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1996-05-23
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47
THE INSURANCE MODULE: LEHISUR
This section deals with the Insurance Module. This module is used
to create a HCFA 1500 Insurance Form from your Encounter Form
data. The HCFA 1500 is then printed and forwarded to the insurance
carrier or financial intermediary.
This module does NOT deal with electronic claims billing. We have
an electronic claims module for Medicaid billing for Florida
users. We anticipate other electronic claims options to be
developed.
******************************************************************
IMPORTANT POINT: If you do a fair amount (which most practices do)
of HCFA 1500 billing, we suggest you purchase a dedicated printer
to hold the HCFA forms. This will avoid the aggravation of having
to reload the printer each time you want to print insurance forms.
The program is hard wired to print to LPT 1, the same port that is
used for printing other reports and forms. We suggest you also
purchase an A-B switch (very inexpensive) to allow you to switch
between your main printer and insurance form printer. The next
version will allow user configuration of multiple printer ports.
******************************************************************
******************************************************************
ANOTHER IMPORTANT POINT: You have the option of saving insurance
forms to diskfile rather than going directly to printer. We
suggest you do this for two reasons.
This will avoid tieup of LPT 1 printer port which may be needed
for other office functions. You can batch print the insurance
forms from the diskfile at any convenient time, e.g. noon hour,
end of day, etc.
The diskfile provides a copy of your insurance claim forms. The
diskfiles can then be backed-up to floppy disks for storage.
Accountants tell us that back insurance billing forms should be
saved at least 5 years.
******************************************************************
******************************************************************
KEY POINT: Before you prepare an insurance form for a patient, she
or he must have a Master Form record. If not, you will need to go
to the Main Module and create a Master record for the patient.
From the Insurance Module you can create an insurance form in one
of two ways: 1) You can retrieve an existing Encounter From and
use this to create the HCFA Form. 2) If there is no Encounter
Form, you can directly create a combined "Encounter/Insurance"
form in the Insurance Module.
******************************************************************
48
Generally you will have an existing Encounter Form detailing
services which you want to bill to insurance. This would be the
usual situation for office visit services. Consider the following
scenario:
An Encounter Form is created for an office visit in which a
patient is seen for an ear infection. The patient makes a
copayment at the time of visit which is recorded on the
Encounter Form. The balance showing on the Encounter Form is
to be billed to the insurance carrier, Healthco, Inc. This
Encounter Form was completed in the Main Module.
Assume that you have created several Encounter Forms for
Healthco, Inc. as described above. Further assume that
billing to Healthco, Inc. (i.e, submission of HCFA Forms to
that company) is only done once a month. At that time you go
to the Insurance Module, retrieve the relevant Encounter
Forms, and use them to create HCFA Insurance Forms. You will
then batch print the forms and mail them to Healthco, Inc.
What about the situation where there is no preexisting Encounter
Form? This would be more common for hospital billing. Consider
this scenario:
The doctor hands you an internal form which he uses to keep
track of hospital services. On this form he indicates two
hospital consultations which he wants you to bill to Blue
Cross. One consultation is for an established patient, the
other for a new patient.
The first thing you will need to do is be sure there is a
Master Record in the Main Module for these two patients. You
check the Master File in the Main Module and find a Master
Record for the established patient. You will need to call the
hospital to get their face sheet with the demographics for
the new patient. Once you have this you can create a Master
Record for the new patient.
At this point you can go directly to the Insurance Module and
select the menu option, Insurance Billing. Here you will, in
effect, create a combined Encounter/Insurance Form. Although
the end result is the same, you do not first have to create
an Encounter Form, retrieve that form, and then do the
Insurance Form. Time is saved by combining the two processes.
49
We will now consider the two menu options in the opening screen of
the Insurance Module.
<< ENCOUNTER FORMS >>
This option is identical to the Encounter Form option in the Main
Module. You can select an existing Encounter Form to modify or
delete, or you may create a new Encounter Form.
You will probably have little use for this option. As already
discussed, your Encounter Forms will typically be created in the
Main Module, and then retrieved in the Insurance Module if you
want to do a HCFA Insurance Form. However, the option is available
should you have reason to use it.
<< INSURANCE BILLING >>
This is where you will create your HCFA 1500 Insurance Forms. This
program uses the 12-90 revision of the HCFA 1500 which is the
currently used revision.
When you select this option you will get a submenu with the
following submenu options:
- Set Provider Number: This is where you will select the
provider number for a particular insurance carrier. This
provider number will be displayed in field 33 of the HCFA
Form. Be sure to read the help screen with this option, and
also be sure to note the use of the F9_key.
***********************************************************
IMPORTANT POINT: The provider number you select will remain
in effect until you change it or until you exit the
Insurance Module. For this reason it is easier to do all
insurance forms of one claim type as a group. For instance,
select your Blue Cross provider number, and then do all
your Blue Cross claims. Then select you Aetna provider
number and do those claims, etc.
***********************************************************
- Field 31 HCFA Form: Field 31 is the signature field in the
HCFA Form. Some carriers require a written signature in
this field. Other carriers allow you to type you name into
the field. If so, type it in here. You can also type in the
date for Field 31 which you need t