurance information screen.

b. Click on the binoculars next to the Insurance Company field to display the “Find Insurance Company” criteria box.

c. Type in the first few letter of the insurance company you are

looking for, or you may also look up by the address of the

insurance company you are searching for.

i. If the insurance company is listed, you may select

it by highlighting the appropriate line, then clicking on the “Select” button.

ii. If the insurance company is not listed, you will have to add as new.

a. Click on the “New” button

b. Fill in the appropriate fields.

c. Click on the “OK” button to add the information to the database and refresh your criteria search.

d. Highlight the appropriate line, then click on the “Select” button.

d. The guarantor information will automatically pull forward.

e. Fill in the group number information

f. Click on the “OK” button.

2) This process may be repeated, depending on the number of

insurance policies the patient may have.

FINANCIAL TAB

[pic]

The financial tab allows you to see an overview of all outstanding charges for

this patient’s account. It lists all charges, the payments applied to that charge, and the responsibility for each outstanding charge.

1) Send Statement checkbox indicates whether or not this patient will

receive a statement. The system will be set up to automatically default to “Send Statement”.

2) Show All Charges checkbox allows you to select whether you wish to see only the outstanding charges (unchecked) or all charges (checked).

3) Flag Account checkbox allows to flag an account for whatever reason, for

instance if the patient is delinquent or you need to remind them about

something prior to making them an appointment, etc. No matter why the

reason, it is advisable to document the reason in the Notes section of the

account. You will always be allowed to schedule an appointment, this just

serves as a reminder that there is something special about the account

that will need to be checked.

ADDITIONAL INFO TAB

This screen allows to pre-fill in information need to file you claim. Fill out the

Visit Information, Patient Status, Accident Information, and Workers’

Compensation information.

Note that not all fields are applicable to all patients.

WinMedStat will automatically fill in the first and last visit, signature on file and

employment status from the default setting, but you can manually override and

change them if needed.

If you click on the box next to “Injury Employment Related”, the system will

automatically remove the check in the “Send Statement” box.

The system will automatically default to “Always” in regards to accepting assignment, which you can manually change while entering a claim if needed.

Once all information is entered, you may click on the “Apply” button, which will then give you access to the smaller icons on top, or you can click on the “OK” button, which will finish the task at hand and allow you to move on to another.

INSURANCE BASICS

When adding a new insurance into the patient’s demographics, you must adhere to the following directions if they are to be processed by the system correctly. When entering patient’s demographic information and the insurance company is not already in your database, you will have to add it. Here are the steps for you to follow to add a new insurance company to your database.

1) While in patient demographics, click on the “insurance tab” field, click on the “add” button. Use the binoculars to search by name and address to be sure not to duplicate an insurance company.

2) If the insurance is definitely not listed in your database, click on the “new” button to add it. This will bring you to the insurance database.

a. Enter all of the information, noting to be consistent when entering the address

(this will be extremely important when trying to search by an address).

b. Assign an insurance group from the menu if applicable.

c. Check to see if the insurance is a capitation plan or not, check the appropriate box.

3) If the insurance company accepts electronic claims and you have the “Payor” id number, enter the information as follows:

a. Enter the Payor id number in the first box. “Note use only the Payor id’s from the payor list provided by your clearinghouse.”

b. Select the appropriate “carrier type” from the pull down menu on the second box.

c. Since this is an Electronic claim, the “carrier status” must be production, which is found in the pull down menu in the third box.

4) If the insurance company does not accept electronic claims, enter the information as follows:

a. The Payor id number box must be left blank.

b. Select the appropriate “carrier type” from the pull down menu on the second box.

c. Since this will be a paper claim, the “carrier status” must be none, which is found in the pull down menu in the third box.

5) If the insurance company does not accept electronic claims, and you are having your clearinghouse send your paper claims for you.

a. The Payor id number should be “PAPER” or “PRINT” depending on your clearinghouse.

b. Select the appropriate “carrier type” from the pull down menu on the second box.

c. Since this will be a paper claim sent to your clearinghouse, the “carrier status” must be production, which is found in the pull down menu in the third box.

6) Finally, you must select an insurance “type”.

a. The “Group Health Plan” and “Other” options will be the most confusing to you.

i. The “Group Health Plan” option is just that, an insurance plan offered for a group or through a large employer.

ii. The “Other” option is for individual health plans, or Medicare secondary plans.

