Embed Size (px)
Citation preview
Pedo Patient Workflow
Pedo Clinical Class
Pedo Setup and Fee Schedules
Pedo Financials Class
2020 UM Pedo Classes
1
Pedo Patient Workflow
Course Code C9C-543, Continuing Education Units–1
Participant Level Basic/AGD Subject Code 550/Practice Management
Course Objective See what different flows may work best for your practice to help more efficient work days. Become familiar what best practices will work for your daily workflow.
Pedo Patient Workflow ................................................................................................................... 1
Pedo Workflow ....................................................................................................................... 2
Seating the Patient .................................................................................................................. 3
Taking Clinical Notes ............................................................................................................... 5
Charting ................................................................................................................................... 6
Setting Treatment as Completed ............................................................................................ 7
Posting and Saving Charges ............................................................................................................ 8
Creating a Treatment Plan for Future Appointments ............................................................. 9
Printing a Treatment Plan ..................................................................................................... 11
Checking Out and Dismissing the Patient ............................................................................. 11
2
Pedo Workflow
Here’s a high-level Pedo patient flow.
3
During the patient visit, you can use the following features in Cloud 9 to track the patient’s
exam or appointment:
• Seating the Patient
• Taking Clinical Notes throughout the Workflow
• Charting
• Setting Treatment as Completed
• Posting and Saving Charges
• Creating a Treatment Plan for Future Appointments
• Printing a Treatment Plan
• Checking Out and Dismissing the Patient
Seating the Patient
Once you seat the patient, the charting window displays.
As you’re talking with the patient, look at the charting window:
4
• Glance at the continuing care tab to see what is due for the patient
• Double check that the correct provider is chosen before you begin treatment planning
• View if any treatment was planned and not yet completed. Evaluate and assess, at a glance, what patient needs today.
• Make sure that you are charting under a treatment plan not titled “None”.
Note: The hygienist can perform duties. You can have multiple tabs open so if the hygienist or assistant would like to begin the clinical note they can and leave it open to complete after the doctor comes to the chair to begin the exam.
5
Taking Clinical Notes
Throughout the exam/appointment, you can take clinical notes. Note: Once you finish charting,
be sure to add any additional clinical notes.
Remember: You can edit clinical notes for 24 hours before Cloud 9 locks the note. Any changes after 24 hours will have to be done as an addendum.
To create a clinical note using a questionnaire
1. From the Clinical Notes tab, click Add. A new tab next to the patient's chart displays at the bottom of the window. This tab allows you to begin your clinical note from questionnaires.
2. Select the desired questionnaire, answer the questions and click OK.
6
To enter a free-form note
1. From the Clinical Notes tab, click the Green Plus Sign.
The free-form text box is now available for notes. 2. Click in the free-form text area and type a note. The note is automatically saved.
Charting
When the doctor is present, select the charting tab to begin charting what he is diagnosing. If you notice that you have charted under the incorrect provider, you have the option to select the provider under that treatment item and can change it to the correct provider.
7
Setting Treatment as Completed
Once you complete clinical notes and charting, you can complete any remaining treatment for today. When you have completely finished all treatment, highlight all of today’s charges by holding the either the control key (allowing you to hop around while selecting) or holding the shift key (allowing you to select first item then last item highlighting all of the procedures in between) to highlight any desired charges to select. You can either right click and select to set charge as complete,
or, select the icon with the tooth and green check mark.
When you select to set the treatment to completed, the post charge screen displays.
8
Posting and Saving Charges
From the Post Charge window, you can make any last-minute changes to make sure everything is perfect. This win is very important to make sure everything is correct. You will want to ask yourself the following:
• Does this include all of today’s treatment performed? If not, select Cancel and make sure you highlight ALL of today’s treatment so that it will only generate onto one claim.
• Is there extra treatment that may not have been completed on this list? If so, highlight treatment and select Remove Charge.
• Is this the correct provider? If not, click on the provider for each charge to update to the correct provider.
• Do all charges look correct? If you need to adjust any charges, this is your last chance before sending them to the ledger. Ex: If a sealant had failed and you do not want to charge for the re-seal, you can $0 out the charge and attach a note explaining that there was no charge for the re-seal per Dr. Finkle.
• Is there any items that we do not want to include on the insurance claim? If not, uncheck the box within that line item in the claim column.
9
Notes:
• The date will automatically place today’s date as the charge, but this is editable if you need to back date treatment.
• The location will pull in from what location the computer is currently logged in to.
• The responsible party should appear and the insurance policy should always say none at this screen. Remember: All charges are first charged to the financially responsible then adjusted over to the insurance tab. This is because if the insurance does not cover it that financially responsible party is responsible for that portion as well. Cloud 9 knows if a patient has insurance and will apply it properly.
When all charges look good, click Save Charges. It will generate the claim, adjust amounts to the insurance tab if needed and post the charges to the financially responsible, updating charting to reflect any completed treatment all with that single click.
Creating a Treatment Plan for Future Appointments
Select Treatment Planning from the Charting window.
All treatment that was planned during this appointment will begin under the (No Phase) Description type. This happens because Cloud 9 does not yet know what you want to group together and what the ordering for importance is.
10
• You can add as many phases (or appointments) as you need to per patient. Then you want to highlight no phase to get the treatment we want to move into phases and to appear within that right box. Within the box of displayed treatment to plan, we can change the ranking so that the money will portion out properly.
• From here, highlight all of the treatment that you would like to move into a specific phase together, right click, and select move to phase. Cloud 9 asks you what phase you would like to move the highlighted treatment into. Select the Phase and then OK. Repeat until all of the treatment has been phased out.
• You can also do multiple things with a treatment plan. If you right click on a treatment plan you are presented a menu of different options to select from. Maybe you want to create an alternate plan (Ex. a crown vs extraction), or a downgrade plan. You can even set a status to
11
a plan if you would like so that you are able to track what was decided on each treatment plan that you have created.
Printing a Treatment Plan
You can now print by click Print which is located next to the Add Phase icon. Select Print Treatment Plan.
• This allows you to print all phases that we would like to complete by each appointment.
• It breakdowns all fees and coverage if applicable along with a complete balance at the end of the list of appointments.
• You will also have a signature area that the guardian can sign off stating that they have read and understand the treatment plan.
You can also print an individual phase, maybe before you take the patient back to go over with guardian again what will be performed and expected from them financially. There is another sign off at the end of this page.
Checking Out and Dismissing the Patient
Move the patient to ready for checkout and dismiss the patient after collecting any money and scheduling them for their next visit.
1
Pedo Clinical
Course Code C9C-534, Continuing Education Units–1
Participant Level Basic/AGD Subject Code 550/Practice Management
Course Objective Go into the fine details of setting up transaction types, tool palettes, clinical note categories and many other customer items to have your pediatric clinic run smoothly. Learn to set up your pediatric office defaults, everything from codes to clinical note templates.
Scheduling ....................................................................................................................................... 2
Setting up Schedule Templates .................................................................................................. 5
Navigating the Patient Locator ................................................................................................... 6
Selecting a Location ................................................................................................................ 6
Changing a Patient’s Appointment Status .............................................................................. 7
Using the Scheduling Buttons ..................................................................................................... 8
Navigating the Toolbar/Clipboard ........................................................................................ 19
Navigating the Appointment Area ........................................................................................ 22
Navigating the Lightbar ......................................................................................................... 25
Locator Details .......................................................................................................................... 27
Pedo Charting Window ............................................................................................................. 28
Treatment Card ......................................................................................................................... 29
Continuing Care/Images/Notes ................................................................................................ 31
Treatment Status, Surface, Quadrant Arch .............................................................................. 31
Tool Palette, Codes, Conditions ................................................................................................ 31
Charting ..................................................................................................................................... 33
Caries Types (Charting Conditions) ........................................................................................... 34
Clinical Notes............................................................................................................................. 36
Update Ranking, Providers and Treatment Entries .................................................................. 36
Post Clinical Charges ................................................................................................................. 39
Images ....................................................................................................................................... 40
Treatment Planning .................................................................................................................. 43
Treatment Plan Options ............................................................................................................ 49
Printing/Emailing the Treatment Plan ...................................................................................... 49
2
Scheduling The Schedule provides a variety of navigation tools to move around the window and display
information.
When View is selected under the Schedule heading on the Home menu, the Scheduling
window (aka the Schedule) displays.
Selecting… Opens the… That…
View Scheduling window Provides a lot of tools to help you navigate the schedule and manage your appointments.
Locator Details Locator Details window Displays all scheduled patients for the current day.
The Schedule can also be accessed from the Patient Header:
3
Understanding how to navigate the Scheduling window helps you plan your schedule and run
your office like clockwork.
The Scheduling window has the following five sections:
1. Patient Locator tracks patients through the appointment process. 2. Scheduling Buttons provide quick access to commonly used functions. 3. Toolbar/Clipboard provide a variety of schedule functions. 4. Schedule View displays appointments. 5. Light Bar provides quick access to view which chairs the patients are located.
When users are on the Scheduling window, clicking the HIPAA button ‘hides’ patient
information.
When you click HIPAA, no patient information is displayed.
4
When you click HIPAA to turn off HIPAA, you must enter your login information.
5
Setting up Schedule Templates Your office can have as many schedule templates as required. If you have several practices, you
need to create templates for each practice, even if you are open at the same time and schedule
the same appointments.
Your designated administrator creates, edits and deletes schedule templates; Setup: Edit menu
> Schedule Template
Administrators may need to set up these additional features for schedules and templates:
Setup: Edit menu > Setup >
• Schedule View
• Appointment Classes
• Appointment Types
• Employees (to set up permissions to setup access to setting up templates)
Notes:
• Appointment classes are used to group specific appointment types together. All appointment types belonging to a specific class should be the same time length.
• Appointment classes allow searching for spots tied to multiple appointment types.
• You can create as many classes as you need but remember if you have more than 15 classes, it might be difficult to place them all on a single day without constricting the day.
• Some offices prefer using an open template in which their schedule have no specific designated appointments types. They only want to have their closed time displayed, and the front desk is free to schedule any type of appointment that fits into the open time. As a result, you will NOT be able to use the search feature when:
o Scheduling the patient’s next appointment o Using the Treatment Card Next Visit section
In addition, you will need to manually schedule every appointment.
6
Navigating the Patient Locator The Patient Locator Bar displays the current patient names and their status while tracking
these patients through the appointment process.
The menu button is used to select the desired office location and view the patients’
statuses for the selected location.
If the list of patients become too long, a vertical scroll bar displays.
The gear displays in each patient’s block.
When the gear is clicked, the Patient Shortcut Menu displays.
Selecting a Location
1. On the Patient Locator, click the menu button . The office’s locations display. The current location being displays on the Patient Locator is check marked.
2. Click the desired location. The Patient Locator changes to show the patient statuses for the selected location.
7
Note: Each time you log into Cloud 9, the system remembers the location you logged
into as displayed in the Location field. If you do not select a different location at login,
you can change it now. Also, if this area is blank, you must select your location, as none
has been set.
Changing a Patient’s Appointment Status
There are two ways of moving a patient through the appointment process to change the appointment status:
• Manually changing the patient’s appointment status.
