billing 101b - part i charge entry introduction (paul) billing cycle overview (paul) charge entry...
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Billing 101B - Part I Billing 101B - Part I Charge EntryCharge Entry
Introduction Introduction (Paul)(Paul)
Billing Cycle Overview Billing Cycle Overview (Paul)(Paul)
Charge Entry Overview Charge Entry Overview (Francesca)(Francesca)
Charge Entry Flow Process Charge Entry Flow Process (Francesca)(Francesca)
QuestionsQuestions
Billing TerminologyBilling Terminology
IDX vs. SMSIDX vs. SMSCoding (CPT/ICD-9)Coding (CPT/ICD-9)ChargeChargeTES EditsTES EditsEncounter/Encounter FormEncounter/Encounter FormInvoiceInvoiceClaim/StatementClaim/StatementA/RA/RPaymentPaymentCharge CorrectionCharge CorrectionLag Days (measuring metric)Lag Days (measuring metric)
THE BILLING CYCLE
Client Relations/ Services
A/R Analysis and Reporting
Billing Inquires (Customer Services)
QA and Training
1. Appointment Scheduling and Registration – The process of scheduling an appointment and obtaining and/or updating all current demographic, financial and insurance information.
2. Arrival/Check-In – The process of arriving patients, verify information and updating as necessary.
4. Coding and Encounter Form Batching – The process of coding a visit completing an encounter form and batching encounter forms.
5. Charge Entry – The process of entering charges, CPT codes, and ICD-9 codes into a billing system.
3. Patient Care
6. Edit Resolution – The process of data verifications using TES, Z-Claim and Pre-Bill edit systems.
7. Claims Submission and Patient Billing – The process of submitting claims to third-party payors and mailing patient statements (bills).
8. Payment Posting – The process of recording all types of payments and adjustments received in a timely manner.
9. A/R Follow-Up – The process of contacting third-party payors and self-pay patients to inquire about unpaid accounts
The billing cycle includes nine major steps and is supported by ongoing quality assurance and training, customer service, analysis and reporting and client relations
Charge Entry OverviewCharge Entry Overview
Functions and ResponsibilitiesFunctions and ResponsibilitiesIDX ComponentsIDX Components
MGBS Charge Entry MatrixMGBS Charge Entry Matrix
DermatologyDermatologyLakeshoreLakeshoreLakesideLakesideMedicine (some BA)Medicine (some BA)NeurologyNeurologyOrtho ApplianceOrtho AppliancePain ManagementPain ManagementProctor FoundationProctor FoundationWomen HealthWomen Health
Charge Slip Batch Control Charge Slip Batch Control DocumentDocument
Department
$Total of Charge Slips
No. of Charge Slips
Abstractor At:
Attention:
Date:
Date Completed
Batch Total
Signature
MGBS Process DefinedMGBS Process Defined
Charge Batches Received
From Department
Charge Batches Are Stamped Daily Logged In Binder
Encounter Forms Are Then Counted
Charges Are Entered Into
TES
After Charges AreEntered, The Batches Are
Then Logged OutFrom The Binder
Batch Proofs Are SentBack To The DeptFor Reconciliation
THE BILLING SYSTEM FLOW
The billing system flow includes four applications and is supported by ongoing quality assurance and training, customer service, analysis and reporting and client relations.
TES (Edit Checking)
Router
Pre-Bill (Edits)
IDX BAR
(Edits)
SMS (Edits)
Payor
Payor
Claims Claims
Payments Rejections
Payments Rejections
(Manual/Electronic) Payments Rejections
(Manual/Electronic) Payments Rejections
Encounter
Claims Claims
Payments Rejections
Payments Rejections
MGBS Charge Entry TeamMGBS Charge Entry Team
Liz, Marian, Terry, Molly, Maureen, Elsie, GailLiz, Marian, Terry, Molly, Maureen, Elsie, Gail
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