User Guide — Patient Statements

1. Display the Providers page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Providers, click Providers.
2. Click Add provider to add a new provider, or click edit to update an existing provider.
3. Add or edit the provider as you normally would.

Patient Communication

4. Patient Portal — Select the Display this provider in the Patient Portal option if you want the provider's name to appear in Patient Portal menus. If you do not select this option, patients cannot send messages or request appointments for this provider.
   Note: This field appears only if you have the athenaCommunicator service.

5. Name — Enter the name for the provider as it will appear in email messages to patients (Subject line, body, and signature of the email). This name is also used in the greeting of automated calls and on the Patient Portal, as well as on patient statements.
   For billing statements, the name you enter in this field overrides the value entered in the Billed name field.

   • You can select the Same as billed name option to use the provider name specified in the Billed name field.
   • If you prefer not to display the provider's name, you can enter "Your Provider" in this field.
6. SMS name — Enter a shortened name for the provider as it will appear in automated text messages to patients (20-character maximum).
• You can select the Same as name option to use the provider name specified in the Name field.
• If you prefer not to display the provider's name, you can enter "Your Provider" in this field.
7. Primary department — Select the provider's home department as it should appear on the Patient Portal.
   Note: This field appears only if you have the athenaCommunicator service.

8. Click Save.

The patient messaging settings specified on the Patient Communication Content Management page can be viewed and edited on the Departments page.

1. Display the Departments page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Departments, click Departments.
2. If you are editing the settings for an existing department, locate the department in the Departments list, and click the update link.
3. Scroll down to the Patient Communications section.
4. You can select Use practice settings (or Use brand settings).
• To create settings for the department that differ from the practice or brand settings, click Use custom settings.
• To remove custom department settings and revert to the settings for the practice or brand, click Use practice settings (or Use brand settings) and then click Save.
5. If you are creating or editing custom settings for patient messaging, edit the following fields.

General Display Settings

6. Name — Enter the name for the department as it will appear in email messages to patients (Subject line, body, and signature of the email). This name is also used in the greeting of automated calls and on the Patient Portal, as well as in patient statements.
   Note: For patient statements, the name you enter in this field overrides the value entered in the Billing name field on the Departments page.
7. Phone number — Enter the general contact phone number for the department. This phone number is used in automated messages to patients. Patients can call this number to reach the office by phone.
   Note: To include the department address in appointment reminder emails, make sure that the Office Address field at the top of the Departments page contains an address (the city, state, and ZIP code are required).
8. SMS name — Enter a shortened name for the department as it will appear in automated text messages to patients (you can enter up to 20 characters).

Billing Display Settings

9. Same as General Display Settings — Select this option to use the same phone number for billing-related messages that you entered in the General Display Settings Phone number field.
10. Phone number — Enter the phone number used for billing-related messages. For self-pay reminders, this setting overrides the general phone number. Patients can call this number to reach the office by phone.
11. Click Save.

1. Display the Fee Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Fee Schedules.
2. Click edit procedure fees next to an unexpired fee schedule.
   The Procedure Fees page appears.
3. Click Show All.
4. Click update for a procedure code.
5. Patient-facing description — Enter a patient-facing description for the procedure code. This description will appear on billing statements.
6. Click Save.

Note: This procedure requires that the Return Mail Service feature be enabled for your practice.

1. Display the Custom Transaction Codes page: On the Main Menu, click Settings > Practice Manager. In the left menu, under Practice Links — Miscellaneous, click Custom Transaction Codes.
2. Add a new custom transaction code, or click update for an existing custom transaction code.
3. Text on Patient Statement — Enter the text to appear on the patient statement when this code is applied to a patient's balance.
4. Click Save.

1. Display the Claim Edit page.
2. Hold All Statements For This Patient? — Select the reason for holding patient statements from the menu.
   Note: This menu appears only when the patient has an outstanding balance. Although this menu appears on the Claim Edit page, the hold statement reason applies to the entire patient account, not just the individual claim. Therefore, if you select a reason to hold statements, athenaOne holds the entire statement, not just the charges associated with this claim.
3. Click Save Claim.

1. Display the Claim Edit page.
2. Hold All Statements For This Patient? — Select the (do not hold statements) option from the menu.
   Note: This menu appears only when the patient has an outstanding balance. Although this menu appears on the Claim Edit page, the hold statement reason applies to the entire patient account, not just the individual claim. Therefore, if you select the (do not hold statements) option, athenaOne releases the entire statement, not just the charges associated with this claim.
3. Click Save Claim.

The Bad Address statement hold reason can be set two ways.

• A user can set a hold statement reason on a claim.
• During statement generation, if the address is incomplete or the data entered is invalid, athenaOne automatically flags the claims with the Bad Address Statement Hold Reason.

Because this reason can be automatically set based on invalid data, it is possible for multiple members of a family to all have a Bad Address Statement Hold Reason flag.

If you use Family Billing and more than one member of a family has the same hold statement reason, you can clear these flags at the same time.

