Practices can accept a patient payment and enter this into the system in many ways, including:

1. Using the ‘Quick Pay’ window
2. Using the ‘Credit Card Payment’ window
3. Patients can pay online via credit card with MyMedicalLocker
4. Patients can pay via credit card using the Intelligent Intake process
5. Using the 'Receipts' window

Each time a payment is successfully made, a new receipt is added to the system with a status of “New”.   Once a receipt is added to the system, it will eventually follow the ‘Receipt Posting Automation Logic’ described below.

For every new receipt that is added to the system, iSalus will process that receipt using our custom Receipt Posting Automation algorithm. This process will take place as soon as the receipt is generated and on a nightly basis.

Co-Pay Receipts

If a receipt is created with a type of 'Co-Pay', the following logic will be followed:

• If the receipt is associated with an appointment... 
  • Check to see if a claim exists for that appointment… 
    • If so, associate the payment with this claim based on the Procedure Code Copay Indicator and the Receipt Disbursement company settings.
    • If not, check to see if only 1 claim exists where the receipt date and claim service date are the same.
      • If only 1 claim exists, associate payment with this claim based on the Procedure Code Copay Indicator and the Receipt Disbursement company setting.
      • If more than 1 claim exists, set the status of the receipt to Error.  
      • If no claims exist, check the Receipt Co-Pay Hold Days company setting to see if receipt date is less than the parameter. 
        • If so, the receipt status will be set to 'Hold'.
        • If not, the receipt status will be set to ‘Error’

NOTE:  A Co-Pay amount will only be applied to one procedure on a claim until that procedure’s balance becomes 0.  After that, the remaining balance is treated as a General Payment and will follow the logic below.   However, if you would not like the remaining balance to be treated as a General payment, you can modify the company setting to only apply the amount to the first procedure that has the Procedure Code Copay Indicator flag set.

Coinsurance and Deductible Receipts

If the receipt is created with a type of 'Coinsurance' or 'Deductible', the following logic will be followed:

• If the receipt is associated with an appointment... 
  • Check to see if a claim exists for that appointment… 
    • If so, associate the payment with this claim.
    • If not, check to see if only 1 claim exists where the receipt date and claim service date are the same.
      • If only 1 claim exists, associate payment with this claim.
      • If more than 1 claim exists, set the status of the receipt to Error.  
      • If no claims exist, check the Receipt Co-Pay Hold Days company setting to see if receipt date is less than the parameter. 
        • If so, the receipt status will be set to 'Hold'.
        • If not, the receipt status will be set to ‘Error’

General Payment Receipts

If a receipt is created with a type not equal to 'Co-Pay', the following logic will be followed:

• Find a list of claims where the Level = 'Statement'', or where the Status is in any of the 'Statement' options, or a 'Claim Invoice Date' has been set.
• Exclude any claims where the Claim Status has the Skip auto-association of patient payments indicator set.
  • If patient outstanding balance is greater than or equal to the receipt balance 
    • Apply payments to these claims based on the Receipt Disbursement company setting
  • If the outstanding patient balance is less than the receipt balance 
    • Apply payments to claims in a way the patient balance would become $0 based on the Receipt Disbursement company setting. For the remaining receipt balance, check to see if the Credit Receipt Hold Days has passed 
      • If it has not, the receipt status should be set to 'Hold'
      • If it has, apply the remaining balance to the most recent claim for the patient and set the claim status to the value in the company setting: Credit Receipt Claim Status 
        • If no claim exists, set receipt status to 'Error'

Pre-Pay Payment Receipts

If a receipt is created with a payment type that is set to ‘Pre-Pay’.  Because these payments are classified as pre-pay, iSalus will not be able to automatically post the receipt, because we will not know which claim to post it to (as the claim is likely to be created several days or weeks in the future).  Because of this, all ‘Pre-Pay’ payments will be immediately set to “Error” after the Credit Receipt Hold Days setting has been met.

