Ann Hage SoftAR Product Specialist Pricing Coding Miscellaneous Tests Following todays presentation you will have been exposed to pricing and coding Miscellaneous Tests through Charge Entry Application ID: 789398
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Slide1
Deep Dive into Charge Entry
Ann Hage
SoftA/R Product Specialist
Slide2Pricing / Coding Miscellaneous Tests
Following today’s presentation, you will have been exposed to pricing and coding Miscellaneous Tests through:
Charge Entry Application
Patient Account Module
LAB Result Fields
Slide3CHARGE ENTRY
Slide4Charge Entry Application - Setup
The
first
section of the presentation will expose you to the different areas of setup that relate to Charge Entry.
System Parameters
Test Flags
Reference Lab Codes
Invoicing Errors
Slide5Setup - System Parameters
The System Parameter, ChargeEntrySrvDates, determines the start date in the Date of Service range used in the Charge Entry Application’s worklist
Slide6ChargeEntrySrvDates = 0
Assuming a system date of 04/30/2019 and a ChargeEntrySrvDates value of 0, the “Srv Dt From” would be set to 04/30/2019
Slide7ChargeEntrySrvDates =
30
Assuming a system date of 04/30/2019 and a ChargeEntrySrvDates value of
30
, the “Srv Dt From” would be set to
03/31/2019
Slide8Setup – Test Flags
Slide9Setup – Test Flags
The ‘Outside Charge’ flag enables Invoicing to use the price and/or codes entered via the Charge Entry Application, Patient Account Module or received in LAB test results fields
The ‘Follow Up Needed’ flag is
responsible for setting the ‘Visit
Readiness’ status for the visit.
Slide10Setup – Reference Lab Codes
Reference Lab Codes provide the ability to define a group of known CPT codes, CDM codes, Modifiers, Units, Descriptions and Prices that relate to a single Miscellaneous Test code.
The ‘Alias’ can then be assigned to the Miscellaneous Test in the Charge Entry Application for ease in coding and pricing.
Slide11Setup - Errors
IN88: Claimed when an attempt is made to invoice a visit in a ‘Not Ready’ status. This status is set when the visit contains a tests flagged as “Follow Up Needed” in A/R setup.
WRN35: Claimed when invoicing occurs for a test not flagged as “Outside Charge” but for which a price and/or CPT code was entered through Charge Entry or PAM or received in a LAB test result field
IN19B: Claimed when the price
calculated for
a test flagged as ‘Outside Charge’ = $0.00. This occurs when there is an explicit price of $0.00 defined for the test and the ‘Outside Charge’ price is also $0.00 at the time of Invoicing.
Slide12Charge Entry Application - Accessibility
Slide13Charge Entry Application – Worklist Dialog
When you initially open the Charge Entry Application, you will be presented with the following dialog
The 'Search' frame contains an 'Order' number filter for which you can specify 'Main' order#, Auxiliary Order# or External Order
#.
The 'Filter' frame contains a
date of service
filter as well as a filter that determines if the
system should qualify follow
up needed tests on 'Not Ready' visits or 'All' visits
.
The 'Grid Options' button launches a customization dialog containing additional columns that can be selected for the grid or to which columns from the grid may be moved
.
Slide14Charge Entry Application
The default filter qualifies visits in a ‘Not Ready’ status having tests flagged as ‘Follow Up Needed’ whose date of service is in the range set by the system parameter, ChargeEntrySrvDates.
Slide15Charge Entry Application
Changing the filter to ‘All Follow-Up Tests
’ returns any visit having a test flagged as ‘Follow Up Needed’ regardless of the visit readiness status.
Slide16Charge Entry Application
In order to price and code a miscellaneous / referral test, you must enter an explicit order number in the Search filter or double click on a pre-qualified order from the grid.
Slide17Charge Entry Application
Once you’ve made your selection, you will be presented with the following dialog from which you will work.
Slide18Charge Entry Application
Slide19Charge Entry Application
The Worklist Button returns the user to the main grid.
The Grid Options button launches a customization dialog
containing additional columns that can be selected for the grid or to which columns from the grid may be moved
.
Slide20Charge Entry Application: Alias in Action
F2
LEPR
Executing F2 from the Alias cell launches a setup search dialog from which Reference Lab Codes can be selected
Slide21Charge Entry Application: Alias in Action
Slide22Charge Entry Application: Save vs Save and Release
Slide23Charge Entry
Application: ‘
Save
’
“Save”
retains the users entries from the Charge Entry Application but does not update the
“Visit Readiness”
status
.
The “Outside Charge” section of the
Procedures dialog refers the user to
the Charge Entry Application in
order to see the
coding that was
Performed using Reference Lab
Codes.
For single miscellaneous tests,
the price, CPT and /or CDM
entered in Charge Entry will be
displayed.
Slide24Charge Entry Application: ‘Save’
The “Visit Readiness” indicator displays a status of “Not Ready”
Slide25Charge Entry Application: ‘Save’
Invoicing results in error IN88 – Visit is marked as review needed.
Slide26Charge Entry Application: Save and Release
“Save
and
Release” retains
the user’s entries
and updates
the
“Visit Readiness” flag
Slide27Charge Entry
Application: Save
and Release
The “Visit Readiness” indicator
displays
a status of
“Ready
”
Slide28Charge Entry Application: Save and Release
Invoicing completes without
errors and items are created for
the miscellaneous test to which
Alias coding was assigned.
