How To: Record Coinsurance

Coinsurance represents the percentage of medical expenses a client is responsible for paying. While TherapyNotes only supports fixed dollar amounts for payment responsibility, there are steps you may take to correctly track and manage coinsurance.

If you are enrolled to receive ERAs from a payer, our assisted ERA payment posting feature detects and applies coinsurance to help maintain accurate records. For more information, read How To: Post ERA Payments.

Role Required: Practice Biller

To record the coinsurance in the client's chart:

  • Click Patients > Patient Name > Billing Settings tab
  • Click anywhere on the Insurance box to edit

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  • If the client always visits for the same service and you consistently charge the same rate for the service, enter the calculated coinsurance amount in the Copay field. Otherwise, leave this field blank
  • Scroll up to Billing Comments. Enter the coinsurance percentage in this field for your reference
  • Click the Save Changes button

If the Copay field is left blank, enter the coinsurance amount per billing line item to ensure that the payment responsibility for the client is correct for every date of service.

To manually enter the coinsurance amount for in-network clients:

  • Click Patients > Patient Name > Patient Billing tab
  • Under Search Billing Transactions, click on the date of service
  • A dialog with additional details about the date of service appears. The Billing tab should be selected
  • Enter the calculated coinsurance amount for the service in the Pt Amt field
  • Click the Save Changes button

To manually enter the coinsurance amount for out-of-network clients:

  • Click Patients > Patient Name > Patient Billing tab
  • Under Search Billing Transactions, click on the date of service
  • A dialog with additional details about the date of service appears. The Billing tab should be selected
  • Enter the calculated insurance responsibility for the service in the Coverage field. For example, if the client's coinsurance is 20% and the rate of the service is $100, enter 80 for Coverage
  • Click the Save Changes button

Coinsurance and ERAs

If you are enrolled to receive ERAs from the client's insurance company, TherapyNotes will detect the coinsurance amount when posting the ERA, suggest changes to client or insurance payment responsibility, and adjust your billing records for the date of service automatically if the suggest is taken.

To verify coinsurance when posting an ERA payment:

  • Click Billing > ERA OR Click To-Do > Process ERAs
  • Click the Post Payment link next to the ERA you want to process

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  • When coinsurance is detected, the ERA Payment Poster shows an alert below the corresponding line item and suggests to set Pt Amt (for in-network payers) or Ins Amt (for out-of-network payers) to the appropriate value
  • If the suggestion has been automatically applied, the affected values are highlighted with a yellow background. If there are conflicting suggestions for the line item, review the ERA and click on the hyperlinked Patient Amount or Insurance Amount value to automatically apply the suggestion
  • Finish reviewing the information in the ERA Payment Poster
  • Click the Post Payment button

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