Billing

The Billing Module is represented by a dollar icon, and is where users are able to manage employee time tracking, set up billing permissions and rates, submit claims, produce invoices and post payments.

Billing

The Billing Module is represented by a dollar icon, and is where users are able to manage employee time tracking, set up billing permissions and rates, submit claims, produce invoices and post payments.

Billing Billing Module Permissions

Employees with the following permissions have various levels of access to the Billing module. These permissions can be enabled via the Permissions module.

  1. Access
    • Basic access to the Billing module for creating timesheets.
  2. Accrued > Access
    • Access to accrued financial reporting.
  3. Billing > Access
    • Access the billing tab.
  4. Billing > Create Invoices
    • Access to create invoices from the billing view.
  5. Billing > Download
    • Access to export the billing view.
  6. Billing > Manage Organization Labels
    • Add, edit, or remove organization billing labels.
  7. Billing > Manage Payments
    • Access to create and manage payments.
  8. Billing > Manage Timesheets
    • Manage timesheets on behalf of other employees and clients in their network. This includes converting appointments, being able to add/edit timesheets of others, see billed rates, as well as override authorization over-billing restrictions.
  9. Billing > Recon
    • Access to the “Batches” and “Transactions” tab in the Payments screen.
  10. Billing > Use organization labels
    • Add and remove organization labels to and from timesheets and payments.
  11. Billing > Visit Verification
    • Access to view the “Visit Verification” section. Must be combined with (Billing > Manage Timesheets).
  12. Invoices > Access
    • Access to view, manage, and print invoices.
  13. Payments > Access
    • Access to the payments module.
  14. Receivables Report > Access
    • Access to the Receivables report.
  15. RCM Report > Access
    • Access to the RCM report.
  16. Service Codes > Manage Organization Labels
    • Add, edit, or remove organization service code labels.
  17. Service Codes > Use Organization Labels
    • Add and remove organization labels to and from service codes.
  18. Settings > Manage
    • Access to the billing settings.
  19. Timesheets > Access
    • Access to the timesheets tab.
  20. Timesheets > Allow Conversion Modification
    • Ability to modify timesheets while converting them from an appointment.
  21. Timesheets > Delete
    • Ability to modify timesheets while converting to from an appointment.
  22. Timesheets > Download
    • Access to export the timesheets tab.
  23. Timesheets > Manage Timesheets
    • Manage timesheets on behalf of other employees and clients in their network.

Click here to learn about other permissions.

Billing CentralReach’s “Patient Responsibility”

CentralReach’s “Patient Responsibility” or “PR AMT” is the cumulative sum of the insurance copayment/copay, the coinsurance, and the deductible amounts the client is monetarily responsible to pay, for the services provided. “Patient Responsibility” was previously referred to in CentralReach as “Copay.”

Billing Coinsurance

Coinsurance is a client’s share of the costs of a healthcare service. It is usually figured as a percentage of the amount a client is to be charged for services. A client would start paying coinsurance after they have paid their plan’s deductible. In CentralReach, the coinsurance amount is included as part of the Patient Responsibility or PR AMT in billing screens and client invoices.

Billing / Claims Completing the Payor Import

New clients must complete a payor import file before beginning implementation. The purpose of this file is to ensure clients’ payors match payors in CentralReach’s database, so that claims will be sent correctly. A spreadsheet application, such as Excel, WPS Spreadsheets, or Google Sheets, will be needed in order to open and complete the payor import.

See below for a breakdown of how to complete columns A-M of the payor import:

  • Column A: The name of the insurance company
  • Column B: The name of the specific plan under the insurance company
  • Columns C- F: The insurance company’s mailing address
  • Column G: The payor’s ID with Office Ally, which indicates where claims should be sent. The ID can be located here, by conducting a search for the payor.

    • Please note, it is important that this ID is inputted correctly, so claims are submitted to the right payor. If you are unsure of the payor ID, contact the payor directly to confirm their ID.
  • Columns H-I: These columns indicate if pre-enrollment is required with the payor to submit claims or receive responses electronically. 
  • Columns J-M: These columns let CentralReach know how you are currently billing and how you want to bill in CentralReach. 

Billing Copay

A copay is a fixed amount a client is responsible for paying for a health care service and is usually paid when the service is received. The amount can vary by the type of service. In CentralReach, the copay amount is included as part of the Patient Responsibility or PR AMT in the billing screens and client invoices.

Billing Deductible

A deductible is an amount a client is responsible for paying for healthcare services before the health insurance begins to pay. In CentralReach, the deductible amount is included as part of the Patient Responsibility or PR AMT in billing screens and client invoices.

Billing / Scheduling Enable Schedulers to Convert Other Employees’ Appointments

The following permission can be granted in the  Permissions module, under the Billing section, for employees, such as the person responsible for scheduling all of your organization’s appointments, to convert other employee appointments into timesheets:

  1. Billing > Manage Timesheets
    • Manage timesheets on behalf of other employees and clients in their network. This includes converting appointments, add/edit others’ timesheets, view billed rates, as well as override authorization over-billing restrictions

These employees also need to have permission to manage other employees’ calendars, which is enabled via the  Scheduling module. Permissions to view or manage calendars can be established via Contact Forms, so new users added to CentralReach already have these permissions enabled based on your Contact Form.

Click here to learn how to create a permission group to grant employees permission to convert other employees’ appointments.

Click here to learn how to review and edit an employee’s permissions.

Click here to learn how to edit the permissions of a group.

Billing / Scheduling Office Location on Billing Entry Different from Appointment Details

If your billing entries are not pulling in the same information as what is set in the appointment details, that can be due to:

  • A location set in the service code properties will override what is set on the appointment. 
  • The fee schedule linked to the client’s payor is also linked to the service code.
    • The location in the modifier overrides the location set in the service code and appointment details.

