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Computer Competency Exercises to Accompany Administrative Medical Assisting, 6th Edition

Module 6: Posting Payments

6.1 Computer Competency

Obtain, View and Print the Provider Payment Advice for all Payers Description of Simulation: The billing manager has asked you to obtain, view and print the Provider Payment Advice in preparation for posting payments on patient accounts. The dates of the billing period are October 1, 2009 through November 30, 2009.

Step 1: Open MOSS and logon with your student identification.

Step 2: From the Main Menu, click on the Claims Tracking button. Click on All in the Payer window to select all insurance carriers that have paid on claims. See Figure 6-1.

Figure 6-1

Step 3: The window to input a start date will open (see Figure 6-2). Enter 10/01/2009 in the field, and then click OK.

Computer Competency Exercises to Accompany Administrative Medical Assisting, 6E

Figure 6-2

Step 4: The next window is for the end date. Enter 11/30/2009 in the field, and then click OK. See Figure 6-3.

Figure 6-3

Step 5: On the start and end dates have been entered, MOSS is display the payment remittance advice for payments received for that period. You should have six pages displayed. (Hint: Use the Record bar in the lower left to advance through the pages). See Figure 6-4.

Module 6: Payment Posting

Figure 6-4

Step 6: Optional: Using the printer icon in the top left menu, print the Provider Payment Advice. This will make it more convenient to view the payments for posting, and making notes, if needed. As an alternate, you may also view the Provider Payment Advice on-screen, and simply minimize the window when not in use, as shown in Figure 6-5. Maximize it when needed to continue your work by clicking on the lower left of your screen in MOSS. See Figure 6-6

Figure 6-5


Figure 6-6


Post Payments from Insurance Companies to Six Patient Accounts Description of Simulation: You are assigned to the billing office on December 17, 2009. The billing manager has asked you to post payment from insurance companies to select patient accounts. Use the Provider Payment Advice that was previously printed for each exercise that follows.

Patient 1: Eric Gordon—Post a Payment from ConsumerONE HRA to the Patient Account

Step 1: Review the insurance companies and patients on the Provider Payment Advice. On page 1, the first insurance is ConsumerONE HRA. Refer to the following questions while reading the payment details for Patient Eric Gordon, as shown in Figure 6-7.

A. What was the Date of Service for this payment (DOS)?

B. What were the total charges?

C. How much did the insurance company allow?


D. How much did the insurance company pay to the provider?

Figure 6-7

Step 2: Next, the payment will be posted to Patient Gordon’s account. From the Main Menu, click on the Posting Payments button and find the account for Eric Gordon from the patient list. Select the patient by single clicking on his name, and then on the Apply Payment button. See Figure 6-8.

Figure 6-8

Step 3: When the Posting Payments window opens, click on the line for 10/22/2009 and then on the Select/Edit button along the bottom. If done correctly, the balance due should appear in Field 13. Check your work with Figure 6-9.


Figure 6-9

Step 4: You are now ready to post the payment details. First, enter the date of posting in Field 3, which is 12/17/2009. In Field 4, select PAYINS to indicate that the payment is from the insurance company. In Field 5, enter the Claim ID number, as shown on the Provider Payment Advice. See Figure 6-10.

Figure 6-10

Step 5: In Field 6, enter the amount paid by the insurance company: $159.30. Press Enter to apply the payment. You should see the balance due in Field 13 now read $20.70. Check your work with Figure 6-11.


Figure 6-11

Step 6: When you have finished checking your work, click on the Post button. Open the Patient Ledger by clicking on the View Ledger button (Hint: This button is located in the lower area of the Posting Payments window). Check your work with Figure 6-12.


Figure 6-12

Step 7: Close the Payment Postings window. This will return you to the patient selection window so you may continue with the next patient. If you will not be continuing work, close all windows and exit MOSS.

Patient 2: Carla Jacobi—Post a Payment from ConsumerONE HRA to the Patient Account

Step 1: Use the Provider Payment Advice that was previously printed, or open it on-screen using the Claims Tracking button from the Main Menu, and entering the start date 10/01/2009 and end date 11/30/2009.

