Receipt Overview and Screens

In the billing portal, there is a category for Payment Posting. Within that category is found the Receipts screen. Users will use this screen to Work Error Receipts, Search for Receipts, Access the Receipt Details screen, Reconcile Receipts, and Import Receipts.

Setup Information

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

Workflow Information

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

1. Using the Quick Pay screen
2. Using the Credit Card Payment screen
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 screen

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.

The Receipts screen can be found in the Billing portal under the Payment Posting category on the navigation bar. This screen by default will display all receipts that are currently in an error status. In addition the screen allows you to perform a variety of other tasks including searching, reporting, making mass changes, and importing receipts.

Fields

• Checkbox: This box will be used to mark the statement(s) as part of the selection.
• Status: The current status of the receipt.
• Receipt Date: The date of the receipt.
• Chart Number: The chart number connected to the receipt.
• Patient Name: The patient name connected to the receipt.
• Patient Primary: The primary insurance name for the patient connected to the receipt.
• Patient Secondary: The secondary insurance name for the patient connected to the receipt.
• Patient Tertiary: The tertiary insurance name for the patient connected to the receipt.
• Appointment: The date and time of the appointment connected to the receipt.
• Resource: The resource name connected to the receipt.
• Appt. Location: The location name for the appointment connected to the receipt.
• Payer Name: The payer name for the receipt.
• Paid Amt: The total paid amount of the receipt.
• Applied Amt.: The amount of the paid amount that has been applied.
• Unapplied Amt.: The amount of the paid amount that has NOT been applied.
• Receipt ID: The id number of the receipt.

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, then click the Search button on the panel.

Buttons at the top of screen

• New:
  • The New button will allow you to create a new receipt for a patient manually.  
    1. Click New and you will be prompted to search and select a patient. 
    2. The Quick Pay receipt window will be opened and the necessary details can be entered.  
    3. The receipt will be generated and the receipt reconciliation process will run.
       
       
• Open button:
  • The Open button will open the Receipt Details screen in a pop-up window for the receipt selected in the Results Grid.
    
    
• 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,  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.

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. 

The Receipt Details screen can be accessed by double clicking on a receipt from the Receipts screen.  This screen can be used to review, edit, and reconcile receipts.

Fields

Receipt Details

• Patient: The patient that is associated with the receipt.  If the patient is not known, the patient name will say Patient Not Known.  Clicking the link will open the patient in the patient setup screen.
• Status: The status 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 associate 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.
• Received: The date and time that the receipt was posted in the system.
• Type: The payment type associated with the receipt.
• Amount: The total amount of the receipt. Clicking the link will open the Patient Transaction History screen.
• Check #: The check number associated with the receipt.
• Location: The location associated with the receipt.
  
• Messages: System generated messaged to provide guidance on what happened with the receipt during the Receipt Disbursement Logic.
• Paid By: The payer associated with the receipt. Clicking the link will open the patient in the Patient Setup screen.
  
• Receipt #: The unique ID automatically assigned to a receipt when it is created. Clicking the link will open the Quick Pay window.
  
• Hold: The hold date and remaining number of days that the receipt is on hold for.
• Method: The payment method associated with the receipt.
• Unapplied: The remaining balance for the receipt that has not yet been applied to the patient’s balance.
• Source: The origin of the receipt:
  • 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.

Past and Future Appointments

This section allows 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: A Link icon will display next to the appointment that the receipt you are viewing is linked to.  
• Date: The date and time of the past/future appointment.
• Resource: The resource associated with the past/future appointment.
• Location: The location associated with the past/future appointment.
  
• Past Appointment Actions:
  • Create Claim: Clicking this will open the create claim screen.
  • View Claim: This option is only visible when this link has occurred.  Clicking this will open the claim for that appointment.
• Future Appointment Actions: 
  • 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. 

Procedures Linked to Receipt

This section 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.

• Claim: The claim id of the procedure line the receipt was applied to.
• DOS: The date of service of the procedure line the receipt was applied to.
• Code: The code of the procedure line the receipt was applied to.
• Charge: The charge of the procedure line the receipt was applied to.
• Payment: The amount of the payment that was applied to the procedure line.
• Balance: The balance of the procedure line the receipt was applied to.
• Provider: The provider of the procedure line the receipt was applied to.
• Location: The location of the procedure line the receipt was applied to.
• Actions:
  • View Payments: Clicking will open the Payment Entry screen displaying the applied payments.

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 'Patient Coinsurance' or 'Patient 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 and Manually Created Payment Type 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.