Charge Entry Physician Billing. Module 5

Transcription

1 Charge Entry Physician Billing Module 5

2 Table of Contents Accessing the Batch Control Screen... 3 Create a New Batch... 4 Querying for an Existing Batch... 7 Posting Transactions... 7 Step by Step on how to post charges, payments or adjustments... 9 To post transactions to another account Quick Multiple Posting Screen --Additional Tabs Change Blocks Precertification Step by Step to build a Precertification Request Claims / EOB s Step by Step to print a complimentary insurance claim EMC Narrative / Additional Paperwork Step by Step for completing the EMC Narrative/PWK screen Post Payment / Adjustment Step by Step to apply a payment to a charge line at the time charges are being posted Payment / Adjustment Allocation Step by Step to Allocate a Payment or Adjustment Receipt Retail Sales Reconciling, Printing and Releasing a batch Step by Step on how to print a batch Step by Step on how to balance and release a batch

3 Charge Entry Physician Billing Quick Multiple Posting Screen Purpose: This module is used for when charge posters do need to look up diagnosis codes or change charge amounts. To post a charge, payment or adjustment a batch must be opened or created. Accessing the Batch Control Screen At the Master Menu, select 9-Transaction Entry with a mouse click or by entering 9 in the Enter Selection Field (MM 9). Selecting the 9-Transaction Entry displays the Transaction Entry Menu. Select 2-Batch Control Charge Entry/Update with a mouse click or by entering 2 in the Enter Selection field (MM 9.2). 3

4 Create a New Batch By selecting 2 Batch Control Charge Entry/Update the Batch Control screen displays. The only fields that are mandatory in this screen are the Group Code, Deposit Date and Batch Number. A unique batch number can be manually created or the system will automatically assign a sequential number after all applicable fields are completed and the batch is saved. The user may choose to use a default date of service, the Lock Box ID and the Bank Batch ID fields. 4

5 The Batch Control Field Name and Description table is available below. Field Name Field Description - Batch Control Group Code This field is for the group number. It will automatically default IF the group default (MM1.1) is set. Enter a Batch number (up to 6 characters) or the system will automatically assign a Batch sequential number after the user Saves by selecting the Save icon or by pressing the Number <F4> Function key. This is a unique number identifying the batch, transactions, and creator. Date This is the current system date. Note: This field will automatically populate. Last Update This field will default to the date the batch was updated. Time This field will stamp the time the batch was opened or last updated. User ID This field will auto-populate the user ID that opened the batch OR last updated the batch. Comments This is a free text field that a user can enter a comment concerning this batch. Deposit Date This is a required field. Depending on the practice, a user can either enter the current date or if posting payments, a user may want to enter the date of the actual deposit. Default DOS Transaction Total Number of Accounts Lock Box ID Bank Batch Enter a Date of Service if all transactions are generally for the same Date of Service. This DOS will default on all transactions posted, but can still be overwritten. This field will reflect the number of transactions that are posted within a batch. This field will reflect the number of accounts that have had transactions posted to them within a batch. Enter the Lock Box number, if posting payments. Enter the Bank Batch ID, if posting payments. 5

6 ID Hash Total Batch Balance Control Totals Actual Amounts Variance Batch Status Batch Post Month Batch Post Year This field can be used for additional reconciling of balancing charge entry batches. Hash totals calculate the sum of all CPT codes posted in this batch during charge entry. Alpha in a procedure code is a zero unless it comes at the end of a procedure code. Examples: G0008 = 00008, for a total of 8. G0008G = which is a total of 80.(More accurate balancing) This field can be used for additional reconciling. It is the sum of the variances within the batch. There is a field for Payments, Adjustments, and Charges. Manually complete these fields after the batch has been balanced and prior to releasing the batch. There is a field for Payments, Adjustments, and Charges. These fields will automatically continue to calculate as transactions are being posted in a batch. Use the totals to balance. There is a field for Payments, Adjustment, and Charges. These fields will automatically populate as transactions are being posted in a batch. They will be the opposite of the Actual Amounts. For example if the actual amount of the charges are 3,650.00, the variance field for the charges will reflect -3, Note: All of the Variance fields will have to be at 0.00, zero, before a batch can be released. There are three (3) batch status H-Hold, E-Release for Editing, and R-Release for Posting. Note: When a batch is opened the status will automatically default to an H. The batch has to be on an H before transactions can be posted or changed within that batch. Identifies the specific month when the transactions in the batch are posted, as well as the Month End the batch will be finalized. Identifies the reporting year of the batch and the year the transactions are finalized. Once all of the information is entered, in the Batch Control screen and it has been assigned a batch number by either selecting the Save Icon from the Task Bar or <F4> Function key on the keyboard, the user is ready to proceed to post transactions. 6

