This section allows you to define exceptions to the insurance coverage you have defined in Step 2. For example, you may have a few items that have slightly different coverage. These items can be defined here without having to create a separate plan.
1. Highlight the item you wish to exclude and click Add. The line item will turn green indicating that it has been selected.
2. Enter the new benefit definitions.
Choosing Between Old and New CMS-1500 Forms
Depending on your insurance carrier, you can set preferences to use the "Old CMS HCFA Form"
or create a new one. Preference can be set up per insurance carrier using the following option that is highlighted on the screenshot shown below.
1. By default 'Use Old CMS 1500 Form?' will be unchecked and while creating HCFAs, you will see the new CMS-1500 (version 2-12) forms.
2. If you want to create old CMS-1500 forms by default, check the checkbox for 'Use Old CMS 1500 Form?'
3. Once the information is complete, you must save the entire record.
Processing an Insurance Sale
An Insurance Sale is very similar to an Rx Sale or Quick Sale with the exception that you are choosing the Insurance Company in the Sale Detail window. The insurance plans must be set up within the patient’s record.
1. To setup an insurance plan, select Add from the Insurance Policies sub-window within Patient Records.
2. Enter the policy information including the patient’s co-pay, insurance payment and maximum coverage. Click Save.
Generating an Insurance Sale
1. Select Generate Sale from the menu bar within the patient’s record or select Sales from the Overview menu.
2. Once you select the patient, choose the associated policy from the drop-down list within the Sale Detail window and select Continue.
NOTE: You will not be able to assign insurance to a sale after this step. It’s imperative that this information be entered at this point.
3. To enter the Patient Diagnosis for this sale, select Diagnosis from the menu bar in the sale window.
4. Select Add.
5. Type the description or code in the Search textbox and click the Search button or press Enter on your keyboard to search the required Diagnosis Code. Click the S (Select) button to select the required Diagnosis Code. The code will get added in the Final Diagnosis section.
Click Save to save the selected Diagnosis codes.
6. After you’ve entered the diagnosis codes, click Invoice Detail and proceed to enter the sale information.
7. Once the sale is completed, you are ready to generate a HCFA 1500 claim form. To do so, select Insurance from the Overview menu.
8. Click Claims from the menu bar.
9. Select Add a New Insurance Claim.
10. The Select Invoice window is now displayed. The invoice from the sale that you have just completed will automatically appear as the first invoice in the list. If this is the invoice you would like to generate an insurance claim for, either double-click on the invoice in the list or highlight the line and click Continue.
11. You may also do a Quick Search by Last Name or Invoice Number.
12. Select the Invoice for which you want to create the HCFA. For the selected invoice, 'Use Old CMS Form?' will be checked/unchecked, depending on the preference set under insurance plan.
13. If 'Use Old CMS Form?' is unchecked, the new CMS-1500 form (version 2-12) will be created. . Even if the checkbox for 'Use Old CMS Form?' is unchecked and you want to create an old CMS-1500 form, you can check the checkbox and proceed ahead.
14. Select CMS 1500 on the next window and click Select.
15. All patient information entered in Patient Records will automatically be carried over to the form.
16. To review the sale information, click on HCFA-2 on the top of the HCFA form. The sales information is automatically carried over to the form.
17. If 'Use Old CMS Form?' is checked, the old CMS-1500 form will be created. Even if the checkbox for 'Use Old CMS Form?' is unchecked and you want to create an old CMS-1500 form, you can check the checkbox and proceed ahead.
18. Select CMS 1500 on the next window and click Select.
19. All patient information entered in Patient Records will automatically be carried over to the form.
20. To review the sale information, click on HCFA-2 on the top of the HCFA form. The sales information is automatically carried over to the form.
22. To print the form select Print.
Saving HCFA Forms for Electronic Submission
1. Complete the HCFA form as stated in Adding a New Insurance Claim. When the form is complete, click Save.
2. Select Export from the menu bar to prepare the file for Electronic Processing.
3. Choose the directory in which to save your file and select Save.
Receiving an Insurance Payment
1. To receive an Insurance Payment, click on Insurance from the Overview menu.
2. Click on Payments from the menu bar.
3. Select the Using Claims radio button and choose the Insurance Company from the drop-down menu as highlighted below.
4. The New Payment option will be enabled. Once you select New Payment, the screen will become active and you may enter the payment.
5. Select the claim you wish to make a payment against from the Select a Claim window, and distribute the payments in the window below. Select Save to continue.
6. The following message will appear when the payment has been applied successfully.
Accessing Patient Ledger
The Patient Ledger can be accessed from the Overview menu or by selecting Go To Ledger from within the patient’s record.
Assessing Finance Charges
1. Select Finance Charges from the menu bar in Ledger.
2. Set the Finance Charge Rate and the number of days to consider when calculating the average daily balance. Select Continue. For example, all invoices older than 30 days will be assessed an annual rate of 15% or 1.23% per month.
3. The following preview window will appear. Select Apply Finance Charges.
4. Select Yes to apply finance charges to the selected patients on the next window.
5. Click OK to view the Finance Charge report.
Reconciling Your Cash Drawer
As you record patient and insurance payments throughout the day, E-Z Frame keeps track of the payment types and calculates the amount that should be in your cash drawer. Periodically, as you make deposits and specify the amount and tender types of the deposit, E-Z Frame manages your cash drawer balance.
1. To reconcile your cash drawer for the day, select Cash Drawer from the menu bar in Ledger.
2. Next, enter your receipt totals for each tender type in the Actual column. It is important that you enter the actual amount excluding refunds, as you will be accounting for the refunds in the adjacent column.
3. The Starting Cash value represents your float, or the money you started with at the beginning of the business day. As you enter the values, the program will automatically recalculate the Computed amount (the dollar amount that E-Z Frame calculates) and the Difference (the difference between the Actual and the Computed amounts).
4. Once the deposit is made you can print the Cash Drawer Reconciliation Report. Select Yes to print, or No to skip.
Marketing
Generating recalls and defining queries is performed through the Marketing section of the program. Click Marketing from the Overview menu to enter Marketing.
There are a number of pre-defined queries available for your selection. These include queries for recalls, Welcome letters, Thank You letters, etc.
1. To execute a pre-defined query, select Edit and enter the desired date range within the Query Criteria.
2. Select Run to execute the query.
3. Once the query results are generated, the following screen appears. Select Print to print a listing of the results or select Save to save the results to a file. Once the results are saved to a file, you will be able to import them into Microsoft Word or an equivalent word processing software, to generate labels, letters etc.
4. Choose the destination in which to save the file and select Open.
5. The following confirmation window will appear once the file is saved. Select OK.
6. Select Close to close the Query Results window.
7. Select Yes to automatically update the recall count in each Patient Record or select No for the recall count to remain the same.
Printing Recalls
In this section, we will reference Microsoft Word to demonstrate printing recalls. To begin, open a new file in Microsoft Word and select Mailings from the main menu.