Read eClinicalWorks Billing Guide V 8.0.47 text version

BILLING USERS GUIDE

V 8.0.47

©

eClinicalWorks, 2009. All rights reserved

CONTENTS

List of New Features _________________________________________ 11 List of Enhancements ________________________________________ 13

ABOUT

Product Documentation ______________________________________ 15 Finding the Documents ___________________________________________ 15 Getting Support_____________________________________________ 15 Conventions _______________________________________________ 16

ENCOUNTERS

About the Encounters Window ___________________________________ 17 Processing Completed Encounters ________________________________ 18 Reviewing Incomplete Encounters ________________________________ 19 Viewing Non-Billable Visits ______________________________________ 19 Claims IPE _____________________________________________________ 19 Running Claims IPE from the Encounters Window ___________________ 19

CLAIMS

About the Claims Lookup Window ______________________________ 24 Identifying Claim Status________________________________________ 30 Identifying Encounters without Claims ____________________________ 32 Viewing Pending Claims ________________________________________ 32 Reviewing Rejected Claims______________________________________ 33 Claim Processes _________________________________________________ 33 About Creating Claims _________________________________________ 33 Creating a Claim without an Encounter ____________________________ 34 Creating a Claim from an Encounter ______________________________ 36 Modifying a Claim _____________________________________________ 37 Deleting a Claim ______________________________________________ 38 Viewing the Claim Summary for a Claim___________________________ 38 Printing the Claim Summary for a Claim ___________________________ 39 Billing Processes ________________________________________________ 39 Adjusting Medicaid Claims ______________________________________ 39 Splitting Claims ______________________________________________ 40 Creating Multiple Claims from Encounters at Once ___________________ 41 Creating a Batch______________________________________________ 41 Printing Claim Forms from the Claims Window ______________________ 42 Changing the Claims Date ______________________________________ 42 Changing Claim Status _________________________________________ 43 Transferring Claim Balances to the Patient _________________________ 43 Writing Off Multiple Claims at Once _______________________________ 44 Writing Off Claims for a Capitation Plan ___________________________ 45 Voiding and Recreating Multiple Claims at Once _____________________ 46 Deleting Multiple Claims at Once _________________________________ 50 Reassign Provider Numbers on Claims ____________________________ 50

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

3

Contents

Reassigning CLIA IDs for Multiple Claims at Once____________________ 51 Copying Insurance Types to Claims _______________________________ 52 Transferring Claims to Collections ________________________________ 52 Removing Claims from Collections ________________________________ 53 Viewing the Claims Report ______________________________________ 53 Claims IPE Processes _____________________________________________ 54 Running Claims IPE from the Claims Window _______________________ 54 Lock/Unlock Processes ____________________________________________ 56 Locking a Single Claim _________________________________________ 56 Locking Multiple Claims at Once__________________________________ 56 Locking Filtered Claims _________________________________________ 57 Unlocking Multiple Locked Claims at Once __________________________ 57 Unlocking a Locked Claim_______________________________________ 58 Viewing the Claim Lock Status Log for a Single Claim ________________ 58 Viewing the Claim Lock Status Log for Multiple Claims ________________ 59 Professional (HCFA) Claims ___________________________________59 Submitting Electronic Claims Using the CMS 1500 Form _________________ 59 Printing Paper Claims Using the CMS 1500 Form _______________________ 59 Printing Batches of Paper Claims Using the CMS 1500 Form ___________ 60 NDC Codes on the CMS 1500 Form _________________________________ 60 About the Professional (HCFA) Claim Window__________________________ 61 CMS-1500 Form Mapping _______________________________________ 69 About the Claim CPT Details Window______________________________ 70 Viewing and Responding to Rule Validation Warnings _________________ 74 CodeCorrect ____________________________________________________ 75 Checking Errors on Claims with CodeCorrect________________________ 75 Claim Header ___________________________________________________ 76 Completing the Claim Header____________________________________ 76 Claim Data _____________________________________________________ 78 Completing Claim Data _________________________________________ 78 Managing EPSDT ______________________________________________ 81 Claim Options___________________________________________________ 82 Viewing Claim Logs____________________________________________ 82 Viewing the Claim Submission Log _____________________________ 82 Viewing the Charges Log _____________________________________ 83 Viewing the Claim/CPT Adjustments Log _________________________ 83 Viewing the Line Refunds Log _________________________________ 83 Viewing the Claim/CPT Payment Posting Log _____________________ 84 Viewing the Claim Lock Log ___________________________________ 84 Viewing the Claim Status Log _________________________________ 84 Viewing the Claim Transfer Log ________________________________ 85 Viewing the Claim Assigned To Log _____________________________ 85 Viewing Finance Charge Logs _________________________________ 85 Viewing the Claim Collection Log _______________________________ 86 Viewing and Printing a Claim Summary__________________________ 86 Reloading Insurances from Demographics to Claims __________________ 86 Reapplying Modifier Percentages on Claims _________________________ 87 Reassigning Provider Numbers on Claims __________________________ 87 Converting HCFA Claims to UB Claims _____________________________ 87 Converting HCFA Claims to Dental Claims __________________________ 87 Deleting a Claim from the Claim Window __________________________ 88

4

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

Contents

Locking a Claim from the Claim Window ___________________________ 88 Unlocking a Locked Claim from the Claim Window ___________________ 88 Configuring My Settings on Claims _______________________________ 88 Printing HCFA Forms _____________________________________________ 89 Printing Claims Using the CMS 1500 Form _________________________ 89 Viewing and Printing Claims on Other Forms _______________________ 90 Adding NY Medicaid Form Data __________________________________ 90 Viewing and Printing ERAs Associated with a Claim __________________ 91 Selecting State Medicaid Forms __________________________________ 91 Entering Financial Adjustments _____________________________________ 92 Entering an Adjustment on a Claim _______________________________ 92 My Claims _____________________________________________________ 94 Viewing the Assigned Claims Log_________________________________ 94 Entering Claim Follow Up Details _________________________________ 94 Using the My Claims Window ____________________________________ 96 Institutional (UB) Claims _____________________________________97 About the Institutional (UB) Claim Detail Window ______________________ 98 Fields 1-31 tab and General Tab _________________________________ 99 Fields 32-49 Tab _____________________________________________ 101 Fields 50-75 Tab _____________________________________________ 102 Fields 76-85 Tab _____________________________________________ 104 Error Log Tab _______________________________________________ 105 About the UB-04 Claim Form ___________________________________ 105 Viewing the Batch Print Log ____________________________________ 107 Dental Claims _____________________________________________107 Patient Setup for Dental Claims _________________________________ 107 Configuring Insurance Companies for Dental Claims_________________ 107 Creating Dental Claims________________________________________ 107 Printing and Transmitting Dental Claims __________________________ 107 Downloading Dental Claims Reports _____________________________ 108 About the Dental Claim Detail Window ______________________________ 108 Patient Coverage Information Tab and General Tab _________________ 109 Charges Tab ________________________________________________ 111 Billing Dentist Tab____________________________________________ 113 Error Log___________________________________________________ 114 Miscellaneous Claim-Related Actions ___________________________115 Recovering the NSF Fee Charged by the Bank _____________________ 115 Moving a Credit _____________________________________________ 116 Hard Closing Claims_____________________________________________ 118 ANSI File Status ___________________________________________119

PAYMENTS

About the Payments Window _________________________________121 Adding Received Payments ___________________________________124 Payment Batches _______________________________________________ 124 Starting Payment Batches _____________________________________ 124 Looking Up Payment Batches ___________________________________ 125 Ending a Payment Batch ______________________________________ 126

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

5

Contents

Fast Payments _________________________________________________ 126 Entering Fast Payments _______________________________________ 126 Patient Payments _______________________________________________ 128 Adding Patient Payments ______________________________________ 128 Adding Paper Payments from Insurance Companies _________________ 132 Performing Actions on Payments ______________________________136 Updating Payments ___________________________________________ 136 Deleting Payments ___________________________________________ 137 Copying the Payment List to a Text or Excel File ___________________ 137 Configuring Payment Default Options ____________________________ 138 Locking Payments ____________________________________________ 139 Unlocking Payments __________________________________________ 139 Posting Payments __________________________________________140 Posting Patient Payments_________________________________________ 140 Posting Insurance Payments ______________________________________ 148 Posting Capitation Payments ___________________________________ 151 Hard Closing Payments ______________________________________154 Miscellaneous Payment-Related Actions _________________________155 Charging for Returned Checks __________________________________ 155

ERA

ERA (Electronic Remittance Advice) ____________________________157 About ERAs ___________________________________________________ 157 Which Payers Provide ERA? ____________________________________ 157 How are Payments Posted? ____________________________________ 157 Setting Up ERA within eClinicalWorks ____________________________ 158 Using ERA with WebMD/Emdeon ________________________________ 158 Importing an ERA from WebMD/Emdeon __________________________ 158 Importing an ERA from another Clearinghouse or Third-Party Vendor ___ 159 Exporting ERAs ______________________________________________ 160 Posting ERAs __________________________________________________ 160 Posting Payments Using the ERA ________________________________ 160 Marking an ERA as Posted _____________________________________ 161 Viewing ERAs __________________________________________________ 162 Viewing an ERA______________________________________________ 162 Viewing an ERA Exception Report _______________________________ 162 Using ERAs with Claims __________________________________________ 163 Showing ERA Reason Codes ____________________________________ 163 Printing ERAs from the Printed Claims Window _____________________ 164 Printing ERAs at the Claim Level ________________________________ 165

REFUNDS

Refunds __________________________________________________167 About the Refunds Window _______________________________________ 167 Looking Up Refunds __________________________________________ 168 Refund Procedures ______________________________________________ 168 Generating a Refund __________________________________________ 168 Viewing a Log of Refund Activity ________________________________ 170

6

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

Contents

Posting a Refund Associated with a Claim _________________________ 170 Posting a Refund Associated with a Payment ______________________ 172 Voiding a Refund ____________________________________________ 173 Deleting a Refund ____________________________________________ 173 Locking a Refund ____________________________________________ 174 Unlocking a Refund___________________________________________ 174 Hard Closing Refunds ___________________________________________ 175

