arriving an appointment for charge batch interface … · web viewin order for the charges to...

Charge Batch Interface

Table of ContentsArriving an Appointment for Charge Batch Interface (Check-in Staff).........................................................2

Opening an Office Visit in EMR (MA/CMA/LPN/RN/Student)......................................................................7

Entering Charges in the EMR (Provider)......................................................................................................9

Searching for Services not on Order Entry Form.......................................................................................13

Entering services (support staff)................................................................................................................15

Entering Charges in the EMR (Resident)....................................................................................................16

Additional Warnings..............................................................................................................................16

Sending Charges from C-EMR to CB (Coding Department)........................................................................17

Correcting a CPT code and removing the wrong CPT code (Coders and Providers)...................................22

Immunization Management Form (Changes for Charge Interface)...........................................................27

Medication Administration Form (Changes for Charge Interface).............................................................30

Transition of Care Management Procedure Code Billing...........................................................................32

Charge Interface for CB.............................................................................................................................33

Viewing and/or Adding NDC Number in CB...............................................................................................34

Duplicate Diagnosis found in Transaction..................................................................................................37

Viewing and Working Edits in the EMR CHARGE BATCH (200) Workfile....................................................40

Billing Provider Changes Or Appointment Type Changes During Visit.......................................................44

Changing Provider or Appointment Type in CB.....................................................................................44

Changing Provider with a Linked Referral or Missing Referral Type......................................................46

Changing Provider in EMR.....................................................................................................................48

Operational Items to Consider..................................................................................................................48

Missing Charge Location Tracking.............................................................................................................49

There are several places to look when tracking charges...........................................................................51

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Arriving an Appointment for Charge Batch Interface (Check-in Staff)

In order for the charges to interface correctly into Centricity Business (CB) the Charge Batch workflow begins with arriving a patient’s appointment and making sure the proper fields are completed correctly so that they will interface appropriately into C-EMR. Please follow existing process and include the steps listed below when arriving patients in CB.

Edit the Appointment on ADF Screen

When the scheduling provider differs from the billing provider update the billing provider field on the ADF screen. For example, if the scheduling provider is a resident the ADF needs to be updated with the preceptor as the billing provider. Also, if the provider has multiple billing providers, the correct billing provider must entered into the ADF (Cooley, Rabara and Powell for a few examples).


If there is a Prior Authorization or PreCert number for the services during this visit make sure to enter into the Authorization#: field.

Make sure the insurance that applies to the visit is appropriately document on the ADF screen if different than current FSC list i.e. Workers Comp, MVA, Mental Health etc.…


The referral needs to be attached at check in so that it will be linked to the charge. To select the patient’s referral hit the arrow for next page.

Once on the second page, at the Referral #: field; select the magnifying glass to select.


The Referral screen will come up with the list of referrals for the patient. If your referral isn’t listed, it can be added at this point following existing processes. Highlight the referral and hit okay.

A pop up will notify the user how many visits are remaining.


The screen will look like the following below. Then select save and your check in will be completed.

Note: If there is anything entered in the Missing Referral Type prompt, be sure to remove it. Otherwise, the referral will not be linked to the charge if the Missing Referral Type field is NOT blank.


Opening an Office Visit in EMR (MA/CMA/LPN/RN/Student)

This process will change slightly with the Charge Interface. There are 3 components that are very important in order for the Charge Interface Process to be successful. After opening an office visit, be certain to follow the below instructions:

1. In the field labelled “Provider”, verify the field is populated with the name of the responsible/billing provider.Note: Choosing the Responsible Billing Provider is very important for Charge Interface, this field is the name of the billing provider that will go out on the claim to the insurance companies.

2. Choosing the Correct Location of Care (LOC)Note: This is important because the LOC determines which Billing Desktop the flag will be routed to for charge review and release to CB. Logging on to the correct LOC on the Centricity EMR Logon screen will assure that the correct LOC waterfalls to the Update Chart Window

3. Click the button to select a visit ID.Note: Choosing the Visit ID is crucial for Charge Interface, without it, the charges will go over without a visit ID which could cause potential revenue issues and appear on your CB missing charge report.


Clicking the in the Visit ID: field will generate the “Select Visit ID Window.”

Once all three of these very important fields are populated, you may press [OK] and proceed into the Office Visit.


