Billing Account Overview

Summary

The program distinguishes between the physical, organizational entities with which an Occupational Health provider may have contact and the financial entities responsible for making payments for services. The first group includes employers (a company in this software), carriers, managed care organizations, TPAs and laboratories. The second includes billing accounts . Each of these types of entities is defined below. It is critical to understanding the system that you first understand the differences among these entities.

Company or Site

Company/Site refers to employers. An employer with only one site is a company in the software. An employer that has multiple sites will have each site set up as a company. For example, UPS could be a company. If UPS has 3 locations with which you are dealing, you would set up 3 companies: UPS-Location 1, UPS-Location 2, and UPS-Location 3.

For very large employers, such as a large city government, you might set up the large departments within the city as separate companies. This would enable you to run reports for that department that identify sub-units within the department. For example, if the Police Department is set up as a separate company, you could identify sub-departments within the Police Department, such as Family, Vice, Training, etc.

The program includes a table of companies, and during set-up and implementation, you will enter all your employers into this table.

Carriers and Workers' Comp TPAs

Carriers are insurance companies which you bill for either Workers Compensation or Private Practice charges. A TPA (Third Party Administrator) is an organization that administers claims for self-insured employers. You may sometimes send a claim to a TPA to bill Workers Comp charges for an employer which is self-insured. Each company record in the program can be linked to an insurance carrier or a TPA for purposes of Workers Comp billing. Each patient can be linked to one or more carriers for purposes of private insurance billing.

MCOs and Bill Review Contracts

Managed care organizations (MCO's) are organizations which manage the care of injured employees and to help reduce the costs of care. Because of the nature of the relationship, employers belonging to an MCO may receive preferred or reduced pricing, and the bills may be sent to the MCO for approval or payment. Each company record in the software can be linked to a MCO record. Furthermore, separate protocols can be set up for each MCO, and the program can use those protocols to guide aspects of the clinical visit and billing processes.

Labs and TPAs for Drug Screen Testing

Occupational Health providers frequently need to send drug screen collections and other types of tests to independent laboratories. Often, an employer will have a special contract with an independent laboratory to manage its drug tests and results. This agreement may require the provider to bill drug screens collections to the lab instead of the employer. To handle this, each company record in the program can be linked to a laboratory record. Furthermore, in the setup of employer protocols, you may designate particular services, such as drug screens, to be billed to the associated lab.

Billing Accounts

A billing account is the financial account to which you send a bill and from which you receive payment. It is the financial account which will carry the receivable while you are awaiting payment. The program includes five types of billing accounts: Employer accounts, Carrier An insurance company that pays for Workers' Comp or Private Practice bills, or an insurance company plan that pays for Workers' Comp or Private Practice bills. accounts, MCO Managed Care Organization. An organization whose purpose is to manage the care of injured employees and to help reduce the costs of care. Each employer company can belong to a MCO. Because of the nature of the relationship, employers belonging to an MCO may receive preferred or reduced pricing, and the bills may be sent to the MCO for approval or payment. Each company record in STIX can be linked to a MCO record. Furthermore, separate protocols can be set up for each MCO, and the program can use those protocols to guide aspects of the clinical visit and billing processes. accounts, contract lab A laboratory that handles certain lab work for an employer. The lab bills the employer for the work and the clinic bills the lab for the specimen collection. accounts, and Contract TPA Third party administrator that administers drug screening on behalf of an employer; not to be confused with a TPA who administers Work Comp insurance on behalf of a self-insured employer. accounts.

Typically, there will be a single organization for each billing account, and the account will have the same name and address as the organization. However, the software uses billing accounts precisely so that you have more flexibility. For instance, it is not uncommon for the billing account for a company to be a headquarters in another town. An employer with multiple sites has three options:

  • A separate billing account for each site