1. No category

Charge Entry
End of Day
How to Read Charge Detail
Edit Transactions
Error Corrections
TABLE OF CONTENTS
CHARGE POSTING
SECTION
A
END OF DAY
SECTION
B
HOW to READ CHARGE DETAIL
SECTION
C
EDIT TRANSACTIONS
SECTION
D
ERROR CORRECTIONS
SECTION
E
QUICK TIP – CHGCO
SECTION
E
EDIT & ERROR CORRECTION DECISION TABLE
SECTION
F
INSURANCE SET EDITING
SECTION
G
DEMANING CLAIMS
SECTION
H
CHARGE
POSTING
Proprietary & Confidentiality Statement
This document contains valuable, proprietary & confidential information protected
by statutory and common law trade secret principles. MedSynergies requests that
the proprietary & confidential nature of this information be respected and that it be
used only by employees in your organization with direct involvement related to the
review of the document. These individuals are to be instructed that this document
and all information contained herein is not to be shared in any form with anyone
outside of your organization’s involved evaluators and decision makers including
unnamed consultants, other vendors or other healthcare organizations. Any
distribution, duplication or other transfer of this information without
MedSynergies’ written permission is unauthorized.
TABLE OF CONTENTS
PAGE
Navigating Charge Posting from Appointment Manager
3
Understanding Mini Menu Options
5
Navigating batch Charge Posting
10
EOD Balancing
11
NOTE:
Screen prints are examples
only.
Various batch control
numbers and account
numbers were used.
CHARGE POSTING – SECTION A
2
Posting Charges in Appointment Manager
Appointment Manager Charge Posting
•
Click on Charge Ticket #
NOTE: If charge has
not been posted,
the ticket # will be
blue with a line
under.
•
Enter assigned Control Group
#
•
Notifies you of the Open Month
•
Check - Hold Control
Group #
•
Click
•
A popup window asks you if you want to
continue with the current open month.
CHARGE POSTING – SECTION A
3
Charge Posting through
Appointment Manager
•
Shows NEW batch
•
Click on
•
Charge Slip # will show
•
Click on
These fields default from appointment
scheduling:
•
•
•
•
•
Provider
Place of Service
Date of Service
Insurance Set
Incoming Referral (if attached to
appointment)
Must ADD
•
•
•
•
Diagnosis Code (can list up to 4)
Procedure Code
Modifier if needed
Incoming Referrals (if not attached to
appointment)
•
Click on
CHARGE POSTING – SECTION A
4
Charge Entry
Soft Warnings will show in RED
Mini Menu Options
Mini Menu
•
•
Repeat Charges
•
Charge Messages
•
Dates
•
Referring/Ordering/Supervising
Physician
•
Preauthorization – In most databases
Referrals Plus has replaced
•
Outgoing Referrals
•
Claimset
•
Comments
•
Courtesy
Standard charge amount is pre-set in Constants per Procedure code by POS.
CHARGE POSTING – SECTION A
5
Repeat Charges
Allows you to post multiple dates of services and
procedure codes at one time.
Great for hospital inpatient charges.
Charge Messages
Charge Messages can be used to give additional
information or description that can be attached to the
charge.
Dates
Important information about admit and discharge dates can be entered here.
CHARGE POSTING – SECTION A
6
Referring/Ordering Physician
A referring or ordering physician can be entered here to be attached to the charge.
Nurse Practitioners
and Physician
Assistants must have
Ordering Physician
attached to the
Preauthorization
In most databases
Preauthorization has been
replaced by Referrals Plus.
Outgoing Referrals
Outgoing referrals can be added to charge for
tracking
Claimset
Allows you to capture charge related
Information that is not entered elsewhere,
such as date of injury
ClaimSets
Used for:
Work Comp
Auto
CHARGE POSTING – SECTION A
7
Comments
Directs you to Patient Manager – Notes
Courtesy
Allows patient balance % to be adjusted after charge has been paid by insurance and
balance has been transferred to patient.
Courtesy
Not MSI
recommended
Allows charge to be posted
Allows you to go back to
charge to make changes.
Warning provided if information is
missing
Click
Add Missing Information
CHARGE POSTING – SECTION A
Then click
8
Second Procedure
Group Mgmt allows for
multiple procedures.
or
Will allow you
to view all charges posted
Last Procedure Entered
To add additional charge(s)
•
•
Select Options
Add Charge
CHARGE POSTING – SECTION A
9
Batch Charge Posting
Charge Posting
Shows NEW batch
•
Click on
Charge Entry screen
•
•
•
Recent Patients
Charge Slip #
Account #
Enter Charge Slip # ONLY!
•
Click on
CHARGE POSTING – SECTION A
10
Balancing Input Totals against Batch Totals
Once all charges and OTC payments have been posted, click Totals on Blue Charge Entry
Tool Bar.
Control Group Totals
Control Total - Once all charges, payments, and
adjustments are balanced, Control Total must
balance to Input Total.
Input Total = Charges + Payments + Adjustments
Breakdown totals
•
Charges
•
Payments
•
Adjustments
CHARGE POSTING – SECTION A
11
END OF DAY
Proprietary & Confidentiality Statement
This document contains valuable, proprietary & confidential information protected
by statutory and common law trade secret principles. MedSynergies requests that
the proprietary & confidential nature of this information be respected and that it be
used only by employees in your organization with direct involvement related to the
review of the document. These individuals are to be instructed that this document
and all information contained herein is not to be shared in any form with anyone
outside of your organization’s involved evaluators and decision makers including
unnamed consultants, other vendors or other healthcare organizations. Any
distribution, duplication or other transfer of this information without
MedSynergies’ written permission is unauthorized.
TABLE OF CONTENTS
PAGE
EOD Process
3
Balancing Audit Journal
5
Printing Audit Journal
8
Appointment Reconciliation Process
9
Printer Management – Report Queue
11
Complete the OTC Bank Deposit Process
12
END OF DAY – SECTION B
2
EOD Process
End of Day (EOD) Process
These steps make up the EOD process in Group Mgmt
1. Appointment Status – Updating all pending appointments to Arrived, Bumped,
Cancelled, or No Show.
2. Preparing Charges and Payments to post
3. Balancing and Printing Audit Journal
= (+Charges) + (-Payments) + (-Adjustments)
4. Appointment Reconciliation – Have all charges been posted?
Appointment Status
Section 3 – Appointment Manager
Explains how to manage the status of
appointments through-out the day by
clicking on PENDING and updating the
appointment through the pop-up screen –
Change Appointment Status.
