Amazing Charts PM Billing & Clearinghouse Portal

Transcription

1 Amazing Charts PM Billing & Clearinghouse Portal

2 Agenda Charge Review Charge Entry Applying Patient Payments Claims Management Claim Batches Claim Reports Resubmitting Claims Reviewing claim batches in clearinghouse portal Payer Response Reports Patient Statements

3 Charges are generated two ways: Charge Entry Overview Electronic: After the provider selects the CPT code for a visit and signs-off on patient encounter in Amazing Charts, those charge codes are transmitted over to ACPM for the biller to review prior to batching the claims. Manual: In addition to the charges that transmit over from AC, you can also manually enter CPT/ICD codes in ACPM.

4 Electronic Charges When an encounter is signed off in AC EHR, the charges will transmit over to ACPM for claims processing. Prior to reviewing the charges in ACPM run the Billing Reconciliation report in AC EHR under the Billing tab. This report includes all charges that were successfully transmitted to AC PM from Amazing Charts or did not due to errors by date range. Lists patient name, date encounter was sign off in AC, DOS, CPT codes, units and date received by PM. Option to print or export report out of AC.

5 Common Reconciliation Errors Error message No Account Cpts are not attached! Cpts do not have ICDs attached! Bill is already in ACPM and cannot be updated! No effective usual charge found for Procedure: Provider Id is not mapped! There are more than 8 ICD codes on this Superbill! ACPM is unreachable! We don't have access to our own authorizationcertificate Date of Service occurred prior to ACPM activation! Primary Diagnosis is not included in the diagnosis pointer Details Do not have an account set up for the patient in ACPM. Need to enter an Account under patient chart. No CPT was selected for the patient in AC so there is nothing to transfer over to ACPM. Need to select CPT s under account information screen in AC. Charges do not have ICD attached in AC. Need to attached ICD codes to all procedures under account information tab in AC. There is already a visit with the DOS in ACPM. Can not resend a charge once it has successfully transmitted over to ACPM. Error is information only. Missing fee for procedure in ACPM. Add fee under ACPM Admin>usual charge schedule Provider needs to be mapped in AC Admin settings Must correct the number of associated ICD 9 codes. You cant have more than 8 codes per visit. internet connectivity internet connectivity Can not transfer visits from AC to ACPM prior to go live date. Visit needs to be manually entered in ACPM. Primary diagnosis is duplicated. Go into the account information screen in AC and remove the extra diagnosis.

6 Reviewing Charges Once the errors are corrected there are two ways to retry transmitting the charges over to ACPM 1. Run the PM Transactions report in AC under Billing. This report includes all inbound and outbound transactions, status of the transactions by date range. Change Type to Outbound and Status Failed. Report includes date and time of transaction, type, event type, status, patient and message. Click the check box next to the errors and then click Retry Selected.

7 Reviewing Charges 2. In the patients Account Info Tab in AC Click in the units field, backspace over the number of units, type the unit amount back in and hit save on the bottom right. This will trigger AC to resend the charge to ACPM.

8 Reviewing Charges Reviewing the patient charges in ACPM 1. Pull up the patients chart 2. Under the Visit History click on View/Change to review charge details

9 Reviewing Charges The Charge Processing screen will display all the information that pulled over from AC. Charge Processing Screen has 3 sections: Case Summary, Visit and Charge Summary Cases are used to group related charges and also for instances when additional claim information is required i.e. Workers Compensation. All charges from AC will attached to the default case (Internal Medicine). Users can selected an alternative case type form the dropdown during charge review. Visit section stores the diagnosis for the charge and other fields that may or may not be required, i.e. Referral, Referring Provider.

10 Reviewing Charges The Charge Summary screen displays the procedure code(s) attached to the visit. Click on the code to view line item detail information. Make changes when necessary. Note: Only 4 Diagnosis Codes can be link to a procedure. If more than 4 are attached click on diagnosis field and uncheck additional codes. To add an additional procedure click Add. To remove a procedure select the procedure code and click Delete.

11 Reviewing Charges To indicate there is a copay/coinsurance responsibility for a procedure click on Copay The patient copay, deductible and coinsurance fields will display. This information pulls from the patients insurance set up. Click Save

12 Reviewing Charges If the patient has an unapplied balance, a Payment Application window will display showing the payment details: date, type, amount and unapplied amount. It is not best practice to apply the copay prior to posting the insurance payment. Applying copays is covered in Session 4. Click cancel to leave money in unapplied.

13 Reviewing Charges If there is no unapplied money in the patients account, a Payment Entry window will display. If a payment needs to be entered: Enter payment type, amount, transactions date, note (if applicable) Save. The Payment Application window will display and the payment can be applied at that time. If there is no payment to enter, click Cancel.