• Dragging the patient’s appointment through the various patient locator statuses or Light Bar.
Manually Changing a Patient’s Appointment Status
1. On the Patient Locator, click one of the following statuses:
• Scheduled
• Waiting
• Seated
The patients with that status display in blocks.
2. Click on the desired patient. The corresponding Patient Locator Status dialog box displays. The example is for a status of Seated.
8
Note: If there’s a greeting for the patient, the greeting will be included with the patient’s name.
3. Do one of the following to select the desired status:
1.
• Click the dropdown arrow next to the Status field. The status options display.
• Click the Forward Arrow to scroll forward through the various statuses.
4. Select the desired status. Note: Use the Checkout button to move the patient to the Ready for Checkout status.
5. Click OK. The system ‘moves’ the patient to the selected status on the Patient Locator to reflect the change in status.
Dragging the Patient’s Appointment
1. On the Patient Locator, click the Scheduled cell.
2. Select the desired patient appointment.
3. Drag the appointment to the Patient Locator cell or Light Bar. Cloud 9 updates the status based on where the appointment is dragged.
Using the Scheduling Buttons The Scheduling Buttons, located under the Patient Locator, provide quick access to navigating
the schedule and managing appointments.
Note: Some Scheduling Buttons are specific to managing appointments versus navigating the
Scheduling window. These buttons include:
• Search (for an appointment)
9
• Patient Appts.
• Reminders
• No Shows
These buttons are described below; however, to learn how they are used when making
appointments, please see Appointment Management.
Left-Hand Buttons
Button Click to…
Search
(for an appointment)
Search for a time or an appointment. For more details on using this feature, see Appointment Management.
Patient Appts
Display a patient’s appointments. For more details on using this feature, see Appointment Management.
Practice (Schedule View)
Display a calendar showing the practice’s location schedules.
Reminders
Display the list of appointment reminders. For more details on using this feature, see Appointment Management.
(Schedule) Notes
Add, edit and delete schedule notes. An example of a schedule note would be to inform the staff of special events, like training sessions or visitors. Note: If there are notes available for the day displayed on the calendar, the Notes button will also display on the right-hand buttons.
No Shows
Display all patients who didn’t show up for their appointments. Note: It is important to keep track of these patients before they fall behind in treatment.
10
Button Click to…
For more details on using this feature, see Appointment Management.
Week (at-a-Glance)
Display the entire week.
Print Schedule
List options for printing the schedule.
Right-hand Buttons and Appointment Information
Tool/Button Description…
# of Appointments
and Patients
Displays the number of appointments and patients for the day displayed on the calendar.
Today
Displays the number of appointments and patients for the current day (today), remains on the same location and refreshes the entire Schedule View to today’s date.
Refresh
Refreshes the entire Schedule View and stays on whatever date and location. This includes updating the # of appointments and patients for the day displayed on the schedule.
Close
Closes the schedule.
11
Viewing the Practice Schedule
If your practice has many locations, you can view a schedule showing the all practice locations.
The colors for each location can be set up; Setup: Edit menu > Setup > Schedule View.
Practice (Schedule View)
1. Click Practice (Schedule View) . The Practice calendar displays.
2. Use the arrow buttons to advance to or go back a month.
3. Click the X on the Practice Schedule View tab, located across the bottom of the window, to close the window.
12
Managing Notes
There are two types of notes:
• Prompt Note notifies everyone when they open the schedule that an event is occurring on a specific day. For example, a staff member is on vacation. It is not a specific time, but when you open the day with a Schedule Note, you must acknowledge the note before you can use the schedule for the day.
• Block Note blocks out a specific timeframe. For example, a Lunch and Learn from 12:00 – 2:00 pm. It displays across all columns of the schedule over the chosen hours.
Clicking Notes provides access to creating, viewing, editing and deleting notes.
(Schedule) Notes
Creating Notes
1. Click Notes . The Schedule Note - < Date displayed on the calendar> dialog box displays.
2. Click Add. The Add Schedule Note dialog box displays.
3. Select the desired date.
13
4. For the start and end time fields, do one of the following:
If you are creating a … Then…
Prompt Note Do NOT enter a start and end date time
Block Note Do enter a start and end time
5. Enter the note.
6. Click OK.
Viewing Notes
• To view all notes for the current day displayed on the calendar, click Notes. The Schedule Note <date> pop-up window displays.
• For Prompt Notes, click Reload. The note displays as a pop-up Schedule Note - <DATE> window.
14
Note: The pop-up Schedule note window also displays on the designated date when you
open the schedule.
• For Block Notes, go to the designated day and time entered for the note. The note displays on the schedule.
Editing and Deleting Notes
1. Open the Schedule to the appropriate day.
2. Click Notes. The Schedule Note <date> pop-up window displays.
3. Click Delete or Edit to perform the desired action.
4. Click OK. The edits are saved, or the note is deleted, depending on which option was chosen.
15
Managing the Week-at-a-Glance Window
The Week View displays the schedule for the entire week.
Week (at-a-Glance)
You have the same functionality in the week view as you have in the daily view except for
rescheduling an appointment because the clipboard/menu is not visible in this window.
Note: The template appointment class/type is visible for each day. If an appointment is scheduled, it displays as a solid color rounded rectangle.
16
1. Click Week . The Week-at-a-Glance window displays.
2. Click the mouse on a specific appointment. The appointment details and an options list display.
3. Select an option from the list. Note: For more details regard appointment options, please see Appointment Management.
4. Use the buttons at the top of the window to navigate.
If want to … Click …
Advance or go back a week at a time
• Left arrow to go back a week
• Right arrow to advance a week
Select a different location
Dropdown arrow and select desired location
Select specific days to display
Select the desired days to display and click OK.
17
If want to … Click …
Close the Week-at-a-Glance view
Viewing and Selecting Schedule Print Options
1. Click Print Schedule . The Schedule Print Options window displays.
Field Use to…
Start Time/End Time Select the timeframe to print.
Rows Height Specify the printed row height.
Fit to page Check if the schedule width should print on one page.
Columns Width Specify the printed column width. Note: Checking the ‘Fit to page’ checkbox overrides any number entered in this box.
Show Reservations Check if the template background should be printed.
Show Manual Overrides Print appointments that have had manual overrides applied.
Landscape Indicate the schedule should be printed in landscape orientation.
2. Make the desired selections.
3. Click OK.
18
Displaying the Number of Appointments and Patients for the Current Day
The number of appointments and patients for the day automatically displays on the calendar.
If you want to … Click …
Displays the number of appointments and patients for the current day (today).
Update the # of appointments and patients for the day displayed on the schedule.
Refresh
Closing the Schedule
Click Close. The Scheduling window closes.
19
Navigating the Toolbar/Clipboard
The Toolbar/Clipboard provides quick access to functions related to the calendar.
Field Used to …
Orthodontist View only the patients who are assigned to a specific orthodontist; select the doctor from the list and the patients who are not assigned to him or her are dimmed out.
Template Show the assigned schedule template.
Mini-Calendar Go to a specific day, month, or year. Click on the month to select a different month. Click on the year to select a different year. Use the arrow keys to go forward or backward.
Toolbar/Clipboard Hide and restore the Toolbar/Clipboard view, using the Left
pointing arrows . This allows viewing more columns on the
schedule. If your practice has many chairs and you would like to
see more columns on the schedule at various times of the day, you can toggle between displaying and hiding the Toolbar/Clipboard.
20
Field Used to …
Clipboard Hold an appointment being rescheduled, preserving the original location. An appointment is dragged on the Clipboard until they are dragged to the new day and time.
Revert Appointments only on the Clipboard
Cancel moving an appointment. Revert Appointments easily returns the appointment to the original location on the schedule.
Needs Appt List active patients who doesn’t have a scheduled appointment or recall. It prevents patients from being lost in the shuffle and falling off their treatment plan.
Sooner List patients who would like an earlier appointment if one becomes available. When creating a patient appointment, you have the option to check a box for “Sooner if possible.” This places the patient on the list. If an appointment becomes available, you can reschedule them and remove the checkmark. If an appointment does not become available, the patient drops off the list automatically.
Displaying an Orthodontist’s Schedule
If the practice has several orthodontists and you want to view only the patients that are
assigned to a specific orthodontist, select the doctor from the list.
1. Click the dropdown arrow next to the Orthodontist field. The available orthodontist calendars display.
2. Select the desired orthodontist or All Orthodontists. The selected calendar displays and the patient appointments who are not assigned to the selected orthodontist are dimmed.
21
Displaying the Schedule Template Name
The name of the schedule template automatically displays underneath under the Template header.
Using the Mini-Calendar
The mini-calendar is used to go to a specific day, month, or year.
• Click the month to select a different month.
• Click the year to select a different year.
• Use the arrow keys to go forward or backward.
Viewing Patients Who Need Appointments
A patient appears on the Needs Appt tab if they are ACTIVE, have no scheduled appointment and no recall.
• Click the Needs Appt tab.
• Use the scroll bars to see additional patients and information.
Note: If you have access permission, you can also use the Patients Needing Appointment report to identify patients needing appointments.
22
Viewing patients who want a sooner appointment
The Sooner tab contains a list of patients who would like an earlier appointment if one becomes available.
• When creating a patient appointment, you have the option to check a box for “Sooner if possible.” This places the patient on the list.
• If an appointment becomes available, you can reschedule them and remove the checkmark.
• If an appointment does not become available, the patient drops off the list automatically.
• Scroll to display additional information about the appointment.
Navigating the Appointment Area
The Appointment Area displays the patients’ appointments and chair assignments for the
designated location and day. The three areas of the Appointment Area include:
• Schedule View
• Day Navigation
• Schedule View
23
Selecting a Schedule View
The Schedule View options can be displayed as either a dropdown list or separate tabs. Setup: Edit menu > Setup > Employees > Show Schedule Views in Dropdown Checkbox.
Schedule View Tabs
Click on the Schedule View tab to display the desired Schedule View to display, in this example,
Atlanta or Woodstock.
Schedule View Dropdown List
Click the dropdown arrow and select the desired Schedule View to display.
Selecting a Day/Week/Month
The Day/Week/Month (M/W/M) functionality allows you to advance or move back the
calendar date or by days, weeks and months.
You’ll use the D/W/M on the left-hand side to go to a past date and the D/W/M on the right-
hand side to go to a future date.
24
1. Determine if you want to display a future or past date to use the appropriate M/W/D fields:
To view a date in the … Use the M/W/D on the…
Past Left-hand side
Future Right-hand side
2. Enter the number of months, weeks or days in the corresponding field.
3. Click M for months, W for weeks or D for days, to move the date forward or backward. The calendar automatically moves to the date corresponding to your selection.
Viewing the Schedule
The Schedule View displays the appointments schedule. The tools on the Scheduling window
help to navigate the calendar, schedules and appointments.
25
Navigating the Lightbar The Lightbar indicates where (which chair) the patient is currently seated and works in conjunction with the Patient Locator:
When a patient is moved from…
On the Lightbar, the patient…
Waiting to Be Seated status Displays under the assigned seat
Seated to Ready for Checkout status
Is removed
To see the available options once a patient is seated, click on the seated patient displayed on the Lightbar:
Option Description
Call Doctor Places a number in the upper right corner of the chair and causes the appointment to blink. The number represents the order that the option was selected and whom the doctor should see next.
