Beaverlog Tips: Volume 21 - November 29, 2004

Rebilling Services On Insurance Claims

In a perfect world every claim would be approved and paid quickly. Alas, the world is not perfect and not every claim is approved. Forget about being paid quickly. Sometimes payers "lose" claims. Sometimes you are required to change or correct something and resubmit the claim or particular services from a claim. There are a couple of ways to accomplish this depending on the type of claims you are submitting.

HCFA-1500

The following technique works only for printed HCFA-1500 forms and for electronic HCFA-1500 print image claims in The THERAPIST EZ. For electronic claims in The THERAPIST Pro, see the next section titled All Claims.

For printed HCFA-1500 claims, this is easy. In both Pro and EZ you simply highlight the patient on the patient list and click on the Print button in the lower left corner of the window. This opens a popup menu that includes an option to print a single HCFA-1500 form where you can select the services to bill. Just select the services you want to rebill and click the Print button to create the claim. Services that are inactive (i.e. have a zero balance) will not be displayed on the list by default. You can select inactive services by checking the Show inactives check box in the upper right corner of the window.

In The THERAPIST EZ, you can create an electronic claim version of the HCFA-1500 by going to the Print Image File tab and checking the "Create a print image file matching the printed claims" check box. This is also where you can specify the print image file name and the form terminator. The terminator is how the claim receiver's software determines where one form ends and the next begins. The default terminator is a series of five characters: CR/LF/FF/CR/LF. Translated into English, that means a carriage return followed by a line feed, a form feed (new page), and another carriage return and line feed. This combination is recognized by most receivers but you can select a different terminator if necessary. Check with your claims receiver to see what they expect.

All Claims

The technique described below will work for all claims for both The THERAPIST Pro and The THERAPIST EZ. However, the technique above is easier to use if you are generating printed claims or print image claims in The THERAPIST EZ.

When you generate either printed or electronic claims, you have the option to mark the services on the claims as billed. When you do this, The THERAPIST saves a record of the claim and service. When you subsequently do a batch claim billing, either printed or electronic, the program checks the list of services on claims and skips services that have already been billed to the selected payer.

At least that is what happens unless you instructed the program to do otherwise. On the option screens for batch printed and electronic claims, there are options to allow rebilling if the services were already billed to the payer, if already paid by the payer, and if not paid but an EOB was received from the payer. These options are great if you want to regenerate an entire batch but are too broad if you merely want to rebill a single service or a few services.

If you want more control over which services should be rebilled in a batch, it requires a few extra keystrokes. Basically it involves finding the record The THERAPIST made when the service was originally billed to the payer and marking it to rebill. There are several routes to this record but they all end up in the same place. We will start with the most specific and move toward the broadest. First, go the the patient's transactions list and highlight the service you want to rebill. Click on the "View Claims" button below the list. This opens a window listing all of the claims in which this service was included and shows the payer to whom it was sent. Double click on the claim record or highlight it and press the Change button to bring up an entry form. On this form, check the box labeled "Allow rebilling service to payer." Click Ok to save it. That's it. Next time you generate batch claims that include the date of the selected service and the desired payer, this service should be rebilled.

There are two other routes to this screen. On the patient list, there is a button labeled "Generated Claims." This will take you to an expandable tree list of all claims generated for the highlighted patient. You will have to drill down the list to find the service and payer and mark it for rebilling. Finally, on the Billing menu is an item labeled Review Claim Batches. This is another expandable tree list of all claims generated for the entire practice. On this list, you will have to go five levels down to find the service and mark it for rebilling.

When the service is billed, the rebilling flag will be cleared so you don't have to find it again and uncheck it yourself.

Summary

Using the methods described above you can rebill specific services or entire claim batches. Just select the technique that fits what you need to do.