7) After all of the information has been entered, click on the “OK” button to save the

information to your database and your screen will refresh with the criteria so that you can then “select” the insurance you have just added.

PATIENT CHECK OUT & CHARGE ENTRY

For your “office visit” charges follow the steps for “Charge Entry through Patient Check Out”. And for your “out patient” or “hospital charges” follow the steps for “Charge Entry through Create Charges”.

CHARGE ENTRY THROUGH PATIENT CHECK OUT

1) Click on the [pic], which will pull up a list of patients checked in.

2) Select the correct patient by highlighting the appropriate line item.

a. You can either double-click the correct line or

b. You can single click the correct line and then click on the [pic] button.

3) This process will bring forward the Charge Entry window, defaulted with the patient’s information.

4) Use the “Tab” key to move between the fields, adding the diagnosis codes and the procedure codes, changing the date of service if needed by using the[pic].

5) Once you have entered all of the appropriate information on the “Charges” window, you can click on the “Visit Information” window to check the rest of the claim information.

6) Once everything has been entered and the charge is complete, click on the [pic] button.

7) The system will ask you if you want to print a receipt, answer accordingly to your office policies and procedures, as each office varies.

[pic]

CHARGE ENTRY THROUGH CREATE CHARGES

1) Click on the [pic] icon.

2) Select the correct patient with the [pic] icon.

3) Enter the doctor that provided the services.

4) Enter the appropriate facility; i.e. office, in-patient hospital, outpatient hospital, etc.

5) Use the “Tab” key to move between the fields, adding the diagnosis codes and the procedure codes, changing the date of service if needed by using the [pic]

6) Once you have entered all of the appropriate information on the “Charges” window, then click on the “Visit Information” window to check the rest of the claim information and enter the “Hospitalization Dates” if the charge is for in-patient care.

7) Once everything has been entered and the charge is complete, click on the [pic] button.

8) The system will ask you if you want to print a receipt, answer accordingly to your office policies and procedures, as each office varies. (See above picture)

Charge Entry

through Check-Out

1) Click on the Check Out Icon [pic]

2) Pick the Patient that you would like to check out. Double click on their name or click one time and then click the checkout button. [pic].

3) The system will automatically take you to the Charge Entry Screen to check out the patient.

4) When adding charges through checkout, the system will default with the location of Office. If the location needs to change, use the pull down menu to pick another facility of location for services rendered.

5) Press the tab key to advance from field to field. Tab to the ICD-9 field. Type in the diagnosis code or use the ellipse button [pic] to pick from within the diagnosis code list. A code can be added from within the search box if it does not exist in the list by clicking on the NEW button in the bottom right.

6) Once the code is entered, tab to the next ICD-9 field and enter the next code. Repeat this process until all of the diagnosis codes are entered. Continue pressing the tab key and it will advance to the procedures field.

7) The dates of service will default to current day, tab to the CPT field. Type in the procedure code or use the ellipse button [pic] to pick from within the procedure code list.

8) Once the code is entered, tab to the next CPT field and enter the next code. Repeat this process until all of the procedure codes are entered. Continue pressing the tab key and it will advance to the responsibility field.

9) If patient has insurance in their demographics, the responsibility will default to Insurance and a claim will be created automatically to bill to the Insurance Company. If there is not insurance in the patient demographics, the responsibility will default to Patient and there will not be a claim created.

10) Tab to the Payment field. The copay amount from Patient demographics will be populated here. This field can be overwritten to the amount of the payment. Use 0.00 for non-payment. If a payment was made, tab to the Payment Method field and use the pull down menu to enter the payment method.

11) Tab to the description field. This is used to print on the patient statements to explain the charges that were put in for the services. It can be overwritten.

12) Tab to the check no field and enter the check number if the patient paid by check.

13) The Visit Information tab is at the top of the screen. It is a second page to the charge entry screen that has the insurance information and additional information for the claim including hospitalization dates. Please check all of the fields on this screen to make sure that everything is correct.

14) To add a RECALL to a patient’s account, this should be done before clicking the OK button. In the bottom left portion of the charge entry screen, press the [pic] button. This will take you to the recall portion of the system. Use the [pic] to add a new recall. Fill in all of the appropriate fields on the screen and press OK to save. This will bring you back to the charge entry screen.