Step 2: Review the insurance companies and patients on the Provider Payment Advice. Locate Carla Jacobi and then refer to the following questions while reading the payment details, as shown in Figure 6-13.






Figure 6-13

Step 2: Next, the payment will be posted to Patient Jacobi’s account. From the Main Menu, click on the Posting Payments button and find the account for Carla Jacobi from the patient list. Select the patient by single clicking on her name, and then on the Apply Payment button.


Figure 6-14

Step 4: You are now ready to post the payment details. First, enter the date of posting in Field 3, which is 12/17/2009. In Field 4, select PAYINS to indicate that the payment is from the insurance company. In Field 5, enter the Claim ID number, as shown on the Provider Payment Advice. See Figure 6-15.


Figure 6-15

Step 5: In Field 6, enter the amount paid by the insurance company: $131.10. Press Enter to apply the payment. You should see the balance due in Field 13 now read $16.90. Check your work with Figure 6-16

Figure 6-16

Step 6: When you have finished checking your work, click on the Post button. Open the Patient Ledger by clicking on the View Ledger button (Hint: This button is located in the lower area of the Posting Payments window). Check your work with Figure 6-17.


Figure 6-17


Patient 3: Christopher Snider—Post a Payment from FlexiHealth PPO In-Network to the Patient Account


Step 2: Review the insurance companies and patients on the Provider Payment Advice. Locate Christopher Snider and then refer to the following questions while reading the payment details, as shown in Figure 6-18.






Figure 6-18

Step 3: Notice that the insurance company has indicated that the patient responsibility is $20.00. Before posting the payment, it would be useful to check and see if the patient paid his $20.00 co-payment at the time of service. Open the patient ledger (Hint: Click on Billing from the drop-down menu, and select Patient Ledger. Select Patient Snider and check to see if he made a payment on 11/17/2009 of $20.00.

A. Did he make a payment?

Step 4: Next, the insurance payment will be posted to Patient Snider’s account. From the Main Menu, click on the Posting Payments button and find the account for Christopher Snider from the patient list. Select the patient by single clicking on his name, and then on the Apply Payment button.


Figure 6-19


Step 6: You are now ready to post the payment details. First, enter the date of posting in Field 3, which is 12/17/2009 (Hint: If the field is populated with the date of service, you may replace it with the date of posting). In Field 4, select PAYINS to indicate that the payment is from the insurance company. In Field 5, enter the Claim ID number, as shown on the Provider Payment Advice. See Figure 6-20.

Figure 6-20

Step 7: In Field 6, enter the amount paid by the insurance company: $110.10. Press Enter to apply the payment. You should see the balance due in Field 13 now read $16.90.

Step 8: Because the patient’s physician is an In-Network provider, the remaining balance, $16.90, will be adjusted off the account. In Field 10, drop down the selection box and click on ADJINS to indicate this is an insurance adjustment. See Figure 6-21.

Figure 6-21

Step 9: Next, in Field 11, enter $16.90 and press Enter to apply the adjustment. The balance due in Field 13 should now read $0.00. Check your work with Figure 6-22.


Figure 6-22

Step 10: When you have finished checking your work for accuracy, click on the Post button. Open the Patient Ledger by clicking on the View Ledger button (Hint: This button is located in the lower area of the Posting Payments window). Check your work with Figure 6-23.


Figure 6-23


Patient 4 Stanley Kramer—Post a Payment from FlexiHealth PPO Out-of-Network to the Patient Account


Step 2: Review the insurance companies and patients on the Provider Payment Advice. Locate Stanley Kramer and then refer to the following questions while reading the payment details, as shown in Figure 6-24.

A. What are the Dates of Service for this payment (DOS)?

B. What are the CPT codes for each service?

C. What were the total charges for each service?


D. How much did the insurance company allow for each service?

E. How much did the insurance company pay to the provider for each service?

Figure 6-24

Step 3: Notice that the insurance company has allowed and paid more on CPT 99231 than the amount billed for the service. This may be an insurance error. The payment will be posted, and the issue needs to be further investigated.

