Computerized Medical Billing MTBC-Billing-proTM

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Computerized Medical Billing MTBC-Billing-proTM Powered By Docstoc
					Medical Billing by MTBC




                                          A Work Book For

                    Computerized Medical Billing
                                                  Using

                               MTBC-Billing-pro™




        Increase practice effectiveness & efficiency with MTBC


           7 Clyde Road, Suite 201, Somerset, NJ 08873, Phone 732.873.5133, Facsimile 732.873.6858
                                               www.mtbc.com
                                                     1
Table of Contents
Chapter 1

Introduction to Medical
Billing………………………………………………………...…6

Objectives . ……………….………………………………………………………………6
Electronic Billing.................................................................................................... 7
Medical Billing ....................................................................................................... 7
Records kept by Billing Assistant/Billing Specialist ............................................... 8
Medical Billing by MTBC ....................................................................................... 8
         • Electronic & Paper claim submission ................................................ 8
         • Entry of Patient Demographics .......................................................... 8
         • Charge Entry ..................................................................................... 9
         • Payment Posting ............................................................................... 9
         • Accounts Receivable and Claims Follow-up ..................................... 9
         • Quality Control .................................................................................. 9
               •    Why choose
                    MTBC……………………………………………………….....……………..9
               •    Do it Yourself Billing
                    ……………………………………………………………………..11


Chapter 2

Using MTBC-BILLING PRO ™ for Medical Billing

Objectives ........................................................................................................... 12
Options Used In MTBC- Billing Pro ™ ...............................................................................13
MTBC-Billing Pro ™ Main Menu ..........................................................................................13
         • Main menu options ...........................................................................................14
         • Tool Strip .............................................................................................................14
Starting MTBC-Billing Pro ™ .................................................................................................15
Welcome Screen .......................................................................................................................16
Navigating through Menus .....................................................................................................16




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Chapter 3

Managing Search with MTBC-Billing Pro ™

Objectives ........................................................................................................... 17
Search options in Billing Pro ™ .......................................................................... 17
         • Patient Search ................................................................................. 18
         • Referring Physician Search ............................................................. 19
         • Financial Guarantor Search ............................................................ 20
         • Insurance Search ............................................................................ 23


Chapter 4

Entering Patient Information /Demographics

Objectives ........................................................................................................... 25
Adding New Patient ............................................................................................ 25
Patient Detail ...................................................................................................... 26
Add/Edit Insurance............................................................................................. 27
CPT: Current Procedural Terminology: ............................................................... 30


Chapter 5

Practice & Provider Profile/overview

Objectives ........................................................................................................... 31
Practice & Provider Profile .................................................................................. 32
         • Practice Information ........................................................................ 32
         • Provider’s General Information ........................................................ 33
         • Payers Information .......................................................................... 34
         • Practice Locations ........................................................................... 35
         • Practice Facilities ............................................................................ 36




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Chapter 6

Using MTBC- Billing Pro ™ Scheduler

Objectives ........................................................................................................... 37
Scheduler: ........................................................................................................... 37
Appointments ...................................................................................................... 37
Calendar ............................................................................................................. 38
Add/Edit Appointments: ...................................................................................... 39

Chapter 7

Using MTBC- Billing Pro ™ Claim Manager

Objectives ........................................................................................................... 41
Claims: ................................................................................................................ 41
Claim Submission ............................................................................................... 44
Claims List .......................................................................................................... 47


Chapter 8

Using MTBC- Billing Pro ™ System Management

Objectives ........................................................................................................... 48

Program Menu Bar: System Management .......................................................... 48
Diagnosis Setup .................................................................................................. 48
Procedure Setup ................................................................................................. 50
Customize Claim ................................................................................................. 50
Insurances .......................................................................................................... 51
Insurance Setup .................................................................................................. 52
Referring Physician Setup .................................................................................. 53
Guarantor Setup ................................................................................................. 54
City State Zip Setup ............................................................................................ 55
Scheduler Settings .............................................................................................. 56




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Chapter 9

Using MTBC- Billing Pro ™ Data Import/Export


Objectives ........................................................................................................... 57
Patient Data Import ............................................................................................. 58
         • File Type: ....................................................................................... 58
         • Claim Submission Status ................................................................ 59



Chapter 10

Using MTBC-Billing Pro ™ Reports

Objectives ........................................................................................................... 61
Reports Overview ............................................................................................... 61
         • Claim payment/Transaction Report ................................................. 61
         • Claim Submission Report ................................................................ 63
         • Aging Report ................................................................................... 65




                  7 Clyde Road, Suite 201, Somerset, NJ 08873, Phone 732.873.5133, Facsimile 732.873.6858
                                                      www.mtbc.com
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Chapter 1
Introduction to Medical Billing


Objectives
•    To describe the major elements of office accounting system
•    To Explain Billing Process
•    Importance and scope of medical billing
•    To define the financial records, a billing assistant maintains.
•    To discuss the responsibilities of a medical assistant
•    Billing services offered by MTBC.
•    Why Choose MTBC?
•    Do it Yourself Billing


Key Terms
Patient Ledger: The patient ledger tracks and shows all the activity in one
patient account.
Payroll Register: The payroll register may be used as a supplementary record
or as a special journal.
ICD-9: A listing of codes for medical diagnosis.
CPT: A listing of codes for medical services or procedures.
Day Sheet: A daily record of all fees charged and payments received.
Superbill: A record of services performed for one patient in a single office visit.
Copay: the amount paid for a medical service by an insured patient.
HCFA-1500: An insurance form accepted by governmental insurance plans in
some states and most private insurers. This form is required by Medicare
nationwide.
Medicare: Governmental health insurance for elderly people and disabled
people.
Medicaid: Governmental health insurance for low-income people.




