How To: Record Coinsurance

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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

copayfield.png

  • 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

erapostingcoinsurance.PNG

  • 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
Have more questions? Submit a request

Comments

  • Avatar
    Christopher Rigling

    Any progress on the coinsurance issue. Its been over one year since this FAQ response.

  • Avatar
    Jordan

    Chris,

    I apologize as this is still a pending feature. For now, in the copay settings for the patient, you can leave it blank and then enter the calculated amount in the copay section of each appointment. However, if the patient always comes for the same service then their amount due isn't going to change each appointment, so you can enter that calculated amount as their copay. For example, if they pay 20% of $80 every week, then just make $16 the copay setting. Please let me know if you have any questions. Thank you!

  • Avatar
    John Diehl

    When do you expect a field for co-insurance to be added?

  • Avatar
    Jordan

    John,

    I apologize but I do not have an eta, I'm sorry for any inconvenience. Please let me know if you have any questions. Thank you.

  • Avatar
    Aubrey Marvel

    I know this question has been asked multiple times recently on this thread, but with the growing rate of deductible/co-insurance plans I just want to make sure its being worked on. It causes significant issues in our patient accounts and has many accounts being billed incorrectly to both the insurance company and to the patient. Unfortunately, there are too many accounts to check every day to make sure they are balanced. Having the co-insurance feature I'm sure would benefit more clinics and offices than mine. Is there any way to get an ETA on this issue, given that it is a significant one? Thank you for your time.

  • Avatar
    Jordan

    Aubrey,

    This suggested feature is planned for the future. No ETA yet. Thank you for your feedback. Please let us know if you have any questions. Thank you.

  • Avatar
    Amanda Fritz

    Hi,

    Several of my clients have both a per session copay and additional coinsurance. Is that something that will be taken into account when you address this issue? Any ETA? Thanks!

  • Avatar
    Laura

    Amanda,

    We will take that into consideration when planning the feature. Thanks so much for your feedback!

  • Avatar
    Marya McNorton

    This really would be a valuable feature.