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Charges Module - Medford Medical Systems

1. Fil Order Empire BCBS 8009922583 20 00 343243242 TAB 1 Charges CPT Modifiers Select the applicable modifiers from the drop down lists up to 4 CPT Amount After entering the CPT code the CPT amount should default based on the individual CPT fee schedule An amount may be entered manually in this field A message will appear as you finalize the charge if you are entering a zero amount of Units Enter the number of units that should be billed for this charge Consecutive Days Use this field when the same service was provided for the patient several days in a row The system will automatically add the correct date range on the claim form Use the of Units field above to make sure the correct amount is billed Anesthesia Enter the hours and minutes that should be billed if this in an anesthesia charge Total Price The total price will default based on the CPT amount and the units days or anesthesia hours min Print on Insurance Select the method that this charge should be billed Electronic to file the claim electronically No to not file the claim to any insurance company or Paper to file the claim on a hard copy claim form Assigned Click Yes or No to accept assignment The system will default with the information that the patient s insurance file has in it set in the patient module This option may be modified per charge as needed Bill Resp Party Click yes or no If clicked yes this option tells the ins
2. If posting a denial select the appropriate denial code from CO 10 The diagnosis is inconsistent with the patient s sex the drop down list in the col CO 100 Payment made to patient insured responsible party z Ahana W umns Denial Code1 and if CO 101 Predetermination anticipated payment upon completion of services i c0 102 Major medical adjustment needed Denial Code2 There CO 103 Provider promotional discount L e Senior citizen discount IS also a Denial Comment field CO 104 Managed care withholding hd Deductible Amount Next Insurance Plan NONE Beg Date B to End Date B pes By I Descending Order P Show Family Charges el amount V Open Charges Only Show Applied Amounts Only icy Date of Service in Show Unappl ed Credits 0 00 Left to Allocate In the charges window each separate billed charge is listed according to the date of service This can be changed to sort by charge amount or CPT code To review the charge as it was billed double click on the line item you are interested in and the charge will open in the Charges Module Date Date of Service CPT Code The billed code and description M1 The primary modifier as it was billed with the charge is listed here PR Payment Responsibility will be listed as it was billed For the primary insurance it will be listed with a PRI secondary insur ances are listed with a SEC and the responsible party is listed as RP
3. Adler Stephen m ew lt Wed Nov 28 2007 D gt w gt M gt Chk In Chk Dut a November 2007 View Provider Resource Multi See gles BE Location Day Week 4 5 6 f bi 4 10 z 1 i 3 4 5 17 Next Confirmed see Sel Eaa Print Superbills Print Sched DSB E 1 20 21 22 23 H 25 26 27 4289 29 30 1 Find Pt Export To Reminder Chg l 2 3 4 5 amp 7 amp Move Appt No Show Annt Outlook Print Reminder Letters Ean No Of Pt Appts 5 3 Today 1128 2007 Below you will find more detailed explanations of the above buttons and their functions Adler Stephen e After selecting Provider Resource or Multi select the appropriate choice from the drop down list Provider Resource Multi P lt M cw lt D CARTET w m e The date in view can be changed by Month Week or Day simply by clicking the left lt M lt W or lt D to go back and gt D gt W gt M to go forward Chk In Chk Out e When a patient checks in before an appointment and checks out after being seen you may find it helpful to indicate such on the schedule shite defaut ry By checking the box to Yes this will allow you to override the default schedule informa sched Info tion as it was set up by the system administrator To permanently change the schedule format see Schedule Set Up mee Te O era Day View or Week View will change the way
4. Charge Amount The amount billed for this particular code Other Credits The amount previously paid on this particular code Allowed Amount If the insurance has specified an allowed amount it should be entered here Apply Amount The amount to apply to the charge 2nd Adjustment The second adjustment to the charge Co Insurance The amount due by the secondary insurance as specified by the primary insurance Co pay The amount due by the patient or responsible party that is considered their copay Deductible This is the amount due by the patient or responsible party that is considered their deductible Auto Apply Checking this box applies the full amount still due on the charge from the total amount of the payment without having to manually enter the amount File Next Checking this box sets the charge to file to the next insurance company Bill Patient Checking this box sets the remaining amount to bill to the patient responsible party Balance This field changes as you complete the previous colugyis showing the remaining balance of each charge Al MBA Adjustments Patient Adjustments for 7576 Kenneth Wayne Maxey DOB 017 2571973 SSM 123 253 1234 CHART NO 3243 DR ID 1 Date 127472007 pi Batch 070c111507en 44 Add Edit Print Receipt Nest Pt 7256 a Save Add Edit Adi Desc INSURANCE ADJUSTMENT SecondAdi INS wRITEOFF Denial Code DUMMY DENIAL AddAnather Cancel Pat B
5. Hoe Phone Rakes Line 1 FO Contact 23 AO MBA Make Appointment MBA Yersion 4 9 06 Established Patient Step 5 Once the correct patient appears in the window you have the op oo BEE tion to update the patient s PatientID 7628 j j j City State Zip Miami FL azar information using the f a amp Miami Update button 1 55N it Contact Information View other appointments en Home Phone 318 y 555 057 1 ate in the Other Appoint _Update Business Phone g 564 555 5584 ments window 2 Patent Information Last Hame bareu Hailing Address Address 1 200 Gator Drive Address 2 FO Click Make Appointment 3 This will take you to the appointment info win PP 2 1 14 2008 10 00 00 AM Hosp Labs Only dow 12 10 2007 9 75 00 4M Consult 3 Hake Appointment Once the Update button is clicked the fields will open up as shown below allowing changes to be made MBA Yersion 4 9 06 Established Patient Patient Information Last Hame IM axel First Mame Kenneth Patient ID 7 629 Birth Date Month n Day 25 Year 1973 Age 34 SSN 111 f1 fi OF Cancel Mailing Address Address 1 200 Gator Drive Address 2 City State Zip Miami FL 32423 County Duachitd Contact Information Home Phone i318 555 a 057 Business Phone 564 555 5584 Click OK to sa
6. Mumber OF Days History On Superbill 2nd Page Change Superbill Type On Print Print Patient Registration With Each Superbill Mo Print Pt Owed Bal Only On Routing Slip Suppress Billing Comments on Superbill Warn user iF patient is scheduled For different doctor his primar Save Cancel Include rescheduled and no show in Appt Hist Iv Yes 19 al MBA Scheduler Options Below is an example of the second page of a routing slip with 30 days of history Jeffrey Honig PT ID 7937 DE 1 defleyeooy DR 1 11 19 2007 DR 1 Lll fle f lt 4007 CURRENT MEDICATIONS ALLERGIES DRUG REACTIONS PATIENT ALERT None BILLING NOTES None COHMENTS DOE FROM PATIENT DOE FROM INSURANCE TOTAL DVE CONTROL Wo 170 RECENT CHARGES AND DIAGNOSIS RECENT CHARGES IN FAST 30 DAYS Office sfop Visit Est Ft Eey ComponenssZzl3 210 00 Postoperative Follow up Visit Include 359024 0 00 Postoperative Follow up Visit Include 359024 0 00 RECENT DPIAGNOSIS IN FAST 30 DATs TRIGGER FINGER 727 03 0 00 3 182 00 23 182 00 MBA Yersion 4 9 06 Program Options Save Cancel 1 General 2 Transactions 3 Claims 4 SchedulerSuperbills Include Mon Ft Appts On Schedule Report No Allow Past 4ppointment Save Iv es Routing Slip 2nd page Iv Yes Number OF Days History On Superbill 30 znd Page Change Superbill Type On Print No Print Patient Registration With Each
7. Cardholder Information Relationship First Middle amp Last Mame lane Kris Address 1 Address 2 City State Date of Birth Employer Sipi Spouse Same s Patient Doe fi 000 Dove Avenue Medford H fi 0015 02 01 11976 a JEX Female Self employed A MBA Add Insurance Info 0 Patient Insurance File Utilities Help Patient Insurance Information Cancel 2 Comments LGenera 2 Comments 3insCardSide1 4lnsCardSide2 SilnsCardSide3 BilnsCardSided Thieieauserdeined eld in p which the user can enter any information associated with the insurance Created by MMSEWH Created 11 14 2007 7 40 18 PH Modified by MHSEWH Modified 11 14 2007 7 40 18 PH Patient Insurance File Utilities Help Patient Insurance Information 3 Insurance Card Side Cancel 1 2 3 and 4 LGenera 2Comments SinsCardSidel 4insCardSide2 SinsCardSide3 6 lnsCardSide4 Scan Tabs 3 4 5 and 6 are used for scanning and storing the patient s in surance card s images 15 AD M A Schedule Set Up w MBA Yersion 4 9 06 Schedule Appointments Schedule Set Up ALL DOCS Before utilizing the MBA January s 2008 Scheduler the system ad zl Hon E Wed Fri Sat Stephen Ader Maureen E Veronica B Anjani K Renee E inistrat t first set 1 2 B 4 B Brogan Delane Dube Garrick argietara tte TTT o schedule set up option Pep Sep e Viehael D PT B Click the
8. FE Last Ins Frnt Hot Found 0 00 Allergic to Penicillin Statement None Created by MMSEKWH Created 12 24 2007 10 15 21 AM zl Modified by MHSKWHM Modified 12 24 2007 10 15 21 4AM 64 File Modules Maintenance File cm Medical Billing Assistant MBA ersion 4 5 06 Fie Modules Maintenance Reports Utilities Help Select the Practice you would like to work with Cancel D nmnnnsnnnnneel D cmmpmmmnmnmmiinnnnnnniiiinnnnnnnsinnnnnneee BE Bw DAL IP UC DEMO Goldberg Nephrology IDEAL Nephrology Use this drop down menu to Open another practice or to exit MBA ALT F will open the menu and then O will open the practice list A quicker shortcut is to use the F12 key ALT X will close MBA Medical Billing Assistant MBA File Modules Maintenance Reports This drop down menu shows the Function Key shortcuts for Patients Charges Adjustments Review Billing Schedules Report Manager F7 Maintenance Reports Utilities Practice File Accounting Months Batch 5 Facilities Insurance Companies Primary Doctors Referring Doctors Patients Procedures d Diagnosis CPT ICD 9 Pairs Adjustment Types Denial Codes Fee Schedules Claim Forms EGB b Master Tables view only zip Codes Electronic Submissions each module as well as the ALT Letter shortcuts For Patients use the F1 key or ALT P For Review use the F4 key or
9. 2 Refresh 3 27 28 29 30 3 1 2 3 4 5 6 7 8 0 1 12 13 4 15 4 17 18 19 20 21 22 23 24 25 26 27 28 29 30 311 2 3 4 5 6 SS Today 1142842007 _D gt wo M gt Chk In Chk Out z ia C Week Place Of 11 DCI Bradhurst Dialysis Clinic Inc Outpt Phelps Memorial Hospital Center X 49 FA ny a a ae 7 7 m z3 z HHHH HH x loo x SERERRRRRRRRRREE Selecting Day View or Week View will change the way ap pointments are viewed in the window Any time slots marked OFF in schedule set up will not appear in either view of the schedule You can use the over ride default sched info to make changes or as shown to the right use non patient appoint ments to block of spe cific time periods 22 DR DR DR D DUBEY GARRIC KLEIN pi Transplant Office M Westchester Artificial Kidney Center 1 1 Westchester Artificial Kidney Center Day View Westchester Artificial Kidney Center Step 3 Upon arriving on the appropriate date Westchester County Jail Office 11 Westchester County Jail Outpt 22 Westchester Medical Center DCI 65 4 double click on the time slot the appointment should be in Or to select a larger time slot click on the beginning time and drag the cursor down to the end time as shown in blue in the Nurse column to the left Then click Next The Day View o
10. MEDICARE ns 6 Bea eaa sowo masa Eec Neee o e O O ea SSS Cho s3010 RPG s053 sms saw Den MEDICARE PWT MEDICARE EMPIRE PWT me __ waaay O pva SMALL BALANCE WRITE OFF a RP OOO O eat SSCS Bea Show Changes By M Show Changes M Show Payments I Descending by Date Sort By Patient g C Insurance f Patientf Both M Show DebitAd I Show Credit Adi T Open Items Only End Date Lal M Show Denials I Show Applied Detail Show Deleted Chgs Delete The delete function is useful when a batch is still open and a charge has been posted or a payment has been posted incorrectly It can simply be deleted by first selecting it and then clicking delete If the charge has a pay ment posted to it or if the payment has been applied to charges the Delete function is not recommended Show Charges By M Show Charges MM Show Payments iW Descending by Date Sort By Patient Insurance Patient Both PA Show DebitAd IM Show Credit Adj Open Items Only M Show Denials I Show Applied Detal Show Deleted Chas By checking the appropriate boxes the order in which the transactions are viewed in the window can be changed If you only wish to view the open items or if you would like to view any charges that have previously been deleted on the account it can be specified here In Show Applied Detail view you are able to view the charge with all as sociated adjustments and payments Beg Date El To only view transactions within a certa
11. 0 00 40 00 Tab 2 New Payments Adjustments This window lists all the previous adjustments and payments Nothing can be changed or edited it is simply for a quick refer ence It shows the adjustment date adjustment type payment type Check Auth Number Adjustment Amount Amount Ap plied Amount Remaining and any comments Tab 3 Comments This tab allocates space to be used for comments associated with the posting of this adjustment Also any patient alerts may be viewed here The last insurance or patient payment date and amount are listed at the bottom of this tab for quick reference Also stamped is the MBA user ID of the person who created and modified the adjustment along with a date and time Patient Adjustments for 7578 Kenneth Wayne Maxey DOB 01 25 1973 SSM 123 253 1234 CHART NO 3243 DR ID 1 Date 12714 2007 El Batch AD 122407 KM 46 Y Add E dit Print Receipt _ Nest Pt oar Save Add Edt AdjDesc INSURANCE ADJUSTMENT Second Ad INS WRITEQFF Denial Code DUMMY DENIAL Add Another _ Cancel Resp Party SELF 1 Ins Plan Empire BCBS Pat Balance 40 00 Payment Type Credit Card ChecksAuth 2341 2344 8578 2342 Ins Balance 40 00 Total Amount s0 00 Running iv Provider Prov Of Chg Adler Total Balance 0 00 Total 1 Charges 2 New Payments Adiustments 4 CCl Edits Date Amount Last Fat Fmt Hot Found 0 00 Patient Alert YIM 7 M
12. Call support for more information Unusual Position Future enhancement Call support for more information Anesthesia Number of Procedures Enter the number of procedures performed while the patient was un der anesthesia Patient Alert If there is an existing patient alert it will be listed here Otherwise check the patient alert box and enter your comments in the field provided 1 Charges 2 Additional Data 3 Doctors amp Comments 4 Other Charges 5 History TAB 4 Other DateOiSeni CPT Code CPT Desc TotalPrice Pri Diag Post pfrom Postplo Provider FacililyName Charges 10 37 2007 Influenza Virus Vaccine 12 06 YUST Octal 2007 Stratilatova Marpa Bradhurst Office 10 31 2007 90772 Administration Injection 22 45 VO4ES1 Oct 31 2007 Stratilatova Mariya Bradhurst Office 10 24 2007 50200 Renal Bx Percutaneo 20 00 paN 4 Oct 24 200 4 Delaney Yeronica B Westchester Medical Cen This point of refer 10 23 2007 99214 Officeop Visit Est Pt 30 00 555 4 Oct 23 2007 Delaney Veronica B Bradhurst Office ence lists the other charges billed on this patient s account BegDate 8 1 2007 El to End Date 1 30 2008 El I Descending by Date J A 1S AO M A Charges Module che Finalize FINALIZE Choose this option to finalize the charges on this patient The system will allow the user to check m all the charges added to the account before accepting or finalizing in the charge summary window O
13. Chg No Show ESk Print Reminder Vetters Font maj April 2008 Close 30 31 1 2 3 5 Refresh 6 7 8 9 0 n 1 13 4 15 16 A7 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 Provider Resource Multi ove Appt ail No Of Pt Appts 1 SD Today 1112812007 oO i e TITLE 3 mant Appointment 2 m 9 A uo m 3 BLOCKE _ _ i 3 f 3 j E j E j i i j i j E i i i i i E j j roo k c z 12 45 pm l l Dr Cxld Copy Appt Prnt Spreill Edit Pt Info Kenneth Maxey 7626 313 555 1057 564 555 5534 Home Phone Business Phone Waiting List for Earlier Appt D MBA ersion 4 9 06 APPT INFO Kenneth Maxey 7623 DOB 17 25 1973 55M M A CHART NUMBER NA File maj mj m Ej mj m mj mj i Ft esc Ft Cxld Dr Resc Dr Cxld Copy Appt Frnt SprBil Frnt Remd Chart Reg Pt Track Lol Error Delete SAE Cancel i ay Kenneth Maxey 7628 EeIeEE Into stephen Adler MD From Time 5 45 AM Home Phone 318 555 1057 Thu Apr 17 2008 l Business Phone 564 555 5584 Waiting List for Earlier Appt Add Sub To Time 10 00AM Sched ame Reason Consult Add Edit Comments ra El Resp Party SELFA Place of Svc Po Ref Doc fo Add Edit Incident 10 O r Add Edi Pre Guth a visits Remaining zn iz 2 Addetl Det Y S Privac Prot Typ
