BILLING AND ACCOUNTS RECEIVABLE (BAR)

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1 UC SF Medical Center BILLING AND ACCOUNTS RECEIVABLE (BAR) IT Systems Training

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3 Table of Contents Table of Contents Overview...1 DESCRIPTION...1 DEFINITION...1 OBJECTIVES...1 POLICY...2 Accounting Terms...3 ADMINISTRATIVE WRITE OFF...3 BATCH...3 CREDIT...3 DEBIT...3 ACCOUNT BALANCE...3 STATEMENT BALANCE...3 Accounting Terms...4 CLAIMS/CHARGES...4 STATEMENT TYPES...5 EOMB/RA...5 FINANCIAL STATUS CLASSIFICATION (FSC)...5 ELECTRONIC REMITTANCE ADVICE (ERA)...5 Navigating BAR...6 LOGGING INTO IDX...6 NAVIGATING BAR...7 BAR INQUIRY...8 BAR Inquiry...9 Navigating BAR One Page Reference Guide...10 Dictionary Inquiry...11 ACCESSING THE DICTIONARY FUNCTION...11 Action Codes...12 VIEWING AN ACTION CODES...12 CHOOSING AN ACTION CODE...12 Payment Posting...15 TO POST A PAYMENT ON THE PAYMENT POSTING SCREEN:...15 LOGGING INTO THE POST RECEIPTS SCREEN...15 CREATE A BATCH:...16 IT Systems Training i January 26, 2005

4 Table of Contents Table of Contents Rejection Posting...25 TO POST A REJECTION ON THE PAYMENT POSTING SCREEN:...25 LOGGING INTO THE POST RECEIPTS SCREEN...25 CREATE A BATCH:...26 TO ACCESS YOUR PATIENT AND INVOICE:...28 TO POST A REJECTION ON THE PAYMENT POSTING SCREEN (UR54.B):...32 Deleting a Transaction...35 DELETING TRANSACTION(S) IN THE PAYMENT POSTING BATCH:...35 TO DELETE A TRANSACTION:...35 TO DELETE ALL LINE POSTINGS FOR A TRANSACTION:...36 TO DELETE INDIVIDUAL LINE POSTING FOR A TRANSACTION:...37 How to Change a FSC...38 WHAT IS A FSC<?>...38 CHANGING A FSC:...38 CHANGING A FSC CODE ON THE POST RECEIPTS SCREEN (UR54.A):...39 Exiting a Batch...45 EXITING THE POST RECEIPTS BATCH:...45 Printing a Batch...46 PRINTING A POST RECEIPTS BATCH:...46 Insurance Verification Procedures for MGBS, Per-Sé and Patient Financial Services...50 DESCRIPTION...50 PURPOSE...50 Insurance Verification Screen...51 Required Insurance Verification Screen Fields...53 INSURANCE EFFECTIVE DATE...53 INSURANCE EXPIRATION DATE...53 BENEFIT STATUS (BS)...53 CERT REQUIRED<?>...53 CERT RECEIVED<?>...53 IT Systems Training ii January 26, 2005

5 Table of Contents Table of Contents Critical Registration Level Follow up (F/U) Questions...55 SPECIAL ACCOUNT CATEGORY...56 PRO-FEE AUTH NUMBER...56 HOSP AUTH NUMBER...56 Index...57 IT Systems Training iii January 26, 2005

6 Overview Overview Description This course is designed to provide a basic overview of IDX Billing and Accounts Receivable (BAR). In this workshop, the trainer guides participants through the procedures for processing charges and payments, producing statements, claim forms and system reports. In addition, trainers provide participants with hands-on exercises to reinforce the learning experience. Definition BAR Billing and Accounts Receivable An Application within IDX that allows users to: View services, charges, payments and adjustments (located on an invoice) Process charges and payments Produce statements claim forms and system reports View dictionaries (FSC, Provider, Billing Area, and Referring Physician) Objectives At the end of the training session, participants will be able to: Section 1 Define Billing and Account Receivables terms and policies Navigate through function and activity screens (Bar Inquiry) View dictionaries (FSC, Provider, Billing Area, and Referring MD) Section 2 Review and process BAR invoices, including posting or transferring: Rejection codes Payments Credits Update insurance plan information Print: Batches IT Systems Training 1 January 26, 2005

7 Overview Overview Policy When patients receive services at UCSF, the practices generate an encounter form that specifies the patient s diagnosis and services received. Staff enters the charges into IDX to generate a claim form that is forwarded to the insurance company or medical group. Depending on the type of charge (pro-fee or hospital), IDX extracts the charges into BAR or SMS. Account Representatives use the BAR application to work outstanding accounts until the balance owed to the institution is zero. The Follow Up Representatives are responsible for: 1. Responding to patient inquiries regarding their accounts, including balance inquiries, request for copies of bills, and payment arrangements. 2. Reviewing E.O.Bs from insurance companies and reworking outstanding accounts, including updating insurance information and posting adjustments, payments, and rejections to accounts. 3. Responding to insurance company requests for claim information including request for copies of medical records. 4. Accessing and doing following up on assigned work files. Clinic staff use the BAR application to respond to patient inquiries regarding their accounts, including payment arrangements, balance inquiries, and request for copies of bills. IT Systems Training 2 January 26, 2005

8 Accounting Terms Accounting Terms Term Administrative Write Off Batch Credit Debit Account Balance Statement Balance Definition An account adjustment that represents the amount the institution is unable to collect due either to billing policy or institutional error. This may only be done when requested by a management decision. A quantity of like or similar objects considered as a group. I.E.: Payment Postings, Rejections, Adjustments, Co-pay transfers. The negative (-) balance remaining on an account. Posting a credit to a patient s bill reduces the amount owed on the account. Example: Posting payments from patient Posting payments from an insurance company Posting adjustment(s) (Originally incorrectly applied/posted to the account). Posting adjustment(s) (Originally not applied/posted to the account). The positive (+) balance remaining on an account. Posting a debit to patient s bill increases the amount owed on the account. Example: Posting charges (for services rendered) to the patients account The total outstanding balance on an account (includes patient and insurance liability) The total outstanding balance on an account (includes patient liability only) Continued on next page IT Systems Training 3 January 26, 2005

