Unbilled charges

1. Unbilled charges Chapter 23

2. Review unbilled charges using the Unbilled Charges Dashboard objective

3. Billable items • Super bill • Billing codes • Computer aided coding (CAC) • Line item charge • Billing editor • Further review needed • Incomplete visits • Completed visits • Needs authorization • Demographics need review • Provider notes are incomplete • Charges available for review • Further review done • Transcriptionist Key Concepts

4. First step: convert clinical activities to billable items present on invoice to payer • Facilities that use paper (Superbill) need to be entered into billing system • Billing coders use info on Superbill plus any other clinical documentation(paper chart)be sure all billable items accurately and completely coded • Coders enter CPT codes into billing system along with appropriate HCPCS codes and National Drug Codes (NDC) Unbilled charges

5. Billing system contains rate tables that add rate to billable item based on type of visit, location, payer • Different rate tables exist for Medicare, insurance companies, workers’ compensation, employee health and self pay • First step in medical billing process is automated, computer aided coding (CAC) • Line item charged including rates based on type of visit, location, payer are automatically created during clinical processing • Automatic line item charge creation eliminates the need for a coder to manually enter charges for visits Unbilled charges

6. Coders now become billing editors and review billing information to be sure each line item charges are reasonable and complete • Billing editors have on-line chart for researching billable items • If they have questions about billable items they can send a request for further info from physician or clinical staff directly in system • Enabling billing editors to work remotely and without paper Coders/Billing editors

7. MedTrak allows all of line item charges created ruing clinical visit to appear on Unbilled Charges Dashboard • This is used by billing editors to track their workflow and process line item charges for encounters • Billing managers also use dashboard to monitor billing editor’s workload • Figure 23-1 MedTrak Main Menu • Figure 23-2 Billing Menu • Figure 23-3 Unbillable Charges Dashboard Unbilled charges Dashboard

8. Provides consolidated view of all unbilled charges for particular medical location • Saves billing editor’s time MedTrak will audit clinical and billing data for visits and categorizes visits Unbilled charges dashboard

9. Top portion of dashboard contains information about charges for patient visits for which additional info is needed before they can be billed • In red these visits are considered incomplete as they still need authorizations • Patient/employer demographics needs review • Provider’s history/exam notes are incomplete • Other questions about visit not yet answered Incomplete visits

10. Authorization for treatment is needed • Billing personnel must review demographic data before posting charges • Provider notes are incomplete and must be completed and/or reviewed before releasing charges for posting to an invoice • FRN (Further Review Needed)charges result when billing staff send a FRN request to physician or other clinical staff asking question about charges related to visit Incomplete visits

11. Charges available for review include all visits that are ready for posting to an invoice that have had FRN order on them • Further review done includes all visits that have had a FRN order on them and that are completed by physician or clinical staff Completed visits

12. The bottom portion of screen contains links to other information in MedTrak links

13. Provides easy access to visits that are not yet authorized Needs authorization

14. Provides access to visits that need demographic information reviewed before posting another invoice • MedTrak sets a DR flag that needs review • Figure 23-4 Unbilled Charges: Patient, Need Demographic Review screen • Figure 23-5 Unbilled Charges: Patient, COMM INS Screen Demographics need review

15. Figure 23-6 Patient Log screen • Figure 23-7 Log Review Approval screen • Figure 23-8 Unbilled Charges: Patient, COMM INS • Do This! Pg. 296 • Continue to review demographic logs • Figure 23-9 Unbilled Charges: Patient, Need Demographic Review Screen • Figure 23-10 Unbilled Charges Dashboard showing no unbilled charges for incomplete visits • Do This! Pg. 298 Demographics need review

16. Includes visits that need CL flag cleared (provider’s checklist containing history/exam questions) • Flag is removed on Pending-Incomplete Visits screen • This is responsibility of clinical staff not billing department • After verification clinical staff member uses “cmcl” command (completed checklist) on PENDING screen next to visit to clear flag Provider notes are incomplete

17. Contains visits that billing department has additional questions about before charges can be posted to an invoice FRN status set by billing department Further review needed

18. Colored in green considered “completed” and ready to post to an invoice • Two categories: • 1-charges available for review –visits flow from Incomplete visits area for Need authorization, Demographics need review and Provide notes are incomplete • 2-further review done flow from Further review needed category • Billing editor either post charges or sends FRN message to physician asking for clarification of some billing information • Unbilled Charges Dashboard constantly updates to reflect current status of unbilled charges for medical facility Charges available for review

19. You will need to print patient’s demographic log to turn in for your assignment • Do This! Pg. 299 & 300 Printing patient’s demographic log