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Entering an Insurance Payment from the Patient Account

Version 14.19
Path: Clinical, Billing, or Practice Management tab > Patient Chart button

Overview

Claim payments received via EOB can be posted from the Patient Chart.

  1. Navigate to the Patient Chart using the path above.
  2. Search for and select the Patient.
  3. Click Payments in the Window Navigation panel.
  4. Click the New Payment button. The Add Payments and Adjustments window is displayed.
  1. Enter the following information:
  • Date- Defaults to the current date the payment is being posted. 
  • Pay method- Method the payer used to remit the payment. Select the method of payment, EFT, Credit Card, etc. from the drop-down menu.
  • Check/Ref# - Payment identification or reference number that will be used to balance your payments at the end of the day.
  • M- Memorizes the check number that is entered. 
  • Ck- Reuses the last memorized check number.
  • Memo (optional)- Used in offices to identify a specific remark on an EOB. It is displayed on the patient's individual claim in which you are posting payment to. It is not displayed on an correspondence sent to the patient.
  • Amount- Populates as you add payments into the payment fields.
  • Claim note- Used to view a claim note on the claim that you are ready to post against or to create a new note for the claim. To create a follow up task for the claim, click the Task button  
  1. Post the EOB information in the Adjudication Details section of the window: the Payment Amount, Allowed Amount, Patient Responsibility, Insurance Adjustments, and Adjustment Reason. The claims are grouped together by OP claim number with the charges displayed below the claim. Click the plus sign or minus sign to the left of the claim number to expand or collapse claims you are not working on.

  • If a contract has been set up in OP, and the amount in the Allowable field matches the EOB allowed amount, click the Green checkmark button to the left of the Allowed Amount field. The Pay Amount field populates with the appropriate insurance write off.

  • If there is not a pre-populated amount in the Allowable field (or the amount differs from what populates), enter the allowed amount from your payer in the field and press Enter on your keyboard.
  • If the insurance has determined a total charge amount to be the patient's responsibility, click the Patient Responsibility button.

  • OP calculates the Adjustment amount based on the amounts in the Allowable and Pat Resp fields. 
  • Select the appropriate Patient Adjust Reason (reason for the patient being assessed a responsibility) from the drop-down menu.
  • Select a Patient Action from the drop-down menu to determine how to handle the patient responsibility. If no reason is selected, Hold on Account is selected by default and the balance remains until statements are generated. The Patient Action options are:
  • Hold on Account: The default option. The balance will be held until statements are generated.
  • Create Statement: A statement is automatically sent to the Statement Queue.
  • Autopay with PC: The balance is automatically paid with the patient credit.
  • Autopay with PC + CC (Instamed Merchant Services Only): The balance is paid with a combination of patient credit and the credit card saved on file. This option is only visible if a credit card is saved on file.
  • Autopay with CC (Instamed Merchant Services Only): The balance is paid with the credit card saved on file. This option is only visible if a credit card is saved on file.
  1. Click Save + Close button once you have all of your adjudication details posted. 
Version 14.10
Path: Smart Toolbar > Account button

Overview

Learn how to post payments from the Patient Account.

When you are ready to proceed with EOB posting from a paper EOB:

  1. On the OP toolbar, click the Accnt  button.
Keyboard Shortcut
The F12 key on your keyboard can be used to access the Patient's Account.
  1. Search for the Patient in the search field.

  1. Click the Payments button.
  2. Click the Plus Payment   button. The Add Payments & Adjustments window is displayed.
  3. When posting EOBs, enter the following information:
    
  • Date- Defaults to the current date the payment is being posted. 
  • Pay method- Method the payer used to remit the payment. Select the method of payment, EFT, Credit Card, etc. from the drop-down menu.
  • Check/Ref# - Payment identification or reference number that will be used to balance your payments at the end of the day.
  • M- Memorizes the check number that is entered. 
  • Ck- Reuses the last memorized check number.
  • Memo (optional)- Used in offices to identify a specific remark on an EOB. It is displayed on the patient's individual claim in which you are posting payment to. It is not displayed on an correspondence sent to the patient.
  • Amount- Populates as you add payments into the payment fields.
Note: Some insurance payers have issued credit card payments to providers, if this is a situation for your office, select Credit Card from the Pay Method drop-down menu and input the details on the right side of the screen.
  • To the far right of your screen, there are insurance details from the patient's insurance record(s).
  • If you are posting a payment and there is a patient responsibility as you are posting, you can create a statement for the patient after your save your insurance payment. You can select a Statement Type. You may select a statement to print of any outstanding Insurance and Patient responsibility, or just strictly Patient responsibility only.
  • The Claim note field allows you to view a claim note on the claim that you are ready to post against.
  • To create a follow-up task for the billing office to follow up on a claim at a later date, click the Task buttonThe Task button can be used to create claim follow up reminders for today or a future date.

You will post insurance payments under the Adjudication Details fields.

  1. Click the Plus Sign or Minus Sign  to hide or show claims you are not working on. Please Note: Claims are grouped together by OP claim number, then charges are displayed below the claim.

  1. In the Adjudication Details section, enter the following:
  • Payment Amount
  • Allowed Amount
  • Patient Responsibility
  • Insurance Adjustments

  1. Enter the Allowed Amount in the Allows field (working off of your Explanation of Benefits). If a contract has been set up in OP, and the Allowed amount matches the EOB allowed amount, click the Green checkmark to the left of the Allowed Amount field. 

The Payment Amount field populates with the appropriate insurance write off.

  1. If there is not an allowed amount populated in the Allowed Amount field (or the amount differs from what populates), enter in the Allowed Amount from your payer and press Enter on your keyboard.

  1. Select the Patient checkbox if the insurance has determined a total charge amount to be the patient's responsibility. OP calculates the Adjustment amount based on the amount in the Allows field and the amount in the patient responsibility field. In the example below, the $10 copay has been entered and noted as a co-payment.

  1.  Select the appropriate Patient Adjust Reason from the drop-down menu.

  1. Select a Patient Action from the drop-down menu. If no reason is selected, a default of Hold on Account will be understood and the balance will remain until statements are generated. 

  • The Patient Action options are as follows:
  • Hold on Account: The balance is held until statements are generated.
  • Create a Statement: A statement is automatically sent to the Statement Queue.
  • Autopay with PC: The balance is paid with the patient credit.
  • Autopay with PC + CC (Instamed Merchant Services Only): The balance is paid with a combination of patient credit and the credit card saved on file (only visible if a credit card is saved on file).
  • Autopay with CC (Instamed Merchant Services Only): The balance is paid with the credit card saved on file (only visible if a credit card is saved on file).
  1. Click the Save + Close button.