Examples > Wellness ERP System > 102.8 -
Health Insurance Billing - A/R - Payer and Patient
Health Insurance Billing may be the most dreaded Accounts Receivable applications in the United States. If you don't fear the billing process, you should definitely fear the software that has been created by others to try to manage it... The process is bad -- the software is aweful.
We spent months and months mastering the reading of EOBs from a provider perspective -- and then we spent months and months try to master one of the software solutions for Billing, EOB Reconciliation, Invoicing and Receivables -- and then we spent months coming up with a spreadsheet based system for handling all but the initial billing and our solution is pretty slick and pretty simple.
We have played with a lot of one to many relationships in non-relational db ways that make this work in a simple manner, but it was worth the hacking.
We spent months and months mastering the reading of EOBs from a provider perspective -- and then we spent months and months try to master one of the software solutions for Billing, EOB Reconciliation, Invoicing and Receivables -- and then we spent months coming up with a spreadsheet based system for handling all but the initial billing and our solution is pretty slick and pretty simple.
We have played with a lot of one to many relationships in non-relational db ways that make this work in a simple manner, but it was worth the hacking.
1 - Insurance Patient Visits 0
Somehow, some way you will need to get a list of patient visits to be billed. There are numerous ways to do this. Ultimately that list needs to be entered into this worksheet. You will then use this spreadsheet as your list for data entry into your EDI billing software, and you will note the claim create date in the final white field.
When done, you will manually cut and paste this info into your Insurance Patient Visits Tab.
When done, you will manually cut and paste this info into your Insurance Patient Visits Tab.
2 - Insurance Patient Visits
This view contains all information relevant to an outstanding EOB and/or invoice. Getting all of this on one screen, in a small enough area that it was not overly overwhelming was tough but after 4-5 iterations we landed at this and generally speaking it should work for many users (and of course it could be modified if needed).
3 - Insurance Patient Visits Archive
Once a visit has been billed, an EOB has been returned and payment has been received, the visit status changes to closed. This is automated in our current system but making it manual is also an option if problems arise or more functionality is added. When the record becomes closed, you will manually cut and paste those records into this archive. We could automate that, but why take the risk? It's just a ctrl-x and a ctrl-v and it leaves you in full control of this process...
4 - Billing Statement Ledger
To create a billing statement of current balances due (and only for those where EOB's have been returned with amounts known), you create a header record in this data table and you set the status to Queue (as in print queue).
5 - Billing Statement
The next step is to go the billing statement tab and select a Patient Name from the drop down... and only those with header records in the queue will show up. Once you select that, the invoice will be populated with Patient Visit records and you are ready to print.
6 - Search Insurance Patient Visits
This will search both active records and closed records.
7 - Dashboard
We do have a dashboard for tracking EOBs and Patient Visits various ways.
Summary
Only those with Health Insurance Billing A/R experience will truly appreciate what has just been presented.