ACCOUNTS LOOKUP

About Accounts Lookup _____________________________________177 Looking Up Patient Accounts ___________________________________ 177 Viewing a Patient Account _____________________________________ 179 Accounts Lookup Procedures _________________________________182 Viewing Payor Invoices ________________________________________ 182 Viewing Guarantor Statement Jobs ______________________________ 183 Setting Patient-Specific Alerts from Accounts Lookup ________________ 183 Copying the Patient Account List ________________________________ 184 Creating Patient Refunds from Accounts Lookup ____________________ 184 Collection Management from Accounts Lookup________________________ 185 Transferring Patient Accounts to Collections _______________________ 185 Removing Patient Accounts from Collections _______________________ 186 Excluding a Patient Account from a Collection Run __________________ 187 Transferring Claims in an Account to Collections____________________ 188 Generating Statements __________________________________________ 189 Configuring Patient Statement Options ___________________________ 189 Generating Printed Patient Statements ___________________________ 190 Generating Electronic Patient Statements _________________________ 191 Generating Paper Guarantor Statements __________________________ 192 Generating Electronic Guarantor Statements_______________________ 193 Transferring Patient Balances into eClinicalWorks _________________194 Transferring Patient Debit Balance _______________________________ 194 Transferring Patient Credit Balance ______________________________ 195

BATCHES

Batch Creation_____________________________________________197 Creating and Submitting a Batch ________________________________ 197 Batch Management _________________________________________201 Saving Batch Files Locally _____________________________________ 201 Previewing Batches___________________________________________ 202 Changing the Claims Status of Batches ___________________________ 202 Regenerating a Batch _________________________________________ 203 Copying Batch Information to a Text or Excel File __________________ 203 Viewing the ITS Transaction Log ________________________________ 204 Assigning Tracking Numbers to Batches __________________________ 204

COLLECTION MANAGEMENT

About the Collection Management Console_______________________205

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

7

Contents

Using the Collection Management Filters __________________________ 205 Using Other Collection Management Features ______________________ 206 Collection Management Procedures ____________________________207 Generating Collection Letters ___________________________________ 207 Searching for Accounts Ready for Collection Management ____________ 208 Using Patient Details Options ___________________________________ 208 Entering Collection Status Notes for a Patient ______________________ 209 Viewing and Setting Patient Alerts from Collection Management _______ 210 Transworld Collection Management ____________________________211 Configuring Transworld Information ______________________________ 211 Setting Up Collection Cycles for Transworld________________________ 211 Transmitting Accounts to Transworld _____________________________ 212 Removing Accounts from Transworld _____________________________ 213 Claim-Based Collection Management ___________________________214 Using Claim-Based Collection Management ________________________ 214 Transferring Claims into and out of Collections _____________________ 215 Claim Collection Logs _________________________________________ 215

ALERTS

Billing Alerts ______________________________________________217 Billing Alert Recalls _____________________________________________ 217 About the Billing Alert Recall Window ____________________________ 217 Setting Billing Alerts for Patients ________________________________ 219 Recalling Patient Accounts using Billing Alerts ______________________ 222 Using Billing Alerts for Insurance Follow-up________________________ 223 Recalling Patient Accounts with Payment Plans _____________________ 223

CLEARINGHOUSES

McKesson Reports ______________________________________________ 225 Medical Statement Reports_____________________________________ 228 Payer Reports (CPR601.01) ____________________________________ 228 Claim Category Status ________________________________________ 228 Uploading Claims to McKesson __________________________________ 229 Downloading Reports from McKesson_____________________________ 230 Saving McKesson Reports ______________________________________ 231 Reviewing the McKesson Reports ________________________________ 231 Clearinghouse Dashboard ________________________________________ 232 Accessing the Clearinghouse Dashboard __________________________ 232

ACCOUNTS RECEIVABLE MANAGEMENT

AR Management ___________________________________________233 Account Analysis Summary Reports ________________________________ 234 Account Summary Aging ______________________________________ 234 Patient Balance Aging Summary ________________________________ 234 Guarantor Summary Aging _____________________________________ 234 Insurance Analysis Reports _______________________________________ 235 Insurance Claim Aging - Summary ______________________________ 235 Insurance Claim Aging - Detail _________________________________ 235

8

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

Contents

Managing AR using Claim Filter Options _____________________________ 235 Finding Aging Accounts Using Filter Options _______________________ 235

REPORTS

Report Sets _______________________________________________237 End of Day Reports (Crystal Reports) _______________________________ 237 Accessing Crystal Reports _____________________________________ 237 Day Sheet - Payments ________________________________________ 238 Provider Payments Based on Posting _____________________________ 238 Day Sheet - Charges _________________________________________ 238 Charges by Service Date ____________________________________ 238 Charges by Service Date and User ____________________________ 238 Charges by Claim Date _____________________________________ 239 Charges by User __________________________________________ 239 Adjustment by User ________________________________________ 239 Refund Summary ____________________________________________ 239 Billing Summary _____________________________________________ 240 Configuring Billing Summary Options __________________________ 240 Out of Office Billing Summary __________________________________ 241 OB - Active Pregnancies _______________________________________ 241 Labels _____________________________________________________ 241 Reminders __________________________________________________ 242 Transactions Reports__________________________________________ 242 EMR Reports ________________________________________________ 242 Cancelled Visits ___________________________________________ 242 Patient Data Logs__________________________________________ 243 Unlocked Visits Report ______________________________________ 243 Access Log Report _________________________________________ 243 Day Sheet - Pathology Detail_________________________________ 243 Scheduling - Provider Productivity Report _________________________ 243 Using the Report Console ______________________________________ 244 PM Scheduled Tasks Status ____________________________________ 244 View Claim Scrub Logs ________________________________________ 245 View Security Logs ___________________________________________ 245 Reconcile Transactions ________________________________________ 245 End-of-Month Reports (APL Reports) _______________________________ 246 Accessing APL Reports through eCW _____________________________ 246 Day Sheet Summary _________________________________________ 246 Charges-Payment Summary ____________________________________ 247 Insurance Claim Aging Detail ___________________________________ 247 Insurance Charges-Payments ___________________________________ 247 Insurance Cross-Tab Analysis ___________________________________ 248 Procedure Code Production Analysis _____________________________ 248 Charges-Payment/Claim Rendering Provider _______________________ 248 Unposted Payments __________________________________________ 248 Payments without Claims ______________________________________ 249 List Refunds ________________________________________________ 249 List Write-offs/Adjustments ____________________________________ 249 A/R Management Report ______________________________________ 249 Daily Financial Summary ______________________________________ 250

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

9

Contents

APPENDIX A: STATE BILLING EXCEPTIONS

_________________________ 251

APPENDIX B: NOTICES ____________________________ 255

Trademarks _________________________________________________ 255

GLOSSARY

10

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

Contents

List of New Features

List of New Features

Splitting Claims ____________________________________________________ 40 Changing the Claims Date ___________________________________________ 42 Writing Off Multiple Claims at Once ____________________________________ 44 Deleting Multiple Claims at Once ______________________________________ 50 Reassign Provider Numbers on Claims __________________________________ 50 Reassigning CLIA IDs for Multiple Claims at Once_________________________ 51 Copying Insurance Types to Claims ____________________________________ 52 Locking Filtered Claims ______________________________________________ 57 CodeCorrect® _____________________________________________________ 75 Viewing Finance Charge Logs _________________________________________ 85 Reloading Insurances from Demographics to Claims _______________________ 86 Reapplying Modifier Percentages on Claims ______________________________ 87 Reassigning Provider Numbers on Claims _______________________________ 87 Converting HCFA Claims to Dental Claims _______________________________ 87 Printing Claims Using the HCFA 1500 Form______________________________ 89 Adding NY Medicaid Form Data _______________________________________ 90 My Claims ________________________________________________________ 94 Dental Claims ____________________________________________________ 107 Hard Closing Claims _______________________________________________ 118 ANSI File Status __________________________________________________ 119 Payment Batches _________________________________________________ 124 Fast Payments____________________________________________________ 126 Hard Closing Payments _____________________________________________ 154 Exporting ERAs ___________________________________________________ 160 Voiding a Refund__________________________________________________ 173 Hard Closing Refunds ______________________________________________ 175 Viewing Payor Invoices _____________________________________________ 182 Viewing Guarantor Statement Jobs ___________________________________ 183 Viewing Payor Invoices _____________________________________________ 183 Creating Patient Refunds from Accounts Lookup _________________________ 184 Transferring Claims in an Account to Collections_________________________ 188 Configuring Patient Statement Options ________________________________ 189 Viewing the ITS Transaction Log _____________________________________ 204 Transworld Collection Management ___________________________________ 211 Claim-Based Collection Management __________________________________ 214 Clearinghouse Dashboard ___________________________________________ 232

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

11

List of New Features

Adjustment by User _______________________________________________ 239 Configuring Billing Summary Options__________________________________ 240 OB - Active Pregnancies ____________________________________________ 241 Labels __________________________________________________________ 241 Reminders _______________________________________________________ 242 EMR Reports _____________________________________________________ 242 Scheduling - Provider Productivity Report ______________________________ 243 Using the Report Console ___________________________________________ 244 PM Scheduled Tasks Status _________________________________________ 244 View Claim Scrub Logs _____________________________________________ 245 View Security Logs ________________________________________________ 245 Accessing APL Reports through eCW __________________________________ 246

12

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Contents

List of Enhancements

List of Enhancements

About the Encounters Window _______________________________________ 17 About the Claims Lookup Window _____________________________________ 24 Creating a Claim without an Encounter _________________________________ 34 About the Professional (HCFA) Claim Window ____________________________ 61 About the Claim CPT Details Window___________________________________ 70 Completing the Claim Header_________________________________________ 76 Completing Claim Data ______________________________________________ 78 Entering Financial Adjustments _______________________________________ 92 About the Institutional (UB) Claim Detail Window_________________________ 98 About the Payments Window ________________________________________ 121 Posting Patient Payments ___________________________________________ 140 Posting Insurance Payments_________________________________________ 148 Posting Payments Using the ERA _____________________________________ 160 Viewing ERAs ____________________________________________________ 162 Showing ERA Reason Codes _________________________________________ 163 Printing ERAs from the Printed Claims Window __________________________ 164 Printing ERAs at the Claim Level _____________________________________ 165 Posting a Refund Associated with a Claim ______________________________ 170 Looking Up Patient Accounts ________________________________________ 177 Generating Electronic Guarantor Statements ____________________________ 193 Creating and Submitting a Batch _____________________________________ 197 Using the Collection Management Filters _______________________________ 205 Generating Collection Letters ________________________________________ 207 Using Patient Details Options ________________________________________ 208 Entering Collection Status Notes for a Patient ___________________________ 209 Viewing and Setting Patient Alerts from Collection Management ____________ 210 Setting Billing Alerts for Patients _____________________________________ 219 Billing Summary __________________________________________________ 240

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

13

List of Enhancements

14

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

ABOUT

This guide provides step-by-step procedures for routine billing tasks. It is intended for billing managers, office managers, and any other staff members responsible for the day-today processing of claims, posting of payments, crediting of refunds, collecting delinquent accounts, and generating financial reports. This guide does not provide procedures for setting up the system, performing scheduling tasks, document management, or EMR. For detailed information about these tasks refer to the respective user guides. The System Administration Users Guide V 8.0.47 consolidates all the setup information for Front Office, EMR, and Billing features.

