PPS: View Edit Charges - Access and Definitions
This article applies to the Private Practice Suite
View/Edit Charges will display all patient transactions and is where to go in order to research and/or fix all billing issues:
- Click on Billing | View/Edit Charges
- Enter the client from the drop-down and this will show all transactions for specific date range
This will list all charges associated to this client.
The different colors of each individual charge are explained by the legend
- Yellow: insurance needs to be billed or the responsibility has been reset to the insurance company
- Gray: insurance has been billed and waiting for payment and adjustment information.
- Orange: the responsibility for the remaining balance rests with the patient.
- Purple: the charges have “Crossover” status indicating that the system expects the primary payer to bill the secondary payer. This only occurs when primary is Medicare / Medicaid and have a crossover procedure to secondary insurance.
- White: this charge has been paid in full
- Click on a charge, this will cause that row to turn baby blue in color. Additional features of the charge are listed below:
- Bundled: is the Add-on Charge associated with a Primary Charge.
- Prim. ID: the ID of the original Primary Charge. Will be associated with each Add-on Charge.
- Bill ID: the sequential, internal ID number assigned to this specific charge.
- Date: the date associated with the encounter, generally pulled from the appointment on the scheduler.
- Provider ID: the ID of the rendering provider.
- Transaction: the Transaction Code ID of the procedure performed.
- Charges: the fee associated with the procedure.
- Payments: all payments applied to the charge. This is a total of both insurance company and patient payments.
- Pat.Pay: all payments applied to the charge from the patient
- Ins.Pay: all payments applied to the charge from the insurance company
- Adjustments: all adjustments applied to the charge. This is a total of insurance adjustments, discounts, and write-offs.
- Balance: outstanding balance after payment and adjustment has been applied.
- Pat.Bal: outstanding balance after payment and adjustment has been applied from patient perspective
- Ins.Bal: outstanding balance after payment and adjustment has been applied from insurance company perspective
- Statement Note: notes which can be added to the Procedure detail and will appear on the Patient Statement.
- Once a charge has been selected the details are displayed in the lower portion of the screen. Additional features are described below:
- Billing ID: the sequential, internal ID number assigned to this specific charge.
- Bundle primary and add-on charges: when bundled add-on charges are not fully editable. Unbundling them via this checkbox on the Primary charge allows full edits.
- Provider: rendering provider, pulled from appointment.
- Facility: facility at which the encounter occurred (pulled from appointment).
- Copay: patient responsibility expected to be collected at the time of service, pulled from patient record.
- Billing Status: check boxes which allow for a claim or statement to be created
Re-Billing corrected claims can require manual resets of these boxes.
- Date: date of service from appointment.
- Transaction: transaction ID from appointment.
- Insurance: identifies insurance company responsible for payment or adjustment.
- Dx 1: displays the ICD-10 code for the primary billing diagnosis.
- Charge: the fee associated with the transaction.
- Units: the number of units of the primary charge.
- Payment: amount collected from payer or patient.
- Adjustment: amount of an adjustment by the payer or the practice.
- Note: note which can be added to details, payments or adjustments.
Once the charge has been selected the details are displayed in the lower portion of the screen. Additional features are described below.
- Click on View/Edit Detail: this allows for edits of the clinical data related to the charge.
- Service Date: allows the service date to be edited.
- Procedure: allows change of Procedure (CPT) Code.
- Dx1, Dx2, Dx3, &Dx4: allows billing diagnoses to be edited, added or removed from the charge.
- Units: the number of units associated with the encounter.
- Modifiers (1-4): modifiers are used to further specify the circumstances of a procedure or service.
- Place of Service: allows for the POS to be changed.
- CPT Code: the CPT code can be changed independently of the Procedure noted above.
- Charge to Patient Only: prevents a charge from being eligible for insurance billing or payment.
- Note: displays as Note for the Charge row in a patient statement.
- Click OK when edits are complete
There are multiple tabs where additional information can be viewed and edited:
- Insurance: insurance Co, Type, ID#, Group#, Subscriber etc. can be modified on a charge-by-charge basis
- Other Details: includes checkboxes to indicate additional information on a claim
- Notes: allows notes to be entered about this claim
- Billing History: shows each time claim was created and what type
- Clinical Notes: shows all clinical notes attached to this claim
- History: audit trail of all activity on this claim
- Once any changes have been made, use the buttons at the bottom of the screen to complete the action
- Undo: reverts any changes made since the last save
- Save: save changes made during current edit session
- Delete: Can delete detail if no payment, adjustment and not saved on a Daysheet
- Options: Allows for the addition or deletion of payers to the charge
It is possible to look at this information in a Ledger view:
Use the Ledger view to list each action in the history of a charge. For example, this view will list the details of a charge followed by any payments that have been posted to that charge. The Ledger can also be used as a quick view to look at a total payment amount that has been applied to multiple charges. The Ledger view can be exported to Excel.