The Multipax billing module provides a full set of features for completing all of the tasks associated with billing patients and insurance companies for services provided. The following features are part of the Multipax billing module:
Office Services: This feature is used to enter the charges for services that were provided to the patient by a doctor during the course of an office visit or hospital stay.
Hospital Admissions: This feature is used to enter the background information necessary to admit a patient to the hospital and to bill for services rendered in the hospital.
Statement/Claim Printing: This feature is used to print billing statements for patients and paper or electronic claims for insurance companies.
Payments: This feature is used to record all payments received by the practice. It includes facilities for payments received from patients and payments received from insurance companies.
The insurance payment feature supports the application of payments to specific charges and provides automatic rebilling directly to the patient or to the patient's secondary insurance provider(s).
Office Services
The Office Services feature is the heart of the billing facility within Multipax. This feature is used to record all of the services provided to the patient by the physician (i.e., it functions as a superbill). In most cases, the information required to complete the office services window will be provided by the doctor on the visit slip created for the patient's appointment.
To open the Office Services feature:
14. Select Office Services from the Office Visits menu in the Patient Billing window.
2. Click on the Insert Record button on the Multipax toolbar.
3. Enter data in the following window header fields:
Required
Patient Account Number
Dependent Number
Note: The preceding two fields can be completed simultaneously by selecting a patient using the Select Patient button at the bottom of the window.
Insurance Code: This field can be completed by selecting an insurance code from the field search dialogue box that is automatically called up when the preceding two fields are completed (see p. for instructions on using the field search dialogue box).
Accept Assignment: The default value of this field is Y.
Location Code
Optional
Direct Billing: This field requires a Y/N response to indicate whether or not the patient's insurance provider should be billed for the services rendered. The default value for this field is Y
Provider: The default value for this field will be the first provider entered in the Masters module of the Multipax system (Doctor code = 1).
Attending: The default value for this field is the default doctor code for the provider field. The default value will be displayed after the insurance field is completed.
Referring: The default value for this field is the default doctor code for the provider field. The default value will be displayed after the insurance field is completed.
Place: This field should contain the place code corresponding to the specific site (within the previously selected location) where the service was actually provided, if applicable. The default value for this field will depend upon the default value chosen when the previously entered location was set-up in the Masters module.
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Accounting Date: This field will display the current system date which will be used as the accounting date for the posting of all charges.
Patient Name
Insurance Dependent Number: The value displayed in this field will be determined by the insurance selected in the field search dialogue box.
Self Balance: This field will display the current balance of outstanding charges billable to the patient for the previously selected account (Note: this field will be automatically updated as new charges are entered in the window body of the Office Services feature).
Insurance Balance: This field will display the current balance of outstanding charges billable to the patient's insurance provider(s) for the previously selected account (Note: this field will be automatically updated as new charges are entered in the window body of the Office Services feature).
Transaction Total: This field will contain the total amount of all charges (whether billable to the patient or to the patient's insurance carrier) currently outstanding for the previously selected account. (Note: this field will be automatically updated as new charges are entered in the window body of the Office Services feature).
4. Enter data in the following window body fields for each service record you wish to enter into the Multipax system:
Required
Hospital Service: This field requires a Y/N response to indicate if the service that is being entered was rendered in a hospital. If Y is selected, the Hospital Admissions window must have already been completed. The default value for this field is N
Diagnosis Code (1): This field requires the standard diagnosis code corresponding to the doctor's diagnosis of the patient. The default value for this field can be selected in the Masters module during system set-up.
Service Code: This field requires the Multipax system code corresponding to the first service rendered by the doctor. The default value for this field can be selected in the Master module during system set-up (The code for office visit is commonly selected as the default).
CPT Code: The default value for this field is the CPT code corresponding to the previously entered service code.
Start Date: The date on which the previously entered service was begun. The default value for this field is the current system date.
End Date: The date on which the previously entered service was completed. The default value for this field is the current system date.
Charge: The amount that the doctor charges for the previously entered service. The default value for this field is dependent upon the value entered in the Masters module during system set-up for the previously selected service. The default value can be overriden as required.
Units: The number of times the doctor rendered the previously entered service. The default value for this field is 1.
Optional
Diagnosis Code (2): This field may contain a secondary diagnosis code if the doctor provided one for the previously selected patient.
Service Code Modifier: This field may contain any modifier code available for the previously entered service code.
Copay: This field should contain the amount of the encounter fee that the patient's insurance company normally requires the patient to pay for an appointment with the doctor.
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Total: This field will contain the total charge for the service rendered by the doctor for the current record. This value is determined by multiplying the entered charge by the number of units of service received.