Note:  To designate a Payment Type as “Pre-pay”, you can do this here:  Setup > Payers > Gear Icon > Setup > Payment Types.   Select one of the payment types where ‘Receipt Type’ = Y.  Then, on the setting page, choose ‘Prepayment’. Save.

There are several company settings and other rules that will affect exactly how receipts are posted (or not posted) to claims.  Below you will find an explanation for each setting along with the default values that are applied. As a practice, you will be responsible for updating these settings to meet your business rules.

Company Settings

• Receipt Co-Pay Hold Days 
  • Description: This company setting will be used to determine the number of days that a co-pay receipt will stay in the receipt association queue before becoming an error.
  • Default Value: 7
  • Business Use Case and Recommendation:  Ideally, when a receipt for a co-pay is collected, it is ideal to associate that money to the claim that correlates with that visit that the co-pay was intended for.  In a perfect world, the receipt and the claim would be created on the same day and be reconciled automatically.  However, the reality is that sometimes the co-pay is collected, but the claim may be created a few days later.  This setting allows for this scenario.         So, if a payment is collected and there is no claim on day 1, the receipt will be held until day 2.         Again, the system will check to see if a claim exists to link this payment to.  This process will continue until the money gets associated with a claim or the days that are allowed for in the company setting passes.  The recommendation is to set this value based on your practice’s workflow. If you know that your providers consistently add their claims 2-3 days after the visit, it is probably a good idea to have this setting set to 7 days.  This allows for the more extreme circumstances where a provider is very far behind.
• Credit Receipt Hold Days 
  • Description: This company setting will be used to determine the number of days that a non co-pay receipt will stay in the receipt association queue before becoming a credit.
  • Default Value: 30
  • Business Use Case and Recommendation:         Dealing with over payments/ credits from a patient is a pretty common thing that happens which requires a practice to issue a refund.  While this is inevitable in medical billing, we wanted to limit the need for this.  This setting is intended to help solve this problem.  The idea here is that if a patient makes a payment that would result in a credit, iSalus will not apply this payment to a claim to result in a refund.  Rather, we will hold the payment for as many days that you set in the setting.          So, if a patient were to come in for a visit 2-3 weeks after making an overpayment and was seen again, this outstanding payment can then be applied to this new visit for the patient without you having to think about it.  Again, you want to set this value to be in-line with your business practices.  If it is common for your patients to return for a follow-up visit every 2 months, it may make sense to change this setting to ‘60’.  However, if you have a practice policy that mandates you to issue refunds within 7 days, change that setting to ‘7’.  
• Credit Receipt Claim Status 
  • Description: This company setting will be used to determine the status that a claim will be set to if a receipt payment results in a credit for a patient
  • Default Value: Refund
  • Business Use Case and Recommendation:         Within iSalus, the status of a claim is used to drive workflow and shift claims into logical “buckets” that can be worked by the billing department.  If a payment by a patient create a credit, iSalus’ receipt logic will change the status of the claim accordingly.  By default, iSalus will set claims that need a refund issued to ‘Refund’.  However, because iSalus allows billing departments to customize their own claim statuses, you may find it beneficial to change this default setting.
• Receipt Disbursement Logic 
  • Description: This company setting will be used to determine how non co-pay payments are applied to a patient balance.
  • Options: Oldest to Newest or Newest to Oldest
  • Default: Oldest to Newest
  • Business Use Case and Recommendation:         As patients are making payments, those payments are associated with past due balances.  Patients may have a balance past due spanning hundreds of days and several claims.  Depending on your business rules, it may make sense to have payments associated with older balances first then progressively work up to newer balances.         Or, you may want to have the most recent balances paid off first.  Be sure to set this setting to be in line with your business rules.