The goal each day is to know the exact
status of each and every appointment that
has been scheduled for the day.
•
Arrived
•
No Show
•
Cancelled
NOTE:
•
Bump
Security
level will
•
Delete
determine Delete
appointment access.
HINT:
The number of Arrived appointments
should match the number of charge
slips that require posting to Group Mgmt.
END OF DAY – SECTION B
3
Preparing Charges to Post
Verify appointment status in Appointment Manager.
Must see no appointments listed as PENDING!
Make sure all OTC (Over the Counter) payments have
been noted on charge ticket.
•
Write check # on charge ticket
•
Group Mgmt account # on check
Batch charge tickets with cover sheet
•
•
•
•
Batch control #
User
Date of Service
Total Charges
END OF DAY – SECTION B
NOTE:
It is recommended by MSI that
a cover sheet be used when
posting charges and payments
into Group Mgmt.
4
Balancing Audit Journal
Audit Journal
When posting charges, payments, or adjustments to an account, a batch
control is opened. For reconciliation of that opened batch an Audit Journal
must be run.
From MAIN MENU
#1 Enter and Post to Accounts
#5 Audit Journal
#1 New Transaction Audit
Journal
#1 Screen - Provides totals of
Charges and Payments
Audit Journals
Enter Control Group
(used in Charge entry)
Display Detail? Y
Screen provides breakdown of
all charges posted.
F5 = Totals
NOTE:
Report lists charges in order of posting.
END OF DAY – SECTION B
5
Audit Journals
F5 = Totals - Will provide Charge,
Payments and Adjustment totals
NOTE:
OUT OF BALANCE
Input Total =
Charges + Payments + Adjustments
Once you are in balance update
Control Total to equal Input Total
Out Of Balance
•
From MAIN MENU
•
#1 Enter and Post to Accounts
•
#5 Audit Journal
•
•
#1 New Transaction Audit
Journal
•
#3 Correct Control Totals
•
Enter Control Group #
•
Input Total = Control Total
END OF DAY – SECTION B
6
Re-Run
From MAIN MENU
#1 Enter and Post to Accounts
#5 Audit Journal
#1 New Transaction Audit
Journal
#1 Screen - Provides totals of
Charges and Payments
NOTE:
IN BALANCE
Printing Audit Journal
Print Audit Journal
#2 Printer
Enter Control Group
•
•
Include Detail - Y
Control Group
Then click ENTER
Printer Options
Printer #
Print Style - C
Printing Status - R
END OF DAY – SECTION B
7
Printing Audit Journals
Audit Journal(s) must be reviewed for correct Dates of Service, Payment dates, Error
corrections dates, Insurance Sets, Incorrect transfers, and Debits vs. payments /
adjustments.
END OF DAY – SECTION B
8
Appointment Reconciliation Process
Appointment Reconciliation MUST be run after all charge posting is complete for a Date
of
Service. This will determine if any appointments remain un-reconciled.
From Main Menu
#6 Reports
#2 Appointment Reconciliation
HINT: Run the Appointment
Reconciliation report several times
throughout the month as a follow-up.
Reconcile Date Range
Print Each Provider on a New
Page - Y
Select Provider / Facility
• For ALL leave blank
Printer Options
Printer #
Print Style - C
Printing Status - R
Delete after printing - Y
END OF DAY – SECTION B
9
Quick Links
Printer Management
Make selections
User Code
Printer Number
Title
Date Range
Job # Range
Paper
Status - All Jobs
Sort By - Ascending (will default) or Descending
Click Search
NOTE:
No un-reconciled appointments are the
goal for Appointment Reconciliation.
All Jobs status allows you to see the
status results of No Matches.
END OF DAY – SECTION B
10
Printer Management – Report Queue
Per the criteria selected, the Report Queue lists all jobs currently in Printer
Management.
No Matches
If all charges have been entered through the ticket number Group Mgmt will provide you
a No Matches status when the criteria selection generated no data.
END OF DAY – SECTION B
11
Appointment Reconciliation Process
Comp
Appointment Reconciliation List
Provides a list of all pending or arrived appointments that have not had a
charge entered by posting through the ticket number generated at appointment
scheduling.
Complete the OTC Bank Deposit Process
END OF DAY – SECTION B
12
HOW TO
READ CHARGE DETAIL
Proprietary & Confidentiality Statement
This document contains valuable, proprietary & confidential information protected
by statutory and common law trade secret principles. MedSynergies requests that
the proprietary & confidential nature of this information be respected and that it be
used only by employees in your organization with direct involvement related to the
review of the document. These individuals are to be instructed that this document
and all information contained herein is not to be shared in any form with anyone
outside of your organization’s involved evaluators and decision makers including
unnamed consultants, other vendors or other healthcare organizations. Any
distribution, duplication or other transfer of this information without
MedSynergies’ written permission is unauthorized.
TABLE OF CONTENTS
PAGE
Accessing Patient Manager
3
Reviewing Current Insurance
4
Navigating into Transactions
5
Understanding Transactions
• Outstanding Balances
• Not Current Insurance
• Insurance History
• Payment / Adjustment Detail
7
HOW TO READ CHARGE DETAIL – SECTION C
2
PATIENT MANAGER
Locate patient through Patient Manager
HOW TO READ CHARGE DETAIL – SECTION C
3
REVIEW CURRENT INSURANCE
Review Current Insurance First
REVIEW
Current insurance
HOW TO READ CHARGE DETAIL – SECTION C
4
Navigating into Transactions – Criteria
Click
Transactions
Click
Ageing
Balances
HOW TO READ CHARGE DETAIL – SECTION C
5
Balances
Navigating into Transactions – Criteria
Status
Open Exclude Corrections
Criteria
The result of searching is as good as the criteria that is entered
Search Options
Display
• Summary: Shows a general overview of charges
• Detail: Breaks out payments and adjustments
Charge Status
• Open: Shows charges with an outstanding balance
• All: Shows open and closed charges
Payer Status
• Sorts charges by status of the payer: Pending, Acknowledged, Informational, Accepted,
Rejected, Completed
Corrections
• Uncheck Corrections to view charges that have been corrected
HOW TO READ CHARGE DETAIL – SECTION C
6
Understanding Transactions
INSURANCE BALANCES
Charges
Transactions
Links allow
additional detail.