Product Documentation

The following documentation supports eClinicalWorks Electronic Medical Record (EMR), Practice Management (PM), and/or Patient Portal software applications: Billing Users Guide Electronic Medical Records Users Guide Front Office Users Guide Patient Portal Users Guide Registry Guide System Administration Users Guide Release Notes eClinicalMessenger Users Guide

Finding the Documents

eClinicalWorks Documentation is available from the following: The eClinicalWorks Support Portal: http://support.eclinicalworks.com eCliniWiki A Living Guide to eClinicalWorks: http://www.ecwiki.com/

Getting Support

Send messages directly to eClinicalWorks Support through the eClinicalWorks Support Portal: http://support.eclinicalworks.com You may also call or e-mail eClinicalWorks Support: Phone: (508) 836-3663 E-mail: [email protected]

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

15

Conventions

About

Conventions

This section list typographical conventions and describes the icons used to call out additional information and to indicate item keys, new features, and enhancements to the application. The following typographical conventions are used in this guide: Bold Italic Monospace Identifies options, keywords, and items in a description. Indicates variables, new terms, and concepts, foreign words or emphasis. Identifies examples of specific data values, and messages from the system, or information that you should actually type.

The following icons are used to highlight new features and indicate enhanced features and Item Keys:

Icon

Description Indicates this is an Item Key.

Identifies New Features.

Indicates an Enhanced Feature. Points out helpful tips or additional information.

16

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

ENCOUNTERS

Encounters are simply documented patient visits. As soon as you book a patient visit in the schedule, an encounter is created. Once a patient has visited the physician and the Progress Notes are complete, you can create a claim. You can create a claim for an encounter only if the physician has clicked the Done button on the Progress Notes Billing window.

About the Encounters Window

The Encounters window is accessed by clicking the Encounters button from the Billing band:

1

3

2

4

5

# 1 Purpose Check the All box to display encounters for all providers, or uncheck the All box and click the More (...) button to checking the boxes next to the individual providers whose encounters you want to display. Multiple providers can be selected at once. 2 Select a specific date range for the encounters you want to display using the Service Date(s) drop-down calendars, or select a general date range (last 30, 60, 90, or 120 days) for the encounters you want to display from the No of Days drop-down list. Click one of the following radio buttons to select the status of the encounters you want to display: Progress Notes Done/Locked - Displays only encounters with Progress Notes that have been marked Done or have been locked. Non-Billable Visits - Displays only encounters that have been marked as non-billable. Progress Notes Incomplete - Displays only encounters with Progress Notes that have not been marked Done or been locked. Progress Notes Locked - Displays only encounters with Progress Notes that have been locked. Visit Status Codes: Non-Billable - Displays only encounters with Visit Status Codes that are marked as non-billable.

©Copyright

3

eClinicalWorks, LLC 2009, Billing Users Guide

17

Encounters

# 4

Purpose To display encounters for specific insurance companies, Insurance Groups, facilities, or Facility Groups, click the More (...) button next to the appropriate field and select the desired item. To alternate between selecting facilities or Facility Groups, select the desired option from the gray drop-down list on the left.

5

Once the filters have been set and the Lookup button has been clicked, click one of the following buttons to perform an action: Copy - Copies the information displayed on this window to a text or Excel file. Progress Notes - Opens the Progress Notes for the highlighted encounter. Claims IPE All - Creates claims for all applicable encounters. Claims IPE Selected - Creates claims for all encounters currently displayed in the list.

Click the Lookup button once all filters have been set as desired in order to view encounters that match the selected criteria.

Processing Completed Encounters

The following steps can be performed to process completed encounters into claims. To process completed encounters: 1. From the Billing band, click the Encounters icon. The Encounters window opens. 2. Click the Progress Notes Done/Locked radio button. OR Click the Progress Notes Locked radio button. 3. Set the remaining filters at the top of the window as desired. 4. Click the Lookup button. All encounters that match your search criteria display in the window. 5. Click the Claims IPE Selected (F6) button. The Claims IPE Selected (F6) button only processes the encounters in the list. 6. Continue submitting the claims as you would normally. For more information on submitting claims, refer to the section titled Running Claims IPE from the Encounters Window on page 19.

18

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Encounters

Reviewing Incomplete Encounters

The following steps can be performed to review incomplete encounters. To review incomplete encounters: 1. From the Billing band in the left navigation bar, click Encounters. The Encounters window opens. 2. Click the Progress Notes Incomplete radio button. 3. Set the remaining filters at the top of the window as desired. 4. Click the Lookup button. The Encounters window displays all Progress Notes that have not been marked as Done by the provider. 5. To open the Progress Notes for an encounter: a. Highlight the encounter you want to review. b. Click the Progress Notes (F3) button. The Progress Notes for the selected encounter opens. Note: The Copy (F2) button can be used to copy the list for the provider to resolve the incomplete Progress Notes.

Viewing Non-Billable Visits

All visits marked as non-billable can be filtered and viewed by clicking one of the two nonbillable radio buttons on the Encounters window: Non-Billable Visits Visit Status Codes: Non-Billable The results of these filtered searches are based on marking the appointment as Non-Billable or Visit Statuses that are marked as Non-Billable.

Claims IPE

The eClinicalWorks Claims IPE is an integrated processing engine. Claims IPE greatly streamlines claims processing and dramatically improves your efficiency. Run the Claims IPE from the either the Encounters window or from the Claims window.

Running Claims IPE from the Encounters Window

Use this procedure to run the Claims IPE for all encounters without claims. To run Claims IPE from the Encounters Window: 1. From the Billing band, click the Encounters button. The Encounters window opens.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

19

Encounters

2. Set the filters as desired and click the Lookup button. Encounters that match the selected criteria display. 3. Click the Claims IPE All (F4) or Claims IPE Selected (F6) button. A confirmation window opens. 4. Click the Yes button. The Claims IPE window opens showing the pending claims that have been assigned to a payer:

The IPE makes each encounter into a claim and changes the status of each claim to Pending. 5. Use the Select Claim Type drop-down list to select Electronic, Paper, or All claims. 6. Click the Process Claims (F2) button. This action causes the following to occur: All error-free claims with insurances set to Electronic claims are automatically placed in the Claims Ready for Electronic Submission pane. All error-free claims with insurances set to Paper claims are automatically placed in the Claims Ready for Paper Submission pane. All error-free claims with errors are listed at the bottom of the window, and each is indicated in the list by an error icon: 7. Perform the required step: For claims with this status... Pending with Errors

Then... 1. 2. Click the View Claim button. The errors are listed under the Errors tab. Resolve the errors and submit the claim.

20

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Encounters

For claims with this status... Claims Ready for Electronic Submission

Then... 1. 2. 3. Click the Set Elec. Status (F4) button. Click the Submit Batch button. The Batch Claims (Electronic) window opens. Click the Submit Batch button. The batch is submitted. Click the Set Paper Status button. Click the Print Batch button. The Batch Claims (Paper) window opens. Click the Print HCFA button. The batch opens in MS Word. Print the batch as needed from MS Word.

Claims Ready for Paper Submission

1. 2. 3. 4.

Note: UB Claims can be created using Claims IPE, but setting their status and submitting them must be performed manually. For more information, refer to the section titled Claims on page 23.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

21

Encounters

22

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

CLAIMS

Claim information derives from current information on the Patient Information window (also known as Patient Demographics), Provider Information, the Provider Number on the Insurance window, and Facility information at the time the claim is created. When you create a claim, eClinicalWorks puts the following information together: Patient Insurance information Encounter information Facility/Physician information Unique eCW-generated claim number IMPORTANT! If there is a change in the patient's information after a claim has been created, or, if you need to update a provider number, the claim will not automatically update to reflect the change. You will need to reload or reassign this updated information to affected claims. For more information, refer to the sections titled Reloading Insurances from Demographics to Claims on page 86 and Reassigning Provider Numbers on Claims on page 87. eClinicalWorks provides flexibility in how you can prepare claims. You can work in the way you are most comfortable and familiar. For example, you can: Create claims from data in the system gathered during the doctor/patient encounter. Create claims from scratch (starting with patient information only). Create bulk claims using the Claims IPE (integrated processing engine) feature. Day-to-day processing of claims is done by accessing the billing options from the Billing band, such as: Looking up encounters Viewing claims and payments Processing ERAs Logging refunds Viewing account information Running batches Printing claims Managing your collection process Recalling patient accounts

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

23

About the Claims Lookup Window

Claims

About the Claims Lookup Window

Claims and encounters can be looked up for processing from the Claims Lookup window. To look up claims and encounters: 1. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens:

2. Set the following filters as desired to look up claims:

Field Appt Provider(s)

Description Check the All box to look up claims for all appointment providers, or click the More (...) button and select a specific provider. Results can be filtered by many different type of date ranges. First, select the desired type of date you want to use from the gray drop-down list on the left. Once the desired type of date is selected, use the two drop-down calendars to select the desired date range you want to filter results by.

Service Dt(s), etc.

Place of Service

To filter results by claims that use a specific place of service (POS) code, select the desired code from this drop-down list.