7 Querying for an Existing Batch If a user already has a batch open and would like to find the original batch, instead of opening a new one, follow the steps below. Go to the Master Menu, select 9 Transaction Entry Menu Select 2 Batch Control Entry/Update, the screen will be in 'Insert' mode which means the user will have to start a query. Start the query/search by selecting the 'Enter Query' icon from the Task Bar or by using the <F1> Function key on the keyboard Enter any of the following information in order to search for an existing batch: o Batch Number o Deposit Date o User ID Select the 'Execute Query' icon from the Task Bar or the <F2> Function key on your keyboard. Posting Transactions Once the batch is open, or found, select the tab or <F12>, to advance to the Patient Registration Block. This screen will automatically be in a query/search mode and the cursor will default to the Last name field. Note: There is a (med)option that can be set if a user would prefer the cursor to default to the Account field in order to search for a patient by their account number instead of name. If interested in this option, please contact your client manager. 7

8 Patient Registration Block (MM9.2, F12) Note: If a patient has multiple insurances, you will see an asterisk (*) next to the insurance sequence as shown above. When accounts have multiple insurances at the same sequence, the system will pull the correct insurance based on the DOS upon charge entry The Patient Registration screen is automatically in a query mode, enter either the patient s Last name and First name, or, if the (med)option is set to default the cursor to the Account field, enter the patient s account number. Select the Execute Query Icon, or <F2> on the keyboard to populate the patient s account that needs a charge or charges posted. Select the, or <F10> on the keyboard. This will display the screen to post the charge or charges and/or payments. 8

9 Quick Multiple Posting Screen (MM9.2, F12, F10) Step by Step on how to post charges, payments or adjustments BLOCK 1 The patient s account number, name, the group code and batch number will automatically populate. The cursor will automatically default to the Dx1 field. Note: If a (med)option is set the patient s previous diagnosis code(s) will populate. If it is desired that the previous diagnosis code(s) do not default, please contact your Client Manager. Dx1, Dx12 - There can be up to twelve (12) diagnosis codes entered. Note: Do not enter the decimal point, the system will insert the decimal point. APhy enter the Attending Doctor number, if on patient s account it will default. RPhy enter a Referring Doctor number, if necessary. Note: The Referring Doctor s RProv and RNPI will populate (if loaded on MM1.2) after selecting <enter> or <tab> key. Loc enter the location where the patient was seen. Note: If there is only 1 location where patients will be seen, the location can be defaulted on MM1.8. Admit enter an admit date, if applicable. Dischg enter a discharge date, if applicable. Last Seen This field if for the date the patient was last seen, if applicable. Acc/Emp enter Y if the visit was due to an accident. Auto? enter Y if the visit was due to an automobile accident. Note: If a Y is entered, then ST must be completed with the state that the automobile accident occurred in. 9

10 Other? enter Y if the visit was due to an accident other than an employer or automobile. Assign- will populate Y/N if practice accepts assignment as shown on Insurance Master Record (MM1.4) ST If the visit is due to an automobile accident, then the state that the accident occurred in will need to be entered in this field. 1 st Sym/Lmp This field is for the date of the first symptom or the date of the last menstrual period. Flag This field is used for maternity claims only. If the Flag field is checked, the date of the last menstrual period will print the date on an electronic claim. Note: Anywhere within this block, after the required fields are entered, a user can bypass the fields that do not need to be completed by either clicking on the F8-Changes blocks tab, or using the F8 function key, or by clicking in the T column in the next block. Field Name Field Description Quick Multiple Posting Screen (Block 1) Acct Name Group Batch Bar Code Patient Diagnosis Dx1 Dx12 APhy RPhy RProv RNPI Loc Admit Dischg Last Seen Acc/Emp Auto Other Assign ST 1 st Sym/LMP Flag BLOCK 2 - This is the patient s account number. This field will default from the Patient Registration Block screen. This is the patient s name. This field will default from the Patient Registration screen. This is the group code that is set within the database. This is the batch that has been opened to post transactions in. This is a field is utilized if there is a bar code scanner. This field will display the description of the diagnosis when the cursor is active in one of the DX fields. These fields are for the diagnosis that needs to be on the insurance claim. This field is for the Attending Physician number and name. This field is for a Referring Doctor number and name, if needed for the claim. This field will automatically default the Referring Doctor s UPIN number if entered on MM1.2 This field will automatically default the Referring Doctor s NPI number if entered on MM1.2. This field is for the Location number and name where the patient was seen. This field is for the hospital admit date, if applicable. This field is for the hospital discharge date, if applicable. This field is for the date last seen, if needed. This field is utilized if the reason for a patient s visit is due to an accident or was employer related. This field is utilized if the reason for a patient s visit is due to an automobile accident. This field is utilized if the reason for the patient s visit is due to an accident other than Employer or Automobile. This field will populate whether the practice accepts assignment or does not accept assignment for the insurance company that is attached to a patients account. This flag is set on the Insurance Master record, MM1.4. This field will need to have the state that the automobile accident happened in if the Auto? Field is set to a Y. This field is to be used if the date of the first symptom or the date of the patient s last menstrual period needs to appear on an insurance claim. This field should only be used for maternity claims. If a Y is entered in this field it will trigger the last menstrual period date that is completed in the 1 st Sym/LMP to populate in box 14 on the CMS 1500 paper claim. T This field is where the type of transaction will need to be entered. The choices are C for charge, P for payment, or A for adjustment. D.O.S Enter the date of service. Note: If the date of service was defaulted on the Batch Control screen, it will automatically populate that specific date of service. The DOS can be overridden on the transaction line item. 10