Text Doctor Sends a text to the doctor listed on the APPOINTMENT, not the doctor that is listed on the Edit Patient tab. This of course, could be the same individual.
Call Emergency Turns the appointment color to emergency and starts to blink.
Doctor is Present Indicates when the doctor comes to the chair; the header turns green indicating to everyone where the doctor is.
Cancel Call Eliminates the number and the blinking. The next number in the sequence is now blinking and displays the number 1.
26
Option Description
Edit Patient Opens the patient’s information.
Import Images Import images (not x-rays) from this option.
Treatment Card Opens the patient’s treatment card, if not automatically specified in the setup menu.
View Images Displays a patient’s images.
Note: Some practices have many more chairs that can comfortably be displayed in one column. A chair can be displayed in a single column, or several chairs in one column, the choice is up to the practice. For these practices, there is an option that displays chairs in as many columns as needed and a prescribed seating order. Setup: Edit menu > Setup > Schedule Views.
27
Locator Details
When Locator Details is selected under the Schedule heading on the Home menu, the Locator
Details window displays.
Field Description
Hide Patient Images Check the box to hide images.
Sort by Check-in Time Check the box to sort by check-in time, not status.
Refresh Click to refresh the locator details.
Close Click to close the Locator Details window.
The Locator Details window displays in a table format displaying all scheduled patients for today. This window works in conjunction with the Patient Locator and the Light Bar. The statuses on the table are color-coded based on your office’s preference. Note: These colors can be Setup: Edit menu > Setup > Schedule View.
28
Each appointment status can be handled through the locator details by dragging the patient’s
picture or name to the cell on the Patient Locator.
Pedo Charting Window
The following features are available for charting surfaces, quadrants and arches:
A. Tool Palette - Completely customizable.
29
B. Charting – Choose drop-down of Treatment Planned, Existing Condition, or Watch, to display in window.
C. Ranking – Treatment/Conditions D. Images/Continuing Care/ Notes – Allows choice of images and running notes. Double-
click on an image will display the Image window. These icons will be under the blue line with a patient name and patient ID.
Options - Allows you to view/not view lingual row. Treatment Card - Allows you to quickly access an opened patient’s treatment card. Which will allow you access to more patient information and options from icons within this screen. Treatment Planning - Takes you to an opened patient’s treatment plan to phase out future appointments and allows you to print these plans to go over with parent/guardian. Ledger - Opens the ledger for opened patient’s information.
Set Tooth - Toggles tooth status for patient Treatment Plan - There needs to be at least one treatment plan created for each patient and you can continuously grow said plan or create multiple (ex: per doctor, per visit) plans. Provider – A provider must be selected to show who performed said treatment or recommended said treatment Responsible Party- You can select the Responsible Party if incorrect for posting charges Numbering System- You can change from Universal, Palmer and International
Treatment Card
Reload – Refreshes the screen with changes that have been made. Add Entry - Gives you access to create an orthodontic appointment note. Edit Entry - Allows you to edit any entry within 24 hours. Delete Entry - Will delete selected entry.
30
Print - Allows you to print treatment card, tray cover, or both. Send Message - Allows you to send text messages to parent/guardian if not present at appointment. View Patient - Will pull up all of patient’s information including patient info, relationships, insurance, financial summary, appointments, and images. Edit Patient - Allows you to edit all the information categories listed under view patient. Ledger - Access opened patient’s financial ledger. Comments/Alerts - Create comments and alerts for your patient that can show up only in certain windows or must be acknowledged with a prompt. Documents - Viewing of all documents uploaded or created for this patient. Appointments - Shows appointment history, scheduled appointments, when they are due for their next ortho appointment, and recall information. Questionnaires - Opens questionnaires to answer questions regarding current patient Charts - Allows access to charting and tooth chart. Recall - Can be filled out to state what/when next appointment should be. Imaging - Allows you take or view images of opened patient. Care Calls - You will make a to do to call a patient that you think may need a check-in call to see how they are doing ex: a dismissed restoration appointment. Send Letter - Send a document or letter to patient, guardian, or professional relationship Screen Play – This is an outside vendor that provides patient education. Practice Genius - This is an outside vendor for patient rewards. Instead of having a coin it is a reward system for the patient. They receive a card and earn points and can redeem points for rewards online. It allows the assistant to access a patient's account with a swipe of their rewards “credit card” to apply points to the patients account for that day’s visit.
31
Continuing Care/Images/Notes
Detailed Tool Palette and Image/Notes Examples
Continuing Care Images tab – Double-click to display Images Notes tab
Treatment Status, Surface, Quadrant Arch Treatment status allows you to select if you are treatment planning, marking existing treatment, or referring out for treatment (these are customizable for color, terminology, and order) Surface Quadrant and Arch are not customizable and are there to select to specify treatment and conditions.
Tool Palette, Codes, Conditions
1. Tool Palette: Everyday codes that you utilize. You will set up your tool palette with
buttons that will help you to chart more quickly. You can set up and customize the codes, explosion codes (gives options, then depending on the option selection, generates further questions to be answered) for certain appointment types and drop-down buttons to select specific type of a procedure (ex: different surface amount for composite)
32
2. Codes: Every Code within Cloud 9 so that you can always add them at any point
3. Caries (Conditions): Mark and condition separately from treatment.
Note: In a future release, the term ‘Caries’ will be replaced with the term ‘Conditions’.
Caries means decay which was not the intent of that tab. The purpose of this tab was
mean to track and document conditions anything that is not "perfect" in a mouth like a
chipped tooth, rotated tooth, etc.
33
Charting
The first thing we must always check when we open a chart is that the Treatment Plan is not set
to (None), and we have the correct provider selected before we begin charting.
If the treatment plan says (None) follow these steps:
1. Click the dropdown arrow under Treatment Plan.
2. Select Add New Treatment Plan.
3. Type in Treatment Plan Name and click OK.
Highlight teeth to change primary/permanent and select Set Tooth Icon. You can also mark
missing, extracted or supernumerary. When selecting supernumerary it will allow you to fully
chart on that extra tooth anywhere in the mouth. If something were charted by mistake, select
the tooth again and toggle option that was mistakenly selected. It will place the tooth status to
what it was.
34
1. Select the tooth or teeth.
2. If a surface quadrant or arch is required, select that.
3. Then do one of the following:
• Select a code from your tool pallet to apply or select your codes tab to look for the
specific code you are going to chart.
OR
• Select the tool pallet button that pertains to today's appointment, for example: Recall
Child.
Result: It will reflect on the odontogram along with the Treatments/Conditions tab.
Caries Types (Charting Conditions) Note: Caries Types are reserved for Pedo.
Caries are charting types that are carried throughout all treatment plans. This tab does not
affect your treatment plan numbers.
35
To chart conditions, select the Caries tab on the left next to Tool
Pallet and Codes. Highlight the tooth you would like to apply the
condition to, select the condition and click Add.
Below is an example of applying an Occlusal Watch on tooth K.
It will also display this separately from the financials on the Caries next to the clinical notes.
36
Clinical Notes Clinical notes are added either by manually typing in the box or you can use customizable
questionnaires that are specific to your practice. These notes generated by the questionnaires,
are still able to be edited for up to 24 hours and saved.
To use auto notes
1. Click the category dropdown and select the note that you would like to run.
2. Select Add.
3. Properly answer questions pertaining to the visit and click OK. The clinical note will
automatically fill out for you and save.
Note: Upon any edits make sure you always click to save by using the Blue Floppy Disc.
If you try to close the chart without saving your clinical note, you will get a warning that
appears to let you know that your note is not saved.
Update Ranking, Providers and Treatment Entries You can rank different items in your chart so that after you add to the chart, if the doctor says
they wanted the last thing completed first, you can then easily move it up in the ranking.
You can also select the provider if a wrong provider was charted and then select the correct
provider.
37
To update the treatment that was previously charted:
1. Highlight the treatment that was completed.
2. If all treatment is charted next to each other, a) highlight the first item, b) hold Shift, select last treatment item. Result: It will highlight all treatments in between.
3. If treatment is separated between treatment and you did not complete it today, you can
hold CTRL while selecting each treatment completed while skipping over treatment not completed.
4. After all treatment is highlighted, right click* on one of the highlighted items. This will allow you to do multiple things with treatment:
• Set Complete • Change Status • Delete/Invalidate Treatment(s) • Create Pre-Auth Claim
38
*If not using a right click, use the following buttons:
• (Yellow Gear) Filter Treatments Show in the Grid: Select the yellow gear. Allows you to select what treatment statuses you view in the grid and odontogram with the following drop down:
• (Tooth) Complete Treatment: upon highlighting treatment, select the icon of the tooth with the green check mark.
• (Gear with Green Arrow) Change Status: upon highlighting treatment, select the icon of the grey and green gear. That will pop up the following screen to select the status change you would like to take place:
• (Red X) Delete/Invalidate Treatment: upon highlighting treatment, select the icon of the red X.
• (Shield) Pre-Auth Claim: upon highlighting treatment, select the icon of the insurance shield.
You can also filter your grid of what treatment you are seeing by tooth. Example if you only wanted to see anything relating to tooth A, you can filter A:
39
Post Clinical Charges When posting a charge from the ledger, this screen allows confirmation and adjustments of
today's charges that have been posted.
You can also post charges from the ledger in HTML5 using .
Notes:
• Make sure that the correct procedures are listed, and providers for each procedure, fee, and insurance claim should be checked.
• Insurance policy will always reflect (None). The software will automatically place the money accordingly.
40
After you save the charge(s), Cloud 9 generates the claim to be sent but does not yet send.
If you needed to adjust any fees for some reason, you can on this screen, as well. For example,
if no charge due to bond failure, you will set the amount to $0 across and then uncheck the
claim checkbox so that it will not appear on the insurance claim.
Images This tab shows an image series along the side of the chart. You
can double click an image to open the window to where you can
import, view, edit and export a patient’s images. Images are
stored in a series using standard or custom layouts.
41
To acquire a new series of bitewings, periapicals, or occlusals, you will select acquire series and
take all images wanted for the series.
All images will display that were taken. Name and save series right away.
42
Drop down series type and select one. You can add additional information in the description if
needed (maybe 4 BWX + Pan).
43
Select an image type name for each image. You can only use each image type name once per
series. You can type the number for the proper display of each x-ray taken for the layout view.
It will be a number matching system with the picture below to properly display images. Even if
you are just taking a 2 BWX you will select the image types 15 and 16 when naming them.
Treatment Planning If someone has charted under (None), you can move it to the treatment plan created so that we
can properly treatment plan for the patient.
1. Select Treatment Planning. The Treatment Planning tab opens.
44
2. If we had not yet created the treatment plan, we would select Treatment Card here:
Note: Notice how we have items under the No Plan category because we were charting
under (None).
3. Select all of the treatment and then right click.
45
4. Select Move to Plan and put the treatment into the treatment plan that we had created. Now you will be able to properly treatment plan for the patient.
Treatment Planning will automatically come over in the no phase category. After you have
created phases, you can then select the treatment you would like to put into each phase and
move it there.