14. Copy appt tion to a different time When using this feature in conjunction with the reschedule option it ig best to copy the appointment before clicking reschedule as the reschedule option deletes the appointment from its time slot Print Superbill This function will print superbills for all patients in the current schedule Prnt SprBill view Print Reminder This function prints a label from a label printer that contains the patient Frnt Remd Name physician name and the patient s future appointment dates and times It can be used to stick on the back of a business card and given to the patient as a reminder of his her next appt with the doctor Chart Request This function is used to send a chart request to the chart room and used for chart Red the program to track which doctor has the chart E Patient Track Label This function prints labels that include the provider s name patient s Pt Track Lbl name chart number patient ID number date and date of birth of the patient m Error Delete This button allows you to delete the appointment without using the doctor or Error Belete patient canceled buttons 2 Are you sure that you want to delete this appointment and mark it as being created in error and deleted _ Save This will save the appointment and close the appointment window Cancel This will close the appointment window without saving the appointment in view Cancel 29 A MBA Schedule Functions _
15. INCIDENT DATE List the date of the incident or first date of service DATE TYPE Choose the date type that best describes the incident from the drop down box Accident Date Date of first symptom of illness Date of Last Menstrual Period INCIDENT CODE Choose the code that best describes incident from the drop down box Accident Auto Acci dent Other Accident Employment Accident Tort Liability Crime Victim Elective Illness No Fault Accident Normal Pregnancy Surgery Third Party Liability Workman s Comp ACCIDENT STATE Choose the correct state abbreviation for the state in which the incident occurred PRE AUTH Enter the pre authorization number obtained from the insurance carrier for this incident AUTH EXP DATE Enter the date when the authorization number expires for the patient for this incident DOCTOR Enter the name of the physician seeing the patient for this incident VISITS REMAINING Enter the number of visits remaining for this incident if applicable DESCRIPTION Enter the description that can be used for this incident so that it is easily identified for future use UB 92 INFO When billing on UB 04 claim forms fill in these fields accordingly Occurrence Code Dates Condi tion Codes and Value Code Amount LOAD DEFAULTS Used for UB 04 billing and preset by the system administrator SAVE OR CANCEL Save the information by clicking on Save or ALT S or cancel the information by clicking on cancel or ALT C 47
16. bring the user back to the patient look up screen to find the next patient listed on the voucher Add Another Choosing this option will save the information entered and allow the user to add another payment to this patient s account without going through the patient look up screen again Next Ins Plan In the case that the patient has a secondary insurance and the option to file next has been checked the next insurance plan will be listed in red in the lower left hand corner 63 al MBA Adjustments id Patient Adjustments for 7578 Kenneth Wayne Maxey DOB 01 25 1973 SSM 123 235 1234 CHART NO 3243 DR ID 1 Date 12714 2007 l Batch H ADJ 122407 KM 46 Add Edit Print Receipt ext Pt pared Save Add _Edit AdjDesc INSURANCE ADJUSTMENT SecondAdi INS WRITEQFF Denial Code DUMMY DENIAL Add Another Cancel Resp Party SELF 1 Ins Plar Empire BCBS Fat Balance 40 00 Payment Type Credit Card Check Auth 2341 2344 8578 2342 Ins Balance 40 00 Total Armour 80 00 Running F Provider Prov Of Chg Adler Total Balance 0 00 Total Adjustment Payment Check 4 amp uth Adiustment Amount Amount TE 12 14 2007 DUMMY DENIAL Empire BCBS Credit Card 2341 2344 6 0 00 0 00 0 00 ee ee ef 14 2007 INS WRITEQOFF Empire BCBS Credit Card 2341 2344 S 50 00 50 00 0 00 12 14 2007 INSURANCE ADJUSTMENT Emp Credit Card 234 2344 8 40 00
17. ing slip if the 2nd page is set to print under program options You can exit this screen by clicking Save or Cancel If you click Save you will be notified if there are required fields that must be entered prior to saving One such figd is found in Tab 2 Billing Primary Doctor AO M A Add Patient Info 0 New Patient File Modules Utilities Help 7 Fi Middl poet itle irst Name iddle Name Last Name Generation Next Pt Save Cancel Print Chart Label ar Print Patient Primary Doctor Add Edit Pis dis Registration Standard Release El Referring Doctor Add Edit of Info Signed Print ad Sli Prim Care Dr x4 Privacy Alert V N No a Billing Cycle 30 Days Bad Debt Collections YIN No Suppress OverDue Notifications N No Suppress Interest Charges YIN No Driver s License State Biling Comments Print Chart Label This button prints a chart label for this patient Print Patient Registration This button prints a demographics sheet Print Routing Slip This button prints a routing slip listing this specific patient s demographics at the top 2 Billing Select the Primary Doctor Referring Doctor and Primary Care Doctor from the drop down lists You may use the Add or Edit buttons to add or change the primary doctor or referring doctor s information Once Primary Doctor is en tered you may save patient record and go back in at a lat
18. to be moved to The new appointment should appear Confirmed Confirmed When a patient confirms an appointment it is easy to update your schedule simply by selecting the appointment and then clicking on the Confirmed button This will then indicate it is confirmed with a CON before the patient s name No Show No Show If a patient fails to show up for their scheduled appointment this information can be recorded by selecting the appointment and then clicking on the No Show button This indicate it is a no show appointment with a NS before the patient s name Next Avail Appt Next Available Appointment Find Next Available Appointment This function allows you to search Provider F Resouce a for an available appointment time based on the criteria you enter in Provider MEAE Al T Cancel the search window Select the Start Date eZ 12972007 THU C lt M lt w lt D D gt w gt Mp saved appointment slot then click Next Avail Appt Search using Ts BB oats EN u the time needed for the appoint Time Frame Hn a Tr EE m ment in time slots selected days From Thursday V of the week or minutes Search e ft ae E using a needed time frame or Sunday E search between the columns Find PtAppt Find Patient Appointment To search for an appointment that a patient already has scheduled click on the Find Pt Appt button This will bring up the patient search window Upon locating the patient the
19. 10 days Monthly E Amourit 120 00 In the space provided enter all comments associated with this contact By what Date fi 2 20 2007 Resolved Date If during this contact a promise to pay has been made check the box enter the amount and date it should be paid If monthly Created by MMSKWM Creed 12 10 2007 11 44 09 payments were promised Modified by MMSKWH Modified 2710 2007 11 44 09 click monthly aa 41 MB Review Module MBA ersion 4 9 06 Review Pt Acct for 7578 Kenneth Wayne Maxey DOB 01 25 1973 SSN 123 23 1234 CHART NO 3243 DR ID 1 B Review ACCT PRI DOC INFO NOT FOUND PrimaryD actor Print Edit Demographics Next Pt Save Herp Eat z Bins YJ Include Family Charges D Cancel 1 General 2 History 4 Ins Info Incidents 5 Stmt Hist 6 Contact Hist 8 Claims Cr 7 Patient Docs This tab allows documents to be linked with the patient s account EOB s and other correspondence can be scanned in saved and linked with the associated patient s account Click Add to add a new document or edit to edit an existing document De lete will delete the highlighted document in the window Launch will open the saved document for review or editing Description Type File Created Category Test Document 12 10 2007 10 57 20 Ak Patient Response Letter Tf Patient Letters 2 10 2007 1 Add Edit
20. AO MBA Charges Module 9 Charges MBA Yersion 4 9 06 Patient Charges ADD MODE for 7576 Kenneth Wayne Maxey DOB 01 25 1973 SSM 123 23 1234 CHART NO 3243 DR ID 1 Batch 7D11 14 07cmacdonald 42 Add Edit Place of Serv Hospital Center MBA ID 3 gt Add Edit Admitted Incident ID Add Edit Dr of Service Adler Stephen Add Edit Discharged Resp Party SELF 1 Referring Dr Abouezzi Ziad Add Edit sd Pre Auth Visits Remaining of Fee Schedule STANDARD FEES 1 Charges 2 4dditional Data 3Doctors amp Comments 4 Other Charges Date of Service fi 2 17 2007 E Add Edit Search Add Edit Search CPT Code Desc Diagnosis 1 Reorder CPT Modifiers A AA A CPT Amount 30 00 0 Print on Insurance Electronic gt of Units fj Assigned Iv Yes eee Bil Besp Party J No ames HZ Anest FromTo iat pies 30 00 Charge on Hold f No Finalize Cancel Add Another Patient Insurance Information Fil Order Insurance Flan Name Fil Order Empire BCBS BO0g922585 0 00 20 00 343245242 RESPONSIBLE PARTY Choose the correct responsible party for the services performed PLACE OF SERVICE Choose the correct place of service The correct POS number will be preset by the system admin istrator or other with access The Admitted and Discharged fields will appear when the POS is an in patient facility DR OF SERVICE Name
21. Billing a nsuranceE mployer 4 Family 5 Other Info Enter the patient s mother ether Father Family Members and father s information in Name Head f HouseH old First Hame j MEDFORD STEPHEN the blanks provided Employer fe Enter the name of the pa work Phone tient s spouse in the space DL provided Home Phone SSM Add Family Members This function allows the user to i i N F5 add family members with P AE Add Family Members Set as Head of Household A Sata to be linked Remove Family Members Erirat with this patient s account Head of the Household This function allows the user to set a different family member with an MBA account as the head of the household This function may be used when there are multiple patients of the same provider that would like only one bill sent to the head of the household Remove Family Members This function allows the user to remove family members from the list For example the patient you are currently entering is a minor and this patient s mother and grandmother are both patient s of the same provider While the mother is the patient s technical guardian all bills should be consolidated and sent to the grand mother In this case you would add the mother and grandmother as family members and then set the grandmother as the head of the household 1 General 2 Billing 3 lnsurance Employer 4 Family 5 Other Into General Comments E
22. Charges of Visits Remaining NA Pre Auth of Last Chg BA Last Charge Mone Last Statement Last Pat Payment Hen 0 00 Next Appt pE None Scheduled LE lne Filing Date Last Ing Payment Hy Ach 0 00 Curent 31 to 60 61 to 90 Over 90 Unapplied Total Total 0 00 0 00 0 00 0 00 0 00 0 00 33 Fi MBA Review Module MBA Yersion 4 9 06 Review Pt Acct for 7578 Kenneth Wayne Maxey DOB 017 2571973 SSN 123 273 1234 CHART NO 3243 DR ID 1 ACCT PRI DOCINFO NOT FOUND Primary Doctor Adler Stephen Print Edit Demographics Next Pt Save Resp Party SELF 1 Practice DEMO DEMO DEMO DEMO DEMO Include Family Charges I Cancel 5 Stmt Hist E Contact Hist 7 Pt Docs 8 Clains eee 2 History 4Ins Info Incidents SSM 23237 Aad Home Phone jei a 555 9801 Business Phone ja 0 555 9675 Address 1002 Stubbs Avenue Monroe LA 71201 Patient Since No Charges of Visits Remaining Ha Pre Auth of Last Chg Ba Last Charge None Last Statement Last Pat Payment By td 0 00 Next Appt None Scheduled Last Ins Filing Date Last Ins Payment Had 0 00 Current J1 to 60 61 to 50 Over 90 Unapplied Total Totals 0 00 0 00 0 00 0 00 0 00 0 00 1 General Primary Doctor From the drop down list the primary doctor may be selected Practice From the drop down list the practice may be selected Responsible Party The responsible party may be selected from the drop down list Inclu
23. Claim History Claim history provides the history of the filing of the claim including the insurance plan name or names the date s the claim has been submitted and the claim format rather it be electronic or paper You can also print off the history and delete as MEDICARE EMPIRE 10 26 2007 03 00 AM Print Delete Edi Edit will open the transaction selected This can also be ac complished by simply double clicking on the selected payment charge or adjustment 35 Fi MBA Review Module a MEA Yersion 4 9 06 Review Pt Acct for 57676 CONSUELO GONZALEZ DOB 09 10 1934 595M 053 30 9175 CHART NO N A DR ID 6 ACCT PRI a a FOUND PrimaryDoctor OS Pie Edit Demographics Next Pt Save Resp Party Practice Wale aee Cancel 5 Stmt Hist 6 Contact Hist 7 Pt Docs 5 Claims 1 General 2 History 3 Comments 4 ns Inforlncidents Patient Transactions File Hext Fiefile Print Claim Bill Resp Patty Claim History Edit Delete GEL of en on vein aiid aro renerra toes TO E 0 00 0 00 0 00 Ad 12 03 2007 INSURANCE DENIAL HEDICAR Ins fo josigy2007 EKG ECGINTERPE amp REPORT cHe ea SOT Che 09719 2007 EKG ECG INTERP amp REPORT 93010 PRI 39 9 57 sooo sas _ r2mav2007 INS DENIAL MEDICARE EMPIRE DENIAL e __ oo Oo Adi 03 14 2005 SMALL BALANCE WRITE OFF RP e6j 210 6210 000 masa Ekee NEPR oe e O o e SSS Fmt 0370872005 MEDICARE PAYMENT
24. Date to End Date J Newer Claims First File Nest Fefile Show I Included Closed Clams Claim sPlant kellet uei De ontesirett No Asrian ame g ppe aler e Or MOUA WOME mic eral Arig gt DELETED HEALTHFIRST 1 PAPER 10 23 2007 11 17 45 4M 1 35 00 435 00 2 DELETED HEALTHFIRST 10 26 2007 3 00 00 AM 435 00 35 00 Dbl click on the claim above to display associated chgs Dbl click on the chg below to pull up the charge form 8 Claims This tab allows you to see the history of several claims at once You can sort by date or newer claims and can include closed claims You can also file next insurance or refile from this screen MBA Yersion 4 9 06 Refile File Next Create Pending y Insurance Record G Flease selectthe insurance you would like to file this claim with as Lance a Filing Order In Plan Name Flan Description ho No Terminated EJ EMPIRE BS HEALTHCHOICE RECOOFAD6S41 l2 BENESIGHT 8450S Ea The current insurance is EMPIRE BS HEALTHCHOICE Filing Order 1 MBA Yersion 4 9 06 YD This is the insurance company that this charge will be Filed with ee Insurance Plan Name EMPIRE BS HESLTHCASILE Insurance Plan ID RECOOY 405941 Plan Description Filing Order 1 Do you wish bo contine MBA Charges Module MBA Yersion 4 9 06 Patient Charges File Help In this module the user will be able to document and bill all charges Recently Accessed TERME
25. Est Ft 2 Key 163 0 Bradhurst Office Adler 5 30 00 1 30 00 0 00 30 00 ee rie a T A C E A Charges above in Red are lt On Hold Total Hew Charges 90 00 Add Edit Delete SAVE CANCEL Select to save or cancel all charges entered APPLY PAYMENTS If this option is chosen the system will bring the user to a modified adjustment screen The user may then apply a payment for that charge at that time using the same methods as applying payments in section five of this manual PRINT SUMMARY This will print a charge summary report and batch ID PRINT CLAIM This will print a paper claim ADD EDIT DELETE Charges may be added edited or deleted using these functions TOTAL NEW CHARGES The total of the new charges entered is listed in red in the bottom center of the window Charges listed in red have been set to Hold PATIENT INFORMATION Listed at the top of the window is a point of reference for patient information NEXT PATIENT If you have the ID of the next patient you want to enter a charge for enter it in the Next Pt field NEXT SUPERBILL Like the Next Pt field you can jump to the next superbill or encounter by entering it into this field COPAY Enter the patient s co pay information in these fields if applicable 58 BA adjustments ae MBA Yersion 4 9 06 Patient Adjustments Adjustments Module File Help In this module the user will be able to Recently Accessed Maxey Kenneth 7576 post and adju