15) When completely finished, click on the OK button at the bottom of the screen.

16) The system will bring up a window to print the Walkout receipt for the patient. Enter the number of copies in the field and press OK.

[pic]

17) This will return you to the Checkout screen to checkout the next patient.

CHARGE ENTRY SCREENSHOT

[pic]

Charge Entry outside of checkout is usually used to enter hospital charges or charges for patients not checked into the system.

1) Follow steps 4-16 above. In step 4, use the pull down menu to enter the facility where the services were rendered. This doesn’t default if not using the checkout process.

Charge Entry Errors Before End of Day

1. Go to Create Charges [pic]

2. Note that the program displays the last modified patient by default. If necessary, click on the binoculars and select the appropriate patient.

3. Choose “Existing Entry” from the Status pull down menu

[pic]

4. Select the item you wish to modify by double clicking on it in the Charge Listing window.

[pic]

5. You may now make any appropriate changes. Be sure that your pointers, CPT’s and ICD9’s remain consistent after you make your changes.

6. If you need to make changes to the Visit Information tab, you may do so at this point.

Charges Entered Before Insurance

Unsubmitted charges occur when charges are created for a patient who has not been set up with insurance. For instance, if the patient does not have their insurance information with them at the time of their appointment, but charges are entered when they check out, those charges will be set to patient responsibility since there’s simply nobody else to bill them to. Even if the insurance info is then added, the claim must be created manually.

1. Verify that the insurance coverage has been set up for the patient in question.

2. Go to Claims Management[pic], select the patient using the binoculars, and click on the New Claim button[pic].

3. Check the items from the service and diagnosis tabs that should be included on the claim. Enter modifiers and diagnosis pointers as necessary. Check the information on the Visit Information tab. Press OK to save the changes and create a claim.

[pic]

[pic]

[pic]

4. Go to the Patient Ledger[pic] screen and click on Accounts Receivable[pic]. Double click on the line item you wish to modify, and set the responsibility from Patient to Insurance.

[pic]

Charge Entry Errors After End of Day

1. Determine the total dollar amount for the entry error.

2. Go to Activities, Make Adjustments, Select the patient’s account you would like to adjust.

3. Choose an Adjustment Category (i.e.: posting error), and enter a Type Of Adjustment. Note: It is advisable to enter a description of what you are doing (e.g. DOS 3/3/00 Posting Error) in the Type of Adjustment field. This makes it easier to track your changes in the future.

4. Enter the amount you need to adjust off in the Adjustment Amount field as a negative (-) amount, and then strike the tab key to display the Outstanding Charges window.

5. Double click on the line item that needs adjusting.

6. Verify the amount in the adjustment edit window and click OK. Then click Done on the main adjustment window.

7. If the charge was entered on a claim by itself, or with other charges that must appear together (for instance, if you are billing for a primary excision with a secondary site):

a. Go to the Patient Statement (ledger icon). Select the patient you wish to modify using the binoculars. To prevent the adjustments and erroneous charges from appearing on the patient’s printed statement, delete the statement lines that are associated with the incorrect charge/adjustment by clicking on the line item, and then clicking on the “fancy X” button. This will highlight the line in green. This does not alter the balance, only hides the line items on the printed statement. You may hide any and all appropriate lines in this manner. If you need to un-hide a transaction, you may repeat the same process.

b. Go to Claims Management (yellow legal pad icon). Use the binoculars to select the appropriate patient, accepting the defaults for Claim Status and Bill Method. Click on OK to display all pending claims for the patient in question. Select the claim you wish to delete with the left mouse button and click on the fancy X. NOTE: This will PERMANENTLY DELETE THIS CLAIM. If you wish for these charges to be billed, be certain to create a new claim (see step 8). If the charge was entered on a claim with other charges that do not need to be deleted, and needn’t appear on the same claim:

c. Go to Medical Records [pic] and mark that charge as Un-submittable by clicking on the correct line item then clicking on the Mark / Unmark Charges as Submittable icon (fourth icon from the left). The “Filed” column displays a 0 for un-submitted claims, a 1 for submitted claims, and a 9 for un-submittable claims. Note that un-submittable CPT codes will not appear when creating new claims for this patient.

d. Next, go to Claims Management [pic] and click on the [pic] to re-create the claim without the charge that was entered in error. You now need to delete the old claim (see step 7b).