24

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

Field Claim Status / Payment Rejection Status

Description Select one of the following methods of filtering results using the gray drop-down list on the left: Claim Status - Filter results by the status of claims. User-(PRS) - Filter results by user based on payment rejection status. User-(CS) - Filter results by user based on claim status. User-(PRS&CS) - Filter results by user based on payment rejection status and claim status. PRS - Filter results by the payment rejection status of claims. Once the method of filtering results is selected, use the drop-down list on the right to select the desired user or status.

Assigned To

To filter results by claims that have been assigned to a specific category of payer (any insurance company, the primary insurance, the secondary insurance, the tertiary insurance, or the patient), select the desired category from this drop-down list. To filter results by a specific payer ID number, enter it in this field or click the More (...) button to select one from the Insurances window. To filter results by a specific type of claim (Professional, Institutional, or Dental), select the desired type from this drop-down list. To filter results by their place in the collection cycle, select the desired status from this drop-down list. This filter is only displayed if claim-based collection management is enabled. For more information on enabling this feature, refer to the Billing Setup chapter of the System Administration Users Guide.

Payer #

Type

Collection Status

Patient

To filter results by a specific patient, click the More (...) button next to this field and select the desired patient. To filter results by insurance company or Insurance Group, select the desired option from the gray dropdown list and click the More (...) button to select an insurance company or Insurance Group. To filter results by facility or Facility Group, select the desired option from the gray drop-down list and click the More (...) button to select a facility or Facility Group. Click the More (...) button next to this field to look up claims that have been assigned to a specific user.

Insurance / Ins. Grp

Facility / Facl. Grp

Assigned To User

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

25

About the Claims Lookup Window

Claims

Field Balance

Description To filter results by claim balance: 1. 2. 3. Select an appropriate math symbol from the leftmost drop-down list. Enter an amount to use with this math symbol in the left-most text entry field. To combine this equation with another equation, select either And or Or from the center-left dropdown list. Select the desired math symbol from the centerright drop-down list. Enter the amount you want to use with this second equation in the right-most text entry field. For example, to search for balances equal to or more than 20 dollars but under 100 dollars, enter the following:

4. 5.

This field is grayed-out if one of the following options is selected from the Claim Status drop-down list: Encounter Without Claims Encounters/Claims Sort By Claim No Show Claims Not in Collection Select the desired criteria for sorting your results from this drop-down list. If you know the specific claim number of the claim you want to look up, enter it here. Check this box to include claims that are not in collections in your results. This filter is only displayed if claim-based collection management is enabled. For more information on enabling this feature, refer to the Billing Setup chapter of the System Administration Users Guide. No. of Statements >= To filter results by claims that have had a certain number of statements sent, enter the minimum number of statements in this field. This filter is only displayed if claim-based collection management is enabled. For more information on enabling this feature, refer to the Billing Setup chapter of the System Administration Users Guide. Show the Following Claims Hide Options Check the box(es) next to the type(s) of claims you want to have included in your results. Click this button to hide all the filters, providing more space to view search results. Once this button is clicked once, it changes to a Show Options button. Clicking this button restores the filters. Lookup Once all filters are set as desired, click this button to display the claims that match the selected criteria.

3. Once all the filters are set as desired, click the Lookup button.

26

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

Claims that meet the specified criteria display with the following information:

Column Lock/Void Icon

Description This column may display one of the following icons: Yellow Lock - Indicates a claim has been locked manually from the Claims window. Red Lock - Indicates that a claim has been locked using the Hard Close feature. Green V - Indicates a claim that has been voided. Red -V - Indicates a claim that has been recreated from a voided claim.

Notepad Icon Claim Indicator Icon

A notepad icon displays in this column for all claims that have billing notes included on them. One of the following letters displays in this field to indicate which type of claim this is: Blank - Professional (HCFA) Claim U - Institutional (UB) Claim D - Dental Claim F - Financial Claim

Coll

The collection cycle that a claim is in is displayed in this column. This column is only displayed if claim-based collection management is enabled. For more information on enabling this feature, refer to the Billing Setup chapter of the System Administration Users Guide.

Claim # Service Date Pvdr

The number of each claim is displayed in this column. The date that service was rendered for each claim is displayed in this column. The initials of the appointment provider for the encounter associated with this claim is displayed in this column. Hover over these initials to display the full name of this provider in a pop-up window.

Patient Payer Status Charges

The patient that each claim is for is displayed in this column. The party responsible for payment on each claim is displayed in this column. The claim status for each claim is displayed in this column. The total amount of the charges on each claim is displayed in this column.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

27

About the Claims Lookup Window

Claims

Column Pmts/Rfds or Pmts/ Adjs

Description The information displayed in this column is determined for each user from their My Settings. One of the following headings displays: Pmts/Rfds - The total of all payments minus all refunds applied to each claim is displayed. Pmts/Adjs - The total of all payments, plus adjustments, plus withheld amounts, minus refunds applied to each claim is displayed.

Adjustments

Any adjustment made on each claim is displayed in this column. This column can be hidden for each user from their My Settings.

Withheld

The amount that is withheld for each claim is displayed in this column. This column can be hidden for each user from their My Settings.

Balance

The remaining balance for each claim is displayed in this column.

Highlighting any claim displays a preview of that claim in the bottom pane on this window. 4. Check the boxes next to the claims you want to perform actions on and use the following buttons to perform actions as desired:

Button < Prev and Next >

Description If more than 20 claims are displayed, click either of these options to move backward and forward a page to view additional claims. Select the desired range of results from this dropdown list to go directly to that page of results. Clicking this button opens a drop-down list that provides the following options: Create New Claim - Create a completely new claim for which there is no encounter. Create Claim for Encounter - Highlight an encounter without a claim and click this option to create a claim for it. Update Claim - Open the selected claim in order to modify it. Delete Claim - Delete the selected claim. View Claim Summary - View a Claim Summary for the selected claim. Print Claim Summary - Print a Claim Summary for the selected claim.

Results Range DropDown List Claim

28

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

Button Billing

Description Clicking this button opens a drop-down list that provides the following options: Create Claims - Create claims for a specific facility and/or provider by date range. This option should not normally be used to create claims. Claims should be created from encounters to ensure proper billing. Create Batch - Create a batch of claims Print... - Print various forms. The forms available here are determined by your billing setup. Filtered Claims - Perform one of the following actions on all claims currently displayed on this window: Transfer Claims Date - Change the date of the claims. Change Claims Status - Change the statuses of the claim. Transfer Claims to Patient - Transfer the balances of the claims to the patient. Write Off Claims - Write off the claims in the system. Change to... - Change the claims to another type of claim. Void and Recreate Claim(s) - Void and recreate the claims. Delete Claims - Remove the claims from the system. Reassign Provider Numbers - Change the provider numbers on the claims. Reassign CLIA ID - Change the CLIA ID numbers on the claims. Reassign Insurance Type to Claim Insurance - Updates the insurance type on the filtered claims to reflect changes made to any insurance companies that were included on claims before they were updated. Selected Claims - Perform the same actions as you would from the Filtered Claims drop-down list, except only for claims with their boxes checked. The following options are unique to Selected Claims, and are only displayed if claimbased collection management has been enabled (for more information on enabling this feature, refer to the Billing Setup chapter of the System Administration Users Guide): Transfer Claims To Collection - Include the selected claims in the collections process. Remove Claims From Collection - Remove the selected claims from the collections process. View Claims Report - The results displayed on this window are exported to an Excel file.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

29

About the Claims Lookup Window

Claims

Button Claims IPE

Description Clicking this button opens a drop-down list that provides the following options: Process Filtered Claims - Begin the Claims IPE process for the claims that are currently displayed on this window. Process All Claims - Begin the Claims IPE process for all appropriate claims in the system.

Lock/Unlock

Clicking this button opens a drop-down list that provides the following options (Users must have appropriate security access to unlock claims): Lock All Checked - Lock all claims that have their boxes checked. Lock Claim... - Lock the claim that is currently highlighted. Lock All Filtered - Lock all claims that are currently displayed on this window. Unlock All Checked - Unlock all locked claims with their boxes checked. Unlock Claim... - Unlock the highlighted locked claim. View Log for Claim... - View a log of the claim lock status for the highlighted claim. View Log for All Checked - View a log of the claim lock status for all claims with their boxes checked. For more information, refer to the Security Attributes section of the System Administration Users Guide)

This has been a quick overview of the options available from this window. For more information on all of these options, refer to the sections below.

Identifying Claim Status

Claim status tells you where the claim is in the processing cycle. The status of a claim is not updated automatically, except for batch claims that are submitted electronically or are printed on HCFA or UB-92 forms. When a claim is submitted electronically, or when a HCFA or UB-92 claim is printed, the system changes the status to Submitted. All other claim status messages must be changed manually. When eClinicalWorks is installed, a standard list of claim status messages is provided. You can customize or modify this list by selecting Claim Status Codes from the Billing menu.

30

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

Because of the many automated Billing features of eClinicalWorks, you will not be able to modify or delete the following claims status messages: Encounters without Claims Pending, Pending with Errors Claims Ready for Electronic Submission Examples of typical claims status messages include the following: Encounters without Claims - These are patient visits that need to have a claim created. Encounters/Claims - This includes all encounters without claims, as well as all claims that have been created in the system. Pending: These claims are ready for you to examine and adjust. Once you examine each claim, and make the necessary adjustment, then you set the claim status to Claims Ready for Electronic Submission or Claims Ready for Paper Submission. Pending claims usually need manual modification by the biller. The system sets a status of pending as soon as the claim is created. The claim remains pending until the status is changed to Claims Ready for Electronic Submission or Claims Ready for Paper Submission. Pending with Errors - These are claims that have errors. Claims Ready for Electronic Submission - These claims are ready to be included in a batch and sent to an insurance company or clearinghouse. This status must be set manually after reviewing a claim. Claims with this status will be picked up by the system when you create a batch for submission. Claims Ready for Paper Submission - These claims are ready to be sent to the printer and printed on a HCFA form. You set this status manually after reviewing a claim. Submitted - Sent to a clearinghouse or insurance company. The system changes the claim status to Submitted (after prompting you that it is going to do so) during the batch submission process or when you select the Print HCFA button from the Claims window (but not on the individual claim itself). Clearinghouse Accepted - A manually set status that you can use, optionally, to distinguish claims that have been accepted by a clearinghouse. Clearinghouse Rejected - A manually set status that you can use, optionally, to distinguish claims that have been rejected by a clearinghouse. Insurance Accepted - A manually set status that you can use, optionally, to distinguish claims that have been accepted by insurance companies. Insurance Rejected - A manually set status that you can use, optionally, to distinguish claims that have been rejected by insurance companies. Claims Ready for Paper Submission Submitted

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

31

About the Claims Lookup Window

Claims

Identifying Encounters without Claims

An encounter is any visit a provider has with a patient. All billable encounters require a claim. Additionally, eClinicalWorks lets you create blank claims that you then fill with data from hardcopy Progress Notes. Blank claims are NOT associated with an encounter. You may also need to create blank claims when you are making certain types of corrections or adjustments to existing claims. To search for a specific encounter for creating a claim: 1. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens. 2. Select Claim Status from the second gray drop-down list on the left. 3. Select Encounters Without Claims from the Claim Status drop-down list. 4. Set any other filters as desired. Leave them all blank to view all encounters without claims in the system. 5. Click the Lookup button. The Encounters without claims that meet your search criteria are listed in the window. 6. Continue with creating a claim for each encounter. For more information, refer to the section titled Creating a Claim from an Encounter on page 36 within this document.