Payments

Information about Payments in Billing

Receivables

The global view of dollar amounts being brought into the organization based on payor

Billing / Billing / Timesheets Rules on Adding Diagnosis Codes to Timesheets

When converting appointments to timesheets, diagnosis codes are added at the time of conversion if they have been set in the authorization or the client’s “Claim settings.” Diagnostic codes rules apply to timesheets created after converting appointments, manually created timesheets, and draft timesheets.

Diagnosis codes pull to timesheets in the following order:

  1. Authorization: when authorized service codes have diagnosis code(s) linked to them, the diagnosis code in the timesheet will pull from the authorization.
    • Please note, diagnosis codes only pull from the authorization at the time the timesheet was created. 
  2. Client’s Claim Settings: if there are no authorized service codes in the authorization or there is no authorization, then the timesheet will pull the diagnosis code(s) from the client’s “Claim Settings.”

Diagnosis codes retain the order in which they were saved to the authorization or the client’s profile. Diagnostic pointers are set based on the order of diagnostic codes in the authorization or client’s “Claim Settings.” 

If multiple authorized codes are in the timesheet, diagnosis codes pull to the timesheet in the order they were added to the appointment. If authorized and unauthorized codes are in the timesheet, diagnosis codes rules will apply and authorized codes will pull to the timesheet before unauthorized codes.

Billing / Insights The RCM Report

The Revenue Cycle Management (RCM) report, formerly the Sales report, will be located in the Billing and Insights modules to provide a summary of billing data. This report allows users with the (Insights > Access) and (RCM Report > Access) permissions to view revenue, payments, receivables, overpayments, resolutions, and payor trends. Click here to learn how to view and download the RCM report.

Users can filter by a desired date range , and by selecting the payor or client bubbles  at the top of the report.

The following icons on the right-hand side change the report’s display:

  • : default view.
  • : view the charts only.
  • : view the grid only.

The search icon on the left-hand side provides the following filters:

  • Client ID or Name
  • Code label
  • Contact label
  • Billing label
  • Parent label
  • Child label
  • Insurance or Plan Name
  • Provider ID or Name
  • Service Code

Below the search filters, the “Overpayments by payor/client” and “Receivables by payor/client” charts include the following information:

  • Overpayments by payor/client: a total of the payments within a selected date range, paid in excess for a service, as well as the overall total amount of overpayments. 
    • The red bubbles represent the overpayments.
  • Receivables by payor/client: a total of the remaining payments within a selected date range, owed for a service, as well as an overall total of the amount of receivables. 
    • The blue bubbles represent receivables.

Selecting each bubble will also filter the grid on the bottom of the report by the information contained in the pop-up.

The following KPIs are located on the left-hand side:

  • Gross collection rate (GCR): the total percentage of payments.
  • Net collection rate (NCR): the total percentage of resolved payments.

Below both charts are the following columns in the grid:

  • Name
  • Charges: Regular charges and agreed charges.
  • Sales Adjustments: All sales adjustments posted.
  • Adjusted Charges: (Charges – Sales adjustments)
  • Payments: The five payment types, cash, check, credit card, electronic, and credit memos.
    • Please note, this column excludes overpayments.
  • Gross Collection Rate (GCR)
  • Bad Debt: All bad debt payments posted.
  • Net Collection Rate (NCR)
  • Receivables: Dollars still outstanding.
  • Overpayments: Dollars overpaid.

Billing / Insights The Receivables Report

The Receivables report is located in the Billing and Insights modules and provides a summary of overpayments and receivables. Users with the (Insights > Access) and (Receivables Report > Access) permissions will receive an insight into collections aging by payor and client. Click here to learn how to view and download the Receivables report.

Users can filter by a desired date range , sort by payor or client, date of service and first billed, and net, outstanding, and overpayments, located at the top of the report.

  • Net: summation of Outstanding and Overpayments.
  • Outstanding: Outstanding revenue at the billing entry line level and by type (Insurance vs. Patient).
  • Overpayments: Overpaid revenue at the billing entry line level and by type (Insurance vs. Patient).

The following icons on the top right-hand side change the report’s display:

  • : default view.
  • : view the charts only.
  • : view the grid only.

The search icon on the left-hand side contains the following filters:

  • Client ID
  • Client Name
  • Code label
  • Billing label
  • Parent label
  • Child label
  • Payor Name
  • Plan Name
  • Provider ID
  • Provider Name
  • Service Code

Below the search filters, the “AR Aging by payor” charts include the following filters:

  • Primary insurance: select to highlight the circular bubbles that represent primary insurance. 
  • Secondary insurance: select to highlight the rhombus (diamond shape) bubbles that represent secondary insurance.
  • Tertiary insurance: select to highlight the triangular bubbles that represent tertiary insurance.

Selecting each shape will also filter the grid on the bottom of the report by the information contained in the summary pop-up.

On the left-hand side of the chart are the following KPIs:

  • AR Outstanding
  • Over Payments
  • AR > 90 Days
  • Aging breakdown

Below “Aging Breakdown,” the following columns are contained in the grid:

  • Name
  • 0-30 days
  • 60-90 days
  • 90-120 days
  • 120-180 days
  • 190-365 days
  • 365+ days
  • Total

The “Name” column has a list of payors or clients’ IDs (depending on if the report is sorting by payor or client), along with the Insurance payments and Patient responsibility amounts under each aging bucket. Clicking each amount will bring you directly to the billing entry.

Timesheets

Information about Timesheets in Billing