Charge Posting (Specialty Hospital) Training Guide

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1 Charge Posting (Specialty Hospital) Vision 4.3 (January 2013) Training Guide SourceMedical

2 Learning Center of Excellence Last change made: January Source Medical Solutions, Inc. All Rights Reserved. No part of these materials may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording or any information storage and retrieval system, without the express permission of Source Medical Solutions, Inc. This document is intended for use with Source Medical Solutions licensed software. Vision is a registered trademark of Source Medical Solutions, Inc. All other products or company names are used for identification purposes only and may be trademarks of their respective owners. CPT codes, descriptions, and material only are copyright 2000 American Medical Association (AMA). All rights reserved. No fee schedules, basic units, related values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Health Care Financing Administration and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liabilities attributable to or related to any use, non-use or interpretation of information contained in this product. The images, descriptions, and examples used in the documentation are illustrations only and not meant to track one patient throughout the data entry process. All patients and patient data are for illustrative purposes only and do not represent actual patients. Any reference to an actual person is purely coincidental. Material in this publication is subject to change without notice. If you detect any errors or omissions, or have comments or suggestions for changes, please the Learning Center of Excellence contact at lcoe@sourcemed.net. Source Medical Solutions, Inc. Attn: Learning Center of Excellence 866 North Main Street Ext. Wallingford, CT Fax Page 2

3 Table of Contents Vision Basics... 4 Logging In... 4 System Wide Features... 5 Charge Posting... 6 Billing Periods and Batches... 6 Billing Period Management... 6 Batch Management... 8 Additional notes regarding Batch Management... 9 Charge Review Edit a Charge Add a Charge Delete a Charge Void a Charge Submit a Charge to a Claim Charge Master and the Charge Drop Rules and Restrictions Automated and Manual Processes Automated Exception: Other Charges Manual Exception: Procedure Charges Page 3

4 Vision Basics Before we begin, there are a few basics that should be reviewed about the Vision software. Understanding these basic features will help you better understand the more complex features of the system. Logging In Logging into Vision requires a Username and Password. After double clicking on the Vision icon, you will see the above screen where your personal Username and Password are entered. After entering both the Username and Password, click Log in. Keep in mind, the Username and Password are case sensitive and the system may require a change to the Password on a periodic basis. Depending on your facility s settings, the system may or may not allow the same password to be used again. Be aware that if the Username and/or Password are repeatedly entered incorrectly or if a user has exceeded the time span for system inactivity, the account will become locked and will need to be unlocked by the system s administrator. The number of attempts a user will have when entering a password and the time span for inactivity are determined by the facility s settings. Page 4

5 System Wide Features Arrow 1: The first arrow at the top points to the software header, which displays the Source Medical software that you are currently using. You will also find the designated four letter support code for your facility. For example if your surgery center was System Test Ambulatory Surgery Center, you may see on your top row Vision TASC. You will need this four letter support code whenever you contact the Vision Support Team. Arrow 2: The second arrow points to the toolbar that list all of the general categories of the Vision system. By left clicking on any of these toolbar headers, you will see a list of specific modules in the system you can open. For example, if you were to left click on the Financial toolbar header you would find links to modules such as Charge Review or Payments & Adjustments. Arrow 3: The third arrow points towards the picture icons that are direct links to the specific modules in the Vision system. These are quick and easy ways to get to these modules if you know exactly where you want to go. For example, instead of left clicking on the Financial toolbar followed by left clicking Charge Review, you may simply left click on the Charge icon. Not all modules are accessible from the picture icons. Arrow 4: The fourth arrow points to the Vision Managers. Left clicking on any of the given managers will open that manager, which will have a number of picture icons. Like the picture icons from Arrow 3, these icons are direct links to the specific modules. Arrow 5: The fifth arrow points to the Open Windows. In the above screen, you will see that there are currently no open windows. As you open different modules in the system, a link to that open module will appear in the Open Windows box. Always be aware of what windows you have opened so that you can avoid potentially duplicating your work. Page 5