Procedure Code Setup Settings

The following option will be added to the Procedure Code Setup screen under the 'Code' section:

• Apply Co-Pay to this Procedure First 
  • Description: This indicator will be used to determine how a Co-Pay payment will be applied. Generally, the acceptable practice is to apply the co-pay towards the E&M code first.
  • Options: On or Off
  • Default: Set to 'Off' by default.
  • Business Use Case and Recommendations:         It is a generally accepted billing practice to assign co-payments to the Evaluation and Management Code for a visit.  However, not all practices follow this rule.  Therefore, iSalus has made a setting available on the Procedure Code Setup screen to allow a practice to determine which code a co-pay will be applied to.  By default, the below code list will be set to do this.  As a practice, it is important to review this list and update any other codes in your system that should follow this rule.
    • 99201-99215 - Office or Other Outpatient Services
    • 99217-99226 - Hospital Observation Services
    • 99221-99239 - Hospital Inpatient Services
    • 99241-99255 - Consultation Services
    • 99281-99288 - Emergency Department Services
    • 99291-99292 - Critical Care Services
    • 99304-99318 - Nursing Facility Services
    • 99324-99337 - Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services
    • 99339-99340 - Domiciliary, Rest Home (e.g., Assisted Living Facility), or Home Care Plan Oversight Services
    • 99341-99350 - Home Services
    • 99354-99416 - Prolonged Services
    • 99366-99368- Case Management Services
    • 99374-99380 - Care Plan Oversight Services
    • 99381-99429 - Preventive Medicine Services
    • 99441-99452 - Non-Face-to-Face Services
    • 99450-99457 - Special Evaluation and Management Services
    • 99453-99091 - Digitally Stored Data and Remote Physiologic Monitoring Services
    • 99457-99457 - Remote Physiologic Monitoring Treatment Management Services
    • 99460-99463 - Newborn Care Services
    • 99464-99465 - Delivery/Birthing Room Attendance and Resuscitation Services
    • 99466-99467- Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services
    • 99483 - Cognitive Assessment and Care Plan Services
    • 99484 - General Behavioral Health Integration Care Management
    • 99487-99490 - Care Management Evaluation and Management Services
    • 99492-99494 - Psychiatric Collaborative Care Management Services
    • 99495-99496 - Transitional Care Evaluation and Management Services
    • 99497-99498 - Advance Care Planning Evaluation and Management Services
    • 99499 - Other Evaluation and Management Services

Claim Status Settings

The following option will be added to the Claim Status Setup screen.

Daily, it is important to find and work any receipt that has been moved to a status of ‘Error’.  These are the receipts that need to be manually reconciled.

It is recommended to use the Revenue Cycle wheel to find these Receipts.  

The receipt search window allows you to perform a variety of tasks including search, reporting, making mass changes, and importing receipts.

Receipt Search Window Layout

Toolbar

New button

The ‘New’ button will allow you to create a new receipt for a patient manually.  Once you click ‘New’ you will be prompted to search and select a patient. Following that, the Quick Pay receipt window will be opened, and the necessary details can be entered.  After that, the receipt will be generated, and the receipt reconciliation process will run.

Open button

The ‘Open’ button will open the Receipt management window as a pop-up window for the receipt selected in the Results Grid.

Train button

The train button will open iSalus University and take you directly to the training material for this window.

More > Change Display Settings

The Change Display settings option allows a user to determine exactly which data points are displayed in the Results Grid.  You can also determine the Maximum number of rows that are returned.

More > Change Status

The ‘Change Status’ option will open a window that lets a user update multiple receipts to a different status at once.  The only statuses that can be changed are ‘New’, ‘Hold’, or ‘Ignore’ or ‘Error’.   Once selected, you can then choose the new status that the selected receipts will be changed to.  You will also be able to determine a new Hold Date for all the selected receipts.  If no Hold Date is selected, the hold date will remain as is on each of the receipts.

