Upon selecting the Collections Module from the main menu, users are presented with a list of all payments received. Each row represents one EOB. The table provides key details such as the payment number, payor’s name, payment method, date of payment, the total amount of the payment, how much of that payment has been applied to invoices, and the remaining unapplied balance.
Search & Filters
Users can search for payments using the payor name, payment number, or patient name. By default, the collections page shows all the added payments that are not closed. Use the date range filter to filter the open payments within a specific date range.
Unapplied Payments
The Unapplied Amount column indicates how much of the payment has yet to be applied to invoices. Until this amount is fully allocated, the payment should ideally remain open and should not be closed.
Icons
- Info Icon: Provides detailed payment information, including reference numbers and payment dates.
- Edit Icon: Allows users to edit payment details if necessary.
- Timeline Icon: Displays the payment history, showing when and where the payment was applied or updated.
- Delete Icon: Allows users to delete payments that have not been applied to any invoices. (This is only accessible until payment is applied on any invoices, in other word until the ‘applied amount’ is zero.
- EDI Icon: Displays payments uploaded through an EDI 835 file.
- Close Payment Button: Once all amounts are applied and the payment is fully reconciled, the Close button will turn green, signaling the user to close the payment and move it to the Closed Payments section.
Adding a Payment
Users can add payments in five different ways to accommodate various types of transactions:
EDI 835 (Automatic Payments from clearinghouse)
Payments received via an EDI 835 file from the clearinghouse are automatically added and matched to invoices. If there are unmatched payments, manual intervention may be required to allocate them correctly.
Manual Payment Entry
Users can manually add payments by clicking the Add Payment button and entering details such as the payor, payment date, payment method, and amount. Users can then manually apply this payment to the open invoices of the payor.
To add a payment, use the Add Payment button on the top right of the Collections Module page.
Payments can be added as a Cash Receipt or EDI (with EDI file attachment being mandatory).
Advance Payments
Payments received in advance can be held in the system until an invoice is generated. These payments are not applied until the relevant patient responsibility invoice is created.
Select this option in ‘Cash Receipt type’ Field while adding a payment.
Payment Gateway Payments
Payments received from patients through a payment gateway like Stripe are automatically applied to patient responsibility invoices.
Manual Upload of EDI Payment
If the system does not automatically fetch payment details from the clearinghouse, users can upload EDI 835 files manually and follow the same steps as an automatic posting.
To add a payment, use the Add Payment button on the top right of the Collections Module page.
Payments for older claims from previous systems
If the payment is from an unrecognized claim (i.e., generated from another system), the payment will remain as unallocated. You can close the payment without applying it to any Motivity invoices.
Closed Payments & Invoices
Once all amounts have been applied, payments and invoices are closed and moved to the Closed Payments and Closed Invoices sections. Users can still access and review closed payments if needed.
Reopening Payments
If there is a need to adjust a closed payment, users can reopen it by locating it in the Closed Payments section. Adjustments can then be made, and the payment can be reapplied as needed.
Reopening Invoice
If there is a need to adjust a closed invoice, users can reopen it only by resetting the amounts applied on it previously locating it in the Closed invoices section. Adjustments can then be made, and the amounts can be reapplied as needed.
Payments Drilldown and Applying Amounts
Applying Amounts Manually
Users can view unapplied payments in the payments list. Clicking on a payment opens a detailed view showing the ‘potentially’ associated invoices and allowing users to manually apply payments to specific invoices. Users can apply amounts to categories such as:
- Covered: Amount paid by the payor.
- Copay/Deductible/Coinsurance: Amount the patient is responsible for.
- Not Covered: Services or amounts not covered by the payor, transferred to patient responsibility or secondary payor.
- Write-Off: Adjustments where the provider agrees to write off the remaining balance.
Motivity will provide an alert if the total applied amount exceeds the unapplied payment balance. Use the Save button to finalize your updates. Rejection codes can also be applied using the Rejection Code Icon if a payment is denied.
Applying Amounts Through EDI Payment
This can be accessed from the following icon
Payments received through EDI 835 from clearing house:
- EOB payments will be automatically added to the Collections screen.
- If manual changes to payment applications are required, delete the auto-applied payments and reallocate manually.
If payment adjustments are needed, use the manual payment posting feature. Delete the auto-applied payments on the claim to make edits.
Manual Payment Adjustments
If an EOB requires manual adjustments (e.g., reallocation of payment from a previous EOB):
- Use the Payment Adjustment icon to adjust the amounts between the payments.
- Select the previous payment number, enter the adjustment amount, and apply it to the appropriate invoice.
You can also edit Closed Payments or Closed Invoices by clicking the pencil icon. Negative amounts can be applied in the Covered or Write-Off sections to reverse previous entries. If an invoice becomes non-reconciled, it will reappear as open.
Workflow for Posting Payments via EDI
Case 1: Full Payment Received (No Secondary Involvement)
If the Contracted Amount = Covered Amount + Contract Allowance:
- Select the rows in the payment screen and click ‘Save & Post.’
- No secondary invoice will be generated.
- A credit memo will be issued for the contractual allowance to reconcile the total billed amount, and the invoice will be moved to Closed Invoices.