6 Charge Posting The first action in the billing process for patient accounts is posting charges to their account. Vision Specialty Hospital (Vision SH) accommodates both automated and manual processes for ensuring that appropriate charges are captured for submission to insurance companies for processing. This document guides you through the tools provided in Vision SH to address these needs. Billing Periods and Batches Billing Period Management Billing Periods are accounting periods that are used to group financial data, posted into Batches, for monthly reconciliation. If the Billing Period for the current month is not open, a new Period must be created prior to the first Charge or Payment entry for the month. Before a Billing Period can be closed during the month end process, all Batches within it must first be closed. Follow these steps to create a Billing Period: Click on Financial under the list of Managers to open the Financial Manager: Click on the Billing Period Icon: Page 6

7 Click the Create button located to the right of the list of billing periods. Answer Yes when prompted with the question Are you sure you want to add a Billing Period? The new Billing Period is added to the list with a status of Open ; Vision creates the Billing Period Description, i.e. 2013/01, automatically. Choosing to Update a billing period is the same as double clicking on the billing period. This function does not allow for edits to be made, but rather displays the Billing period s Description, Status, and Beginning and Ending A/R balances in the fields below the list. Choosing to Close a billing period locks the financial data entered in the batches associated with the selected period. A closed billing period cannot be reopened. Note: While it is generally recommended that only one Billing Period be open to avoid data entry errors, Vision allows up to 2 Billing Periods to be open at one time. Page 7

8 Batch Management Batches are sub-units within the Billing Period that are used to organize billing transactions. Source Medical recommends opening, reconciling and closing new Batches on a daily basis, organizing billing transactions into Batches by transaction type (i.e. Payment Batch), and only allowing the person who opens a batch to enter transactions using that batch. These recommendations are not required practices, but tend to result in easier management of financial data. Prior to posting Charges, a Batch for data entry must be created. Click on Financial under the list of Managers to open the Financial Manager: Click on the Batch Manager Icon: Page 8

9 Verify that the correct year and month is displayed in the Billing Periods field. Click the Create button to open a new Batch. Description Enter a meaningful description for the Batch. One suggestion for naming Batches is using the Date, Batch Type, and User s Initials, i.e PMT CD. Type Select from the drop down list. o Free Posting Allows all types of financial entries into the Batch. Free Posting Batches are accessible from the Charges, Pay/Adj, and Deposits screens. o Charges Allows only charge entries, along with any corresponding contractual adjustments and prepayments posted with those charges at the time of billing. Accessible only from the Charge Review screen. o Pay/Adj Allows Payments, Credit and Debit Adjustments, Transfers, and Refunds. Accessible only from the Payments & Adjustments screen. o Deposits Allows only Deposit (Pre-Payment) entries. Accessible only from the Deposits screen. Shared Select the radio button for Yes or No. o Yes Allows other Users to make entries into the Batch and close it. o No Only the User creating the Batch can make entries into and close the Batch. Even Users with top level security cannot enter data into or close an unshared batch of another User. Click Save. The Batch is then added to the list with a status of Open. Additional notes regarding Batch Management Batches do not need to be closed for the transactions to be posted to the account. Once a Batch has been closed, it cannot be reopened. Before closing a Billing Period during the month end process, all Batches must first be closed. Be consistent with the naming conventions for Batch Descriptions. When viewing the list of Batches or running the Batch Ledger report, the Batches are grouped by Billing Period, and then sorted alphabetically by name, not by creation date. Page 9

10 Charge Review When charges are captured for patient accounts, they are sent to the Charge Review screen. This window is accessed by clicking on the Charges icon in either the tool bar or in the Financial Manager. 1) Select the Patient and Visit whose charges you are reviewing. Use the information to the right of these selections to verify the patient and their visit status. 2) This section shows the different charges associated with the selected visit and some details pertaining to each. Sort this list by clicking on the column headers. Service date Revenue Code Charge Description CPT/HCPCS Code Modifiers #1-4 Number of Units charged Fee per unit per the CDM entry associated with that item Total Charge for the line item Whether the charge has been sent to the Claims Queue Whether the charge is marked as a non-covered charge. Charges appearing in this list may be sorted for claim presentation by high-lighting a line and using the up/down arrows to the right to move them up and down the list so long as revenue codes remain grouped together. If moving an item up or down the list results in the charge being separated from other line item(s) with the same revenue code, the charge is not moved. The order that CPT modifiers appear in is adjusted by selecting the modifier and using the left/right arrows below the list or by clicking the modifier and dragging it to the position it needs to appear in. 3) Use these buttons to manually Add new charges, Edit existing charges, Delete or Void unwanted charges, Save changes made to a charge line or modifier order, Save changes and Submit selected charges to a claim or Cancel (discard) any unsaved information and close the window. Page 10

