This guide outlines the steps to set up and manage a personal injury (PI) case from start to finish. For a video tutorial, please refer to the Video Guide.
1. Setting Up the Attorney or Insurance Company as a Third-Party Payer
Insurance V1
Navigate to Insurance Settings and add a third-party payer.
Set up the payer as paper billed.
Insurance V2
Navigate to Insurance Settings and add a third-party payer.
Set up the payer as paper billed.
Note: Setting up the third-party payer as paper billed helps separate PI cases from regular insurance cases, allowing the office to bill them separately.
2. Setting Up a PI Case for the Patient
Open the patient profile and create a new case.
Select Personal Injury/Settlement as the case type.
Case Name will default to Personal Injury/Settlement (editable).
Set Suspend Billing to Suspend (recommended to avoid weekly claims and generate a statement at the end of the case).
3. Adding a Policy to the Case
Navigate to the personal injury case and add new insurance/coverage.
Select the third-party payer set up in step 1.
Set the coverage start date to the first appointment date for the PI case.
Remove the coverage end date (leave blank).
Enter the claim number or "LIEN" for attorney liens.
Select Auto Accident for Claim Related to.
Set the state of the incident to where the accident occurred.
Fill in max coverage if applicable.
Enter the date of the accident for the date of current illness or injury.
Select 439 - Accident for onset qualifier.
4. Treating the Patient
Add charges to the ledger for each treatment.
Record a SOAP note for each service date.
Provide a copy of all SOAP notes to insurance companies or attorneys upon request.
5. Billing a PI Case
Confirm with the third-party payer if they require claims on a HCFA form or just a statement of account and SOAP notes as that dictates which billing method you use.
A: Statement of Account and SOAP Notes
To generate statement of account:
Generate a statement of account for the PI case.
Leave date ranges blank to include all service dates.
Include case details such as DX codes, provider's NPI, EIN number, and place of service code.
To generate SOAP Notes
Generate a report of all SOAP notes for the PI case.
Leave date ranges blank to include all notes.
B: Generate HCFA form
Insurance V1
Create bills as standard paper.
Select the specific patient (do not batch bill).
Validate and correct any errors.
Create the claim and print on HCFA form if required.
Insurance V2
Create claims as standard paper.
Select the specific patient (do not batch bill).
Validate and correct any errors.
Create the claim and print on HCFA form if required.
Note: If HCFA forms are not required, just send the statement of account and SOAP notes. All service dates must go through the billing process to post a PI check.
6. Posting a PI Check
Once payment is received, post the check like an EOB.
For a visual guide, please watch the Video Guide.
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Below are the steps to set up and handle a personal injury case from start to finish:
Video Guide: https://vimeo.com/789065227 |
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1. Set up the attorney or insurance company as a third-party payer -
Insurance V1: Within the location > Insurance > Insurance Settings > Insurance/Third-Party Payers > Add Third-party Payer > set up the payer as paper billed.
Insurance V2: Within the location > Insurance > Settings > Payers > Add Third-party Payer > set up the payer as paper billed.
*An office wants to set up the third-party payer as paper billed because it can help separate PI cases from normal insurance cases so that an office can bill them separately.
2. Set up a PI case for the patient -
Open Patient Profile > Cases > Create New Case
Type - Personal Injury / Settlement
Case Name - it will default the case name to Personal Injury / Settlement. This can be edited and changed.
Suspend Billing - it will default to bill normally. This means that anytime a service is added to the patient's PI ledger, that service will be in the office's create billing queue. If billing is set to suspend, the dates of service will not show in the create billing queue until the case is set to bill normally. It is common practice to suspend billing for a PI case. The reason being is that most attorneys or insurance companies do not want claims every week, they just want a statement of account at the end of the entire case. Billing suspended is commonly used when an office will process all claims at the end of the patient's care and the case is closed. There is a health check report that will show any cases that have billing suspended.
3. Add a policy to the case -
Cases tab > click into the personal injury case > Insurance / Coverage tab > Add new insurance / coverage.
Insurance Company / Attorney - select the third-party payer that you set up in step 1.
Coverage start date - this will be the date of the first appointment in the office for the PI case specifically.
Coverage end date - click on the x to remove an end date as an office will not know the end date of a PI case upfront.
ID / Claim Number - if the office is working off of a lien with an attorney, type LIEN (all caps). If the office is working with an insurance company, a claim number will be assigned to the case.
Claim Related to (box 10) - use the drop-down menu to select Auto Accident.
State of Incident (box 10b) - this is the state where the auto accident happened, not the state in which the patient lives.
Max coverage - this can be filled out if there is a max coverage for a case the patient has, common use is Med Pay.
Date of current illness or injury (box 14) - this is the date the accident occurred.
Onset Qualifier - use the drop-down arrow to select 439 - Accident.
4. Treat the patient -
Each time the patient is treated, charges should be added to the ledger. A SOAP note should also be added for each date of service.
Most insurance companies and attorneys will request a copy of all SOAP notes when reviewing a PI case.
5. Billing a PI case -
Typically with a PI case, the attorney or insurance company does not actually want claims on a HCFA form like a normal insurance company does. They traditionally just ask for a statement of account and a printout of the SOAP notes - however, the office needs to confirm with the third-party payer how they want claims processed.
Statement of Account
Patient Profile >Statement of account (gray button) > BETA > Statement > Patient case - select the PI case > leave date ranges blank as it will pull all dates of service on the case > Include case details - use the drop-down menu to select use case details.
Case details will include DX codes, Provider's NPI and EIN number, and Place of service code.
SOAP Notes
Patient Profile > Care History (gray button) > Case type - select PI case > leave date ranges blank as it will pull all soap notes on the case > generate.
Regardless of the answer to the above, the office HAS to take all dates of service through the billing process.
Insurance V1: Insurance tab > create bills > Bill type - Standard paper (if paper billed was set up on the third-party payer) > only check off the one patient whose case is being processed (do not batch bill a PI case with other patients) > Validate > make sure everything passes validation and/or created any errors > create claim > if the third-party payer is requesting claims on a HCFA form - the office can now click on View paper claim and print on a HCFA form. If not, the office just stops at this point.
Insurance V2: Insurance tab > create claim > Claim type - Standard paper (if paper billed was set up on the third-party payer) > only check off the one patient whose case is being processed (do not batch bill a PI case with other patients) >if under the Failed validation tab - correct any errors first > once the patient is in the claim details tab - click create claim > if the third-party payer is requesting claims on a HCFA form - the office can now click on Print to HCFA and print on a HCFA form. If not, the office just stops at this point.
At this point, if the third-party payer does not want claims on a HCFA form - the office will end up not doing anything with the claim file that was created. They will just send the statement of account and soap notes....but all dates of service HAVE to go through the billing process in order for an office to post a PI check.
6. Posting a PI check -
Once the office receives payment for the PI case, they will post the check like an EOB.