Quick Start: Billing
Billing for the first time can be intimidating, but with one-click electronic claim submission, simple CMS-1500 and superbill generation, easy-to-use reporting, integrated credit card processing, and more, TherapyNotes makes billing a breeze.
After you have scheduled an appointment and completed the corresponding note, your To-Do list will automatically create a reminder to submit the electronic claim, generate a CMS-1500 form, or mark that the claim was submitted outside of TherapyNotes, depending on your practice's default billing method or the billing method your set up for the specific payer. Simply enter any payment received from your client, let TherapyNotes help you generate and submit your claim, and enter the payment you receive from insurance.
This article is designed to help you set up your TherapyNotes account to be able to simply and efficiently bill for the services you provide. Be sure that you have configured the settings outlined in Quick Start: Set Up Your TherapyNotes Account before beginning this tutorial.
Follow the steps below to set up billing in TherapyNotes or click on any of the links below to jump to that section of the article.
Part 1: Practice Billing Settings
Click the User Icon > Settings > Practice Billing
Select the Enable Billing Features checkbox to display configurable billing settings for TherapyNotes.
Enable TherapyNotes EDI
Select the Enable TherapyNotes EDI checkbox to submit claims electronically within TherapyNotes.
EDI (electronic data interchange) allows TherapyNotes to submit your claims electronically to payers that you have added in TherapyNotes. Electronic claims in TherapyNotes pass through Change Healthcare, our clearinghouse partner who supports claim submission to over 2,000 payers nationwide.
Preferred Billing Methods
Select your default billing methods for in- and out-of-network payers. The billing method can also be adjusted per payer and per individual billing line item, if desired. Even if you are out-of-network with a payer, TherapyNotes can help you submit claims electronically on your client's behalf, saving your client from the hassle of submitting on their own and waiting for reimbursement.
Out-of-Network Payment Assignments
Select whether insurance payments should be assigned to the client or your practice on out-of-network claims.
(A) By default, payments should be assigned to the practice: This option assumes that the client is only responsible for paying their portion of the amount due (excluding the amount paid by the payer). This should be used when the practice submits the out-of-network claim and only charges the client the remainder of the balance not covered by insurance.
(B) By default, payments should be assigned to the patient: This option assumes that the client is responsible for paying the full amount due. This should be used when the client pays the entire balance upfront, the practice submits the out-of-network claim, and the payer reimburses the client directly.
Diagnosis Codes on Claims
Select whether to include only the primary diagnosis code or up to four diagnosis codes on electronic claims. Including multiple diagnoses per claim may be useful for payers who want to track information about co-occurring disorders, justifying diagnoses associated with medical conditions or substance use, and more.
Configure your preferences for handling paper claims in TherapyNotes. When generating a CMS-1500 (formerly known as HCFA forms), TherapyNotes allows you to choose whether you want to print your data onto pre-printed red forms or you want to print the red form background along with your data. CMS-1500 forms can be purchased from a variety of places and may be required by some payers. Adjust your printer settings here to make sure the data you print lines up correctly with the pre-printed form.
Alternate Billing Address
If applicable, enter the alternate billing address for your practice here. An alternate billing address may be useful if you rent office space and want your billing correspondence sent to a home address or PO Box.
When you are finished configuring your Practice Billing settings, click the Save Billing Settings button.
Part 2: Review Staff Roles for Billing
Click the User Icon > Settings > Staff User Accounts
Assign the role of Practice Biller to each staff user who needs to have access to practice-wide billing.
- In the staff user's profile, click the Information tab
- Click anywhere on the Roles box
- Select the checkbox next to Practice Biller
- Click the Save Changes button
Note: If a Clinician needs access to billing features such as entering rates, entering insurance information, and collecting copays, check the box next to Biller for Assigned Patients Only. This role does not let Clinicians submit any electronic claims, generate CMS-1500 forms, or generate superbills. It does enable Clinicians to add copays and insurance information for their clients.
Part 3: Adding Payers
TherapyNotes and Change Healthcare support claim submission to over 2,000 payers. To manage your insurance billing in TherapyNotes, add each of your payers.
Click Payers > Add a Payer
(A) Ins. Provider Name: Begin typing the insurance provider's name to see a list of exact or similar payer matches. Click on the payer in the list to automatically populate the Payer ID as well as information regarding the Clearinghouse EDI Enrollment Status for the payer.
(B) Network: Select the Network checkbox to indicate that you are in-network with the payer.
(C) Address, Phone Number, Fax Number: Generally, when submitting claims electronically, this information is not necessary. However, address information is required when submitting paper claims.
Click the Save New Payer button and repeat the above process to add each of the payers you bill to, regardless of the frequency or whether you are in-network or out-of-network.
Part 4: EDI and ERA Enrollments
Click Payers > Payer Name > Clearinghouse EDI Enrollment Status
To take full advantage of our integrated billing features, enroll to submit electronic claims and receive ERAs for each of your payers. Enrollments can be started on each payer's profile and may take a few weeks to process.
Even if you are already credentialed with a payer, additional enrollment paperwork may still need to be submitted to our clearinghouse, Change Healthcare, in order to submit electronic claims to the payer through TherapyNotes. Most payers do not require enrollment in order to be able to submit claims electronically. For those that do require special enrollment, each payer may bear slight differences on how to enroll, and instructions for enrollment can be found in the box labeled Clearinghouse EDI Enrollment Status of the payer's profile. For more information, read Electronic (EDI) Claims Enrollment.
To receive electronic remittance advice (ERAs) directly in TherapyNotes, most payers do require enrollment. To learn more, read Electronic Remittance Advice (ERA) Enrollment.
ERAs act as electronic versions of a paper explanation of benefits routed directly into your TherapyNotes account. TherapyNotes offers an assisted ERA payment posting feature which pulls information from your ERA to help you post the payment into TherapyNotes quickly. For more information on ERAs, read Electronic Remittance Advice (ERA).
Part 5: Patient Billing Settings
Once all of your payers have been added to your account, enter relevant insurance billing information for each of your clients.
- Click Patients > Patient Name > Billing Settings tab
- Click anywhere on the Insurance box to edit
- If the client uses insurance, select the Patient Has Insurance checkbox to enter primary and secondary insurance information, pre-authorizations, and additional claim information related to referrals or illness
Note: Insurance claims require you to indicate that you have your client's signature on file. This signifies that the client has provided consent for billing to their insurance company and for the insurance company to pay the provider.
For more information, read How To: Manage Client Billing Settings.
You've configured your settings in TherapyNotes, learned how to schedule appointments, explored our powerful note templates, and prepared your account for billing. Your account is ready to go!
Read the following articles to learn more about specific billing functions in TherapyNotes and begin billing for your services:
- How To: Submit Electronic (EDI) Claims
- EDI Claim History: Claim Status and Rejected Claims
- How To: Resubmit EDI Claims
- How To: Create CMS-1500 Claims
- How To: Submit Claims Outside of TherapyNotes
- How To: Enter Client Payments
- How To: Enter Insurance Payments