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Patient Name

This will list the name of the patient(s) on the account who currently have open charges in which the payment can be applied to. 

Procedure Date

This column will display the procedure date from the procedure code entered into the Charge Window. MacPractice tracks both the Procedure Date (the one that you can edit) and the Posted Date (the day that you posted the transaction in the ledger).

Incident Name

This will reflect the name of the incident in which the charge(s) are located on the ledger. This can be useful if you are wanting to apply a payment to a specific charge in a specific incident. 

Tooth

*Not present in MacPractice DC or 20/20*

This column displays the tooth number(s) associated to the procedure code in that row, either from the New Charge window in the ledger or from entering the procedure through Restorative Charting.

Procedure Code and Description

The procedure code and description columns will pull their information from the corresponding New Charge windows. For a patient payment, all charges with open balances will be listed, unless otherwise indicated through the Patient or Incident menus. For an insurance payment, all charges sent out on the claim selected in the Outstanding Claims menu will be listed.

Fee

This will list the full cost of the procedures, regardless of any payments applied to them. This should match the amounts that were on the claims and in the new charge window.

 Allowed

This is the amount that the insurance carrier says is the usual customary and reasonable price. This information is typically found on the EOB but you may set the information in advance if you know it.

This will pull in the amount listed on the Plan tab of the Insurance Company Reference. If there is no amount entered on the reference, then MacPractice will assume that the full amount is allowed. It can be edited as you enter the payments.

If plans are not used, then this box will always be empty. Manually type in the amount from the payment.

Payment

This is the amount that is actually being paid toward each charge. MacPractice recommends entering specific amounts per procedure instead of using the Apply to All button.

You may only enter in a payment amount that is less than the full fee amount. If an insurance payment has already been applied, then you can only enter in the amount remaining.

Write-Off

This is the amount that will not be charged to the patient. Usually the write-off is based on a contractual obligation with the insurance carrier.

Enable the Preference > Ledger > Payments > Insurance Payments "Auto calculate the write off when the provider participates with the carrier" to have this number fill in on it's own. The amount will auto-calculate to be the difference between the procedure fee and the allowed amount. [Office Fee] - [Insurance Allowed] = [Write-off]

In MacPractice, write-offs will only display on the insurance payment and are intended for use with insurance only. Any other amounts that need zeroed out or discounted are entered in as negative adjustments.

Negative Adjustment

The Negative Adjustment column allows you to apply a negative adjustment to this particular charge. This column only displays when posting or editing an Insurance Payment. Negative Adjustments previously posted to this charge are not necessarily reflected in this column, so you'll need to be sure to select the charge in the ledger to determine if a negative adjustment has been posted prior to adjusting directly from the payment window.

 Insurance Portion

*Insurance Payment*

This column will display on insurance payments only, listing the insurance's balance for this procedure. If insurance estimating is used, it will show the estimate. Otherwise, it will display 100% of the fee until the insurance payment is entered and the claim is closed.

When entering the payment, you can enter more than the insurance portion, but only up to the amount of the fee and not counting any other insurance payments.

Patient Portion

*Patient Payment*

This column will display on patient payments only, listing the patient's balance for this procedure. If insurance estimating is used, it will show the estimate. Otherwise, it will display 0 until the insurance payment is entered and the claim is closed.

Unpaid

The Unpaid column displays the amount of the charge that has not been addressed by a patient or insurance payment, and has not been adjusted via a positive or negative adjustment.

Record #

MacPractice automatically assigns this number to each ledger transaction, numerically as they are entered. As this number is for internal identification purposes only, we suggest moving this column to the far right end of the window.

Pr/Of

These two columns will list the Provider and Office's ID associated with the procedure(s) listed in the table. This may or may not match the Provider listed at the top of the Payment.

Date Applied

This column tracks the last date that a payment was applied or changed for the given charge. This impacts both patient and insurance payments, but will always track the most recent date that the applied amounts were touched upon for this specific charge.

Save Allowed Checkbox

*Insurance Payments*

The "Save Allowed" checkbox is used to update the patient's insurance plan procedure amounts when you edit an allowed amount for a given procedure. When using insurance plans, it will take the new allowed amount and update the procedure's allowed amount in the insurance plan. Adjusting the allowed amount will automatically check Save Allowed.