8. Complete the process by entering the correct charges in Charge Entry (thereby creating a new claim for these items), if necessary.

MAKING PAYMENTS

PRIVATE PAYMENTS

1) Click “Make Payments” icon. [pic]

2) Enter the amount of the payment, then “Tab”.

3) Select the appropriate payment type (private payment) from the pull-down menu or use the short cut keys, then “Tab”.

4) Enter method of payment; i.e. check/cash/credit, then “Tab”.

5) If payment is by check, enter check number then “Tab”.

6) Enter description of payment, then “Tab”.

7) Use binoculars to select the correct patient; once patient found, double-click on appropriate line to bring foreword the patients claim information.

8) Double-click on appropriate line item where you wish to apply the payment, the “Private Payment” window will appear. Check to make sure that the paid amount is correct & who is the responsible party. If the insurance carrier has not paid the claim, the insurance company is still responsible.

9) Click on the “OK” button, this will bring you back to the claim information screen.

10) Click on the “Apply” button to record the information entered and move on to another payment, this action will also cause a “Print Invoice” option to appear. If you need to send or give a patient a receipt, click “OK”. If you do not need a receipt, click “Cancel”.

INSURANCE PAYMENTS

1) Click “Make Payments” icon. [pic]

2) Enter the amount of the payment, then “Tab”.

3) Select the appropriate payment type (Record Payment of Claim) from the pull-down menu or use the short cut keys, then “Tab”.

4) Enter the check number, (when entering an insurance payment, screen will always default to check number since insurance companies always pay by checks), then “Tab”

5) Use binoculars to select the correct patient; once found, double-click on the appropriate line to bring foreword the patients claim information.

6) Double-click on the appropriate line item where you wish to apply the payment, the “Record Payment of Claim” window will appear.

A) If the payment is for a single patient, the paid amount will be the same as the amount of the check entered.

B) If the payment is for multiple patients (Bulk Payment), the paid amount will have to reflect the amount that you wish to allocate to the claim selected.

7) Click on the “Distribute” button to display the Apply Payment to Procedure window, you will then be asked to enter the amount paid to each CPT code. When finished, click “OK”.

8) If you need to make an adjustment, type in the amount you wish to write off in the “Write Off Amount” box. NOTE that you do not need to put a negative sign in that field. Be sure to select the appropriate adjustment category and fill in the “Description” field, which will appear on the patient’s statement.

9) If there is secondary or subsequent insurance coverage, the system will automatically default to have the “Complete Secondary Claim” box checked and will create your secondary claim to paper.

10) When finished, click “OK” to bring you back to the Record Payment of Claim window.

A) If the payment is for a single patient, click on the “Apply” button to record the information entered and move on to another payment.

B) If the payment is for multiple patients, you will have to enter all payments related to the amount of the check before you will be able to click on the “Apply” button.

NON-PAYMENT OF CLAIMS

1) Click “Make Payments” icon. [pic]

2) Select the appropriate payment type (Record Non-Payment of Claim) from the pull-down menu or use the short cut keys, then “Tab”.

3) Use the binoculars to select the correct patient; once found, double-click on the appropriate line to bring foreword the patient’s claim information.

4) Double-click on the appropriate line item to which the insurance is not paying to bring foreword the “Record Non-Payment Of Claim” window.

a. If the claim is being denied to be applied to the calendar year deductible, check the deductible box and the description box will change to reflect that the services were applied the deductible.

b. Make sure that if the services are denied for whatever reason, the responsibility box needs to reflect “patient” and not “insurance”.

c. If the claim is being denied for a reason other than deductible, i.e.: insurance termed, services not covered, etc. Enter this information in the claim information description box. This line will appear on the patient’s statement.

d. From this window you can also make appropriate write-off adjustments on the claim and print a patient statement to mail to the patient at the time of posting.

5) When all of step 4 is complete, click the “OK” button to bring you back to the claim information screen where you can click on the “Apply” button to record the information entered and move on to the next transaction.

PRE-PAYMENTS

This option allows you to apply a pre-payment or deposit to a patient’s account that the charges or services will be posted at a later date in time.

1) Click “Make Payments” icon. [pic]

2) Enter the amount of the payment, then “Tab”.