Step 4: Next, the insurance payments will be posted to Patient Kramer’s account. From the Main Menu, click on the Posting Payments button and find the account for Stanley Kramer from the patient list. Select the patient by single clicking on his name, and then on the Apply Payment button.

Step 5: When the Posting Payments window opens, click on the line for 10/27/2009 and then on the Select/Edit button along the bottom. If done correctly, the balance due of $145.00 should appear in Field 13.

Step 6: You are now ready to post the payment details. First, enter the date of posting in Field 3, which is 12/17/2009 (Hint: If the field is populated with the date of service, you may replace it with the date of posting). In Field 4, select PAYINS to indicate that the payment is from the insurance company. In Field 5, enter the Claim ID number, as shown on the Provider Payment Advice for CPT 99221. See Figure 6-25.

Figure 6-25



Step 8: Because the patient’s physician is an Out-of-Network provider, the remaining balance of $16.67 will be due from the patient. This will be invoiced during patient billing at a later time. Check your work with Figure 6-26.

Figure 6-26



Figure 6-27

Step 10: You are now ready to post the payment for the next service (the Payment Posting window should still be open to Patient Kramer). Select the line for date of service 10/29/2009 by single clicking on it, and then click on Select/Edit.

Step 11: Enter the date of posting in Field 3, which is 12/17/2009. In Field 4, select PAYINS to indicate that the payment is from the insurance company. In Field 5, enter the Claim ID number, as shown on the Provider Payment Advice for CPT 99231. See Figure 6-28.

Figure 6-28

Step 12: In Field 6, enter the amount paid by the insurance company: $314.42. Press Enter to apply the payment. Remember, this was an overpayment by the insurance company. You should see a credit balance due in Field 13 of <$156.42>. Check your work with Figure 6-29.


Figure 6-29



Figure 6-30

Step 14: You are now ready to post the payment for the last service (the Payment Posting window should still be open to Patient Kramer). Select the line for date of service 10/30/2009 and click on Select/Edit.

Step 15: Enter the date of posting in Field 3, which is 12/17/2009. In Field 4, select PAYINS to indicate that the payment is from the insurance company. In Field 5, enter the Claim ID number, as shown on the Provider Payment Advice for CPT 99212. See Figure 6-31.

Figure 6-31

Step 16: In Field 6, enter the amount paid by the insurance company: $70.80. Press Enter to apply the payment. You should see a balance due of $9.20 in Field 13. Check your work with Figure 6-32


Figure 6-32

Step 17: When you have finished checking your work for accuracy, click on the Post button. Open the Patient Ledger by clicking on the View Ledger button (Hint: This button is located in the lower area of the Posting Payments window). Check your work with Figure 6-33. NOTE: The credit caused by the insurance overpayment has an effect on the overall balance as follows: $383.00 (charges) - $70.80 (payment) - $314.42 (overpayment) - $128.33 (payment) = <$130.55> (credit balance).


Figure 6-33

Patient 5: Francois Blanc—Post a Payment from Medicare Statewide to the Patient Account


Step 2: Review the insurance companies and patients on the Provider Payment Advice. Locate Francois Blanc and then refer to the following questions while reading the payment details, as shown on the Provider Payment Advice.





E. What is the Claim ID number for this payment?


Step 3: Open the Posting Payments window for patient Blanc and click on the line for 10/27/2009. Next, click on the Select/Edit button along the bottom. If done correctly, a balance due of $60.00 should be in Field 13.

Step 4: You are now ready to post the payment details. First, enter the date of posting in Field 3, which is 12/17/2009. In Field 4, select PAYINS to indicate that the payment is from the insurance company. In Field 5, enter the Claim ID number, as shown on the Provider Payment Advice.

