FAQ: Billing with Insurance
Quick answers to common questions about insurance billing workflows.
Q: What happens if the patient has insurance but it's not set up in Usystems yet?
A: You can still create an invoice for the patient, but the system won't automatically split the charges between insurance and patient responsibility. It's best to add the insurance to the patient's record first (see "Assigning insurance coverage to a patient") so that all future invoices are correctly allocated. If you've already created an invoice without insurance information, you can edit it later to add the insurance details.
Q: Can one patient have multiple insurance plans active at the same time?
A: Yes, some patients have primary and secondary insurance. Usystems allows you to register multiple insurance plans for a single patient. When creating an invoice, the system will apply the primary insurance first, then secondary insurance for any remaining balance. Specify which plan is primary when registering the insurance.
Q: What if the insurance company approves less than what I charged?
A: This is common and called a "partial payment" or "denial." When the insurance company sends their remittance advice, record the payment they approved (see "Settling with the insurance company"). The difference between what you charged and what they paid becomes the patient's responsibility. Send the patient a bill for their balance (copay, deductible, coinsurance, or denied charges).
Q: How do I know which invoices to link when recording an insurance payment?
A: The insurance company will send a remittance advice or explanation of benefits (EOB) that lists which invoices or claims they are paying for. Match the invoice numbers on the remittance advice to the invoices in Usystems, then link those invoices to the payment record. This is called reconciliation.
Q: What if a patient tells me their insurance was canceled or changed?
A: Update the patient's insurance record immediately. Edit the existing insurance entry and set an end date, then add the new insurance plan. Any invoices created after the end date will use the new insurance information. For invoices created while the old insurance was active, you may need to resubmit claims to the correct insurance company.
Q: Should I collect the patient's copay when they receive the service or after insurance processes the claim?
A: This depends on your clinic's policy. Some clinics collect copays upfront (at the time of service), while others bill the patient after insurance settles. Discuss this with your clinic manager and set a consistent policy. In Usystems, you can add the copay as a separate charge on the invoice, and you'll track whether it was collected before or after the insurance payment.
Q: Can I change the insurance coverage for an invoice that's already been created?
A: Yes, you can edit an invoice to update the insurance information, but only before you submit the claim to the insurance company. Once the claim is submitted, it's best practice to keep the original invoice as is and create a new invoice if the patient requests changes or if insurance denies charges. This preserves your audit trail.
Q: What if the patient never filed a claim and the insurance company says they don't have a record?
A: This usually means the claim submission failed or didn't reach the insurance company. Check that you have the correct insurance company name, policy number, and member ID. You may need to resubmit the claim manually or contact the insurance company's claims department. In the meantime, you can bill the patient directly for the service to keep the account current; if the insurance claim is later approved, you can refund the patient or apply a credit to future services.
Q: How long should I keep insurance claim records?
A: Keep all remittance advices, explanations of benefits, and claim submission records for at least 3–5 years. This protects you in case of audits, disputes, or if the insurance company later questions a claim. Check your local regulations or clinic policy for specific retention requirements.
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