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OR350 > 8.0 Configure Technical Charging > Flashcards

8.0 Configure Technical Charging Flashcards

1
Q

How are each charge in Epic is categorized?

A

As professional or technical.

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2
Q

What are professional charges?

A

Charges for services rendered by a licensed practitioner.

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3
Q

What are PROFESSIONAL CHARGES typically based on?

A

Professional charges are typically based on CPT codes in the procedure (EAP) master file. They are used to send charges for services performed on a patient.

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4
Q

In what two ways will professional charges for surgeons be generated?

A

Professional charges for surgeons will be generated in two ways:

  • based on the CPT code in the base procedure
  • through chargeable procedures and supplies documented in the Charge Capture navigator section.
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5
Q

What are technical charges?

A

Charges for non‐physician staff and hospital‐owned resources used during surgery. These charges can include:

  • Facility
  • Supplies
  • Implants
  • OR time
  • Recovery time
  • Equipment Instruments
  • Staff Procedures (flat‐fee procedures)
  • Anesthesia supplies and resources
  • Medications
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6
Q

To charge for any of the technical charges, OpTime must send to the billing system?

A

A charge code (EAP), and in some cases a charge amount.

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7
Q

What is a charge code?

A

A record in the procedure (EAP) master file that contains charging information. The creation of charge codes are handled mostly by Hospital Billing (HB) charging analysts.

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8
Q

What are the build steps for setting up Technical Charging?

A

What are the build steps for setting up Technical Charging?

  1. Configure surgical procedure and inventory item records with charging‐related information
  2. Configure charge code table records for time‐based resources
  3. Configure charge settings
  4. Configure a charge profile
  5. Attach a charge profile to an OpTime Location or System Definitions (EAF)
  6. Test your work
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9
Q

What can generate charges?

A

Surgical procedures (ORP) Inventory items (SUP) Charge code tables (OCT)

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10
Q

What documentation will generate charges?

A

Charge settings (ORT)

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11
Q

When will those settings apply?

A

Charge profile (ORT)

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12
Q

Where will those settings apply?

A

OR Location (EAF) OpTime System Definitions (EAF)

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13
Q

What are two ways procedures are most commonly charged?

A

The first method is based on time

the second uses a flat rate.

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14
Q

For time‐based charges, what will setting the Procedure level field on the Additional Information form of the Procedure (ORP) record will allow you to do?

A

To charge differently for resources based on procedure difficulty

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15
Q

True or false: At minimum, a SUP record must have a charge code and be flagged as chargeable to send a charge on to the Post Charges Navigator.

A

True.

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16
Q

SUP records that are flagged as chargeable and contain a charge code must then contain either… What?

A

A cost per unit or have an override charge amount specified in order to generate an actual charge.

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17
Q

Without either a cost per unit or override charge amount, then the charge that is sent is a… What?

A

Zero dollar charge.

18
Q

Charge Code Tables for Time‐Based Resources Technical charges are commonly generated for the what resources?

A
  • Facility Operating room
  • Staff Equipment
  • Preprocedure time
  • Recovery time
  • Anesthesia technical charging time
19
Q

True or false: Nurses may document the length of time certain pieces of equipment are used to trigger charges.

A

True: Times recorded in the Equipment navigator section can send charge information to a billing system.

20
Q

What does it mean when Set Send procedure charges? to “No”?

A

This means your organization will not charge any flat fee for procedures when these settings are applied.

21
Q

What are charging rules?

A

A charging rule tells the system under what circumstances your charge settings should apply.

22
Q

What are some ways to locate and add properties to a rule?

A
  • You can open and explore the property tree.
  • There is a search bar above the property trees that allows you to search for properties by their name.
  • Advanced search options help narrow your searches even further.
23
Q

What are the final steps in setting up charging for a location?

A
  1. Create a charge profile (ORT)

2. Attach the charge profile to either the OR Location (EAF) or OpTime System Definitions (EAF).

24
Q

What is a charge profile?

A

It indicates which charge settings should apply under certain circumstances.

25
Q

True or false? There can be many charge profiles per Location Definition?

A

False: There is only one charge profile per Location Definitions (EAF). Because of this, you can set both default charge settings as well as use rules to indicate when alternative charge settings should apply.

26
Q

In what order are rules applied?

A

Rules are evaluated from top to bottom, meaning the first rule a procedure matches will determine which charge settings apply.

27
Q

If you have multiple rules, what must you do to make the work properly?

A

You must make sure the most specific rules are at the top of the table and the less specific rules are listed towards the bottom. This will ensure the most accurate charging for those unique situations.

28
Q

Some organizations send a single procedure‐based charge, usually called a packaged procedure charge?

A

A flat‐fee procedure charge.

29
Q

What are flat-fee procedures most commonly used for?

A

Flat‐fee procedures are most commonly used in same‐day surgery locations or ASCs.

30
Q

Where are flat-fees specified?

A

Flat‐fees are specified in the Charge code field of the Additional Information form of a base procedure (ORP) record.

31
Q

To send a package charge, what should the Send procedure charges? field be set to?

A

Yes in the Charge Settings (ORT) being used for that case.

32
Q

What can generate charges?

A

Surgical Inventory Item (SUP)
Charge Code Table (OCT)
Base Procedure (ORP)

33
Q

What documentation will generate charges?

A 
Charge Settings (ORT)
Alterative Charge Settings (ORT)
34
Q

When will those charges apply?

A

Charge Profile (ORT)

- Default Charge Settings (ORT)
- Override Charge Settings (ORT) --> Rule (CER)
35
Q

Where will those charge settings apply?

A

OpTime Location Definitions (EAF)

OpTime System Definitions (EAF)

36
Q

Some organizations send a single procedure-based charge, usually called a packaged or flat-fee procedure charge. What does this generate?

A

This generates one standard fee for a procedure without considering the length of a surgery, its acuity, or supplies used. Flat-fee procedures are most commonly used in same-day surgery locations or ASCs.

37
Q

Where are flat fees specified?

A

Flat fees are specified in the Charge code field of the Additional Information form of a base procedure (ORP) record. Also, to send a package charge, the Send procedure charges? field must be set to yes in the Charge Settings (ORT) being used for that case.

38
Q

True or False: Charge codes are stored in the ORP master file.

A

False. Charge codes and procedure codes are records in the EAP master file. ORP is the master file which holds all of the preference cards and base procedures for OpTime.

39
Q

Imagine an organization wants OpTime set up so that a charge code will drop every five minutes that a patient is in the OR, starting as soon as the nurse marks “In Room” and ending when the nurse marks “Out of Room”. In which record would you indicate that a charge code will drop every five minutes?

A

Charge Code Table

40
Q

In which record would you indicate that the count should start at “In Room” and end at “Out of Room”?

A

Charge Settings

41
Q

An OR Manager says, “I need you to make a new rule that says, ‘If a supply is wasted because it was opened but not used, charge for it anyway.’” Would this be configured in a rule, as the manager suggests? If not, where would it be configured?

A

This shouldn’t be set up in a rule. It is configured in a charge settings record.

OR350 (11 decks)

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