Header columns
Insurance – 5000, 7700, or AET
Balance Types – I or W (WC)
Insurance Types - BRDHOS
Links to
Payment & Adjustments
Hover
Provider, POS,
Trans/Mod, Pri Dx, &
Due From to get a description
HOW TO READ CHARGE DETAIL – SECTION C
7
Understanding Transactions – Outstanding Insurance Balances
Outstanding
Balances
Do they match
Current?
Current
HOW TO READ CHARGE DETAIL – SECTION C
8
Understanding Transactions – Not current insurance
Not current
Insurance
How do I review past
History insurance?
Follow steps on pages 10-12
HOW TO READ CHARGE DETAIL – SECTION C
9
Understanding Transactions – Insurance History
Click
Demographics
Click Insurance
Select Option:
View Insurance Set History
Enter Set #
1 = Medical
2 = Work Comp
(Depends on how
database Is set up)
HOW TO READ CHARGE DETAIL – SECTION C
10
Understanding Transactions
Edit History #
Enter the History #
to review or update
Update insurance
as needed.
Re-point Charges
if update has
been done.
HOW TO READ CHARGE DETAIL – SECTION C
11
Understanding Transactions
NOTE:
AET was set at
history #18
Since update, it has
changed to #33.
* Indicates current
What insurance
is current?
Understanding Transactions – Charge Detail with Payment / Adjustments
Charge Detail
See page 13
Payments / Adjustments
See page 14
HOW TO READ CHARGE DETAIL – SECTION C
12
Understanding Transactions
Charge Detail
Insurance
Primary
Secondary
Tertiary
HOW TO READ CHARGE DETAIL – SECTION C
13
Understanding Transactions – Payment / Adjustment Detail
Payment Code
Current Insurance
Payment
HOW TO READ CHARGE DETAIL – SECTION C
Indicates where insurance
balance is setting.
14
EDIT
TRANSACTIONS
Proprietary & Confidentiality Statement
This document contains valuable, proprietary & confidential information protected
by statutory and common law trade secret principles. MedSynergies requests that
the proprietary & confidential nature of this information be respected and that it be
used only by employees in your organization with direct involvement related to the
review of the document. These individuals are to be instructed that this document
and all information contained herein is not to be shared in any form with anyone
outside of your organization’s involved evaluators and decision makers including
unnamed consultants, other vendors or other healthcare organizations. Any
distribution, duplication or other transfer of this information without
MedSynergies’ written permission is unauthorized.
TABLE OF CONTENTS
PAGE
Navigating into Edit Transactions
• PM/Transactions/Charge #
• Quick Links
3
NON- FINANCIAL Fields:
6
Under Mini Menu
DOS
Diagnosis codes
Insurance sets
Secondary and Tertiary Insurance
Preauthorization
Physicians Incoming Referrals
Charge Messages
Dates
Ref/Ordering/Supervising
Outgoing Referrals
COB Sets
Claimsets
Editing Insurance Sets
12
Re-Pointing Charges
14
Demanding Claims in PM
15
Editing Insurance Set Scenarios
16
NOTE:
These items require Correcting Off and Re-Posting
PROVIDER
POS
CPT / PROCEDURE
MODIFIER
PRIMARY INSURANCE
UNITS
EDIT TRANSACTIONS – SECTION D
2
There are two ways to access Edit Transactions
•
•
Transactions
Quick Links
PM / Transactions




Locate Patient Account
Transactions
Charge #
Edit
EDIT TRANSACTIONS – SECTION D
3
Quick Links / Edit Transactions
Quick Links
Click on Edit Transactions
Transaction Edit Screen
Criteria selections include:
•
Account #
•
Date of Service
•
Charge #
•
Claim ID
•
History #
•
Status - Open or All
Locate account # through
Recent Patient drop down
or gray search box
Click
EDIT TRANSACTIONS – SECTION D
4
Transaction Edit Screen
Per criteria selected a charge list is generated.
Select and click radio button.
Charge with Payments / Adjustments:
Lets you determine if charge, payment, or
adjustment require editing.
NOTE:
PM / Transactions Option to edit
payment/adjustment
or charge.
Select and click radio button.
Charge with No Payments /
Adjustments:
Takes you directly to the charge to be
edited.
Select and click radio button.
EDIT TRANSACTIONS – SECTION D
5
Non-Financial Fields
*Only Non-Financial fields can be edited
in Groupcast.
Date of Service - Date service was
rendered to patient
Diagnosis Codes 1 – 4 - Codes
describe why patient was seen by
physician.
Insurance Set History - Set can be
updated to current
Secondary and Tertiary
Insurance - If charge remains in
primary insurance, secondary and
tertiary can be edited without
correcting off and re-posting charge.
Claim Group - Is used to place a claim
to paper.
Preauthorization - In most databases
the has been replaced by Referrals Plus.
Incoming Referrals 1 & 2 - Links to
Referrals Plus
EDIT TRANSACTIONS – SECTION D
6
Mini Menu Options
Edit Transactions - Mini Menu
Charge Messages
EDIT TRANSACTIONS – SECTION D
•
Misc Charge Date - Use determined at
database set-up (client specific)
•
Charge Message 1 & 2 - Charge Transaction
message codes – tells a story of what is
happening to this charge
•
Add Desc Line 1 – 4 - Use determined at
database set-up (client specific)
•
Info 1 & 2 - Use determined at database
set-up
7
Mini Menu Options
Edit Transactions - Mini Menu
Dates
•
Claim Delay - Date added to delay claim
from submission
•
Admit - Inpatient hospital admit date
•
Discharge - Inpatient hospital
discharge date
•
Thru - Use determined in database setup
•
Misc Date 1 – 10 - Use determined in
database set-up (client specific)
EDIT TRANSACTIONS – SECTION D
NOTE:
Indicates this file
contains information.
8
Refer/Order/Supervise Phys
•
Referring Physician - Who referred
patient to provider of service. If Patient
registration has been updated this will
default in Mini Menu.
•
Ordering Physician - Use determined at
database set-up
•
Supervising Physician - Use
determined at database set-up
NOTE:
Indicates this
file contains
information.
Outgoing Referrals - Links to Referrals Plus
COB Set / Coordination of Benefits This is used for Coordination of
Benefits from Primary to
Secondary to file electronically.