14 Manual Charge Entry Manual Charges can be entered from the following places Patient Chart>Account Pane (Recommended) Front Desk> Front Desk Activities Pane Bookkeeping> Bookkeeping Activities Pane

15 Manual Charge Entry From any of the 3 locations, click on the Charge Entry link. In the Charge Entry pane, search for patient, select account for the charge. (these fields will auto populate if charge is entered from chart) Select Case for the charge i.e. Workers Comp, Accident, etc. The selected case will determine what data will be required during the charge entry process. If the charge should be tied to a previous case number select the case number from the drop down. This will allow the practice to run a personal Injury report for the case number. The visit field will default to New Visit. Click Save to go to the Charge Processing screen

16 Manual Charge Entry Once the information in the Charge Entry pane has been saved, the Charge Processing screen opens with three additional panes: Case Summary Visit Charge Summary

17 Manual Charge Entry Case Summary Pane: The fields appearing in the Case Summary pane will vary depending on the case type selected in the charge entry pane. The information entered in the Case Summary section will be stored and a case number will be assigned. The next time a charge is entered for the same case, this information will automatically populate.

18 Manual Charge Entry Visit Pane: Mandatory Fields- Service location, Billing Provider, Diagnosis and Accepts Assignment. Please Note: additional fields may be required for the specific charge. Once the necessary fields are completed, click the Save button to access the Charge Summary pane.

19 Charge Summary Pane: Manual Charge Entry Several fields in this pane will populate based on selections made in previous sections, as well as the Bookkeeping default values. Note: Any defaults may be changed if needed. Enter the procedure(s) that took place for the visit. Select any modifiers, and select the correct diagnosis for the procedure(s). The units will default to 1; the amount defaults from the Usual Charge table; and the payer defaults from the account information for the patient. Click the Save button after each charge has been added. Click the Save button once all applicable charges have been entered.

20 To create a claim batch Open the Billing Screen Batching Claims Click Select claims under Billing Activities Claim can be batched by one or more criteria Claim date is the only required field. Leaving all the other fields blank assumes all claims for all criteria. This will include new charges and any resubmitted claims. Once the criteria has been selected, click Save.

21 Refine Claim Selection Once the claim selection has been saved, the Refine Claim Selection pane will open and display all visits to be batched. If any need to be removed click to highlight the visit (to select more than one hold Ctrl and select additional visits.) Once all visits are highlighted click Toggle Selection Removed visits will show No under the selected column and will not be batched. Click Save again.

22 Claim Rendering ACPM will then begin the batch process. Once complete the number of visits in the batch will display along with the message they were successfully auto-rendered (batched). Close out the screen and return back to the billing screen

23 Manage Claim Batches Go to the Manage Claims Batches pane on the billing screen. By default this pane is set to filter by electronic not transmitted. Use the drop down to view other statuses if needed. Click Search to view the claim batches created. The search results will display all electronic batches and the following information for each batch: Claim batch ID Number of claims in batch Conduit-whether it is a paper claim batch or electronic claim batch. Claim date Provider-batches are broken out by provider. Action- Actions will differ by batch status.

24 Manage Claim Batches In the Action column click Validate to open the validation report. This reports displays all the patients and visits in the batch. Claim errors will be bold and italicized.

25 Common Validation Errors Missing plan street address, city name, state code, postal code. The primary insurance plan address is missing from plan table. Go into Admin>plan table and add insurance address for plan. Must include 4 digit zip code extender Missing other plan street address, city name, state code, postal code. The secondary insurance plan address is missing from plan table. Go into Admin>plan table and add insurance address for plan. Must include 4 digit zip code extender Missing subscriber street address, city name, state code, postal code The subscriber address for the insurance is missing or incomplete. Go into patients chart>insurance set up and add address. Missing patient street address, city name, state name, postal code. The patients address is missing or incomplete. Go into patients chart>demographics and add address. Missing MSP insurance type. The patient has Medicare as a secondary and the policy type field under the insurance set up is set at Medicare Part B. Go into patients chart>insurance set up and change the policy type for Medicare to Medicare secondary working aged beneficiary or spouse with employer group plan. Missing release of authorization code. One if not all three authorization fields on the patient insurance set up is missing. Release Info Authorization must be set to Y Assignment Authorization must be set to Y Patient Sig Source must be set to B

26 Manage Claim Batches If there are claims with errors, click Delete under action to remove the batch. This action does not delete the charges only the batch. Fix the errors as needed and then repeat the batch process again. If there are no claim errors, a Transmit link will appear under the Action column after validation. Click Transmit to submit the batch to the clearinghouse for further processing. After the batch has been transmitted, the batch will move into the status of Electronic-Transmitted. The Summarize link is a copy of the validation report.

27 Manage Claim Batches To print paper claim batches click into the By field and select Paper-Unprinted from the drop-down list, then click the Search button. T he same information will be displayed, and the batch process is completed the same way as electronic batches. Once the paper batch has been successfully Validated, the actions will change to Print, Print w/form, Complete, Delete, Align, and Summarize. To print the batch on pre-printed claim forms, select the Print action. Use the Align action link if the printed forms do not line up correctly in the boxes. Use the Complete action link to mark the batch as printed. Note: All previous batches, in either paper or electronic format, may be viewed by using the drop-down in the By field and selecting a search option.

28 Claim Remedi Portal After transmitting your claims you will then log into the clearinghouse portal to view the status of the claim batches transmitted and check for errors.