Case 2: Partial Payment + Copay/Deductible/Coinsurance
If the Contracted Amount = Covered Amount + Contract Allowance + Copay/Deductible/Coinsurance:
- Review to ensure that the amounts are correct.
- If a secondary payor exists, select 'Post secondary invoices to clearing house.' If there is no secondary payor, the amount will be transferred to Patient Responsibility. It is safe to select this checkbox always- 'Post secondary invoices to clearing house.', if secondary payor is not present then it will go straight to patient responsibility anyway.
Case 3: Underpayment or Denial
If the Covered Amount is less than expected, or there is a denial:
- Do not post the payment. Instead, correct the issues (contract, patient coverage, authorization) and resubmit the claim.
- Posting the payment will send any denied amount to the secondary payor, which may not be correct.
Secondary Invoice/Claim
If a secondary payor is available for a patient:
- The system will automatically generate a secondary invoice for the amount entered in the Not Covered/Copay/Deductible/Coinsurance/Other field.
- This secondary invoice will be available in the Posted Invoices section.
When applying payments from EDI, you can safely select the ‘Post secondary invoices to clearing house’ checkbox. If no secondary payor exists, the amount will automatically be transferred to Patient Responsibility.
Patient Responsibility: Copay/Deductible/Coinsurance Invoice
When copay or deductible or coinsurance amounts are applied on a claim and secondary payor is configured in Motivity:
- A new invoice will be created for the copay or deductible or coinsurance.
- This invoice will be available under Billing -> Unposted Batches.
Secondary and Copay/Deductible/Coinsurance Adjustments
If secondary or copay adjustments need to be rolled back:
- Use the ‘Reset Applied Amount’ option on the claim row to reapply the categories such as Covered, CO, Copay, etc.
Interest Payment
Interest payments received can also be applied through the Interest Icon on the claim row. This will help reconcile the full invoice total.
Adjusting Payment Amounts
In the event of an overpayment or if a refund is required, users can make adjustments to payments by using the Adjust Payment icon. Payments can be refunded or offset to another payment, ensuring the correct application of funds.
Adjusting Applied Payments
If a payment is applied incorrectly, users can revert the applied amount by selecting the adjustment icon at the claim service level. This reopens the invoice and allows users to reapply the payment correctly. Any associated secondary claims or patient responsibility will be automatically voided and can be regenerated after
Denials and Resubmission Process
If you want to resubmit a claim and avoid passing all denied amounts from the primary payor to the secondary payor, you need to be cautious when using the ‘Save & Post’ function. Do not use 'Save & Post' in this case, as it will automatically send the denied amount to the secondary payor. Instead, use the ‘Resubmit’ option to correct the claim and resubmit it to the primary payor.
When a denial is received:
- The system automatically categorizes the claim and moves it to the Denials page.
- Denials not associated with CO, P1, P2, or P3 will appear here for review.
- You can manually assign denial categories to claims to locate them in the Denials section.
Before resubmitting, ensure that any necessary corrections are made to the contract, patient coverage, authorization, or appointment details. These updates must be done before resubmission to avoid any errors.
Here's how you can make corrections:
Contract, Patient Coverage, Authorization: You can update these details from their respective modules within Motivity.
Appointment Corrections: Once an appointment is billed, it is locked and cannot be changed from the scheduler. However, you can update the appointment by clicking on the pencil icon next to the Date of Service in the Collections Module. After making the necessary changes, save your updates and then click the Regenerate button. The system will regenerate and send the claim to the clearing house at the same time.
When a resubmission is made, the claim will include resubmission code 7 and the original claim ID in the new claim submission. After this process, you will start seeing the newly resubmitted claim in Motivity.
Closing Invoice
Once the claim is fully reconciled, it will move to the Closed Invoices section automatically.
Closing Payments
In an ideal scenario payments should only be closed when all amounts have been applied to open invoices. Payments remain in the Collections Module until you click the Close Payment button. Closed payments can be accessed from the Closed Payments section.
The ‘Close’ button becomes green when all the received payment is allocated across claims.
Notes/Comments Related to a Claim
In the Billing, Collections, and Denials modules, the Notes/Comments Section at both the Invoice and Date of Service levels serves as a centralized location for users to track and document important updates or communications regarding a claim. These comments stay with the invoice as it moves through different statuses and modules, ensuring consistent tracking and collaboration among teams.
In Billing: This section can be used to document the status of a claim that is under review or has not been processed by the payor for a long time.
In Collections: Notes can be added to document any payment-related updates, including communication with the payor about partial or reduced payments.
In Denials: The comments section is ideal for tracking communication with the payor, internal notes on resolving denials, and any updates regarding the resubmission of claims.
Accounting Handling
- Covered Amount: Reduces the due amount of the invoice.
- Contract Allowance: Reduces the due amount and generates a credit memo.
- Copay/Coinsurance/Deductible/Not Covered/Other: Reduces the due amount, generates a credit memo, and creates a new open balance (for secondary or patient responsibility).
- Write-Off: Reduces the due amount and generates a credit memo, without creating any further invoices.