26. PRI Oxford 39 04 jor sov2007 J6 INS WRITEOFF PRI Oxford 30 96 0 05 2007 4 PATIENT PAYMENT FAP 20 00 Bea Date ooo E Show Charges By M Show Charges I Show Payments IY Descending by Date D Sort By Patient a L E Insurance C Patient Both fA Show Debit Adi I Show Credit Ad Open Items Only End Date m W Shon Denias Show Applied Detail Show Deleted Chgs 2 History Show applied details for trans selected After clicking on this line the transaction details will appear at the bottom of the win dow If you have a charge selected and you click on this show applied details for trans selected any payments or adjustments that have been made on this charge will appear with the transaction dates transaction codes descriptions source ie patient or insurance and the amount applied If you have a payment or adjust ment selected and the applied details line is clicked the charges these payments or adjustments have been applied to will ap pear with the transaction date code description source and amount File Next Refile By selecting a charge and clicking the File Next Re file button this will file the claim either to the secondary or tertiary insurance carrier or to the primary insurance again Print Clair The Print Claim button will allow you to print a paper claim Bill Resp Party By selecting a charge and clicking the Bill Responsible Party button the charge selected will then be billed to the responsible party
27. Superbill No Print Pt Omwed Bal Orly On Routing Slip No Suppress Billing Cormments on Superbill No Warn User iF patient is scheduled For different a doctor his primary Include rescheduled and no show in Appt Hist Schedules A BA calendar Functions November 2009 PEP PET PPP eee FRPP Pre FPPPP PEC ITITI Eind Pt Appts Default To Last Schedule Selected Next Avail Appt Next Available Appointment This function will take you directly to the next avail able appointment slot Find Ft Appts Find Patient Appointment To search for an appointment that a patient already has scheduled click on the Find Pt Appt button This will bring up the patient search window Upon locating the patient the appointment list window will come up Then select the appointment you are looking for in the appointment list window Once you have selected it click on find appointment This will allow you to edit and view the appointment Print Waiting List Print Waiting List This function allows you to print a list of all the patients waiting for an earlier appointment You can sort this report by patient name or patient ID Print Schedule Print Schedule This allows you to print a schedule and set date parameters for the schedule printed Schedule Set Up Schedule Set Up Before utilizing the MBA Scheduler the system administrator must first set up each provider under the schedule set up option Ex
28. appointments are viewed in the window e You can jump to the desired date by clicking on it in this calendar Navi gate months by using the left and right arrows at the top Today s date will be listed at the bottom with a red circle If you are in the same month of today s date it will be circled in red on the calendar Wo 3 4 6 17 1 619 200 2106220 23 H 25 26 27 228g 23 30 1l 2 3 4 5 G 7 8 E Today 12812007 Location e Use the location field to view appointments by a specific place of service No Gf Pt Appts S e Shows total number of appointments scheduled for the selected day for the selected provider resource or all the providers if ALL DOCS is selected 30 2 23 30 H 1 2 3 hedules A MBA Schedule Functions Next Confirmed bars ae See ie Print Superbilts Print Sched DSB Find Pt Export To Reminder Chg Hove Appt Ho Show Appt Outlook Print Reminder Letters Font Below you will find more detailed explanations of these buttons and their functions Next Next After selecting a time slot to which an appointment will be made click next to open the appointment details window Move Appt Move Appointment This function allows you to move an appointment and all of its saved infor mation to a new date time slot Click once on the appointment time slot you wish to move then click on the Move Appt button Then click on the new time date slot you wish the appointment
29. been added in this module or any other module within MBA tab 3 will appear red to alert all users of this alert Ifa privacy alert has been added in this module or any other module within MBA tab 3 will appear yellow to notify all users of this alert If both alerts have been added tab 3 will appear in the color of the last alert added The Standard Release of Info Signed date carries over from the Patient Module This allows information to be entered relating to the HIPAA Standard Release of Info that must be signed by each patient The date this document was signed can be entered in the space provided In the case that the patient has specific requests as to how his her information is handled the Privacy Alert box may be checked General Comments Allergies Current Medication and Drug Reactions will also show in the Patient Module General Comments il Current Medications l Allergies Drug Reactions IS AO MBA Review Module MBA Yersion 4 9 06 Review Pt Acct for 7576 Kenneth Wayne Maxey DOB 01 25 1973 SSM 123 273 1234 CHART NO 3243 DR ID 1 ACCT PRIDOC INFO NOT FOUND PrimaryDoctor Print Edit Demographics Next Ft Pe x Bracie x Include Family Charges M E Stmt Hist E Contact Hist Z Pt Docs Claims 1 General 2 History Insurance Plans Empire BCBS BCBS 3432 343245242 New ork NY 10008 1 1 2006 500992258 1 Delete Sort By Incidents C Date C D
30. insurance setup A MBA Add Patient Info 0 Patient Information 7571 STEPHEN MEDFORD File Modules Utilities Help ee rae oc a Co mio mEn l t v Cancel SSN 123 45 6789 Chart 548792 Birth Date 01 01 1967 EI Age 40 Print Chart La 1 General 2 Billing 3 Insurance Employer 4 Family 5 0ther Info Responsible Parties fie i a 5 Print Patient Registration Print Routing Sli bel ip Workmen s Comp SSS Yes Edit MEDFORD STEPHEN Delete Patient Insurance Plans Insurance Co Type Group ID City St zip EffDate Tem Date Description Ma Add Edit Delete El Employment Info Employer Southern System Sales 1 Add Edit Contact Name Philip Medford Employer s Phone Number 604 505 6957 Contact Phone Number 604 505 6900 Employment Status Employed Full Time Additional Information Employed 20 years 3 Insurance Employer Responsible Parties Responsible Party CD 1 for Self will default as the saved responsible party You may edit this record by clicking the Edit button or add additional responsible parties is applicable This ensures that there is a finan cially responsible party whether that be the patient a legal representative or a guardian To begin click Add or Edit Select the responsible Responsible Party Information for STEPHEN MEDFORD 7571 File Utilities Help party CD from the Responsible Party list on This patient is responsi
31. per row listed in the daily schedule For larger fonts increase the number of lines per row If you want to see more of the day with a smaller font keep the setting between 1 and 3 columns 3 Print Insurance Print Chart Number on Scheduler Report These two boxes affect the way the daily schedule reports are formatted to print including the insurance company and or the patient s chart number if desired 4 Blank Line On Scheduler Report This feature allows an extra line to be printed between patients located on the daily schedule when printed 5 Group Schedule Report by Column Printed schedule reports can be divided according to the column that under which the appointment falls see 1 6 Time Increments The entire schedule may be formatted according to how often the provider would like to see patients or schedule appointments Once the increment is set for the provider this option will no longer appear in schedule set up for that provider and any changes to time increments would need to be made by support staff f Show Doctors Show Resources E Save Cancel Default Number of Appointments 1 is Col eee Dbl pi on field to select column background color Number OF Lines To Display Per Row mo E Column Title 2 2 Column 1 Appointment Column 2 Time Increments OU Men 6 Column 3 Appointment 3 9 Minutes a Column 4 Appointment 4 20 Minutes Column E Appointment C 30 Minutes Column F Appo
32. relation ship field you may enter the patient s name or SELF Select the appropriate fee schedule to apply to this patient s billing And also select the frequency with which the patient should receive a statement The demographic info at the bottom will default to information entered in tabs 1 and 2 Another Patient Enter the responsible patient s MBA account number Click yes to make this the default responsible party Check the box if the patient is uninsured otherwise leave it blank In the description field and relationship field you may enter the responsible party s name Select the appropriate fee schedule to apply to this patient s billing And also select the frequency with which the patient should receive a statement Enter the demographic info at the bottom that applies to the responsible party A Responsible Party An Institution Workmen s Comp Click yes to make this the default responsible party Check the box if the patient is uninsured otherwise leave it blank In the description field and relationship field you may enter the responsible party s name Select the appropriate fee schedule to apply to this patient s billing And also select the fre quency with which the patient should receive a statement Enter the demographic info at the bottom that applies to the responsible party Click Save Another responsible party may be added by clicking Add or you may edit the existing responsible parties by clicking edit To permanen
33. 2 MBA User Manual weed wn Where would you like to go ars Table of Contents Patients Insurance Schedules Review Charges Adjustments Top Menu Fi MBA Main Module Menu To enter any of the seven main modules simply click on the desired module You may also use keyboard short cuts on this main screen and throughout MBA Hold down the ALT key and then the letter that is underlined For example to enter the Patient Module you may click on the Patient button with your mouse or use the key board shortcut ALT P Review would be ALT W and so on Look for the underlined letter and then use that er letter combined with the ALT key to quickly navigate through MBA using just your keyboard Where would you like to go Patients If you know that patient ID number you may use the B Next Pt box by typing in the number and then clicking on the desire module This shortcut will allow you to Charges bypass the patient search form which is available for the Patient Review Charges and Adjustments modules A The Billing Module will be added to this document or to a system administrator or billing manual as well as de Adjustments tails on the Top MBA menu including maintenance re ports utilities and program options The Report Man ager Manual is also available in another document This manual can be accessed at Report Manager http www tsma com portal downloads ReportManagerModuleManual pdf Patient Search Fo
34. 5 19 2004 SMALL BALANCE WRITEGFF peja sso eso o Chg 04 21 2004 EKG CG INTERP amp REPORT an0 j RPA 2 35 00 000 o Chg 0472172004 EKG ECGINTERP amp REPORT 3300 78 RP 2 of so 0 Cha 04272004 STRESS TEST CVW DINTERP ame SEC 12 som e000 Cha 0471272004 STRESSTESTWINTERREPAT 30e SEC 12 soo s000 0 00 Cha 07 02 2003 EKGEDGINTERPRREPOAT emo AP 2 3600 S500 o Cho 06 16 2002 EKG ECGINTERP amp REPORT samo jaj so 36 00 Bea Date Show Changes By M Show Changes I Show Payments IY Descending by Date Sori By Patient Baer Ic Insurance Patient Bath I Show Debit Ad IM Show Credit Adj I Open Items Only End Date Ei M Show Denias Show Applied Detal D Show Deleted Chgs Type The type of transaction is listed here as Chg Charge Adj Adjustment or Pmt Payment Trans Date The date the transaction was posted Either the date the charge was entered the date of service or the date the payment was posted Trans Description This is the description of the transaction Any comments that are made to the specific transaction can also be viewed in the transaction description window CPT Code The CPT code is listed in this column M1 The primary modifier used in billing a charge is listed in this column PR The payment responsibility column will list either RP for responsible party PRI for primary insurance or SEC or TER for secondary or tertiary on charges DR The corresponding doctor of
35. ALT W and so on The Maintenance menu allows you to enter information about your practice and further customize MBA to suit your needs When you click on Practice file or ALT P the screen below appears Double click on the practice you want to edit or highlight and click the View button MBA ersion 4 9 06 Browse Edit Practice File Table E PracticeCode PracticeName PhysicalAddr1 PhysicalAddr2 PhysicalCity PhysicalState PhysicalZip PhoneNumber EJ emo DEMO DEMO DEMO 19 BRADHURST SUITE 100 HAWTHORNE NY 10532 914 DEMO DEMO DEMO 19 BRADHURST SUITE 100 HAWTHORNE Filter cm Medical Billing Assistant MBA ersion 4 5 06 File Modules Maintenance Reports Utilities Help Top Menu 66
36. ApptHistory NS 12 11 2007 04 30 PM s 00 Pe TEN JACOBSON 1171672007 12 18 EWAN JANOWIT2 10572007 3 09 11 PM 525 00 525 00 PrimaryDoctor Print Edit Demographics Nent Pt Save Cancel 3 Comments 4n Into lncidents 7 Pt Docs 5 Claims View Delete oo 0 00 oo 25 00 4525 00 Include Family Charges D 2 History 6 Contact Hist x ILLO UF 5335 ALSO HAS BALAN gror 2007 03 30 PM 04 30 PM ROBERT WOLFF HEW PATIEL 2222 ess 5 Stmt Hist This window shows a list of all statements this particular patient has received the date it has been printed and the aging balances You can view the statement by clicking the View button and delete by clicking the Delete button Also included is the patient s appointment history MANNARO HECH NY 105 3 AMOUNT DUE 62600 PLESAC COTA AHL RETUR TIC URPRCR PORTIO WTI YOUR FOIT TAHTE SMOUNT REMITTED Gan A CUETO AE N E OEE NERY TENSE men E e a CC 03 03 200T a2 525 00 525 00 ROBERT WOLFF WO be babice on yorracoomite bow 30 days od Teephowe bows Drollilng kge ame Mow Frhday trom Sam ipm Pease callyorr carrer prior to allg orr otie INB O DAYE IHA Ai B0 DAYE DUE EY IHEU RANCE OMOUMT CURRENT LY DUE BY INE U RO WCE PROV DED POR YOUR 000 7 0o00 7 000 F000 3000 aj IH RO POT Oe PE DIOT RIC HEU ROLOGY OB BOC ATER Po P D BOs 1020 HOVWTHORME HWY 10682 214 268 0 180 40 PT 0 80 0478 Fi MBA Revi
37. BA screen If a fee schedule is not used then simply leave the fee amount as zero The zero fee schedule number is the default unless otherwise specified on the responsible parties for each patient The Medicare Allowable Fees for the current year or the previous year is listed at the bottom of the window To change between last year and the current year click the VIEW button on the right 51 AO BA Charges Module cher User Defined Procedures Procedures Inactive Y N M Na Cancel sereset CPT Type pe Vali From Thru u e newenve Cove z Documentation Required Y N No Replacement Code a Count As Visit N M No Charge Code gt Medicare Part A pO Sex Medicare Part B Lo Min Max Age O O Medicaid CLIA Type Blue Cross Status Code fg Print Description On Claim N M No MC ASC Group UB92 Y N M No DME YIN No Anest Base Units Type Of EPSDT KidMed Procedure NA CEM Vision Hearing C Immunization 3 Procedure Details CPT Type Select the appropriate CPT type from the drop down list Revenue Code Select the appropriate REV code from the drop down list when applicable Replacement Code In the case that this CPT code should expire enter an alternate code to be used in the space provided Charge Code Select the appropriate method in which the charge should be billed Units Days Months Time Sex For sex specific procedures enter the sex of the patie
38. Chart Birth Date E Age Print Chart Label 1 General 2 Billing 3 Insurance E mployer 4 Family 5 0ther Info ae tint Patient m Contact Info Mailing Address In case of Emergency Registration Home Phone Address Line 1 Contact rint Row j Mobile Phone Address Line 2 Phone Number Slip Pager City State Zip Relationship Business Phone County Parish Patient Alert Y N I7 No Fax Email Address o O OE Other Phone Physical Address if different from Mailing Sex O Address Line 1 Race Unreported Unknown Address Line 2 FO Marital Status Unknown City State Zip o T aa Patient Type County Parish BO Addl Edt E Type of o Date of Death o E Residence 1 General Enter the patient s Name SSN Chart Birth Date Contact Info Address and other demographic infor mation including Sex Race Marital Status Patient Type and Date of Death when applicable There are also fields to enter the patient s Emergency contact information and a Patient Alert that will noticeable in other modules also The Patient Alert checkbox opens a user defined field in which all pertinent information regarding this patient may be entered and highlighted in red This field can be viewed in the patient s account under the following modules Review Charges Adjustments and Scheduling The alert will also print on the 2nd page of the rout