EDIT TRANSACTIONS – SECTION D
9
Claimset # - Click on Claimset to open
Click on gray search box to view list of existing claimsets.
Click on Claimset # to view or click on New Claimset to add.
EDIT TRANSACTIONS – SECTION D
10
Editing a Claimset
Claimset (client specific)
•
DOI / 1ST Sym date - Work
Comp date of injury is used
here
•
Similar illness date
•
All other fields are determined
at database set-up
EDIT TRANSACTIONS – SECTION D
11
Editing Insurance Sets
Recommended Steps:
1. PM / Transactions
–
NOT Quick Links / Edit Transactions
2. Review Insurance
–
–
Insurance Sets
Primary / Secondary / Tertiary Ins
3. Current History
–
* Current
4. Review Insurance History
–
Is there history?
5. Transactions
–
Locate charge
6. Review Charge Detail
–
–
–
Primary / Secondary / Tertiary Ins
Current Ins
Ins Set History / Re-pointed
EDIT TRANSACTIONS – SECTION D
12
Editing Insurance Sets
Issue
Action
Comments
- Update to Secondary
insurance policy #.
- Secondary insurance is
attached to charge.
- Balance is sitting at
Primary ins.
- Update Secondary ins
- Re-point charges
- No claim demanded
- No claim is demanded
since still waiting for
response from Primary
insurance.
- Patient contacts office
with new Secondary ins.
- Balance is sitting at
Primary ins.
- Expire Current Insurance
- Add New Secondary ins
- Edit Charge
- Re-point Charges
- No Claim demanded
- Adding Secondary ins for
the first time.
- Must pull in Secondary ins
code in Edit Transactions
screen.
- No claim is demanded
since still waiting for
response from Primary
insurance.
- Patient contacts office
with Secondary ins.
- Balance is sitting at
patient.
- Primary ins is attached
to charge.
- Expire Current insurance
- Add New Secondary ins
- Re-Point Charge
- Edit charge
- Transfer balance to
Secondary
- Demand Secondary claim
- Adding Secondary ins for
the first time.
- Must pull in Secondary ins
code in Edit Transactions
screen.
- Change in Secondary
insurance.
- Primary & Secondary
ins attached to charges.
- Multiple balances sitting
at Primary, Secondary &
patient.
- Expire Current Secondary
insurance
- Add new Secondary ins
- Re-Point
- Edit charges within effective
date range of new ins
- Transfer balances to
appropriate payer
- Demand Secondary claims
that need to be sent to
Secondary ins
EDIT TRANSACTIONS – SECTION D
13
Re-Pointing Charges
Re-Pointing –
When a change is made to insurance history, Group Mgmt will prompt you to
‘Re-Point’ all charges that were attached to that insurance history to the new
updated insurance history.
NOTE:
Insurance History #
changes.
NOTE:
If Primary Ins Code changes,
no re-pointing is necessary.
EDIT TRANSACTIONS – SECTION D
14
Demanding Claims – PM
Step #2
Click DEMAND BILLING
Select the Charge and click the
button.
The insurance code, balance type, and format, from where the charge is currently sitting,
will pull in to the demand billing fields.
Click the
button to complete.
EDIT TRANSACTIONS – SECTION D
15
Editing Insurance Set Scenarios
Scenario 1 –
•
Patient has Primary & Secondary Ins.
•
Patient calls with an update to the
Secondary Ins policy #.
•
2 Charges posted to Ins set 1 history #
5.
•
Balances are sitting at Primary Ins.
•
No Secondary Ins has been filed.
Action Steps:
•
Update Secondary Ins.
•
Re-point charges within effective date
range.
NOTE:
No claims are
demanded since
balance is still pending
to Primary Ins.
EDIT TRANSACTIONS – SECTION D
16
Scenario 2 –
•
Patient has Primary Ins.
•
3 Charges for DOS 02-15-09 have
been posted.
•
Primary Ins has paid; balances are
transferred to patient responsibility.
•
Patient calls with Secondary Ins
information.
•
Charges are sitting at 1/1* Ins
history.
Action Steps:
•
Add Secondary Ins.
•
Re-point charges within effective
date range.
•
Attach Secondary Ins code in Edit
Transactions.
NOTE:
To attach secondary
insurance to a charge,
click on gray search
box and type in
insurance code.
EDIT TRANSACTIONS – SECTION D
17
•
Transfer balances to Secondary Ins.
Quick Links –
Payments/Adjustments
– enter Control Number
– Next – Next – Select
Adjustments – Find the
Patient
Enter the Adjustment Code – TRAN
Select ALL
Select Search
Select the charge
Transfer the balance to the Secondary
Insurance Code (type code in and press Tab
Key)
Select Post
EDIT TRANSACTIONS – SECTION D
18
•
Demand claims to Secondary Ins.
EDIT TRANSACTIONS – SECTION D
19
Scenario 3 –
•
2 Charges for DOS 01-02-09 have
been posted.
•
Patient has Primary and Secondary
Ins.
•
Primary Ins has paid; balances are
transferred to Secondary Ins.
•
Patient calls with different Secondary
Ins information.
•
Charges are sitting at 1/1* Ins
history.
Action Steps:
•
Enter Expiration Date for old
Secondary Ins.
•
Update Secondary Ins.
•
Re-point charges within effective
date range.
•
Attach Secondary Ins code in Edit
Transactions.
NOTE:
DON’T FORET to
remove the expiration
date while adding new
Secondary Ins
information.
NOTE:
To attach secondary
insurance to a charge,
click on gray search
box and type in
insurance code.
EDIT TRANSACTIONS – SECTION D
20
•
Transfer balances to Secondary Ins.
Quick Links –
Payments/Adjustments
– enter Control Number
– Next – Next – Select
Adjustments – Find the
Patient
Enter the Adjustment Code – TRAN
Select ALL
Select Search
Select the charge
EDIT TRANSACTIONS – SECTION D
21
Demand claims to Secondary Ins.