5. Repeat step 4 for each service provided by the doctor on this occasion. (Note: each record entered in this window, subsequent to the initial record, will be display default values corresponding to the values entered in the initial record for the following fields: Hospital Service, Diagnosis Code(s), Start Date, and End Date. These default values can be modified as required.)
6. Click on the Save button on the Multipax toolbar.
7. Click on the Yes button in the confirmation dialogue box. This will automatically open the additional insurance information window. (Note: this window may also be opened by clicking on the Additional Ins. Info button at the bottom of the Office Services window.)
8. Enter data in the window body fields (Note: The additional insurance information window does not have a window header). Every field in this window is optional; however, although the Multipax system does not require that the fields in this window be completed, this information may be required or helpful for filing insurance claims. If you do not wish to enter data in this window, proceed to step 11.
The following fields are available:
Insurance Code: The default value for this field is the insurance code entered in the Office Services window.
Insurance Dependent Number: The default value for this field is the insurance dependent number displayed in the Office Services window.
Accident Type: This field should contain one of the following accident codes - A for automobile accident, for other accident, or N for no accident.
Lab Charges: This field should contain the exact amount of any charges for laboratory services provided in conjunction with the services recorded in the Office Services window.
The following fields require date information:
First Consulted
Admission Date
Discharge Date
Partial Disability From
Partial Disability To
Total Disability From
Total Disability To
Return to Work
Surgery Date
The following fields require Y/N responses:
Outside Lab
Family Planning
Abortion/Sterilization
Emergency
Previous Symptoms
Multiple Diagnosis Codes
Resource Code
EPSDT
Employment Related
The following fields require codes or other information specific to the previously selected insurance company:
Surgery Type
Medical Status
Adjudication Code
Payment Code
CHAP Code
Prior Authorization Number
Number of Attachments
9. Click on the Save button on the Multipax toolbar.
10. Click on the Yes button in the confirmation dialogue box.
11. Exit from the additional insurance information
window. This will display the Office Services window containing the record(s)
you previously entered.
The Hospital Admissions feature is used to enter the background information that is necessary to bill for services provided to patients in the hospital. In addition, data entered in this feature is used to keep a census of all patients in the hospital at a given time.
To open the Hospital Admissions feature:
2. Select Hospital Admissions from the Office Visits menu of the Patient Billing window.
2. Click on the Insert Record button on the Multipax toolbar.
3. Enter data in the following window body fields (Note: the Hospital Admissions window does not contain a window header):
Required
Patient Account Number
Dependent Number
Accept Assignment: The default value for this field is Y.
Bill to Insurance: This field requires a Y/N response to indicate if the provider has accepted this patient for insurance billing purposes. The default value for this field is Y.
Admission Date: The default value for this field is today's date.
Location Code: This field must contain a location code corresponding to a hospital.
Room Number
Optional
Insurance Code
Insurance Dependent Number
Discharge Date
Provider: The default value for this field will be the first provider entered in the Masters module of the Multipax system (Doctor code = 1).
Referring: The default value for this field is the default doctor code for the provider field.
Place of Service: The default value for this field will depend upon the default value chosen when the previously entered location was set-up in the Masters module.
Remarks: These two fields should contain any remarks that the doctor wishes to include with the hospital admission data for the previously selected patient. (Ex. -
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Patient Name
4. Click on the Save button on the Multipax toolbar.
5. Click on the Yes button in the confirmation dialogue box. This will open the Additional Insurance Information window.
6. Enter data in the additional insurance information window. If you do not wish to enter any data in this window, proceed to step 9. This window is identical to the additional insurance information window accessed from the Office Services feature (see p. for instructions on entering data in this window).
7. Click on the Save button on the Multipax toolbar.
8. Click on the Yes button in the confirmation dialogue box.
9. Exit from the Additional Insurance Information window.
Statement Printing/Claim Submission
This feature includes facilities for generating patient billing statements and for generating insurance claims. Multipax supports both paper-based and electronic claim submission. This feature is one of the most important for managing the business aspects of a physician practice.
Note: In order for statements and claims to include recently incurred charges, the data submission procedure must be completed (see p. ). Only those charges entered prior to the most recent completion of the data submission procedure will be available for statements or claims.
To open the Claim/Statement feature:
2. Select the desired option from the Claim/Statement menu of the Patient Billing window. Options include: New Insurance Claim, Old Insurance Claim, Electronic Claim, or Statement.