11 Procedure Enter the procedure according to the type of transaction that is being posted. Note: Once the procedure code is entered and the user uses either the <tab> or <enter> key, several hidden fields will open for Accession Number, NDC Code, NDC U.M., and/or NDC Qty. If these fields are not applicable by using the <tab> or <enter> key twice the hidden fields will no longer be visible and the Description field will automatically populate according to the code that was entered in the Procedure field. Accession Number This is a hidden field that can be utilized for lab procedure codes, if applicable. NDC Code This is a hidden field where the NDC, National Drug Code, can be entered if the procedure code being posted is an injection. Note: There is a (med)option that will create a pop up with the NDC codes that would be appropriate for the J code that is entered. NDC U. M. This is a hidden field that can be utilized for the NDC Unit Measure, if applicable. NDC Qty This is a hidden field that can be utilized for the number of units, if applicable. Description The description that is attached to the code, in MM1.6, that is being posted will automatically populate in this field. MD MD MD These 3 fields are utilized to enter any modifiers that will be applicable to the charge being posted. A This field will automatically populate according to which type of transaction is being posted. The options are D for debit. If a charge is being posted the column will default to a D or C for credit. If a payment or adjustment is being posted the column will default to a C. UnitAmt This is the dollar amount of the transaction that is being posted. Note: If the CPT fees spreadsheet was completed and loaded into a database, during the implementation period, the dollar amount for the CPT code will automatically populate. It can be overridden if necessary. Also, for a copayment that is being posted, if the copay amount has been attached to the patient s insurance record, the amount will automatically populate in the UnitAmt field. Perf This field is where the Performing Doctor will need to be entered, if different from the Attending Doctor. Note: This field will automatically populate the doctor number that is entered in the APhy, attending physician, field. It can be overridden if the patient was seen by a NP or PA. If the NP or PA cannot bill to the patient s insurance under his or hers own numbers then the Supervising physician s number will need to be in the APhy field and the NP or PA s doctor number will need to be entered in the Perf field. However; if the patient s insurance company allows a NP or PA to bill under their own numbers, then the NP or PA s doctor numbers can be entered in both the APhy and Perf fields. Tm- This field is utilized if there were a team of doctors working to provide services to a patient. If this is necessary enter a T in the field. ExtDoc-This field is for the Extended Doctor number, used in Team. Qn This field is for increasing the quantity of a procedure code that is being posted. If you need to multiply the units enter a 2,3,4, etc. If the quantity is increased the dollar amount will also multiple. IT This field represents the Insurance Type. This will automatically populate according to the patient s primary insurance. Ins Seq- This field is for the insurance sequence, 1 for primary, 2 for secondary, etc. PS Place of Service This represents that POS of the charge that is being posted. D D D D These 4 fields are to rank the diagnosis codes that are entered in the Dx1 - Dx12 fields. It gives the user the ability to rank the diagnosis per charge line item. Note: These fields will automatically populate when tabbing or entering through them in the order the diagnosis codes are listed. However; if a charge needs the order changed or if the charge only needs the second diagnosis code on that line item, the fields can be overridden to match up to any of the diagnosis codes that were entered. E This field represents if a line item has been error corrected. Todate This field can be utilized if there are multiple dates for the same procedure code and they can be billed as one line item. Amount This field represents the dollar amount of the charge line item. This will automatically populate according to the dollar amount that was entered in the UnitAmt field. Tot Chgs This field will continue to calculate as charge(s) are being posted. This will give the user the total dollar amount of the patient s charge(s) posted in order to ensure that all charges were posted. Field Name Field Description Quick Multiple Posting Screen (Block 2) 11

12 T D.O.S. Procedure Accession Number NDC Code NDC U.M. NDC Qty Description MD MD MD A UnitAmt Perf Tm ExtDoc Qn IT Ins Seq PS D D D D E Todate Amount Tot Chgs This field represents the type of transaction that is being posted. The options are C for Charge, P for Payment, or A for Adjustment. This is the Date of Service for the transaction line item. Note: This field will automatically populate if the Default Date of Service was entered on the Batch Control screen. This field is where the code of the transaction line item will be entered. This is a hidden field that will populate after the Procedure field has been entered and the user uses the <enter> or <tab> key. This field is utilized by clients if there is an internal lab in the practice in order to enter the accession number, if applicable. This is a hidden field that will populate after the Procedure field has been entered and the user uses the <enter> or <tab> key. This field is utilized if the procedure code is a J code for an injection. This is a hidden field that can be utilized for the NDC Unit Measure, is applicable. This is a hidden field that can be utilized for the number of units, if applicable. The description that is attached to the code, in MM1.6, that is being posted will automatically populate in this field. This field is for the 1 st Modifier on a charge line item, if necessary. This field is for the 2 nd Modifier on a charge line item, if necessary. This field is for the 3 rd Modifier on a charge line item, if necessary. This field will automatically populate according to what type of transaction is being posted. The options are D for Debit, charges will be a debit, or, C for Credit, payments and adjustments will be a credit unless the transaction being posted is a refund. If the code is pertaining to a refund this column will then populate a D for debit. This field is for the dollar amount of the transaction that is being posted. Note: For charges, the dollar amount will automatically populate if the fee is attached to the procedure code in MM1.10. Also, this field will automatically populate for a payment if the transaction being posted is a copay and the copay dollar amount is attached to the patient s insurance record. This field is for the Performing doctor. This field will automatically populate the doctor number that was entered in the APhy field. This field is utilized if there were a team of doctors working to provide services to a patient. If this is necessary enter a T in the field This field is for the Extended Doctor number, used in Team. This field can be utilized if the transaction line needs to be multiplied. This field represents the Insurance Type that is attached to the insurance record in MM1.4. This reflects the patient s primary insurance. This field displays the insurance sequence: 1 primary, 2 secondary, etc. This field is for the Place of Service This field is to rank the diagnosis code that needs to appear first on an insurance claim. This field is to rank the diagnosis code that needs to appear second on an insurance claim. This field is to rank the diagnosis code that needs to appear third on an insurance claim. This field is to rank the diagnosis code that needs to appear fourth on an insurance claim. This field represents an Error Correction by populating an E in this field. This field is utilized if there are multiple dates included on a claim. This field will populate the dollar amount for the transaction line item being posted. This field will continue to calculate as charges are being posted on a patient s account. This will be the total that will be used to ensure that all charges were posted. If multiple charges need to be entered on the same patient the user will down arrow or click in the T column on the next line and post the additional charge, to be repeated until all charges are posted for a specific patient. If a true copay is being posted at the same time as the charge(s), please follow the steps below: After the charge(s) have been posted, the user can down arrow to the next line item to post the patient s copay. 12