Once you have located the correct Visit ID, highlight it and press OK

Entering Charges in the EMR (Provider)

1. When in an active office visit update, click the link for the “Order Entry Form Launch” form. Click the button for the specialty just as you would for labs, radiology and referrals.

2. After clicking your specialty, your specialty’s custom Order Entry form will appear. Navigate to the Billing tab.

Note: If the Problem selected has not been converted into a proper ICD-10 code, the form will not allow you to enter the order.


3. If more than 4 diagnoses need to be added, this must be done by clicking the red button for [Go to Orders] or . Highlight each individual diagnosis and arrow over one at a time in the order you want them on the service.

4. The Provider can also add modifiers at this point:

5. If the units need to be increased for a specific CPT code, you must also do this in the orders module.


6. This is also where the NDC number can be added to the instructions after being administered.

7. If all CPT codes have been added and are ready for review, the provider can sign the orders at this point:

Signing your orders when you put the update “On Hold” or “Sign” the updateIf a user chose not to sign the order from the “Update Orders” form; then you may do so at the close of the office visit.

Click the “End Update” button. In the “End Update” pop-up window, make sure the checkbox for “Sign Clinical List Changes” is checked and select either “Sign Document” or “Hold Document”.


Note: Because orders are considered “clinical list changes” they will be signed at this point. Since Service Orders are on “Admin Hold” Status, they will be routed to the Coding Department’s desktop in the EMR. Please see workflow for “Admin Hold Process for charges in EMR”.

Note: After signing clinical list changes adding additional service orders will generate a second flag to the coding desktop.


Searching for Services not on Order Entry Form

1. From any “Orders Entry” form, click on the “Go To Orders” button.

2. When the “Update Orders” dialogue box appears, click on the tab labelled “Categories”.

3. Make sure the radio button labelled “Service” is selected.

4. Select the Category that applies to what you are looking for. Then select the desired order, followed by clicking the “Enter” button.

5. If you don’t want to search by Categories, the next tab is general search functionality.


6. After entering the order, add the corresponding problem from the “Potential Diagnosis” box by highlighting the problem and clicking the add button.


Entering services (support staff)ORDERS WORKFLOW FOR URINALYSIS, STREP TEST, EKG, PREGNANCY TESTS, ETC.

1. Open the office visit2. Double –click on the “Order Entry XX” link in the “Inserted” window

3. Click on the “Billing” Tab

4. Choose the diagnosis for the test being performed the choose the test that was ordered by clicking on the correct button(s) in the form. The order will show under the “New Orders Committed” window.

5. Click the “Close” button.

6. End the visit & put it back on hold.


Note: The request for the service to be performed must be documented in the chart as well as who performed the service.

Entering Charges in the EMR (Resident)

1. If you are a Resident, you must be listed as the Responsible Provider of the document in EMR, even though you will not be the Billing Provider. Follow all previous steps in the provider enter charges workflow, however, when you come to the “End Update” window below, and before signing the document or putting it on hold with the clinical list changes checkbox checked, you must change the Provider dropdown to your name.

After the Resident has selected his/her name in the Provider dropdown, they may then put the document on hold or sign it with the clinical list change box checked.

Note: GE/GC Modifiers must be added to Medicare Office Visits.

Additional Warnings 1. There are multiple encounter types that users can enter orders. If an order is completed

with one of the following encounter types (Orders only, Clinical List Update, Phone etc.…) the user must uncheck the clinical list changes and put the document on hold, if the document is signed, the user will be listed as the service provider.


2. Putting a document on hold with the clinical list change box checked automatically signs the orders by default. The encounter type drives the users that can sign the orders.

3. If you use the document routing to notify providers that patients are in the rooms, you can add them when putting document on hold in the Route To: section.

Sending Charges from C-EMR to CB (Coding Department)

1. After the provider has entered his/her charges in the EMR, a flag will go to the respective Coding Desktop for the location of care to which the user who opened the visit was logged in under and/or the location the update was started under.

2. Double clicking on the flag will take you to the Order Tab of that patient’s chart. The coding can then be reviewed/compared to documentation, changed to make corrections and completed.