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Electronic Billing
The benefits of switching to electronic claims greatly outnumber those of paper
claims.
•    Electronic billing reduces processing costs by introducing two specific
financial applications - "accounts payable" and "accounts receivable,"
•    Reduces claim rejections.
•    Creates a paperless environment.
•    Claim is paid within 7 days compared to paper billing which takes 20-30
days.
•    Streamlines transaction processing
•    Improves business relationships.

Medical Billing

This section discuses the process of medical billing and duties of a billing
specialist or assistant and the billing services provided by MTBC.

Records kept by Billing Assistant/Billing Specialist

Medical specialist performs following services related to health care insurance.
•   Paper and electronic billing
•   Annual code updates
•   Dead claim recovery
•   Super bill design
•   Claim entry
•   Claim submission
•   Physician online remote access and consultation
•   Fee reviews
•   Insurance Eligibility testing
•   Insurance verification
•   Customized services for each practice
•   Reporting




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Billing Process
The billing system in a medical office produces super-bills, day sheets, patient
ledgers, patient statements, insurance forms, and patient information forms. The
process is described in detail.


A patient is given an appointment. The patient arrives in a medical office, signs
the Sign-in –Sheet, fills the information form and provides an insurance card
copy. The patient usually makes a copayment before encountering the Doctor.
The Doctor marks the super-bill with CPT and ICD9 Codes. The doctor notates
any special handling. Upon check-out, the billing assistant lists all charges,
payments including copayments, verifies the forms and uses the super-bills or
day sheet to update the patient ledger. Afterwards the billing assistant prepares
and fills out the insurance form, enters CPT codes against ICD-9 codes, verifies
the codes and sends HCFA printed insurance claim or electronic claim either to a
clearing house or to a corresponding insurance company. Finally, the insurance
verifies and processes the claim and pays the claim directly to the Physician. The
adjustments & rejections are posted directly to the Physician or submission
source. The frequency of rejections, denials and underpayment is high because
of the high complexity of claims and data entry errors. Through billing technology,
procedures and training help manage the billing process to receive all payments
on time.

Medical Billing by MTBC
MTBC has been billing on behalf of physician groups across different states
     /regions in
the United States of America among different specialties and payer sources.
MTBC provides the following billing services to its clients.

Electronic & Paper claim submission
Charge entered claims are transmitted to different payer sources electronically.
Where required, paper claims are printed & posted by a clearing house. Claims
that encounter transmission problems are fixed with a high priority.




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Entry of Patient Demographics
Capturing information such as Patient's Name, Residence Address, City, State,
Zip Code, Social Security Number, Employer Details and Insurance Details (like
Primary, Secondary Tertiary, and guarantor information etc.)

Charge Entry
Super bill / Encounter Forms are used to capture details such as Date of Service,
Referring Physician, Attending Physician, Place of Service, Type of Service, CPT
Codes, ICD Codes, Modifiers, Authorization or Referral Details and Co-pay
Details.

Payment Posting
EOB / Private Checks or scanned credit card statements are used to capture
details such as Patient Account Number / Patient Control Number, Patient Name,
Date of Service, Procedure Code, Billed Amount, Allowed Amount, Adjusted
Amount, Paid Amount, Deductibles and Denial Details, Refunds, Offsets and
Reconciliation.
From ERA, payment information is directly imported to MTBC’s system
comprising the above mentioned detail.

Accounts Receivable and Claims Follow-up

•    Denials / Rejections Analysis - Re-billing.
•    Systemic A/R projects - Re-billing.
•    Insurance / Patient Follow Up - Collection Agency Reporting.
•    Tracking and Management Reports.

Quality Control

All information, changes and payment entered are verified by a quality
resource/follow up team.

Why Choose MTBC?
Money -- big money -- is on the table for America's physicians who adopt the
electronic medical claim billing system that eliminates the tedious task of manual
claim processing. Today most practices & hospitals in America outsource the
task of medical claim billing to other companies which charge the physicians for
their services according to their own terms & conditions. Electronic Medical
Billing is the fastest growing business in America

            7 Clyde Road, Suite 201, Somerset, NJ 08873, Phone 732.873.5133, Facsimile 732.873.6858
                                                www.mtbc.com
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that generates & saves millions of dollars per year for a practice or physician.
Many companies are offering their services nationwide and saving time & money
for physicians. MTBC, a NJ- based Medical Billing Company is ranked by
Deloitte LLP Technology Fast 500™ as one of the fastest growing technology
companies in the USA.