46
First add as many phases (appointments) as you would like. You can call them whatever you
prefer (Example: Appointment 1, Appointment 2, Op Appt, Recall) Notice everything is under
no phase until we tell it what treatment goes to what appointment.
You can also schedule and appointment for the phase connecting the treatment and the
appointment together from this screen. This will properly display the estimated production for
each day on the schedule view.
47
Make sure not to highlight a phase to see all the treatment we are to plan for and assign to
appointments.
You can change ranking at this point, if need be, as well as to reflect money appropriately –
deductible applied to the correct treatment, or when money will run out on which procedures.
Highlight the treatment you would like to select to bring over to an appointment. Holding CTRL
while selecting different treatment allows you to skip unwanted treatment to move to that
appointment. If you would like to select multiple items that are next to each other quickly,
highlight the first item, hold Shift, and select the last item. It will automatically highlight
everything in between.
48
After everything that you would like to move is highlighted move, right click to have a drop
down appear. Select move to phase and move it to the appropriate appointment. Note: You
can also at this time create a pre auth claim that Cloud 9 sends to the insurance queue.
When you select OK, all of the highlighted treatment will now appear under that appointment
or phase. Phase out all treatment so there is nothing left in the no phase category.
If you want to view the treatment attached to that phase, select the phase.
49
When you right click on that phase, you can do the following:
● Rename my phase
● Schedule the appointment using search; again this is how to schedule to view
estimated production on the schedule view for each day.
● Move up or down in ranking. Money will recalculate automatically if need be.
● Delete the phase completely. This will remove that phase and put treatment
back into the no phase category.
Treatment Plan Options You can also do multiple things to the entire treatment plan when you right click on it.
● View the phases for that plan.
● Rename the Plan
● Delete the Plan
● Create an Alternate Plan (example: EXT vs. saving the tooth to properly show money
from insurance for each separate option since both would not be completed)
● Create Downgrade Plan
● Make Copy of Plan
● Set Plan Status
○ Created (automatically set to this until changed)
○ Rejected
○ Accepted
○ Completed
○ Proposed
● Queue Letter
Printing/Emailing the Treatment Plan The Treatment Planning screen gives two options to print or email.
1. Print one phase only where it will show only the treatment and financials for that specific appointment. Usually utilized to present day of treatment.
50
2. Print all phases of treatment to be completed. It will separate by phase and give a phase total before showing the next phase along with a calculated total at the very end of all phases together. Usually utilized to present total fee after exam had been completed to schedule upcoming appointments.
51
Pedo Setup and Fee Schedules
Course Code C9C-535, Continuing Education Units–1
Participant Level Intermediate/AGD Subject Code 552/Financial Management
Course Objective Learn all there is to know about creating and managing Fee Schedules. Since Fee Schedules are an integral part of Pediatrics, this is one class you should not miss. Learn how to create and apply fee schedule according to the insurance carrier requirements. Creating benefits information and percentages are also detailed.
Pedo Setup and Fee Schedules ................................................................................................... 0
Setup for Cloud 9 ........................................................................................................................ 1
Transaction Types ....................................................................................................................... 3
Fee Schedule Types ..................................................................................................................... 7
Fee Schedules ............................................................................................................................. 8
Appointment Classes ................................................................................................................ 10
Appointment Statuses .............................................................................................................. 11
Appointment Types ................................................................................................................... 13
Caries Types .............................................................................................................................. 15
Code Limit Group ...................................................................................................................... 15
Treatment Status ...................................................................................................................... 16
Schedule Views ......................................................................................................................... 16
Schedule Templates .................................................................................................................. 18
Clinical Notes............................................................................................................................. 21
Step 1: Clinical Notes Categories .......................................................................................... 21
Step 2: Clinical Note Templates ............................................................................................ 21
Result: Display in Charting .................................................................................................... 22
Case Review Note Categories ................................................................................................... 23
Case Review Note Templates ................................................................................................... 24
1
Setup for Cloud 9
Cloud 9 gives you complete administrative control over setting up your practice information.
The choices made during setup determines how your users view your practice information.
Only users with administrative permission can make setup changes.
2
For each setup option, you can add, edit, delete and restore setup items:
• Use Add, Edit and Delete to manage setup items for the selected category.
• Use Restore to restore setup items you deleted: 1. Select the desired setup category. A listing of the items display.
2. Click ✓ Show Deleted. The deleted items for the selected category display.
3. Check the checkbox next to the items you want to restore.
4. Click Restore. The selected items are restored to the listing.
3
Transaction Types Edit > Setup > Transaction Types
The transaction types window contains all types of payments, adjustments, charges that add
monies owed and charges that are clinical procedures.
Each group can be color-coded to assist you in selecting the correct transaction when posting to
a patient’s ledger or the patient’s Treatment Card. In order to add, delete or edit a transaction,
you must have the correct privileges assigned.
• Edit > Setup > Transaction Types: Verify that the Transaction Type exists.
• Edit > Setup > Code: Search for the code you’re entering. The code is important because it
will appear on the insurance claim and determine how Cloud 9 calculates the benefits.
Note: If the code is not there, you will need to add it to Codes before creating it under
Transaction types.
4
When you add the transaction codes, the CDT code on the claim form displays in the
Code field.
Edit > Setup >Transaction Types > Charting tab
You can also edit the restrictions and appearance in your chart by editing transaction types.
5
Continuing Care
Checking Is Continuing Care gives you the ability can apply generic time frame for continuing
care. This will display in reports as well as in charting to easily display what the patient is eligible
for. Every time a charge that is setup with continuing care is completed, it will automatically
reset the next date of care expected.
Transaction Type Restrictions
For each code, you must have at least one type of restriction applied. Even if it is, for example, a
Prophy, you will select “mouth” as the restriction. Upon selecting some of the restrictions, such
as Tooth, you will have the possibility to add more restrictions to go further in depth.
6
7
Fee Schedule Types Edit > Setup > Fee Schedule Types
Before creating a Fee Schedule, you must first create the Fee Schedule Types.
FIELD DESCRIPTION
Description The name of the fee schedule type.
Code The unique identifier of the fee schedule type.
Is UCR Check this box if the fee schedule type should use the Usual, Customary or Reasonable amounts. Typically, you’ll have one UCR Fee Schedule. When checked, the balance of the check boxes cannot be selected. When creating the fee schedule, the only columns available for fee entry will be the UCR column. This Fee Schedule type is typically assigned to a Responsible Party.
Default to UCR Check this box on all other Fee schedule types. This is a safety net, so if you do not have a fee for a specific Code your fee will put in the UCR amount, or if you missed putting on a Code, the software will default to UCR, instead of $0.
Use Chargeable Amount
Check this box when you have a copay plan. Example: Total charge is $100; insurance pays $50 and the patient pays a copay of $50 – no percentages are involved.
Use Patient Copay Check this box to indicate the fee schedule should use the patient copay on the fee schedule. When checked, additional check options
8
FIELD DESCRIPTION
are available. If checked, this column displays for fee entry on the fee schedule.
Copay Notes: If this box is check on the Fee Schedule Type, any amounts entered will not display in a column on the Financial Arrangement. There is NOT a column for Copay amounts. They will, however, be added to the Patient Share amount.
Fee Schedules Edit > Setup > Fee Schedules
You will start with entering your UCR (Usual and Customary) fee schedule or Practice After you
upload your UCR or Practice fee schedule, you can import it and adjust for each fee schedule that
you would like to create. Then you won’t have to input every piece of data repeatedly into Cloud
9.
9
FIELD DESCRIPTION
Name Name of the fee schedule.
Type The applied fee schedule type.
Parent If this fee schedule is a subset or a ‘child’ of another fee schedule, select the applicable parent. This fee schedule will be applied first and then go back to the parent fee schedule for additional transactions.
Order The fee schedule list order.
Filter The applied location for this fee schedule. The default is all locations.
Entries
Open transaction type lookup and select a transaction type.
Add all transaction types to the fee schedule that are not already on the fee schedule.
Delete a fee schedule entry.
Import fees from another fee schedule.
Location-specific Fee Schedules
If the fee schedule is for ALL locations, then the default is All locations.
10
If you have multiple fee schedules for a particular insurance company, you can add the location
next to the CDT Code so that fee takes precedence over the “all” location fee schedule. You do
not have to add the same fee schedule multiple times. Just add the CDT codes that the fee differs
and assign the location. See above example for how that will look.
Doctor specific fee schedules are assigned in the Edit menu > Setup > Employee window.
Appointment Classes Edit > Setup > Appointment Classes
Classes are used to group specific Appointment Types together. All Appointment Types should
be the same time length that belongs to a specific class. You can create as many classes as you
need but remember if you have more than 15 classes, it might be difficult to place them all on a
single day without constricting the day.
11
Appointment Statuses Edit > Setup > Appointment Statuses
Appointment Statuses allow you to track the progress of a patient’s appointment in your practice.
They work in conjunction with the Light Bar and the Patient Locator. Never change the Code of
appointment statuses that are provided by Cloud 9. You can change the Description if desired, but
the code must remain the same.
If you change the code it causes the status to be omitted from the Patient Locator. If you create
an appointment status, you can create your own specific code. Appointment Statuses can
automatically trigger specific tasks based upon the current status.
Edit Appointment Statuses
● From the Edit menu, click Setup.
● Click Appointment Statuses.
● Select the status and click the Edit.
● Click Save when the choices have been made.
12
Code – Do not change any code that has been created by Cloud 9. Changing a code could cause
omission in the locator.
Description – The name of the status.
Show in Locator – Displays as a cell in the patient locator.
Show in Schedule – Display the appointment on the schedule view.
Locator Details Color – Determine the color code for the locator details view.
Locator Sort Order – What cell order should the status display?
Locator Details Sort Order – In the locator details view, what order should this status be sorted.
Recommended Defaults
Note: You may want to customize the colors for each code.
13
Appointment Types
Edit > Setup > Appointment Types
Appointment Types should be created based on the procedures performed in the office. Appointment
Types can be used to setup schedule templates as well as trigger specific tasks. i.e., triggering
documents or ToDo’s.
FIELD DESCRIPTION
Description Name of the appointment that displays on the schedule.
Code An abbreviated version of the description.
Gaidge If using Gaidge reports, create a unique tracking code.
Background Color The color that displays on the schedule template for the appointment.
Minutes The anticipated length of time for the appointment class.
Show on Summary of Activity Report
Checkbox to include this appointment type of the Summary of Activity Report.
Appointment Classes The available classes to attach the appointment type to if desired. If you do not use classes, nothing will be checked.
14
FIELD DESCRIPTION
Patient Status Changes When the patient’s appointment status changes, what should the
patient status become. Patient statuses are created in
Edit menu > Setup icon > Patient Statuses.
Procedures When the appointment status changes, what are the standard
procedures that should be added to the patient’s treatment card?
Procedures are created in Edit menu > Setup icon > Transactions.
Tracking New patient exams have the date automatically entered into the
patient’s tracking tab. Tracking items are created in Edit menu >
Setup icon > Tracking tab.
ToDos Create tasks for employees or positions when an appointment
status change occurs. ToDos are created in Edit menu > Setup
icon > To-Do Types.
Documents When the patient’s appointment status changes, what
documents, if any, need to be added to the letter queue? Documents are created in the Document Editor.