Patient Statements are used to bill patients for charges that they have incurred, but for which they did not make payment at the time of service, and for charges rebilled from insurance claims. Statements usually include basic account information, an itemized list of all charges and payments, the current account balance (amount due), and summary information about the age of past due charges. Patient statements can be printed and mailed at any time, but are usually sent on a monthly basis.
To print a Patient Statement:
2. Enter data in the following window header fields:
Required
Form Type: this field requires the code corresponding to the type of form on which you wish to print the statement.
Minimum Balance: This field should contain the minimum account balance (in dollars) that is required for a statement to be printed. The default value for this field is $5.00.
Start Date: The date of the first charge that you would like to include in the printed statement. The default value for this field will be the thirty days prior to the current system date.
Optional
Age Type: This field should contain the code corresponding to the age range of the charges you would like to include on the statement. The following codes are available: 1 for >120 days, 2 for 91-120 days, 3 for 61-90 days, 4 for 31-60 days, and 5 for 1-30 days. The default value for this field is 5.
End Date: The date of the last charge that you would like to include in the printed statement. The default value for this field is the current system date.
Comments/Remarks: These fields should contain codes corresponding to the comments you would like to print on the statement(s) for any of the following conditions (Note: comments can be entered and assigned codes using the Masters module):
Charges > 120 days
Charges > 90 days
Charges > 60 days
Charges > 30 days
Charges > 15 days
Birthday
Diagnosis
Procedure
Additional Comments (up to two)
Common Message: This field may contain text (up to characters) to be printed on every claim.
Print: This field requires a Y/N response to indicate if comments should be printed on every claim.
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Paper Type
3. Click on the Select Patients button to select the patient(s) for whom you wish to print statements (see instructions on using the field search dialogue box on p. ).
4. Click on the Print button.
5. Follow the printing procedure on p. .
6. Exit from the Statements window.
Claims are used to bill the patient's insurance company for services that are eligible for coverage under the terms of the patient's policy and under the terms of agreements between the physician and the insurance company, if applicable. Claim forms usually include basic account information, an itemized list of all services provided and corresponding charges, and a summary of total charges including: amount of insurance claim, amount charged to patient, and total of all charges. Claims may be submitted at any time, but are usually sent after the completion of a course of treatment (e.g., daily for office visits, after discharge from the hospital for hospital admissions). Multipax provides the following options for claim processing:
Electronic Claims: electronic claims are submitted via computer directly to the insurance company's electronic claims processing center (usually a bulletin board system (BBS)).
2. Enter data in the following window header fields to indicate which claims should be printed (Note: if you do not enter any selection criteria in the window header fields, new claims for all insurance companies will be printed):
Optional
Insurance Code
End Date: This field should contain the date of the most recent services for which you would like to submit new claims. The default value for this field is the current system date.
Display Only
Insurance Company Name: Display only.
3. Click on the Select Patients button. This will call up the field search dialogue box which you can use to select the patients for whom you wish to print new claims (see p. for instructions for using the field search dialogue box).
Note: This step is optional. If you do not select any patients, new claims will be printed for every patient under the previously selected insurance carrier (Note: if you have selected an insurance carrier, it is important that you only select patients who have claims to file with the selected carrier. If you wish to print claims for patients with different insurance carriers, you must leave the insurance code field blank and select patients individually using the Select Patients feature or you must repeat this procedure for each insurance carrier.).
4. Click on the Print button.
5. Follow the printing procedure on p. . Select New Claims from the Report Type drop-down list box.
6. Exit from the New Insurance Claims window.
Note: Before electronic claims may be submitted, the Multipax system must be configured for each insurance carrier to whom you wish to submit claims electronically.
2. Enter data in the following window header fields (Note: this window does not contain a window body):
Required
Insurance Code: You may only select codes corresponding to companies that have been configured for electronic claim filing.)
Optional
Provider
End Date: This field should contain the date of the most recent services for which you would like to submit electronic claims. The default value for this field is the current system date.
Display Only
Insurance Company Name
3. Click on the Print button.
4. Follow the printing procedure (p. ). Since this procedure is only used to create a file for electronic submission, the print method is irrelevant.
5. Record the name of the file generated after you click on the OK button. The file name will be displayed in the message bar at the bottom of the print window.
6. Exit from the New Electronic Claims window
7. Select Old Electronic Claim from the Statement Printing/Claim Submission menu of the Patient Billing window.
8. Use the retrieve records procedure (p. ) to locate the record containing the file you just created.
9. Select the file you have just created from the appropriate record.
10. Click on the Send button. This will open the Com program which will allow you to submit your claim file electronically. Instructions for using the Com program can be obtained from the online help available when the Com program is invoked by Multipax. Once you are connected to the insurance companyÕs electronic claim submission BBS, you will need to follow the instructions provided by the insurance carrier for using their system. If you do not have these instructions, they can be obtained from the insurance carrier in question.
