User Guide — Family Billing

athenaCollector

Family Billing is an optional feature of athenaOne billing. To request that this feature be enabled for your practice, please contact the CSC from athenaOne > Support > Success Community > Contact Client Support Center.

 

 

Note: This option requires the Family Billing feature.

  1. Display the patient Quickview page for the head of the family.
  2. On the Patient Actions Bar, click Registration, and select Register Family Member.
  3. Verify or edit the pre-filled information.
  4. Complete the registration fields.

Add insurance information (recommended)

  1. To copy the insurance policy information from the other family member, select the Copy insurance policy information from patient name option (at the bottom of the page).
  2. To add a different insurance policy, click Save and Add Insurance to display the Add Policy page. (To check in a patient for an appointment, you must select a primary insurance policy for the patient or select the self-pay option.)

Save or save and schedule an appointment

  1. Click Save to save the information and go to the patient Quickview page without adding an insurance policy.
  2. Click Save and Schedule to proceed to the Schedule Appointment page.

 

 

Note: This option requires the Family Billing feature.

  1. Display the patient Quickview page for the head of the family.
  2. On the Patient Actions Bar, click Registration, and then click Full Registration.
  3. Click the add patient to this family link to access the Family Member Lookup tool.
  4. Select the family member that you want to add.
  5. Click Save.
    The Patient Registration page appears with the family information pre-filled.
  6. Verify or edit the pre-filled information.
  7. Complete the registration fields.

Save or save and schedule an appointment

  1. Click Save to save the information and display the patient Quickview page without adding an insurance policy.
  2. Click Save and Schedule to display the Schedule Appointment page.

 

  1. Display the Patient Registration page: On the Main Menu, click Patients. Under PATIENT REGISTRATION, click New Patient Registration.
  2. Scroll down and locate the Family Members (share the same guarantor) heading on the lower right side of the page.
  3. Click show family structure. The Show Family Structure window opens, showing a tree-like diagram of the family structure.

 

 

This function can be used to generate a list of patients who have unapplied credit or prepayment balances. You can use this worklist to identify patients with unapplied credit and/or prepayment balances that should be applied to outstanding charges.

Tip: To display the list of patients who have balances in their prepayment plans and also have outstanding patient balances, use the Prepayments Worklist.

 

Note: You must have the Credit Balance Worklist permission to generate the worklist.

  1. Display the Billing Worklists page: On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Billing Worklists.
  2. At the top of the page, in the View Patients with Credit Balances section, use the menus and fields provided to generate a worklist with the desired contents.

With athenaEnterprise

To filter the results based on provider group, select the provider groups using the Show All Accounts in the Provider Group menu.

 

The worklist shows patient accounts grouped by their primary patient department. Depending on the criteria that you selected, the worklist will contain some or all of the following:

  • Patient Last Name, Patient First Name, Patient ID# (which links to the patient's Quickview)
  • The total outstanding patient amount on the account
  • The amount in Unapplied (this does not include any money associated with prepayment plans)
  • The amount in each prepayment plan for the patient
  • Post Payment (a link to the Post Payment page)

 

 

 

With the Family Billing feature, you can collect payments for any family member at any point during the workflow, using the Collect Payment page. The family guarantor receives a single patient statement for the entire family, itemized by patient, with details for each transaction.

 

From the Patient Registration page, you can add new and existing patients as family members and remove family members from a family using the remove link next to the patient's name (located under the Guarantor fields on the right side of the page). Or you can remove the current patient from the family by clicking remove this patient from family.

 

Note: When you remove a patient from a family billing relationship, athenaOne does not delete the guarantor data in the patient's account. You can update or delete this data manually on the Patient Registration page. If the patient is billed under a guarantor in multiple departments, you must remove the patient from the guarantor in each department before you can update the Patient's relationship to guarantor field to Self.

 

 

A best practice for Family Billing is to designate one (and only one) family member as the guarantor for the entire family. Once selected, this guarantor receives patient statements for "patient responsibility" balances incurred by any family member.

 

It's easy to spot patients in multi-guarantor families: A message in red text appears just under the Guarantor Information heading, warning you that the family includes more than one guarantor.

 

Note: For multi-guarantor families, athenaOne sends statements to the most recently designated guarantor; we are not changing this behavior. We are also not changing the syncing behavior. We are merely limiting where users can make updates to demographic information.

 

 

 

When a payment is first received for the family, athenahealth applies the payment to open charges for family members. We post the payment to the charge with the oldest date of service first. If there are charges with the same date of service, we post to the largest outstanding balance first.

 

Any remaining money from that payment is posted to the guarantor's unapplied amount and remains there until it is manually applied to charges by your practice.

 

When there is an unapplied balance in the guarantor's account, athenaOne does not automatically apply it to new family charges. That must be done manually, by someone in your practice.

 

 

 

athenahealth will send a patient statement to the family guarantor only when the total family outstanding charges, minus the total family unapplied, exceeds the total family balance, and the total family balance exceeds the "Minimum Statement Balance" amount set for your practice.

 

The total family balance includes any unapplied amount in the guarantor's account. When there is an unapplied balance in the guarantor's account, your practice must apply those funds to other family members' outstanding charges manually.

Note: When unapplied funds in the guarantor's account exceed the total outstanding charges for the family, no statement is sent to the guarantor, even if individual family members have outstanding charges.