15
Caries Types Edit > Setup > Caries Types
Caries Types are reserved for Pedo. Caries are charting types that are carried throughout all treatment
plans. This tab does not affect your treatment plan numbers.
Code Limit Group Edit > Setup > Code Limit Group
16
Treatment Status Edit > Setup > Treatment Status
Schedule Views Edit > Setup > Schedule Views
The Schedule View contains options on how a specific schedule is displayed. The Start and End Times,
the background color for the tab as well as the Columns/Chairs are created in this setup. If you open
another office location, this is where you specify the parameters for each location.
17
FIELD ENTER/SELECT
Description Name of the schedule.
Minutes Per Row The timeframe unit desired.
Location The correct office, if applicable.
Start Time The opening time desired. It is normal to designate the opening time at least 30 minutes prior to opening so that you can add schedule notes for the day at the top.
End Time The closing time desired.
Time Zone The time zone of this location.
Order Which office displays first when clicking the schedule icon.
Background Color The schedule tab background color.
Foreground Color The schedule tab text color.
Hide From Schedule A schedule that needs to be hidden to keep from displaying when the schedule icon is clicked.
Columns/Chairs Create the chair information for your schedule. NEVER delete a chair without calling Support.
18
Schedule Templates Edit > Schedule Templates
You have access in HTML5 to setup schedule templates and
permissions. A template is where you can set up what you
would consider to be a ‘perfect’ day. Once the template is
created, you can apply it to the calendar.
You can edit these templates or make more customized templates at your discretion. To use features, such as Search to input certain criteria to bring up desired future appointment dates, you mush have a template created in Cloud 9.
19
Buttons
FIELD DESCRIPTION
Add Schedule Template Create a new schedule template.
Edit Schedule Template Modify an existing schedule template.
Delete Schedule Template Remove an unwanted existing schedule template.
Apply Schedule Template Apply the selected template to the selected days of the month.
Un-Apply Schedule Template Remove any applied template on a selected day(s).
Close Days Indicate the days the office is closed.
Close (the window) Close the window.
Schedule Template Window
When you click Add or Edit, the Schedule Template window displays. Here you set up
the template. The template serves as an outline for employees to follow for scheduling
and also pulls information to schedule when searching for available appointments.
20
You can have many types of templates, such as your regular school year schedule an s holiday schedule to use during school breaks. In the upper left-hand corner of the Schedule Template window, there are Print and Copy buttons:
BUTTON DESCRIPTION
Print the template
Copy
Copy and save the template under a different name.
21
Clinical Notes Step 1: Clinical Notes Categories
Edit > Setup > Clinical Note Categories
These will be the titles for the different categories that your Clinical Note Questionnaires will
appear in the dropdown lists.
Field Description
Description The name of the category to organize clinical notes. Common categories include: Administrative, Anesthetics, Clinical Exams, Miscellaneous, and TXPlan.
Order The numeric order to display the categories.
Step 2: Clinical Note Templates
Edit > Setup > Clinical Note Templates
22
Field Description
Description The name of the template.
Category The grouping assigned to the template.
Questionnaire The questionnaire assigned to the template.
Document The document assigned to the template.
Order The numeric order to display the templates.
Result: Display in Charting
Once these two clinical note areas have been setup, they will appear under the Clinical Notes
section in Charting.
23
Case Review Note Categories
Field Description
Description The name of the category to organize case review notes. Common categories include: Mid Treatment Review, Notes, Post Banding Review, Post Treatment Review.
Order The numeric order to display the categories.
24
Case Review Note Templates
Field Description
Description The name of the template.
Category The grouping assigned to the template.
Questionnaire The questionnaire assigned to the template.
Document The document assigned to the template.
Order The numeric order to display the templates.
1
Pedo Financials, Insurance, Claims and Reports
Course Code C9C-537, Continuing Education Units–1
Participant Level Basic/AGD Subject Code 552/Financial Management
Course Objective Learn the ins and outs of a pediatric ledger. See how to post charges from the planned treatment that has been performed and how to correct an entry if needed. Insurance benefit templates to take the guesswork out of treatment planning. If you are the financial coordinator for your Pediatric office, this class should be tops on your list. What reports are recommended for Pediatrics within Cloud 9. Be the confident financial coordinator in the office. Learn how and when to add charges, payments and adjustments. Insurance benefits templates. Reports designed for Pediatrics within Cloud 9.
Financials and Insurance ............................................................................................................................... 2
Adding Insurance to a Patient ................................................................................................................... 2
Setting up Benefits .................................................................................................................................... 7
Setting up Benefits that Affect All Patients........................................................................................... 7
Setting up Benefits that Affect a Patient ............................................................................................ 11
Insurance Queue ......................................................................................................................................... 48
View a Claim from the Insurance Claim Queue ...................................................................................... 49
Editing Patient Information from the Insurance Claims Queue ............................................................. 50
Editing Insurance Billing Center and Company from the Insurance Claim Queue ................................. 52
Adding a Manual Claim ........................................................................................................................... 54
Submitting a Claim .................................................................................................................................. 55
Viewing a Claim Status ............................................................................................................................ 55
Viewing the Claim Status Report ............................................................................................................ 55
Viewing Claim Report Immediately after Submitting Claim ............................................................... 56
Viewing Claim Report Later After Submitting Claim ........................................................................... 56
Changing a Claim’s Status ....................................................................................................................... 56
Correcting and Resubmitting a Rejected Claim ...................................................................................... 57
Using Claim History ................................................................................................................................. 58
Accessing the Claim History .................................................................................................................... 59
Adding a Note ......................................................................................................................................... 59
Deleting a Note ....................................................................................................................................... 60
2
Financials and Insurance
Adding Insurance to a Patient Important: Adding insurance must always be completed before the patient is seated. The Employer/Plan:
• Is where benefits are determined for a particular plan under the employer. There can be multiple employer plans under one employer.
• Associates the Insurance Carrier with the proper Billing Center for the claim. You’ll complete all fields for the employer plan.
1. From the Edit Patient window, select Insurance tab.
2. Click + Add. The Add Patient Insurance window displays.
3
3. In the Employer Plan field, click Search . Note: It’s important to always search for the Employer Plan to avoid creating duplicates.
4. Search for the desired Employer/Plan, and do one of the following:
• If you locate the desired Employer/Plan, go to Step 5.
• If you DO NOT locate the desired Employer/Plan, do the following:
4
a. Click Add. The Add Employer dialog box displays.
b. Enter the Employer information.
c. Click + (Add) under the Employer Plans section. The Add Employer Plan dialog
box displays.
d. Enter the Plan Info. Note: It’s important to make sure the correct fee schedule is attached.
e. Click the Benefits tab.
f. Enter the benefits information. Note: See Setting up Benefits that Affect All Patients for more details.
g. Once you’ve completed the Plan Info and Benefits tabs, click Add. The Add Employer dialog box displays with the Employer Plan displays on the Employer Plans grid.
5
h. Click Save. The Employer Plan dialog box displays with the newly added employer name in the search box.
i. Select the Employer/Plan Name and click Select. The Push Benefits dialog box displays.
j. Select one of the following options:
• Push means that you will apply these benefits to ONLY this specific patient.
• Push and Reset to Max applies these benefits and resets the max which you will only do if it is a new plan or the plan’s year just renewed.
• Don’t Push will not apply anything to anyone other than this specific patient.
k. On the Plan Info tab, complete at least the required fields – Subscriber and
Responsible.
l. On the Benefit tab, make any additions or edits. Note: You can setup Cloud 9 to
automatically downgrade posterior composites to amalgams.
m. Click Add. The insurance plan info and benefits display on the Insurance grid. The
newly add employer has been added to Cloud 9. To see the employer details or if you
6
need to make changes in the future, go to Edit > Setup > Employers.
Note: End of Adding an Employer Plan from the Insurance tab.
5. From the Employer Plan dialog box, select the Employer/Plan Name and click Select.
The Plan Info and Benefits insurance information will auto-populate, saving you time. IMPORTANT: You will need to complete the Subscriber and Responsible (Party) fields, which are required. Those fields will NOT automatically populate. Plan Info Screenshot
7
Benefits Screenshot
6. Click Add to complete adding insurance to the patient.
Setting up Benefits The Benefits tab is where you enter the benefit information and create restrictions. If you want to apply the benefits to all patients in an employer plan or just to a particular patient determines how you access the benefits tab.
Setting up Benefits that Affect All Patients
To set up and update the benefits to an employer plan that will affect all patients belonging to that plan, go to Setup > Edit > Employers > Add or (select Employer) Edit > Add or (select Employer) Edit Employer Plans > Benefits
8
Below is an example of a completed Benefits tab.
From this dialog box, you can Import a basic template of what the plan usually covers, and then adjust it as needed after the import is completed. You can also Export an existing template. RECCOMENDATION: Cloud 9 recommends going in to test a patient and create a standard benefit template. These benefits can be Exported to the desktop. Then you can Import this template in the future when setting up employer benefits. Once you set up the benefits, you can Push To Patients and select how you want the updated benefits applied all of the patients in the employer plan.
1. Go to Setup > Edit > Employers > Add or (select Employer) Edit > Add or (select Employer) Edit Employer Plans > Benefits. The Benefits tab displays.
2. Click Add to add a benefit or select a listed benefit and click Edit to edit an existing benefit. The Add Benefit or Edit Benefit dialog box displays.
3. Enter the information pertinent to the benefit. Note: You can setup Cloud 9 to automatically downgrade posterior composites to amalgams. This is helpful when discussing a treatment plan with the guardians in order to show them the correct fees.
9
• Setting up a downgrade for a code does not permit entry in the % Covered field. The % Covered field comes from the CDT code category already linked to the codes in Edit menu> Setup> Codes.
• Establishing Tooth Range limitations, like sealants D1351, the software requires the individual tooth numbers be separated by commas; there is no space between the comma and the next number. For example, if teeth 2,3,14,15,18,19,30,31 are covered, then that is the format you will use in the Tooth Range field.
• Setting up a limitation for Minimum/Maximum Age Range or Frequency for a specific Transaction type requires the % Covered field to be filled out.
4. Click OK. The updated benefit displays on the Benefits grid.
5. Continue to add or edit benefits until you’re completed.
6. Click Push to Patients to update all patients linked to this employer plan. The Push Benefits dialog box displays.
10
7. Select one of the following options: • Push is used when you make a change to the employer plan and want to affect this
change to ALL patients attached to this Employer plan.
• Push and Reset Max is used primarily when adding an employer plan into Cloud 9 for the first time. This sends the benefits to the patient files as well as updates the Maximum and Deductible amounts. This is a MUST so the software knows how much of the benefits it has to allow for treatment planning and charges. Note: If the patient has met/used a portion/all of their deductible maximum, you will need to manually change the fields in the patient’s Insurance tab located on the Edit Patient window.
• Don’t Push is used when you view the employer plan but do not make any changes that need to take effect.
8. From the Add or Edit Employer Plan dialog box, click Edit.
9. From the Add or Edit Employer dialog box, click Save. Cloud 9 has saved all the updates.
11
Setting up Benefits that Affect a Patient
From the Edit Patient window on the Insurance tab, you can view the patient’s Benefits.