EDIT TRANSACTIONS – SECTION D
22
ERROR CORRECTIONS Proprietary & Confidentiality Statement This document contains valuable, proprietary & confidential information protected by statutory and common law trade secret principles. MedSynergies requests that the proprietary & confidential nature of this information be respected and that it be used only by employees in your organization with direct involvement related to the review of the document. These individuals are to be instructed that this document and all information contained herein is not to be shared in any form with anyone outside of your organization’s involved evaluators and decision makers including unnamed consultants, other vendors or other healthcare organizations. Any distribution, duplication or other transfer of this information without MedSynergies’ written permission is unauthorized. TABLE OF CONTENTS Navigating Error Corrections for Charges PAGE 3 Error Corrections for Charges with Payments and Adjustments 8 Error Corrections for Charges with Payments, Adjustments, and Tagging 12 Payment Error Corrections 14 FYI...Transaction Error Corrections 17 Charge Error Corrections that will result in a REFUND 24 ERROR CORRECTIONS – SECTION E
2
Navigating into Charge Error Corrections The Error Correction function is used ONLY if the information posted is incorrect. Locate patient through Patient Manager (see Chapter 5) ASK YOURSELF…Can the charge be edited if? CHARGE POSTED TO Incorrect or Missing Insurance Modifier Patient Place of Service Procedure Provider Transactions Locate charge Then click on charge # Charge Detail Click on ERROR CORRECTIONS – SECTION E
3
Charge Error Corrections Enter Control Group # twice Then click Group Mgmt will take you into WFE – Corrections Account # and Charge # will show on screen Then click Charge Error Corrections Charge # that was selected will show Enter selection in yellow box Then click ERROR CORRECTIONS – SECTION E
4
Charge Error Corrections Second Correction screen will appear with account and charge # plus payments and adjustments posted Enter charge selection in yellow box Then click NOTE: Once you have clicked ENTER, you have gone pass the POINT OF NO RETURN! Correct / Repost Charges screen will appear In this example the charge was posted prior to the insurance being entered. 1. Tab down to the 0 Insurance Set 1. Then click F2 search 1. Charges – Insurance Set Summary screen will appear 4. Select Charge Insurance Set – Make selection 5. Then click ERROR CORRECTIONS – SECTION E
5
Charge Error Corrections Correct / Repost Charges screen will appear with selected Insurance Set attached Now click New and Original Charge amount will appear. Verify if correct. Now click ERROR CORRECTIONS – SECTION E
6
Charge Error Corrections Correct / Repost Charges screen will appear with Mini Menu on right of charge. Enter Selection #2 = Charge Messages then click Charge Message 1 & 2 will appear. Search for Transaction Message codes. Charge Message #1 = Why corrected off? Charge Message #2 = Use CHGCO to state that charge has been corrected off and reposted. Correct / Repost Transaction screen will appear. Charge information will be listed at top of screen. Screen will indicate charge correction has been completed. Now click Claim can be demanded by entering ERROR CORRECTIONS – SECTION E
Note: Demand claim is NOT necessary since a new claim will be generated next business day. 7
Charge Error Correction with Payments or Adjustments Follow steps on pages 3 to 7 to correct off and repost charge. #1 Charge #2 Correct #3 Control Group #4 Account & Charge #5 Charge and payment will be listed. Select charge. ERROR CORRECTIONS – SECTION E
8
Charge Error Corrections with Payments and Adjustments Once correction has been made on charge and Charge Messages have been entered, then click on twice. Correct / Repost Transaction screen will appear showing the payment attached to the original charge. Click on
Correct / Repost Payments and Adjustments screen will appear showing the payment amount and new corrected charge at bottom. Click on ERROR CORRECTIONS – SECTION E
9
Charge Error Corrections with Payments and Adjustments NOTE: Group Mgmt is built to transfer the balance to the next bucket – Secondary, Tertiary, or Patient.
Charge must be placed back to the primary insurance. Then click
Group Mgmt will default Then click ERROR CORRECTIONS – SECTION E
10
Charge Error Corrections with Payments and Adjustments Payment Date will show Then click Payment Mini Menu will show Then click Correct / Repost Transactions screen will show Screen will indicate charge correction has been completed. Then click ERROR CORRECTIONS – SECTION E
11
Charge Error Corrections with Payments, Adjustments, and Tagging NOTE: DO NOT REPOST TAGGING When correcting off charges, only repost the payments and necessary adjustments. Tagging = No Payment = Yes The corrected charge will keep all tagging. See page 13. F8 = DELETE THIS TRANSACTION ERROR CORRECTIONS – SECTION E
12
Charge Error Corrections with Payments, Adjustments, and Tagging Corrected Charge Tagging on Corrected Charge ERROR CORRECTIONS – SECTION E
13
Payment Error Corrections Follow steps on pages 3 to 7 to locate charge with payment to correct off and repost or update payment amount. #1 Charge #2 Correct #3 Control Group #4 Account & Charge #5 Charge and payment will be listed. Select payment. ERROR CORRECTIONS – SECTION E
14
Payment Error Corrections Corrections screen will show Enter selection payment only Then click Selected payment will appear in BLACK Click to delete payment ERROR CORRECTIONS – SECTION E
15
Payment Error Corrections Correct / Report Transaction screen will appear Screen will indicate that the payment has been corrected off and will not be reposted. Continue Y / N If Yes then enter Y Then click Screen will indicate payment has been Corrected off. Note: If payment should be posted to another charge, then go to Quick Links – Payments & Adjustments and post to correct charge
ERROR CORRECTIONS – SECTION E
16
FYI...Transaction Error Corrections What happens to the charge that has been corrected off? Can I still view the corrected charge? Does the corrected charge stay connected to the reposted charge? Can I see that a payment or adjustment has been corrected?