(Note: You may also save your electronic claim file onto a floppy disk by clicking on the Copy to Floppy button.)
The Payments feature is used enter any payments for services rendered. Multipax is able to process two types of payments: those made by patients (either at the time of service or in response to a billing statement) or those made by insurance companies in response to a claim. In addition, this feature includes facilities for making adjustments to patient accounts and for rebilling insurance claim charges to secondary insurance carriers or to the patient. This feature is critical for managing the cash flow of the practice and for insuring that bills and claims are paid promptly and processed correctly. For accuracy in billing, accounting, and practice analysis, it is extremely important that the data entered in this feature is completely accurate.
Patient (Self) Payments
This facility is provided to handle all aspects of patient payments including payments at the time of service, payment in response to billing statements, and adjustments to patient accounts. Payment for the following types of charges should be entered in this feature: charges billed directly to the client (i.e., insurance code = self), copayments, coinsurance, charges rebilled from insurance, and all charges for which the patient will seek direct reimbursement from his/her insurance company. Adjustments can be made to the patients account to cancel disallowed insurance charges, to write-off charges, to correct billing errors, to reimburse patient overpayments, to write off bad debt, and for courtesy write-offs.
To open the Patient Payments feature:
2. Select Self Payments/Adjustments from the Office Visits menu of the Patient Billing window.
To record patient payments:
2. Click on the Insert Record button on the Multipax toolbar.
3. Enter data in the following window header fields (Note: this window does not contain a window body):
Required
Patient Account Number
Dependent Number
Note: The preceding two fields can be filled simultaneously by selecting a patient using the Select Patient button at the top of the window.
Attending
Transaction Type: This field should contain the code corresponding to the type of transaction being entered. For patient payments 1 should be entered in this field.
Amount: This field should contain the exact amount of the payment or adjustment made to the patient's account. It is extremely important that data entered in this field is verified for correctness. Failure to enter payments and adjustments correctly will lead to billing and accounting errors which will be difficult to identify and correct once they have been entered into the system.
Optional
Pay Mode: This field is available only when 1 has been selected under Transaction Type. It should contain a code corresponding to the method of payment. Available codes include: 1 for check, 2 for cash, 3 for credit card.
Check/Credit Card Number: This field is available only if 1 or 3 was selected in the Pay Mode field. This field should contain the check or credit card number, as appropriate, used by the patient to pay for account charges.
Remarks: This field is provided to allow entry of comments regarding payments and adjustments to the patientÕs account.
Display Only
Patient Name
Account Date
Attending Doctor Name
Provider
Referring
Self Balance
Insurance Balance
4. Click on the Save button on the Multipax toolbar.
5. Click on the Yes button in the confirmation dialogue box.
6. Exit from the Payments/Adjustments window.
The procedure for making adjustments to a patient's account is identical to the procedure for recording patient payments, with the following differences:
b. Optional: A code may be entered in the Reason field to indicate the reason for the account adjustment. The following codes are available: 1 for courtesy, 2 for charges disallowed by the insurance company, 3 for write-offs, 4 for corrections of billing errors, 5 for reimbursement of patient overpayments, and 6 for bad debt.
Insurance Payments
This facility is used to enter all of the information necessary to process payments received from insurance companies. This information includes the patient account to which the payment should be applied, check details, and the amount to be applied to specific outstanding claim charges. In addition, this facility is also used to rebill claim charges that the patient's primary insurance carrier did not cover, if allowed. Charges may be rebilled to the original insurance company, to the patient's secondary insurance carrier(s), or to the patient him/herself, according to the arrangements established between the provider, the patient, and the insurance company.
To open the Insurance Payments feature:
2. Select Insurance Payments from the Insurance Billing menu of the Patient Billing window.
2. Click on the Insert Record button on the Multipax toolbar.
3. Enter data in the following window header fields:
Required
Patient Account Number
Dependent Number
Source Insurance Code: This field should contain the code corresponding to the insurance company that made the payment you are entering. This field can be completed by selecting an insurance code from the field search dialogue box that is automatically called up when the preceding two fields are completed.
Source Insurance Dependent Number: This field should contain the dependent number used by the insurance company providing payment to identify the patient.
Rebill To: This field should contain the code corresponding to the insurance company to which you wish to rebill applicable charges. Use code 100 to rebill charges to the patient.