IMPORTANT: Editing is available in this window; however, it will only affect this patient, not everyone who has this plan. There may be times when you have to adjust benefits for a patient. For example, if the patient
has met/used a portion/all of their deductible maximum, you will need to manually change the
fields in the patient’s Insurance tab located on the Edit Patient window.
1. Go to Edit Patient > Insurance and click Add. The Add Patient Insurance dialog box
displays.
2. Select the Employer Plan. The Push Benefits dialog box displays.
3. Select one of the following options:
• Push means that you will apply these benefits to ONLY this specific patient.
• Push and Reset to Max applies these benefits and resets the max which you will only do if it is a new plan or the plan’s year just renewed.
• Don’t Push will not apply anything to anyone other than this specific patient.
12
4. On the Plan Info tab, complete at least the required fields – Subscriber and
Responsible.
5. On the Benefit tab, make any additions or edits. Note: You can setup Cloud 9 to
automatically downgrade posterior composites to amalgams.
6. Click Add. The insurance plan info and benefits display on the Insurance grid.
Posting Charges You can access the Post Charge(s) window from various locations, including the Home menu,
Financial Menu, Patient Ledger, Family Ledger, Patient Header, and Patient Checkout.
When you post a charge, Cloud 9 automatically:
• Performs eligibility calculations for primary insurance, secondary insurance and patient amounts based on the patient benefits listed in the Edit Patient Insurance tab.
• Calculates the amount and allowable (amount) from assigned Fee Schedules.
• Covers posting the transactions to the appropriate responsible parties and insurances.
• Updates the deductible, annual max and allowable amounts.
• Displays the patient’s default location and provider; however, you can use the dropdowns to make updates.
• Adds treatments to charting for open item charges when a pediatric dentist or hygienist is listed as the provider of the charge.
• Updates Continuing Care when a corresponding Continuing care transaction type is posted.
• Provides a Post Charge Grid that includes columns for Region, Tooth and Surface. The Surface field includes a dropdown arrowing giving you access to the Surface Picker that allows you to select the affected surface. Or, you can enter the text in the Surface field.
• Allows you to adjust amount. For example, if the procedure is to be done at no charge, you will set the amount to $0 across the Amount, Allowable, Primary and Patient fields and then uncheck the claim checkbox so that it will not appear on the insurance claim.
13
The following is an example of the Post Charges window and field descriptions. When posting a
charge, this screen allows you to confirm and adjust today's posted charges.
Button Used to
Treatment Look up the patient’s current planned treatments and allows the user to post those planned procedures to the ledger from post charge
Add Add a charge(s)
Save Save and post a charge(s) and creates an insurance claim, when necessary
Cancel Remove any charge(s) and exit the window.
Field Description
Patient The patient’s name to charge.
Location The location the user is currently signed in at, this should be “where” the procedures are being physically completed at
Responsible Party The person(s) financially responsible. If there is only 1 it will default to that 1. If there are more than 1 FR persons, the user will have to select one.
Date of Service The actual date of the charge. You can backdate a charge if necessary.
Column Headers Description
Type The number of the transaction type.
CDT The CDT code.
Description The name of the transaction type.
14
Column Headers Description
Region Region of the tooth serviced.
Tooth The tooth serviced.
Surface The surface serviced.
Provider The provider assigned to the charge. This is typically done at the time for treatment planning. If it’s an “added” code, then you are correct it will be the provider the patient is currently assigned to.
Amount The dollar amount associated with the assigned fee schedule for the patient.
Allowable The maximum amount of a billed charge that the insurance company considers payable. This is pulled from the assigned fee schedule.
Primary Patient’s primary insurance estimate. This is calculated based on the patient’s eligibility.
Secondary If applicable, patient’s secondary insurance pay estimate. This is set up in Eligibility Coverage.
Patient The patient’s estimated out of pocket cost
Claim Checked when the patient has insurance and the transaction type is set to send to insurance.
Note: The Claim box will be checked if the following criteria are met:
1. The patient has insurance.
2. The Charge Type must have a CDT code tied to it.
Delete Used to remove the charge from the window.
Notes Relevant information about the charge. Note: This note appears on the patient’s ledger; however this note does not appear on the insurance claim form.
As you’re posting a charge, Cloud 9 will:
• Warn users when allowable is greater than the amount
• Prevent mix of Ortho and Pedo charges
• Mark Tooth as Missing or Extracted on the tooth chart, when applicable
• Provide warnings for Invalid Treatments
• Provide a tooltip to Edit Benefit window for multiple teeth
15
• Lookup Planned Treatments and display invalid treatment warning
• Allow for the posting of Supernumerary teeth
1. Access the Post Charge window from the Ledger, Main Menu, Patient Header, or Patient
Checkout window.
Note: If the patient is not already selected, the Lookup Patient dialog box displays, and
you need to locate the desired patient .
2. Select either to post a planned treatment charge or to search for a transaction to post.
3. From the Choose a Charge dialog box, if you selected Add or from the Choose a Treatment dialog box, if you selected Treatment, check the box for a charge or treatment, or several charges/treatments, from the list. Note: These checkboxes can be checked and unchecked until all the correct charges are selected.
4. Click Select. The Post Charge window displays with the charge(s).
Note: You can designate if the charge is or isn’t a claim by checking or unchecking the Claim checkbox, if the patient has insurance and the charge type has a CDT code tied to it.
5. Continue adding charges, as appropriate.
6. Make sure the correct procedures are listed, the correct providers for each procedure and fee is entered, and the claim box is checked. Note: If there’s an invalid treatment, a red box displays around the invalid treatment or missing content.
You cannot save the charge until the invalidation is fixed.
7. Click Save. The charge(s) is/are posted to the ledger and indicates who is financially responsible. Note: After you save the charge(s), Cloud 9 generates the claim to be sent. You can find
16
the claim in the Insurance Claims Queue.
Posting Payments There are four types of payments you can post to a patient’s account:
• Patient Payments
• Family Payments
• Insurance Payments
• Insurance Bulk Payments
When posting a patient payment, the Post a Payment window displays. The Post a Family Payment window displays when posting a Family Payment.
Highlights of the payment windows include:
• When you check Pay by Charge, a grid displays on the right-hand side of the window with additional fields used to apply the payment to charges and open items. In addition, the Numbering System field displays. When you uncheck Pay by Charge, Cloud 9 removes the grid and adds the assigned location and provider dropdowns.
• When you use the Numbering System dropdown to change the numbering system and Pay by Charge is checked, Cloud 9 immediately updates the Tooth (sub region) column in the grid. Cloud 9 remembers the preference that you saved so when you open the Post a Patient or Post a Family Payment window, the same numbering system is selected. Cloud 9 also updates the Number System on the ledger; you may need to click Reload to see the update.
• Auto Apply displays next to the Amount field when Pay by Charge is checked. When you click Auto Apply, Cloud 9 distributes the payment from the oldest charge (top to bottom) until it runs out of money to allocate. Note: You cannot select a charge further down in the list to be paid first; the oldest charge gets paid first.
• The Payment Remaining field shows you the amount of money you have left to allocate to charges. Cloud 9 automatically subtracts the amount you have allocated from the payment amount to show you what money is left.
17
• The Payment Total field that calculates the total payment amount from the payments applied to the transactions. If the payment exceeds the payment amount, the Amount, Payment Remaining and Payment Total fields turn red. Once the payment total is equal to the payment amount, the field turns green, and you can save the payment.
The following is an example of a patient’s Post a Payment window and field descriptions:
Note: A snapshot of the Post a Family Payment window is included in the Posting a Family
Payment.
Field Description
Patient Enter the patient’s name.
Posting Location Enter the location where the payment should be posted to.
Defaults to the location you are signed into; this is the location where the money is being entered.
Responsible Select the responsible party’s ledger to which the charge should be posted.
Insurance (Post a Patient Payment)
Select the insurance company to which the payment corresponds to.
Payment Type Select the payment type from the dropdown. If you select a credit card type, the Authorize Credit/Debit Card button becomes unshaded and checked.
Amount Enter in the amount of the payment.
18
Field Description
Card Type
Optional field. If the payment is a credit/debit card, enter the name for reference.
Reference # Optional field. If a credit card, you can put in the approval code.
Note Optional field. Enter any information you want to add as a ledger note. When pay by charge is checked, this note will appear on every transaction that appears in the post payment screen. For individual transaction specific notes, place your cursor in the note field next to that transaction and type your note there.
Receipt # Optional field. Rarely used; enter if your office writes paper receipts from a receipt book.
Receipt Note Optional field. Enter any note you would like to add to the printed receipt.
Print Receipt Check if you want to print a paper copy.
Email Receipt Check if you want to email a receipt, rather than printing a copy.
Authorize Credit/Debit Card
If enrolled with an integrated processor and the payment type has been selected as a credit card, a checkmark should automatically appear in the checkbox to authorize the card. You will receive an authorization code after processing.
Pay by Charge When Pay By Charge checkbox is checked, the window displays a grid on the right with additional fields for applying the payment to charges/open items. It also displays the Numbering System field.
Show Inactive Patients (Family Payment)
This button allows you to toggle between displaying inactive patients or not.
Numbering System This field displays only if Pay By Charge is checked. It provides a dropdown list with the options for Universal, Palmer and International.
Due Now The current due now owed.
Future Due The amount owed that has not been charged to the ledger.
Total Due The amount owed to pay off the balance.
19
Posting a Patient Payment
1. Access the Post a Payment window from one of the following paths:
• Patient Ledger > Post a Payment
• Home menu > Patient Payment
• Financial menu > Patient Payment
• Patient Header > Patient Payment
• Treatment Card > Patient Payment
2. Select the Payment Type.
3. Enter the payment Amount and do one of the following:
If you want to… Then…
Have Cloud 9 automatically apply the payment to the oldest to newest transactions
Click Auto Apply.
Manually apply the payment to the transactions
For each transaction listed on the payment grid, go to the transaction’s corresponding Payment field and manually enter the
20
If you want to… Then… amount that you want to apply to that transaction. Notes:
• You cannot overpay a responsible party payment. For example, if the portion is set to $35, you cannot enter $36 on that line when making a responsible party payment. However, you can overpay an insurance payment.
• If the totals do not add up to the payment amount, Cloud 9 turns the Amount and Payment Total fields red. Once the discrepancy is resolved, Cloud 9 turns these fields back to green.
4. Optional: Enter the following applicable fields: Card Type; Reference #; Note; Receipt # and Receipt Note.
5. Optional: Check the desired options: Print Receipt and Email Receipt. Note: If Credit Card payment type is selected, automatically the Authorize Credit/Debit Card checkbox is checked.
6. Click Save.
If you checked… Then the…
Either the Email or Print Receipt checkboxes
Ledger displays.
Email Receipt checkbox Send E-Mail dialog box displays.
Print Receipt checkbox Report Viewer displays the receipt and the Print dialog box displays.
21
If you checked… Then the…
8. Do the following:
If you’re… Then…
Not emailing or printing a receipt
Click Reload. The payment displays on the ledger.
Emailing the receipt See Emailing and Printing receipts.
Printing the receipt See Emailing and Printing receipts.