Technology Fast 500™ recognizes innovative companies that have broken down
barriers to success and defied the odds with their remarkable five-year revenue
growth; and
MTBC is one of those rendering certified software and services for a modern
healthcare system. MTBC performs practice management and provides CCHIT-
certified EMR software for physician offices and hospitals. Its integrated Premium
Plan, billed at only
5% of collections presents a service suite unmatched in the industry for its scope
and value.
The innovative approach of MTBC has increased its clientele across all states of
America. MTBC is proud to serve the healthcare industry by providing the
following services and benefits:

   •   Cost-effective and time-efficient Electronic Medical Billing nationwide.
   •   Efficient web-based practice management system having reliable backup.
   •   HIPAA-compliant secure system.
   •   No crashes or freezes, ensuring quick access round the clock.
   •   Ensuring practice growth by saving millions of dollars wasted in manual
       claim submission.
   •   Eliminating manual labor & overload and minimizing administrative cost for
       your practice.
   •   Real time claim submission, real time insurance eligibility, real time error
       tracking reducing claim rejection.
   •   Electronic claim submission reduces reimbursement time to less than 10
       days.
   •   Eliminating the need for you to print paper forms, envelopes and spend
       money on postage.
   •   Your clients get paid faster so you can continue to service your client’s
       needs, which, in turn, will make your clients refer more business to you
       without your having to ask.
   •   Providing excellent customer service and technical support round the
       clock.
   •   Electronic Remittance Advice (ERA) and excellent reporting capabilities
   •   CCHIT-Certified EMR ensures ARRA incentives for physicians by 2011.
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   •   Toll free number, Touch screen Patient Kiosk at Physician’s office.
   •   Web Pro, a physician’s site for online scheduling.
   •   Not charging beyond the industry norm.


An increase in the lifespan of people, advancements seen by medical technology
and the high cost of medical treatment have made the task of keeping paper
records next to impossible. Step into the new realm of Electronic Medical Billing,
the fastest growing
business today saving yourself millions of dollars per year. MTBC saves your
time and increases patient care by providing excellent Medical Billing Services.


Do It Yourself Billing
Healthcare providers today only have two options in medical billing: do it in-
house with expensive software, or outsource the billing.

For the past 10 years, MTBC has provided its premium medical billing and
practice management services to physicians across the nation. During this time,
we’ve learned the ins-and-outs of medical billing and we know what it takes to
submit payable claims. MTBC’s Billing Pro ™ takes all that we’ve learned over
these past 10 years, and puts it all into your hands.

We don’t believe healthcare providers need to spend thousands of dollars on
software, especially when they are doing all of the work themselves!

With MTBC’s Billing Pro ™ software, you can quickly and easily begin submitting
medical claims to payers across the country without any charge. Finally, you can
eliminate all medical billing expenses, without eliminating any functionality.
Download, setup the software, and enter your claims in less than 5 minutes. Give
it a try today!

Features:
          •    Completely free electronic medical billing software
          •    Electronic medical billing submissions to nearly all payers
          •    Detailed, real-time reports
          •    Integrated appointment scheduler
          •    Seamless patient statement generation
          •    Real-time claims scrubbing


              7 Clyde Road, Suite 201, Somerset, NJ 08873, Phone 732.873.5133, Facsimile 732.873.6858
                                                  www.mtbc.com
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Chapter 2
Using MTBC-BILLING PRO ™ for Medical Billing
Objectives
1. To replace manual medical billing processes with a computerized billing
system.
2. To create a paperless environment and fast processing as compared to
manual claim processing.
3. To comprehend the specific objectives of MTBC-Billing Pro ™
4. To know the options used in MTBC-Billing Pro ™
5. To start MTBC-Billing Pro ™
6. To use the Welcome Wizard
7. Navigating through Menus
8. Using Main Menu
9. Using Tool Strip
10. Exiting Billing Pro ™.

Key Terms
1. Login: The process of identifying oneself to a computer, usually by
entering one's username and password.
2. Menu bar: The primary list of options available to the user at the main
screen.
3. Tool strip/operations menu: The menu options in the title bar are the
application's main menu.
4. Cursor: A bright, usually blinking, movable indicator on a display, marking
the position at which a character can be entered, corrected, or deleted.
5. Dropdown menu: A menu that appears below a menu item when it is
selected.




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              Options Used In MTBC- Billing Pro ™

                        MTBC-Billing Pro ™ Main Menu

The operation menu in Billing Pro ™, shown in screenshot-1, is the first screen
that appears after signing onto the Billing- Pro ™. The Welcome screen displays
the contents of MTBC web. The user can search the web from the hyperlinks
provided on the screen. Two menu bars appear at the top.
First is the menu bar and the second is tools strip.




                                            Fig-1 (Welcome Screen)



Main Menu options                 Purpose                                              Used in billing


1. File                Enter new patient information for billing                                 Yes
                       Scheduler to check appointment Scheduler                                        Yes
                       User management                                                           Yes
                       Logout                                                                    Yes
                       Exit                                                                      Yes
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2. Practice              To enter practice & provider profile                                            Yes
                         To record Location information                                            Yes
                         To record facility information                                                  Yes

3. System Management To add, modify or delete various set ups                                            Yes

4. Import & Export   To import or export data                                                            Yes
                         Patient data
                         Claim manager
5. Opened Screens To track windows in use                                                          Yes

6. Reports               To track claim submission                                                 Yes
                         Payment transactions
7. Help                  Help related with different modules                                             Yes


Tool Strip                          Purpose                                              Used in billing



1. Patient Search To sort the existing patient record                                              Yes

2. New Patient           To enter demographic record, insurance                                          Yes
                         & physician record for a new patient

3. Scheduler             To manage appointments                                                    Yes

4. Claim Manager          To manage claims, to submit claims                                             Yes

5. Logout                To logout of the wizard                                                   Yes




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                            Starting MTBC-Billing Pro ™

To start the software, click “MTBC-Billing Pro ™ icon located at the following
path:
              [Start » Program Files » MTBC-Billing Pro ™]

Or double click the MTBC –Billing Pro ™ icon located on your desktop.




A login dialog box will appear. Provide the login details in the respective fields
and click the “OK” button. Following screenshot details the functionality.