Step 5: In Field 6, enter the amount paid by the insurance company: $48.00. Press Enter to apply the payment. You should see the balance due in Field 13 now read $12.00. Check your work with Figure 6-34

Figure 6-34

Step 6: When you have finished checking your work, click on the Post button. Open the Patient Ledger by clicking on the View Ledger button (Hint: This button is located in the lower area of the Posting Payments window). Check your work with Figure 6-35. NOTE: This patient has a $12.00 balance, which will be billed to his secondary insurance (Medicaid) at a later time.


Figure 6-35


Patient 6: Maria Carvajal—Post a Payment from Medicare Statewide to the Patient Account


Step 2: Review the insurance companies and patients on the Provider Payment Advice. Locate Maria Carvajal and then refer to the following questions while reading the payment details on the Provider Payment Advice.

A. What are the Dates of Service for this payment (DOS)?

B. What are the CPT codes for each service?

C. What were the total charges for each service?

D. How much did the insurance company allow for each service?

E. How much did the insurance company pay to the provider for each service?


F. What is the Claim ID number for each service?

G. What is the difference between the Charges and the Allowed Amount for each procedure?

Step 3: Now that you have gathered this information, the insurance payments can be posted to Patient Carvajal’s account. From the Main Menu, click on the Posting Payments button and find the account for Maria Caravajal from the patient list. Select the patient by single clicking on his name, and then on the Apply Payment button.

Step 4: When the Posting Payments window opens, click on the line for CPT code 99204 and then on the Select/Edit button along the bottom. If done correctly, the balance due of $283.00 should appear in Field 13.

Step 5: You are now ready to post the payment details. First, enter the date of posting in Field 3, which is 12/17/2009 (Hint: If the field is populated with the date of service, you may replace it with the date of posting). In Field 4, select PAYINS to indicate that the payment is from the insurance company. In Field 5, enter the Claim ID number, as shown on the Provider Payment Advice for CPT 99204.


Step 7: Because the patient’s physician is a PAR (Participating) provider for Medicare, the non-allowed portion of the charges will be an insurance adjustment. Calculate the amount that is to be adjusted for CPT 99204 as follows: $283.00(charges) - $160.15 (allowed amount) = $122.85 (adjustment write-off).

Step 8: Next, drop down the selection box in Field 10 and select ADJINS for Adjustment Insurance. In Field 11, enter the adjustment amount of $122.85 and press Enter. The Balance due in Field 13 should now read $32.03, which matches the Patient Responsibility amount for CPT 99204 on the Provider Payment Advice.

Check your work with Figure 6-36. NOTE: This patient has a secondary insurance (Medicaid) which will be billed at a later time.


Figure 6-36

Step 9: When you have finished checking your work for accuracy, click on the Post button. Open the Patient Ledger and check your work with Figure 6-37


Figure 6-37

Step 10: You are now ready to post the payment for the next service (the Payment Posting window should still be open to Patient Carvajal). Click on the line for CPT code 85014 and then on the Select/Edit button along the bottom. If done correctly, the balance due of $7.00 should appear in Field 13.

Step 11: Enter the date of posting in Field 3, which is 12/17/2009. In Field 4, select PAYINS to indicate that the payment is from the insurance company. In Field 5, enter the Claim ID number, as shown on the Provider Payment Advice for CPT 99231.

Step 12: In Field 6, enter the amount paid by the insurance company: $2.65. Press Enter to apply the payment. The balance due in Field 13 should read $4.35.

Step 13: Again, the non-allowed portion will need to be adjusted. Using the Charges and Allowed Amount for CPT 80514, calculate the adjustment amount.

A. The adjustment amount is:

Step 14: Post the adjustment by dropping down the selection box in Field 10 and select ADJINS for Adjustment Insurance. In Field 11, enter the adjustment amount of $3.69 and press Enter. The Balance


due in Field 13 should now read $0.66, which matches the Patient Responsibility amount for CPT 85014 on the Provider Payment Advice. This balance will be billed to the secondary insurance at a later time. Check your work with Figure 6-38.

Figure 6-38



Figure 6-39



Step 18: In Field 6, enter the amount paid by the insurance company. Press Enter to apply the payment. The balance due in Field 13 should read $35.18.

