How To: Enter Insurance Payments
TherapyNotes' billing features allow you to keep a record of charges and payments for both insurance companies and your clients. After you receive a payment from a payer, record the payment in TherapyNotes.
If you are enrolled to receive electronic remittance advice (ERA) from a payer, TherapyNotes offers assisted ERA payment posting to help post the payment to your account. For detailed instructions, read How To: Post ERA Payments.
To manually enter an insurance payment:
- Click Billing > Enter Insurance Payment OR Click Patients > Patient Name > Patient Billing tab > Enter Insurance Payment
- Enter information about the payer, payment, and allocation
(A) Payment Type: Select whether the payment is from an in-network payer or an out-of-network payer. Your selection for Payment Type dictates which payers are available in the Payer dropdown.
(B) Payment Amount: Enter the total amount of the insurance payment. By default, Payment from Payer is selected in the dropdown next to Payment Amount. This selection indicates that you are receiving a positive payment from the payer. If you are recording a refund paid to the payer, select Refund Paid to Payer from this dropdown. Selecting this option automatically sets the Payment Amount as negative.
(C) Items dropdown: The items dropdown below the payment information defaults to Submitted Items. If the insurance payment was meant for a specific service that is not visible in the table below, select another option from this dropdown. Submitted Items shows only items that have been marked as submitted in TherapyNotes and are awaiting payment from the payer. Open Items includes items that are pending submission to the payer in addition to submitted items that are awaiting payment. All Items includes all submitted and open items plus items that have been marked as paid.
(D) Allocation: Enter the amount of the insurance payment that should be applied to each date of service.
(E) Adjustment: If the Allocation for a date of service differs from the Ins Amt, the exact value of the discrepancy will be shown in the Adjustment column. To accept the adjustment, select the checkbox next to the value. If the Ins Amt is set to $0.00, select the Approved checkbox next to the corresponding date of service to indicate that the claim was approved by the payer as indicated on the explanation of benefits (EOB) or ERA.
(F) Payment Adjustments: Enter the Description of Payment Adjustments and total Adjustment amount, if applicable. Adjustments may include bonuses from incentive programs, interest payments or charges, or deductions for prior overpayment, among others.
- Click the Save Payment button
What if the insurance payment is negative or zero?
Occasionally, a payer may send you an explanation of benefits (EOB) or electronic remittance advice (ERA) for a $0 payment. In these instances, a payer acknowledges the charge but will not reimburse you for the service, such as when a client has a deductible.
To record a $0 payment, enter 0 for Payment Amount and 0 in the Allocation field for each corresponding date of service. To move the payment responsibility to the client, click on the hyperlinked date of service. For in-network items, enter the rate for the service in the Pt Amt field. For out-of-network items, enter 0 in the Coverage field. If you don't want the client to be responsible for the payment, select the Write Off Patient Balance checkbox next to Patient Paid.
Refunds and Negative Payments
A payer may require a refund or submit a negative payment in the event of overpayment, penalties, or other adjustments.
To enter a refund, select Refund Paid to Payer from the dropdown next to Payment Amount after the Payment Amount has been entered. This will automatically set a negative value for Payment Amount. Allocate the refund to the applicable dates of service by entering a negative value in the corresponding Allocation fields. A negative value can be entered with a minus (-) sign or surrounded by parentheses. For example, -20 or (20).
Negative payments may also be applied per date of service if the total Payment Amount is positive.