                                        Fig-2 (Login Screen)

(To navigation through various ongoing fields, use “SHIFT + TAB” keys.)




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Welcome Screen
After the user name and password is entered in the login window, the system
displays a default “Welcome Screen”




                                    Fig-3 (Welcome Screen)

Navigating through Menus

1. To navigate the menus, move the cursor to the selected menu and click the
mouse.
2. To enter data in a selected field, use the key board to type the data.
3. To save the data, press “Enter” on keyboard or click “Save” button.
4. To close the application click “Logout” button in the menu bar.




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                                                www.mtbc.com
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Chapter 3
Managing Search with MTBC-Billing Pro ™

Objectives
1.   To locate information stored in MTBC- Billing Pro ™ database.
2.   To search for new/existing patients
3.   To search for Referring Physician
4.   To search for Financial Guarantor


Key Terms
1. Financial Guarantor: One who assumes financial responsibility for another:
backer, sponsor
2. Referring Physician: The Physician who refers the patient to the relevant
Physicians.



Search options in Billing Pro ™

Patient Search

The search function works on different modules for different fields.
1. To search existing or new patient, click “File” and then click “Patient Search”
as displayed in screenshot-4 or click Patient Search option in the “Tool Strip” of “
Welcome” window as displayed in screenshot-5




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                              Fig-4 (Patient Search File Menu)




                                Fig-5 (Patient Search Screen)


2. Enter one of the following into the search field and click “Search” button:
•   Patient Last Name
•   Patient First Name
•   Patient Date of Birth
•   Patient Account
•   Chart ID #
•   Social Security #
3. To sort search results, select the radio button for one of the above
mentioned options.



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4. To open patient detail for the selected patient click “Open” button present at
the bottom of “Patient Search” window.
5. To add a new patient to the database, click “New” button present at the
bottom of “Patient Search” window.
6. To delete a record click “Delete” button present at the bottom of “Patient
Search” window.
7. To refresh the task, click “Refresh” button present on the left side of the
“Patient Search” window.
8. To close patient search screen click “Close” button present at the bottom of
“Patient Search” window.

Referring Physician Search
Referring Physician Search function works on “Patient Detail” chart and “Patient
Claim” forms.




                       Fig-6 (Adding Referring Physician)


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1. To search for Referring Physician, click the search option on “Patient Detail”
or on “Claim” form. A search window displaying different options will appear.




                                 Fig-7 (Physician List Screen)

2. Enter one of the following options in the respective field and click search
button present at the bottom of “Referring Physician Search” window.
3. To enter the selected Physician from search window click the “Select”
button present at the bottom of “Referring Physician Search” window.
4. To remove the search click “Clear” button present at the bottom of
“Referring Physician Search” window.
5. To add new Referring Physician click “New” button present at t the bottom
of “Referring Physician Search” window. A separate window will be displayed,
enter information in the relevant fields and click “Save” button on this window.
6. To exit “Referring Physician Search” click “Close” button.




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Financial Guarantor Search

1. The “Guarantor Search” function works on “Patient Detail” form.
To search the Financial Guarantor click the option on “Patient Detail” screen as
displayed in the screenshot –Fig 8.




                      Fig-8 (Financial Guarantor Search Screen)

2.   A search window displaying different options will appear. Screenshot-9.




                         Fig-9 (Financial Guarantor List Screen)
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3. Enter one of the following options in the respective field to search for
Financial Guarantor.
•    Last Name
•    First Name
•    Zip Code
•    SSN

4. To enter the selected Guarantor from search list click the “Select” button
present at the bottom of “Guarantor Search” window.
5. To end the search, click “Clear” button present at the bottom of “Guarantor
Search” window.
6. To add a new Guarantor, click “New” button present at the bottom of
“Guarantor Search” window. A separate window will be displayed, enter
information in the relevant fields and click “Save” button on this window.
7. To cancel the search, click “Cancel” button.

Insurance Search

Insurance Search function works on “Patient Detail” chart and “Patient Claim”
forms.

1. To search insurance click “Add/Modify Insurance” on “Patient Detail” The
following window will allow you to search insurance on the basis of certain
criteria.




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                     Fig-10 (Insurance Search Screen)
2. Select criteria on the above screen and the following search window will be
displayed.
3. You can search insurance by name or by address. Select one option and
click      “ Select” button




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                                   Fig -11 (Insurance List Screen)

4. Select insurance from the list and it will be inserted in the first row of
“Insurance Information” section of “Patient Demographics” screen.




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Chapter 4
Entering Patient Information /Demographics

Objectives

1. To add, delete or modify patient information.
2. To organize information into different fields.
3. To enter correct demographic information
4. To add & edit insurance.


Key Terms
1. Demographic information: Pertaining to characteristics of the population,
such as race, sex, age, household size, and to population growth and density.

2. Provider: One that makes something, such as a service, available: primary
health care providers.

3. Primary Insurance: Property or liability coverage that provides benefits
(usually after a deductible has been paid by an insured) up to the limits of a
policy, regardless of other insurance policies in effect.

4.   Secondary Insurance: A private or second insurance

5. Tertiary Insurance: Third-in-line beneficiary to receive benefits from an
insurance policy.

Adding New Patient/Patient Detail

To add a new patient, click “New Patient” in the tool strip or go to” File” in the
“Menu bar” and click ‘new patient’. Refer to the screenshots below.




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                                 Fig-12 (New Patient Screen)

Patient Detail
The software will open a separate window known as “Patient Detail” as shown in
Screenshot 13.