Locate Patient and Transactions Follow steps on pages 3 and 4 To locate charges. ERROR CORRECTIONS – SECTION E
17
FYI...Transaction Error Corrections Transaction viewing will default to open charges with balances. To view corrected charges click New Transaction Search screen will appear that will allow you to select updated search criteria. 1. Date of Service 2. Charge number 3. Claim ID 4. Status – All or Open 5. Sort – Ascending or Descending by Date of Service, Charge #, Posting date, and Provider Group 6. Corrections – Exclude or Not Exclude Note: To see Corrected charges you must Select…ALL & uncheck Exclude. ERROR CORRECTIONS – SECTION E
18
FYI...Transaction Error Corrections Additional Transaction Filter Options 1. Charge 2. Payment and Adjustment 3. Insurance Charge 1. Control Group 2. Provider 3. Provider Specialty 4. Provider Group 5. Place of Service 6. Procedure Code 7. Benefit Category 8. Contract Status 9. Insurance Code 10. Balance Type 11. Claimset # 12. Referral # 13. Open or Paid Charges ERROR CORRECTIONS – SECTION E
19
FYI...Transaction Error Corrections Payment / Adjustments 1. Pay / Adj Date 2. Payment Code 3. Adjustment Code 4. Check / Credit Card # 5. Payer Reference ID # Insurance 1. Set Number 2. Set Name 3. Set History Number 4. Set Effective Date 5. Set Expiration Date 6. Set Primary Care Provider ERROR CORRECTIONS – SECTION E
20
FYI...Transaction Error Corrections To view all corrected charges 1. Status ­ All 2. Corrections ­ Uncheck Exclude Then click Transaction Search Results screen will appear Charges that have been corrected off will be indicated in the DUE column. ERROR CORRECTIONS – SECTION E
21
FYI...Transaction Error Corrections Click on a corrected charge to view Charge Detail 1. Charge # 2. Control Group # 3. Date of Service 4. Posted Date 5. Last Edit Date 6. Corrected Date 7. Corr Control Group # 8. Reposted Charge # Charge Corrected off New Charge ERROR CORRECTIONS – SECTION E
22
Charge Error Corrections that will result in a REFUND 1. Wrong insurance was filed as primary
2. Primary has paid. Payment and Adjustment has been posted
3. Refund to incorrect Primary will need to be made
4. Charge will be corrected off and reposted to correct insurance keeping the
appointment reconciliated
5. Payment will be reposted to wrong insurance using same CPT with NC modifier
New 6. Adjustment will notCharge be re-posted
1. Wrong insurance was filed as primary 2. Primary has paid. Payment and Adjustment has been posted 3. Refund to incorrect Primary will need to be made 4. Charge will be corrected off and reposted to correct insurance keeping the appointment reconciliated 5. Payment will be reposted to wrong insurance using same CPT with NC modifier 6. Adjustment will not be re­posted 7. Transaction Message – INOVER ­ Insurance Overpayment must be used ERROR CORRECTIONS – SECTION E
23
Steps to Correct 1. Update insurance in Patient Demographics 2. Correct Off and Re­post Charge only to new insurance. Do not post insurance overpayments or adjustments to new charge. NOTE, this will keep the appointment reconciled 3. Post second charge to the same originial Primary insurance that paid. 4. Post same CPT with NC modifier and Zero charge amount 5. Now post insurance payments to Zero NC charge. Left balance at that Primary Insurance code (Primary that paid) 6. Do not repost Adjustment(s) 7. Add Transaction Message code – INOVER = Insurance Overpayment ERROR CORRECTIONS – SECTION E
24
BADPC
CO4
CR4
INCPC
MA66
PR4
INCPS
BINPI
Incorrect code used
Posted to incorrect Insurance
Set
MODIFIER - Incorrect, missing,
or incomplete
Incorrect POS
Posted to incorrect insurance
CPT / PROCEDURE CODE
INSURANCE SET
MODIFIER
POS / PLACE OF SERVICE
PRIMARY INSURANCE
1
BADMO
CO182
CO4
CR4
INCMO
INSET
INCCA
MESSAGE
CODE 1
Incorrect charge amount
Message codes are required
when charges are CORRECTED
OFF & RE-POSTED
CODE
CHARGE AMOUNT
CATEGORY
DESCRIPTION
BILLED INSUR NOT PRI INSUR
M/I/I POS
MOD INCONS W/PROC/AGE/SEX/PROV/POS
PROC MOD INV ON DOS
PROC CD INCONS W/MOD OR REQ MOD MISSING
PROC CD INCONS W/MOD OR REQ MOD MISSING
INC/INC MOD
INC INSUR SET/HISTORY
PROC CD INCONS W/PROC/AGE/SEX/PROV/POS
PROC CD INCONS W/MOD OR REQ MOD MISSING
PROC CD INCONS W/MOD OR REQ MOD MISSING
INC/INC PROC CD
M/I/I PRINCIPAL PROC CD
PROC CD INCONS W/MOD OR REQ MOD MISSING
INC CHARGE AMOUNT
WHEN CHARGES ARE CORRECTED OFF and RE-POSTED
MESSAGE
CODE 2
Always add CHGCO = CHARGE
CORRECTED OFF & REPOSTED to
2
CHGER
PPWC
WRGPT
M53
CHGPR
INCPR
CHGI
CODE
Pymt posted to wrong charge
Edit charge 1st then correct
WHEN CORRECTING OFF A
charge. Message will remain
CHARGE & NOT RE-POSTING
with corrected charge.
CHARGE POSTING ERROR
PYMT POSTING ERROR
Charge posted to wrong patient
Incorrect amount
UNITS
WRONG PATIENT
Incorrect provider posted
PROVIDER
CATEGORY
DESCRIPTION
CHARGE POSTING ERROR
PYMT POSTED TO WRONG CHG/MOVED TO RIGHT CHG
CHG POSTED TO INC PT ACCT
M/I/I DAYS OR UNITS OF SRV
CHARGE POSTED TO INC PROV
M/I/I PROV NAME/#/ADDR
CHG POSTED BEFORE INSUR ENTERED
WHEN CHARGES ARE CORRECTED OFF and RE-POSTED
* RELATIONSHIP CODE
SUPERVISING PHYSICIAN
REFERRING PHYSICIAN
PRE-AUTH (database specific)
REFERRALS
DATE OF SERVICE
DIAGNOSIS (s)
INSURANCE SET NUMBER
ORDERING PHYSICIAN
CLAIM SET (Date of Injury)
*CORRECTED INS POLICY ID / GROUP #
*CORRECTED PT ID / NAME
*SECONDARY INSURANCE
*TERTIARY INSURANCE
*UPDATE HISTORY #
CLAIM DELAY DATE
CLAIM GROUP
ADMIT / DISCHARGE DATE
EDIT THE CHARGE
Note - Editing claims may require Demand Claim
* Note - requires re-pointing of charges to new history
When editing always add Chg Message Code 1
When error correcting always add Chg Message Code 1 (Why?) and Charge Message Code 2 (CHGCO)
ACCOUNT NUMBER
CHARGE AMOUNT
CHARGE PROVIDER
CHARGE SLIP NUMBER (error correct - Post charge to correct charge slip #)
COPAY AMOUNT (payment correction)
COURTESY % AT CHARGE LEVEL
MODIFIER (s)
NUMBER OF UNITS
PLACE OF SERVICE
PRIMARY INSURANCE
PROCEDURE CODE (CPT)
ERROR CORRECT and REPOST
CHARGE DECISION TABLE
INSURANCE
SET EDITING
3.1
Proprietary & Confidentiality Statement
This document contains valuable, proprietary & confidential information protected
by statutory and common law trade secret principles. MedSynergies requests that
the proprietary & confidential nature of this information be respected and that it be
used only by employees in your organization with direct involvement related to the
review of the document. These individuals are to be instructed that this document
and all information contained herein is not to be shared in any form with anyone
outside of your organization’s involved evaluators and decision makers including
unnamed consultants, other vendors or other healthcare organizations. Any
distribution, duplication or other transfer of this information without
MedSynergies’ written permission is unauthorized.