13 Change the T column from a C to a P for payment. The D.O.S. will default to the same as the charge(s), <enter> Enter the method of the co-payment in the Procedure field. A user will need to select from the specific co-payment pay codes that are set up in the database, <enter>. The user will see a hidden field for a Check Number. If the payment was something other than a check, the user will <enter> past the check number field. Note: If the patient is paying by credit card, the type of credit card could be entered in this field, if needed. The cursor will default to the UnitAmt field, the user will enter the amount of the copayment. At this point the user can Save. To post transactions to another account Once all transactions have been posted to a specific account, the user will continue to exit back until the Patient Registration Block is displayed at which time the user can search for the next account that needs to have transactions posted. Note: Please see in the bullet for Post Payment/Adj on steps to post a payment, other than a true copay, at the time a charge(s) are being posted. 13

14 Informational Fields CPT Code This field represents that CPT code that is being posted. This will default from the Procedure Master, MM1.6 Medicare Code This field represents the code that Medicare may require instead of the actual CPT code. This will default from the Procedure Master, MM1.6. Medicaid Code This field represents the code that Medicaid may require instead of the actual CPT code. This will default from the Procedure Master, MM1.6. Quick Multiple Posting Screen - Additional Tabs Change Blocks This tab or <F8>can be utilized if a user wants to bypass fields that are in block 1 that do not need any information entered in that field. By clicking on this tab or by using the <F8> function key on the keyboard, the cursor will default to block 2 avoiding a user using the <tab> or <enter> through each field to get to the next block to post a transaction. Also, if a user is in block 2 and needs to get back up to block 1 the Change Blocks tab, or the <F8> function key, can be utilized to get back to block 1 from block 2. Precertification - This tab or <Shft F8> can be utilized, if the user needs to enter a precertification or authorization at the time the charge(s) are being posted. 14

15 Field Name Group Account Insured Name Primary Insurance Secondary Insurance Tertiary Insurance Ins Company Effective Date Expiration Date Visits Authorized Certification ID Specialty Doctor Available Visits Pending Visits Contact Phone Number Field Descripton Precertification Numbers This field will default the group code of the database if set up on MM1.1. This field will default the patient s account number and patient s name. This field will default the insured s name. This field will default the Insurance Key Code, Insurance Company Name, Product Type, Policy Number, and Group Number, according to the patient s primary insurance. This field will default the Insurance Key Code, Insurance Company Name, Product Type, Policy Number, and Group Number, according to the patient s secondary insurance. This field will default the Insurance Key Code, Insurance Company Name, Product Type, Policy Number, and Group Number, according to the patient s teritary insurance. The Insurance Key Code from the applicable insurance providing the precertification/authorization number in this required field. First day the precertification/authorization number is effective in this required field. Last day the precertification/authorization number is effective in this required field. The total number of visits the insurance company approved in this required field. Precertification/authorization # obtained from the insurance in this required field. Users can manually enter or click the Specialty LOV to assign the specialty that is applicable to this precertification/authorization#, if assigned by specialty. This can only be assigned by Specialty OR Doctor and not both. Users can manually enter or click Doc LOV to assign the correct doctor that is applicable to the precertification/authorization#, if assigned by doctor. This can only be assigned by Specialty OR Doctor and not both. Once saved, this field will auto-populate the number of available visits the insurance has approved. The number of visits remaining for this specific precertification/authorization # will auto-populate after each precertification use. Enter the insurance contact name. Enter the insurance contact phone number. Step by Step to build a Precertification o Ins Company This is a required field. Enter the insurance key code of the insurance company that issued the precertification. The patient s insurance information will be displayed in the INS1, INS2, or INS3 fields. o Effective Date This is a required field. Enter the effective date of the precertification. o Expiration Date This is a required field. Enter the expiration date of the precertification. o Visits Authorized This is a required field. Enter the number of visits authorized on the precertification. o Certification ID This is a required field. Enter the certification number assigned by the insurance company. o Specialty If the precertification states that the patient can see any provider within a practice the user will enter the specialty code that is set in the database in this field. Note: Either the Specialty field or the Doctor field needs to be completed, not both. o Doctor If the precertification states that the patient can only see a specific provider the user will enter the provider s number in this field. Note: Either the Specialty field or the Doctor field needs to be completed, not both. o Available Visits This field will automatically populate according to the number of visits that is entered in the Visits Authorized. field. This field cannot be updated by a user. o Pending Visits This field will automatically populate as the precertification is attached to either an appointment or a charge line item. Note: As the precertification is attached to either an 15