                                Fig-13 (Patient Detail Screen)
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“Patient Demographics” window contains fields regarding patient’s general
information and insurance information mainly comprising of:

•    Patient’s Account #
•    Chart ID
•    Patient’s picture (can be browsed through hard disc or captured by means
of an attached web cam instantly.)
•    Last name
•    First name
•    Date of birth
•    Social security #
•    Address information regarding patient’s financial guarantor
•    Emergency contact information
•    Any specific notes inserted by the user or its staff about that particular
patient.
•    Insurance name
•    Insurance address

Add/Edit Insurance
Please Note that: Clicking on “Add/Modify Insurance” search button will result in
opening of a window (see below) which allows the user to search insurance on
the basis of certain criteria.




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                         Fig -14 (Insurance Search Screen)
Select criteria on the above screen and the following search window will be
displayed. Reference Fig-15




                                Fig-15 (Insurances List Screen)

Select a particular insurance from the list and it will be inserted in the first row of
“Insurance Information” section of “Patient Demographics” screen.




                          Fig-16 (Insurance Information Screen)
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CPT: Current Procedural Terminology:

The Current Procedural Terminology (CPT) code set is maintained by the
American Medical Association through the CPT Editorial Panel. The CPT code
set accurately describes medical, surgical, and diagnostic services and is
designed to communicate uniform information about medical services and
procedures among physicians, coders, patients, accreditation organizations, and
payers for administrative, financial, and analytical purposes.




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Chapter 5
Practice & Provider Profile/overview
Objectives
1.   Practice Locations
2.   Practice Facilities
3.   Practice & Provider setup
a.    Practice info
b.    Provider info
c.    Payer info

Key Terms

1.   Practice Facility:

2. Practice: A PRACTICE (with a C) is the work of a professional person, or
the process of carrying an idea. Doctors refer to their work as 'practice'.

3. CLIA #: Clinical Laboratory Improvement Amendments (CLIA) of 1988 are
United States federal regulatory standards that apply to all clinical laboratory
testing performed on humans in the United States, except clinical trials and basic
research.
4. EIN: Employer identification number to be saved in this field.
5. NPI: National Provider Identifier is used in electronic healthcare transactions
6. Insurance Payer ID: It includes Insurance payer IDs for which the provider
IDs need to be updated.
7. Insurance Payer Description: It shows the description of the insurance
payer ID.
8. Provider Payer ID: Provider ID is updated against a specific payer ID.

Practice & Provider Profile

This setup is used for creating, saving and editing practice, provider and payer
information in the database.




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Practice Information

1. To use this setup go to “Practice” in the “Menu bar” and click “Practice &
Provider Profile”. The following window will be displayed.




                           Fig-17 (Practice Information Screen)

2. To modify a practice, select “Modify”, enter information and click “Close”.
The system will ask to save the changes or not. This is shown in the figure
below:




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                                    Fig-18 (Modify Practice)


Provider’s General Information

1.     To add a new provider or practice, click “New”, enter information in the
     fields and click “Save” button.
2.    To modify or delete the record click “Modify” or “Delete”.
3.   To close the file, click “Close” button.
4.   To delete a patient record, click the “Delete” button. But be very sure, as this
     would delete the record permanently.
5.   To modify a practice, select “ Practice” add changes in the respective fields
     and click the “Close” button




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This is shown in the figure below:




                                Fig-18 (Provider Info Screen)
Payer Information

Payer’s info is used for claim submission purposes against different insurances.




                                 Fig-19 (Payers Info Screen)
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Payers Info
1. To add payer info, first select the provider’s name and code from the list of
providers.
2. Select location form the drop down menu as it is important for claim
submission.
3. Enter Insurance ID, Insurance Payer description, Provider Payer ID and
     Provider Payer Group
4. Enter individual or group NPI of a provider, participating insurance, SSN and
     EIN.
5. If the provider is giving lab services and has CLIA # then save that number

6.   Enter the address carefully as the address portion is used for submitting the
     address in submission files. This address should be the one with which a
     practice/provider is enrolled with a payer.

Practice Locations

This setup is used for saving, editing or deleting location information against a
specific practice.

Other than location information, a user can also save CLIA# and its expiry date in
order to identify CLIA# against each location of a provider.

1. To use this setup go to “Practice”, click “Practice Locations” and the
following window will be displayed.




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                             Fig-20 (Practice Location Screen)

2. To add a new location, click “New”, enter code, Name, Address and CLIA #
for the new practice and click the “Save” or “Cancel” button.
3. To modify an existing location, click “Modify” button and add changes into the
respective fields; then click “Save” button.
4. To cancel the task or to close the window, click “Cancel” or “Close” button.

This is shown in the figure below:




                        Fig-21 (New, Modify and Delete Screen)

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Practice Facilities
This setup is used to update information related to the facilities with which a
provider of a practice participates. These facilities are used at claim level,
therefore the information is important for different facilities.




                               Fig-22 (Practice Facility Screen)

1.   To add a new facility click “ New”, and enter the following information:
•    Facility Name
•    Facility Type from drop down menu
•    Facility Address
•    Facility NPI

2.   To modify, click “Modify” button and insert changes in the respective fields.
3.   To delete, click “Delete” button.
4.   To cancel the task, click “Cancel” button.
5.   To close the window, click “Close” button.




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This is shown in the figure below:




                        Fig-23 (New, Modify and Delete Screen)




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Chapter 6
Using MTBC- Billing Pro ™ Scheduler
Objectives
1.   To view appointments for a group practice or all providers.
2.   To view appointments for a specific provider or location
3.   To add and edit appointments for patients

Scheduler
The scheduler function allows you to maintain a calendar and organize
appointment schedules. Click the Scheduler button from the tool strip menu bar
located at the top of the MTBC-Billing Pro ™ window.