TABLE OF CONTENTS
PAGE
Identify the need to Edit Insurance Set
3
Where can an Insurance Set be edited?
3
Steps to Edit an Insurance Set
4
Editing Insurance Set Scenarios
5
Discussion - Do you Know
INSURANCE SET EDITING – SECTION G
17
2
Identify the need to Edit Insurance Set
•
Issue
•
Charge Status
•
Action Required
•
Desired Results
NOTE:
Always view the Whole account
before editing Insurance Sets.
Where can an insurance set be edited?
•
•
•
•
Patient Registration – Patient Manager
Appointment scheduling
Charge entry
Edit Transactions
This function is a complex yet valuable function within Group Mgmt. The steps you will
take vary depending on the answer to the following key questions:
•
What information has changed?
•
Does this information relate to the charge primary insurance?
•
Does this changed information affect charges that have already been posted?
•
Has a claim already been filed with incorrect information?
The concept of insurance set history numbers is introduced in this lesson. History numbers
are automatically assigned by Group Mgmt in an effort to allow a single insurance set to
retain a record of previous coverage information.
INSURANCE SET EDITING – SECTION G
3
First steps to Edit an Insurance Set
1. Locate patient in Patient Manager
2. Navigate to Insurance Demographics
INSURANCE SET EDITING – SECTION G
4
Editing Insurance Set Scenarios
Each practice runs into a variety of situations where they need to utilize this functionality.
It is important that each practice establishes consistent procedures for these types of
scenarios. The following scenarios are included in this chapter.
•
Incorrect subscriber information
•
Incorrect primary insurance group information
•
Missing secondary coverage information
•
Incorrect primary insurance coverage – no charges posted
SCENARIO 1
Incorrect Subscriber Information
A patient comes in for an appointment and the front desk staff verifies whether the
insurance information is correct. The primary insurance subscriber relationship, name,
sex, and birth-date are wrong in the insurance set in the patient’s registration.
Issue:
Incorrect Registration information
Charge Status:
No Charges have been posted
Action:
Correct information in Patient Registration. Follow these steps to
do this:
1. Access the Insurance Set through Patient Manager and make
appropriate changes to the subscriber's name and birth-date
2. Click
Results:
to save Changes
The history number remains the same as no charges were posted to
cause the creation of a new history number. The Patient
Demographics are now correct and charges posted retain the
correct information.
NOTE: See page 6 for screen prints.
INSURANCE SET EDITING – SECTION G
5
SCENARIO 1 - cont’d
Incorrect Subscriber Information
1. Navigate into Patient Manager Insurance Demographics - Locate insurance set to
update
2. Select insurance rank from – Primary, Secondary, or Tertiary
3. Insurance Detail will open
4. Update all information
5. Click
to save changes
INSURANCE SET EDITING – SECTION G
6
SCENARIO 2
Incorrect Primary Insurance Group Number
A rejection is received for a claim submitted with three charges. The patient’s
demographic information is checked and it is determined that the primary insurance
group number in the current insurance set history is wrong. The insurance set is #1
for the patient, and the current history is #1.
Issue:
Charge Status:
Action:
NOTE:
See page 8
for screen
prints.
Results:
There are claim rejections due to incorrect patient demographic
information.
Three charges have been posted and billed on one claim to the
insurance carrier.
Patient demographic information needs to be corrected and charges
need to be rebilled. Follow these steps to do this:
1. Access the Insurance Set through Patient Manager - Insurance
demographics and make the appropriate changes to the
primary insurance group number.
2. Click
to save all changes.
3. The three charges associated with Insurance Set #1, History #1
that were just edited, are displayed on the screen.
4. Specify Y, for each charge that should be re-pointed to the new
version of the set.
5. Click
when complete.
6. A question box displays, asking if you wish to correct and
repost the selected charges.
7. Specify N
8. A question box displays, asking if Demand Claims should be
accessed. Answer Y in order to rebill.
9. Print demand claims to the appropriate claim queue.
10. You return to the Registration – Insurance Set Summary
screen.
Since all of the associated charges were pointed to the edited set,
there is no need to maintain a history version of the pre-edited set,
where the group number was wrong. The insurance set is edited and
the history number is changed to #2.
INSURANCE SET EDITING – SECTION G
7
SCENARIO 2 - cont’
Incorrect Primary Insurance Group Number
INSURANCE SET EDITING – SECTION G
8
SCENARIO 3
Missing Secondary Coverage Information
A patient’s insurance info is incorrect. The patient’s primary coverage is Aetna and
secondary is AARP. The Insurance Set info is incorrect and only reflects the
patient’s primary coverage. Three charges are posted to this insurance set. The
payment is posted and the balance is transferred to the responsibility of the patient.
The patient receives their statement and calls with the secondary information.
Issue:
The balance of the charges has been transferred incorrectly due
to incorrect registrations information.
Charge Status: Payments have been posted to the three charges. The balance
has been transferred to the responsibility of the patient.
Action:
The Insurance Set information needs to be corrected. Each
charge needs to be edited to add the secondary insurance.
1. Access the Insurance set through Patient Manager –
Insurance Demographics. Add the secondary insurance
to the active set.
NOTE: See
page 11- 14
for screen
prints.
2. Press
to save the changes.
3. The three charges associated with the active insurance
set, which was just edited, display on the screen.
4. Specify Y, for each charge that should be re-pointed to the
new version of the set.
5. Click
when complete.