22
Posting a Family Payment
The Post a Family Payment window shares most of the same fields as the Post a Payment.
Differences include:
• The responsible party’s name in the upper left-hand corner since Family Ledgers are
responsible party-specific. Note: If there are more than one responsible parties, you’ll
be prompted to select one. There will only be one instance of a responsible party on the
payment window.
• The Insurance field is not included on the payment window. Thus, the resolution column
does not display on the payment grid.
• The Show Inactive button displays, allowing you to toggle between displaying or not
displaying inactive patients.
1. Access the Post a Family Payment window from one of the following paths:
• Patient or Family Ledger > Post a Family Payment
• Home menu > Family Payment
• Financial menu > Family Payment
23
• Patient Header > Family Payment
Note: If the Post a Family Payment window doesn’t display, search for and select the
Responsible Party. The Post a Family Payment window displays.
2. Select the Payment Type.
3. Enter the payment Amount and do one of the following:
If you want to… Then…
Have Cloud 9 automatically apply the payment to the transactions
Click Auto Apply.
Manually apply the payment to the transactions
Manually enter the amount you want apply to each transaction Note: If the totals do not add up to the payment amount, Cloud 9 turns the Amount and Payment Total fields red. Once the discrepancy is resolved, Cloud 9 turns these fields back to green.
4. Optional: Enter the following applicable fields: Card Type; Reference #; Note; Receipt #
and Receipt Note.
5. Optional: Check the desired options: Print Receipt and Email Receipt. Note: If Credit Card payment type is selected, automatically the Authorize Credit/Debit Card checkbox is checked.
6. Click Save Payment.
If you checked… Then the…
Either the Email or Print Receipt checkboxes
Ledger displays for the first patient.
Email Receipt checkbox Send E-Mail dialog box displays.
24
If you checked… Then the…
Print Receipt checkbox Report Viewer displays the receipt and the Print dialog box displays.
7. Do the following:
If you’re… Then…
Not emailing or printing a receipt
Click Reload. The payment displays on the ledger.
Emailing the receipt See Emailing and Printing receipts.
Printing the receipt See Emailing and Printing receipts.
25
Posting Insurance Payments Posting payments to the insurance ledger follows the same process as posting payments to the
responsible party’s ledger with a few minor differences. Make sure you:
• Choose a payment type that distinguishes the payment as an insurance payment.
• Verify that the payment is being posted to the insurance ledger.
Note: If you have not done so, be sure to add in the correct payment transaction types: Edit
menu > Setup icon > Transaction Types.
1. Access the Post a Payment window from one of the following paths:
• Patient Ledger > Post a Payment
• Home menu > Patient Payment
• Financial menu > Patient Payment
• Patient Header > Patient Payment
• Treatment Card > Patient Payment
Note: The correct Posting Location defaults to the location you’re signed into, so it should be correct.
2. If not already selected, click Pay By Charge.
3. Select Insurance. Note: If the charges are not displaying on the grid, click Show $0 Charges.
4. In the Payment Type field, select the appropriate insurance option: Insurance Check; Insurance Credit Card; Insurance Payment Bulk; Insurance Payment DSHS; or INS BULK.
5. In the Amount field, enter the insurance payment amount.
• Optional: Enter the following applicable fields: Reference #; Note; Receipt # and Receipt Note.
• Optional: Check the desired options: Print Receipt and Email Receipt.
6. Do one of the following:
26
• Click Auto Apply. Cloud 9 distributes the amount on the charge grid.
• In the Payment field on the charge grid, enter the amount to apply to the charge. The Resolution field becomes a dropdown field, when applicable.
7. Select the appropriate Resolution, depending on the following situations:
• If the insurance pays the appropriate amount or underpays:
Note: If an insurance company pays the appropriate amount or underpays, you can select Close Line Item where the money transfers to the responsible party automatically or select Leave Item Open if you are expecting additional money from the insurance company and the money does not transfer to the responsible party.
• If the insurance overpays:
27
Note: If an insurance payment overpays, Cloud 9 will not allow you to move from the Post Payment window until you select a resolution to direct where the extra money should go. You’ll have the following options:
• Adjust Charge to Match Payment: Will the money stay within the practice and you adjust to match the payment?
• Move Remaining Payment to Patient: Did the responsible party overpay and the extra money should go onto the patient ledger as a credit?
When the resolution is selected and the payment is successfully posted, Cloud 9 automatically makes the adjustment.
8. Click Save. If there’s no secondary insurance, Cloud 9 takes you to the next open tab.
9. If there’s a secondary insurance, the following dialog box displays and click Create:
Cloud 9 allocates the initial charge to both the primary and secondary insurances; you can see this by clicking Show Future Charges on the patient’s ledger.
Posting Bulk Insurance Payments
1. From the Financial menu, select Insurance Payment. The Insurance Company Billing Center
dialog box displays.
2. Search for the desired billing center and click Select. The Post Insurance Payment - <Selected Billing Center> window displays. The Insurance Company and Posting Location
28
fields are completed.
3. Click Search, located in the upper right-hand corner.
The Choose Policies to Add dialog box displays.
4. Select the desired policies and click Select. The selected policies display.
29
5. In the Payment Type field, select Ins Bulk Ck. Note: The Adjustment Type is automatically selected to Ins Bulk Ck Adjustment.
6. In the Amount field, enter the amount of the Insurance Bulk Check.
7. In the To Apply column, enter the appropriate amounts for each policy that should receive a portion of the bulk insurance check. Note: When all of the money is applied and equals the check amount, the Amount and Payment Total fields turn green. If the applied amount goes over the check amount, the fields turn red.
30
8. Click Save Payment. The Post Insurance Payment window closes. Cloud 9 applies the amounts and displays the payment on the patient’s ledger.
Emailing and Printing Receipts When posting a payment, you have the option to email the receipt.
1. From the Post a Payment or Post a Family Payment window, complete the fields related to posting the payment.
2. Check the desired options: Print Receipt and/or Email Receipt.
3. Do one of the following:
• Click Save from the Post a Payment window.
• Click Save Payment from the Post a Family Payment window.
If you checked… Then the…
Email Receipt checkbox Send E-Mail dialog box displays.
Print Receipt checkbox The Print dialog box displays ‘on top’ of the Report Viewer, displaying the receipt.
31
If you checked… Then the…
Both the Email Receipt and Print the Receipt checkboxes
Report Viewer with the Print dialog box displays firsts. The Send Email dialog box is ‘behind’ the print windows.
4. Do the following:
If you’re… Then…
Emailing the receipt a. Enter the To, Subject and Message fields.
b. Click Send.
• Cloud 9 sends the email and attaches the receipt to the email.
• Ledger displays.
c. Click Reload. The payment displays on the ledger.
32
If you’re… Then…
Printing the receipt a. Select the desired printing options.
b. Click Print.
• The receipt prints
• Ledger displays.
c. Click Reload. The payment displays on the ledger.
Emailing and printing the receipt
a. Complete printing the receipt.
b. Complete emailing the receipt.
33
Financial Ledger This is the traditional ledger view. All Charges, Payments, Adjustments, Ledger notes, etc., show on this view in chronological order. This can be sorted by an individual provider, multiple providers, or all providers. In the drop-down, you can view ALL responsible parties or select a single responsible party, i.e., a particular insurance company. The colors correspond to the setup of your practice’s transaction types. This is all customizable.
The Pedo ledger has one ledger tab with a dropdown list allowing you to individually view the ledger for each responsible party, insurance or for all. From the Family Ledger, when you select a patient (family member), a gear displays next to the
patient’s name. You can click the gear to navigate to that patient’s various areas. It’s works like
the Patient Header does.
34
When you display a ledger, you can click Print and select Print Ledger to print the displayed ledger.
35
Date of Service Tab This tab is specifically designed to display the pediatric line item charges by the date of service. It is abbreviated as DOS.
The DOS tab displays charges for each family member on the Family Ledger.
36
Displaying the Provider
The Provider dropdown list enables you to filter the ledger activity by
specialty and/or provider. When you make your selection, Cloud 9
updates the DOS tab to display the activity associated with the
provider and/or specialty you selected.
Navigating the DOS tab
Clicking on the black arrow to the left of the date will further expand to show the details of Date of Service and an Overview of Date of Service Financials. The black arrow to the left of the individual line item indicates that there are additional details that are currently rolled up. Clicking on that arrow will reveal line item detail of that procedure’s financial history.
You can rearrange the order of the DOS columns by positioning your mouse on the column heading until the cursor turns into a cross arrow you drag the column to the desired location. Each user can customize their column order and Cloud 9 will retain those preferences for each user. Note: We recommend that you do NOT drag any column to the left of the patient’s name.
37
When you’re on the DOS tab, you now have the option to print the date of service report.
• Click Print and select Print Date of Service:
The Print of Date Of Service dialog box displays.
• Select Responsible Party and the From Date and To Date and click OK. The Financial Date Of Service report displays.
38
Applying Unallocated Payments
Unallocated payments are payments or overpayments appear down at the bottom of the DOS
tab.
Applying Payment allows you to apply money to the account prior to services being rendered versus later. You can go back and allocate those funds to the completed procedures. This area will also house overpayments. They can be kept for future charges or a refund.
1. From the patient’s ledger, select the DOS tab.
2. Expand the Unallocated section and locate the unallocated payment.
3. Select the desired unallocated payment. A hamburger menu icon displays next to the selection.
39
4. Click the Hamburger menu and select Apply Payment.
The Apply Payment window displays.
5. Verify an unpaid charge is displayed at the bottom of the window and click Auto Apply. The payment amount is automatically applied to the oldest charge.
40
6. Click Apply. The payment is now rolled up under unallocated and displays $0.
7. Locate the charge the payment was applied to and verify the payment displays and was successfully applied to the charge.
Making Corrections and Adjustments
From the ledger, you can make corrections and adjustments to an account.
Correction Options
Correction Type Used to correct a …
Adjust Charge Charge on the ledger in which the fee is incorrect or the benefits were not properly entered into Cloud 9.
Correction
This is primarily ORTHO
Posted payment with the incorrect amount. Note: When correcting a payment, the new amount needs to be a negative amount entered as either -100.00 or (100.00).
Reverse (a payment) That was posted to the incorrect ledger or should have never been posted.
Void/Return By voiding the transaction or returning the money to the patient or insurance company. Note: Void is only used for credit cards.
41
Adjustment Options
For Pedo, this type of an adjustment should only be used for:
• Account write-offs;
• Transfers; or
• Refunds
Cloud 9 recommends that for all other Pedo adjustments, you should use Adjust a Charge
option.
Correction Options Corrections provide you the opportunity to fix incorrect transactions.
Adjust a Charge
1. From the ledger, select charge to be adjusted.
2. Click Corrections Options and select Adjust Charge. The Adjust Charge dialog box
displays.
3. In the Amount field for the Responsible/Ins charge that needs to be adjusted, enter the
correct amount.
42
4. In the Adjustment field, select the type of adjustment being made.
5. Optional: Enter a comment to track why the adjustment was made. The note displays on
the DOS in the Note column for the adjustment.
6. Click Adjust. The adjusted amount displays on the ledger.
Note: You have the ability to adjust the charge as many times as necessary.