More > Receipt Reconciliation

The ‘Receipt Reconciliation’ option will allow you to force the receipt reconciliation process to run against all the selected receipts.  Please note, if a receipt is not in a status of either ‘New’ or ‘Hold’, the receipt will automatically be skipped.  This option may be helpful to use only if you want the process to run earlier than normal.

More > Import Receipts

The ‘Import Receipts’ option allows a user to upload a Microsoft Excel file containing patient payment information.   The file must meet the iSalus Import specs which can be accessed on the import window.

Search

Quick Search

The ‘Quick Search’ feature allows you to search for receipts for a given patient by typing in their chart number, first name, or last name.  If you need to perform a more detailed search, please use the ‘Advanced Search’ option.

Advanced Search

The ‘Advanced Search’ feature allows for the most complicated and specific type of searches.   By clicking the ‘Advanced Search’ button, a panel with search criteria will be displayed on the left-hand side of the screen.  Select the criteria that is pertinent, the click the Search button on the panel.

Gear Icon

The ‘Gear’ icon found in the upper right-hand corner provides access to some basic settings and options like print/export.

Security

This option will open the ‘Role Setup’ screen which is where you can determine who has access to the window.

Screen

This option is not used here.

Company

This option will provide access to Company Settings related to Receipts. This is helpful for setting up pertinent business rules related to the receipts process.

User

This option will provide access to User Settings related to Receipts.  Currently, there are none.

Setup

This option is not used here.

Print

This option will allow you to print the Results List or export the Results List to Microsoft Excel. You will be prompted to select the pertinent action.

Audit

Receipt auditing is not currently supported from this window.

Refresh

This option will refresh the window.

Close

This option is not used here.

Results Grid

The ‘Results Grid’ will display a list of receipts based on the search criteria provided.  The results grid allows you to sort and filter the data by selecting the menu icon above each column. Also, by double clicking on a receipt, the Receipt Management window will open. Additionally, for all results displayed, the data will be reported below.

The ‘Receipt Management’ window is accessed by double clicking on a receipt from the Receipt Search window.  This provides access to key details related to a receipt as well as actions that can be taken to reconcile a receipt into a payment.  Many of the Receipt Reconciliation actions are described in detail above.

Receipt Management Window Layout

Receipt Details

The Receipt Details section will display information related to both the patient and receipt collected. The following detail will be displayed:

• Patient:   The is the patient that is associated with the receipt.  If the patient is not known, the patient name will say ‘Patient Not Known’.  
• Chart:   This is the patient chart number.
• Status:   This is the status that the receipt is currently in.  The possible receipt statues are:
  • New:   The receipt has been newly created and has not been processed by the ‘Receipt Disbursement Logic’.
  • Hold:   The receipt is in a hold state and will be processed at night through the ‘Receipt Disbursement Logic’.
  • Completed:  The entire receipt balance was applied and no remaining balance for the receipt exists.
  • Error:   The system was unable to automatically associated the receipt balance to a claim and the receipt must be reconciled manually.
  • Reversed:   This status is set after the ‘Reverse Receipt’ process has been executed.
  • Ignore:   This status is used to exclude receipts from being processed by the ‘Receipt Disbursement Logic’.
• Receipt #:  This is the unique ID automatically assigned to a receipt when it is created.
• Received:   This is the date and time that the receipt was posted in the system.
• Hold:   This is the hold date and remaining number of days that the receipt is on hold for.
• Type:   This is the payment type associated with the receipt.
• Method:   This is the payment method associated with the receipt.
• Amount:   This is the total amount of the original receipt collected.
• Unapplied:  This is the remaining balance for the receipt that has not yet been applied to the patient’s balance.
• Check #:  This is the check number filed added to the receipt.
• Source:   This is where the receipt originated from:
  • Normal: The receipt was generated from the Quick Pay window.
  • MML: The payment was generated via credit card in MyMedicalLocker.
  • OfficeEMR: The payment was generated via credit card in the application.
  • Intake: The payment was generated via credit card in Intelligent Intake.
• Messages:   System generated messaged to provide guidance on what happened with the receipt during the ‘Receipt Disbursement Logic’.

