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Adding Billing Codes Inside vs. Outside a Claim

Have you ever wondered what the difference between the “Add Private Billing Codes” option is versus “Add Billing Codes” inside the claim?

In short, the patient total works out to different amounts based on where the billing code is placed.

Read on for the full explanation!

Outside a Claim

If you choose to add billing codes via the Add Private Billing Codes option, Jane will set the treatment price based on the billing codes, over-riding the original price.

This option was intended to allow clinics to bill any appointment amount to insurance as they are often different than private pay amounts in the US.

Here’s how:

  • Click Add New Claim/Policy under the “Insurance Info” section of the appointment pane and choose Add Private Billing Codes.

  • Then click Add Additional Claim/Policy to add the claim:

For example, a $100 billing code has been added outside a claim to an Initial Visit that is normally priced at $75 with a Blue Cross claim with 50% coverage beneath the billing code:

Based on the billing code, the treatment price is now $100 with 50% Blue Cross coverage so the patient owes $50 if the “Patient Pays Remaining” is toggled on.

Inside a Claim

If, instead, you add the claim first with billing codes contained inside, Jane keeps the original treatment price, bills the fee codes to the insurer, and then any remaining amount to the patient.

Using the same example, the billing code is now inside the claim.

  • The original visit remains unchanged at $75.

  • Blue Cross with a $100 billing code in the claim is added with 50% coverage.

  • This means that Blue Cross is covering $50 (50% of $100) of the visit.

  • Patient owes $25.

Here’s the math:

Original Treatment Price $75 - Insured Amount $50 = Patient Total $25

As you can see, the patient total works out to different amounts based on where the billing code is placed.

Which scenario you use ultimately depends on how you want Jane to split up the bill :)

A Quick Note on the Patient Pays Remaining Toggle

Some clinics like to have a bit more control over the patient portion using the “Co-Pay” or “Deductible” fields with the “Patient Pays Remaining” option off.

​Working with the same example, a $50 Co Pay is entered with Patient Pays Remaining off.

​ You arrive at the same result with the luxury of having the words “Co-Pay” and/or “Deductible” appear on the Detailed Receipt and on the Unsubmitted Report: ​

​ Compared with a Detailed Receipt with the Patient Pays Remaining enabled and no Co-Pay entered: ​

​ As always, let us know if you have any questions!