3. If changes are needed, once on the Orders tab highlight the service order and then click the [Change] Button.

4. The Change Service window will appear


5. In the “Change Service” window you will be able to add modifiers, add NDC #s, change the insurance, change/add diagnoses and add any additional comments necessaryNote: Please verify with management which options you are allowed to change

a. Add Modifiers (If you are allowed):

b. Change or Add Problems (If you are allowed):


Note: If there is a problem that is not on the active problems list, but needs to be there for billing purposes, click [New…] to temporarily add the problem

Search for the required diagnosis

Once you press [OK] the problem will be temporarily moved to the problems list and listed in italics


6. Once all changes have been made or the charge is approved and you are ready to send to CB, click the [Complete] button

7. In the “Select Orders to complete” window select the service order/CPT code that you want to send over to CB by clicking the checkbox, then click [OK]

Note: Please make sure you select all service for the whole visit. Do not send service orders individually


8. The status will change from “Admin Hold” to “Complete". This activity sends the charges across the interface to CB.

9. The flag that was sent to the Coding Desktop can now be deleted from coding desk top.

Note: If providers sign the orders during the office visit and then add additional orders a second flag will be sent to the Coding Desktop.

Note: Validate that the authorizing provider and the signing provider is correct. The Authorized By: should be the Billing Provider. The Signed By: should be the Service Provider.

Note: Nursing staff will complete the TCM codes once they have reached the 30 days. See TCM Section below.

FLAG ROUTING KEY:


o Office Charges that need corrections will be sent to the Provider Desktop.o Ancillary charges that need corrections will be sent to the clinical support staff’s

Desktop.o TCM charges will be sent the Billing Desktop for each location to monitor.


Correcting a CPT code and removing the wrong CPT code (Coders and Providers)

There are times when an end user may enter a CPT code in the EMR that is not supported by the documentation in the chart. CPT codes can only be added and changed in an update, follow the step listed below.

1. The flag/Orders on the Coding Desktop will be reviewed by the Coders.

2. If the coders detemine that a different level of coding is required or that a additional codes are needed, they will append the original office visit by right clicking or highligting and selecting Append.


3. Once the Append is selected, a window will appear for documentation. Document the change by using the “Per chart audit …” and explain the correction being made and why, then select “Click here to do a Full Update”.

4. When the Full Update window opens, select Orders Only encounter type. If the append is done on the correct office visit the important visit information should default. Then select okay.


5. The template will open with your message and the Order Launch Link. Double click the link.

8. Click the button for the specialty just as you would for labs, radiology and referrals.

9. After clicking your specialty, your specialty’s custom Order Entry form will appear. Navigate to the Billing tab.


10. If more than 4 diagnoses need to be added, this must be done by clicking the red button for [Go to Orders] or .

11. Can also add modifiers at this point:

12. If the units need to be increased for a specific CPT code, you must also do this in the orders module.


13. This is also where the NDC number can be added to the instructions after being administered.

14. If you needed to go into orders to make additional changes, just select OK at this point.

15. Then once you end the update, place it on hold and route the document to the Responsible provider.

16. The provider will either agree and sign the order or route it back with a note as to the another correction being made or the reason they are disputing the change.

17. Once signed, a new flag will be generated to the Coding Desktop. That is when the Coder will review the chart to confirm that the original CPT code is removed and complete the correct CPT code.

Note: Clinical date must be the same as the original date of service.


Immunization Management Form (Changes for Charge Interface)

The most important thing to remember on the Immunization Management form is to check the checkbox for Auto-Generate Orders if your location is going live with charge interface.

Once you document the administration of the Immunization on this form (those instructions are included in the CCC-9 Immunization Management Instructions) as long as the “Auto Generate Orders” checkbox is checked, the CPT serum code and CPT administration code will automatically push to the Orders Module with the correct diagnosis.


Note: Make sure to select the correct serum for each vaccine.


NOTE: The NDC number will still needs to be added into the Order in the instructions box, it does not default from the form.

NOTE: Checking the box for Physician Counselled will bill a Pediatric Admin Code no matter the patient’s age.

VFC default is wrong and must be changed to the appropriate Eligibility Code


Medication Administration Form (Changes for Charge Interface)

The most important thing to remember on the Medication Administration form is to check the checkbox for Auto-Generate Orders on the Administer Medication Tab if your location is going live with charge interface.

If the patient brings in their own medication, select the medication that shows the Patient brought their own. Selecting this option will only generate an order for the Administration.