Step 19: Again, the non-allowed portion will need to be adjusted. Using the Charges and Allowed Amount for CPT 80053, calculate the adjustment amount.


Step 20: Post the adjustment by dropping down the selection box in Field 10 and select ADJINS for Adjustment Insurance. In Field 11, enter the adjustment amount of $32.23 and press Enter. The Balance


due in Field 13 should now read $2.95, which matches the Patient Responsibility amount for CPT 80053 on the Provider Payment Advice. This balance will be billed to the secondary insurance at a later time. Check your work with Figure 6-40.

Figure 6-40



Figure 6-41



Step 24: In Field 6, enter the amount paid by the insurance company. Press Enter to apply the payment. The balance due in Field 13 should continue to read $18.00, since Medicare did not allow this charge.

Step 25: Calculate the non-allowed portion to be adjusted. Using the Charges and Allowed Amount for CPT 36415, calculate the adjustment amount.



Step 26: Post the adjustment by dropping down the selection box in Field 10 and select ADJINS for Adjustment Insurance. In Field 11, enter the adjustment amount of $18.00 and press Enter. The Balance due in Field 13 should now read $0.00, which matches the Patient Responsibility amount for CPT 36415 on the Provider Payment Advice. Check your work with Figure 6-42.

Figure 6-42

Step 27: When you have finished checking your work for accuracy, click on the Post button. Open the Patient Ledger and check your work with Figure 6-43.


Figure 6-43



On Your Own—Post Four Medicare Payments to Patient Accounts Description of Simulation: Post the payments that follow using the procedures you have learned for posting Medicare payments. Dr. Heath is the doctor for each of the patients. He is a Medicare PAR (Participating) provider. As such, adjustments will need to be calculated and made for the non-allowed portion of each procedure. Today’s date is 12/17/2009.

Patient 1: Xao Chang—Post a Payment and Adjustment from Medicare Statewide to the Patient Account

Step 1: Using the Provider Payment Advice that was previously printed, or open it on-screen using the Claims Tracking button from the Main Menu, and entering the start date 10/01/2009 and end date 11/30/2009.


Step 2: Review the insurance companies and patients on the Provider Payment Advice. Locate Xao Chang and then refer to the following questions while reading the payment details, as shown on the Provider Payment Advice.





E. What will the adjustment amount be for each procedure?

F. What is the Claim ID number for this payment?

Step 3: You now have all the information needed to post the payment. Open the Posting Payments window for patient Chang and complete the posting of the Medicare payment for procedure 99307. Check your work with Figures 6-44 and 6-45.

Figure 6-44


Figure 6-45

Step 4: When finished, close all open windows and return to Payment Posting. Continue with the next patient.

Patient 2: Vito Mangano—Post Payments and Adjustments from Medicare Statewide to the Patient Account

Step 1: Using the the Provider Payment Advice that was previously printed, or open it on-screen using the Claims Tracking button from the Main Menu, and entering the start date 10/01/2009 and end date 11/30/2009.

Step 2: Review the insurance companies and patients on the Provider Payment Advice. Locate Vito Mangano and then refer to the following questions while reading the payment details, as shown on the Provider Payment Advice.

A. What was the Date of Service for the payment (DOS)?

B. What were the total charges for each procedure?

C. How much did the insurance company allow for each procedure?


D. How much did the insurance company pay to the provider for each procedure?


F. What is the Claim ID number for each procedure?

Step 3: You now have all the information needed to post the payments. Open the Posting Payments window for Patient Managano and complete the posting for each of the three procedures. Check your work with Figures 6-46 and 6-47.

Figure 6-46


Figure 6-47


Patient 3: Anna Pinkston—Post a Payment and Adjustment from Medicare Statewide to the Patient Account


Step 2: Review the insurance companies and patients on the Provider Payment Advice. Locate Anna Pinkston and then refer to the following questions while reading the payment details, as shown on the Provider Payment Advice.







F. What is the Claim ID number for this payment?

Step 3: You now have all the information needed to post the payment. Open the Posting Payments window for patient Pinkston and complete the posting of the Medicare payment for procedure 99308. Check your work with Figures 6-48 and 6-49.