Reversing a Charge
When a charge is posted to the ledger incorrectly, you can use the Reverse feature you to reverse the incorrect charge. When doing so, you will be prompted as to what you would like to do with the procedure, i.e., put back as treatment planned procedure, record as an existing procedure, etc.
1. From the ledger, select charge to be reversed.
2. Click Corrections Options and select Reverse. The Reverse Group Charge dialog box
displays.
43
3. Select Posting Location and Invalidate Status (Invalidated or Refused Treatment).
4. Click Reverse. The Reverse a Transaction dialog box displays.
5. Click Reverse. The Reversal displays on the ledger.
Voiding a Payment
Note: Voiding and returning payments are only for Credit Cards.
Is your office enrolled in OpenEdge (X-Web)?
Then…
Yes • You can void the payment until OpenEdge batches and processes the payment, which could still be less than 24 hours.
• Once OpenEdge processes the payment, you have to reverse in OpenEdge’s portal and do a Due Now Adjustment on the patient’s ledger to show the void.
44
Is your office enrolled in OpenEdge (X-Web)?
Then…
• After 1:00 pm, you must reverse in X-Web’s portal.
No You must void the Credit Card payment through your portal and then do an adjustment to the patient’s ledger.
Adjustments
Adjustments are customizable. This is where you can post adjustments to the ledger. Here are
a few sample adjustments types:
IMPORTANT: For Pedo, this type of an adjustment should only be used for:
• Account write-offs;
• Transfers; or
• Refunds
Cloud 9 recommends that for all other Pedo adjustments, you should use Adjust a Charge
option.
When you click Adjustment from the ledger, the Post Adjustment dialog box displays.
Here is where you enter the adjustment amount and adjustment type.
45
Field Description
Patient Name of the patient whose ledger is open.
Responsible Party Name of the responsible party’s ledger where the adjustment will take place.
Insurance Name of the insurance company’s ledger where the adjustment will take place.
Contract (Ortho) Contract description for contract that will be adjusted.
Before This Adjustment Current amount due now, the contract future due, other future due and total due BEFORE the adjustment.
After This Adjustment Adjusted amount due now, the contract future due, other future due and total due AFTER the adjustment.
Adjustment Type List of adjustment options.
Contract Adjustment (Ortho)
Amount the user enters to adjust the CONTRACT.
Due Now Adjustment Amount the user enters to adjust the LEDGER.
Comment Required field. Notes the user enters to detail why the ledger or contract is being adjusted.
46
Note: From the Post Adjustment dialog box, the Other Future Due fields only display when
appropriate.
1. From the patient’s Ledger, click Adjustment. The Post Adjustment window displays.
2. Select the Responsible Party.
3. View the Before Adjustment to see the current balances. Note: The amounts under the
After Adjustment will be the same.
4. In the Adjustment Type field, select the adjustment type from the dropdown.
5. In the Due Now Adjustment field, enter the adjustment amount.
Note: The Due Now Adjustment value may be a positive or negative amount.
• A negative amount to indicate a credit, such as an overcharge.
• A positive amount to indicate a debit, such as an undercharge.
6. In the Comment field, provide a detailed explanation of the adjustment. Note: This is a
required field.
47
7. Click Save. The patient’s Date of Service tab reflects the adjustment in the Unallocated
section.
Note: If the adjustment applies to a specific date of service, apply that adjustment to that
charge line.
Reminder: For Pedo, this type of an adjustment should only be used for:
• Account write-offs;
• Transfers; or
• Refunds
Cloud 9 recommends that for all other Pedo adjustments, you should use Adjust a Charge
option.
48
Insurance Queue No matter if you accept assignment or not, you manage all claims through the Insurance Claim
Queue. From the Insurance Claim Queue window, you can do the following regarding claims –
viewing, adding, printing, e-filing, changing a claim status and looking up specific patient claims.
Note: If using our integrated electronic claim submission service, Change Healthcare, you can
also get the status of a claim by downloading reports directly from Change Healthcare.
You can access the Insurance Claim Queue window from the Financial menu.
Insurance Claim Queue window
Buttons
Button Description
Reload Queue
Print Claims
Send Claims
Add Claim
Edit Claim
49
Button Description
Set Status (for a claim)
Claim History
Fields
The following fields are used to query which claims you desire to access:
Field Description
Claim Status The status of the claim you want to display –New (default), Printed – Submitted – Rejected – Paid – Partially Paid – Deleted.
Include Substatuses Additional status to further define the primary status.
Claim Type One of the following claim types: Continuation – Initial – One-Time or Pre-Determination or view them All.
Location The specific location, if you have several offices.
Patient Patient you’re looking up claims for.
Use Date Range Checked if using a date range. Note: Start and End dates need to be entered.
Start Date Start date of the date range.
End Date Last date of the date range.
Rank Desired insurance as it is listed on the Insurance tab from the Edit Patient window. Note: This is NOT an indication of primary and secondary.
View a Claim from the Insurance Claim Queue 1. From the Insurance Claim Queue window, check the box to the left of the claim you
want to open.
2. Click Edit Claim. The ADA Dental Claim Form displays.
50
3. Click Close.
Editing Patient Information from the Insurance Claims Queue
If you need to correct any information on the claim form, click , the shortcut menu called
Insurance Claim Actions.
51
The shortcut menu provides quick access to the following features:
• Edit Patient
• Financial Ledger
• Contract
• Edit Insurance Company
• Edit Insurance Billing Center
1. From the Insurance Claim Queue window, click the Insurance Claim Actions menu
. The menu displays.
2. Select the desired option from the following:
• Edit Patient
• Financial Ledger
• Contract
• Edit Insurance Company
• Edit Insurance Billing Center The corresponding window displays.
3. Make and save the desired change.
4. Return to the Insurance Claim Queue window.
5. Select the desired claim and click Edit Claim. The claim displays.
6. From the Claim window, click Rebuild Claim. The system updates the claim.
7. Click Save and then Close. The Insurance Claim Queue window displays. Note: From the Insurance Claim Queue window, click Reload Queue to update the content displayed on the window.
52
Editing Insurance Billing Center and Company from the Insurance Claim Queue Now you can edit insurance billing centers and insurance companies from the Insurance Queue
window by selecting an insurance claim and the hamburger menu to access the edit options for
an insurance billing center and insurance company.
Prior to this release, you could only edit an insurance billing center or insurance company from
the Home menu and selecting Companies under the People/Companies header.
1. From the Financial menu, select Insurance Claim Queue. The Insurance Claim Queue window displays.
2. Select the desired insurance claim. The insurance claim row is highlighted, and the
hamburger menu displays in the first column.
3. Click the hamburger menu. The context menu displays.
4. Do one of the following:
53
Select… The following dialog box displays…
Edit Insurance Billing Center
Edit Insurance Company
5. Make the edits and do one of the following: • If editing an insurance billing center, then click Save. • If editing an insurance company, then click Edit.
The edits are saved.
54
Adding a Manual Claim 1. From the Insurance Claim Queue window, click Add Claim. The Add Claim dialog box
displays.
2. Select the Patient.
3. Select the Insurance Plan.
4. Select the Claim Type.
5. Select the Claim Date.
6. Click Add. The new claim displays.
7. Click Close. The Insurance Claim Queue window displays. The claim is listed on the Insurance Claim Queue table.
55
Submitting a Claim 1. From the Insurance Claim Queue window, check the box next to the claim to send.
2. Do one of the following:
Are you enrolled in Change Healthcare?
Then click…
Yes Send Claims. Cloud 9 sends the selected claim to the Change Healthcare to be processed.
No Print Claims. The selected claim prints.
Viewing a Claim Status
1. From the Insurance Claim Queue window, click in the Claim Status field or use the dropdown arrow. The list of available statuses display.
2. Select the desired status.
3. Click Reload Queue. The Insurance Claim Queue table displays a list of the claims with the selected status.
Viewing the Claim Status Report As the claim is being sent to Change Healthcare, reports are being downloaded indicating the
status of past-submitted claims. You can choose to view the reports after downloading or open
the report later. If you choose to view later, be sure to view these reports within 24 hours after
submission.
56
Viewing Claim Report Immediately after Submitting Claim
1. From the Financial menu, click Insurance Claim Queue. 2. Do NOT select any claims and click Send Claims. This updates the report and the statuses
of claims in the queue.
Viewing Claim Report Later After Submitting Claim
Note: This information comes directly from Change Healthcare.
1. From the Reports menu, click Reports.
2. Select Claim Status Reports from the list, click Lookup.
3. In the From Date and To Date fields, enter the desired date range.
4. Click Search.
5. Select the File Name of the report you want to view.
6. Click OK.
Changing a Claim’s Status
1. From the Insurance Claim Queue window, check the box next to the claim that needs to have its status changed.
2. Click (Set) Status.
The Set Claims Status dialog box displays.
57
3. In the New Claims Status field, select the desired status.
Note: It is extremely important to mark a claim as Paid or Partially Paid. Marking the
submitted claim properly will help you stay on top of paid claims.
4. Click Select.
5. Click Reload Queue . The claim’s status is updated.
Correcting and Resubmitting a Rejected Claim
1. From the Insurance Claim Queue window, select Rejected from the Claim Status field.
2. Click Reload Queue . The rejected claims display on the table.
3. Select the desired rejected claim.
4. Click Edit Claim. The claim displays.
5. Make the desired changes to the claim.
58
6. Click Save. The Insurance Claim Queue displays.
7. Click Send Claims for e-filing. A Send Claims confirmation dialog box displays.
8. Click OK.
9. In the Claim Status field, select Submitted/Re-submitted. The status of the claim becomes Submitted/Re-submitted. Note: If you don’t see the claim on the table, select (All) in the Claim Status field and click Reload Queue. Since the status was changed, the original status query may not display the updated claim.
Using Claim History The Claim History window tracks the actions and associated details taken for a claim. In
addition, you can add or delete a note to provide information for future reference.
Button Description
Reload History
Add Note
Delete Note
Close (window)
59
Accessing the Claim History
1. From the Insurance Claim Queue window, select the checkbox next to the desired claim.
2. Click History. The Claim History window displays and lists the history entries.
Adding a Note
1. From the Claim History window, click Add Note .
2. Type the note in the box.
3. Click Save. The note displays on the table.
60
Deleting a Note 1. From the Claim History window, select the desired claim to delete. The row becomes
highlighted.
2. Click Delete . The Delete Note confirmation dialog box displays.
3. Click Yes. The note is removed from the table.
61
Reports Here are examples of Pedo financial reports you’ll use to manage your office:
Note: Only the Production sheet and daily close are based on posting location. All others are
patient location.
Production Sheet Pedo offices use this report to check their daily charges. Often $0 production items are posted
and need to be checked for accuracy.
62
Unallocated credits This report shows how the totals and breakdown of unallocated credits for all patients. It helps
to make it easy to find patients with credits/debits that aren't associated with an open item.
63
Unscheduled Treatment Plans This report lists patients who have treatment plans and haven’t scheduled corresponding
appointments. It also provides the ability to include patients’ unused benefits amounts.
64
Patients Needing Continuing Care This report remove patients with existing future-scheduled appointments and shows a more
accurate, shorter list of patients who actually need an appointment.
65
Patient Route Sheet
66