9 Accounting Terms Accounting Terms Term Claims/Charges Definition A statement generated by the health care provider outlining services provided to the patient. There are two types of claims/charges: 1. Professional Fee (Pro Fee) The professional component or fee for a procedure that represents a physician s work. 2. Hospital Charges submitted by the facility that represent services provided within each department/facility. Professional Fee (Pro Fee) HCFA 1500 Physician charges, including: Office visit Hospital visit Consultation Radiologist (reading film) Hospital Fee (Tech) UB 92 Facility charges, including: Inpatient admissions Radiology Technician Exam rooms Hospital/facility supplies How the Pro-Fee charges are billed How the hospital/facility charges are billed Continued on next page IT Systems Training 4 January 26, 2005

10 Accounting Terms Accounting Terms Term Definition Statement Types These include: EOB Patient statement EOMB/RA Financial Status Classification (FSC) Electronic Remittance Advice (ERA) A form sent to the patient and/or service provider advising of: Services provided Charges billed/considered Contracted amount/negotiated rate Patient liability (if any) Amount paid by insurance company. A code used to group similar types of Payers or large individual Payer types. These codes are used to Identify and collect billing and follow up information Determine if the insurance company or patient should be billed Determine if the patient is liable for balance or copayments Track billing and collection activity on financial reports An electronic notification advising of the services provided, charges billed and amount paid, denied, or adjusted by the insurance company. (Medicare, Medi- Cal, or Commercial Insurance) IT Systems Training 5 January 26, 2005

11 Navigating BAR Navigating BAR Logging into IDX 1) Access the PACE program from your desktop computer screen. 2) Select Option 4 -- Training Bar, Organization 3, Group 3 to access the BAR training environment. 3) At the Select function prompt, enter a <?> to see a list of options. Refer to the screen display and select Function 7, Invoice Inquiry. IT Systems Training 6 January 26, 2005

12 Navigating BAR Navigating BAR Navigating BAR 4) At the Patient Name prompt, type the patient s name and press enter. Note: Always use the appropriate naming convention method to select the correct patient account. 5) Locate the patient and enter S to select the patient. PATIENT S NAME PATIENT S NAME *NOTE: ALWAYS USE ALL CAPITAL LETTERS WHEN ENTERING/UPDATING INFORMATION IN BAR. IT Systems Training 7 January 26, 2005

7) Press enter again and screen displays: a) Patient s employer address and phone numbers b) History of

13 Navigating BAR Navigating BAR Bar Inquiry 6) Verify the patient s identification information. Screen displays: a) Social Security number and Date of birth. 7) Press enter again and screen displays: a) Patient s employer address and phone numbers b) History of insurance information (including FSC) c) Registration date 8) Press enter again and screen displays: a) Current statement balance b) Last patient payment IT Systems Training 8 January 26, 2005

All invoices (Including non-zero balance invoices).

14 Navigating BAR Navigating BAR BAR Inquiry 9) Press enter and the screen prompts Invoice. Type a <?> for a listing of the invoices attached to the patient s account. All invoices (Including non-zero balance invoices). Use Action Code B (toggle) to view Non-zero balance invoices only. Use Action Code E (toggle) to view Non Expanded/Contract invoices only. IT Systems Training 9 January 26, 2005

15 Navigating BAR Navigating BAR One Page Reference Guide To Look for... Do this... Date of Birth Medical Record number Social security number Group number FSC number Patient s address Employer address Current Statement balance Last Patient payment Adjustments Admission date Balance Batch number Billing area Billing provider Charges CPT Code/Procedure Diagnosis 1 Description of diagnosis Balance Billing area Charges/Total charges FSC Hospital Patient payments Posting dates Patient s phone number Registration dates Subscriber ID number Cert/Policy number Discharge date Discount Hospital Invoice FSC Location Payments Posting date Procedure/CPT Code Referring physician Rejection code Service date Service description Invoice number Location Physician Service date Visit number Insurance payments (per invoice number) Patient payments (per invoice number) Total balance Contractual adjustment Description (of service) Detailed adjudication (pg 2) Insurance payment Posted amount Billing Physician (full) Claim FSC Claim number Diagnosis 1 to 10 (pg 3) Division Admitting physician Attending physician Chief complaint Posting date Procedure code Procedure Description (pg 2) Rej. Code Description (pg 2) Service date Service Description Patient Type Rejection codes (pg 2) TES Batch number TES Encounter TES FSC Referring provider (detail) Primary provider At the Select Function prompt, select 7, Invoice Inquiry. Enter patient s name and select the patient. At the Select Function prompt, select 7, Invoice Inquiry. Enter patient s name and select the patient and press enter (once). At the Select Function prompt, select 7, Invoice Inquiry. Enter patient s name and select the patient and press enter (twice) At the Invoice prompt, enter a <?> and press enter. Select the correct invoice number and select D (view detail). At the Invoice prompt, enter a <?> and press enter. At the Invoice prompt, enter a <?>, Select the correct invoice number, select T (More actions), and P (Patient Account Summary) At the Invoice prompt, enter a <?> and press enter. Select the correct invoice number, Select T (More actions), P (Patient Summary), and V (View payments). At the Invoice prompt, enter a <?> and press enter. Select the correct invoice number, select D (View detail) and T (Transaction detail) At the Invoice prompt, enter a <?> and press enter. Select the correct invoice number, select D (View detail), and M (More Invoice Header) At the Invoice prompt, enter a <?> and press enter. Select the correct invoice number, and Select D (View detail), and V (Visit information) IT Systems Training 10 January 26, 2005