6. A question box displays, asking if demand claims should
be accessed. Answer N
7. Access Edit Transactions and add the secondary
insurance for each charge. Make sure to update the
Balance and Insurance Type. (PIWC and BRDHOS)
INSURANCE SET EDITING – SECTION G
9
SCENARIO 3 - cont’
Missing Secondary Coverage Information
A patient’s insurance info is incorrect. The patient’s primary coverage is Aetna and
secondary is AARP. The Insurance Set info is incorrect and only reflects the patient’s
primary coverage. Three charges are posted to this insurance set. The payment is
posted and the balance is transferred to the responsibility of the patient. The patient
receives their statement and calls with the secondary information.
Action:
8. Access Quick Link - Payments and Adjustments using
adjustment code – TRAN to transfer patient balance to edited
secondary insurance for each charge.
9. Transfer balance to secondary insurance for each charge.
Make sure to update the Balance Type (PIWC).
10. Uncheck Print Claim and Post
11. Once all claims have been edited then click on Demand Claim.
12. Group Mgmt will automatically point to Primary insurance.
You must update to Secondary code and correct claim format
(electronic or paper).
13. Select Y and Click F9 = Batch
Results:
Because all three charges are pointed to the corrected version of the
insurance set, a new history number is not created. Each charge
needs to be edited to match the Patient Manager - Insurance Set
information. The correct balance transfers need to be edited to
match with the Insurance Set information. The incorrect balance
transfers need to completely be corrected off and reposted for the
charge information to be accurate.
INSURANCE SET EDITING – SECTION G
10
Missing Secondary Coverage Information
Add secondary insurance to
insurance set.
Re-point charges
INSURANCE SET EDITING – SECTION G
11
Missing Secondary Coverage Information
Quick Links to Payments
and Adjustments
Adjustments – TRAN
Transfer each charge.
INSURANCE SET EDITING – SECTION G
12
Missing Secondary Coverage Information
Transfer patient balance to
Secondary and update
Balance Type
Uncheck Print Claim
Demand Claim
INSURANCE SET EDITING – SECTION G
13
Missing Secondary Coverage Information
Demand claims will take you
in WFE
Update secondary
information and select Y for
all charges.
To view formats, tab to box
showing P or E and Form
number, then F2.
.
F9 = Batch
INSURANCE SET EDITING – SECTION G
14
SCENARIO 4
Incorrect Primary Insurance
The patient’s insurance set contains primary insurance Aetna and secondary insurance
AARP – along with all associated insurance/subscriber information. It has been
determined at patient check-in time, that the primary insurance should be Medicare. No
Charges have been posted.
Issue:
The primary insurance is incorrect in the current set
Charge Status: No charges have been posted
Action:
NOTE: See
page 16 for
screen
prints.
Results:
Correct the insurance code for the current set. Follow these steps
to do this:
1. Access the insurance set through Patient Manager –
Insurance Demographics and make the appropriate
changes to the primary insurance code.
2. Press
to save the changes.
3. You return the Insurance Demographics – Insurance Set
summary screen.
The history number remains the same as no charges were posted
to cause the creation of a new history number. Insurance
Demographics are now correct and charges posted retain the
correct information.
NOTE: See page 16 for screen prints.
INSURANCE SET EDITING – SECTION G
15
SCENARIO 4 - cont’
Incorrect Primary Insurance
Old
insurance
New
insurance
INSURANCE SET EDITING – SECTION G
16
DISCUSSION - DO YOU KNOW?
History #1*
What does * indicate?
After charges were
posted, the Primary
Plan # was updated,
charges were Repointed and Demand
Claims were done.
Why has the History
changed to 5*?
INSURANCE SET EDITING – SECTION G
17
Expiration Date used
History # changed to 7
In reviewing the changes in
insurance on page 21, should you
re-point the charges (posted to
Aetna) to History #7?
INSURANCE SET EDITING – SECTION G
18
DEMANDING
CLAIMS
3.1
Proprietary & Confidentiality Statement
This document contains valuable, proprietary & confidential information protected
by statutory and common law trade secret principles. MedSynergies requests that
the proprietary & confidential nature of this information be respected and that it be
used only by employees in your organization with direct involvement related to the
review of the document. These individuals are to be instructed that this document
and all information contained herein is not to be shared in any form with anyone
outside of your organization’s involved evaluators and decision makers including
unnamed consultants, other vendors or other healthcare organizations. Any
distribution, duplication or other transfer of this information without
MedSynergies’ written permission is unauthorized.
TABLE OF CONTENTS
PAGE
Reviewing Insurnace and Charge Balance
3
Reviewing Insurance History
3
Demanding Claims through PM – Patient Manager
4
Demanding Claims through WFE
5
DEMANDING CLAIMS – SECTION H
2
REVIEWING INSURANCE & CHARGE BALANCE
PM – Patient Manager
Step #1
What is the current Insurance
History?
Review insurance and charges to
determine current insurance balance
Insurance History
may need to be
reviewed.
DEMANDING CLAIMS – SECTION H
NOTE:
PM – Patient Manager screen shots will be used in
these examples
3
DEMANDING CLAIMS – PM
Step #2
Click DEMAND BILLING
Select the Charge and click the
button.
The insurance code, balance type, and format; from where the charge is currently sitting,
will pull in to the demand billing fields.
Click the
button to complete.
DEMANDING CLAIMS – SECTION H
4
DEMANDING CLAIMS - WFE
Demanding from WFE
#4 – Billing
#4 – Select Demand Claims
Enter Account #
NOTE:
MSI recommends using Patient Manager to
Demand Claims not WFE.
WFE Step #1
Group Mgmt will take you back
Into WFE. Screen will appear listing
account and “O” (for open charges)
Click Enter to see all charges
NOTE:
Takes you back into WFE
DEMANDING CLAIMS – SECTION H
5
Example Account #1
WFE Step #2
NOTE: Demand will always default to
Primary insurance code, Balance
Type, Bill Type, & Format.
NOTE:
DOS 8-11-06 & 8-12-06 are currently
sitting at secondary – AARP.
Therefore the primary should not be
demanded.
To Demand secondary – AARP
F2
or use bookends for search
Enter secondary code then Enter
Insurance Code search screen will
appear. Make selection and then click
DEMANDING CLAIMS – SECTION H
6
NOTE:
WFE Step #3
will allow you to
view formats for Primary,
Secondary. and Teritary.
Takes you back into WFE
This example shows the
secondary goes E 13.
Click
to exit back
to demand screen.
Update Bill Type and Format
Sel “Y’ on DOSs
Click
or
to generate claim.
DEMANDING CLAIMS – SECTION H
7