Payment Type

To enter a payment, select the Payments menu, then choose the type of payment you wish to enter. The default patient payment types are Check, Cash, Card, and Other. When entering an insurance payment, choose either .

Patient Payment Types (Check, Cash, Card, ACH, and Other)

Once in the Payment Window, you can change the type of payment through the drop-down menu in the top left corner of the window. The options available correspond to those in the Payments menu in the ledger. Using the Credit Card option will also allow you to process Credit Cards via TSYS's integration.

Note: In 12.21 we've added the Patient Payment Type of ACH to categorize ACH payments. This can be used for EFT payments as well. For one-time ACH payments you'll still need to process these outside of MacPractice, but you can process Recurring ACH Payments with our TSYS Integration. Click here for more information on our TSYS Integration.

Insurance Payment (Check, Credit Card, or Other)

MacPractice recommends highlighting the corresponding outstanding insurance claim in the patient's ledger before selecting New Insurance Payment from the Payments menu. This will ensure that the payment is tied to the proper insurance claim in the event that there are multiple open claims for this patient. You may also use the Payment From and Outstanding Claims drop-down menus to associate the appropriate insurance company and claim after the fact.

Selecting the New Insurance Payment type enables more fields in addition to those available when choosing a patient payment type. Insurance payments include the Payment From and Outstanding Claims menus as well as a checkbox for EOB Columns. Allowed, Save Allowed, Write-Off, and Negative Adjustment columns are added to the Procedure Summary Table at the bottom of the window. Using the Insurance Credit Card option will also allow you to process Insurance Credit Cards via TSYS's integration.

Reference Number

The Reference Number field is an alpha-numeric free-text field. When selecting Patient or Insurance Check from the Payments menu, the Reference Number field will be labeled "Check #" and can be used to document the check number for your internal tracking purposes.

When a non-check type of payment is selected, the field will be labeled "Reference #" and can be used to document additional information about the payment. "VISA1234" could be used for a Credit Card payment type to document the type of card and the last four digits on the credit card, for instance. This is one common example, but you can use the Reference Number field in a way that fits the needs of your office.

The Reference Number field may be located before or after the Amount field in the Payment Window, depending on your settings in Preferences.

Amount

Enter the total amount of the payment in the Amount field, both dollars and cents. MacPractice will automatically format the entry as you type; there is no need to enter the decimal point. E.g., typing "12345" in the Amount field will be saved in MacPractice as "$123.45."

The Amount field may be located before or after the Reference Number field in the Payment Window, depending on your settings in Preferences.

Remaining

After hitting the tab key or otherwise leaving the Amount field, the Remaining Amount will be populated with the full amount of the payment. The Remaining area will update as the Amount is applied towards open charges, and reflect how much of the payment is currently unapplied.

Procedure Date

The Procedure Date field will show today's date by default, but this can be changed. When entering the date, you can enter the two-digit month, two-digit day, and two-digit year, and MacPractice will auto-format this field for you. E.g., entering "010117" will display as "01/01/2017" in MacPractice. If you prefer to enter and view the date before the month or use dashes instead of slashes, you can change the format in your Localization Preferences. When typing in a date field, you can also type T for today, Y for yesterday, and M for tomorrow, and the corresponding date with be filled in.

The Procedure Date field is useful if you are entering payments late and need to backdate the payment to the real date that it was received, or if you'd like for the payment to reflect the date on a check. 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). The Posted Date is not editable. Both dates are shown in columns in the ledger, and the ledger can be organized by either the posted or procedure date by changing the Preference accordingly. Likewise, many reportscan be run based on the procedure date or the posted date.

Attach File Button

Clicking the Attach File button in the top right corner of the Payment Window will open a Finder window. You may then select a file from your computer to attach to this payment in MacPractice. Choose the file and click the Open button in the bottom right corner of the Finder window. The Finder window will close. Save the payment to add the file.