39. Delete Launch File Mo To add a new document click add Begin by entering a description of the document and select the document cate gory from the drop down list This list may be added to or edited by clicking add or edit To select the document click update this will open a windows search screen Find the file where the document has been saved and click okay The document will then be linked with this patient s account and the path to find the original saved document is listed under path The file name is listed below it Click save to save your work and exit or click cancel to exit without saving Description Patient Response Letter i Save Document Category Patient Letters Add Edit Cancel m Source File Computer l Path ICD ocuments and Settings masey shy Documents TEMP FileName Pstient Response Lettertxt Created By MHSEWH Created 12 10 2007 10 56 15 AM Modified By HMSKWH Modified 1271072007 10 56 15 AH 42 iil Launch AO MBA Review Module Z Review MBA Yersion 4 9 06 Review PE Acct for 18663 CARLOS ECHEYARRIA DOB 07 05 1953 SSN 564 46 3363 CHART NO N A DR ID 12 ACCT PRI DOCINFOQ NOT FOUND PrimaryDoctor Eir Edit Demographics et OG Save Resp Party Precios x Include Family Charges D Cancel 1 General 2 Histo 3 Comments 4 Ins Infodlncidents 5 Stmt Hist 6 Contact Hist Z Pt Docs 8 Claims Beg
40. NE incurred for individual patient s i Cancel emanate Open the charges module and the aS Mane patient search window will appear Middle Name OR Enter the patient s information to Patient Number T search for the patient with whom OR the charges should apply You may Social Security No select the patient from the recently a accessed dropdown list Click Add Phone Number oR This will bring up the charges win Birth Date dow OR If the Place of Service selected is an in patient facility the Admitted and Discharged fields will appear Chart Murmber OR Superbill Ctrl Mo LELU MBA Yersion 4 9 06 Patient Charges ADD MODE for T578 Kenneth Wayne Maxey DOB 01 25 1973 SSN 123 23 1234 CHART NO 3243 DR ID 1 Batch 7D1114 07cmacdonald 42 Add Edit Place of Serv Hospital Center MBA ID 3 Add Edit Admitted Finalize Incident ID Add Edit Dr of Service Adler Stephen Add Edit H Cancel l r l l Discharged Resp Party SELF 1 Referring Dr Abouezzi Ziad Add Edit B Add Another Fre Auth Visits Remaining of Fee Schedule STANDARD FEES bi L Charges 2 Additional Data 3Doctors amp Comments 4 Other Charges Date of Service 2A772007 E Add Edt Search Add Edt Search CPT Code Desc o fo Diagnosis 1 a Hi Reorder CPT Modifiers J jf CPT Amount foo Print on Insurance Electronic of Units i Assig
41. Schedule Set Up PPP ee E 26 Butt the keyboard shortcut AIS to begin PPP Prt This screenshot shows six providers and one nurse setup individually and a Print Schedule resource to be able to view all schedules at the same __Find Pt Appts _ Schedule Set Up time on one screen for a Print Waiting List multi provider view Default To Last Schedule Selected Close MBA ersion 4 9 06 Print Insurance On Scheduler Report Add and Edit buttons Available Doctors astName After opening Schedule Set Up the set up window will appear This window is used to make all changes associated to the appearance timetable and preferences of each provider Ader Brogan a Delaney Duby Gamick Kein Inactive E In Out In Out Sunday OFF Sunday OFF Sunday Sunday When setting up a pro Monday Off Monday Of Monday Mandap vider for the first time Tuesday 10 00 AM Tuesday 12 00 PM Tuesday Tuesday click the Add button with Wednesday 10 00 AM Wednesday 12 00 PM Wednesday Wednesday the row selected for the Thursday Off Thursday Off Thursday Thursday doctor you would like to Friday Off Friday Friday Friday add to the schedule Saturday Off Saturday Saturday Saturday This will allow you to input the providers specified information including the regular schedule clinic hours 16 al MBA Schedule Set Up ins 1 Appt Times Next click on the row of the provider you would like to
42. alance P ausa Check Auth E 2341 2344 9578 2342 Resp Party SELF 1 Ins Plan Empire BCBS D Adjustments Ins Balance 90 00 Total Balance 90 00 Bunning Provider Total m Total Amount 40 00 Prov OF Chg Adler INS WRITEOFF 50 00 1 Charges 2 New PaymentsAdiustments 3 Comments 4 CCI Edits 50 00 eames Pa Ma 0 00 cor Deductible Z mewe a e Se Sey spe Next Insurance Plan NONE sort By I Descending Order Show Family Charges f e amaun J Open Charges Ony D Show Applied Amounts Only Beg Date l to End Date A f Date of Service Show Unapplied Credits Total Amoun After entering applied amounts to the billed codes the amount applied will be subtracted from the total amount and will display at the bottom right as the Left to Allocate amount To verify that the Provider the adjustment is being listed under is the same as the provider who billed the charge the Provider of Charge will appear in red next to the provider listed on the adjustment Save with Defaults The user may choose this option when posting bulk mass checks from insurance companies This option will save the payment for this patient and also save the insurance payment voucher EOB information that was entered for this payment so that is may be used for the next patient listed on the same voucher EOB without having to reenter all of the same payment information over again The system will
43. ance Info 0 Insurance Plan Information File Help Insurance Plan Aetna HMO Type Private Commerical Insurance Save Description JAE TNA HMO Ins Group Astra Add Edit Cancel Pri Accept Assignment Only what insurance allows Participating Provider l No Sec Accept Assignment H No Auto Sec HFA l No Medi T H Timely Filing Limit Ini edicare Crossover T No Days Ref Doctor Required Mo Anest Time Interval Anest Claim Units m Submit Signed Release C No Medigap Code Form with Claim Capitation Plan TPL H No 2 Plan Info Pri Accept Assignment Select according to office policy when this insurance plan is used as primary on the account Sec Accept Assignment Select according to policy when this insurance plan is used as secondary on the account Timely Filing Limit Enter the number of days the billing agent has to file claims for this insurance company before they are considered unpayable due to timely filing limitations Anesth Time Interval Choose the corresponding claim units from the drop down box for the Anesthesia claims if applicable for this insurance company Anesth Claim Units Choose the corresponding claim units from the drop down box for the Anesthesia claims if appli cable for this insurance company Medigap Code Either choose the corresponding number from the list in the drop down box or enter the code manually in the field provided Thes
44. ance information Step 6 e All available appointment information can be added in this window e Inthe upper left hand corner the patient s name account number and phone numbers are listed e There is also a checkbox that can be selected to add the patient to a waiting list for an earlier appointment See Calen dar Window Functions Page for list printing instructions You can also edit the patient s info using the Edit Pt Info but ton e Inthe upper right hand corner the date and time of the appointment are listed To add or to subtract additional time to the appointment simply click the Add or Sub buttons e Past appointments as well as all insurance information associated with the patient are located in the windows on the right e Copays can be entered by selecting the Copay batch from the Batch drop down list or by adding a Copay batch by click ing the Add button Then enter the Copay amount select payment type from the drop down list and enter the Check Auth if applicable You can also print a receipt for the Copay to give to the patient by clicking the Print Receipt button e Click Please click here for Patient Balance Information at the bottom to see patient s current AR You can also include all family alata Ril by slaai that box or view the AR for only the scheduled doctor for this appointment Copay Eligibility Into AR a ia Batch H Add Edit Prot Type Check 4uth H AR F
45. appointment list window will come up Then select the appointment you are looking for in the appointment list window Once you have selected it click on find appointment This will allow you to edit and view the appointment Export To Excel Export To Excel This button will export the schedule in view to a Microsoft Excel file 31 A MBA Schedule Functions Next Confirmed airs T EES p Print Superills Print Sched DSB Find Pt Export To Reminder Chg Hove Appt Ho Show ae Outlook Print Reminder ne Foni Below you will find more detailed explanations of these buttons and their functions Export To Outlook Export To Outlook This button will _atieaishdicho export the schedule in view to your Adler Stephen ok Microsoft Outlook Calendar You have From Date AA To Date 11 29 2007 Cancel the opportunity to set the date and Include Non Pt Appts M Columns To column parameters as well as include non patient appointments Print Superbills Print Superbills This function will print superbills for all patients in the current schedule view Print Reminder Print Reminder This function prints a label from a label printer that contains the patient name physician name and the patient s future appointment dates and times It can be used to stick on the back of a business card and given to the patient as a reminder of his her next appt with the doctor Print Sched Print Sched
46. ble for the payment of his account Eae the left Cancel Piesparels Fati Responsible Patient hi Default Resp Party INI fw ves This Patient C Another Patient C 4 Responsible Party 1 This Patient 2 Another Patient Uninsured iMY No f An Institution Description SELF ssid C Workmen s Comp Relationship fC O O 4 An Institution Fee Schedule STANDARD FEES Statement Options After allinsurances respond gt Name STEPHEN MEDFORD This Patient Resp Party Address Line 1 1000 Dove Avenue CD 1 will be set as the Address Line 2 Po Default Resp Party as City State Zip Medo m fons indicated by the Yes Phone Number check mark box This can be changed if another Resp Party is added and made the default If the address was entered on None of the information entered into the patient account the first tab it will be fields is saved until you click save Exiting this module by added when the record is clicking cancel will do just that It will cancel the creation saved of this new patient account 3 A Responsible Party 5 Workmen s Comp REMEMBER AO M A Add Patient Info 0 3 Insurance Employer continued Responsible Parties This Patient The Responsible Patient will default to this new MBA account number Click yes to make this the default responsible party Check the box if the patient is uninsured otherwise leave it blank In the description field and
47. ce attached NEIC Payer o Referring Doctor Proy Mmm OR Pane to it usually go to the Ine Payer H anual E0054 Bill as Clinic E Hoa claims offices this Way Default Claim Form JCMS s00 Print Provider in 24k No The rae be over Print Amt Paid Pri Claim No Print SSN in Box 257 S No ridden in the charge Print Amt Paid Sec Claim T No Suppress PIN tram Box 33 No screen Suppress Diag Decimal on Claim 7 No a Pa Doc Prov Mo In Place of No Type of Processing If Group Claim Charges By Pri Diag D No Cardholder MUST Patient go the file claims code is uimit NECPT No Use Clinic Name In Box 31 Bo Send Secondary Claims wia EDI No Electronic choose the correct processing type for the insurance plan NEIC Payer or Insurance Payer Select the NEIC Payer or Insurance Payer from the drop down list If you do not see the correct code in the payer dropdown then manually enter it in the manual field NOTE Even if you see a similar name match in the payer dropdown always check to make sure the number is correct Default Claim Form Choose the corresponding answer from the drop down box This option tells the system which claim for to use when printing claims Clinic Provider Primary Doctor Provider Referring Doctor Provider If you want to override the default set tings for printing claims select the applicable choices from the drop down list Check the remaining option boxes yes when applicable In
48. d Add Edi pprop AdjDesc INSURANCE PAYMENT v SecondAdi INSRUANCE DISALLOWED v Denial Code mua DENIAL Add Another _ Cancel justment description from the drop ResePaw fri _InsPlan Empire Medicare Pat Balance 12 84 down list Payment Type Check Check Auth 1154156 Total Posted For This Chk 43 24 Ins Balance 30 40 Total Amount 843 24 Bunning Vv Provider Prov Of Chg M Stratilatova Total Balance 43 24 Total Denial Code Select the appropri 1 Charges 2 New Payments Adjustments 3 Comments 4CClEdits ate denial code description from the T ee Terea il o erea vl oe ee E ner drop down list if the adjustment soe Ses Beas a samj 6 08 0 00 21 08 0 00 0 00 jf 000 1 107572007 S8214 Ofic sec son s3933 sooo 608 000 000 0 00 0 00 includes a denial _ 9721 2007 98214 Offic 25 SEC s105 41 s9833 S000 6 08 0 00 0 00 0 00 0 00 A v 8 24 2007 99214 Offic SEC 105 41 39 33 0 00 6 08 0 00 0 00 0 00 0 00 py o 8 17 2007 99214 Offic SEC 105 41 99 33 0 00 6 08 0 00 0 00 0 00 0 00 EA 3 15 2007 99213 Offic RP 69 61 5569 0 00 13 92 0 00 0 00 0 00 0 00 Ala 0 00 gt 2 16 2007 99213 Offic RP 69 61 70 63 0 00 1 08 0 00 0 00 0 00 0 00 wv Responsible Party Select the corresponding responsible party that should be linked with this ad j
49. de Family Charges Checking this box will allow the user to view all charge information for all family members that are linked to this patient account Patients may be linked as family members under the Family tab in the Patient s Module SSN The patient s social security number will reflect the number entered in the Patients Module Home Phone Business Phone Address Patient contact information will reflect what is listed in the Patient s Module Patient Since This date will default to the first date of service that has been billed in MBA Last Charge This date will default to the last date a charge was entered Next Appt This date corresponds with the next appointment the patient has scheduled in MBA scheduler of Visits Remaining This applies only to incidents that have been created which allow a certain number of dates un der a particular authorization code before another authorization needs to be obtained Last Statement This date defaults to the most recent date this patients statement was printed Last Insurance Filing Date This date corresponds to the last date the charges billed on this patient s account were filed to their insurance Pre Auth of last chg This pre authorization number is linked to the incident of the last charge requiring a pre authorization Last Patient Insurance Payment The last payments made by the patient or the insurance default here with the amounts paid Aging Window In the grid at t
50. e AR For This Doc Ony Include Family Charges Add Edit t Check4uth H Print Receipt 04 17 2008 09 45 4M Consult Stephen Adler On 4 2008 10 00 AM Hosp Labs Only Nurse Nurse 12 10 2007 09 15 AM Stephen Adler 11 26 2007 10 15 AM Veronica Delaney 1 Aetna PPO 0 00 Eligibility Info e AO MBA Appt Info Window Below you will find a more detailed explanation of these buttons and their functions j PE Resc Cancel Patient Rescheduled This button may be used in the case where a saved appointment t Resc needs to be rescheduled by the patient Once it is selected the appointment is deleted from its time slot It can be retrieved however by clicking in the time slot again to open the ap pointment window then selecting save This feature is best used in conjunction with the Copy Appt button see below Patient Canceled This button may be used in the case where a saved appointment must be Ft cxld canceled upon the patient s request yy Doctor Rescheduled This button may be used much in the same way as the Patient Re Dr Resc scheduled button It is only specifies the physician as the source of the rescheduling Doctor Canceled This button may be used in the case where a saved appointment must be Dr Cxld canceled upon the doctor s request Copy Appointment This feature copy s the appointment and all of its associated informa
51. e codes are assigned by Medicare for automatic secondary crossover filing TPL Enter if applicable the federally assigned Third Party Liability number for this insurance company Participating Provider Check the box if the providers in the practice are participating providers for this insurance company No Auto Sec HCFA Check the box if no HCFA is wanted to automatically print when posting an ERA for the insurance company being added Medicare Crossover Check the box if the insurance is a Medicare Crossover company Referring Dr Required Check the box if this insurance company requires a referring Dr for all charges submitted Submit Signed Release Check this box if a signed release from Form with Claim should be sent with every claim sent to this insurance company Capitation Plan Check this box if the insurance company hg a capitation plan A MBA Add Insurance Info 0 3 Claim Info Insurance Plan Information File Help File Claims Choose the Insurance Plan Aetna HMO Type Private Commerical Insurance Save corresponding answer Description JAETNAHMO Ins Group Aetna Add E dit Cancel Electronic Paper None S 1 General Flan Info 3 Claim Info 4 Pre duth Allowables 6 User Defined B Comments from the drop down box a E This option tells the sys File Claims Electronic Clinic Prow a J tem that claims with Type of Processing Primary Doctor Prow H gt this insuran