11 Edit a Charge Information related to a charge can be edited in a limited capacity. Restrictions on edits are in place to preserve coding entered for the visit and financial information contained in closed batches and billing periods. To expose the details of a charge line and make changes to it: Check the box to the left of the charge line and then click the Edit Charge button. -or- Double click on the charge line. Editable fields are highlighted below in yellow. Batch The charge can be assigned to a new batch if process calls for it. Units The number of units billed for on a single line item. Only editable when the batch associated with the charge still has the status of open. Fee This field is only editable when the charge listed in the CMD library is set up to allow it and the batch associated with the charge still has the status of open. Revenue Code The revenue code used on insurance claims, if this number is incorrect, it is recommended that the charge listed in the CDM library be inspected for accuracy. AA and GC Accept Assignment and Generate Claim: These items are checked based on the Payer library entry for the insurance company displayed at the top of the window. GC may always be edited; AA may only be edited when the payer library indicates Sometimes for that parameter. Non-Covered Charge Indicates that this charge should be displayed in the non-covered charge column on the claim. CPT Codes and Modifiers Existing codes cannot be modified. However, the checkboxes indicate whether they are used for claim presentation. NDC Billing If the charge listed in the CDM library is a resource charge, this checkbox can be populated to include the NDC # on the bill. The NDC entered in the CDM library for the charge populates in the box. Select Override to select or enter an alternate number. Page 11

12 If any information not listed here needs to be changed, the charge needs to be deleted (see delete a charge, below) or voided (see void a charge, below) and manually re-posted (see add a charge, next) Add a Charge Non-procedure charges can be added to cases by clicking on the Add Charge button. Some examples of charges that would need to be posted manually: Any Other charges Charges for resources, perioperative rooms, and anesthesia types added to a case after the original charges were dropped Charges for rooms on outpatient visit accounts Charges posted to replace deleted or voided charges that couldn t be edited. Payment Profile The payment profile and primary payer the charge is being applied to is shown here. If this information is not accurate, it must be corrected in the registration module prior to posting charges. Batch Select the batch this charge is being saved in. The billed revenue is attached to the billing period the batch is associated with. Visit/Case Select whether the charge is associated just with the visit or if it is for services or resources rendered/used during a specific case. o Visit When selected, the DOS shows the date the patient was registered (outpatient) or admitted (inpatient) and the Provider shown is the attending provider selected in patient registration. o Case When selected, the DOS shows the date the case was performed and the Provider shown is the doctor who performed the case. Charges can only be assigned to cases with the status of performed which is set in the chart manager, typically by clinical staff. Charge Select the charge code from the list. The list can be searched by description or key and may also be filtered by type using the check boxes provided. Room Type When a room charge is selected from the list, the room type being billed must be selected. Page 12

13 Units The number of units billed for on a single line item. Fee This field is only editable when the charge listed in the CMD library is set up to allow it. Revenue Code The revenue code used on insurance claims, if this number is incorrect, it is recommended that the charge listed in the CDM library be inspected for accuracy. AA and GC Accept Assignment and Generate Claim: These items are checked based on the Payer library entry for the insurance company displayed at the top of the window. GC may always be edited; AA may only be edited when the payer library indicates Sometimes for that parameter. Non-Covered Charge Indicates that this charge should be displayed in the non-covered charge column on the claim. CPT Codes and Modifiers Existing codes cannot be modified. However, the checkboxes indicate whether they are used for claim presentation. ICD-9 Procedure and Diagnosis Codes These are populated from the coding module and are for display purposes only. NDC Billing If the charge listed in the CDM library is a resource charge, this checkbox can be populated to include the NDC # on the bill. The NDC entered in the CDM library for the charge populates in the box. Select Override to select or enter an alternate number. Delete a Charge Charges that were posted in a batch that is still open can be deleted. When a charge is deleted, there is no record of its posting. To delete a single charge, check the box to the left of the charge line and click the Delete button. To delete multiple charges at once, check the boxes next to each and click the Delete button. The following box is displayed that shows all charges that were deleted in the top section and all charges that could not be deleted because they were posted in a now closed batch in the bottom section. Page 13