16 Dictionary Inquiry Dictionary Inquiry Dictionary Inquiry is a reference tool within IDX that stores specific data. The four dictionaries that account representatives use most often include: 1. Financial Status Classification (FSC) 2. Provider 3. Billing Area 4. Referring Physician Accessing the Dictionary Function At the Invoice prompt, enter a <?>, select the appropriate invoice and select D (View detail) and I (More Inquiries) and D (Dictionary Inquiry) Dictionary Name/# Financial Status Classification Dictionary # 19 Provider (physicians) Dictionary # 3 (see note below) Billing Area Dictionary # 202 Referring Physician Dictionary # 123 (See note below) Displays Claim form information for the FSC Reporting category Patient or insurance liability FSC (determination) Provider division Blue Shield, Medi-Cal and Medicare billing numbers State License number UPIN numbers Office phone number and address Description of Bill Area UPIN numbers License number SMS referring number Note: The physician s name valuing the Attending Provider field is invalid. The physician listed is a Resident or is not currently listed in the Attending Provider dictionary with a PIN#. Contact Michael De Lane in the Medical Staff Office (MSO) at (415) to have the physician added to the dictionary. Press <F10> or <F7-Q> to exit the Dictionary Inquiry Function. IT Systems Training 11 January 26, 2005

17 Action Codes Action Codes Action Codes This section describes the most commonly used Action Codes and how they are accessed through the Post Receipts Screen (Function 4) within the BAR System. These actions include: Inquiry Posting payments/rejections General and Financial Comments Batch Maintenance/Printing Viewing an Action Codes Enter a <<?>>at the Action prompt on the Post Receipts Screen and press enter. Choosing an Action Code Enter the number of the action code at the Which of these is the entry<?> field. Press enter. The system displays the alpha code in the Action Field. Press F10. OR Enter the alpha code directly in the Action Field. Press F10. IT Systems Training 12 January 26, 2005

Action Codes Action Codes Action Codes continued: Action Codes and their functions: Action Code Delete Transactions (D) Exit Batch (X) Financial Comments (F) General Comments (G) Hold Batch (H)

18 Action Codes Action Codes Action Codes continued: Action Codes and their functions: Action Code Delete Transactions (D) Exit Batch (X) Financial Comments (F) General Comments (G) Hold Batch (H) Inquiry (Q) Function Allows posted transactions to be deleted. Transactions cannot be deleted after function code (X) Exit Batch has been completed. Exits and closes your batch. The batch cannot be reopened. Displays the Financial Comments Screen for updating or viewing Displays the General Comments Screen for updating or viewing Puts the batch on hold. To recall the batch by entering the batch number in the Batch Field. Displays the Invoice Inquiry Screen (ARII.A) to view a patient s invoices. Enter the number of the action code at the Which of these is the entry<?> field. Press enter. The system displays the alpha code in the Action Field. Press F10. OR Enter the alpha code directly in the Action Field. Press F10. IT Systems Training 13 January 26, 2005

19 Action Codes Action Codes Action Codes and their functions: Action Code Post Receipt (O)* Print Batch Proof (L) Statement Message (S) Temporarily Exit Batch (T) Function Displays the Post Receipts Screen (UR54.A). Allows posting of payments, rejections, transfers, adjustments, and FSC changes. *The system automatically defaults to this function. Displays the set up print set up screen. Prints an open/closed batch at a selected printer. Displays the Statement Screen. Generates a specific statement message to a patient. Temporarily exits the batch and returns the Select Function Prompt. To recall the batch: Select Function 4 (Post Receipts). Press enter. Enter the number of the action code at the Which of these is the entry<?> field. Press enter. The system displays the alpha code in the Action Field. Press F10. OR Enter the alpha code directly in the Action Field. Press F10. IT Systems Training 14 January 26, 2005

20 Payment Posting Payment Posting To post a Payment on the Payment Posting Screen: Logging into the Post 1. Access the PACE program from your desktop computer screen. 2. Select Option 4 Training Bar, Organization 3, Group 3 to access the BAR training environment. Receipts Screen 3. At the Select function prompt, enter a <?> to see a list of options. Refer to the screen display below and select Function 4, Post Receipts. IT Systems Training 15 January 26, 2005

21 Payment Posting Payment Posting To post a Payment on the Payment Posting Screen continued: The system displays the Post Receipts Screen (ARPH.A). DESCRIPTION BATCH NUMBER TODAY S DATE CONTROL ACTION Create a Batch: Data Field Action Batch Enter <G> to generate a batch number. Press <enter>. Bank Dep Dt Enter <T> for today s date. Description Enter your name and a description of the function you are performing. This will vary by department and task. Control Enter Difference The system automatically completes. Press enter 4 times until the cursor displays the Action Field. Action The system displays the letter O. Press F10 to enter the Post Receipts Screen (UR54.A). IT Systems Training 16 January 26, 2005

22 Payment Posting Payment Posting Example of a completed Post Receipts Screen (ARPH.A) DESCRIPTION BATCH NUMBER TODAY S DATE CONTROL ACTION Note: Enter a <?> at the Action Field to display the available actions. IT Systems Training 17 January 26, 2005

23 Payment Posting Payment Posting Payment Posting Screen (UR54.A) 1. At the Patient Name prompt, type the patient s name and press enter. Note: Always use the appropriate naming convention method to select the correct patient account. 2. Locate the patient and enter S to select the patient. Press enter. 3. Type a <?> at the Invoice field for a listing of the invoices attached to the patient s account. Select the invoice. Press enter. OR 4. The user can enter the Invoice Number at the Patient Field Prompt and press enter. OR 5. You can use R/N to recall the same patient and enter a <?> at the invoice prompt to select the correct invoice. SELECT THE PATIENT'S NAME OR ENTER THE INVOICE NUMBER OR ENTER R/N TO RECALL THE SAME PATIENT IT Systems Training 18 January 26, 2005

Payment Posting Payment Posting To access the Payment Posting Screen (UR54.A) continued: 6. Enter a <?> in the Code Field to view the Payment Posting Options.