52. e insurance company requires a code to be added to the provider s tax id for claims to be filed enter it in this field Other fields may be used as needed for special claims setup and other user defined needs Insurance Plan Information File Help Insurance Plan Aetna HHO Type Private Commerical Insurance Save Description AETNA HMO Ins Group Aetna Add Edit Cancel Created by HWDOCony Created 11 8 2007 3 23 46 AH Modified by MDOCony Modified 11 6 2007 3 23 46 AH 6 Comments Enter any comments related to this insurance plan 12 a Patients A MB A Add Insurance Info 2 Patient Insurance File Utilities Help Patient Insurance Information Save Select the appropriate insurance plan Cancel from the drop down list If secu rity 1 Genera 2 Comments 3 InsCardSide1 4 InsCardSide2 5 InsCardSide3 6 InsCardSide4 access permits the user may ADD a Insurance Plan rd Et Insurance Plan new plan to the main data base or Hes ela aa Ss ous Plan Number i EDIT an existing plan a ooo Fist mide tas nme Resp Party SELF 1 J J Address 1 ID Number Patient s insurance ID Filing Order 1 2 3 4 2 TT Address 2 Accept Assignment City State Zip Plan Number Patient s plan number Signature on File Y N No Date of Birth Sex Effective Date w Employer Group Number Patient s group Larne signed Release of info l MC Seconda
53. e of Info v Signed Release Type Special Program Addl Claim Data Privacy Y N No To add an insurance AO A MBA Add Insurance Info _ 1 GENERAL LGenera 2Comments 3lnsCardSidel 4lnsCardSide SilnsCardSide3 BinsCardSided company that is not Insurance Plan Add Edt currently in the drop ID Number Claim Address InsGrp _ down list click Add This E 1st Century 443 215T CENT2 Private Comr PO Box 4397 Woodland H aN MUOMDEr 21st Century Health amp Bene 2157 CENT PrivateComr PO Bos 5037 Cherry Hill N wi openthewincow M AARP 5E AARP Private Comr PO Box 740819 Atlanta Gi shown below With Adventist Risk Managemer ADVENTIST Frivate Comr PO Box 4759 Silver Spring certain security permis Resp Party Aetna Global 423 SETNA GLO Private Comr PO Box 30260 Tampa FL i i Aetna HMO 1 SETH HRC Private Cornr PO Bos 981106 El Paso T ei nl Daweh Filing Order Werst4 Aetna PPO 7 AETNA PPO Private Comr PO Box 981106 El Paso T will allow you to edit Accept Assignment Aetna Special Case Custon SE TNA SCC Private Comr PO Box 9607 Cranbury MJ the existing insurance l Affinity Health Flan 15 AFFINITY FPrvate Comr Gracie Station PO Box 611 record from the master Signature on File YIN Attra Health Retirement Fur AFTRA Private Comr 261 Madison Ave New ro AlG 180 Alg ALBANY Private Comr 1 Park Place Albany N 1 table Effective Date i Insurance Plan I
54. e top four will print on the claim forms REORDER Use this tool to reorder the diagnosis code for this charge and your next charges when you click the Add Another button 48 9 al MBA Charges Module chr Ck CPT Code OR Description Mew CPT In the case that a particular procedure code is not found in the search a procedure code may be added by clicking ADD next to the fields provided for CPT entry The ADD function will bring up a search win dow where the user may do an additional search for the code or simply click New CPT to enter an en tirely new code This will bring up the procedures window where all information related to the CPT code may be entered User Defined Procedures Procedures OK Inactive Y N M No Cancel 1 General 2FeeSchedules 3 Procedure Details 4Comments 5 CCI Edits Procedure ID Get Info For CPT Origin MB Short Description sie uae Stmt Description Detailed Description Type of Service v Taxable V N P No CPT Category X Req Referral YIN T No Default CPT Mods X Postup Dye Additional Claim Info File Claims Code fw Print Below Line Item T 1 General Procedure ID Enter the CPT code in the spaces provided Short Description Enter a short description of the procedure in the space provided This will serve as a future search identifier for the code Get Info fo
55. ed Modified Reason Select a pre existing reason from the dropdown list Otherwise The reason for the visit can be added using the Add but ton or existing reasons can be edited using the Edit button Responsible Party This option allows you to select the responsible party self guard lan primary insurance etc Place of Service Select from the drop down list the place where the service will be provided Referring Doctor If another physician referred this patient their information can be added and edited here Incident ID If there is a corresponding insurance authorization for this service that can be added and edited here Once added or selected the pre authorization number and remaining office visits if applicable will be displayed below At the bottom of Tab 1 the user name is detailed with who created the appointment with date and time as well as who last modified the appointment with the date and time of modification a Cancel ave Enee xl Wo 11 48 2007 4 32 41 AM 11 8 2007 3 17 39 PH AO MBA Make Appointment 2 Additional Details Kenneth Maxey 7628 Edit Pt Info Fee Schedule This drop down field allows Home Phone 318 555 1057 you to select an established insurance fee Business Phone 564 555 5594 waiting List for Earlier Appt D schedule associated with the patient s ac count Fee Schedule i l Patient Type Add Edit Patient Type This dr
56. er time to enter more information or continue setting up the account Select the Billing Cycle from the drop down list Bad Debt Collections can be selected for a patient for future MBA reports and optional Collections Module Suppress Overdue Notifications Check to keep these notifications from being printed on the patient s statement Suppress Interest Charges Check this box to keep interest from being applied to this patient s bill If available add the patient s Driver s License number and State from the drop down list The Billing Comment s field may be used to enter specific information about how this patient s billing should be handled This comment field can also be viewed in the review module NOTE This field will print on the superbill on both page 1 and 2 Any sensitive information should be entered in the patient alert field in tab 1 unless Sup press billing comments Is selected from Program Options Privacy Info Enter the date the standard release was signed or use the calendar button to select the date Privacy Alert Check yes if the patient s account should be flagged with a privacy alert This will highlight the privacy tab red and open the privacy comments box for comments to be entered relating to patient privacy This alert will also show in the scheduler appointment information form and the review comments tab 3 At this point you are able to save or go on to the next tab 3 that includes responsible party and
57. eren cal DEMO DEMO DEMO DEMO I 070c111507en i Batch Report Close Batch Done Reprint Batch AA Reports Chg Review Apt Browse Charges 1 4114 Batch ID Practice Mame 15 Browse PrnitsAdjs Also from the close batch screen you can browse the charges payments or adjustments that have been entered into that batch There is also a charge review report which that list in the order the charges were entered a sum mary of the charge including patient id name date of service doctor facility cot code modifier diagnosis code price and insurance id There is also a practice drop box if you have more that one practice file To view a list of closed batches check the show closed batches box You can print any report to screen or to the printer 46 a al MBA Charges Module ches MBA ersion 4 9 06 Incident EdM ed Save Patient Incident Information Load Defaults Cancel UB 92 Into Oecurence Codes Dates Condition Codes Incident Date fi 2710 2007 El Date Type Accident Date Incident Code Accident Auto Accident State LA Pre Auth 345435435 Auth Exp Date i 2131 07 El Doctor Adler Stephen Visits Remaining i of 7 Description Auto T INCIDENT ID This option is used to store pre authorization or other information regarding services provided other than the standard or normal service The user may Add or Edit the Incident ID for any specific patient
58. ew Module MBA Yersion 4 9 06 Review Pt Acct for T578 Kenneth Wayne Maxey DOB 01 25 1975 SSN 123 273 1234 CHART NO 3743 DR ID 1 ACCT PRI Slee INFO HOT FOUNO PrimaryD actor Print Edit Demographics Next Ft Save Resp Party Practice a Im Cancel 1 General 2 History 4 Ins Infodlncidents 5 Stmt Hist 6 Contact Hist Z Pt Docs 8 Claims Contact History Add Edit Print InsPlanName 12 10 2007 Bob 120 00 12 20 2007 SELF Empire BCBS Follow Up Date fi arap r E 6 Contact History This tab will allow the user to view add and edit any contact for the patient in regards to follow up or phone consul tations regarding the account or patient status While this option is more often used as a tool for patient follow up the uses are not limited to patient follow up alone and can be used for any account correspondence MBA Yersion 4 9 06 Account Correspondence Patient Na Mee kenneth Wayne M dacy Jr gave Cancel it Select from the drop down Responsible Party SELF 1 0 iti s sS YS BAL 0 00 lists Insurance Plan Empire BCBS 11012 x BAL 170 00 Correspondence Type Phone Conversation Enter the date of contact Date of Contact fi2nov2o07 Follow Up Date 2 20 2007 EI i 2 Enter the person contacted ARES TeIeR Bot Promise to Pay v Comments Bob with BLBS says payment for 9 07707 date of service has been approved and we should receive payment within
59. f the multiple provider sched ule is shown to the left w ALL DOCS 3 20 2008 Actions Print ALL DOCS j cm ewj o Thu Mar 20 2008 D gt w m Chk In Chk Out View C Provider Resource Multi Qverride default yg Location 7 C Day Week sched info March 2008 mel 26 2 28 29 1 2 3 4 5 6 7 8 7 9 10 tH 2 2 4 15 _ A ext O Confirmed ae Ava Export To Print Superbills Print Sched DSB Find Pt E tT Reminder Chg Move Appt No Show pee Gutlook Print Reminder ee Font No Of Pt Appts 0 APPT Thu Thu Thu Thu Thu The The Thi Fri Fri Fri Fri Fri Fri Sat DR DR DR _ DR NURSE DR DR DR DR __ DR DR 9 00am Oooo o es y O C ee a 9 15am Oooo ooo o S Oooo o ooo o S 9 30 am Oooo oo S S Oooo o oo o S 10 15 am 10 30 am 11 00 am 11 15 am 11 30 am 11 45 am BLOCKE O BLOCKE O 12 00 pm BLOCKE BLOCKE BLOCKE Medicine BLOCKE BLOCKE BLOCKE Sadie 12 15pm D No D No D No gt No D No D No __ ra Service BLOCKE BLOCKE BLOCKE Service BLOCKE BLOCKE BLOv A 2 20 pm Office Offce ofice lveeprcan Office Office Office D No D Ne D No MEDICIN D No D No D No 12 45 pm E O Office Office Office E E Office Office Office 1 00pm SERYICE OoOo Hours Hours Hours SERYICE Hours Hours Hours 1 15pm HOLIDA HOLIDA HOLIDA HOLIDA HOLIDA HOLIDA Y Y Y Y Y 1 30p
60. ges ADD MODE for 7578 Kenneth Wayne Maxey DOB 01 25 1973 SSM 123 273 1234 CHART NO 32435 DR ID 1 Batch 7D111407cmacdonald 42 Add Edit Blace of Serv Bradhurst Oifice MBA ID 1 Add Edit Finalize Incident ID a J Add Edit Dr of Service Adler Stephen Add Edit Cancel Resp Party SELF 1 Referring Dr Abouezzi Ziad Add Edit Add Another Pre Auth H fo Visits Remaining fel Fee Schedule STANDARD FEES 1 Charges 2 Additional Data 4 Other Charges Charge Comments Additional Claim Info Print Below Line Item E Late Bill Override Reason Code D ate Patient lert viii z fv Field Advoidsnce AM C No Allergic to Penicillin Unusual Position Anest Wo OF Procedures Patient Insurance Information Fil Order Insurance Plan Name Empire BCBS 9003522583 20 00 343245242 TAB 3 Doctors amp Comments Charge Comments This user defined spaces may be used to add any additional information regarding the billed charge Additional Claim Info Information entered in this field will be included in the claim electronic file and in Box 19 Reserved for Local Use of the CMS 1500 Print Below Line Item Check yes if the information entered in the Additional Claim Info field should be printed on the HCFA Late Bill Override Reason Code Date Enter the late bill override reason code and date if applicable Field Avoidance Y N Future enhancement
61. he billing of this code click yes Inactive Click yes if this code should no longer be active or used in billing for this practice Detailed Description Enter any additional information regarding this code and the circumstances in which it should be billed OK Cancel Click OK to save and return to the charges page or cancel 54 al MBA Charges Module 2 MBA Yersion 4 9 06 Patient Charges ADDO MODE for 7576 Kenneth Wayne Maxey DOB 01 25 1973 SSN 123 253 1234 CHART NO 3243 DR ID 1 Batch H 7011 14 0 emacdonald 42 Add Edit Place of Serv Hospital Center MBA ID 3 Add Edit Admitted Finalize Incident ID Add Edit Dr of Service Adler Stephen Add Edit Cancel Discharged Resp Party SELF Referring Dr Abouezzi Ziad Add Edit rd I Add Another Pre Auth H Visits Remaining of Fee Schedule STANDARD FEES 1 Charges 2 4dditional Data 3Doctors amp Comments 4 Other Charges Date of Service fi 22172007 E Add Edit Search Add Edit Search CPT Code Desc Diagnosis 1 Reorder CPT Modifiers gt CPT Amount 0 00 Print on neurance Electronic of Units fi Assigned Jv es wd OsCOS i Resp Party No Anesthesia Anest From To HH MBA Total price 30 00 Charge on Hold No Patient Insurance Information Fil Order Insurance Plan Name CoPay Amt
62. he bottom of the window the aging on this patient s account can be reviewed from cur rent up to over 90 days The unapplied column lists any amounts that have been posted as an unapplied amount 34 Fi MBA Review Module MBA Yersion 4 9 06 Review Pt Acct for 6011 Irwin Hochberg DOB 07 26 1928 SSN 107 20 9195 CHART NO 6011 DR ID 1 ACCT PRIDOCINFO WOT FOUND Frima Doctor Print Edit Demographics Next Ft Save a nian x Pit x Include Family Charges M Cancel 5 Strt Hist 6 Contact Hist 7 Pt Docs 5 Claims 1 General 2 History 3 Comments 4 Ing Intorlncidenta Patient Transactions File Next Refile Print Claim Bill Resp Patty Claim History Edit Delete Show applied details for trans selected EE on rnon teowem onions tenes aetaires me 1 a wean soo aa 07 30 2007 INS WRITEDFF S re 1 056 193096 0 00 Pt o7 a0 2007 INSURANCE PAYMENT Oiled Tine 3804 93808 000 Chg OF 03 2007 Officeop Visit Est PL 2 Rey Components 99213 PRI 1 90 00 90 00 0 00 AG OVO NSWRNEO Oded Pde TP Gea ee E Pt 01 06 2007 NSURANCE PAYMENT Owed re 1 1671 58 e759 s000 11 28 2006 PATIENT PAYMENT AP 2000 anf a000 Cha 11 28 2006 Ofice op Vist Est Pt 2Key Components 99214 AP 1 131 00 ano sao SSCS _ TransDate TransCode Description Source _ Amont ppled 07 30 2007 INSURANCE Pay MENT
63. hrough l UBS2 Type OF Bill Patient Insurance Information Fil Order Insurance Plan Name Empire BCBS 8009922583 20 00 343243242 TAB 2 Additional Data Type of Accident Enter the type of accident in the space provided Disability T P Enter T for total disability or enter P for partial disability Disabled From Through Enter the dates of disability Return to Work Enter the date the patient can return to work after this procedure Outside Charges Enter the amount of any outside charges for this same service such as Lab Lab HHA Name Enter the Lab or Home Healthcare Agency s name and number These facilities may be added or edited from here First Consulted Enter the date of the first consultation 2nd 3rd Opinion Enter 2 or 3 in the field provided if this charge is a second or third opinion UB92 Type of Bill Enter extra UB 04 Bill if needed Hospital ID Enter extra hospital ID if needed Emergency Check yes if the service provided was emergent care Condition Rel to Empl Check yes if this was an employment related charge Elective Procedure Check yes if the procedure should be classified as elective Patient Insurance Information is listed in the box at the bottom of this tab as a convenient point of ref erence showing filing order plan name phone number co pay info and insurance ID number 56 vs Charges AO MBA Charges Module vs Charges MBA ersion 4 9 06 Patient Char
64. ic SEC 105 41 99 33 0 00 6 08 0 00 0 00 0 00 0 00 AmE 0 00 aa 8 17 2007 99214 Offic SEC 105 41 99 33 0 00 6 08 0 00 0 00 0 00 0 00 yy 4 4 7 3 15 2007 99213 Offic RP 69 61 55 69 0 00 13 92 0 00 0 00 0 00 0 00 z mi 0 00 D 2 16 2007 99213 Offic B 69 61 70 69 0 00 1 08 0 00 0 00 0 00 0 00 i SiE saoj Next Ins Plan Aetna PPO Sort By J Descending Order Show Family Charges ae amount J OpenCharges Only Show Applied Amounts Only BegDate a toEndDate itw Ei Date of Service Show Unapplied Credits 0 00 Left to Allocate Batch The system allows the user to create as many batches as needed to enter charges and adjustments into the system The user can ADD or EDIT several batches for different types of work Once the work is complete for a specific batch the user must run a batch report and balance then close the open batch Date Enter the date of service using the space provided or by using the button to the right of the field to use the calendar Adjustment Description Select the appropriate adjustment description from the drop down list If the user has permission to add or edit adjustment descriptions this can be done in Maintenance by selecting Adjustment Descriptions Or this can also be accessed by clicking the Add or Edit buttons Adjustment Code An adjustment code is automatically assigned to each new adjustment by MBA MBA Versi