3) Select the appropriate payment type (Pre-Payment) from the pull-down menu or use the short cut keys, then “Tab”.

4) Enter method of payment; i.e. check/cash/credit, then “Tab”.

5) If payment is by check, enter check number then “Tab”.

6) Enter description of payment, then “Tab”.

7) Use binoculars to select the correct patient; once patient found, double-click on appropriate line to bring foreword the patient’s information.

8) Click on the “Apply” button to record the transaction, this will cause the “Print Invoice” option to appear. If the patient wants a receipt click “OK”, if the patient does not want a receipt click on the “Cancel” button.

BALANCE FORWARD STEPS

1. Go to Preferences/ Manage Tables / CPT Codes & Fees.

2. Click on the White piece of paper to add a new CPT code.

3. Enter BALFWD into the Code field. Press the tab key until you get to the Description field. Type a description of “Balance Forward”. Press tab and pick a category. Press Tab and pick a POS (e.g. 11). Press tab and pick a TOS (e.g. 1). Check the “NO” for file insurance and then press OK. Close the CPT Code Maintenance window.

4. Go to Preferences / Manage Tables / Diagnosis Codes.

5. Click on the white piece of paper to add a new Diagnosis Code.

6. Enter BFWD in the code field. Press tab to the description field and type in the description of Balance Forward. Click OK to save changes and then close out the Diagnosis Code Information window.

7. Go to the Charge Entry Icon to enter the balance forward. Pick the patient using the binoculars. Enter charges as you would normally enter a charge, but use the diagnosis code of BFWD and the CPT code would be BALFWD. After you enter the CPT code, press tab over into the Amount field and type in the balance forward amount. Click update to save your changes and then click Apply to save the charge entry if you would like to enter continuous balance forwards. If you are finished with charge entry, click on the OK instead of Apply.

NSF Check Handling

1. In Preferences: Manage Tables set up an ICD9 for NSF Check, a CPT code for NSF Check Charge ($25.00), and under Lookup Lists create an Adjustment Type for NSF Check. Be certain to set “File Insurance” to No on the CPT.

2. When a patient has a check returned, go to Create Charges and select the NSF ICD9 for diagnosis and the NSF CPT for procedure.

3. Go to Activities: Make Adjustment and create a positive adjustment for the amount of the check (Adjustment Type should be, of course, NSF Check). Use the Description field to specify the date of payment on the check for tracking purposes.

4. Upon receipt of secured funds, go to Payment Entry and enter the entire amount of the payment (check amount plus NSF fee), and disburse the funds to the appropriate line items. Be sure to put the appropriate amounts in the amount fields in the distribution windows, since it will default to the entire amount of the payment.

ELECTRONIC CLAIMS SUBMISSIONS

We here at WinMedStat recommend that you submit your electronic claims, run your insurance check summary report and your download response report daily after you do your End of Day & Daily Closing Reports.

1) Click on the ECS Submit Claims icon.

2) Click on the Download Response option. Once you do this, do not touch the keyboard or mouse!

a. Once the system has finished downloading your response, it will pop up a box that says how many response files you have received when you click OK the system will automatically print out you response reports that have downloaded and take you back to the submit claims options menu.

3) Once complete click exit to close ECS screen.

4) Go to Reporting, Claim Reports, ECS No Response/Clearinghouse Reject Report.

5) Select the preview option. This will allow you to see if there is anything that might need to be re-qued to be filed.

a. If report is blank, move on to the next step.

b. If there is something on the report, go into claim management correct the claims and then re-que the batches to be re-filed.

6) Once complete click on the ECS Submit Claims icon.

7) Click on the Insurance Check Summary option, this will allow you to see if any of the claims that are to be filed are missing anything.

a. If the report is blank, move on to the next step.

b. If there is something on the report, you will want to fix what the system is saying is wrong with the claim before you continue.

c. After you fix the issues, re-run the Insurance Check Summary again to make sure everything is good to go.

8) Click on the ECS Submit Claims icon to get back to the submit claims window.

9) Click on the Prepare Claims option, this will bring up a box that will ask you for a date you can use the default date which will always be today’s date or you can change it if you are not ready to send claims for today but you want to send claims for yesterday or before.

a. Once you choose the date and click OK the system will bring up a window that tells you how many claims you have that are ready to be filed.

b. If you want to print out a list before you click the send button you can click on the print button to the left.

c. If you are ready to send claims then you click on the send button. Once you say yes to submit, do not touch the keyboard or mouse!

d. Once the system has finished the process of submitting your claims it will automatically print out your sent report and any additional response reports that have downloaded and take you back to the options menu.