24 Payment Posting Payment Posting To access the Payment Posting Screen (UR54.A) continued: 6. Enter a <?> in the Code Field to view the Payment Posting Options. Press enter to page through the Post Code Options. When the appropriate Option displays enter the number in the "Which of these is the entry<?>" prompt and press enter. Example: To choose insurance payment enter a <?> at the Code Field and press enter seven times, select 4 (INSURANCE PAYMENT) and press enter. WHICH OF THESE IS THE ENTRY PROMPT BE SURE TO ALWAYS USE THE CORRECT PAYMENT CODE FOR YOUR TRANSACTION. IT Systems Training 19 January 26, 2005

25 Payment Posting Payment Posting 7. The user may also enter a letter or a few letters of the Payment Posting Code type. Example: Enter I, IN, or INS to display the Insurance Payment Posting Codes. Select 2 and press enter. ENTER "INS" IN THE CODE FIELD OR 8. If you know the Payment Code you can enter it in the Code Field and press enter. BE SURE TO ALWAYS USE THE CORRECT PAYMENT CODE FOR YOUR TRANSACTION. IT Systems Training 20 January 26, 2005

Payment Posting Payment Posting To access the Payment Posting Screen (UR54.A) continued: The system displays the payment code. The LI (Line Item) field defaults to Y (YES).

26 Payment Posting Payment Posting To access the Payment Posting Screen (UR54.A) continued: The system displays the payment code. The LI (Line Item) field defaults to Y (YES). PRESS ENTER. LINE ITEM BROWN AND TOLAND COMMERCIAL FSC SELF PAY AFTER BROWN AND TOLAND FSC DO NOT PRESS <F10> OR THE PAYMENT WILL POST IT Systems Training 21 January 26, 2005

27 Payment Posting Payment Posting Posting a payment on the Payment Posting Screen (UR54.B) Data Field Post Apprvd (Approved) Ded/Coi (Deductible/Coinsurance) Pmt (Payment) Contra/Adj (Contractual Adjustment) Rej (Reject) Com (Comments) Msg (Message) Action Change <N> to <Y>. Press <enter>. Complete the approved amount. Press <enter>. Complete the patient s deductible or co-payment amount. Press <enter>. The system displays the next three fields. If applicable, enter the appropriate amount for each data field. Press <enter>. Complete a comment for the posted charge. Press <enter>. Enter the alpha code or a <?> to select a Message. Press <enter>. CONTRA/ADJ FIELD POST FIELD APPROVED AMOUNT DED/COI FIELD MESSAGE FIELD COMMENT FIELD IT Systems Training 22 January 26, 2005

Payment Posting Payment posting To post a payment on the Payment Posting Screen (UR54.B) continued: The system redisplays the Post Receipts Screen (UR54.

28 Payment Posting Payment posting To post a payment on the Payment Posting Screen (UR54.B) continued: The system redisplays the Post Receipts Screen (UR54.A) for final review before the user completes the Payment Posting The cursor moves to the FSC Field. Data Field Additional Transactions Action Displays: The FSC code 70 (FSC change), the dollar amount of the change, if a claim is being demanded, the dollar amount of the Patient s liability, and the new FSC code. Press F10 to complete the Payment Posting The system displays a blank Post Receipts Screen (UR54.A). Press F7 Q The system displays the Post Receipts Screen (ARPH.A). Enter a <Q> in the Action Field and press F10 to access the Invoice Inquiry Screen (ARII.A). IT Systems Training 23 January 26, 2005

The system displays the new FSC and Patient Balance.

29 Payment Posting Payment Posting Invoice Inquiry Screen (ARII.A): Enter R/N at the Patient prompt. Press enter. Put a <?> at the invoice prompt and press enter to locate the correct invoice. The system displays the new FSC and Patient Balance. NEW FSC NEW PT BALANCE Select the invoice and press D (View Detail) to see a detail of the payment posting. PAYMENT FSC CHANGE CONTRACTUAL ADJUSTMENT IT Systems Training 24 January 26, 2005

30 Rejection Posting Rejection Posting To post a Rejection on the Payment PostingScreen: Logging into the Post 1. Access the PACE program from your desktop computer screen. 2. Select Option 4 Training Bar, Organization 3, Group 3 to access the BAR training environment. Receipts Screen 3. At the Select function prompt, enter a <?> to see a list of options. Refer to the screen display below and select Function 4, Post Receipts. IT Systems Training 25 January 26, 2005

31 Rejection Posting Rejection Posting To post a Rejection on the Payment Posting Screen continued: The system displays the Post Receipts Screen (ARPH.A). DESCRIPTION BATCH NUMBER TODAY S DATE CONTROL ACTION Create a Batch: Data Field Action Batch Enter <G> to generate a batch number. Press <enter>. Bank Dep Dt Enter <T> for today s date. Description Enter your name and a description of the function you are performing. This will vary by department and task. Control Enter Difference The system automatically completes. Press enter 4 times until the cursor displays the Action Field. Action The system displays the letter O. Press F10 to enter the Post Receipts Screen (UR54.A). IT Systems Training 26 January 26, 2005