1. Access the Patient Account View or Quickview and display the Patient Registration page: On the Patient Actions Bar, click Registration, and then click Full Registration.
2. Update the patient and/or guarantor address. When you update the guarantor address for one family member, athenaOne automatically updates it for all family members who share the same guarantor.
3. Scroll to the bottom of the Patient Registration page, then select (do not hold statements) from the Hold statements menu. Below the Hold statements menu, a checkbox is enabled that says Clear all family members with the same current status.
4. Select the Clear all family members with the same current status option to clear the hold for all family members so that the family statement can be generated.

1. Display the Patient Registration page: On the Patient Actions Bar, click Registration, and then click Full Registration.
2. Update the patient address.
3. Scroll to the bottom of the page, then select (do not hold statements) from the Hold statements menu.
4. Apply hold statement to all copies of this patient's record — If your practice uses provider groups, you see this option below the Hold statements menu. To clear the hold status on statements from all provider groups where this patient is registered, select this option.
5. Click Save to save the address changes and to remove the hold statement reason. This action removes the account from the Workflow Dashboard and drops the patient statement.

1. Display the Patient Registration page: On the Patient Actions Bar, click Registration, and then click Full Registration, then update the guarantor information.
2. On the Patient Registration page, from the Hold statements menu, select (do not hold statements).
3. Apply hold statement to all copies of this patient's record — If your practice uses provider groups, you see this option below the Hold statements menu. To clear the hold status on statements from all provider groups where this patient is registered, select this option.
4. Click Save to save the updated guarantor information and to remove the hold statement reason. This action removes the account from the Workflow Dashboard and drops the patient statement.

1. From the Patient Account View, click the [payment plan #] link in the Outstanding Charges Section to display the Update Payment Plan page.
2. To resolve the hold reason, remove the assigned charges from the payment plan by deselecting any checked boxes.
3. Click Update Plan at the bottom of the page to remove the charges from being associated with the cancelled payment plan. These charges will then be billed out as standard fee-for-service charges.
4. If desired, you can create a new (non-cancelled) payment plan to assign these charges to. This action sets the claim status to drop, removes the account from the Workflow Dashboard, and drops the patient statement.

If this problem occurs, please contact the CSC by selecting Support > Create Case or Call in the Main Menu and open a support case with a detailed description, including the correct patient ID number. athenahealth will correct the patient account number for you.

In the interim, you can print a summary of the patient's balances to send to the patient: On the Quickview page, under the Outstanding Balances heading, click Show patient statement as it would be printed today and print the statement.

If a patient has outstanding charges from the same date of service, the closed charges appear on one statement to let the patient know that the charge was paid in full; closed charges are dropped from subsequent statements.

Example

A patient has a routine physical and pays his $20 copay at the time of service. During the physical, the physician performs an X-ray. The patient's insurance pays for the routine physical in full but pays only partially for the X-ray because the patient has a deductible. The routine physical appears on the first statement after the date of service, along with the balance for the X-ray.

Closed charges appear on the next patient statement when the charges were paid off using non-TOS payments, specifically:

• Payment that was mailed to either the lockbox for athenaCollector and athenaCollector (No Follow-Up) clients
• Payment mailed to the practice for athenaCollector (No Posting) clients 

On a family statement, any charge that has been paid off, regardless of whether the family member currently has an outstanding amount, appears on the statement (as long as the payment was not collected within a TOS batch).

By default, athenaOne generates and sends patient statements only for outstanding balances that exceed $9.99. This minimum statement balance does not apply to departments and practices in New Mexico. Since July 2021, the state of New Mexico requires that patients receive a statement when the patient balance on a claim reaches $0.

athenaOne sends a statement to patients when the patient balance on a claim reaches $0 under the following circumstances:

• The service department on the claim is in New Mexico.
• The patient previously had a non-$0 balance on the claim.
• The patient balance on the claim is now $0.

Note: If your organization has departments in New Mexico and in other states, the patient statement includes only claims for departments in New Mexico.

This feature is enabled by default. If you want to disable the automatic sending of statements to patients of departments in New Mexico when the balance on a claim reaches $0, create a case by selecting Support > Create Case or Call in the Main Menu.

1. Display the Claim Edit page: Click the edit claim link on the Claim Review or Post Payment page (the link is on the line item's advanced view).
2. Scroll down to the charge lines. Under the Type column, locate the TRANSFERIN information.
3. On the Claim Edit page, click Void this transaction for the transaction.
   The Void Transaction page appears.
4. Click Void This Transaction.
5. Click Continue. The Claim Edit page reappears showing the updated balance under the Ins1 column.

Medicaid not the secondary payer

If the balance is under the Ins1 column on the Claim Edit page and Medicaid is not the secondary payer, display the Claim Edit page for the claim:

1. Secondary Payer — Select the secondary payer for the charge.
2. Kick Reason — Enter the kick code that correlates with the EOB (COINSURANCE, DEDUCT, COPAY).
3. Click Save Claim.

Medicaid is the secondary payer

If the balance is under the Ins1 column on the Claim Edit page and Medicaid is the secondary payer, display the Post Payment page for the patient:

1. Locate the charge, highlight it, and click to expand the fields.
2. Patient Insurance — Select the Medicaid payer.
3. Other Transfer — Select the reason for the transfer. (Medicaid requires a reason that the charges are transferred to Medicaid.)
4. $ — Enter the amount of the transfer.
5. Click Save.