If the patient is not associated to a particular insurance plan, the Save Allowed checkbox will be greyed out.

Save Allowed will not be checked if you choose to click "Appeal" on the "Would you like to appeal the amount paid for this charge" prompt.

Appeal Payment Checkbox

*Insurance Payments*

If insurance appeals are turned on in the ledger preferences, then this box will be enabled. It will automatically check when the allowed amount that pulls from the insurance plan is overridden in the payment to a lower amount.
appeal.gif

Appealed claims display in the Claim Manager for further action by the office.

Save as Flat Rate Checkbox

*Insurance Payments*

When using insurance plans, this allows you to save the charge's payment amount as the flat rate amount.

Deductible, Co-Insurance, and Copay

*Insurance Payments with 'Use EOB Columns Checked'*

The deductible, coinsurance, and copay columns will appear in the procedure summary table of the Payment Window when Use EOB Columns is checked. If the disallowed amount is actually the copay, co-insurance or deductible amount, it is important that you fill out the amount in the appropriate column. This information should be located on the EOB you received from the primary payer. Using an incorrect column or failure to fill in these columns when applicable may cause your secondary eClaim to be unbalanced or rejected.

Any amount added to the Deductible and Copay amounts will be sent to the Patient portion if applicable.

Disallowed

*Insurance Payments with 'Use EOB Columns Checked'*

The Disallowed amount will be auto-populated when applying a payment towards a procedure and using EOB columns. It is calculated from the total Fee Amount minus the Payment. Entering information in the Deductible, Co-Insurance and Copay columns will reduce the amount in the Disallowed column. If the Disallowed amount is zero, you may save the insurance payment. If there is any remaining Disallowed Amount, it must be accompanied by an appropriate Reason Code.

MacPractice will use the following formula to calculate the Disallowed amount:

Fee - Payment - (Deductible + Coinsurance + Copay) = Disallowed amount

Any remaining Disallowed amount requires a corresponding Reason Code.
If the Disallowed is zero, no additional Reason Code is required.

Reason Code

*Insurance Payments with 'Use EOB Columns Checked'*

The Reason Code identifies the reason why the primary Payer did not pay the entire amount, aside from the Deductible, Co-Insurance and Copay. The Reason Code column will appear in the payment window when Use EOB Columns is checked. A reason code must accompany a disallowed amount on a primary insurance claim in order for the corresponding secondary eClaim to be accepted. You will find the reason code on your primary payer's EOB.

Some payers use their own set of reason codes to disallow payment, however electronic claims require all reason codes to be sent in a HIPAA-mandated format. A list of HIPAA approved reason codes can be found in your Products and Services Ability in MacPractice by clicking on Claims Adjustment Reason Codes in the sidebar.

Each Reason Code will also need to be accompanied by a Group Code. Group Codes are the two digit alpha-characters in front of the Reason Code.

Explanation of Claim Adjustment Group Codes:

• CO - Contractual Obligations: This group code should be used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment. Generally, these adjustments are considered a write-off for the provider and are not billed to the patient.

• CR - Corrections and Reversals: This group code should be used for correcting a prior claim. It applies when there is a change to a previously adjudicated claim.

• OA - Other Adjustments: This group code should be used when no other group code applies to the adjustment.

• PI - Payer Initiated Reductions: This group code should be used when, in the opinion of the payer, the adjustment is not the responsibility of the patient, but there is no supporting contract between the provider and the payer, for example a medical review or professional review organization adjustments.

• PR - Patient Responsibility: This group should be used when the adjustment represents an amount that should be billed to the patient or insured. This group would typically be used for deductible and copay adjustments.

You should use the reason code indicted on the EOB you receive from the payer. When in doubt as to which reason code to use, please consult the WPC Website or contact the patient's primary insurance company. MacPractice Support will be unable to tell you which reason codes to use on an insurance payment.

ICN

*Insurance Payments with 'Use EOB Columns Checked'*

With the EOB columns turned on in the payment window, you will also be able to enter the claim ICN number, or the payer's Internal Control Number. However, the ICN number is not sent on claims and is purely informational.