32 Rejection Posting Rejection Posting To post a Rejection on the Payment Posting Screen: Example: DESCRIPTION BATCH NUMBER TODAY S DATE CONTROL ACTION Note: Enter a <?> at the Action Field to display the available functions. IT Systems Training 27 January 26, 2005

33 Rejection Posting Rejection Posting To access your patient and invoice: 1. At the Patient Name prompt, type the patient s name and press enter. Note: Always use the appropriate naming convention method to select the correct patient account. 2. Locate the patient and enter <S> to select the patient. Press enter. 3. Type a <<?>> at the Invoice field for a listing of the invoices attached to the patient s account. Select the invoice. Press enter. OR 4. You can use the invoice number at the patient field prompt. OR 5. You can use R/N to recall the same patient and enter a <?> at the invoice prompt to select the correct invoice. SELECT THE PATIENT'S NAME OR ENTER THE INVOICE NUMBER OR ENTER R/N TO RECALL THE SAME PATIENT IT Systems Training 28 January 26, 2005

34 Rejection Posting Rejection Posting To access the Payment Posting Screen (UR54.A) continued: 6. Enter a <?> in the Code Field to view the Payment Posting Options. Press enter to page through the Post Code Options. When the appropriate Option displays enter the number in the Which of these is the entry<?> prompt and press enter. Example: To choose insurance payment enter a <?> at the Code Field press enter seven times, select 4 and press enter. WHICH OF THESE IS THE ENTRY PROMPT BE SURE TO ALWAYS USE THE CORRECT PAYMENT CODE FOR YOUR TRANSACTION. IT Systems Training 29 January 26, 2005

Rejection Posting Rejection Posting To access the Payment Posting Screen (UR54.A) continued: 7. The user may also enter a letter or a few letters of the Payment Posting Code type.

35 Rejection Posting Rejection Posting To access the Payment Posting Screen (UR54.A) continued: 7. The user may also enter a letter or a few letters of the Payment Posting Code type. Example: Enter I, IN, or INS to display the Insurance Payment Posting Codes. Select 2 and press enter. ENTER "INS" IN THE CODE FIELD 8. If you know the payment code you can enter it in the Code Field and press enter. OR BE SURE TO ALWAYS USE THE CORRECT PAYMENT CODE FOR YOUR TRANSACTION. IT Systems Training 30 January 26, 2005

36 Rejection Posting Rejection Posting To access the Payment Posting Screen (UR54.A) continued: The system displays the payment code. The LI (Line Item) field defaults to Y (YES). PRESS ENTER. LINE ITEM BROWN AND TOLAND COMMERCIAL FSC SELF PAY AFTER BROWN AND TOLAND FSC DO NOT PRESS F10 OR THE PAYMENT WILL POST IT Systems Training 31 January 26, 2005

Rejection Posting Rejection Posting To post a rejection on the Payment Posting Screen (UR54.B): Data Field Post Apprvd (Approved) Rej (Reject) Action Change N to Y. Press enter.

37 Rejection Posting Rejection Posting To post a rejection on the Payment Posting Screen (UR54.B): Data Field Post Apprvd (Approved) Rej (Reject) Action Change N to Y. Press enter. Complete the approved amount. Press enter. The system displays the Rej Field. Enter the alpha code of the rejection or a <?> to view the Reject Codes. Select the appropriate code, press enter. POST FIELD APPROVED AMOUNT FIELD REJECT FIELD IT Systems Training 32 January 26, 2005

Posting the rejection: Data Field Com (Comments) Msg (Message) Action Complete a comment for the posted charge.

38 Rejection Posting Rejection Posting To post a rejection on the Payment Posting Screen (UR54.B) continued: The system displays the Rejection Code for verification. Press F10 to select. Posting the rejection: Data Field Com (Comments) Msg (Message) Action Complete a comment for the posted charge. Press enter. Enter the alpha code or a <?> to select a Message. Press enter. COMMENT FIELD REJECT FIELD MESSAGE FIELD IT Systems Training 33 January 26, 2005

39 Rejection Posting Rejection Posting To post a rejection on the Payment Posting Screen (UR54.A) continued: The system redisplays the Post Receipts Screen (UR54.A) for final review before the user completes the Rejection Posting. The cursor moves to the FSC Field. Data Field Additional Transactions Action Displays: The FSC code 70 (FSC change), the dollar amount of the change, if a claim is being demanded, the dollar amount of the Patient s liability, and the new FSC code. Press F10 to complete the Rejection Posting The system displays a blank Post Receipts Screen (UR54.A). Press F7 Q The system displays the Post Receipts Screen (ARPH.A). Enter a <Q> in the Action Field and press F10 to access the Invoice Inquiry Screen (ARII.A). IT Systems Training 34 January 26, 2005

Deleting a Transaction Deleting a Transaction Deleting transaction(s) in the Payment Posting Batch: Transactions posted in your Batch can be deleted if they were posted incorrectly or in error.

40 Deleting a Transaction Deleting a Transaction Deleting transaction(s) in the Payment Posting Batch: Transactions posted in your Batch can be deleted if they were posted incorrectly or in error. Transactions can only be deleted if the Batch has not been closed (exited). To delete a transaction: 1. Access the Post Receipts Screen (ARPH.A). 2. Change the Action Code to <D>. Press F10. ACTION CODE FIELD Note: Enter a <<?>> at the Action Field to display the available functions. IT Systems Training 35 January 26, 2005

41 Deleting a Transaction Deleting a Transaction To delete all line postings for a transaction: 1. Access the Post Receipts Screen (AR81.A) Data Field Patient Invoice Delete All Action Enter <R> to recall same patient or use the patient s name. Locate the patient and enter <S> to select. Press enter. Enter the invoice number or type a <?> at the Invoice field for a listing of the invoices attached to the patient s account. Select the invoice. Press enter. Enter <Y> to delete all lines posted. System displays <Y> for each Del line of posting. Press F10 PATIENT NAME FIELD INVOICE FIELD DELETE ALL FIELD 2. The system displays the message Deleted. 3. Press Enter to return to the Post Receipts Screen (ARPH.A). IT Systems Training 36 January 26, 2005