10) It may be necessary to perform a download response again in about thirty minutes if you do not receive immediate responses to all of your batches.

11) Every time you transmit claims each one of the above steps should be performed to insure you have the entire necessary claim / batch information and to ensure your claims are transmitted successfully.

Important Note: It is strongly recommended that you review the ECS No Response Report/Clearinghouse Reject Report every day. This report allows you to keep tabs on claims that have been submitted but yet to be processed or rejected.

Financial:

End of Period: (these reports can by selected by date range / dr or all)

➢ Check-In Report

➢ Total Patients Seen Report

➢ Services Rendered

➢ Adjustments Report

➢ Receipts & Earnings Report

➢ Complete End-of-Period Report

➢ Payment/Earnings Exception Report

Transaction History

➢ Year to Date Summary Report

➢ Deleted Transaction Report (select by date range)

➢ Practice Summary Report (select by date range / Ins. or all)

➢ Transaction History Report (select by date range/ dr or all / fee code, bill code, chart # , Ins co. or all)

➢ Daily Charges, Payments & Adjustments Report

Accounts Receivable

➢ A/R by Insurance Report (select by dr or all / bill code or all / insurance group/plan or all)

➢ A/R no Statements Report (select by start/end age / dr or all / bill code / Pt/Ins/Both)

➢ Detailed A/R Report

➢ A/R Doctor Summary Report

➢ A/R Short Report

➢ A/R by Responsible Party – Short Report

➢ Patient Aging Report

➢ Payment Aging Report

Misc:

Check No Transaction Listing

Adjustment Categories Report

Credit Card Revenue Report

Daily Receipts Report

Patient Credit Report

Unallocated Receipts Report

Year-to-Date Summary Report

End of Day

End of Day Report

➢ End of Day Report (only)

➢ Daily Services Report

➢ Daily Receipts Report

➢ Doctor Summary Report

➢ Transaction Summary Report

End of Day Report & Daily Closing

Claim Reports:

ECS No Response Report

Insurance Check Summary Report

Insurance Forms Listing Report

Medical Reports

Services Procedures Report

All Services Report

➢ One Category Report

➢ One CPT Code Report

➢ Procedure Statistics Analysis Report

➢ Charges by Facility Summary Report

➢ CPT Charge Listing by Insurance Company Report

➢ Billing Code Charge Summary Report

Diagnosis Reports

➢ One ICD-9 Code Report

Hospital Service Report

Prescription Report

Recall Report

Referring Doctor Report

Referring Source Report

Service Procedure Reimbursement Report

Workers Comp. Report

Insurance Reports

Insurance Performance Report

Unpaid Claims Report

Un-Submitted Charges

Patient Reports

Birthday Listing Report

Patient Listing Report

Print Recall Letters

Print Labels

Mail Merge

WinMedStat Recommended Reports

Daily Close Reports:

Balancing Deposits with Reports

End of Day Report (to screen or printed out)

• Balancing Individual Users Payment Posting with Reports

Daily Receipts Report (to screen or printed out) < Reporting/End of Day/End of Day Reports/ Daily Receipts>

• Balancing Individual Users Charge Entry with Reports

Daily Services Reports (to screen or printed out) < Reporting/End of Day/End of Day Reports/ Daily Services>

End of Day Closing after Balancing

End of Day and Daily Closing

• Correct any Problems with Claims in both Claims Management and in Patient Demographics.

Insurance Check Summary Report

Electronic Claims Processing

Paper Claims Processing

Weekly Reports:

• Go over any Claims that have NOT been Submitted

Un-Submitted Claims Report

• Follow-up with All Insurance Companies

Un-Paid Claims Report

• Look over Claims that have not been Answered yet

ECS No Response Report

• Unallocated Receipts Report

Monthly / Yearly Reports:

• YTD Summary Reporting

• Accounts Receivable Reports:

A/R Aging Summary

A/R by Patient

• Adjustment Category Report

• YTD CPA Report

• MTD CPA Report

• Recall Report

**** At Year End, Put A Weekly Backup Tape In A Safe Deposit Box ****

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