Slide29ADDING TESTS
VIA CHARGE
ENTRY
Slide30Charge Entry
Application: Adding New Tests
The visit to the right contains
only one Miscellaneous Test
Slide31Charge Entry Application: Adding
New Tests
From the Charge Entry Application, add a new test to this visit and Save
Slide32Charge Entry Application: Adding
New Tests
The visit in the Patient
Account Module reflects
a
ddition of the new test.
Slide33CHARGE ENTRY
VIA PAM
Slide34Charge Entry via the Patient Account Module
While in Edit Mode, updating the
Outside Charge section of the
Procedures dialog directly in PAM
results in the same outcome as
updating via the Charge Entry
Application.
Slide35Charge Entry via the Patient Account Module
While still in Edit Mode,
select the ‘Visit Readiness’
Icon
and select ‘Yes’ from
the message dialog to
update the status to
‘Ready’.
Slide36INVOICING
ERRORS
Slide37IN88: Split Skip Functionality
Setting IN88 action to “Split Skip” allows the system to successfully invoice tests that do not require follow up while keeping tests that do on a ‘Not Ready’ visit until coded and released.
Slide38IN88: Split Skip Functionality
The visit to the right contains
a ‘regular’ test and test that
requires follow up. The visit
is in a ‘Not Ready’ status.
Slide39IN88: Split Skip Functionality
When the visit is invoiced,
the system splits the visit
i
n order to successfully
invoice the ‘regular’ test
and keep the test requiring
follow up on an erroneous
Visit.
Slide40IN88: Split Skip Functionality
Erroneous visit contains
the test requiring follow up.
Visit status remains ‘Not
Ready’
Slide41IN88: Split Skip Functionality
Invoiced visit contains
the ‘Regular’ test.
Slide42WRN35: Outside
Charge entries ignored
In this example, the ‘Outside
Charge’ section of the dialog
was completed for a test not
flagged As ‘Outside Charge’.
Slide43WRN35: Outside Charge entries ignored
When the visit is
Invoiced, the system
claims WRN35 and
assigns the price
and CPT code defined
in setup for the test.
Slide44Charge Entry Prices and Defined Prices
If a price is defined
for a test flagged as
‘Outside Charge’, the
system calculates the
item price as the sum
of the price entered
via Charge Entry and
the price defined in
Setup.
Slide45Charge Entry Prices and Defined Prices
+
=
Slide46LAB RESULT
FIELDS: PRICE
Slide47LAB Result Fields
When flag 23 is selected for a test in LAB setup, the value of the result field is sent in OBR[23] which posts to the visit procedure outside charge in SoftAR.
The automated assignment of the price does not update the visit readiness status and IN88 will be claimed during invoicing.
If the CPT code is known and a billing rule is defined, the ‘Follow Up Needed’ flag is not needed and the system will simply error out due to IN29 (Missing Price) until the price is received from the LIS in OBR[23].
Slide48LAB Result Fields: Test Setup
LAB Test Setup
Flag 23 must be selected in order to
use the result field as a means to send
the price to SoftAR.
Slide49LAB Result Fields: Example
Order contains test SOCHG having a “result” = 50.00
Slide50OBR[23] of the message processed by SoftAR contains the value entered in the result field in
LAB
MSH|^~\&|LAB|SCC|||201905061622||
REF^I12|9602962-201905060422^9602962^U^9602962|D
^^^S|2.4
EVN|I12|201905061622
PID|||M0000031
PV1|||^^^^^^^^M4||MX00000000000000037
DG1|1
ORC|OE|||I206000022|||||||||BA01A
OBR|1|I206000022|1|
SOCHG
^^^^^^SOCHG_L||201905061621|201905061622|201905061622||||||201905061622||AABPA|||||||
50.00
||||1||76781||||||||||||||||||||||||||||||||BA01A
OBX|1||SOCHG||50.00||||||F|||201905061621|^^ALAB||747|||
201905061622^M4|N|201905061622
LAB Result
Fields: OBR Segment
Slide51LAB Result Fields: SoftAR Procedure
The “result” entered in Soft LAB is
posted to the ‘Charge’ field in
SoftAR and will be used during
invoicing
Slide52LAB RESULT
FIELDS:
PRICE, CPT, DESCRIPTION
Slide53LAB Result Fields: Price / CPT / Description
LAB Setup (Example)
Group Test with three components as follows:
ZPRIC (Miscellaneous Test Price)
ZCPT (
Miscellaneous Test
CPT)
ZDESC (
Miscellaneous Test
Description)
SoftAR Setup (Example)
AR Group Test flagged as Outside Charge
Components flagged as “Store Results”
RBS rules that copy value from the component result field to the visit procedure price,
CPT and
description
fields
.
Slide54Lab Group Test Setup: Example
Slide55SoftAR Group Test
Setup: Example
Slide56SoftAR Group Test
Component Setup: Example
Slide57LAB Result Fields: Example
Slide58SoftAR Visit Procedure: Pre RBS Execution
Slide59SoftAR Visit Procedure: Post RBS
Execution
Slide60Slide61Please remember to take a few moments to fill out the session survey. You can find the QR code in your Conference Brochure as well as hyperlinks to the survey online at
www.snuginconline.org
with the SNUG 2019 handouts.