To view the attached file, double-click on the payment in the ledger, then click on the drop-down menu that has replaced the Attach File button in the top right corner of the payment window. Choose Open. Keep in mind Payment attachments can only be accessed via the payment window; they cannot be accessed using the Images or Attachments ability.

The Attach File button is most commonly used to attach a copy of the EOB to an insurance payment, although the option to attach a file is available in a patient payment as well.

Card Entry Method 

If your office has the TSYS feature purchased on your MacPractice license, a valid Credit Card Machine is connected, and you have selected the Credit Card payment type, you should see a  a Card Entry Method menu and Transmit to Device button on the payment window. 

The Card Entry Method menu is used to select the method of processing the credit card payment.

Once you make your selection, click the Transmit to Device button, and the payment window will have a spinning indication that says "Waiting for Device". Once you see this indicator, you can swipe the credit or debit card.

Provider/Office

Use the Provider and Office menus to change the provider or office associated to the payment. The provider and office in the Payment Window will default based on the the corresponding Preference.

The payment provider affects receipts and deposit reports in MacPractice. The payment provider is not credited with earning the money applied to charges; this is instead based on the charge provider. The payment provider is credited for earning any unapplied amounts. The payment provider will be printed on statements as the recipient provider for payment and will be displayed in such reports as the Day Sheets and Deposit Slip.

• If using a statement that details provider information per item, the payment provider will be shown next to payments, and refunds.

• Filters the Day Month Year report for gross and unapplied payments.

• Filters the Gross Receipts report for unapplied payments only.

• Filters the following Accounting/Financial reports: Negative Adjustments, Refunds, and Unapplied (Credit) Balance.

• Filters the Posted Date Day Sheet and the Procedure Date Day Sheet reports for payments, negative adjustments, deposits, refunds, and unapplied amounts.

• Wherever the payment provider is used, the office listed in the Payment Window will be used as well.

Co-Pay Checkbox

*Patient Payments*

If the payment is a copayment mandated by the patient's insurance, check the Co-Pay checkbox. If a copay is entered in the Insurance sub-tab of the Patient tab in the Patients Ability, the Amount field will be automatically populated with the copay amount upon checking this box.

Please visit our Copay article for more information. 

Patient

*Patient Payments*

The patient menu contains a list of all patients in the account. When set to "All," MacPractice will display all open charges in the family account (provided that no Incident is selected), allowing you to apply the payment to any open charge. You can use the Patient menu to filter the list of procedures to show only charges associated with that patient. This can be useful if you are applying a payment on an account with multiple patients and you want the whole payment to go towards a single patient's balance.

Incident

The Incident menu will display all incidents in the account. It will display all incidents for the individual patient if you have a patient selected in a patient payment window, or if you are in the new insurance payment window.

In the patient payment window, you can use the Incident menu to filter the list of procedures to show only open charges within that incident. This can be useful if you are applying a payment for a patient with multiple open incidents.

In the new insurance payment window, the Incident menu will filter the list of claims available in the Outstanding Claims menu. This can be useful if there are many outstanding claims in the patient's account.

Payment From

*Insurance Payments*

Use the Payment From menu to select the insurance company making the payment. Generally, this will be the same company that you sent the outstanding claim to. Remember that selecting the insurance claim in the ledger before entering the insurance payment will cause this menu to default to that insurance company automatically.

Selecting an insurance company from this menu that does not match the insurance company selected in the Outstanding Claims menu will cause MacPractice to create a crossover claim. The crossover claim will be generated for the insurance company listed in the Payment From menu. You will see the words "Crossover Payment" appear below the Payment From menu, if a crossover claim is to be created.

Deposit Account

Any Bank Accounts setup in References will be present as options when posting insurance or patient payments in a ledger. All payments associated with a Deposit Account will be listed in a new column in the Trace Payment Manager.

The Posted/Procedure Date Day Sheets will use the Deposit Account and Allocation Accounts information when viewing the Deposit Slip. The Deposit Account and Allocation Account can be set in Preferences > Financial > Banking tab.