Appointments:
The following screen will appear showing Daily Appointments by default when
you open the scheduler window. Users with access to the schedule can view
and edit Daily, Weekly, and Monthly Appointments by clicking on the various tabs
at the top of the window.




                                    Fig-24 (Scheduler Links)


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Click the scheduler link shown above takes user to the following screen.




                                  Fig-25 (Scheduler Screen)

Calendar:
The calendar is located on the top left corner of the Scheduler window. The
current date is indicated by a red square. The date of the appointment view is
indicated by a filled blue box. Use the mouse to click the arrows and days of the
week or specific dates to navigate the calendar, and select a date to view and
edit appointments.




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Add/Edit Appointments:

1. To view the schedule, first select the Provider and Location at the top of the
Scheduler window. Click the … button and select the providers and locations for
which you would like to view the schedule; click OK.




                                      Fig-26 (Providers List)


Opening a New appointment can be done in two ways:

2.   Right click the mouse and choose New Appointment.

3.   Use the Patient Search function on the left side of the window.
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      Search for patient by last or first name. Choose a day on the calendar and
     then click the Providers View for that day. Click and drag the name of the
     patient from the left box into the desired time slot on the right side.
4.   To make a new appointment, follow step # 2 and the following window
     entitled Save Appointment will appear.




                            Fig-27 (Save Appointment Screen)


5.   Select either New or Existing Patient to add an appointment for a selected
     patient. The basic information of existing patients will already be stored into
     the program. For new patients, you must add this information.

6.   Use the Text Color menu to color code and organize your schedule e.g.
     based on appointment type or provider.

7.   Click Save to add the appointment.

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Chapter 7
Using MTBC- Billing Pro ™ Claim Manager
Objectives

1.   To store the data regarding Diagnosis Codes, Procedure Code setup, Place
     of Service setup, Type of Service Setup, Modifiers Setup, attachment
     codes, facility code setup, HCFA Notes List.
2.   To ensure claim submission to MTBC
3.   HCFA 1500 claim submission
4.   To print patient statements.

Key Terms
1.   Date of Service: The date when the patient was examined in the provider’s
                        office.
2.   ICD: A listing of codes for medical diagnosis.
3.   CPT: A listing of codes for medical services or procedures.

Claims:

Claim is referred to as a bill for medical services rendered, typically submitted to
the insurance company by a healthcare provider.
The Claims Manager in Billing Pro ™ allows you to enter information regarding
service and billing.




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                                      Fig-28 (Claim Screen)

1.   Enter the Date of Service (DOS) and Location (Loc) under the section
     marked General on the top left side of the window.

2.   Enter the provider information under the Providers section on the top right
     side of the window. Here you can enter the Attending, Billing, and Referring
     physician from your preset physicians list. You can also enter a
     corresponding referral number in the box marked Ref #.

3.   Enter the Diagnosis by using the Search by Code or Description functions
     located above the list of diagnoses. You can also choose to filter your
     search by clicking “My List” option; otherwise you can search all codes by
     clicking the “All” option.

4.   (Please see Charges Diagnosis/Procedures in Claims of System
     Management menu,

5.   Enter the Procedure by using “Search by Code or Description” functions,
     located above the list of diagnoses. You can also choose to filter your


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     search by clicking “My List” option; otherwise you can search all codes by
     clicking “All” option.
6.   Click Pointers/Modifiers located at the bottom left side of the screen to add
     or modify specific ICD pointers against a specific CPT code.

7.   Click the Payment/Insurance button in order to add, view, or modify the
     insurance information associated with a specific claim. You can enter
     information in the appropriate fields. Some fields may be drop-down, while
     others may open a new window with a checklist and some fields may
     require you to enter text where necessary. To return to the Claims page
     simply click Go to Claim located on the bottom left hand side of the window.

8.   Click Other Information to enter hospitalization information. To return to the
     Claims page simply click the <<<Go to Claim button located on the bottom
     left-hand side of the window.

9.   Out of pocket or self payment can be indicated by simply clicking the Self
     Payment check box on the lower right hand side of the window.

10. Click Save or Cancel to complete this portion of the Patient Detail.




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Claim Submission




                                     Fig-29 (Claim Manager)

11. To submit a claim, enter the date from the calendar, select insurance type
and claim status from the drop-down and click “Fetch Claims”. Select the claims
and press one of the following buttons at the bottom of the Claim Manager.


•                         Click this button if you want to submit your claim via MTBC.

•                       The insurance claim forms include information about the
patient, practice, and the visit including procedures, diagnosis, and charges. A
number of Insurance forms such as HCFA-1500 are available for paper claim
submission.
•     Click this button to print an insurance form; you need a preprinted form to
insert in the printer. MTBC-Billing Pro ™ will print information in the correct
places on this form.




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                             Fig-30 (Printed HCFA 1500 Form)


•                       Click this button if you want to print health insurance
claim on a blank paper without specific fields and format. Ref to the Pre-printed
HCFA 1500 form.

•                          The patient statement informs the patient of the money
owed for a particular visit. The statement includes the list of procedures
performed, along with the cost of the visit.
•    Click “Print Patient Statements” button to print a specific statement. The
system will print the following statement.




