OCHIN Billing Workshop – Part I
Learning Forum 2012
Charge Router
Functionality Review and OCHIN Recommendations
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
What is the Charge Router?
• Charge Router is a module sitting between
EpicCare and Billing.
• A powerful tool that can review, modify and
distribute charges from multiple sources.
• Charges from source applications such as
EpicCare Ambulatory, Interface, etc.
• Charges can be sent to Professional Billing,
Hospital Billing or a 3rd party billing system
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
What can the Charge Router do?
• Charge Router Review WQs
– Catch chart errors more upstream than Charge Review and
Claim Edit Review WQ
– Hold charges until the whole encounter is completed and
ready for billing
• Charge Handler Tasks
– Data manipulation on the charges before they drop into
billing (i.e. add/delete charges, add/delete modifiers,
change procedure codes, add pricing contract, etc.)
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
OCHIN Recommendations
We have set up the following charge handler tasks for
some OCHIN members, which might be beneficial for
others as well:
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MAR Visit Hold Setup
Lab Visit Hold Setup
Addendum Biller Review WQ
Deletion of External Interface Lab Charges
Immunization Administration Charge Coding
Venipuncture Coding
Modifiers Addition/Deletion
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
• Work with your OCHIN Revenue
Cycle analyst to request more
information or to implement any
recommended set up for your
organization
• Questions?
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
Billing WQ Routing & Automatic
Activities
Functionality Review and OCHIN Recommendations
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
How are credits created & resolved?
Created when a filed payment is:
• A recoupment,
• Left undistributed, or
• Larger than the charge it’s matched to
Completed and removed from the Credit WQs
when the balance is zero.
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
How are follow-up records created &
resolved?
• Follow-up = charge + coverage
• Created when claim run is accepted.
• Completed & removed when insurance
balance = $0
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
Organizing credit and follow-up
records: Routing Setup
• Time-based
– Deferral tabs in credit and follow-up WQs
– Credit deferral WQs
• Rule-based
– Self-pay vs. insurance credits
– Payment types (co-pay, pre-payments)
– Payor types
– Many other options
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
Resolving credit & follow-up records:
Automatic Activities
• Available per WQ or for entire SA
• Can automatically perform:
– Transfer to another WQ
– Create an account note
– Create an account letter
– Send to System Deferred tab of a WQ
– Perform auto-write offs, payment matching, and
transfers
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
Automatic Activities: Credit
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Auto Debit Off Small Balance
Auto Transfer Self-Pay Balance to Insurance
Auto to Oldest Outstanding Charge
Over-posted Payments Auto-debit
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
Automatic Activities: Follow-up
Define rules that automatically perform actions
based on time elapsed:
• Defer
• Write-off
• Resubmit claims
• Perform an Next Responsible Party (NRP)
• Change account status
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
Next steps
• Review your current credit and follow-up WQ
workflows and needs
• Log a JIRA and meet with your Revenue Cycle
Member Services analyst to discuss build
requirements
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
Remittance Code Mapping
Functionality Review and OCHIN Recommendations
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
Mapping of ANSI Codes
Why is this important?
• Electronic files will not load correctly if an EOB/Remit
code is not currently in the system and/or mapped.
How does a user know if this is the case?
• Typically the Remittance is in a “Created” status.
Please enter a JIRA and an analyst will be able to
determine if this is the case. They may request your
assistance to determine what ANSI code it should be
mapped to, if non-HIPAA standard code.
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
Mapping in Epic
Actions Taken:
1-Not Allowed Adjustment
2-Transfer to Self-Pay
3-Next Responsible Party
6-Write Off Insurance
9-Denied
14-Research
Consider: Review your Claims Research FollowUp WQ. If there is a pattern of EOB codes that
fall into that queue that do not need manual
intervention, consider changing the mapping.
When in doubt….send to Research for Biller
review.
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
Override Action/Assign Adjustment
Code
• The Action and Adjustment codes can be different
depending on the Payor.
• For example: The first screenshot can handle most if
not all of your Commercial Payors, but maybe for your
Family Planning Coverages/Payors you want a specific
adjustment code stating “Family Planning Adj”.
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
NAA Vs. Write-Off
• Difference between the action of 1-NAA and
6-Write Off Insurance
• Benefits of using 1 instead of 6 (streamline of
manual payment posting)
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
Other Recommendations
• Remit files incoming with payor status of 4Denial are mapped with action of 9-Denied
• If CO45 is sent by payor with full charge
amount, override action of write-off/NAA and
send to Research for biller review
• Identify patterns by code, by payor
– Can map different actions at remittance code level
by SA and payor lists
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org
Questions?
1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org