Entering And Reviewing Charges Ch.4 Flashcards
Manuel charge entry
Charge router
charge entry
Epic clinical activity
Epic care and etc.
Non-epic charging activity
Interface
Route charges to billing and error checking
Charge router
Physician fees is professional billing error checking
PB charge review WQ.
Pre AR
Facility fees is Hospital billing error checking
HB charge review WQ
Pre AR
PB charge review WQ sends to
Posted to guarantor account and send the claim to the insurance.
Active AR
HP charge review WQ sends it to
Posted to hospital account.
Active AR
HAR encounter
Manuel charge entry:
1) Some clinicians might not always do their documentation an epic. For example, they might be documenting in another hospital, EMR, and that Pb charges are built out of epic.
2) Clinicians perform services outside of place of service, such as nurse homes, community hospitals, and had in charge tickets or documentation from which staff enters charges.
3) charges might also be manually entered by analyzing a providers documentation to determine what services were performed.
4) during revenue cycle testing charges might be enter manually as a quick way to create a scenario to test a workflow or some system configuration.
For these reasons, staff will learn how to post charges manually using charge router charge entering .
Procedure codes are used to define
What service a provider performed
Diagnosis codes are used to describe
Why a provider perform the services
There are two types of messages that could appear on the error tab of the sidebar
Errors and warnings:
Errors must be fixed before going forward.
Warnings you should review the problem, but you do not need to fix to change it.
Operational decisions:configuration considerations
Which type of validation check should be evaluated during charge router charge entry.
It is recommended to check for the billing critical items for PB and HB during charge entry
Operational decisions: Configuration Considerations
Will these validation checks be error or warnings
Because PB and HB chargers can be entered in charge router charge entry planning for validation checks and how they behave (Error vs. Warnings) will need to be discussed since PB and HB have different billing needs for charging.
Picture of batch closed and processed
You can see how many charges are pending from the visit tab of professional TX inquiry
From the storyboard, and the pending session tab, you can see which charge review WQ in which they are held.
Charge router review:
Timing: after charge triggering charges are still in the charge router and before entering PB.
General recommendation : 1) critical billing checks. 2) mainly IT owned and system WQ
Examples: if a provider created a patient on the fly when they saw a patient at an outside place of service to charge session would likely stop in charge router charge entry for staff to finish registering the patient. You cannot post charges for a patient without a guarantor account.
Reporting consideration :
The dollar amounts displayed in reports are estimated dollars amounts .
PB charge review: Timing:
When the charges are within the PB before posting.
General recommendation: * enter users, work PB critical, and PB coding specific checks.
* Most PB charges you want to review should go here.
Examples: *a PB placeholder charge was triggered from an epic clinical application and needs to be coded.
* a PB charge is missing a require modifier
* PB charge does not have a link diagnosis
Reporting consideration : the dollar amounts displayed are calculated pre-AR.
Re-submitting a charge session
Why might you use force resubmit?
*To meet timely filing.
*To bypass errors that do not need to be corrected.
*Need posted charges for testing later in the revenue cycle.
PB Revenue Guardian runs:
*When an encounter is closed or addended.
- When charges post or are voided
- When charges are evaluated in PB charge review
- During nightly processing for encounters left unclosed for five days or for encounters that have active revenue garden checks (only the active checks on the counter to see if any have been resolved).
PB revenue guardian looks at encounters level information. If you have charging scenarios that you separate encounters except for surgical and anesthesia contacts, they will be considered separately. For example if a patient has a separate lab encounter during admissions, the lab and counter and omissions will be checked separately.
The main purpose of revenue Guardian is finding charges missed due to workflow problems.
PB charge review:
Review existing charge sessions with issues:
*the purpose is review charge sessions with define problems
*audit a targeted percentage of clean charge sessions.
Flexibility: charge session criteria
PB revenue Guardian checks:
Review encounters for possibly missing charges.
* Review encounters without charges
* Review encounters with current charges, but not all expected charges
* Review encounters with HB charges but missing PB charges
Flexibility: Variety of criteria to search patient’s rules, current charges, BPA’s, etc.
Review chapter 4:
True = one charge ticket is the equivalent of one charge entry session.
True
Review ch.4 : On the charge line, what purpose does the diagnosis field serve?
Associates the charge with the appropriate diagnosis from the diagnosis tables.
Review Ch4: what is the purpose of processing your charge entry batch?
Post clean charges and sends charges to charge review.
Review ch4: what is the difference between a warning and an error?
Warnings can be ignored, but arrows must be fixed
Review ch4: false= users review charge sessions in charge review WQ after the system has posted the charges to the account
False
Review Ch4: When should I use or resubmit a charge session?
When the user thinks all the issues are corrected
Review ch.4: where are revenue guardians checks reviewed?
Charge review WQ
Revenue guardian reports