65. in time frame dates can be entered to narrow the view End Date m ing field show Charges By These charges or patient transactions may be viewed in this window according to insurance Insurance Patient Both ee ites i ap eae responsibility patient responsibility or both 36 Fi MBA Review Module MEA Yersion 4 9 06 Review Pt Acct for 18863 CARLOS ECHEYARRIA DOB 07 05 1953 SSN 584 468 8663 CHART MO N A DR ID 12 ACCT PRI DOCINFO NOT FOUNDO Primary Doctor Pririt Edit Demographics Next Ft Save Resp Party Practice Include Fame Chane ll Cancel 5 Stmt Hist E Contact Hist 7 Pt Docs 8 Claims 1 General 2 History 0 3 Comments l 4 Ins Info Incidents Patient Transactions File Next Retile Print Claim Bill Resp Party Claim History Edit Delste show applied details for trans selected EE ire on wt eo was OOOO T INSURANCE DENIAL HEALTHFIRS Ing 0 00 0 00 0 00 EXG ECGINTERPEREFORT amo PRI 33 500 soo S50 Trans Date Ad 12 04 2007 1 Pmt 1171072004 COMMERCIAL PAYMENT HEALTHFIRS e gasa 84469 SD Adj 03 30 2004 NON FAR PROVIDER ADJUSTMENT ins 12 wo e 0 00 Adj 09 30 2004 NON PAR PROVIDER ADJUSTMENT e 4455 S485 o Adi 0570272004 SMALL BALANCE WATE OF e 3800 so o Adi 0970272004 SMALL BALANCE WRITE OFF d2 eso sso mooo Adi 0970172004 SMALL BALANCE WRITE OFF eje 89800 eso DO Adj 0
66. intment 7 W Print Insurance On Scheduler Report 3 alumn amp Appointment E Chart No On Scheduler Report Blank Line On Scheduler Report Group schedule report by Column yt T a cal JE 18 fi MBA Scheduler Options One of the key features of MBA Scheduler is the flexibility to customize it according to your specific needs These program options allow you to include only the features that best compliment your schedule Utilities Additional Schedule Options can be found in the top menu under Utilities Program Options Then select Program Options 4 Scheduler Superbills To access the additional schedule options select tab 4 Scheduler Superbills Then check or uncheck the options you need to customize your scheduler If Routing Slip 2nd page is Yes select the number of days of history you want included on that second page File Modules Maintenance Reports Utilities Help 4oplication Settings Security Printer Options Printer Setup Program Options Backup Restore Databases Export to MDDicbate Export Filtered Patients Import From Experior Import Charges From EMR A2 Browse EMR Charges Check For MBA Update Merge Duplicate Records Import MIS Fees Update Blank DeletedBatchID Fields Run Query MEA Terminal MBA Yersion 4 9 06 Program Options Include Mon Pt Appts On Schedule Report Allow Past Appantment Save Routing Slip 2nd page
67. l Curent Medications El Created by HMHSSHHM Created 11 15 2007 3 37 19 PH Modified by MHSKWH Modified 1172872007 1 40 56 PH Allergies Drug Reactions 5 Other Info These fields are used for entering information related to the patient s account and treatment These user defined fields in clude General Comments Allergies Current Medications and Drug Reactions These fields may also be viewed from tab 3 in the review module At the bottom of Tab 5 the user who first created this account ang the user that last modified the account is listed with dates and times Fi BA Add Insurance Info Patient Information 7571 STEPHEN MEDFORD File Modules Utilities Help Patient Title First Name Middle Name Last Name Generation z571 STEPHEN MEDFORD SSN Chart Birth Date ef Age 1 General 2 Billing 3 Insurance Employer 4 Family 5 0ther Info Responsible Parties Resp Party CD 5 1 a Workmen s Comp Southern Systems Sales MEDFORD STEPHEN Patient Insurance Plans Insurance Co Aetna HMO res Noli Add Edit Delete Employment Info Employer Employment Status Patient Insurance Add Edit Contact Name Employer s Phone Number po z Plans Contact Phone Number Additional Information Next Pt Save Cancel Print Chart Label Print Patient Registration Print Routing Sli
68. m 2 00pm 2 15 pm 2 30pm 2 45pm 3 00pm Al WI BA Make Appointment 2 File Help Recently Accessed MBA ersion 4 9 06 Schedule Appointment Patient Search i Cancel Step 4 After clicking Next in Step 3 the patient search form will load giving you various choices At this point you may select Last Name a patient by utilizing the available fields to search for First Mame an existing patient account Middle Name Odd This will take you to the es oR tablished patient window Mon Patient Patient Number Appointment e A a OR can be entered Social Security Mo Also yO ae add AEW pa tient by selecting the Add OR button Phone Wumber oe OR e This will bring up the New Patient window Enter the Birth Date patient s information and OR click Save Chart Number OR Superbill Ctrl Mo The only required fields are name and phone number Primary doctor is only re quired when the patient is added in the patients mod ule Once the appointment is made the patient record can be updated at anytime If an appointment is not made MBA will not store the name and phone number as a new patient Fie Modules Utilities Help Patient Title First Mame Middle Name Last Mame Generation gt OE ee Eee su lt a YS S Rates es 1 General 2 Billing 3 lnsurance E mplover 4 Family 5 Other Info Contact Info Mailing Address In case of
69. nce the Cancel user decides that the charges are complete choose to Apply Payments Save or Cancel You can also print Add Another a paper claim or summary akip to Sum CANCEL This option will cancel any data entered The system will ask the user to be sure this is the option they want to choose before finalizing the cancel ADD ANOTHER Choosing this option will save the data entered for the charge and bring the user back to the patient look up screen to enter a charge for a new patient SKIP TO SUM This option will NOT save data entered for a charge This option should be used to view add edit or delete charges entered for this specific patient ONLY MBA Yersion 4 9 06 Patient Charge Summary for 7576 Kenneth Wayne Maxey DOB 01 25 1973 SSN 123 23 1234 CHART NO 3243 DR ID 1 Patient Information Nest Pt eee Frewiogs Mew Batch Charges Balance Charges Balance ES Practice DEMO DEMO DEMO DEMO DEMO Patient 0 00 0 00 0 00 Next Superbill Resp Party SELF 1 0 00 430 00 430 00 oOo Apply Primary Ins Empire BCBS R Payments San tia Tetel s soo s900 CoP ay Amt 20 00 Last Patient Payment E Found 0 00 Print S CoP ay 2 0 00 Last Insurance Payment Mot Found rint ummary 0 00 Total Co Payment 20 00 etal eRe eta Copay Adj Desc Prt Type Check Auth Amount PATIENT COPAY Check i256 20 00 Hew Charges 1172672007 99413 Office op Visit
70. ned Iv Yes Consecutive T Baie Bill Resp Party Wo Anesthesia Anest From Te HH FiF Total price 0 00 Charge on Hold f No Patient Insurance Information Fil Order Insurance Plan Name Empire BCBS 5009922583 20 00 343243242 To quickly put in the current date hit the space bar while in the Date of Service field Remember you can use the keyboard shortcuts throughout MBA by holding the Alt key then typing the underlined letter in the description of the field you want to jump 44 al MBA Charges Module 2 MBA ersion 4 9 06 Patient Charges ADD MODE for 7578 Kenneth Wayne Maxey DOB 01 25 1973 55N 123 235 1234 CHART NO 3243 DR ID 1 Batch 7011 14 07emacdonald 42 Add Edit Place of Serv Bradhurst Office MBA ID 1 Add Edit Finalize Incident ID o Add Edit Dr of Service Adler Stephen Add Edit Cancel Resp Party SELF 1 Referring Dr Abouezzi Ziad Add Edit Add Another Fre Auth SSS Visits Remaining ec ee Fee Schedule STANDARD FEES Skip to Sum 1 Charges 2 Additional Data 3Doctors amp Comments 4 Other Changes Date of Service 20 2007 a Add Edit Search Add Edit Search CPT CodeDesc Diagnosis 1 Reorder CPT Modifiers CPT Amount 0 00 Print on Insurance Electronic of Units fi Assigned W es T ai Bil Resp Paty 7 No Anesthesia Anest From To HH MF Total p
71. nformation File Help Insurance Plan PEE Type Private Commerical Insurance Save Description AETNA HMO Ins Group Aetna Add Edit Cancel 1 General 2 Plan Into 3 Claim Info 4 Pre 4uth 4llowables 5 User Defined 6 Comments Claim Address Refilling Address Address Line 1 Po Fox 491106 Address Line 1 Address Line 2 Address Line 2 City State Zip EI Fazo Tx 79998 City State Zip Contact Person PO Fee Schedule STANDARD FEES Main Phone i800 624 0756 Default Payment Code Po Fax Phone PO Default Adjustment Code Claim Phone PO EDI Phone PO 1 GENERAL Enter the Insurance Plan Name and Description into the fields provided Select the Insurance Type and insurance group from the drop down list The Ins Group field is user defined and any group can be added to help filter these insurances for reporting Enter the Claim and Refiling Addresses The contact person and claim phone numbers can be listed below Select the Fee Schedule from the drop down list Default Payment Code Enter the payment description that should be associated by system default with this insurance plan when posting payments for a patient account with this plan attached to it Default Adjustment Code Enter the adjustment descriptign that should be associated by system default with this insurance when posting adjustments for a patient account with this plan attached to it A M A Add Insur
72. nt that must correspond with the procedure Minimum Maximum Age Enter any age cap or floor CLIA Type In the case that the providers office houses an internal lab enter the CLIA type in the space provided Valid From Through Enter the dates this code is valid from and through Documentation Required If documentation is required for this code to be billed check yes Count As Visit If the code being billed should count as an office visit check yes Print Description on Claim Check yes if the description of the code should be billed on the claim UB92 If this code should be billed in the UB 04 format check yes UB 04 replaced the UB 92 DME If this code is durable medical equipment check yes Type of EPSDT KidMed Procedure Select the applicable procedure type 52 a Charges Module amg E os oe eos _ m a a em e amm mr owes User Defined Procedures Procedures Inactive Y N No Cancel 1 General 2FeeSchedules 3 Procedure Details i 4 Comments 5 CCI Edits Created by MMSPSM Created 6 24 2007 1 14 10 PM Modified by MMSPSM Modified 6 24 2007 1 14 10 PM 4 Comments Enter any additional comments regarding this CPT code or the method in which it should be billed User Defined Procedures Procedures Inactive Y N M No Cancel 1General 2FeeSchedules 3 ProcedureDetails 4Comments 5 CCI Edits Code 5 CCI Edits Please contact MBA s
73. o view a specific range of dates of service or to view a single date of service enter the beginning date and end date in the spaces provided Sort By Sort the charges listed by either charge amount CPT or Date of Service Charges default using the date of service Descending Order To view the charges in descending order from most recent to earliest check the box Open Charges Only To view only the open or unresolved charges check the box Show Family Charges To include the linked family members charges to this account check the box Show Applied Amounts Only To show only the applied amounts check the box 61 al MBA Adjustments andl Patient Adjustments for 7578 Kenneth Wayne Maxey DOB 01 25 1973 SSN 123 23 1234 CHART NO 3243 DR ID 1 Date fia 4 2007 al Batch vy Add Edit Print Receipt 7 Next Pt ESA Save Add Edit AdiDesci INSURANCE ADJUSTMENT v SecondAd INSWAITEOFF gt Denial Code DAT DO Add Another _ Cancel Resp Party SELF 1 Ins Plan Empire BCBS Pat Balance soo Payment Type CredtCad x CheckAuth 2341 2344 8578 2342 Ins Balance f 90 00 Total Amount s4000 Bunning r Provider Adler Stephen Proy Of Chg S Adler Total Balance 90 00 INS WRITEOFF 50 00 1 Charges 2 New Payments Adjustments 3 Comments 4 CCl Edits oee rcs Ja ee ome cae ono au 11 28 2007 88213 Orie PRI 90 00 0 00 Ee ene 0 00 Deductible DenialCode a e CO 1
74. octorame F Edit Delete Incident Fre Authorizati ve Rema Suto 12 10 2007 Accident Date Accident Auto 345435475 4 Insurance Info Incidents Insurance Plans Z Review Save Cancel 4 lns Info Incidents Listed in this window are all the active and inactive insurance plans for this patient To edit or view more detailed insurance information double click on the insurance company that you are interested in viewing Insurance Plans Empire BCBS BL Iata a4s245242 New York F 10008 17172006 Incidents Any prior authorization information may be entered by adding an incident You may also edit or delete existing incidents RidMed Save Patient Incident Information T 4 Defauts ae UB 92 Info Oecurence Codes D ates Condition Codes Incident Date fi 2710 2007 l Date Type Accident Date Value Code Amount Incident Code Accident Auka g Accident State La Pre Auth H 345435435 Auth Exp Date h 2131 07 El Doctor Adler Stephen Visits Remaining ji of B Description Auto 39 Fi MBA Review Module MBA Yersion 4 9 06 Review Pt Acct for 20620 EYAN RYAN JANOWITZ DOB 05 29 2006 SSN N A CHART NO N A DR ID 2 ACCT PRI DOC INFO MOT FOUND Resp Party 1 General Previous Statements Recipient Hame Print Date E Wis H J fan N E Vwi T 7 Appointment aah Appointment StartTime EndTime SchedName Reason Comments
75. of the provider performing the service for this charge REFERRING DR Name of the provider who referred the patient to the practice if applicable TAB 1 Charges This TAB will allow the user to enter needed information for a specific service provided DATE OF SERVICE Enter the correct date of service in one of the following methods 010101 01012001 01 01 01 01 01 2001 MBA will format the date for the user CPT CODE DESC Enter the correct CPT Procedure Code for the service provided The user may enter the num bered code or tab over to the description and enter by description Begin typing the code or description using the drop down arrow arrow to the correct code and highlight the code then tab to the diagnosis field s The ADD EDIT and SEARCH buttons above and to the right of this field are used to add edit or search for a CPT Code Description DIAGNOSIS Enter the correct Diagnosis ICD 9 code for the services provided The user may enter the num bered code or tab over to the description and enter by description Begin typing the code or description using the drop down arrow arrow to the correct code and highlight the code then tab to the modifier field s The ADD EDIT and SEARCH buttons above and to the right of this field are used to add edit or search for the Diagnosis Code Description There are EIGHT diagnosis fields available Once the user has entered the first diagnosis another field will appear and so on Only th
76. on 4 9 03 Adjustment Types Inactive If the adjustment code should be classified as inactive and re Save stricted from use check the Inactive box yes Adjustment Cod Inactive No Cancel Ea Description Description The description of the adjustment may be entered here a l 7 Transaction Type v Adjustment Type Select either payment or adjustment from the drop gapai down list Comments Required No Refund Related Code No THIS IS THE COLOR IT WILL APPEAR IN REVIEW Changs Transaction Type Select Debit Credit or No Change from the list Color 2 x i C d 87672 Source Decide if the adjustment is from the patient insurance a respon een Weems rE M e ONNE sible party or other B a a Comments Required Check the box yes if comments should be entered in conjunction with this specific adjustment Custom colors C a a Refund Related Code Check this box if the adjustment that is being entered is related to a refund Seen Define Custom Colors gt gt Color Change The color with which the description of this adjustment will be listed can be changed using Cancel this function 60 al MBA Adjustments 2 Patient Adjustments for 758 Duncan Best DOB 07 03 1948 SSN 084 80 1908 CHART NO 758 DR ID 3 7 E mene aea If neeced I Date fiznar2007 Batch v Add Edit Print Receipt P Next etl tae Save Selec e appropriate Se cond a
77. op down field assists Add Edit in identifying patients Use the Add and am eee 1 4ppt Bet Edit buttons to specify patient type criteria 3 Patient Alert v m 7 No E Race Patient s race may be entered here for identification purposes a Patient Alert Y N By clicking the check gt box a blank field for notes opens This field E EEE Gane ee eT a er oo reated by reated TO maybe used to Input pertinent Information i Modified 11 28 2007 10 10 36 PM regarding the patient s account status health conditions or special needs By selecting ream Yes the patient alert will flash red upon reopening the appointment window Amt Prot Type Check Auth H AR For This Doc Only C Print Receipt O include Family Charges Standard Release of Info Signed fi 1712 2007 E 3 Privacy Privacy Alert EYIN W Yes 1 Appt Detl e Standard Release of Info Signed In accordance with the HIPPA privacy regu lations the date when the patient signed the standard release of information can be entered here Parents ok to check lab results 2 4ddtl Det Privacy Alert Y N This field can be opened by clicking YES to add informa tion about the release of medical informa tion associated with this patient T o Privac Step 7 e Click Save or use the keyboard shortcut Alt S BA Yersion 4 9 06 CHART NUMBER M A File mj El Pt Fesc Pt Cxld D
