Transcript Unbilled charges

UNBILLED
CHARGES
Chapter 23
OBJECTIVE
• Review unbilled charges using the
Unbilled Charges Dashboard
KEY
CONCEPTS
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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
UNBILLED
CHARGES
• 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
• 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
CODERS/BILLING
EDITORS
• 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
UNBILLED
CHARGES
DASHBOARD
• 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
• 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
INCOMPLETE
VISITS
• 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
• 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
COMPLETED
VISITS
• 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
LINKS
• The bottom portion of screen contains
links to other information in MedTrak
NEEDS
AUTHORIZATION
• Provides easy access to visits that are
not yet authorized
DEMOGRAPHICS
NEED REVIEW
• 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
• Figure 23-6
• Figure 23-7
• Figure 23-8
Patient Log screen
Log Review Approval
screen
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
PROVIDER
NOTES ARE
INCOMPLETE
• 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
FURTHER
REVIEW
NEEDED
Contains visits that
billing department has
additional questions
about before charges
can be posted to an
invoice
FRN status set by
billing department
CHARGES
AVAILABLE
FOR REVIEW
• 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
PRINTING
PATIENT’S
DEMOGRAPHIC
LOG
• You will need to print patient’s
demographic log to turn in for your
assignment
• Do This! Pg. 299 & 300