Outstanding Claims

*Insurance Payments*

The Outstanding Claims menu will list the date and insurance company for all the selected patient's outstanding claims (any status besides Paid/Closed is considered outstanding). When you select a claim, the list of procedures in the payment window will change to display the procedures on that claim. Insurance payments can only be applied to charges on the claim they are tied to. If you wish to apply an insurance payment across multiple claims, you will need to use the Bulk Insurance Payment within the Managers ability.

Once any portion of the insurance payment has been applied, the Outstanding Claims menu will be grayed out, and you will no longer be able to change your selection unless the payment is fully unapplied once more. Remember that MacPractice recommends selecting the claim in the ledger before creating a new insurance payment. This will ensure that the payment is tied to the appropriate claim.

Electronic Funds Transfer Checkbox

If the payment is an electronic funds transfer (or EFT), meaning your office will not be physically depositing the money into your account, check the Electronic Funds Transfer checkbox. On your Deposit Slip, you can choose to exclude EFT payments. 

Use EOB Checkbox

*Insurance Payments*

Check "Use EOB Columns" to add additional fields to the payment window (Deductible, Co-Insurance, Copay, Disallowed, Reason Code and ICN). These fields are generally used on primary payments, before generating a Secondary eClaim. Secondary eClaims require that the EOB information is included on the claim, similar to sending a copy of a paper EOB with a secondary paper claim.

If the insurance payment is applied to the open charge(s) and there is a portion of the charge(s) that has not yet been paid, the payment line will turn red. This is because the Reason Code is now a required field, and you will be unable to save the payment until all applicable reason code fields have been filled out. The remaining EOB columns may be filled out as well, although this is not required in order to save the payment in MacPractice.

Make Provider Adjustments Checkbox

*Insurance Payments*

A Provider Level Adjustment is an option in MacPractice when addressing Insurance Payments where you can credit some or all of an insurance payment to a specific Provider. This is useful in situations where the Insurance may overpay due to being late in remitting payment, or other similar reasons. In this situation, you wouldn't want to credit the patient the additional insurance funds, as it is a payment intended to go to the provider.

In order for this option to be available within the insurance payment window, you will need to make sure the Provider Adjustments are enabled in Preferences > Ledger > Payment > Insurance Payments > Enable Provider Adjustment in insurance payment window.

Once this option is checked within the insurance payment window, a new lines will appear as options to apply the payment to with the procedure code "Ins. Credit To Provider". You can then apply the Insurance Payment to those providers.

You can find more information about Provider Level Adjustments here. 

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.

Patient Portion Only Checkbox

*Patient Payments*

If you have the 'Apply to Patient Portion Only' checkbox checked, the payment will only be applied up to the amount that is currently allocated to the patient portion. This is particularly useful if you are using Insurance Estimating.

Unpaid Checkbox

*Insurance Payments*

If you have the 'Apply to Unpaid' checkbox checked, MacPractice will apply the insurance payment to any of the unpaid portion, regardless if it is Patient or Insurance portion. 

Apply to All Button

This button will appear when you do not have a specific charge selected in the Procedure Summary Table. MacPractice will apply the payment to the oldest available charges first. 

*Insurance Payment*

If you would like to have this button as an option when posting Insurance Payments, you can enable it by going to Preferences > Ledger > Payment tab > Insurance Payment sub-tab > Check 'Enable the "Apply to All" button or insurance payments'.

Apply To Selection Button

When you have a procedure selected within the summary table above, the "Apply to All" button becomes an "Apply to Selection" button. Click this button to apply the payment to the selected procedure, up to the amount of the payment or the unpaid amount, whichever is lesser.

Close Paid Claim

*Insurance Payment*

When checked, MacPractice will automatically set the claim status to 'Paid/Close'. If there are charges with no amount under the Payment column, $0.00 will automatically be filled in.