Success Guide for Billers (Fusion)

Use the short videos and links to help articles in this Success Guide for an introduction to the Billing tab, where billers spend most of their time in Fusion. Billers will use the billing tab to submit claims, process remittances, and manage patient accounts. 

Videos include chapters to help you quickly find the information most important to you. Click the Open Chapters icon in the lower right of each video to view and select available chapters. 

 

The Claim List

Billing successfully in Fusion requires an understanding of how claims are organized and processed in Fusion. For an introduction to claims, check out the video below.

Billing: Management

Before you begin submitting claims, it's important to understand how claims are organized and processed in Fusion, how to create and review claims, and how to troubleshoot claim rejections.  

• Understand how to Navigate and Filter the Claim List: The Claim List is where all clinic claims are located and organized according to where they are in the claim process. 
• Review the Claim Lifecycle: Claims are submitted, received by insurance, paid and finalized to a patient account. 
• Create a Claim: Claims can either be created automatically when charges are submitted from a daily note or manually after a daily note has been signed.
• Review a Claim: Always review your claims before printing or sending them electronically to a payer to make sure the information is correct.
• Revise a Claim: If you need to make changes to a claim that's already been finalized, you must revise the claim first.
• Return a Claim to the Therapist: If you need to change something about a claim that appears on the daily note, such as billing codes or units, you can return the claim to the therapist, which allows the therapist to update the daily note.
• Correct a Rejected Claim: When you submit a claim electronically through Fusion, the clearinghouse or payer may reject the claim, indicating that something about the claim was invalid and could not be processed. If this happens, you can correct the claim's information and resubmit it through Fusion.
• Refresh a Claim: Refreshing a claim resets any fields you've made changes to, copies current information into each field, and runs claim rules again.
• Set up Claim Rules: Claim rules provide a way to automatically change the information that appears on a claim.
• Contact the Enrollments Team to start the ERA Enrollment Process: You can check the status of the ticket that was created when you competed the New Payer Enrollment form, or email [e-mail].

Billing: Claim Reconciliation & Account Management

Most of the time, Fusion receives remittances electronically. It's also important to understand this process and know how to manually create and balance EOBs in Fusion. 

• Process Electronic Remits: When you receive electronic remits from a payer through Fusion, you can review the payments that were made and then finalize each claim to the next payer or to the billing account.
• Post a Manual Remit: When you receive remittance advice from a payer outside of Fusion, you'll need to record that information in Fusion so you can finalize its claims to the next payer or to the billing account.
• Navigate and Manage a Patient's Billing Account: Billing Accounts are where you will track and manage what patients or a third party owe.
• Add a Non-Patient Billing Account: If a third party will be paying the amount owed by a patient after the claim process, you can create a non-patient billing account to record those payments and keep track of how much is still owed.
• Transfer a Line to Another Account: Transfer a charge or credit from one billing account to another. 
• Redirect a Billing Account's Charges: Set up a patient's billing account to automatically redirect to another billing account. 
• Crossover Claims: Handle crossover claims within Fusion. 
• Create an Invoice: Use an invoice to create a list of charges owed by a client and the payments the client has made toward those charges.
• Email an Invoice: Email an invoice through Fusion. The email recipient will see a summary of the invoice and have a link to view the full invoice online. Clinics enrolled in payment processing can also allow clients to pay the invoice online. 
• Fax an Invoice: Fax an invoice through Fusion.
• Print an Invoice: Print an invoice from Fusion.
• Print a Statement: Print a statement for a client with a list of their charges and credits for a period of time and their account balance as of the end of that period.