Viewing Pending Claims

Pending claims are claims that have been created but have not been submitted. Claims remain in pending status until you manually change them to Claims Ready for Electronic Submission or Claims Ready for Paper Submission. To view pending claims: 1. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens. 2. Select Claim Status from the second gray drop-down list on the left. 3. Select one of the following statuses from the Claim Status drop-down list: Pending Claims Ready for Electronic Submission Claims Ready for Paper Submission Clearinghouse Rejected Insurance Rejected. 4. Set any other filters as desired. 5. Click the Lookup button. The Claims window displays all the claims that match your filter options.

32

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

Reviewing Rejected Claims

Use this procedure to review and revise claims that have been rejected by a clearinghouse or by an insurance company. You can revise a claim after you create it. If you know the claim number, you can enter it directly into the Claims window to find the claim. Make sure your select Submitted as the claims status. To revise a claim: 1. From the Claims window, enter the claim number in the Claim Number field, or select filter options to show the claim(s) you need to review and revise. 2. Click Lookup. The claim(s) display in the Claims window. 3. Double-click on the claim you need to review and revise. The Claim detail window opens. 4. Modify the claim as desired. IMPORTANT! If any changes affect the financial information on this claim (CPT Codes or charge amounts), the Void and Recreate process should be used to make the desired changes. For more information, refer to the section titled Voiding and Recreating Multiple Claims at Once on page 46. 5. Click the OK button. 6. Resubmit the claim electronically or on paper.

Claim Processes

About Creating Claims

Claims can be created from the Claims window in the following ways: Click the Claim button to open a drop-down list, and from this drop-down list, click the Create New Claim option. For more information, refer to the section titled Creating a Claim without an Encounter on page 34. Highlight an encounter without a claim, click the Claim button to open a drop-down list, and click the Create Claim for Encounter option. OR Double-click on an encounter without a claim, from the list on the Claims window. For more information, refer to the section titled Creating a Claim from an Encounter on page 36. Click the Billing button to open a drop-down list, and from this drop-down list, click the Create Claims option.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

33

About the Claims Lookup Window

Claims

IMPORTANT! This method of claim creation should not normally be used, as it creates claims for all encounters in a date range, regardless of whether the Progress Notes for those encounters are completed or not. There are three types of Claim detail windows, depending on which type of claim is being created. Most claims are HCFA claims, but you also have the option of creating UB claims and Dental claims. UB-92 claim forms are typically used for rural healthcare settings and surgical and ambulatory care centers. Dental claims are typically used for dental procedures. For more information, refer to the sections titled About the Professional (HCFA) Claim Window on page 61, About the Institutional (UB) Claim Detail Window on page 98, and About the Dental Claim Detail Window on page 108.

Creating a Claim without an Encounter

Claims can be created without an associated encounter from the Claims window. For information on searching for encounters without claims, refer to the section titled Identifying Encounters without Claims on page 32. Claims may need to be created without an associated encounter for some of the following reasons: A patient buys medical supplies. A patient has billable services as an inpatient (Out of Office encounters can also be used for these types of visits). Creating a claim without an encounter: 1. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens. 2. Click the Claim button to open a drop-down list. 3. From the drop-down list, click the Create New Claim option. The Patient Lookup window opens. 4. Highlight the desired patient and click the OK button. The Create Claim window opens:

34

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

5. Select the provider that this claim is for from the Provider drop-down list. 6. Click the Sel button next to the Facility field to select the facility for which this claim is being created. 7. Select the date of service that this claim is for using the Service Date drop-down calendar. 8. To select a different patient, click the Sel button next to the Patient field. 9. Enter the place of service code for this claim in the POS field. 10. Click one of the following radio buttons in the Select Claim Type section: Professional (HCFA) - Create a claim for professional medical services. Anesthesia Claim (HCFA) - If this professional claim is for anesthesia procedures, check this box. This box is only available when the Professional (HCFA) radio button is selected. Note: The option for creating an Anesthesia claim only displays when manually creating a claim. It does not appear when you double-click an existing encounter to create a claim. Note: The Anesthesia Claim looks and works just like a regular HCFA Claim, except that when a mapped CPT code is added, a window pops up that allows you to replace it with a mapped Anesthesia code. Institutional (UB) - Create a claim for institutional medical services. Dental - Create a claim for dental services. 11. Click the OK button. The Claim window opens, with a system-generated claim number. 12. Complete the claim information as required. For more information, refer to the sections titled About the Professional (HCFA) Claim Window on page 61, About the Institutional (UB) Claim Detail Window on page 98, and About the Dental Claim Detail Window on page 108.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

35

About the Claims Lookup Window

Claims

Creating a Claim from an Encounter

Claims can be created for encounters without claims from the Claims window. To create a claim from an encounter: 1. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens. 2. Select the Encounters Without Claims option from the Claim Status drop-down list. 3. Set the remaining filters as desired and click the Lookup button. The encounters that match the selected criteria display. 4. Double-click on the encounter for which you want to create a claim. OR a. Highlight the encounter for which you want to create a claim. b. Click the Claim button to open a drop-down list. c. From the drop-down list, click the Create Claim for Encounter option.

The Create a New Claim window opens:

5. If desired, click one of the following buttons to view information about the selected patient: Info - Opens the Patient Information window for the selected patient. Hub - Opens the Patient Hub for the selected patient. 6. Click one of the following radio buttons: Professional (HCFA) - Create a claim for professional medical services. Institutional (UB) - Create a claim for institutional medical services. Dental - Create a claim for dental services. 7. Click the OK button.

36

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

The Claim window opens, with a system-generated claim number. 8. Complete the claim information as required. For more information, refer to the sections titled About the Professional (HCFA) Claim Window on page 61, About the Institutional (UB) Claim Detail Window on page 98, and About the Dental Claim Detail Window on page 108.

Modifying a Claim

Unlocked claims can be modified at any time from the Claims window. IMPORTANT! If any changes affect the financial information on this claim (CPT Codes or charge amounts), the Void and Recreate process should be used to make the desired changes. For more information, refer to the section titled Voiding and Recreating Multiple Claims at Once on page 46. To modify an unlocked claim: 1. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens. 2. Set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 3. Double-click on the claim you want to modify OR a. Highlight the claim you want to modify. b. Click the Claim button to open a drop-down list. c. From the drop-down list, click the Update Claim option.

The Claim window opens. 4. Update the information here as desired. For more information, refer to the sections titled About the Professional (HCFA) Claim Window on page 61, About the Institutional (UB) Claim Detail Window on page 98, and About the Dental Claim Detail Window on page 108.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

37

About the Claims Lookup Window

Claims

Deleting a Claim

Unlocked claims can be deleted from the system from the Claims window. IMPORTANT! Claims should not normally be deleted from the system unless they are dummy claims used for training purposes. Ordinarily, the Void and Recreate process should be used to make any desired changes to claims. For more information, refer to the section titled Voiding and Recreating Multiple Claims at Once on page 46. To delete an unlocked claim: 1. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens. 2. Set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 3. Highlight the claim you want to delete. 4. Click the Claim button to open a drop-down list. 5. From the drop-down list, click the Delete Claim option. A confirmation window opens. 6. Click the Yes button. The selected claim is now deleted from the system.

Viewing the Claim Summary for a Claim

The Claim Summary for any claim can be viewed from the Claims window. To view the Claim Summary for a claim: 1. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens. 2. Set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 3. Highlight the claim for which you want to view the Claim Summary. 4. Click the Claim button to open a drop-down list. 5. From the drop-down list, click the View Claim Summary option. The Claim Summary window opens. 6. To print this information, click the Print... button. OR Click the Print Preview... button to open the Print Preview window and click the Print icon.

38

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

Printing the Claim Summary for a Claim

The Claim Summary for any claim can be printed from the Claims window. To print the Claim Summary for a claim: 1. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens. 2. Set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 3. Highlight the claim for which you want to print the Claim Summary. 4. Click the Claim button to open a drop-down list. 5. From the drop-down list, click the Print Claim Summary option. The Claim Summary for the selected claim is now printed.

Billing Processes

Adjusting Medicaid Claims

Medicaid claims can be adjusted from the Claims window. This feature is used only on UB claims where a Rate Code and Rate Value have been set up. To adjust Medicaid claims: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. From the drop-down list, click the Adjust Medicaid Claims option. The Adjust Claims window opens:

4. Select a date range that includes the claims you want to adjust using the Inv Date drop-down calendars. 5. Click the Create button. Claims that fit the selected criteria are now adjusted, and the Adjusted Claim Results window opens with the results of the adjustments displayed.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

39

About the Claims Lookup Window

Claims

Splitting Claims

Existing claims can be split from the Claims window. This process is only used by specific types of practices (FQHC/RHC/CHC/ASC) when one encounter contains charges that need to be submitted on both CMS 1500 and UB claim forms.