 

 

 

 

With Family Billing, the merge function provides you with a warning and instructions when the patient whose records you want to merge belongs to a family. Merges of patient records that are part of a family billing group present some risk because athenaOne does not know exactly how to transition family members through this merge. Therefore, athenahealth recommends that you do the following:

  • Note the family record numbers displayed in the warning.
  • When the merge is complete, check the merged patient record to ensure that all appropriate family members are linked to that record.
  • From the merged patient record, you can add any family members that may have been dropped during the merge.

 

 

To add a patient to a family for billing purposes.

 

The Family Billing feature must be enabled for your practice.

  1. Display the Patient Registration page: On the Patient Actions Bar, click Registration, and select Register Family Member. The Patient Registration page appears with much of the patient demographic information pre-filled.

 

 

The Family Outstanding field appears on the Appointment page, which is the first stage of the 5-stage patient encounter.

This field shows the combined outstanding balance for the patient's family. This field appears only if the patient has other family members registered in the practice, and if your practice has the Family Billing feature enabled.

 

 

 

If your practice has the Family Billing feature enabled and the patient has family members registered in the practice, this page also provides a link to transfer unapplied credit to another family member's account.

 

 

 

If your practice has the Family Billing feature enabled, when family members make payments through the appointment workflow, the receipt will indicate all payments made for all family members that day. The Check-in page indicates the total payment made by the patient for the entire family on the day of the appointment.

 

 

 

For patients with Family Billing, the worklist results are grouped by family, where all family members are listed under the head of the family. Because only one account alarm is active for any family, all family members appear in the worklist whether or not they have an outstanding balance. You need to review all family members and follow up on the family account as a whole. You can access the Patient Account View page for any individual family member; notes saved on the Patient Account View page for one family member appear on the Patient Account View for all other members of the family.

 

Because a family receives one consolidated family statement, the dunning message on that statement is based on the most severe charge across all family members. At the same time, each member of the family has a specific dunning level. This separate dunning level is important because membership in a family can fluctuate. To set the patient account alarm, we look at the most delinquent charge of any current family member at the time of statement generation to ensure that the family appears on only one worklist and that one user pursues the outstanding amount from the entire family.

 

 

 

A Family heading appears on the Billing Summary and Patient Activity pages.

This heading appears if the Family Billing feature is enabled and the patient has family members registered in your practice.

 

If a patient is registered in another provider group and you have access to view information in that provider group, this label, with family member links, appears at the top of the page for this patient's other accounts.

 

 

If the Family Billing feature is enabled, the Transfer Family Unapplied Credit page displays a summary of each family member's outstanding balances and total unapplied credits. You can use the Transfer Family Unapplied Credit page to apply a payment made for one family member to the outstanding balance of another family member.

Note: You cannot void transfers between family members. If you need to remove funds from the account, you can transfer the funds to another patient in the family, or you can issue a refund for the amount.

 

If the Family Billing feature is enabled for your organization, you can collect payments for any family member at any point during the workflow (see the Collect Payment page).

 

 

In some cases athenaOne does not automatically move unapplied credit balances from one family member to another. In these cases, you must move credit balances manually.

 

Guest payment service

athenaOne does not automatically move unapplied credit balances from one family member to another when a payment is made using the Guest Payment service.

 

Provider groups and unapplied credit balances

If your organization uses provider groups, you can move unapplied credit balances from one family member to a different family member only within the same provider group unless the Branded Patient Statements feature is turned on for your organization. The Branded Patient Statements feature allows family billing to automatically transfer funds across provider groups.

 

 

 

 

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.

 

 

Electronic payment contracts also work with Family Billing.

 

To use Family Billing, an athenahealth employee must enable this functionality for you.

 

Card on File agreements for Family Billing

  • Only one Card on File agreement can exist for a family.
  • A Card on File agreement newly established for any member of a family covers all future claims for all members of the family.
  • When a member removed from a family is not the originator of the agreement, the claims for the removed family member are no longer associated with the Card on File agreement.
  • When a member removed from a family is the Card on File agreement originator, the agreement moves with the removed family member; that is, athenaOne removes from the Card on File agreement all claims for all other family members.
  • The following message appears in the confirmation pop-up window when removing a family member: "A Card on File agreement exists for this family. Current and future claims for the removed family member will not be associated with this agreement. If the family member being removed is the Card on File agreement originator, then the claims for all other family members will be removed from the agreement."
  • When adding a family member (or registering a new family member), all future claims for the new family member are added to the existing Card on File agreement.
  • The following message appears on the Family Member Lookup pop-up window when adding a patient to a family with an existing One-Year agreement: "A Card on File agreement exists for this family. All future claims for the newly added patient will be associated with the existing agreement."

Electronic payment plans for Family Billing

  • Multiple electronic payment plans can exist for a single family.
  • A newly established electronic payment plan using the Collect Payment page for any family member includes all existing charges not already on a payment plan for all family members.
  • For electronic payment plans shared among family members, the plan is cancelled for all family members, if a single family member is removed from the family.
  • The following message appears in the confirmation pop-up window when removing a family member: "A shared credit card Payment Plan agreement exists for this family. As a security control, removing a family member will cancel the existing agreement."
  • When adding a family member, athenaOne does not add outstanding balances to an existing electronic payment plan. You can add these balances manually using the Update Payment Plan page.