New Billing Features

Let's go over the new features and changes to the billing update.

Usage

In order to use the new billing in Chiro Cat, support needs to enable it on your account. Once enabled, several tools and reports become available to you. The new billing functionality can co-exist with your existing processes and financial procedures. In fact, new billing is set up on a per patient basis. Many may find it useful to test with one or a handful of patients to understand and get a hold of the new processes before migrating everyone. You might select several patients (or even create some test patient profiles), or you might decide to do all new patients as your test cohort.

For a patient profile (new or existing) to be converted the patient must have a zero balance. When you open a patient dashboard that has a zero balance, there will be a banner in the billing tab with a convert button. Once you convert a patient to new billing, this is a one-way, one-time action. They will now be on the new billing and cannot be converted back. The principal change you will notice is a new view/interface for the billing > overview tab in the patient dashboard.

Basic Structure

The base structure for new billing is broken into 5 core components wrapped in month-end closing statements. All principles in the new billing adhere to double-entry accounting (DEA) principles as closely as possible. You do NOT need to understand DEA to use the new billing update. The basic formula you need to understand is: 

Charges - Payments - Insurance - Adjustments = Owing

One primary principle of DEA is that once a transaction is recorded you don't edit or delete, instead you make adjustments. Now, the Chico Cat implementation does allow a set of edit and delete options. For example if a charge or payment was accidentally added or added incorrectly and it doesn't have any linked transactions it can be modified. However, in your month-end closing process you will confirm balances and amounts for your patients and POST those transactions to the patient ledger. Once an item is posted to the ledger it can never be altered. You balance or make the patient account right through adjusting entries. Sometimes that will be a write-off, other times a refund, and yet others a discount or something more generic or specific. Adjustments can be both positive and negative. Negative adjustments have the effect of adding to the patient balance, whereas positive adjustments reduce the balance because of the formula above.

Definitions

With that understanding of the basic formula let's see what makes up each piece.

1. Charges can be one of the following

• Services - rendered by a provider to a patient. Should be linked to an appointment and ideally chart notes and even diagnosis'.
• Products - sold on a date to a patient but do not need to be linked to an appointment or any chart but in a perfect world could be (but technically this is optional).
• Tips - paid by a patient for a provider linked to an appointment. These generally do NOT need to be added manually (even though they can), but they are offered when adding services to a patient.
• Fees - charged to a patient as a result of several things. The only automated fee in the system right now are credit card fees. If you navigate to your settings > patient fee. You can set up a credit card fee and this will be automatically calculated at time of payment when payment type is credit card. Nothing manual is needed here. You can also configure late payment, missed appointments, or cancellation fees that you can add to a patient's ledger.
• Packages - these are groups of services, products and visits that can be sold to a patient. These packages once paid for can be used as a form of payment method on the patient's ledger.
• Memberships - these are similar to a care package but instead of paying for everything up front you pay an amount per month for a set amount of time. You will set what services, and products can be used each month and the quantity of each available per month.
  
  

1. Payments have the following methods

• Cash - used to pay for any charge on the patient's account. When you record a payment (cash or other method) you select which charge or charges you want to cover with this cash payment. You can select one or multiple charges. This payment is then automatically applied to all of those charges. You have the opportunity to customize the amount applied to each charge - but the remaining balances for each charge are automatically calculated and entered for you (including anticipated insurance payments for services).
• Credit Card - the same definition as cash above, other than you can also apply the credit card fee if one is set up.
• Apply Care Package - this works the same as cash and credit card other than you don't actually collect any form of payment from the patient. Think of it as a balance on account that can be used to cover charges (services, products or visits).
• Apply Membership - this is again like a care package, if the patient has an active membership it can be applied if applicable to a service or product.
  
  

1. Insurance include the following

• Claims - You can select any service in the billing tab and start a claim for that service. If you are using fee schedules for your different insurances/payers, then when you start a claim the appropriate amounts for each service (as you have it set up) will be applied between contractual amount vs total billed amount. The balance for each charge/service will be displayed/calculated as a patient responsibility or can be written off. Once a claim is started for a charge then it will be displayed in this insurance column reducing the balance owing for the patient - even if the claim is unsubmitted or awaiting response. The claim status is displayed next to this value so you always know where it's at. Once you receive a response on claims or receive remittances you can record those as insurance payments
• Payments - these insurance payments will be recorded with check number, date and amount or ACH confirmation and date and amount and then can be distributed to any outstanding services that have a claim for the same payer. Once they are applied the insurance values on the patient balance will automatically be updated. If they pay the anticipated amounts nothing further is required. If they underpay when you record the payment you can define whether you want to write off the remainder or mark it as patient responsibility or a combination of the two.
  
  

1. Adjustments

• Discounts - you can apply a discount adjustment to any charge. You can specify whether it's a fixed amount or a percentage and that will be applied to each charge transaction you choose and will be calculated to offset the patient balance.
• Generic Adjustments - you may apply a general (or choose a type) of adjustment and apply it to any charge and the rules follow discounts - the only difference is discounts allow you to put fix/percent and it calculates for you.

• Insurance/Contract

• Patient Responsibility - when recording insurance payments you can specify how much you want to mark as patient responsibility and this adjustment will go in automatically for you. Normally you do not ever need to do these manually.
• Write-off - these also get added automatically in the insurance process but also can be added manually and do NOT have to be insurance related.
• Refunds - these special types of adjustments apply only to payments (note: remember the formula from above). You can refund different payments in the system as necessary. The system will apply refunds on transactions to the different charges that each payment is linked to. Again you can specify how much and for what charge you want to refund. Each of these are used to calculate balances for each charge and therefore overall for the patient. You can issue a refund across multiple payments at the same time.
  
  

1. Owing

• Invoices - these are simply a way to generate a document that can be printed or sent to a patient showing their current balance and a breakdown of previous owing amounts from statements and then includes any current charges (from the current month) to calculate an overall balance. The system generates these in the PDF format.
• Statements - these are automatically generated documents that link together all new billing transactions when you close the month. This is to serve as a record in time and history of where an account was at for a given time period (by default 1 month). These can also be generated as a PDF to be distributed to a patient. But they also serve as a basic grouping on the new billing overview screen.
  
  

        Creating a new payment

Applying a new payment in the new billing system differs slightly from the previous          method. You can now link a payment directly to a service or product, or just simply add a payment. From the payments drop down select the form of payment and you will be presented with the following screen.

Afterwards, you can select the "Add Charges" drop down to apply a payment directly and link it to the service. To add an unlinked amount just select the "Enter Amount" button and you can manually enter a payment amount and description.

After applying payments to services, you will be able to view their payment status through color coded circles. A green circle indicates that the service has been fully paid, while a yellow circle indicates partial payments. By hovering your cursor over the circle, you can access the payment history.