Figure 6-48


Figure 6-49


Patient 4: Naseem Rahman—Post Payments and Adjustments from Medicare Statewide to the Patient Account


Step 2: Review the insurance companies and patients on the Provider Payment Advice. Locate Naseem Rahman and then refer to the following questions while reading the payment details, as shown on the Provider Payment Advice.

A. What was the Date of Service for the payment (DOS)?







Step 3: You now have all the information needed to post the payments. Open the Posting Payments window for Patient Rahman and complete the posting for each of the three procedures. Check your work with Figures 6-50 and 6-51.

Figure 6-50


Figure 6-51

Step 4: When finished, close all open windows and return to Payment Posting.


Post a Payment from Signal HMO to Daniel Oliver’s Account Description of Simulation: You are assigned to the Billing Office on December 17, 2009. Both doctors participate with Signal HMO. This means they agree to accept what that insurance company pays as payment in full for their services. Calculate the non-allowed amount and adjust it as Insurance Adjustment when posting payments. (Hint: Subtract the Allowed Amount from the Charges in order to get the non-allowed amount)


Step 2: Review the insurance companies and patients on the Provider Payment Advice. Locate Daniel Oliver and then refer to the following questions while reading the payment details:






E. What is the non-allowed amount?

Step 2: Next, the payment will be posted to Patient Oliver’s account. From the Main Menu, click on the Posting Payments button and find the account for Daniel Oliver from the patient list and open it.

Step 3: When the Posting Payments window opens, click on the line for 11/10/2009 and then on the Select/Edit button along the bottom. If done correctly, the balance due should appear in Field 13.

Step 4: You are now ready to post the payment details. First, enter the date of posting in Field 3, which is 12/17/2009. In Field 4, select PAYINS to indicate that the payment is from the insurance company. In Field 5, enter the Claim ID number, as shown on the Provider Payment Advice.

Step 5: In Field 6, enter the amount paid by the insurance company: $120.10. Press Enter to apply the payment. You should see the balance due in Field 13 now read $16.90. Next, enter the adjustment of the non-allowed portion in Fields 10 and 11. Check your work with Figure 6-52.


Figure 6-52

Step 6 When you have finished checking your work, click on the Post button. Open the Patient Ledger by clicking on the View Ledger button (Hint: This button is located in the lower area of the Posting Payments window). Check your work with Figure 6-53.


Figure 6-53

Step 7: Close the Payment Postings window. This will return you to the patient selection window so you may continue with the next patient.


On Your Own—Post Two Signal HMO Payments to Patient Accounts Description of Simulation: Post the payments that follow using the procedures you have learned for posting HMO payments. Remember to calculate the adjustments for the non-allowed portion of each procedure. Today’s date is 12/17/2009.

Patient 1: Shinn, Robert—Post a Payment and Adjustment from Signal HMO to the Patient Account



Step 2: Review the insurance companies and patients on the Provider Payment Advice. Locate Robert Shinn and then refer to the following questions while reading the payment details, as shown on the Provider Payment Advice.







Step 3: You now have all the information needed to post the payment. Open the Posting Payments window for patient Shinn and complete the posting of the Signal HMO payment for procedure 99214. Check your work with Figures 6-54 and 6-55.

Figure 6-54


Figure 6-55


Patient 2: Eugene Sykes—Post Payments and Adjustments from Signal HMO to the Patient Account


Step 2: Review the insurance companies and patients on the Provider Payment Advice. Locate Naseem Rahman and then refer to the following questions while reading the payment details, as shown on the Provider Payment Advice.

A. What were the Dates of Service for the payment (DOS)?







Step 3: You now have all the information needed to post the payments. Open the Posting Payments window for patient Sykes and complete the posting for three procedures on 10/16/2009 and one procedure on 11/2/2009. Check your work with Figures 6-56 and 6-57.

Figure 6-56


Figure 6-57

Step 4: When finished, close all open windows and return to the Main Menu.

Module 6 is complete.

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