16 o o o appointment that has been booked or a charge that has been posted. The available visits will automatically decrease. Contact Enter the contact name that provided the authorization, optional. Phone Number Enter the phone number for the contact, optional. Save Request Claims / EOB s This tab or <Shft F7> can be utilized, if the user would like to print a CMS1500 form to give to the patient in order for the patient to file the claim to their insurance company. Field Name Format Field Description Request Insurance Claims/EOBS This field has several options that a user can select by clicking on the down arrow. The options are: o 1- Form CMS-1500 This option will print a paper claim o 2- Form IDPA This option will print an Illinois Medicaid 2360 form. o 3- Form UB-04 This option will print a facility UB04 claims. o 4- Form C-4 This option will print a New York workers comp claim form. o 5 Form MI BCBS This option will print a special Blue Cross Blue Shield form for Michigan. o 6 Form IL 2210 This option will print an Illinois Medicaid DME form. o 7 Form IL 1443 This option will print an Illinois Medicaid Podiatry form. o 8 - Form CMS-1500 Old This option will print a paper claim on the retired CMS form. o E Demand EOB This option will print a demand Computer Generated Admittance 16

17 Group Group Name Account Patient Name Doctor Doctor Name Ins Co INS Co Name Begin Date End Date Printer Copies Ins Seq# For This Patient: INS Co1 INS Co2 INS C03 Advice. This is the database group code that is stored on MM1.8. This is the database group name. The name will automatically populate. This is the patient s account number. This is the patient s name. The name will automatically populate. This field is for the doctor that performed the service. This field will automatically populate the doctor s name according to the doctor that was entered in the Doctor field. This field is for the insurance company key code. This field will automatically populate the insurance company name according to the insurance key code that was entered in the Ins Co field. This field is for the beginning date of the claim. This field is for the ending date of the claim. This field is for the selection of the printer where the CMS-1500 forms are loaded. Note: A user will need to select the print with the CMS-1500 forms loaded instead of defaulting to View. This field is for the number of CMS-1500 paper claims that need to be printed. This field is for the sequence number if the claim is for insurance other than the primary. These 3 fields will automatically populate according to the insurance records that are attached to the patient s account. This will automatically populate the patient s primary insurance key code and Insurance Type (IT). This will automatically populate the patient s secondary insurance key code and Insurance Type (IT). This will automatically populate the patient s tertiary insurance key code and Insurance Type (IT). Note: When a patient has multiple sequences on insurance, the system will automatically bill to the correct insurance according to the date parameters entered. Step by Step to print a complimentary insurance claim Select the Request Insurance Claims/EOB s tab or <Shift F7> on the keyboard. This will advance a user to the Request Insurance Claim/EOBS screen. In the Format field, the default will be 1-Form CMS Leave the field defaulted to CMS Use either the <tab> or <enter> key. o Group field will automatically populate the database group code if it is defaulted on MM1.1. o Group Name field will automatically populate. o Account number field will automatically populate. o Doctor field As shown in the help message a user can enter a valid doctor number, or leave the field blank for ALL doctors. o INS Co field As shown in the help message a user can leave this field blank for the Primary Insurance, enter a C for Courtesy claim, or put a valid INS Co key code to be selected from the fields on the right of the screen titled INS Co1, INS Co 2, INS Co 3. o Begin Date As shown in the help message a user can enter the beginning date, or use <enter> to default to the date of 01/01/91. o End Date As shown in the help message a user can enter an Ending date, or use <enter> to default to the current system date. o Printer The user will choose, from the drop down, which printer the CMS-1500 forms are loaded in. o Copies A user can print multiple copies, if needed. o Ins Seq# - A user can enter the Ins Seq number in this field depending on which insurance company the CMS-1500 needs to be printed. 17