42 Deleting a Transaction Deleting a Transaction To delete individual line posting for a transaction: 1. Access the Post Receipts Screen (AR81.A): Data Field Patient Invoice Delete All Del Action Enter R to recall same patient or use the patient s name. Locate the patient and enter S to select. Press enter. Enter the invoice number or type a <?> at the Invoice field for a listing of the invoices attached to the patient s account. Select the invoice. Press enter. Enter N. The system displays the cursor at the first Del field. Select the line posting you want to delete. Enter a Y in the Del field. Press F10. PATIENT NAME FIELD INVOICE FIELD DEL FIELD 2. The system displays the message Deleted. 3. Press enter to return to the Post Receipts Screen (ARPH.A). IT Systems Training 37 January 26, 2005

43 How To Change a FSC How to Change a FSC What is a FSC<?> A Financial Status Classification (FSC) Code is used to group similar types of payers or larger individual payer types. These are numeric codes attached to the IDX Plan Codes found in the IMF. These codes are used to Identify and collect billing and follow up information. Determine if the insurance company or patient should be billed. Determine if the patient is liable for balance or co-payments. Track billing and collection activity on financial reports. Changing a FSC: When insurance information is changed and the new FSC differs from the current one it is necessary to update the FSC Code to allow a bill to be generated. IT Systems Training 38 January 26, 2005

Select Option 4 Training Bar, Organization 3, Group 3 to access the BAR training environment. 3. At the Select function prompt, enter a <?

44 How To Change a FSC How to Change a FSC Changing a FSC on the Post Receipts Screen (UR54.A): Logging into the Post Receipts Screen 1. Access the PACE program from your desktop computer screen. 2. Select Option 4 Training Bar, Organization 3, Group 3 to access the BAR training environment. 3. At the Select function prompt, enter a <?> to see a list of options. Refer to the screen display below and select Function 4, Post Receipts. IT Systems Training 39 January 26, 2005

45 How To Change a FSC How to Change a FSC Changing a FSC Code on the Payment Posting Screen continued: The system displays the Post Receipts Screen (ARPH.A). DESCRIPTION BATCH NUMBER TODAY S DATE CONTROL ACTION Create a Batch: Data Field Action Batch Enter <G> to generate a batch number. Press <enter>. Bank Dep Dt Enter <T> for today s date. Description Enter your name and a description of the function you are performing. This will vary by department and task. Control Enter Difference The system automatically completes. Press enter 4 times until the cursor displays the Action Field. Action The system displays the letter O. Press F10 to enter the Post Receipts Screen (UR54.A). IT Systems Training 40 January 26, 2005

46 How To Change a FSC How to Change a FSC Changing a FSC on the Payment Posting Screen continued: Example: DESCRIPTION BATCH NUMBER TODAY S DATE CONTROL ACTION Note: Enter a <?> at the Action Field to display the available functions. IT Systems Training 41 January 26, 2005

47 How To Change a FSC How to Change a FSC Changing a FSC on the Payment Posting Screen (UR54.A) continued: To access your patient and invoice: 1. At the Patient Name prompt, type the patient s name and press enter. Note: Always use the appropriate naming convention method to select the correct patient account. 2. Locate the patient and enter <S> to select the patient. Press enter. 3. Type a <?> at the Invoice field for a listing of the invoices attached to the patient s account. Select the invoice. Press enter. OR 4. You can use the invoice number at the patient field prompt. OR 5. You can use R/N to recall the same patient and enter a <?> at the invoice prompt to select the correct invoice. SELECT THE PATIENT'S NAME OR ENTER THE INVOICE NUMBER OR ENTER R/N TO RECALL THE SAME PATIENT IT Systems Training 42 January 26, 2005

How To Change a FSC How to Change a FSC Changing a FSC on the Payment Posting Screen (UR54.A) continued: The fields in the Additional Transactions section match the Line Item posting fields.

48 How To Change a FSC How to Change a FSC Changing a FSC on the Payment Posting Screen (UR54.A) continued: The fields in the Additional Transactions section match the Line Item posting fields. The Additional Transactions area is used to update or change a FSC. Select the correct patient and invoice. Press enter two times to move your cursor to the Code Field in the Additional Transactions area. Enter 70 = (FSC change) in the Code Field and press enter. ENTER 70 IN THE CODE FIELD ENTER THE NEW FSC CODE The system displays the invoice total in the Amount (Amt) and Balance fields. The cursor displays at the FSC field. Key in the new FSC code and press enter. IT Systems Training 43 January 26, 2005

How To Change a FSC How to Change a FSC Changing a FSC on the Payment Posting Screen continued: The system changes the numeric code to an alpha or alpha/numeric code.

49 How To Change a FSC How to Change a FSC Changing a FSC on the Payment Posting Screen continued: The system changes the numeric code to an alpha or alpha/numeric code. The cursor displays at the CLM (Claim) prompt and the system defaults to Y (Yes) to prompt the system to generate a claim with the new insurance information. Press enter. SYSTEM DEFAULTS TO Y TO GENERATE A CLAIM FSC CODE 124 CHANGED TO FSC CODE PB1 Completing the FSC change: Data Field Com (Comments) Msg (Message) Action Complete a comment for the FSC change, press enter. Enter the alpha code or a <?> to select a Message, Press F10 to complete the FSC change. COMMENT FIELD MESSAGE FIELD The system displays a blank Post Receipts Screen (UR54.A). IT Systems Training 44 January 26, 2005

Exiting a Batch Exiting a Batch Exiting the Post Receipts Batch: 1. The Post Receipts (Payment Posting) Batch must be closed and printed on a daily basis. 2.