29 Claim Remedi Portal To check the status of the batch go to Search>Claim File. Claim File contains the files or batches that were submitted through ClaimRemedi and is a general summary of the files and the user who uploaded them. From the Claim File screen you can view the file Type, File Name, Upload date/time, Error Amount, Status, Total number of claims in batch, how many were forwarded to the payer and how many had errors. Removed and Fixed are manual statuses.

30 Claim Remedi Portal Click on the number under the status column to view claims in the corresponding status. Reports can be saved, printed and/or exported. Claims in the error column need to be corrected.

31 Common Error Messages This Billing Provider ID (xxxx) is not enrolled with payer xxxx for Professional claims OR Payer with ID xxxx not yet supported Payer is not set up for electronic claim submission. Contact your Claim Remedi representative Value for Other Payer Billing Sequence (other insurance) = P must be not equal to that of Subscriber Payer Billing Sequence (insurance being billed) = P. P=primary, S=secondary. Insurance sequence is incorrect. Check the primary and secondary set up in the patients chart in ACPM and make sure the correct insurance is linked to charge. This can also occur when sending secondary claims. This can also occur when sending secondary claims if the primary insurance claim was voided by mistake. NDC code must be 11 numeric. Invalid field value. NDC code is missing digits. Correct NDC code for procedure under Administration>procedure table or on the charge. Drug NDC Code missing NDC is missing from claim. Add NDC code for procedure under Administration>Procedure Table or on the charge. Only four diagnosis pointers allowed per service line. Too many diagnosis attached to procedure. Can only have 4. Go into visit in ACPM uncheck extra diagnosis.

32 Claim Remedi Portal If desired certain errors can be corrected in the portal while others will need to be corrected in ACPM. To view the claim errors click on the claim batch link The Claim File Editor screen displays the list of claim errors. Any errors with the Note: Error Cannot Be Corrected At This Time will need to be removed and corrected in ACPM. Click on the wand icon on the top right to remove non fixables.

33 Claim Remedi Portal 1. Users can view claim errors by error message or individual claim 2. Click on the arrow to view the claim line details by patient. 3. Click on the Claim ID link to view additional information and or take action on the claim. 4. Click Summary on the left to view a claim status summary of all claims in the batch and claims uploaded. 5. Depending on the error the user may be able to correct the error for multiple patients claims in the portal or by individual patient. 6. Click on the pencil icon to edit the claim(s). The edit template pop up box will display.

34 1. The edit template pop up will display the claim information being corrected. 2. Check off box(s) for the claims that are ready to be edited. 3. The Editor screen will display. This is where errors are corrected. 4. Make necessary corrections and SAVE to return to the Claim Editor screen. 5. Once errors are corrected click the remove non fixables icon to remove all claims that could not be corrected in the portal. 6. Click on the scrubber icon to rescrub the batch. Claim Remedi Portal

35 Claim Remedi Portal The user can then return to the Claim File to see the status of the batch after it was rescrubbed. If the claims passed the scrubbing process they will then show under the forward to payer column. User can click on the link to view and save the report. The non fixable claims that were removed will show under the removed column. Client should then print the removed claims report and correct those claims in ACPM.

36 Voiding claims with errors Once the necessary corrections are made in ACPM Open the Patient s Chart. Open the Claim History pane. Note: It is collapsed by default click the double arrows to expand the pane. Find the last entry for the corrected date of service (DOS). Click Void. Next time claim batches are transmitted the updated claim will go out. Resubmit is used in cases when nothing has been changed, but the claim needs to be resubmitted. Example: when you called the payer they state they never received the claim.

37 Payer Response Reports Once the claims have been forwarded to the payers, the payers will send response reports acknowledging claims were received. To view Payer Response Reports in ACPM: (This should be reviewed daily) In the Billing screen under the Manage Claim Reports pane. Select ClaimFx Clearinghouse from the Claim Strategy drop down, then click the Search button. Read- Allows the user to view the response report. Mark Read- Will mark that the report has been viewed. Delete- to delete report (not recommend).

38 Payer Response Reports Example of a Payer Response Report in ACPM

39 Payer Response Reports Payer response reports can also be accessed in the clearinghouse portal To view Payer Response report in Claim Remedi 1. Hover over Search 2. Click on Response Report 3. Modify Search results if necessary 4. Filter Report Type by Payer Report 5. Click on Report File name and open report

40 Patient Statements On the Billing screen under Billing Activities pane click the Select Statements link. In the Select Patient Statements screen, select a statement date. Leave the other fields blank to comprise all billing offices and account types. Statement batches can be separated by Billing office or Account types if desired by using the drop-downs. Save. ACPM will direct the user back to the Billing screen

41 Manage Patient Statements Statement batches are located under the Manage Statements pane on the Billing screen. Batches will include the following information: Statement date. Number of statements in batch. Total dollar amount of statements in batch. Type and status. A user can take the following actions View: Displays the statements for review and printing. Summarize: Summary Report. Void: Deletes the statement batch. Done: This will move the batch from Pending to Complete.

42 Manage Patient Statements Or let us automate the expensive process of generating and sending patient bills in-house, and give your staff more time to focus on your patients. Statements can be sent digitally from Amazing Charts Practice Management with just a few clicks. See more at: