EOP Summary

As was stated in the EOP chapter, when the payer pays the provider, the provider is informed which procedures are being paid with a statement called an "Explanation of Payments" or "EOP". The TFM EOP Summary dialog displays the EOP information. The EOP Summary dialog is used to enter new EOPs and for viewing existing EOPs.

Start a New EOP

There are two ways to enter a new EOP. First option, select the New button in the Find EOP dialog as we discussed in the previous chapter. The second option is to select the New button, shown in the image, in the toolbar under EOP. Either selection will cause a blank EOP Summary dialog to appear. The steps taken to fill-in the Enter New EOP are discussed in a later section.

EOP Summary Dialog

As shown in the image above, the TFM EOP Summary dialog contains all of the information from an EOP. TFM displays this information in two different sections, Payer Information and Payments. There is also is a section of the dialog for control buttons. Each of the dialog sections is discussed below.

Payer Information

This section of the EOP Summary dialog captures the Payer payment information. There are several fields that must be filled-in and they are marked with a red "*". The fields are:

• Payer* - a required field; This is a popup list containing the configured names of Payers. This may also be an insurance clearing house like PPOM. Where the claim is submitted to the clearinghouse but the payment comes for a third party, refer to 3rd Party Payer below.
• Payment Number* - a required field; This is a text field were the payment number is recorded. This could be a check number or an automatic deposit number.
• Payment Date* - a required field; This is a date associated with this EOP payment. You must pick one of multiple dates for this field then be consistent on subsequent entries. You can enter the date this information is entered into TFM. Other options include the check date or the date the payment is deposited in the bank. It is important to be consistent with this date.
• Payment Amount* - a required field; This is the total amount paid for this EOP.
• 3rd Party Payer - As described in the Payer field description above, if a claim is sent to an insurance clearing house like PPOM and the payment comes from a third party, you can select the third party payer in this popup. Note: the third party payer must be one of the configured payers to appear in this popup.
• Method* - a required field; There are two options for method of payment, Check or Direct Deposit.
• Type* - a required field; There are two options for type of payment, Fee for Service or Capitation.
• Payer Payment Notes - a free form text field for you to enter any other information about this payment.

In the example above, the image shows all of the fields in a light gray color that is because these fields are not editable. They remain that way until you select the Edit button, then you may edit these fields. You will also notice that the Record and Cancel buttons are grayed out. This is because they are only active when the fields are editable.

When the EOP Summary dialog is displayed to enter a new EOP, all of the fields are editable by default and the Record and Cancel buttons are selectable.

NOTE: When the Payer Information fields are editable and all fields are correct, either the Record or Cancel buttons must be selected before the remainder of the dialog can be accessed.

Payments

This section of the EOP Summary dialog displays the procedure payments that have been recorded. There can be one or more procedure payments from one or more patient encounters on a single EOP. All of the payments appear in the payments table in this dialog.

The fields of the payment table are:

• Patient - the name of the patient that received the procedure
• Code - the procedure code number
• Charge - the practice's stated charge for the procedure
• Adjust - payer designated adjustment to the Charge
• Allow - the payer designated amount allowed to Charge for this procedure.
  (Allow = Charge - Adjust)
• W/hold - payer designated withhold
• Paid - the amount paid for this procedure by the payer.
  ( Paid = Allow - withhold - deductible - co-ins - co-pay)
• Deduct - the amount the payer indicates the patient owes to satisfy the contract deductible
• Co-Ins - the amount paid by another payer
• Co-Pay - the amount the payer indicates the patient owes to satisfy the contract

If the total of all procedure payment paid fields is equal to the EOP Amount then the EOP is balanced. TFM indicates the state of the EOP in red just below the payment table. In this example, the EOP is balanced and is shown with PAYMENT BALANCED.

Next to the PAYMENT BALANCED indicator is the TOTAL PAID amount. This total is the total of all the currently entered payments. The value is a total of all the amounts in the Paid column of the table.

One last characteristic about this section of the EOP Summary dialog is the Delete button to the right of the table. The Delete button as shown in the image is not active because there isn't a payment selected in the table. When a payment is selected it will be highlighted in yellow and the Delete button to be active. When you select the Delete button, the currently selected payment will be removed from the database and the Total Paid amount will be adjusted.

Buttons

This section of the EOP Summary dialog provides buttons to access to the dialogs used to enter and edit payments. These buttons are:

• Enter New Payment - selecting this button will open a dialog used to enter a new procedure payment that was paid on this EOP. (see the next section for details)
• Edit Selected Payment - selecting this button after selecting a payment in the Payment table will open an edit dialog. Another way to edit an existing payment is to double-click a payment in the table. (see section describing the edit dialog)
• Finished - selecting this button means that you are finished working with this EOP. The dialog is closed.

Report

There is one more feature provided by TFM through the EOP Summary dialog. The current EOP data can be written to a PDF report. This is accomplished by selecting the PDFdoc menu item under the File menu of this dialog. This selection will write a PDF document in the Reports directory that has been specified in the TFM preferences. The filename will be constructed as a combination of the payer-name and the string "_EOP_Summary.pdf". In the example in this chapter, the report filename would be "HAP_EOP_Summary.pdf"

Note: if you are going to produce multiple EOP PDF reports for the same payer, you will need to edit the file name or the previous file will be over-written.