            7 Clyde Road, Suite 201, Somerset, NJ 08873, Phone 732.873.5133, Facsimile 732.873.6858
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                                  Fig-31 (Patient Statement)

•                       Click this button if you want to exit the window.

Claims List

This section allows you to view the complete record of a patient’s claim history.
Click the New button to add a new claim. The details of all past claims can be
viewed simply by double clicking any claim item from the list or by clicking the
Open button on the lower right side of the window.



            7 Clyde Road, Suite 201, Somerset, NJ 08873, Phone 732.873.5133, Facsimile 732.873.6858
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                             Fig-32 (Claim List)




7 Clyde Road, Suite 201, Somerset, NJ 08873, Phone 732.873.5133, Facsimile 732.873.6858
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Chapter 8
Using MTBC- Billing Pro ™ System Management
Objectives

1.    To add and modify various setups i.e. diagnoses setup and procedure
      setup.
2.    To customize claims for Billing Pro ™
3.    To add and modify insurance setup

Program Menu Bar: System Management

Diagnosis Setup




                        Fig- 33 (Diagnosis Setup Screen)
1. To setup diagnosis information, click Diagnosis Setup in “System
Management”.
2. Click “New” to enter Diagnosis Description in Code, Description fields and
click Save or Cancel to complete the process.
3. Click “Modify” to change existing diagnosis details and click Save or Cancel
to complete the process.
4. Click “Delete” for deletion.
5. Click “Close” to exit.
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This is shown in the figure below:




                        Fig-34 (New, Modify and Delete Screen)

Procedure Setup




                             Fig-35 (Procedure Setup Screen)

1. To setup procedural information, click Procedure Setup in “System
Management”.

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2. Click “New” to enter Procedure Description in Code, Description, Default
Changes and Default Place of Service fields. Click “Save” or “Cancel” to
complete the process.
3. Click “Modify” to change existing procedural details and click “Save” or
“Cancel” to complete the process.
4. Click “Delete” for deletion.
5. Click “Close” to exit.
This is shown in the figure below:




                        Fig-36 (New, Modify and Delete Screen)

Customize Claim
Patient and provider information for the claim can be configured through this
function of System Management menu.




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                            Fig-37 (Customize Claims)
1.   To customize claims, click Customize Claims in System Management menu.
2.   Select criteria from Diagnosis or Procedures.
3. Click Code and Description tab. Use              buttons to move the codes
from Available Codes and Description to Diagnosis or Procedures displayed on
Claim windows.
4. Click Close to exit.

This is shown in the figure below:




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                                 Fig-38 (Customize Claims 2)

Insurances
The term insurance or health insurance is generally used to describe a form of
insurance that pays for medical expenses. It is sometimes used more broadly to
include insurance covering disability or long-term nursing or custodial care
needs. It may be provided through a government-sponsored social insurance
program, or from private insurance
companies. In each case, the covered groups or individuals pay premiums or
taxes to help protect themselves from high or unexpected healthcare expenses.

Insurance Setup




                              Fig-39 (Insurance Setup Screen)

1. To access the insurance setup, click Insurance Setup in “System
Management”
2. Click “New” and enter Payer Details.
3. Click “Save” or “Cancel” to complete the process.
4. Click “Modify” to change the details of an existing payer and click Save or
Cancel to complete the process.
5. Click “Delete” to delete selected payer.
6. Click “Close” to exit.

This is shown in the figure below:


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                              Fig-40 (Insurance Setup Screen)
Referring Physician Setup




                            Fig-41 (Referring Physician Setup)

1. To set up referring physician information, click Referring Physician Setup
in “System Management”.
2. Click “New” to enter referring physician demography and taxonomy details.
Click “Save” or “Cancel” to complete the process.
3. Click “Modify” to change existing referring physician details and click
“Save” or “Cancel” to complete the process.

4.   Click “Delete” for deletion.
5.   Click “Close” to exit.

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This is shown in the figure below:




                        Fig-42 (New, Modify and Delete Screen)

Guarantor Setup




                             Fig-43 (Guarantor Setup Screen)

1. To access guarantor setup, click Guarantor Setup in “ System Management”
2. Click “New” and enter the guarantor demographic information.
3. Click “Save” or “Cancel” to complete the process.
4. Click “Modify” to change the details of existing guarantor and click “Delete”
to delete it.
5. Click “Close” to exit.

This is shown in the figure below:


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                        Fig-44 (New, Modify and Delete Screen)
City State Zip Setup




                           Fig-45 (City State Zip Setup Screen)

1. To access City State Zip setup, click the Setup in “ System Management”
2. Click “New” and enter the city name and state code information.
3. Click “Save” or “Cancel” to complete the process.
4. Click “Modify” to change the details of existing city-state setup and click
“Delete” to delete.
5. Click “Close” to exit.

This is shown in the figure below:

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                        Fig-46 (New, Modify and Delete Screen)

Scheduler Settings




                                  Fig-47(Scheduler Settings)

1. To access the scheduler setting, click Scheduler Settings in System
Management menu.
2. Click Visit Reason tab. Use               buttons to move the reasons from
Available Appointment Reason to Current Appointment Reason windows. Enter
new reason in the text field and click Add Reason.
3. Click Close to exit.
4. Click Office Timings tab.
5. Click Modify and enter Office Timings, Provider and location details.
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6.   Click Save or Close to complete the process.

7.   Click Modify to change existing details and click Save or Cancel to complete
     the process.
8.   Click Close to exit.