18 o Once all of the above information has been completed, the user will click on the Generate Form tab or use the <F8> function key from the keyboard. EMC Narrative / Additional Paperwork This tab or <Shft F12> would be used if the charge that is being posted needed additional information on the claim. The user would need to have the cursor sitting on the line item on the Quick Multiple Posting Screen that would need the additional information attached to the claim. The user would then click on the EMC Narr/PWK tab or <Shft F12> and the screen would advance to the EMC Narrative/PWK screen. Field Name Group D.O.S. Perf Account MD PS Status Field Description EMC Narrative / PWK This is the group code of the database. This field will automatically populate from the charge line item. This is the Date of Service of the charge line item. This field will automatically populate from the charge line item. Performing Doctor. This field will automatically populate from the charge line item. This is the patient s account number. This field will automatically populate from the charge line item. Modifier. This field will reflect a modifier if attached to the charge line item. Place of Service. This field will automatically reflect from the charge line item. This is the status of the charge line item. The options are: H Hold, if the charge line item is still in a batch. P- Posted, if the charge line item is not in a batch and has been posted to the patient s account. 18

19 IT Amount Procedure Description Insurance Claim Message Updated User ID MEA Ref ID MEA Qualifier MEA Value SV1 Text Paper Work Transmission Code Report Code Updated Control Number User ID Insurance Type. This field will automatically populate according to the patient s primary insurance. Dollar amount of the charge line item. This field will automatically populate from the charge line item. This is the CPT code for the charge. This field will automatically populate from the charge line item. This is the description of the charge that was posted. This field will automatically populate from the charge line item. This is the field where a user would enter any note that needs to appear in box 19 on the CMS-1500 paper form. There are two (2) lines for a free text message. This field will automatically populate the date that the message was entered at the time it is saved. This field will automatically populate the User ID of the person entering the message at the time it is saved. This is a drop down field options are: OG Original Starting Dosage; TR Test Results This is a drop down field where a user would select from if the MEA Ref ID field is completed. This is a free text field that a user would enter the value. This is a free text field that must be completed if the charge code is a Not Otherwise Specified code. These fields can be completed if there needs to be an attachment to a claim in order for Medicare to process the claim. This is a drop down field where a user would choose what method of sending the paper work to Medicare. This is a drop down field where a user would choose what type of paperwork they are sending to Medicare. This field will automatically stamp the date the Paper Work fields were completed at the time the user Saves. This is a free text field that a user will enter the control number that they create to identify the paper work that is being sent to Medicare. Note: If the Paper Work fields are utilized, the user will need to go onto their Medicare website and download their carriers cover sheet that must accompany the paper work. The control number will need to be entered on the cover sheet. This field will automatically stamp the user Id of the person that entered the Paper Work fields. Step by Step for completing the EMC Narrative/PWK screen. Note: The charge line item that the user had selected on the previous screen will automatically populate in the Charge Detail block. o o o o o Insurance Claim Message There are 2 lines available for a user to free text any statement that would need to appear in block 19 on a CMS1500 form. MEA Ref ID - If either the OG Original Starting Dosage, or, the TR Test Results need to be appear on a claim. the user would accomplish this by clicking on the down arrow in the MEA Ref ID field and clicking on the appropriate choice. MEA Qualifier - If this field needs to appear on a claim, the user would click on the down arrow and select the appropriate option. MEA Value This is a free text field that can be completed. SV1 Text This is a free text field that must be completed if the charge code is a Not Otherwise Specified code. 19

20 o o o o Paper Work These fields can be completed if a claim needs to have additional paper work sent to the carrier in order to get the claim paid. This will allow the claim to go electronically however; the carrier will hold the claim until the additional information has been received. Transmission Code This is a drop down field that the user will select to indicated to the carrier as to how the additional information will be sent. Report Code This is a drop down field that the user will select what type of paper work will be sent to the carrier. Control Number This is a free text field that the user will create their own code to identify the additional information that will be sent to the carrier. The carrier will use the control number to identify which claim the additional information needs to be attached to. Note: The user will need to go to the Medicare website and download Medicare s cover sheet in order to utilize this feature. Post Payment / Adjustment Use this tab or <F11> If a patient is paying a payment, other than a true copay, at the time of service, this tab will allow a user to post the payment on each charge line item. It is very important that any payment, other than a true copay, is posted per each charge line item. Otherwise the payment will go into unallocated and will have to be allocated to the charge(s) at a later time. Field Name Check/EOB Nbr Check Date Field Description Payments/Adjustment by Charge Enter the Check number, if patient paid by check. Note: This field can also be utilized if the payment was by credit card to enter the credit information. This is a required field. Enter the date of the payment or if preferred the date of the 20