Appointment Details

The appointment details allow a user to see both past and future appointments for the patient.  By default, iSalus will show the last 3 appointments and the next 3 appointments for the patient based on today’s date.   This date range can be controlled by clicking the ‘Set Date Range’ button under the Receipt Actions.

Receipt/Appointment Link

Because receipts are often associated with appointments, a ‘Link’ icon will display next to the appointment that the receipt you are viewing is linked to.  

Past Appointment Actions

Also, for each appointment listed, actions will be displayed to the right.  For past appointments, you will either have the option to ‘Create Claim’ or ‘View Claim’.  Because claims can be linked to appointments, the ‘View Claim’ option is only visible when this link has occurred.  Clicking this will open the claim for that appointment.

If a claim is not linked to the appointment, the option to ‘Create Claim’ will be available.  By clicking this, details from the appointment will be passed to the claim window and a new claim can be generated and linked to this appointment.

Future Appointment Actions

For future appointments, the actions will be different compared to past appointments. For a future appointment, you will see the option of ‘Hold Receipt’.  Clicking this link will open the window that will set the hold date for the receipt to be the same as the future appointment.  

Claim Details

The claim details (aka Procedures Linked to Receipt) is used to display the exact relation between the original receipt and the claim procedure lines that the receipt has been applied to.  You can use this section to launch the payment window to modify how the receipt was associated.

Once you have found receipts in a status of Error, what you need to do next is reconcile these receipts.   There could be many different options that you may take depending on why the receipt was set to a status of “Error”.    The various actions that can be taken are described below.

Action:  Hold Receipt

If you would like to place a receipt back into the “Hold” status, click the ‘Hold Receipt’ button.    If you want to set the hold date yourself, you must click ‘Hold Receipt’ in the upper right-hand corner of the screen.   If you want to hold the receipt based on an upcoming appointment date, you will click the ‘Hold Receipt’ button next to the appointment.  After that is done, the receipt’s status will be changed, and the hold date will be set accordingly.  Because the receipt is in this status, we will continue to attempt to turn this receipt into a payment using the receipt logic described above.

Use Case:  One reason for doing this is that you may know that for a receipt, you know that the claim may be added in the coming days/weeks.  So, you put the receipt back on hold for that day or a few days later so that the receipt will be automatically reconciled once that claim gets generated.

Action:   Reverse Receipt

If you determine that a receipt was added by mistake, the receipt can be reversed.  To do this, click the ‘Reverse Receipt’ button. After doing this, any payments that resulted from this receipt will be reversed.   Also, a negative receipt will be added with the exact same amount as the receipt selected – this allows reports to balance correctly.

Also, if this receipt had been generated from a Credit Card payment, you will be prompted to refund the credit card as well.  You may or may not want to issue the refund directly to the credit card – this is up to you to determine how the money will be returned to the patient.

Use Case:  A duplicate payment was made and one needs to be reversed.  

Action:  Edit Receipt

When reviewing a receipt, you may realize that the information was captured incorrectly, or a patient/guarantor was not assigned correctly.  You can fix some of these details by clicking ‘Edit Receipt.  This will provide you with a window to link the receipt to a patient (if one was not already linked), change the Payment Type and Payment Method.

Action:   Create Claim

As a reminder, receipts must be applied to claims.  If no claim exists, it may be necessary to create a claim to then link the payment to.   When you click ‘Create Claim’ button, a new claim will be created using the following details from the receipt or the appointment.  If you want the receipt details to be used, you must click ‘Create Claim’ in the upper right-hand corner of the screen.  If you want the appointment details to be used, you must click ‘Create Claim’ next to the appointment.