Rebill To Insurance Dependent Number: This field shoulc contain the dependent number used by the insurance company to which charges will be rebilled to identify the patient.
Display Only
Patient Name
Account Date
Self Balance
Source Insurance Name
Rebill To Insurance Name
When all of the required data has been entered, the system will display all of the charges to which the insurance payment can be applied.
4. Enter the number of the check you wish to apply to the displayed charges in the Check Details portion of the window. This will automatically display the amount of the check and the remaining balance. If the check you would like to apply to the available charges hasn't been entered into the system yet, you must click on the New Check button at the bottom of the window and enter the check number and amount before clicking on the OK button.
Note: You may proceed to the next step without selecting a check (e.g., if you wish to rebill charges for which you have not received a check).
5. Select the first charge to which you would like to apply payment from the previously selected check or which you would like to rebill without applying payment.
6. Click on the Payments/Rebill button. This will call up the Payments dialogue box.
7. Enter information in the following fields in the Payments dialogue box:
Required
Allowed: The amount that the insurance carrier will allow the doctor to charge for the claimed service. (Note: this should be indicated in the EOB (Explanation of Benefit) that accompanies the check from the insurance company). The default value for this field will be the expected amount.
Not Allowed: The difference between the allowed amount and the charged amount (Note: any changes to the Not Allowed amount will result in automatic adjustments to the Allowed amount).
Deductible: The amount of the original charge that was applied to the account holders annual deductible. This amount will be automatically rebilled.
Coinsurance Fraction: The percentage of charges that the insurance carrier will pay for allowed charges, expressed as a decimal (e.g., where a 80/20 coinsurance agreement exists, the coinsurance fraction paid by the insurance company will be .8). This fraction will be applied to the allowed amount minus the patients deductible to calculate the actual insurance payment. Note: the coinsurance fraction is fixed by the agreement between the doctor and the insurance company, as specified in the account holders insurance policy. The patients portion of the coinsurance will be automatically rebilled.
Withheld: The amount of the payment that the insurance carrier is withholding from the provider. The withheld amount may be paid to the doctor at a later date, depending on the policy of the insurance carrier.
Payment: The amount of the check that you should apply to the selected charge. Generally, you will wish to apply the amount that has been calculated based on the data entered in the other Payment dialogue box fields, although it is possible to enter any amount up to the allowed amount multiplied by the coinsurance fraction.
Write-off: The amount that the doctor does not expect to recover through rebilling. Typically, this is the amount that the insurance carrier has disallowed as a charge, although additional amounts, with a total not to exceed the difference between the charge and the payment, can also be written off.
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Charge: The amount claimed for the selected charge.
Expected: The amount of payment expected from the insurance carrier.
Rebill: The amount of the initial claim that can be rebilled.
8. Click on the OK button.
9. Repeat steps 5 - 8 for every charge to which you wish to apply payment from the previously selected check, until all charges have been accounted for or until the check balance reaches zero. Note: The Delete Check button can be used to remove a check from the system when the check balance is zero.
Rebilling
Although the Insurance Payments feature automatically assigns charges for rebilling, the Data Submission procedure must be followed before these charges can be included on a patient statement or submitted as a new claim to a secondary insurance carrier.
Data Submission (Day-End Processing)
The Data Submission feature is used to submit all new billing and payment data (e.g., charges entered in the Office Services window, patient payments, and insurance payments) for permanent storage in the Multipax system. It is also used to reconcile all cash transactions on a daily basis. Since Multipax uses a batch-processing methodology for data submission, data is not incorporated into the system until the Data Submission procedure is completed. Once this procedure has been completed, the most recent billing and payment data is available for inclusion with patient statements, insurance claims, and accounting reports. In order to maximize efficiency, the Data Submission procedure should be completed, minimally, at the end of each business day; however, the Data Submission procedure can be implemented as frequently as needed (i.e., multiple times per day).
To open the Data Submission feature:
2. Select Day End Processing from the Transaction Processing menu in the Patient Billing window.
2. Enter the data necessary to reckon the cash balance for the day in the following fields (Note: all fields are optional):
Cash Received
Checks Received
Cash Expenditure
Bank Deposits
Note: Cash balance accounting is provided to allow the ability to manage the daily cash flow of the practice; however, it is not required in order to complete the Data Submission procedure.
3. Click on the Day End Posting button.
4. Click on the Yes button in the confirmation dialogue box to verify that the displayed closing cash balance agrees with the actual cash balance on hand (Note: you should click on the Yes button even if you have chosen not to implement cash balance accounting). This will implement the Data Processing procedure.
5. Click on the Exit button.