NOTE: Injections where the patient brings their own medication will always hit a TES edit for the Serum Code to be added at a zero charge.

NOTE: If the units need to be increased for a specific CPT code, you must also do this in the orders module.

NOTE: The NDC number will still needs to be added into the Order in the instructions box, it does not default from the form.


Transition of Care Management Procedure Code Billing

When these CPT codes are received by the Coding Department, they will forward the flags for these orders to the Office’s Billing Desktop. The clinical staff will monitor these orders and at 30 days follow up with the patient to confirm the ability to bill the TCM code is still valid. If it is still and appropriate code, the clinical staff will complete the order and remove the flag. If it isn’t still an appropriate code, the flag will need to be routed to the provider to append the office visit with the correct E&M code and the flag deleted.


Charge Interface for CB

There is no major impact to the existing TES work file workflows. There is one new work file and new TES edits. The work instructions on how to resolve these edits are below.

The new edits are:

SOM EMR CHARGES REQUIRE NDC NUMBER DUPLICATE DIAGNOSIS FOUND IN TRANSACTION SOM EMR CHARGES WITHOUT AN APPOINTMENT (This TES edit will capture charges

entered in EMR without an appointment attached. Encounter will appear on the missing charge report.) Note: The encounter will not file into the department’s work file. The encounter will file in work file 200 EMR CHARGE BATCH (instructions below).


Viewing and/or Adding NDC Number in CBTo satisfy the TES edit for Missing NDC you will need to follow the steps outlined below.

1) Access TES Encounter Edit via your department workfiles2) Enter the patient’s name3) Select Okay

4) Select the appropriate encounter5) Select C- Edit Trans6) Select Okay


7) Select the Actions Button

a. Select G-More Actions

b. Select M-Chg Info

c. Select P-Prescription


8) Enter the NDC number in the NDC Override Field


Duplicate Diagnosis found in Transaction

To satisfy the TES edit for Duplicate Diagnosis NDC you will need to follow the steps outlined below.

1) Access TES Encounter Edit via your department workfiles2) Enter the patient’s name3) Select Okay

4) Select the appropriate encounter5) Select C- Edit Trans6) Select Okay


7) Select the Actions Button

8) From the list of action codes, select X - Diagnoses

9) The list of Diagnoses linked to the transaction displays, each repetitive entry requires deletion. In this scenario lines 2 and d must be delted.


10) Once deleted, click OK

NOTE: The process should be repeated for each transaction impacted by the Duplicate DX Found in Transaction Edit

Click into the Proc: (Procedure) field and depress the down aarow key to access the next line item, and repeat the process outlined above.


Viewing and Working Edits in the EMR CHARGE BATCH (200) Workfile

This workfile will be available to Level 4 users. If a missing charge appears on your weekly report and the Orders are entered into EMR and completed, the charge is most likely in this workfile. DO NOT work this workfile. Work the Missing Charge report, when searching for a missing charge for a specific patient in CB, TES Inquiry or Edit will show all Encounters for that patient no matter the workfile.

SOM EMR CHARGES WITHOUT AN APPOINTMENT

To satisfy the TES edit for Appointment you will need to follow the steps outlined below.

1) Access TES Encounter Edit via the 200 Workfile.2) Enter the patient’s name 3) Select Okay

4) Select the appropiate encounter5) Select E- Edit Header


6) Select the magnifying glass at the Appt No: field.

Note: There’s no Billing Area or Location attached to the encounter when a charge is entered in EMR without an appointment attached.

7) Select the appropiate appointment to attach to the encounter8) Select Okay


9) After selecting the appropriate appointment the Billing Area and Location will automatically default to what’s on the appointment header hierarchy.

10) Select Okay11) The Encounter is refiled

12) The encounter is now in an open status.


Billing Provider Changes Or Appointment Type Changes During Visit

Changing Provider or Appointment Type in CB

The Change Provider feature allows the scheduling staff to change the provider for patients that are being seen by a covering physician, without having to cancel or reschedule. This must be done so the Charge is entered for covering physician and not the doctor the appointment was originally scheduled under.

1. On the Appt Manager screen, select the appointment that needs to be changed and click the Actions button.

2. Click on Change Provider.

3. At the Change to Provider prompt, type the Provider’s name or click the drop down menu to select a provider.

4. If the provider remains the same and only the appointment type is changing, tab to the Appt Type field and select the correct one.


