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Deep Dive into Charge Entry

This presentation covers pricing and coding miscellaneous tests in Charge Entry Application, Patient Account Module, and LAB Result Fields. Learn about system parameters, test flags, reference lab codes, and invoicing errors setup.

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Deep Dive into Charge Entry

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  1. Deep Dive into Charge Entry Ann Hage SoftA/R Product Specialist

  2. Pricing / 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

  3. CHARGE ENTRY

  4. Charge 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

  5. Setup - System Parameters • The System Parameter, ChargeEntrySrvDates, determines the start date in the Date of Service range used in the Charge Entry Application’s worklist

  6. ChargeEntrySrvDates = 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

  7. ChargeEntrySrvDates = 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

  8. Setup – Test Flags

  9. Setup – 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.

  10. Setup – 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.

  11. Setup - 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.

  12. Charge Entry Application - Accessibility

  13. Charge 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.

  14. Charge 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.

  15. Charge 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.

  16. Charge 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.

  17. Charge Entry Application • Once you’ve made your selection, you will be presented with the following dialog from which you will work.

  18. Charge Entry Application

  19. Charge 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.

  20. Charge Entry Application: Alias in Action LEPR F2 Executing F2 from the Alias cell launches a setup search dialog from which Reference Lab Codes can be selected

  21. Charge Entry Application: Alias in Action

  22. Charge Entry Application: Save vs Save and Release

  23. Charge 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.

  24. Charge Entry Application: ‘Save’ • The “Visit Readiness” indicator displays a status of “Not Ready”

  25. Charge Entry Application: ‘Save’ • Invoicing results in error IN88 – Visit is marked as review needed.

  26. Charge Entry Application: Save and Release • “Save and Release” retains the user’s entries and updates the “Visit Readiness” flag

  27. Charge Entry Application: Save and Release • The “Visit Readiness” indicator displays a status of “Ready”

  28. Charge Entry Application: Save and Release Invoicing completes without errors and items are created for the miscellaneous test to which Alias coding was assigned.

  29. ADDING TESTS VIA CHARGE ENTRY

  30. Charge Entry Application: Adding New Tests The visit to the right contains only one Miscellaneous Test

  31. Charge Entry Application: Adding New Tests • From the Charge Entry Application, add a new test to this visit and Save

  32. Charge Entry Application: Adding New Tests The visit in the Patient Account Module reflects addition of the new test.

  33. CHARGE ENTRY VIA PAM

  34. Charge 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.

  35. Charge Entry via the Patient Account Module While still in Edit Mode, select the ‘Visit Readiness’ Iconand select ‘Yes’ from the message dialog to update the status to ‘Ready’.

  36. INVOICING ERRORS

  37. IN88: 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.

  38. IN88: 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.

  39. IN88: Split Skip Functionality When the visit is invoiced, the system splits the visit in order to successfully invoice the ‘regular’ test and keep the test requiring follow up on an erroneous Visit.

  40. IN88: Split Skip Functionality Erroneous visit contains the test requiring follow up. Visit status remains ‘Not Ready’

  41. IN88: Split Skip Functionality Invoiced visit contains the ‘Regular’ test.

  42. WRN35: Outside Charge entries ignored In this example, the ‘Outside Charge’ section of the dialog was completed for a test not flagged As ‘Outside Charge’.

  43. WRN35: 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.

  44. Charge 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.

  45. Charge Entry Prices and Defined Prices + =

  46. LAB RESULT FIELDS: PRICE

  47. LAB 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].

  48. LAB 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.

  49. LAB Result Fields: Example • Order contains test SOCHG having a “result” = 50.00

  50. LAB Result Fields: OBR Segment • OBR[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

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