This is shown in the figure below:




                                 Fig-48(Scheduler Settings 2)




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Chapter 9
Using MTBC- Billing Pro ™ Data Import/Export

Objectives
1.   To import and export information from one system to another in order to
      avoid re-submission of the same information.
2.   To export patient statements for Patient Billing.
3.   To import ERA from insurances into MTBC-Billing Pro ™.
4.   To import information on ERA that is pending or unresolved.

Key Terms

1. ERA: Electronic Remittance Advice is an electronic version of a payment
explanation which provides details about providers' claims payment.
2. ANSI 837: The file format used for electronic billing of professional services
(CMS-1500 billing). ANSI 837 is shorthand for the ASC X12N 837
(004010X098A1) file format.
3. ISA: Interchange Control Header mandatory for electronic data exchange.
4. ISA01: Authorization Information Qualifier code to identify the type of
information in Authorization Information.
5. ISA02: Information used for additional identification or authorization of the
interchange sender or the data in the interchange; the type of information is set
by the Authorization Information Qualifier
6. ISA03: Security Information Qualifier - a code to identify the type of
information in the Security Information
7. ISA04: Security Information This is used for identifying the security
information about the interchange sender or the data in the interchange; the type
of information is set by the Security Information Qualifier
8. ISA05: Interchange ID Qualifier to designate the system/method of code
structure used to designate the sender or receiver ID element being qualified


9. ISA06: Interchange Sender Identification code published by the sender for
other parties to use as the receiver ID to route data to them; the sender always
codes this value in the sender ID element.
10. ISA07: Interchange ID Qualifier to designate the system/method of code
structure used to designate the sender or receiver ID element being qualified.
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11. ISA08: Interchange ID Qualifier code used to designate the receiver ID.
12. ISA14: Interchange Acknowledgment denoted through data element.
13. GS02: The application sender’s code used to identify sending unit of the
transmission.
14. GS03: The application receiver’s code used to identify receiving unit of the
transmission.
15. PER02 [1000A]: Submitter’s contact name.
16. PER04 [1000A]: Submitter’s complete communications number including
country or area code when applicable.
17. NM109 [1000A]: Submitter name identification Code identifying a party or
other code.
18. NM103: Receiver’s last name or organizational name.
19. NM109 [1000B]: Receiver’s identification code identifying a party or other
code.
20. NM103[2010BB]: Payer’s last name or organizational name
21. NM109 [2010BB]: Payer’s identification code identifying a party or other
code.


Patient Data Import

Patient Data Import setup allows a user to import patient demographic in the form
of an excel sheet in CSV format.

File Type:
The data is imported form Ms Excel files in CSV format.

1. To import a file, go to “Import/Export” in the main menu bar and click “
Patient Data Import”
2. Select default Location from the drop down menu and click the “Open”
button at the end.
3.    After opening a specific file, map the fields available in the database with
the ones defined in the CSV import file.




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                         Fig-49 (Patient Data Import Screen)

Claim Submission Status




                            Fig- 50 (Claim Status Progress)




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               Fig-51 (Data Import/ Export Screen)




               Fig-51 (Data Import/ Export Screen)


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Chapter 10
Using MTBC-Billing Pro Reports

Objectives

1.   To track patient and insurance payments
2.   To print claim payments/Transactions
3.   To check the status of claim submission and to rule out aging.

Reports Overview:
Reports are summaries of information stored in the database. There are three
reports available in MTBC-Billing Pro ™, which help in the analysis process.

•    Claim Payment/Transactions.
•    Claim Submission.
•    Aging Report


Claim payment/Transaction Report
1. Click “Claim Payment/Transaction Report” from the reports menu; a criteria
screen will be loaded as displayed below:




                   Fig-52 (Claim Payment /Transactions Screen)
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2. Select “Attending Physician” from the drop down menu to extract report
based on specific attending physician.
3. Select “Location” from the drop down menu to extract claim report based on
specific location.
4. Select “DOS From” and “-To” for generating a report of claims against a
specific DOS-Date of service.
5. Select “ Payment Date From” and “-To” for generating a report based on
payment entry date
6. Click “Ok” after selecting specific criteria.
7. Click “Cancel” to exit the criteria box.
8. Clicking on “OK” after selecting specific criteria will generate the following
report:




                              Fig-53 (Claim Payment Screen)




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Claim Submission Report
Claim Submission Report is generated to check the claim submission status for
the claims submitted through MTBC-Billing Pro ™.


1. Click “Claim Submission Report” from the reports menu; a criteria screen
will be loaded as displayed below:
2.




                            Fig-54 (Claim Submission Screen)

3. Select “Submission Date From” and “Date To” from the drop down menu.
4. Select “Submitted To” from the drop down menu. Select one of the following
options:

•    All: Claims with submission history against any party i.e., primary,
secondary, tertiary or patient.
•    MTBC: Claims for which file is sent to MTBC.
•    HCFA 1500: Claims for which HCFA 1500 file has been generated.
•    Patient Statement: Claims for which patient statements were generated
during any specific date range.

5. Click “Ok” or “Cancel”. On clicking “Ok” the report will be displayed in
“Claims List”.




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                             Fig-55 (Claim Submission Report)
Aging Report:
To view the aging report, go to Reports, and select Aging Report. The following
screen will show up:




                             Figure 56- (Aging Report Screen)

Enter search criteria in the screen shown above and press OK button at the
bottom of the screen. The Aging Report is shown in the figure below:


            7 Clyde Road, Suite 201, Somerset, NJ 08873, Phone 732.873.5133, Facsimile 732.873.6858
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                       Figure 57- (Aging Report)




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