21 Account Balance FC Ex Group Batch Hold Stmt. Msg Code Count Ins 1 Ins 2 Ins 3 Mst Code deposit. The account number of the patient that the payment is being posted to. Note: The account number will automatically populate from the Quick Multiple Posting Screen. This is the balance on the patient s account which includes the patient s balance and insurance balance combined. The Financial Class will automatically populate according to the patient s primary insurance. If an Exception Code is attached to the patient s account, it will display in this field. Displays Group Code Displays Batch Number This field will reflect the Hold Statement flag from the Patient Account screen. This field will reflect the Message flag if one is attached to the patient s account. This field will display the number of times the message is to appear on a patient s statement. This field will display the patient s primary insurance key code and insurance company name. This field will display the patient s secondary insurance key code and insurance company name. This field will display the patient s tertiary insurance key code and insurance company name. This field will display the master code that is attached to the insurance key code on the insurance master. All Charge Items Block Field Name Field Description DOS Date of Service for the charge line item. This field indicates the responsibility of the charge line item. The options are H for Resp hold, if the charge is still in a batch, P if the charge is patient responsibility and I if the charge is out to insurance. Procedure Procedure code that was posted for the charge line item. Description Loc Doc Amount IT Item Balance Description of the CPT code that was posted. Location where service was rendered. Doctor that performed the service. Dollar amount of the charge line item. This field represents the Insurance Type that is attached to the insurance record in MM1.4. This reflects the patient s primary insurance. This field will indicate the balance remaining on a specific charge line item. Enter Payments/Adjustments against a Charge Item Block Field Name Field Description DOS This is the Date of Service that will automatically populate according to the charge line item that was chosen in the All Charge Items block. An insurance key code can be entered in this field if the payment was from an Ins Code insurance company. However; in this method of posting payment, this field would be left blank due to the payment being from a patient. P/A This field is for the type of service. The options for this posting screen would be either a P for payment or an A for adjustment. Procedure The internal payment or adjustment codes as set in the database. Description The description of the payment or adjustment code that is being posted. Amount This field is where the user would enter the amount of the patient payment. 21

22 OPS Item Bal This field stands for Other Payor Source. This is used for Ohio Medicaid when it is secondary to any carrier other than Medicare. The code that is entered in this field will print in Block 10D of the CMS-1500 form. The payor source code can be found in the Ohio Medicaid Manual. This field will automatically populate the item balance after the payment or adjustment has been entered. Note: The following fields will not be utilized in posting patient payments and will be explained, in detail, in the Payment Posting module. Ins Code Ins Seq Prefix Code Amount Reas 1-9 Code Rmk 1-5 History Step by Step to apply a payment to a charge line at the time charges are being posted Select Post Pymt/Adj or <F11> from the Quick Multiple Posting Screen. The screen will advance to the Payments/Adjustments by Charge screen as shown above. The following fields will automatically populate and the cursor will default to the Check/EOB Nbr field. o Group o Batch o Account If the payment was made by a check, enter the check number in this field. If some other method of payment was received a user will <tab> or <enter> past the Check/EOB/Nbr field. The cursor will default to the Check Date field. This is a required field. A user will either enter the current system date or the date the deposit will be made. The cursor will default to the Account field, where the patient s account number will be displayed. The user will either use <tab> or <enter>. Note: At this time the following fields will populate: o Patient s name o Balance This field will display the patient s account balance o FC - Financial class o Ex Exception code, if one is attached to the patient s account o Hold Stmt. This field will display what is populated in the hold statement field on the patient s account o Msg Code This field will display a statement message code if one is attached to the patient s account o Count This field will display the number of times a user has asked for the Message to appear on a patient s statement. o Ins 1- Ins 3, Mst Code- These fields will display the insurance key code, name and master code for the primary, secondary and teriterary patient insurance. After all of the above fields are completed the user will either use the <F8> function key twice or <tab> or <enter> until the All Charge Items block displays the patient s charges. Note: This screen does not have the Change Blocks tab however; a user can use the <F8> function key instead. 22

23 The All Charge Items block will display all of the charges on a patient s account. The line item that is selected will be indicated by the raised blue button, that Clinix refers to as the Blue Selector Button. The user can view all of the charges by either using the down arrow on the keyboard or using the scroll bar to the right of the Item Bal field. Once the charge line item has been found, that the payment needs to be applied to, the user can either click on the blue selector button on the charge line item or can <enter>. The cursor will advance to the Enter Payments/Adjustment against a Charge Item block and the charge line item that was selected will change the selector button from blue to red in order for a user to know which line item they are currently working on. The DOS will automatically populate from the chosen charge line item. The user will enter past the Ins field as this is a patient payment not an insurance payment. The user will enter the type of transaction in the P/A field. The choices are P for payment or A for adjustment. Procedure, the user will enter the internal code for the payment or adjustment in this field, <enter>. The Description field will automatically populate with the procedure description as set in the database. The cursor will default to the Amount field. The user will enter the amount the patient paid in this field. If the patient paid the line item in full the Item Bal will default to 0.00, zero. If the patient is only paying a partial payment on a line item, the Item Bal will default to the difference between the charge amount and the payment. Note: The OPS field pretains to Ohio Medicaid if they are secondary to any insurance other than Medicare. Once the payment or adjustment has been posted to the charge line item, the user will Save. If there is another charge line item in the All Charge Items block, the cursor will default to the next charge. If the user needs to post a payment or adjustment to that charge, they will repeat the above process for each charge that a payment or adjustment needs to be posted. 23

24 NOTE: It is very important that payments or adjustments are posted to each charge line item when a payment has been received. Otherwise the payment or adjustment will appear on the Unallocated report and will have to be allocated at a later time. Payment / Adjustment Allocation This tab or <F9> function key, if there is a payment or adjustment that was posted prior to the charge(s) in order to apply the payment or adjustment to the charge line item. For example; if a pre-payment was posted prior to the date of the charge utilizing this tab will allow a user to allocate the pre-posted payment at the time the charge(s) are posted. Field Name Group Batch Account Unallocated Amt Balance Field Description Payment/Adjustment Allocation The group code will default. The batch that the highlighted payment was posted. This will automatically default. Patient s account number will automatically default. This will automatically populate the unallocated payments and/or adjustments on the patient s account. This is the balance on the patient s account which includes the patient s balance and insurance balance combined. Unallocated Payments/Adjustments Block This block will display any payments or adjustments that have not been allocated to a specific charge line item. Field Name Field Description Unallocated Payments/Adjustments Svc Date Date of Service the payment or adjustment was posted to. St Status of the transaction. Options would be P for Posted, if not still in a batch or H 24