Note: The Appt Type: prompt will default the appointment type from the original appointment.

5. Enter the Reason for Change or click the drop down menu to select from the list and click OK.

6. Click No at the “Print follow up slips?” pop-up.7. If a time slot has a patient already schedule with the new provider when changing the

provider, the system will ask to over book. Click Yes to complete the provider change.


Changing Provider with a Linked Referral or Missing Referral TypeIf available, users have the option to link a referral to an appointment for specialty departments while scheduling an appointment. When a referral is linked to an appointment, the system sees this as the appointment is linked for a specific provider and not just to the department. When this occurs and the user needs to change the provider, please follow the process listed below.

1. On the Appt Manager screen, select the appointment that needs to be changed and click the Actions button.

2. Click on the Appointment Data Form.


3. On the Appointment Data Form screen, delete the information displayed in the Authorization #, Insurance, Referral # prompts and/or Missing Referral Type.

Note: When the information is deleted, this will unlink the referral.

4. After removing from ADF, hit the Next > button to remove the info from the MCA Form.

Once the information is deleted, the users will follow the steps listed in the section Change Provider.

5. Once the appointment has been changed to the correct provider, return to the Appointment Data Form to return the Referral information for billing and referral decrementing.


Changing Provider in EMR

If the patient has already been roomed when the provider change takes place, you will need to also make the change in the Office Visit Update Properties. To do this, follow these steps:

If you have forgotten to enter the correct Billing Provider, LOC or Visit ID, you may update them during the office visit update; however, this must be done before the service orders are signed.

Operational Items to ConsiderSelf Pay – collecting

Forms/other non medical charges

Credit Card Slips – Attach to CBO Batch Spreadsheet


Missing Charge Location Tracking

Validating that all charges have been entered is a process that should be run on a regular basis. The office staff should run the missing charge report often and for a date range from the last completed missing charge date to current date. Example: If the last valid missing charge was 12/15/2015, the report should be run starting with this date until that missing charge is entered.

Note: You may want to allow for a 3 day delay for charges to be signed and interfaced.

FROM THE TRAINING MANUAL:

All staff should print a Missing Charge Report to Excel; this report shows all the appointments that were arrived or still in pending but do not yet have charges entered for that visit.

1. Click on Missing Charge List to Excel


2. At Include All Departments prompt, click on the drop down and click Include

3. At the Department prompt, choose the department.

4. At Include All Providers for Departments prompt, click the box directly to the right of the prompt.

5. At Include All Locations prompt, click box directly to the right of the prompt.

6. At From Date prompt, enter a single date or date range from the past.

7. At the Through Date prompt, enter a single date or a date range (per policy).

8. At # of Copies prompt, enter 1 and hit Tab key.


9. Click OK

10. Choose printing device and Click OK

There are several places to look when tracking charges.

First:

Review the Office Visit document in the EMR. Validate that chargers/services were entered during the visit. If the Order is in the chart, make sure the note is signed or at least the Clinical List changes have been signed. (Remember to ‘Organize’ your Orders tab to show Completed Orders)

Second:

If the orders are in the EMR and on Admin Hold, review the different desktops where the orders could be pending for different actions:

a. The Coder’s Desktop to see if it is still pending Coder Reviewb. The Provider’s Desktop to see if it is pending provider actionc. The Staff’s Desktop to see if it is pending ancillary actiond. The Billing Desktop to see if it is pending the TCM waiting period

NOTE: If you don’t find a flag on any desktop, remember to generate a new flag from the patients chart with a note of the DOS to the Coding Desktop.

Third:


If the orders are in the EMR and Completed and the account is still on the missing charge report, verify the correct Visit ID was associated with the office visit. This can be found in under Change Properties with a right click on the office visit. If the order is completed with the wrong Visit ID, it will forever be on your missing charge report. You will need to verify that the charge generated correctly due to all billing information coming from the Visit ID. Contact the CBO if a Charge Correction is required.

Fourth:

Review charges in Centricity Business, by looking up the patient in TES. If the patient has any TES edits in any work file, they will show under the account. If the charges are not being held in TES and still on the missing charge report verify the invoice was created correctly.

If you still can’t find the order, encounter or invoice; please enter a ticket with IRT.


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