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Courtesy Billing or Patient Pre-Pay

Courtesy Billing refers to the workflow where your patients pay at the time of service, and you as the provider submit a claim to insurance on their behalf. Patients then receive reimbursement from insurance directly. For some clinics, it’s the Goldilocks of workflows that’s hits on a sweet spot between running a cash vs. insurance practice.

On every Jane account, the insurance billing default is set to Collect from Insurance. This means that you are expecting the insurance company to pay you (the clinic) rather than send money directly to the patient. However, you do have the option to switch a purchase on your account to Patient Pre-Pay if you plan on courtesy billing.

If a purchase is set to Patient Pre-Pay, Jane will bill the patient your full cash/private fee (the sum of the procedures added to the visit) at the time of service. After accepting payment from your patient, you submit the claim to insurance on your patient’s behalf (to save them the trouble of navigating the turbulent waters of insurance billing).

We have heard slightly different requirements as to what sort of information is required for courtesy billed claims, so if you’re unsure, we’d recommend reaching out to the insurer for specifics.

There are some common trends though, so let’s dive in!

1) Insure the Visit

Get started with Patient-Pre Pay by insuring the visit as normal.

2) Accept Assignment

Next, you’ll need to view the patient’s insurance claim/policy, and confirm that Accept Assignment is set to No.

When Accept Assignment is set to No, this tells the insurance company they should send payment directly to the patient.

Note: Rules may vary depending on the insurance company. We always recommend checking with the insurance company directly for individual assignment guidelines. If payment is still sent to your clinic, you will need to contact the insurer to find out why the payment was not sent to the patient.

Here are the steps:

  1. Click the drop arrow to the right-hand side of the claim, and then select Edit Policy:

Scroll down to find Accept Assignment and set this option to No.

As mentioned earlier, some insurers have different requirements as to what information they would like as part of that submission. While “Accept Assignment” (Box 27) set to ‘no’ is very common a requirement for courtesy billing, some insurers may also want Box 12 — Patient Release of Information — set to “No”. We can toggle this field from the Policy while we are setting Accept Assignment.

3)Turn On Courtesy Billing/Patient Pre-Pay

With the policy attached to the appointment, click on the cogwheel button, and set the option to Patient Pre-Pay.

When you switch a purchase to Patient Pre-Pay, Jane will still generate an insurer invoice for the full amount of what was billed, but Jane will also push that full amount down to the patient so you can accept their payment at the time of service. Note that the full amount is passed to the patient — so if you add Allowed Amounts to the visit, they will be ignored when generating the patient invoice.

4) Submitting the Claim

Okay, so Jane has generated the insurer invoice for the visit, now what?

Well, if you’re submitting the claim on behalf of your patient, then you’ll want to generate either a paper (CMS - 1500) or electronic (EDI) file to submit to the insurer.

You can learn all about how to do that within Jane in our US Insurance Billing series:

5) Approving the Insurer Invoice

The insurer invoice that is created is just for your own tracking purposes. Once you submit the claim to insurance, it is up to you when you’d like to record the claim as Approved.

Typically, clinics will mark the claim as “Paid & Approved” once the patient has been paid by insurance.

Within the Insurance Info section in the appointment panel - you can click on the drop-down arrow within a patient’s primary policy and “Pay & Approve” the insurer invoice.

This can also be done in the patient’s profile directly, by heading into the Billing tab > click to “view” the purchase > scroll down to the primary policy > select the “Pay & Approve” option.

When you select this option, Jane won’t actually record a payment from insurance. Instead, Jane will just move it to the Approved folder.

If you courtesy bill for the majority of your insurance patients, then please reach out to our team and we can change the insurance default on your account to Patient Pre-Pay (rather than Collect from Insurance).

Alternate Workflow

There is another workflow that can be used to manage courtesy billing that some clinics prefer - by setting Coinsurance to be 100%.

This workflow has some distinct advantages (we like advantages!), especially for those clinics that do a mix of courtesy billing, and regular insurance billing (where the clinic receives payment from the insurer). Using this workflow, you won’t need to set your claims to “Patient Pre-Pay”, and you won’t need to “Pay & Approve Pre-Pay Invoice”. Let’s take a look 👀

This option ensures that when a policy is added, all charges will be passed to the patient and the insurer invoice will be indicated as “No Charge”.

All we need to do is set our Coinsurance on the visit to be 100%. You can also add the default to be 100% when Creating a Patient Policy

If you would like to collect what you know to be “Allowed” for each billing code, you can add these amounts into the Allowed Amount fields per code - which ensures that only these specific amounts will be passed to the patient.

When using this option - you will still need to manually mark the insurer invoice as Approved.

These amounts are entered per billing code, within the patient’s primary policy in the Insurance Info section of the appointment panel:

Note: When generating a receipt or statement for the patient, these charges will be indicated as Co-Insurance.

This is a great alternative, as when using the traditional Patient Pre-Pay option - Jane will pass the full billed amounts of the codes down to the patient.

We hope this helps! As always, let us know if you have any questions on this. :)