Note: This feature is enabled by item key. Contact eClinicalWorks Support for more information. When claims are split, two letters are appended to the end of the claim number. The second letter indicates number of claims into which the claim was split, and the first alphabet indicates the relative number of split claim. For example, if Claim 1250 was split into three claims, then three claims numbered 1250AC, 1250BC, and 1250CC will be submitted. The second letter represents the total claims created from the split (C=3), and the first letter represents the split section of the claim (A=1, B=2, etc.). To split claims: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. From the drop-down list, click the Split Claims option. The Split Claims window opens:

Note: Claims are split on the date the claim was created - not the service date. 4. Select a date range that includes the claims you want to split using the Inv Date dropdown calendars. 5. Click the Create button. The Split Claims Results window opens and displays the split claims information, including the claim number and the newly created Split Claims ID numbers. The preview also displays the status, and lists any errors if the claim was not split successfully. The Copy button on the Split Claims Results window creates a text (.txt) file of the claim results for exporting to other applications, such as Microsoft Excel.

40

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

Creating Multiple Claims from Encounters at Once

Multiple claims can be created from encounters at once from the Claims window. The system automatically creates claims from encounters without claims within the specified date range. This option should not normally be used to create claims. This option creates claims for all encounters within the specified date range, regardless of whether the Progress Notes for the encounter have been completed or not. To create multiple claims at once: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. From the drop-down list, click the Create Claims option. The Create Claims window opens:

4. If desired, select a specific provider you want to create claims for from the Provider drop-down list. 5. Click the More (...) button next to the Facility field to select the facility for which you are creating these claims. 6. Select the date range containing the encounters you want to create claims for using the Date drop-down calendars. 7. Click the Create button. The Verify Billing Data window opens, displaying any potential errors or missing information on the selected encounters. If desired, click the Cancel button and add any missing information to the appropriate encounters. 8. Click the Create Claims button to create claims regardless of errors. Claims are now created for all encounters without claims within the selected date range.

Creating a Batch

Batches can be created from the Claims window. For more information on creating batches, refer to the section titled Creating and Submitting a Batch on page 197.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

41

About the Claims Lookup Window

Claims

Printing Claim Forms from the Claims Window

The various claim forms can be printed directly from the Claims window. Claims must have the Ready to Print status in order to be printed using this process. To print claim forms from the Claims window: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Highlight the claim you want to print. 3. Click the Billing button to open a drop-down list. 4. From the drop-down list, click the desired Print... option. The selected claim is now printed as specified.

Changing the Claims Date

The date of claims can be changed for filtered or selected claims from the Claims window. This feature is used to move claims that are preventing a Hard Close from being performed outside of the date range that is being Hard Closed. To change the date of claims: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. From the drop-down list, hover over either the Filtered Claims option or the Selected Claims option to open another drop-down list. If using the Selected Claims option, check the box(es) next to the claim(s) of which you want to change the claims date. 4. From this drop-down list, click the Transfer Claims Date option. The Change Claim Date window opens, with the number of selected claims indicated:

5. Select the date to which you want to change the selected claims. 6. Click the OK button. A confirmation window opens. 7. Click the Yes button. The Claim Date for all selected claims is now changed as specified.

42

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

Changing Claim Status

The status of claims can be changed for filtered or selected claims from the Claims window. To change the claim status: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. From the drop-down list, hover over either the Filtered Claims option or the Selected Claims option to open another drop-down list. If using the Selected Claims option, check the box(es) next to the claim(s) of which you want to change the claim status. 4. From the desired drop-down list, click the Change Claims Status option. The Change Claims Status window displays indicating of the number of claims selected:

5. Select the desired claims status from the Change Claims Status to drop-down list. 6. Click the OK button. A confirmation window opens. 7. Click the Yes button. The status of the selected claims is now changed.

Transferring Claim Balances to the Patient

The balance on a claim can be transferred to the patient for filtered or selected claims from the Claims window. To transfer the claim balance to the patient: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. From the drop-down list, hover over either the Filtered Claims option or the Selected Claims option to open another drop-down list. If using the Selected Claims option, check the box(es) next to the claim(s) for which you want to transfer claim balances. 4. From the desired drop-down list, click the Transfer Claims to Patient option.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

43

About the Claims Lookup Window

Claims

The Change Claims Status window displays indicating of the number of claims selected:

5. Check the Transfer claims to Patient box. 6. Select the desired claims status (most often this will be Patient) from the Change Claims Status to drop-down list. 7. Click the OK button. A confirmation window opens. 8. Click the Yes button. The balance of the selected claims is now assigned to the patient.

Writing Off Multiple Claims at Once

Batches of filtered or selected claims can be written off at one time from the Claims window. Claims can be completely written off, or written down to a specific balance amount using this feature. To write off multiple claims at once: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. From the drop-down list, hover over either the Filtered Claims or Selected Claims option to open another drop-down list. If using the Selected Claims option, check the box(es) next to the claim(s) you want to write off 4. From this drop-down list, click the Write Off Claims option. The Write Off Claims window opens, with the number of selected claims displayed:

44

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

5. Click the More (...) button next to the Write Off/Adjustment Code field to select an adjustment code from the Adjustment Codes window. 6. Enter the amount you want to change the selected claims' balances to in the Make Claim(s) Balance to field. 7. Check the Adjust claims with credit balances box to include claims with credit balances. Note: Voided claims in the batch cannot be written off, and will be unaffected by any actions taken on the remaining claims in the batch. 8. Click the OK button. A confirmation window opens. 9. Click the Yes button. The selected claims are now written off as specified.

Writing Off Claims for a Capitation Plan

Claims for a capitation plan can be written off from the Billing menu. This is performed once the EOB is received for all patients that went to capitation for the quarter. To write off claims for a capitation plan: 1. Click the Billing menu, hover over the Capitation to display a drop-down list 2. From the drop-down list, select Plans The Managed Care/Capitation Plans window opens. 3. Select the plan (for example, BCBS) and click View Outstanding Claims. The Managed Care/Capitation Plans Claims window opens. 4. Select the claims that were part of the EOB and Post Capitation Adjustment. This will write off all the capitated codes and leave any that should be billed. The claim status will remain as Submitted. Any services that may have a procedure that is billable to the carrier will remain open for posting the payment to once it has been received.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

45

About the Claims Lookup Window

Claims

Voiding and Recreating Multiple Claims at Once

Claims cannot be edited if they have been closed with the Hard Close feature. However, the Void and Recreate feature allows billing staff members to void the original claim and create a new copy for editing. Claims should also be voided and recreated if any changes to the financial data (CPT Codes or charge amounts) of a claim are needed. When Void and Recreate is used, the feature voids the original claim, and generates two new claims: The first claim voids all the financial transactions for the original claim (payments, adjustments, refunds, etc.), and is posted in the current, open billing period with financial totals that effectively cancel out the transactions. The second new claim is editable and is generated in the current, open billing period with all original claim data (patient, CPT codes, service date, etc.) yet with a new claim date and number. All claim information can be edited, including financial transactions, and can then be resubmitted. Note: When a payment or refund is posted for a claim that has been voided, the system automatically applies the payment to the recreated claim that was generated during the Void and Recreate process. A confirmation window pops up to notify you of this action. To void and recreate a claim: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. Claims locked with the Hard Close feature are indicated by a red lock icon in the left column. Claims indicated with a yellow lock are claims that have been locked but can be unlocked by users with permission:

46

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

2. Click the Billing button to open a drop-down list. 3. From the drop-down list, hover over either the Filtered Claims or Selected Claims option to open another drop-down list. If using the Selected Claims option, check the box(es) next to the claim(s) you want to void and recreate. In this example, Claim Number 1072 needs to be edited, so we'll use the Void and Recreate feature:

4. From this drop-down list, click the Void and Recreate Claim(s) option. A confirmation message displays asking if you want to void and recreate the selected claims. The message lists the claim numbers that will be affected. 5. Click the OK button to proceed with the Void and Recreate process. The Void Claim Results window displays each original claim number under the Claim No. column, and also lists the two new claims that have been generated in the Status column. The process creates a Voided Claim and a Duplicate Claim for each original claim, with successive claim numbers:

6. Click the Close button. Note: If you attempt to void a claim that has been previously voided, the Void Claim Results window will list a claim void error, and will display the previously recreated claim numbers. In our example, Claim 1072 was the original claim, and the process created Voided Claim 1600 and Duplicate Claim 1601. To verify the process, the claim numbers can be located using the Claims Lookup window.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

47

About the Claims Lookup Window

Claims

First, let's look at the voided claim. A lime green V displays next to the claim in the Claims Lookup window to indicate that the claim has been voided:

The window header of the original claim lists the claim number of the voided claim and the claim number of the duplicate (copied) claim:

Second, let's look at the duplicate claim. The window header of the duplicate claim lists the claim number of the of the original claim. The duplicate claim is an exact copy of the original, except that it is editable, and it now contains a new claim number and the current date as the claim date - not the original claim creation date:

48

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

The patient's Account Inquiry window reflects all of the changes that occurred during the Void and Recreate process:

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

49

About the Claims Lookup Window

Claims

Deleting Multiple Claims at Once

Multiple claims can be deleted at once from the Claims window. To delete multiple claims at once: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. From the drop-down list, hover over either the Filtered Claims or Selected Claims option to open another drop-down list. If using the Selected Claims option, check the box(es) next to the claim(s) you want to delete. 4. From this drop-down list, click the Delete Claims option. A confirmation window appears. 5. Click the Yes button. The selected/filtered claims are now deleted from the system permanently.

Reassign Provider Numbers on Claims

Provider numbers can be reassigned for multiple claims at once from the Claims window. This is useful if the provider numbers have changed since this claim was created. To reassign provider numbers for filtered/selected claims: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. From the drop-down list, hover over either the Filtered Claims or Selected Claims option to open another drop-down list. If using the Selected Claims option, check the box(es) next to the claim(s) for which you want to reassign provider numbers. 4. From this drop-down list, click the Reassign Provider Numbers option. A confirmation window opens. 5. Click the Yes button. The provider numbers are now reassigned for the filtered/selected claims and a confirmation window opens. 6. Click the OK button to close this window.