25 Ins Ty Procedure Description Amount Unalloc. Amt for hold, if still in a batch. Insurance Key Code, if it is an insurance payment or adjustment. Type of transaction. Payment or adjustment code as posted. Description of the payment or adjustment code posted. Dollar amount of the payment or adjustment. This field will automatically populate the amount of the payment or adjustment that has been selected for allocation. All Charge Items Block This block will display all charges that are posted to the patient s account. Note: The date order is from most current to oldest date of service. Field Name Field Description All Charge Items Svc Date This is the Date of Service for the charge. This field reflects who is responsible for this charge line item. Options are: H for hold if the charge is still in a batch P for Patient if the charge is patient responsible R I for insurance if the charge is out to insurance X if the charge is in the claim rejection on MM5.5 Y if the line item balance is zero Z if the line item balance is less than zero. Procedure Procedure code that was posted for the charge line item. Description Description of the CPT code that was posted. Loc Location where service was rendered. Doc Doctor that performed the service. DX Code Diagnosis code attached to the charge line item. Amount Dollar amount of the charge line item. Item Bal The balance still outstanding on the charge line item. This field is utilized for the user to enter the dollar amount of the unallocated payment or Alct Amt adjustment. Step by Step to Allocate a Payment or Adjustment The Group Code, Batch Number, Account number will display along with the Unallocated Amt and Balance. Unallocated Payments/Adjustment Block This block will display any unallocated payments or adjustments that are posted to the patient s account that are not attached to a charge line item. All Charge Items Block This block will display any open charges that are on the patient s account. Note: The charges will be listed with the most current DOS to the oldest DOS. Highlight the payment or adjustment line item that needs to be allocated and either click on the Next Block tab or use the <F8> function key. At this time the user will see an asterisk * displayed in the St column indicating this is the line item that the user will allocate. Also the dollar amount of the payment or adjustment will be displayed in the Unalloc.Amt field and the cursor will default to the Alct Amt field in the All Charge Items block. The payment or adjustment can then be applied to any charge line item that the user prefers to allocate it to. Note: Once the payment or adjustment has been reallocated, the user will Save. After the allocation has been completed, the Item Bal on the line item will decrease by the amount of the payment or adjustment that was allocated and that payment or adjustment will no longer be displayed in the Unallocated Payments/Adjustments block. If there are multiple unallocated payments or adjustments, the process can be repeated to allocate each line item. If the user does not want to allocate all of the payments or adjustments and exits out of the screen a 25

26 pop up will appear that states Are you sure you want to exit without reallocating? The user will choose either Yes or No Receipt This tab will allow a user to print a receipt, if necessary. After the charge(s) and payment, if applicable, have been posted and Saved the user will click on the Receipt tab or use <Ctr A> on the keyboard. The user will then see the Print Receipt Parameter pop up. The options for printing the receipt are to either choose a printer by clicking on the down arrow in the Printer field or it can be left on View to create a PDF version. Multiple copies may be printed by entering the number of copies needed in the Copies field. The user will then click on OK. If the printer option was left on VIEW, the user will get the PDF version and can then proceed to print the receipt by choosing a printer. Please see below for sample of a receipt. 26

27 If a user is posting payments to each charge line item as described in the Post Payment/Adj section, once all of the payment has been posted on the Payments/Adjustments by Charge screen, the user can exit back to the Quick Multiple Posting Screen and print the receipt. Retail Sales - For a Future Enhancement which will be announced at the time of release. Reconciling, Printing and Releasing a batch Batch Status o H= Hold A batch must be on a hold status before any transactions can be posted in it. The batch will automatically default to a H when a batch is opened. o E= Release for Editing In order to print the batch edit report, the user will change the batch status to and E and Save. Please see below for steps to printing a batch edit report. o R= Release for Posting Once a batch has been balanced and the Control Totals have been changed, the user will change the batch status to a R. Note: Clinix will only look for batches that have the R status on them to process in the nightly post. If the batch status is either a H or E that batch will still be available, to the user, until it is released. Step by Step on how to print a batch Change the Batch Status to an E and Save. Click on the Batch Edit tab or <Shft F8> function key. Note: Please see the Field Name and Field Descriptions for the Batch Control screen in the Create a New Batch section. 27

28 The printer Parameters pop up will appear. o Printer The user can either click on the down arrow and choose a network printer, or choose to leave it on VIEW. o Updated By This field will automatically default to the person that is working in the batch. o Report Type The option of PDF will automatically default. However; if the user prefers to have the batch edit report print in the CSV format, the CSV radio button can be selected. Once the parameters have been selected, the user will click on OK. This will create the batch edit report. This report can be used to balance the batch or can be utilized as a hard copy of the transactions that are posted within the batch. 28