78. or This Doc Ony Include Family Charges Print Receipt Current 31 to BD 61 to 30 Over 0 Unapphed Total Totals 0 00 0 00 0 00 0 00 0 00 Z AO MBA Make Appointment E Reason Add E dit Comments E I T z ei E Resp Party SELF 1 a cl Place of Swc Ref Dac Add Edit E Incident ID gt Add Edit mil Pre Auth Visits Remaining of MBA ersion 4 9 06 Appointment Reason Reason Save Default Appt a Cancel Comments Default Mum of Minutes ftam eftu Generate Routing Slip YIN 7 fw Yes Inactive Mi J No THIS 15 THE COLOR IT WILL APPEAR IN REVIEW Background Color Text Color MMS Ke 1172872007 10 32 06 PH 11 28 2007 10 32 06 PH Created Hodified Created by Modified by MMSKWH When you click the Reason Add or Edit buttons the form above will load The color chosen to associate with the specific reason will appear that way on the full schedule view You may choose to add a background color and or a new text color Color Basic colors Reason Default 4ppt Comments Default Mum of Minutes 30 Generate Routing Slip iNj fw es Created by MDOCONY Modified by mmskwm Define Custom Colors gt gt Cancel 26 1 Appt Detail MBA ersion 4 9 06 Appointment Reason Consul Inactive YIN THIS IS THECOLORITWIECAPRESPUNIREVIEWEN Background Color Text Color__ Creat
79. p AO Patients This function allows the user to add the patient s insurance information to the account The primary insurance company is listed first and the secondary and tertiary insurances follow in the list Any inactive insurances will be listed in red Add This function will allow the user to add insurance information for this patient s account Edit This function will allow the user to edit existing information associated with the insurance plans selected on the account Delete This function will delete a selected insurance policy The system will not allow the user to delete an insurance plan with any filing history outstanding charges or payments attached to it Add or Edit will open the general tab Save Cancel 1Genera 2Comments 3lnsCardSidel 4InsCardSide2 SinsCardSide S lnsCardSided File Utilities Help Patient Insurance Information Insurance Plan ID Number PO Plan Number PO Group Number PO Resp Party SELF 1 gt Filing Order 1 2 3 4 fi Accept Assignment r Signature on File Y N No Effective Date Termination Date MC Secondary Type m Co payment Information Not Applicable C Lump Sum Amount Percentage Both Lump Sum amp Percentage fi Add Edt Cardholder Information Relationship Address 1 Address 2 City State Zip Date of Birth Employer First Middle amp Last Name Signed Releas
80. port To Outlook Export To Outlook This button will export the schedule in view to your Microsoft Outlook Calendar You have the opportunity to set the date and column parameters as well as include non patient appointments Default To Last Schedule Selected Default To Last Schedule Selected When this is checked the schedule program will open directly to the current day s daily schedule of the last doctor that the user s computer had been scheduling This bypasses the first form where you must choose a specific scheduler 21 al BA Make Appointment Step 1 Double click the provider or resource with which the appointment should be made The icon will appear as a clock for providers and a graph for resources You can also left click once on the provider or resource desired and then double click on the date you would like the appointment scheduled im ALL DOCS 8 21 2008 Actions Print ALL DOCS lt M lt w lt D rs ten fo C Multi Override default a Sverre defaut F No Location Next Avail Export To Bradhurst Office Confirmed Appt Excel Frnt 2 DCI Bradhurst Dialysis Clinic Inc 61 61 Find Pt DCI Bradhurst Dialysis Clinic Inc 65 ae ey Print Bi DCI Bradhurst Dialysis Clinic Inc Office Move Appt i No Show ADLER BROGAN Step 2 Verify the date using the day week and month arrow keys if needed to select the date of the appointment to be scheduled m August 2008 mj Close
81. r Existing CPT After entering a valid CPT code in the procedure ID field clicking Get Info for Exist ing CPT button will populate all information on this CPT code from the default information from the MBACorp Data Base 49 a al MBA Charges Module chr User Defined Procedures Procedures OK Inactive Y N M No Cancel 1 General 2FeeSchedules 3 Procedure Details 4Comments 5 CCI Edits Procedure ID Get InfoFor CPT Origin MI z Short Description ENREGA Stmt Description Detailed Description Type of Service X Taxable Y N P No CPT Category Reg Referral YIN No Default CPT Mods 7 y Post Up Dape Additional Claim Info File Claims Code pe Print Below Line Item 1 General Detailed Description Enter the full description of the procedure code Type of Service Select the type of service from the drop down list CPT Category Select the CPT category from the drop down list Default CPT Modifiers Select the any CPT modifiers that should automatically be attached to this code when billed from the drop down list Up to four may be selected Additional Claim Info Enter any additional claim information in the space provided Print Below Line Item To enter additional information below the line item check this box CPT Origin Select the CPT origin from the drop down list Statement Description Enter the description of the procedure
82. r Fesc Dr Cxld Copy Appt Prnt SprBll Prot Remd Chart Reg Pt Track Lbl Error Delete Save Cancel Kenneth Maxey 7628 lle N lala Yeronica B Delaney MD From Time 0 15 AM Home Phone 318 555 1057 Wed Nov 28 2007 Business Phone 564 555 5584 Waiting List for Earlier Appt I Add Sub To Time 10 30 AM 27 al Once an appointment has been made it will appear in the time slot s to which it has been designated Step 1 If for any reason the appointment needs to be rescheduled simply double click on the appoint ment to open the appointment information window Step 2 Click on the Pt Resc button if it is the pa tient rescheduling the appointment and if it is the pro vider rescheduling the appointment click on Dr Resc This will close the appointment information window and the appointment will disappear off of the sched ule Step 3 By clicking on the new time date slot the previous appointment information will be transferred to the new time slot that you have selected The ap pointment will appear in the information window to offer the opportunity to edit any information if needed Step 4 Click Save By clicking Cancel the appointment will be reset to its original time Reschedule Appointment Schedules mm ALL DOCS 4 17 2008 Actions Print ALL DOCS zene Sa Bo 27 Confirmed tire Avail Export E Print Superbills Print Sched DSB End P Export To Reminder
83. r payer as part ot coordination of benetts CO 24 Payment lot charges denied Charges are covered under captahon agreement c0 25 Chagas denied Your stop lost deductible has not been met Next Insurance Plan NONE Sort By F a s ae amount p I Show Applied Amounts Only BegDate toEndDate Date ot Serce r z 5 M Show Extended Into 0 00 Left to Allocate 59 al BA Adjustments Mod Patient Adjustments for 758 Duncan Best DOB 07 03 1948 SSN 084 80 1908 CHART NO 758 DR ID 3 Date fi271472007 Batch i ee v Add Edit Print Receipt Next Pef oo par Save AdiDesc INSURANCE PAYMENT x SeeondAd INSRUANCE DISALLOWED i DenialCode INSURANCE DENAL gt Ad Ancther Cancel Resp Party SELF 1 tsi Ins Plan Empire Medicare Pat Balance 12 84 Payment Type Check v Check Auth 754756 Total Posted For This Chk 43 24 Ins Balance 30 40 Total Amount s32 Bunning F Provider fo Prov Of Chg M Stratilatova Total Balance 43 24 1 Charges 2 New Payments Adjustments 3 Comments 4 CCI Edits om rica a aoe orc ie 52007 99214 0ffic SEC 105 41 93 33 0 00 6 08 0 00 21 08 0 00 0 00 fra L L 0 00 10 5 2007 99214 Offic SEC 105 41 99 33 saoo 6 08 0 00 0 00 0 00 0 00 A sooo 9 21 2007 105 41 99 33 0 00 6 08 0 00 0 00 0 00 0 00 yy mj a 8 24 2007 99214 Off
84. rice 0 00 Charge on Hold P No Patient Insurance Information Fil Order Insurance Plan Name CoPay Amt Empire BCBS 8009922583 20 00 343243242 Batch The system allows the user to create as many batches as needed to enter charges and adjustments into the sys tem The user can ADD or EDIT several batches for different types of work Once the work is complete for a specific batch the user must run a batch report and balance then close the open batch Add Batch To add a batch click on the Add button File Hel Batch The system will automatically assign a number Je to the batch Batch Save inti i Description Description This name is user defined Usually a short een Cancel description and the users initials are used Practice DEMO DEMO DEMO DEMO DEMO i Practice Enter the practice to be used for this batch Accounting Month 12 v vear 2007 x Month Year The month and year for which the infor mation is beina entered Created by MMSKWH Created 1271072007 12 35 53 PH i Modified by MMSKWH Modified 12 10 2007 12 35 59 PM Edit Batch To edit a batch click on the Edit button This option allows the user to edit the description month and year for any open batch Save Cancel Save once the desired information is entered or Cancel to start again or exit out of the field 45 D i AO b i Charges Module charges Close Batch Once all of the information is entered for a specific batch
85. rm File Help Recently Accessed MEDFORD STEPHEN 7571 Cancel Add Lask Mame Firsk Mame Middle Mame OR Patient Number 7571 OR Social Security Mo OR Phone Wurnber OR pn Birth Date pooo m OR Chart Wumber OR Superbill Ctrl Mo AO MBA Add Patient Info 0 MBA ersion 4 9 06 Patient Lookup File Help Recently Accessed Last Mame o ceme After entering the Patient s Module of MBA you come to a patient search form The top drop down item Recently Accessed will give you the option to choose from the last 20 accessed pa ne add tients listed in order If you have nothing in any OR of the fields when OK is pressed it will bring up a Patient Number 7 list of all the patients in the system By entering information in 1 or more of the name fields you a a can pull up a list of all patients For example all Phone number 7 patients with last name starting with MED all OR patients with first name JANE or all patients saa with first name starting with J and last name Chart numee with SMI You can also enter patient number OR social security number phone number birth Superbil Ctrl No OU date chart number or superbill encounter num ber New Patient File Modules Utilities Help Patient Title First Name Middle Name Last Name Generation z ar O i e 7569 cs Y Cancel su
86. ry Type Signed Release Type o y Responsible Party Select the associ nace Special Program 7 j is li Lump Sum moun ated responsible party from this list n Be Amount Stee 1 1 _ Fercentage The Responsible Party list may be ed E EEE TETE No ited in Ins Employer tab Filing Order This number will default based on the insurance company s order in the list as well as effective and termina tion dates If an incorrect filing order number has been assigned to an insurance company you may change the filing order number manually For example If in the list above United Healthcare should have been listed first as the primary insurance but was mistakenly listed as the secondary after Medicare the user may select Medicare click edit and type the number 3 in the filing order This will automatically make United Healthcare primary and Medicare the secondary The proper way to control the filing order is by setting the effective and termination dates Accept Assignment Select the appropriate assignment from the drop down list Signature on File Check the box if the patient s signature is on file corresponds to boxes 12 and 13 on CMS 1500 This must be checked to Yes in order for the claim to be sent out electronically Effective Date Termination Date Enter the effective date and termination of the insurance policy These dates will automatically affect the filing order Once an insurance plan has reached i
87. service is listed by his her assigned provider number within MBA Trans Amount This amount is the original amount either charged or posted Amount Applied This amount is how much of the transaction amount was actually applied to the specific transaction Amount Remaining This amount is the remaining amount after the amount applied has been deducted from the trans actions amount Amount Allowed This amount is the amount allowed by the insurance company Save Cancel Save to save changes made or cancel to not save any changes made Print To print a summary of review for this specific patient click print The window will prompt you to specifications 37 B A MBA Review Module se MBA Yersion 4 9 06 Review Pt Acct for 7578 Kenneth Wayne Maxey DOB 017 2571973 SSN 123 23 1234 CHART NO 3243 DR ID 1 ACCT PRIDOC INFO NOT FOUND PrimaryDoctor Print Edit Demographics Next Pt Save Pe ERa z Practice H Include Family Charges D Cancel 5 Stmt Hist 6 Contact Hist 7 Pt Docs 8 Claims 1 General 2 History 4 lng lnfodl ncidents General Comments Allergies Drug Reactions Current Medications Patient Alert ini z Allergic to Penicillin Standard Release of Info Signed fi 7172006 pl Privacy Alert VIMY Iv ves Hom can call for test results 3 Comments These user defined fields are for entering information relevant to the overall treatment of the patient If a patient alert has
88. setup and click the Edit button You now have the option to spec ify time parameters of the schedule as well other preference options Listed under Tab 1 Appt Times you will find columns labeled In and Out These boxes are labeled according to Sun day Saturday and coordinate with the times and days that will be included in your schedule Feel free to create the sched ule times according to what best suits your needs When entering times in these fields please use the format as it is de tailed in the example below Days that will not be included in your schedule should be listed as OFF To setup a scheduled lunch break for any day enter the time the lunch will start in the first Out column and the time the lunch will end in the second In column Shown below is a lunch break from 12 30 pm to 2 00 pm on Monday only Also selected below is the ALL DOCS resource which will show a multi provider view with clinic hours ranging from 9 00 am to 6 00 pm on Monday and 9 00 am to 4 00 pm Tuesday through Friday Each individual provider schedule will match the schedule setup specifically for them and does not have to match the ALL DOCS schedule below Also at anytime the schedule can be overrode using the override default schedule info feature al lowing times to be blocked off for vacation lectures procedures or anything else that may need to change from the regu lar schedule MBA Yersion 4 9 06 Print Insurance On Sched
89. st payments for individual patient s Last Mame Cancel First Name Open the adjustments module and the patient search window will appear Middle Mame or Enter the patient s information to search for the patient with whom the adjust ments should apply You may select the Patient Number OR patient from the recently accessed drop Social Security Plo down list Click Add OR aan This will bring up the adjustments win Phone Mumber dow OR In addition to posting and adjusting pay Birth Date ns ments you can also post denials Sherk Vua Tr Once the adjustment form is populated oR you can enter your next patient s ID in aa the Next Patient field next to the Save w Superbill Ctrl Mo Defaults button Date 1173072007 Batch Netetl Daa bs Save Adi fai Ack Desc 2 Carce Resp Party SELF t Ins Plax AetmaPPD a Pat Balance 12 84 Payment Type 7 Check Auth Int Balance 30 40 Total Amount p mo Provider Delaney VeroncaB Prov Of Chg V B Delaney Total Balance 43 24 L Changes 2 New Paymerts Adustments 3 Comments wi Lo orsusarnce Amoun Ciam dered because thee injury covered by the lisbity camet all c0 21 Ciam deried because this injury i the liabdity of the nofauk carier CO 22 Clam dered because this care may be covered by another payer per coordination of bereits c0 23 Clam derved reduced because charges have been p d by anothe