50

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

Reassigning CLIA IDs for Multiple Claims at Once

CLIA IDs can be reassigned for multiple claims at once from the Claims window. To reassign CLIA IDs for multiple claims at once: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. From the drop-down list, hover over either the Filtered Claims or Selected Claims option to open another drop-down list. If using the Selected Claims option, check the box(es) next to the claim(s) for which you want to reassign CLIA IDs. 4. From this drop-down list, click the Reassign CLIA ID option. The Reassign CLIA ID window opens:

5. Click the radio button that best describes the action you want to perform. 6. Click the OK button. A confirmation window opens. 7. Click the Yes button. A confirmation window opens. 8. Click the OK button. The CLIA IDs for the selected claims are now updated as specified.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

51

About the Claims Lookup Window

Claims

Copying Insurance Types to Claims

The Insurance Type of a specific insurance carrier can be copied into specific claims that use that insurance carrier from the Claims window. To copy an Insurance Type into Claims: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. From the drop-down list, hover over either the Filtered Claims or Selected Claims option to open another drop-down list. If using the Selected Claims option, check the box(es) next to the claim(s) for which you want to copy Insurance Types. 4. From this drop-down list, click the Reassign Insurance Type To Claim Insurance option. A confirmation window opens. Note: This change is not applied to claims with Medicare set as a secondary, tertiary, or unspecified insurance. 5. Click the Yes button. A confirmation window opens. 6. Click the OK button. The selected or filtered claims are now updated with the current Insurance Type Codes. Note: The system automatically copies Insurance Type Codes to claims when the claim's insurance is changed or a new insurance is added to the claim.

Transferring Claims to Collections

Claims can be transferred to collections from the Claims window. Claim-based collections must be enabled in order to use this feature. For more information on enabling this feature, refer to the Billing Setup chapter of the System Administration Users Guide. To transfer claims to collections: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. Check the box(es) next to the claim(s) you want to transfer to collections. 4. From the drop-down list, hover over the Selected Claims option to open another dropdown list. 5. From this drop-down list, click the Transfer Claims To Collections option. The Collection Codes window opens.

52

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

6. Highlight the collection status you want to apply to the selected claims and click the OK button. A confirmation window opens. 7. Click the OK button. The selected claims are now transferred to collections with the specified collection status.

Removing Claims from Collections

Claims can be removed from collections from the Claims window. Claim-based collections must be enabled in order to use this feature. For more information on enabling this feature, refer to the Billing Setup chapter of the System Administration Users Guide. To remove claims from collections: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. Check the box(es) next to the claim(s) that are currently in collections that you want to remove from collections. 4. From the drop-down list, hover over the Selected Claims option to open another dropdown list. 5. From this drop-down list, click the Remove Claims From Collections option. A confirmation window opens. 6. Click the OK button. The selected claims are now removed from collections.

Viewing the Claims Report

The information displayed on the Claims window for filtered claims can be exported to an Excel file for viewing and printing. To view the Claims Report: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Billing button to open a drop-down list. 3. From the drop-down list, click the View Claims Report option. The information displayed on the Claims window for the filtered claims is exported to the default spreadsheet program installed on your system (e.g., Microsoft Excel). 4. Edit, print, or save this file as desired

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

53

About the Claims Lookup Window

Claims

Claims IPE Processes

The eClinicalWorks Claims IPE is an integrated processing engine. Claims IPE greatly streamlines claims processing and dramatically improves your efficiency.

Running Claims IPE from the Claims Window

The Claims IPE feature can be run for all claims in the system, or just filtered claims, from the Claims window. To run Claims IPE from the Claims window: 1. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens. 2. If you are processing filtered claims, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 3. Click the Claims IPE button to open a drop-down list. 4. From the drop-down list, select one of the following options: Process Filtered Claims - Run the Claims IPE feature for all claims currently displayed on the Claims window. Process All Claims - Run the Claims IPE feature for all appropriate claims in the system. The Claims IPE window opens:

54

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

5. Click the Process Claims (F2) button, or press the F2 key on your keyboard. A pop-up window displays while the claims are processing, notifying you of the progress. Once all claims have been processed, the following actions occur: All claims without errors with insurances set to Electronic claims are automatically placed in the Claims Ready for Electronic Submission pane. All claims without errors with insurances set to Paper claims are automatically placed in the Claims Ready for Paper Submission pane. 6. To view any claims and resolve any potential errors, highlight the desired claim in the Claims to be processed pane and click the View Claim (F3) button. OR Press the F3 key on your keyboard. OR Double-click on the desired claim. 7. Perform one or more of the following steps as desired: For claims with this status... Claims Ready for Electronic Submission

Then... 1. 2. 3. Click the Set Elec. Status (F4) button, or press the F4 key on your keyboard. Click the Submit Batch button. The Batch Claims (Electronic) window opens. Click the Submit Batch button. The batch is submitted. Click the Set Paper Status (F5) button, or press the F5 key on your keyboard. Click the Print Batch button. The Batch Claims (Paper) window opens. Click the Print HCFA button. The batch opens in MS Word. Print the batch as needed from MS Word.

Claims Ready for Paper Submission

1. 2. 3. 4.

8. Click the Close button once all claims have been processed as desired.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

55

About the Claims Lookup Window

Claims

Lock/Unlock Processes

Locking a Single Claim

Individual claims can be locked from the Claims window. Any boxes that are checked on this window are irrelevant when using this feature. To lock a single claim: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Highlight the claim you want to lock. 3. Click the Lock/Unlock button to open a drop-down list. 4. From the drop-down list, click the Lock Claim... option. A confirmation window opens. 5. Click the Yes button. The selected claim is now locked, and a yellow lock icon displays to the left of the locked claim.

Locking Multiple Claims at Once

Multiple claims can be locked at once from the Claims window. For more information on locking all displayed claims at once, refer to the section titled Locking Filtered Claims on page 57. To lock multiple claims at once: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Check the box(es) next to the claim(s) you want to lock. 3. Click the Lock/Unlock button to open a drop-down list. 4. From the drop-down list, click the Lock All Checked option. A confirmation window opens. 5. Click the Yes button. The selected claims are now locked, and yellow lock icons display to the left of the locked claims.

56

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

About the Claims Lookup Window

Locking Filtered Claims

Filtered claims can be locked on the Claims window. This feature locks all claims currently displayed on this window. To lock filtered claims: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Click the Lock/Unlock button to open a drop-down list. 3. From the drop-down list, click the Lock All Filtered option. A confirmation window opens. 4. Click the Yes button. The filtered claims are now locked, and yellow lock icons display to the left of the locked claims.

Unlocking Multiple Locked Claims at Once

Multiple locked claims can be unlocked at once from the Claims window. Note: You must have security permission to unlock claims. This permission is set by the administrator in the Security Settings. To unlock multiple locked claims at once: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. When looking for claims that need to be unlocked, you may want to set the Claims Status to All Claims. 2. Check the box(es) next to the claim(s) you want to unlock. 3. Click the Lock/Unlock button to open a drop-down list. 4. From the drop-down list, click the Unlock All Checked option. A confirmation window opens. 5. Click the Yes button. The selected claims are now unlocked, and the yellow lock icons are removed.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

57

About the Claims Lookup Window

Claims

Unlocking a Locked Claim

Locked claims can be unlocked one at a time from the Claims window. Any boxes that are checked on this window are irrelevant when using this feature. Note: You must have security permission to unlock claims. This permission is set by the administrator in the Security Settings. To unlock a claim: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. When looking for claims that need to be unlocked, you may want to set the Claims Status to All Claims. 2. Highlight the claim you want to unlock. 3. Click the Lock/Unlock button to open a drop-down list. 4. From the drop-down list, click the Unlock Claim... option. A confirmation window opens. 5. Click the Yes button. The selected claim is now unlocked, and the yellow lock icon is removed.

Viewing the Claim Lock Status Log for a Single Claim

A log of all the changes to the lock status of a claim can be viewed from the Claims window. Any boxes that are checked on this window are irrelevant when using this feature. To view the Claim Lock Status log for a single claim: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Highlight the claim for which you want to view the Claim Lock Status log. 3. Click the Lock/Unlock button to open a drop-down list. 4. From the drop-down list, click the View log for Claim... option. The Claim Lock Status window opens, displaying the lock history for the selected claim. 5. To print this information, click the Print button.

58

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

Viewing the Claim Lock Status Log for Multiple Claims

A log of all the changes to the lock status of multiple claims can be viewed from the Claims window. To view the Claim Lock Status log for multiple claims: 1. On the Claims window, set the filters as desired and click the Lookup button. The claims that match the selected criteria display. 2. Check the box(es) next to the claim(s) for which you want to view the Claim Lock Status log. 3. Click the Lock/Unlock button to open a drop-down list. 4. From the drop-down list, click the View log for Claim... option. The Claim Lock Status window opens, displaying the lock history for the selected claims. 5. To print this information, click the Print button.

Professional (HCFA) Claims

There are currently two different versions of the HCFA form in use in the healthcare field: the original HCFA form, and the new CMS 1500 form. The changes related to the new 1500 form went into effect in early 2007 and some practices are using both forms for various reasons. CMS 1500 - Important Information: MS Word is required for printing the CMS 1500 form. New NPI-related fields include: 17a, 17b, 24J, 24I, 32a, 32b, and 33b. Field 24E populates the diagnosis pointer without comments as per the new guideline. The new form may require alignment modifications.

Submitting Electronic Claims Using the CMS 1500 Form

Electronic claims automatically include all NPI numbers that have been set up in the correct electronic fields. If NPI numbers have not been entered, then the legacy numbers are populated.

Printing Paper Claims Using the CMS 1500 Form

New options are available to view and print claims on the new CMS 1500 form that contains boxes for NPI numbers. From the Claim information window, click the green arrow next to Print HCFA and select one of the following options: Print HCFA (New) - Print a claim onto the CMS 1500 form and record it in the system. Print HCFA (New w/No Log) - Print a claim onto the CMS 1500 form but do not record it in the system. View HCFA (New) - View claim data populated onto the CMS 1500 form.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

59

Professional (HCFA) Claims

Claims

Printing Batches of Paper Claims Using the CMS 1500 Form

Batches of CMS forms can still be printed from the Claims window as usual. On the batch window, an option is available to print either new or old forms for this batch.