50 Exiting a Batch Exiting a Batch Exiting the Post Receipts Batch: 1. The Post Receipts (Payment Posting) Batch must be closed and printed on a daily basis. 2. Close the batch only after all payment and/or rejection postings, and FSC change transactions have been completed. 3. The Control and Difference fields MUST both equal the same amount. If an amount is displayed in the Actual field, it must be corrected before closing the batch. 4. Remember to delete all erroneous transactions before the batch containing the incorrect transactions is exited (closed). Transactions CAN NOT be deleted after the batch has been exited (closed). 5. Access the Post Receipts screen (ARPH.A). Enter the letter X at the Action prompt. Press F10. The system displays a blank Invoice Inquiry screen (ARII.A). CONTROL AND DIFFERENCE FIELDS ENTER ACTION CODE X PRESS F10 IT Systems Training 45 January 26, 2005

Press enter. 3. The system displays the Device prompt.

51 Printing a Batch Printing a Batch Printing a Post Receipts Batch: 1) At the Select Function prompt, choose 3 (Batch Maintenance). Press enter. 2. The system displays the Select Activity prompt, choose 4 (Batch Proofs). Press enter. 3. The system displays the Device prompt. Enter the appropriate Device (printer address) Press enter. 4. The system displays the Right margin prompt, press enter. IT Systems Training 46 January 26, 2005

Press enter. 7. Type ALL at the Include Batch Types prompt. Press enter. The system displays the From batch number prompt again.

52 Printing a Batch Printing a Batch Printing a Post Receipts Batch continued: 5. Enter your Batch Number in the From batch number field. 6. Enter ONLY the same Batch Number in the Through batch number field. Press enter. 7. Type ALL at the Include Batch Types prompt. Press enter. The system displays the From batch number prompt again. If needed enter another From batch number & through batch number. If there is only one batch being printed, press enter to bypass the second batch request. IT Systems Training 47 January 26, 2005

Press enter or type a Y and press enter to complete printing set up screen and send printing request to the designated printer. 9.

53 Printing a Batch Printing a Batch Printing a Post Receipts Batch: 8. System displays Do you want to queue this activity<?> prompt and defaults to No. Press enter or type a Y and press enter to complete printing set up screen and send printing request to the designated printer. 9. The user can leave the Device (printer address) blank and press enter. The system displays the same prompts and requests the same information. OR DEVICE PROMPT LEFT BLANK 10. Press enter at the "Do you want to queue this activity<?>" prompt. IT Systems Training 48 January 26, 2005

Printing a Batch Printing a Batch Printing a Post Receipts Batch continued: The system displays the Batch Totals and all the Posting information entered. 11.

54 Printing a Batch Printing a Batch Printing a Post Receipts Batch continued: The system displays the Batch Totals and all the Posting information entered. 11. The user can scroll through the Batch to find where an error occurred or proof the Batch prior to printing it. BATCH TOTALS INDIVIDUAL BATCH POSTINGS 12. Type STOP at the stop prompt or scroll through the entire Batch to exit the Batch Proof and return to the Select Activity prompt. IT Systems Training 49 January 26, 2005

55 Insurance Verification Procedures for MGBS, Per-Se and PFS Insurance Verification Procedures for MGBS, Per-Sé and Patient Financial Services Description This document is designed to provide a basic overview of Insurance Verification for the Accounting Departments. In this training the instructor guides you through the procedures for: Completing the required Insurance Verification fields Completing the IDX Financial Status Classification (FSC) Follow-up (F/U) Questions Screen Purpose The purpose of this document is to understand the impact of changes made to the insurance plans on individual accounts. When changes are made to the insurance plans and the accounts are not system verified, false bill holds are created which appear on various reports worked throughout the Medical Center. The Insurance Verification Flags are located on The Insurance Verification Screen. The Flags must be reset for the patient types listed in the table below: Scheduled or unscheduled services include the following Patient Types: Patient Type Ambulatory Surgery Outpatient Bed Status Outpatient Needing Bed Special Procedures Inpatient Code OAS OBS ONB OSP IP You must complete the Insurance Verification screens for these Patient Types Important Note for Inpatient Accounts Do not make any changes to Inpatient accounts! To report any changes always call Financial Counseling at IT Systems Training 50 January 26, 2005

2) Select action code <E> Edit Addr/Ins Verif.

56 Insurance Verification Screen Insurance Verification Screen 1) Use the Up/Down Arrow key to select and highlight the appropriate insurance plan. 2) Select action code <E> Edit Addr/Ins Verif. IDX displays the Insurance Selection screen (U6PQ.A) 3) Press <Enter> three times. IDX displays the Verification screen (U6PO.L). IT Systems Training 51 January 26, 2005

Insurance Verification Screen Insurance Verification Screen Continued The following Insurance Verification screen fields must be verified: Insurance Effective Date Insurance Expiration Date Benefit

57 Insurance Verification Screen Insurance Verification Screen Continued The following Insurance Verification screen fields must be verified: Insurance Effective Date Insurance Expiration Date Benefit Status (1st Flag) Cert Required (2 nd Flag) Cert Received (3 rd Flag) Verified By Date Verified 4) Use the line specific instructions on the next page to complete the required Insurance Verification screen fields listed above. Note: The Insurance Verification screen differs according to the type of insurance selected. IT Systems Training 52 January 26, 2005