90. surance Plan Information File Help Insurance Flan etna HMO T pe Private Commerical Insurance Save Description JAETNA HMO Ins Group Aetna Add Edit Cancel 4 Pre Auth Allowables Check the instances when pre authorization is required Enter the Pre Authorization Phone as well as Eligibil ity Phone in the fields provided Pre Authorization Required Payment Information Ins Resp Surgery Pre Guthorization Phone Inpatient Hospitalization Specialist Eligibility Phone Office Home Health Patient Resp vo Accident Claim Ye Max Accident In the field provided enter any Pre Authorization Comments Capitation Amount Uh Annual Max Gut of Pocket Individual 00 Family 00 Pre Authorization Comments Payment Information En ter the percentage and dollar Annual Deductible ddd rahe 00 amounts that apply to the Family 00 insurance policy Well Care Annual Amt Oo 11 MBA Add Insurance Info Insurance Plan Information File Help Insurance Plan Aetna HEE Type PrivateCommerical lnsurance Save Description SETHA HMO Ins Group Aetna Add E dit Cancel Tas ID Tag fa User Defined 6 User Defined 2 User Defined 7 User Defined 3 User Defined User Defined 4 Uzer Defined 9 User Defined 5 User Defined 10 AETNA HMO 5 User Defined Tax ID Tag In the instance that th
91. t Middle amp Last Mame STEPHEN MEDFORD Resp Party SELF 1 Address 1 Filing Order jajar 1 Address 2 Accept Assignment Only what insurance alle gt City State ip Signature on File WMI 7 Yes Dake of Birth Sex Employer g o Description 12 MSP Working Aged Beneficiary or Spouse with Employer Group Heal a ener 13 MSF End Stage Renal Disease Beneficiary in the 12 month coordinal ump 14 MSF No fault Insurance including Auto is Primary MSP WorkerEs Compensation MSP Public Health Service PHS or Other Federal Agency MSP Black Lung MSP Veterarve s Administration MSP Disabled Beneficiary Under Age 65 with Large Group Health Ple F Effective Date Termination Date Signed Release of Info a M Secondary Type Signed Release Type Co payment Information C Not Applicable Cardholder Information Relationship Select the relationship the patient has to the primary cardholder If Self stop here and the patient s name will auto populate If different than self enter the Cardholder s information in the appropriate fields Be sure to include the date of birth to avoid claim rejections If the primary cardholder s address is the same as the patient s click the Same As Patient box in the upper right hand cor ner to default to the information from the General tab of the patient record There are also fields to enter the cardholder s sex and employer
92. t Number OR Superbill Ctrl Mo The totals shown in Tab 1 General can be filtered by selecting the Responsible Party from the drop down list or by Primary Doctor or by Practice If the patient is linked to a family account you can view that balance by check ing the Include Family Charges box You can also move to the next patient by typing in the desired patient s ID number in the Next Pt box The Edit Demographics button will open the patient module allowing you to make changes The Yellow background on Tab 3 Comments indicates there is a privacy alert A red background indicates a patient alert If there are pri vacy and patient alerts the background color will match the color of the last alert To navigate between the eight tabs in Review simply left click the desired tab or use the keyboard shortcuts such as ALT 2 for History MBA ersion 4 9 06 Review PE Acct for 7578 Kenneth Wayne Maxey DOB 017 2571973 SSM 123 253 1234 CHART NO 3243 DR ID 1 ACCT PRI DOC INFO NOT FOUND PrimaryDoctor Adler Stephen Frint Edit Demographics Nent Pt Save Resp Party SELF 1 Practice DEMO DEMO DEMO DEMO DEMO Include Family Charges 7 Cancel 5 Stmt Hist 6 Contact Hist Z Ft Docs 8 Claims 1 General 2 History o Bomments O 4 Ine Infoslnciderts 55M 123 231 aad Home Phone fei a 555 9801 Business Phone fia 8 555 9675 Address fi O02 Stubbs Avenue Monroe L 71201 Patient Since MHo
93. that you would like to have appear on the patient s statement Taxable Check yes if this this a taxable procedure to be charged Requires Referral Check yes if this code requires a referral to be billed Post Op Days Enter the number of post op days assigned to this procedure File Claims Code Select the method in which this procedure should be filed to insurance from the drop down list 50 Al A BA Charges Module User Defined Procedures Charges Procedures FERRE EEE EEE EEE EERE EEE E EEE EEE E EEE EEE EERE HEHE Oe 1 General 2 FeeSchedules 3 Procedure Details 4 Comments 5 CCI Edits Grr ese tt Fee Schedule Description Amount es Standard Fee Schedule m g 2 Blue Cross Blue Shield Ke Medicare Allowable Fees For Year 2007 Place Of Service Full Mod TC Mod 26 View Last Year s Medicare s Fees Non Facility office N A NA NA Facility NAA NAA NAA Cancel Enter the appropriate amount for each of the fee schedules listed at left To add more fee schedules please use the Maintenance Menu from the Main MBA screen If a fee schedule is not used then simply leave the fee amount as zero The Zero Fee Schedule number ts the default unless otherwise specified on the responsible parties for each patient 2 Fee Schedules Enter the appropriate fee schedule amount for each of the fee schedules listed To add more fee schedules please use the Maintenance Menu from the main M
94. the user must balance and close the batch om Medical Billing Assistant MBA ersion 4 9 06 DEMO DEM File Modules Maintenance Reports Utilities Help v Print to Screen e STEP ONE In the main menu on the top of the screen se Print to Printer Print Export to File Report Manager Report Designer Printer 4ssignments Hospital Rounds Edit Correspondence Recall and Reminders Chart Requests Patient Registration Routing Slips Close Batch Labels lect the Reports option Then select the Close Batch option A list of open batches will appear STEP TWO Select the Batch that is ready to be closed by highlighting the corresponding number STEP THREE Then select Batch Report A report will print showing all information that was actually entered into the sys tem The user should balance each item entered to the items on the report STEP FOUR Once the batch report has printed and the in formation balances select the balanced batch number and select Close Batch The system will close the batch and bring the user back to the Main Menu Patient Ledger Once a batch has been closed the system only allows cer tain corrections to be made to the info in the batch MBA Yersion 4 9 06 Close Batch Show Closed Batches 7 Practice F Please select the batch you wish to close Print Charges Print CPT Totals Print Pronta djs DEMO DEMO DEMO DEMO 11 9 07 Patient Copays 011 14 0 cmacdonald vist Ta
95. tly delete a responsible party click Delete If the responsible party has been linked to a charge MBA will not allow you to delete that responsible party Employment Info Employers File Help Enter the patient s employer information Mame as well as other contact info into the Seuthem System Sales appropriate fields Address 1 1000 West Esplanade Avenue Cancel Address 2 Suite 1001 Select employment status from the drop City State Zip Kenner e Apos down list Phone 504 505 6957 A contact name may be entered if there Contact Phone Philip Medford te04 506 6900 is a specific point of contact at the pa Fax 604 505 6901 tient s place of employment Any addi Comments Added Workman s Comp Resp Party for 8 07 3 12 0 changes tional information may be entered in the Additional Information field at the bot tom Fil After initially saving the patient s ac Created by MMSKWM Created 11 28 2007 1 51 31 PM count all information can be updated or Modified by MMSKWM Modified 11 28 2007 1 51 31 PM edited at any time with the exception of things linked to charges or payments Employment Info Employer Southern System Sales 1 Add Edit Contact Marne Philip Medford Employer s Phone Sumber i504 n05 6957 Contact Phone Number i504 505 6900 Employment Status Employed Full Time Additional Information Employeed 20 years A MBA Add Patient Info 0 4 Family 1 General 2
96. ts termination date this plan will be listed in red to indicate it cannot be used to file claims that fall outside the dates MC Secondary Type Select the appropriate code and description from the drop down for Medicare Secondary claims Co Payment Information Check the applicable co payment information Signed Release of Info Select the appropriate type from the drop down list Signed Release Type Select the appropriate type from the drop down list Special Program Select the appropriate type from the drop down list Medicare Secondary Type Select the appropriate type from the drop down list This is used only for filing Medicare Secondary claims electronically Additional Claim Data This is a user defined field Privacy Y N Check the box to select yes when applicabld 3 AO MBA Add Insurance Info MC Secondary Type Codes 12 47 are listed There are two codes that are the most com monly used and most likely to be approved by MSP The first code is 12 for patients over 65 The second code is 43 for patients under 65 The remaining codes are rarely used but available as needed a Patients Patient Insurance File Utilities Help Cancel LGenera 2Comments SlnsCardSidel 4InsCardSide2 SilnsCardSide GlnsCardSided Patient Insurance Information Insurance Plan Aena HMO O Add Edit ID Humber 235434534 Cardholder Information E psa Relationship Seli Group Number CE Firs
97. ule This allows you to print a schedule and set date parameters for the schedule printed Reminder areas Reminder Letters This function will print reminder letters for all patients in the current schedule view Font psg DSB This is a future enhancement called Digital Superbill Font Terminal O Times New Roman O Trebuchet MS Chg Chg Font This allows you to use the window to the right to Font change the font style and size AaBbYy2z Sample Close Close Exits schedule view Script This is an OpenType font This same font will be used on both your printer and your screen Refresh This button will refresh the view 32 MBA Review Module MBA Version 4 9 06 Review Patient Account File Help Recently Accessed Last Mame First Mame Middle Warne OR Patient Number Cancel In this module the user will be al lowed to review a patient s current information history as well as rec oncile the account or view the aging for the patient This module can be used for follow up on any out standing balance for the patient Open the review module and the Z Review patient search window will appear Social Security Mo OR Enter the patient s information to Phone Number search for the patient You may a select the patient from the recently ee eee accessed dropdown list Click OK This will bring up the review win dow Char
98. uler Report Available Resources __ ResourcelD ShortDescription LongDescription ReferingDoctor _CreationDate CreationUserlD Phe TALL DOCS O 2200F 10 33 35 AM MSSMM Add f Show Doctors f Show Resources ie Save Cancel 2 4ddtl Setup Inactive In Out In Out 1 Appt Times Sunday OFF Sunday OFF Sunday OFF Sunday OFF Monday 09 00 AM Monday 12 30 PM Monday 02 00 PM Monday 06 00 PM Tuesday Tuesday 04 00 PM Tuesday Tuesday OFF Wednesday 09 00 AM Wednesday 04 00 PM Wednesday Wednesday OFF Thursday 09 00 AM Thursday 04 00 PM Thursday Thursday OFF Friday 09 00 AM Friday 04 00 PH Friday Friday Saturday OFF Saturday OFF Saturday Saturday 17 A MBA Schedule Set Up in 2 Additional Setup In tab 2 you will find additional options to further customize the schedule depending on the provider s needs 1 Default Number of Appointments This option allows you to set the number of columns on the daily sched ule The default number of columns is two so if you select more than two you will need to save and then return to ed iting for the additional columns to appear for title and color editing As shown below there are eight default number of appointments which creates eight columns The default name of the appointment column is shown below You may change the name and then double click to change the background color 2 Number of Lines To Display Per Row This option adjusts the number of lines
99. upport if you need this feature This is for the Correct Coding Initiative Edits 53 A WA BA Charges Module cher MBA Version 4 9 03 Diagnosis Diagnosis Cancel 1 General 2 Comments Diagnosis Code Inactive Short Description Alternate Code 1 Detailed Description Alternate Code 2 Valid From valid Thru Replacement Code Required Addl Digit FN Required Accident Info F In the case that a particular diagnosis code is not found in the search a diagnosis code may be added by click ing ADD next to the fields provided for ICD 9 entry The ADD function will bring up a search window and then if the particular code or description is not found the diagnosis window will appear See above Diagnosis Code Enter the ICD 9 code in the field provided Short Description Enter a short description of the diagnosis in the space provided This will serve as a future search identifier for the code Alternate Code 1 Enter the first alternate code if applicable Alternate Code 2 Enter the second alternate code if applicable Valid From Thru Enter the dates that the code is identified as valid in the space provided Replacement Code Enter the code that replaces this one after the Valid Thru date Required Additional Digit In the case that an additional digit is required when this code is billed click yes Required Accident Info In the case where accident information is required in conjunction to t
100. urance is billed The charge will then age in the patient portion of the A R Anesthesia From To Enter the actual time of day from and to that anesthesia was administered The system will auto matically calculate the number of units depending on the predetermined minute intervals set by the system administrator Charge on Hold Click Yes or No If clicked yes you will be prompted to enter a hold reason It will not be billed to the insurance company or patient until the charge is taken off of hold status When claims are run any charges on hold will print out on the error report so as to remind you that this edie needs to be fixed AO MBA Charges Module BA ersion 4 9 06 Patient Charges ADD MODE for 7578 Kenneth Wayne Maxey DOB 017 2571973 SSM 123 23 1234 CHART NO 3243 DR ID 1 Batch 7D1114 0Fcmacdonald 42 w Add Edit Place of Serv Gradhurst Office MBA ID 1 Add Edi Incident ID Poo YL dd Edit Dr of Service Ader Stephen Add E dit Resp Party SELF 1 sd Referring Dr Abouezi Ziad x Add Edit Fre Auth H Po Visits Remaining otf Fee Schedule S7ANDARD FEES haves ZAddtional ais O 4 Othe Chaves Return to Work asd Hospital ID Outside Charges 0 Emergency rN No Type of Accident LabsHHA Name Add Edit Condition Rel to Empl No Disability T F pooo First Consulted B Elective Procedure N 7 No Disabled From E Andr 3rd Opinion 2 3 Disabled T
101. ustment payment Next Ins Plan Aetna PPO Sort By V Descending Order Show Family Charges Charge amount V Open Charges Only Show Applied Amounts Only Insurance Plan Select the insur soa J wenna LE Baleot Seni ie hearers ance plan for this adjustment 0 00 Left to Allocate Payment Type If in the initial adjustment description is a payment then select the payment type Cash Check Credit Card Debit Card Direct Deposit Money Order Check Auth Enter the check number or authorization number that corresponds to the check credit card debit card direct deposit or money order Total Amount Enter the total amount of the payment or adjustment Running Total In the case that a total amount is unavailable or inconvenient the running total check box may be se lected to tally a total amount based on the amounts entered in the Apply Amount and 2nd Adjustment fields Provider Select the corresponding provider from the drop down list Print Receipt Check this box if a receipt of this transaction should be printed Next Patient Once the adjustment form is populated you can enter the next patient s ID before saving the adjust ment Balance Windows The balance windows show amounts owed and credit amounts for the patient responsible party or insurance The total amount due on the account is also listed Beginning Date to End Date T
102. ve the revisions MBA Yersion 4 9 06 Established Patient Patient Information Last Hame Maney First Marne Kenneth Fatient ID 7 25 Birth Date Month 01 Dap 25 Year 1973 Age 34 Son 111 f1 h11 Update Hailing Address Address 1 200 Gator Drive Address 2 City State Zip Miami FL 32423 County Quachita Contact Information Home Phone 318 y 555 josz Business Phone 564 555 k 5584 24 AO MBA Make Appointment MBA Yersion 4 9 06 APPT INFO Kenneth Maxey T628 DOB 17 25 1973 SSN N A CHART NUMBER N A File E Cancel j l Pk Resc Ft Cxld Dr Cxld Kenneth Maxey 7628 Edit Pt Info Home Fhone 318 555 1057 Business Phone 564 555 5584 Waiting List for Earlier Appt D Reason Add Edt Comments j Dr Resc Yeronica B Delaney MD From Time 0 15 4h Add Sub To Time 10 30 AM SchedN ame O114 2008 10 00 4M Hosp Labs Only Nurse Nurse 12 10 2007 03 75 AM Stephen Adler ppt Detl La Resp Party SELFA Place of Svc P Ref Doc Po YS Add Edit Incident ID r Add Edt Pre Auth e visits Remaining off Eligibility Into Prot Type Check Auth H T Include Family Charges D Print Receipt 2 Adde Det 1 Setna PPO MENDEA Y 3 Privac AR For This Doc Only Please click here for Patient Bal

Charges Module - Medford Medical Systems

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