1. Patient and Insurance Details
2. Receipt Date or Appointment Date -> Claim Service Date
3. Receipt Location or Appointment Location - > Claim Service Location
4. Appointment Resource -> Rendering Provider

You will be able to set the following details as well:

1. Provider -> Rendering Provider
2. Procedure Code (you can add one procedure code, more can be added later)

Once the claim is created, the claim window will then be opened, and you can make any changes as you see fit.

Now, it is important to know, the receipt is not automatically applied to this claim.    You have one of two options once you have created the claim.

Option 1:  With the Claim window open, you can launch the ‘Edit Payments’ window.  From here, the receipt can be posted as a payment to this claim.

Option 2:  You can click the ‘Reconcile Receipt’ button.   This will force the system to immediately run the Receipt Reconciliation process.

Option 3:  You can set the Hold date for the claim so that the Receipt Reconciliation process will link the receipt to the claim automatically overnight.

Action:   Communication

If you have reviewed a receipt and you need more information from a staff member, a common action to take would be to send an office communication to a staff member asking for the necessary details.  To do this, click the ‘Communication’ button.  This will open a new office communication window with the patient’s chart automatically attached.  

Please note, the receipt has not been reconciled at this point. You may need to take one of the other actions later once you receive the information from your team.

iSalus Healthcare allows a practice to import patient payments so that receipts can be generated in mass.  This is commonly done when a bank or other third party may be able to provide a file containing patient payment information.  For example, when a patient mails in a statement payment to your bank/lock box, the bank may be able to provide a file with these details on a recurring basis.

Generate a Receipt Import Template

The first step to import a receipt is to obtain the Import Specifications/ Import Template.  This can be done by taking the following steps:

1. Navigate to Billing > Receipts
2. Click More > Import Receipts
   
3. Click Template > Select the Template Type
   1. Full: This template includes multiple tabs that define each column for the import.
   2. Basic: This template only includes the necessary column headers for the import.
      
4. A Microsoft Excel template will be opened on your computer
   

Understand the Receipt Column Definitions

The Import Template provided will ask for the following columns:

• Patient ID: The iSalus patient chart number
• Statement ID: This statement number generated out of our application.
• Date:  The date of the receipt. This must be in the format MM/DD/YYYY.
• Amount:  The total value of the receipt. This must be in the to be format as ###.##.
• Type: This is the payment type for the receipt (i.e. Co-Pay or General Payment).  
• Method:  This is the payment method for the receipt (i.e. Check or Cash)
• Check or Trace Number:  This field will populate the 'ID #' field on the receipt.
• Comment:  This is the comment that will be associated with the claim.

Setup your file to include these options as you see fit.

Import Receipts

To begin the receipt import process, follow the below steps:

1. In the Receipts window, click More > Import Receipts
2. Click the Import button
   
3. In the Import Table tab, click Browse... to locate the file you want to load
   
4. Select the file from your computer to import.  Click Upload.
   
5. In the Field Mapping tab, map each column header to the appropriate receipt field.
   
6. In the Field Mapping tab, be sure to match Your Field Values from the import to the correct OfficeEMR Value.
   
7. In the Record Verification tab, click the Go button to perform the verification.
   
8. In the File View tab, review failed records as needed.
   
9. In the Ready to Go tab, click Go to import the receipts.
   
10. Monitor progress in the File Import screen.
    

1. Go to Setup: Billing Setup: Payers
   
   
   
   
2.  In the upper right corner, next to the magnifying glass, click on the gear icon to open the Window Settings menu. Go to Setup, then Claim Status. The Claim Status dialog box will open.
   
   
   
   
3. Select a Claim Status on the left side of the screen. On the right side of the screen, check the Skip Auto Receipt checkbox. Save.
   
   
   
   
4. Repeat as necessary for each Claim Status. At this time, each Claim Status will need to be marked individually.
   

   If the Claim Status option is not available on the menu, and the user has the Admin role, please contact the iSalus Customer Success team to turn this functionality on.