14 Void a Charge Charges that were posted in a batch that is now closed, but whose billing period is still open can be voided. When a charge is voided, the charge is zeroed and marked as a voided charge. To void a single charge, check the box to the left of the charge line and click the Void button. To void multiple charges at once, check the boxes next to each and click the Void button. The following box is displayed that shows all charges that were voided in the top section and all charges that could not be voided because they were posted in a still open batch or in a now closed billing period in the bottom section. Submit a Charge to a Claim Charges are sent to a claim in one of two ways: Automatic In your Vision Specialty Hospital settings are a pair of settings, one for inpatient and another for outpatient that ask how many bill days after discharge to hold charges for. After this time period has passed, all charges for the visit are released to a claim. Any new charges posted to a visit after this are flagged as late charges and must be sent to the claim manually. Manual To manually release a charge to a claim, check the checkbox to the left of the charge line in the Charge Review window and click the Save and Submit Claim button. Late charges must be submitted this way. This function can also be used to produce a claim for a discharged visit prior to automatic submission. In either situation, a visit status must be Discharged before any claim submission can occur. Once a charge has been submitted to a claim, the column on the charge review window labeled ICQ (In Claims Queue) reads Yes for that charge. Page 14

15 Charge Master and the Charge Drop Vision uses a Charge Master to manage the fees associated with patient accounts. Charges are broken down into six categories: Anesthesia, Procedures, Rooms, Resources, Orders, and Other. With the exception of procedure charges, any of these can be posted directly to patient accounts as needed, but most charges are posted automatically using various triggers. Anesthesia, Room, Resource, and Order charges are captured by a charge drop that occurs every night at midnight. The charge drop looks at activity that occurred during the previous day and produces charges in the following instances: Performed Cases For cases marked performed the previous day, charges for any billable resources, anesthesia types and intraoperative rooms associated with those cases are applied to the appropriate patient accounts. Completed Orders For non-medication orders marked complete the previous day, charges associated with those orders are applied to the appropriate patient accounts. Dispensed Medications For medications dispensed on the previous day, charges associated with the medication in the resources library are applied to the appropriate patient accounts. Occupied Inpatient Rooms For inpatient rooms occupied at the time of the charge drop, inpatient room charges associated with those rooms are applied to the appropriate patient accounts. Procedure Charges are not subject to the charge drop and are posted immediately to patient accounts when the procedure is coded. Any Other charges are posted directly to a patient account and are not captured by any system processes. This includes (but is not limited to) charges for PACU recovery care and for resources added to a case after the charge drop has been performed for that case. Rules and Restrictions Which types of charges are eligible for automatic capture and posting to a patient account is determined based on a patient s status as an inpatient or outpatient and whether the bill being produced is global or itemized: Inpatient Global Charges for procedures, inpatient rooms, billable orders and billable resources with the option Bill with global fee checked to yes. Inpatient Itemized Charges for intraoperative and inpatient rooms, anesthesia, billable resources and billable orders associated with the visit. Outpatient Global Charges for procedures, billable orders and billable resources with the option Bill with global fee checked to yes. Outpatient Itemized Charges for anesthesia, billable resources and billable orders associated with the visit. Page 15

16 Automated and Manual Processes Automated For VisionSH to help automate portions of the charge posting process, Charge Codes created in the CDM library must be attached to the items they are related to in their respective libraries. As an example, for a charge to be automatically generated by the charge drop for an implant, the charge code must be created in the CDM library, the implant must be created in the resource library and the two must be linked by selecting the charge code from the list presented in the resource library. Any item that does not have a charge code associated with it cannot also have a charge produced on the patient account using an automated process. This is true for all charge types (Orders, Resources, Procedures, Rooms and Anesthesia Types). Exception: Other Charges Other charges can only be posted via a manual process. Unlike the other charge types, they cannot be associated with any other library entry. Manual Charges may be posted manually with the exception of procedure charges, which must flow from coding activity. If there are any items or services which are more conveniently charged for manually, the automatic posting of charges for that item can be avoided simply by not attaching a charge code to the item s library entry. Exception: Procedure Charges Procedure charges can ONLY be produced via automated processes. While not dictated by the charge drop, procedure charges can only be produced when a CPT is coded to the visit. A charge is then produced based on the charge code selected for that CPT in the procedures library. Failure to link the appropriate charge to a procedure results in a missing line on the bill as there is no way to manually post the charge. Page 16