e-MDs Billing Virtual Lesson: More Revenue From Proper Insurance Entry

e-MDs® Billing Virtual Lesson: How to Increase Revenue?  Get Your Insurance Information Entered Correctly

You’ve just seen a patient and want to get paid, right?  Rhetorical question of course.  IF the patient has insurance, unless you follow a specific set of steps, the claim won’t be paid and your staff will spend needless time chasing down the denial which costs time and money.  What is the best practice for insurance entry in the e-MDs® system?  Read on to find out.

From most any screen in the system, you can pull up a patient’s demographic information.  Here we see the demographic entry screen for Daffy Duckworth.

At the bottom of the screen, you see the place to add a patient’s insurance information.  Press the yellow plus “Add” button. Once that button is pressed you will be taken to the “Select insurance group by company” screen (See below)

Here’s where things get interesting.  From this point, you need to make sure 5 key pieces of information are entered correctly to ensure that the process is followed:

1. Insurance Company Name
2. Address
3. Group Number
4. Copay
5. Subscriber ID

1. Insurance Company Name

You want to look at the card to make sure you have the correct company name.  The back of the card sis a great place to look if you are confused.  Look for a spot that says “File Medical Claims To:” and that will generally give you the insurance company name.

2. Address

This is where we start to lose some folks.  You need to make sure that the claims address on the back of the card MATCHES EXACTLY WITH WHAT IS IN THE SYSTEM. (See screen shot below) Yes, we even want the 4 digit zip code extension to match.  If it is not on the screen, (and you’ve double checked by scrolling up and down in the top section) then you can create a new insurance company (Separate topic for another day). Click on the company with the correct address.  The line should turn blue.

3. Group Number

Once you have selected an insurance company you will look at the bottom of the screen.  There should be some group numbers associated with the insurance company unless you have just created the insurance company from scratch. (See image below)

Here we can see a few of the group numbers associated with this insurance company.  You can see more by using the slider on the right side of the window.  **DANGER WILL ROBINSON: THIS DOESN’T SHOW YOU ALL OF THE GROUP NUMBERS FOR THIS INSURANCE COMPANY. You need to use the search function to find the group number BEFORE you create a new entry.  Type in the group number from the card into the “Group Number” section at the bottom and then click on the “Search” button to the right.  If the group number already exists, it will appear at the bottom.  I can’t tell you how many practices we’ve gone into and seen multiple group numbers with the same copay amount in the system.

Back to our screen, we should be seeing the group number for which we have typed in and searched.  DON’T PICK THE FIRST ONE YOU SEE!!! 

4. Copay Amount

This step is the one that get most practices in trouble.  In a typical scenario, the front desk person just uses the slider (like we know NOT TO from the previous step) and can’t find the copay.  What we want to do is look for the group number that matches our card AND has the same copay amount that is listed on our card.

**KEY POINT:  YOU CAN HAVE THE SAME GROUP NUMBER AND DIFFERENT COPAY AMOUNTS.

Does that make sense?  Think about it, most employers allow their employees to choose what plan they want: Higher or lower deductibles, higher and lower copay amounts.  All the employees are still under the same group number that is associated with the employer.

Back to our screen, we want to make sure that the group number is correct and that the copay amount matches what is on the card.  If we have searched and see that the copay amount on our card is not in the system, we then can enter a new copay by clicking on the “New” button beside the “Group Description” box in the lower third of the screen.  (See screen shot below)

A new screen appears. (See screen shot below)

The key here is to put in the group number correctly.  Take your time and re-check before adding your copay amount and hitting “Save”.  This takes you back to the previous screen.

If you created a new copay for a group number or you selected one from the already existing ones, you should have a gray line on the insurance company you chose at the top and a blue line over the group number you chose at the bottom.  Hit “Select” (green check) at the top of the screen.  This will take you to a separate final window.

5. Subscriber ID

In the “Insurance Maintenance” window that is now open (See screen shot) you will need to put in 5 pieces of data:

1. Policy number
2. Policy holder
3. Relationship to the Policy Holder
4. Effective Date
5. COB Indicator

1. Policy number (Red arrow)

Rule of thumb: All caps, no spaces, no dashes

1. Policy Holder (Orange arrow)

This information may not be on the card.  You will often need to ask who that person is.  If the policy holder is not in the system already, you’ll need to add them by clicking on the blue plus and add them.

1. Relationship to Policy Holder (Green arrow)

This will be the patient’s relationship to the policy holder.  The answer is self, child, or spouse in 99% of the cases.

1. Date Effective (Blue arrow)

This is often listed in the corner of the card somewhere.  If it is there, then it’s a great idea to enter it. This will be of tremendous benefit to your billing team if they need to track down denials.

1. COB Indicator (Purple arrow)

This information is used to let your billing tem know if the patient has a secondary insurance policy.  If they do, choose the secondary insurance from the list given.  IF they don’t have a secondary, select “No other insurance”

Once all of that information has been entered and double checked, hit “Save” in the upper left corner and you have put in the correct insurance information for your patient!  Of course, this technique is the basic entry process.  There are other fields that can be used, but this is meant to be an overview of best practices.

If you have any questions on this, or any other billing issue while using the e-MDs® software, we’d be happy to help.  Simply click on the contact form below.

Solor is a specialized third party medical billing company for e-MDs® Practices.  e-MDs® is a registered trademark of e-MDs Inc.  e-MDs Inc. is not affiliated with Solor, Inc., our products, services, or website.