Billing For Private Insurance

NEW CLIENT Clinicians add new client’s information into Therapy Notes and will send an email to Accounts Receivable (AR) department to check eligibility. The AR department emails clinician back with eligibility information. Once it is determined that the client is eligible to be seen; the clinician schedules an appointment with the client. The clinician will enter session information into Therapy Notes to be sent in for payment. 

CO-PAYS 

Clinician verifies in the client profile for co-pay in Therapy Notes. If applicable the Clinician asks the client to pay the co-pay at the beginning of the session.  Clinician collects the co-pay and provides a written receipt to the client.  If client is unable to pay at the time of service a statement will be generated within 30 days and sent to their address on file. Mains’l only accepts checks or money order.

CLAIM SUBMITTION 
Clinician enters in all private insurance information required for billing by Therapy Notes. Therapy Notes notifies AR on the billing screen that there are entries for payment submission. AR electronically sends claims through Therapy Notes.

 
REMITTANCE ADVICE
Once the 835 form is electronically submitted into Therapy Notes from the clearinghouse AR applies all payments to the client’s claims.  As payments are received and posted in Therapy Notes the AR department will add the date of payment, the amount of payment and payer into the spreadsheet located on the T drive/month end/Mental Health Payments for the general ledger account. A report is printed out for exceptions that the system is unsure of how to handle the reconciliation. The AR manager will research and resolve those exceptions.     
For clients using Medical Assistance (MA) once the state receives the files and processes the claims that were submitted for payment the State of MN DHS will create an 835 file to be downloaded and the remittance advice to coincide with the information in the 835 file.  AR will download the 835 file and print off the remittance advice to reconcile the payments.
If claim is denied for any reason AR corrects and/or investigates the denial reason and follows up, as necessary, with clinician. AR resubmits 835 form with correction to third party payer.   

REVIEWAL OF EXPENSE/REVENUE
At month end, the Finance Coordinator reviews the general ledger to ensure accuracy of proper revenue and expense recognition.
AR and Chief Financial Officer will review the aging monthly to review and research any and all outstanding billings that may have been denied.

SYSTEM UPDATES
System updates are performed regularly to be in compliance with any changes to the procedures, tasks, or responsibilities of Mains’l Services in billing.