You should enter a charge whenever an encounter with a patient results in a fee or an amount that you will want to bill and track, or when you have rendered a service to be recorded in the patient’s ledger. Typically, a service will be rendered and a fee will be charged. In many cases, the responsibility for paying that fee will fall on the patient — or on another responsible party — and one or more insurance companies. As you enter the charge for the service, you can divide the amount due among the responsible parties. In most cases a portion of the charge will be “split” to the patient, and the rest will be “split” to the primary insurance carrier. Later, when payments are received, you can assign the remaining balance to the available payers on the account. For example, if insurance denies a claim, you can move responsibility back to the patient, or perhaps to a secondary insurance payer.
Manual Charge Entry
- To enter a charge, begin by opening the Daysheet screen. Expand Billing in the navigation bar, then click Daysheet.
- From there, open the Charge Entry form by clicking the left-most icon on the toolbar, or by right-clicking anywhere in the daysheet list area and selecting the top option, New Charge.
- Selecting a patient. Click anywhere in the Patient field, or <TAB> to the field and press <ENTER> to open the patient list. You can type anything you like for the full text search, including any part of a name or birthdate and the list will be immediately filtered down to just the rows that contain the characters you typed for the search. For example, first name, last name, or birthday (like “4/12”). Note that even matches in the middle of a name or date are included, so in our example below, all patients with birth dates starting with “5/”, as well as those birthdates containing “5/” in the middle, are counted as matches. When you see the desired patient appear in the selection list, click that row, or highlight it using the arrow keys and press <ENTER> to select.Once the patient has been selected, several pieces of information will appear in the charge screen. The patient’s most recently used POS (place of service) code and Sort Code (optional) will appear if there has been a previous charge entry made for this patient. The Provider will be selected based on your preference in Settings > System Options >Transactions > Charge Defaults.If any default values are missing or not correct for the charge you are entering, you can correct each. A little button with a “V” arrow symbol to the right of a field indicates that you can select from a list (or calendar, in the case of a date). To do so, move the mouse cursor over the field and click the field, or the “V” button at the right of the field. Most of the fields on the charge screen are, in fact, selection lists that work just as described above for the Patient list. Once you have selected patient, service, and provider SOS will find the appropriate fee and divide it among the patient’s payors as your various settings dictate. In most cases, that will complete the entry and you will be able to save and continue with additional transactions or other tasks.
You may have some questions about some of the fields on the Charge screen, so let’s take a closer look at those that may be unfamiliar to you:
- Care Episode. The Care Episode can be thought of as an “admission”. If a patient completes or terminates treatment and returns at a later date for more care, you should open a new Care Episode for her and select it as the Active Care Episode. If you do so, it will automatically be inserted into your new charge entries, but you can use select any of the patients other episodes for a particular charge. For more information about Care Episodes, please see the related article.
- Claim Type. Select “None” for non-insurance charge entries. For insurance-billable entries in the Standard Version of SOS, the only other choice for Claim Type is “Professional”. If you are using the Pro Version of SOS, you can choose either “Professional” for billing normal office services that could be filed on a CMS1500 claim form, or “Institutional” if the charge is one that could be filed on a UB claim form.
- Claim Setup. SOS Standard only supports one Claim Setup per Care Episode, so the system will use it automatically. SOS Pro, however, supports an unlimited number of Claim Setups. You could, for example, have one Claims Setup that is right for home visits and a different one for in-office treatment. The right choice will be apparent if you use a good description when you create each of your Claim Setups. For more information about Claim Setups, please see the related article.
- J#. This value is simply a sequential number that the system automatically assigns to every transaction. It can be valuable for reporting and troubleshooting.
- Sort Code. The Sort Code is an arbitrary value that your organization can use to help with unique reporting requirements. When an organization uses Sort Codes, the system administrator will probably have configured the Sort Code field as mandatory. In that case the Sort Code prompt will be colored red and you won’t be able to save your charge entry without selecting a value for that field.
- CPT Modifier. CPT Modifiers further describe the nature of the service being billed. Many services do not require any modifiers, but others won’t be paid without them. You will have to check with your payers to be sure.
- Charge Dx. Each charge submitted to an insurance payer must be accompanied by one or more diagnoses, appropriate for the type of service being billed. The lookup list for the four Dx fields will show all active diagnosis codes that are on the patient’s Care Episode diagnostic list. If the diagnosis you want to use does not appear on the list, you can add it on-the-fly by clicking the NEW button at the bottom of the lookup list.
Prior to saving your charge, be sure to review the panel at the bottom of the charge screen to see how SOS has split the fee among the payers on the account. If you want to change the amount of a split, just double click the row, adjust the amount, and save. In 99% of the cases, you will have to change at least two of the rows to keep the overall fee the same. SOS always adjusts the fee to match the sum of the split amounts, so if you were to increase just one split by $5, the fee will increase by $5 as well. Reduce a different split by $5 to bring the total fee for the service back to the correct amount. If the splits are not correct, your aging reports will not be correct either.
If you find that SOS is not calculating the charge splits the way you think it should be, start by reviewing our article that explains exactly the process in detail.
You have probably noticed the Copy Previous Service button. Using this button, you can reproduce any previous charge in a patient’s ledger for the current date. For the details, please see this article on the topic.