58 Required Insurance Verification Screen Fields Required Insurance Verification Screen Fields Data Field Insurance Effective Date Insurance Expiration Date Benefit Status (BS) Flag # 1 Cert Required<?> Flag # 2 Cert Received<?> Flag # 3 Instruction Press <Enter> to move to the next data field Enter the effective date indicated by the insurance representative. This is the date the patient s eligibility and benefits began. Example: The card issue date is 01/01/2003 Enter the last day of the admission month. Example: Patient was admitted 01/15/03, enter 01/31/03. If the patient remains an inpatient the following month: 1. Re-verify the patient s eligibility and benefits. 2. If the patient s benefits are still in effect, change the expiration date to the last day of the current month. In order to re-bill claim you must answer the following in the Benefit Status Question (Flag #1) Completing this field by entering a Y will allow the claim to drop for processing. Enter the following codes: Y = Verified In order to re-bill claim you must answer the following in the Benefit Status Question (Flag #2) Completing this field by entering an N (as a default) allows the claim to drop for processing. An Authorization is... Not Required Enter No In order to re-bill claim you must answer the following in the Benefit Status Question (Flag #3) Completing this field by entering an N (as a default) allows the claim to drop for processing. An Authorization is... Not Required Enter No IT Systems Training 53 January 26, 2005

Required Insurance Verification Screen Fields Required Insurance Verification Screen Fields Continued 5) After completing the Date Verified data field, press <Enter>.

59 Required Insurance Verification Screen Fields Required Insurance Verification Screen Fields Continued 5) After completing the Date Verified data field, press <Enter>. IDX displays the Plan Comments screen (U6PO.C). Note #1: If an authorization is obtained, enter a <Y> to complete flags 2 & 3. 6) Type <E> to enter additional free-text comments, if appropriate. 7) Press <F10> twice to file and save your comments Note #2: Even if you do not enter comments for the patient, you must press <F10> from the Plan Comments screen (U6PO.C) to access the FSC Follow-up Questions. IT Systems Training 54 January 26, 2005

Critical Registration Level Follow-Up Questions Critical Registration Level Follow up (F/U) Questions The instructions below detail how to complete the Critical Registration Level Follow-up Questions.

60 Critical Registration Level Follow-Up Questions Critical Registration Level Follow up (F/U) Questions The instructions below detail how to complete the Critical Registration Level Follow-up Questions. From the first page of the patient s FSC Follow-up Questions screen 1) Type the appropriate line number at the Change item number (if any) prompt, press<enter>. 2) Complete the following Critical Registration Level Follow-up Questions: Line Data Field Enter the... 5 Subscriber Name (Req) Subscriber s Name The person who obtains the insurance. 4 Patient Relationship to Appropriate relationship from the IDX dictionary. Subscriber 32 Group Name Subscriber s employer s name, if available. 2 Group Number Group number listed on the insurance card. 1 Policy Number (Req) Policy number listed on the patient s insurance card. 12 Medicare HIC# Managed Care Plan Number, if appropriate. 20 Subscriber s SSN Subscriber s Social Security Number (SSN) Office Visit Copay Amount Co-payment amount indicated on the insurance card. If no co-payment is listed, leave field blank. Table continued on next page IT Systems Training 55 January 26, 2005

61 Critical Registration Level Follow-Up Questions Critical Registration Level F/U Questions Continued Table continued from previous page Line Data Field Enter the Special Account Category The following departments must complete this field: Admitting and Registration Refer to the Account Category Codes handout to determine the appropriate Account Code for each Clinical Laboratory Department Financial Counseling Patient Financial Services Revenue Management Services Utilization Review Note: If user obtains authorization, you must enter the authorizations in line 252 and line 64 of the Registration Level Follow-up Questions. Line Data Field Enter the Pro-Fee Auth Number Only complete this field when there is a separate authorization number for the Pro-Fee services. 64 Hosp Auth Number Insurance company s authorization number associated with the approved service. If the authorization is a Verbal Auth : Type VERBAL in this field Add to Comment Screen Reminder: When insurance plans are changed on the Outpatient accounts, changes automatically update to SMS. IT Systems Training 56 January 26, 2005

62 Critical Registration Level Follow-Up Questions Index Accessing the Dictionary Function, 11 Account Balance, 3 Accounting Terms, 3, 4, 5 Administrative Write Off, 3 BAR Inquiry, 9 Batch, 3, 13, 16, 26, 45, 46, 47, 48, 49 Choosing an Action Code, 12 Claims/Charges, 4 Create a Batch, 16, 26 Credit, 3 Critical Registration Level Follow up (F/U) Questions, 55 Debit, 3 Definition, 1, 3, 4, 5 Deleting a Transaction, 35, 36, 37 Description, 1, 11 Dictionary Inquiry, 11 Electronic Remittance Advice (ERA), 5 EOMB/RA, 5 Exiting a Batch, 45 Exiting the Post Receipts Batch, 45 A B C D E Financial Status Classification, 11 Financial Status Classification (FSC), 5 FSC, 1, 8, 11, 14, 23, 34, 44 F H Hosp Auth Number, 56 How to Change a FSC, 38 Insurance Verification Procedures for MGBS, Per-Sé and Patient Financial Services, 50 Insurance Verification Screen, 51 Logging into IDX, 6 Logging into the Post Receipts Screen, 15, 25 I L N Navigating BAR, 6, 7, 8, 9, 10 Navigating BAR One Page Reference Guide, 10 Objectives, 1 Overview, 1, 2 Payment Posting, 3, 15, 16, 17, 19, 20, 21, 22, 24 Policy, 2 Printing a Batch, 46, 47, 48, 49 Printing a Post Receipts Batch, 46, 48 Pro-Fee Auth Number, 56 O P R Rejection Posting, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34 Required Insurance Verification Screen Fields, 53 IT Systems Training 57 January 26, 2005

63 Index Special Account Category, 56 Statement Balance, 3 Statement Types, 5 S V Viewing an Action Code, 12 W What is a FSC<?>, 38 IT Systems Training 58 January 26, 2005