NDC Codes on the CMS 1500 Form

The NDC code is populated in the CMS 1500 for CPT codes where the NDC code is provided. NDC codes are populated on the Associated Codes tab when updating a code in the CPT dictionary. If the NDC code is not populated in the CPT code dictionary, it can be added to the claim on the Claim CPT Detail window on the Additional Information tab.

60

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

About the Professional (HCFA) Claim Window

The Professional (HCFA) Claim detail window is the most commonly used claim form. It opens with the ICD-9 & CPT tab and Summary tab displayed:

The following table describes the fields and options available on this window: Field/Option Claim Number Description The system-generated number assigned to this claim is displayed in this field. This information is read-only and cannot be edited. The date that this claim is created on can be selected from this drop-down calendar. The current date that this claim was created is automatically populated here.

Claim Date

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

61

Professional (HCFA) Claims

Claims

Field/Option Service Date

Description The date that medical services were rendered for this claim can be selected from this drop-down calendar. The date on the encounter this claim was created from is automatically populated here. Click the Sel button next to this field to select the facility where services were rendered for this claim. The facility for the encounter that this claim was created from is automatically populated here. The place of service code for this claim is displayed in this field, based on the POS that has been set up for the appointment facility. This information is read-only and cannot be edited. Basic demographic information for the patient is displayed in this field. Click one of the following buttons next to this field for more information on this patient: Info - Opens the Patient Information window for the selected patient. Hub - Opens the Patient Hub for the selected patient.

Appointment Facility

POS

Patient

Servicing Provider Resource Copay

The appointment provider for this encounter is displayed here. This information is read-only and cannot be edited. The resource for this encounter is displayed here. This information is read-only and cannot be edited. The patient's co-payment for this encounter can be entered in this field. The co-pay entered in the patient and insurance setup process is automatically populated here. The amount that is not covered by the patient can be entered in this field. Click this button to hide the Claim Follow Up Details pane. Once this button is clicked, it changes to Show >. Click this button again to restore the Claim Follow Up Details pane. For more information, refer to the section titled Entering Claim Follow Up Details on page 94.

Pt. Uncovered Amt. Hide <

Billing

The billing provider for this claim can be selected from this drop-down list. To copy the billing provider to the Rendering and Supervisor fields, click the pages icon button to the right of this field. This information is automatically populated based on the appointment/service provider for this claim.

Rendering

The rendering provider for this claim can be selected from this drop-down list. This information is automatically populated based on the appointment/service provider for this claim.

Supervisor

The supervising provider for this claim can be selected from this drop-down list. This information is automatically populated based on the appointment/service provider for this claim.

62

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

Field/Option Claim Status

Description The submission status of this claim can be selected in one of the following ways: Select the desired status from the drop-down list. Click the More (...) button next to this field and select the desired status from the Claim Status Codes window. Press one of the following keys on your keyboard to change the Claim Status automatically: F6 - Ready to Submit (Electronic) F7 - Print HCFA F8 - Ready to Submit (Electronic)

ICD-9 Codes

The ICD-9 Codes that were selected for this encounter are displayed in this section. To add new ICD-9 Codes to this claim: Click the Add button and select the desired code(s) from the Select Assessments window. OR Enter the desired code into the Code column for the * row. The name of the code you entered is automatically populated in the Name field, the next number in the list replaces the *, and a new * row displays beneath this row. To update an ICD-9 Code on this claim, replace the text in the Code field with the desired code. To remove ICD-9 Codes from this claim, highlight the code you want to remove in this section and click the Remove button.

Insurances

The insurance companies that are associated with the selected patient are displayed here. One of the following icons displays to the left of each insurance company to indicate their status: P - Primary S - Secondary T - Tertiary This information is read-only and cannot be edited.

Labs/Diagnostic Imaging/Imm

The lab tests, diagnostic imaging tests, and immunizations that were selected for this encounter are displayed in this section. This information is read-only and cannot be edited.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

63

Professional (HCFA) Claims

Claims

Field/Option CPT/HCPCS

Description The CPT Codes that were selected for this encounter are displayed in this section. To add new CPT Codes to this claim: Click the Add button and select the desired code(s) from the Fee Schedule window. OR Enter the desired code into the Code column for the * row. The name of the code you entered is automatically populated in the Name field, the next number in the list replaces the *, and a new * row displays beneath this row. To update a CPT Code on this claim, replace the text in any column with the desired text. To enter claim CPT details for this code, highlight the code you want to update and click the Update button. For more information on the Claim CPT Detail window, refer to the section titled About the Claim CPT Details Window on page 70. To remove CPT Codes from this claim, highlight the code you want to remove in this section and click the Remove button. To prevent a CPT Code from being submitted on this claim, uncheck the box to the left of the desired code.

Medicare Edits

To check Medicare edits for this claim, and view any potential errors, click the Medicaid Edits button. eClinicalWorks performs CCI (Correct Coding Initiative) and LMRP (Local Medical Review Policy) edits on your claims to ensure that you submit Medicare claims with the correct coding. CCI edits look for discrepancies between CPT codes, while LMRP edits look for discrepancies between ICD-9s and CPTs. When you perform the edits manually, you typically save time and effort because you can catch coding errors before you submit the claim.

Fee Schedule

The Fee Schedule associated with this claim is displayed here. To change the fee schedule used for this claim, select the desired schedule from this drop-down list. Note: When a fee schedule is specified, changed, or selected from the Appointment window, it takes priority over the other fee schedules specified for the appointment facility, patient's primary insurance, or Patient's Information (demographics).

64

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

Field/Option Billing Notes

Description Any miscellaneous notes about this claim can be entered here. These notes are for internal use only, and are not displayed on the printed or transmitted claim. Click the TimeStamp button here to add a time stamp to this field. Click the Browse button to select a keyword to enter into this field.

Patient Portion

The portion of the charges, payments, and balance that the patient is responsible for is displayed here. This information is read-only and cannot be edited. The total charges, payments/adjustments, and balance on this claim are displayed here. This information is read-only and cannot be edited. Click this button to enter additional information for the header of this claim. For more information, refer to the section titled Completing the Claim Header on page 76.

Total

Claim Header

Claim Data

Click this button to enter additional data related to auto accidents and worker's compensation claims. For more information, refer to the section titled Completing Claim Data on page 78.

Options

Click this button to open a drop-down list. The following actions can be performed from this drop-down list: View various logs related to this claim Print a claim summary Reload the insurance companies on this claim with the insurance companies currently in this patient's demographics Reapply modifier percentages Reassign provider numbers Convert this claim to a UB or Dental form Delete this claim Lock this claim Void and recreate this claim Configure My Settings for this claim For more information, refer to the section titled Claim Options on page 82.

Print HCFA (New)

Click this button to print the new version of the HCFA claim form. Click the green arrow next to this button to open a dropdown list. The following actions can be performed from this drop-down list: Select the state Medicaid forms you want to use Print and view any of the forms available Add additional Medicaid data View and print ERAs for this claim

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

65

Professional (HCFA) Claims

Claims

Field/Option Adjustments

Description Click this button to view and modify the Patient Statement Billing Message and any Financial Adjustments for this claim. For more information on this feature, refer to the section titled Entering an Adjustment on a Claim on page 92.

Prog. Notes CPT Payers

Click this button to view the Progress Notes associated with this claim. Click this button to view which payers are responsible for each line item. To select different payers for different line items: 1. 2. 3. 4. 5. Click the CPT Payers button. The Line Item Payers window opens. Check the Enable different payers for different line items box. Click in the Bill To column for the desired CPT/HCPCS code to expose a drop-down list. Select the insurance company you want to bill for this line item from the Bill To drop-down list. Click the OK button. The Line Item Payers window closes and your changes are saved.

OK Cancel

Click this button to close the Claim window and save your changes. Click this button to close the Claim window without saving your changes.

Click the Insurances & Payments tab in the middle of the window to view insurance and payment information:

66

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

The following fields and options are available on this tab: Field/Option Bill to Patient Insurances (top pane) Description Check this box to bill this claim to the patient. The insurance companies associated with this claim can be configured in this section. To add insurance companies from this patient's demographics, click the Add Pt Insurance button and select the desired insurance companies. To add an insurance company not associated with this patient, click the Add button. To update an existing insurance company, highlight the desired company and click the Update button. To remove an existing insurance company, highlight the desired company and click the Remove button. Payments/ Adjustments/ Refunds Claim Collection Status The payments, refunds, and adjustments that have been applied to this claim are listed here. This information is read-only and cannot be edited. Click the More (...) button next to this field to select a collection status for this claim. This filter is only displayed if claim-based collection management is enabled. For more information, refer to the Billing Setup chapter of the System Administration Users Guide. Add Pt Payment View CPT Pmts View Click this button to add payments from the patient to this claim. Click this button to view payments posted to the CPT level. Click this button to open a drop-down list. The following actions can be performed from this drop-down list: View CPT Payments - This option performs the same function as the View CPT Pmts button (see above). View Detail - Highlight a payment and click this option to view the details of that payment. View Msg Codes - highlight a payment and click this option to view any billing message codes associated with the payment. Click the Additional Information tab in the middle of the window to enter additional information for this claim:

The following fields and options are available on this tab:

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

67

Professional (HCFA) Claims

Claims

Field/Option Provider 1 and Provider 2

Description Select any additional providers that you want to be associated with this claim from these drop-down lists. This information is used for reporting purposes only, and is not included when transmitting or printing this claim. Select a payment rejection status for this claim from this drop-down list. This option is only displayed if the Payment Rejection Subsystem is enabled. For more information, refer to the Billing Setup chapter of the System Administration Users Guide.

Payment Rejection Status

Department

Click the Select button next to this field to select a department for this claim from the Departments window. To clear a selected department from this field, click the Clear button.

Note: This feature is enabled by item key. Contact eClinicalWorks Support for more information. Click the Error tab at the bottom of the window to view the errors that have been detected on this claim: Note: An asterisk (*) displays on the Error tab if any errors have been detected.

The following fields and options are available on this tab:

Field/Option Errors

Description The errors detected on this claim are displayed in this section. You may have to scroll down using the scroll bar at the right side of this section to view all the errors. Click this button, or press the F9 key on your keyboard, to save the information entered on this claim and move back to the previous claim in your list of My Claims. Click this button to copy the list of errors on this claim to a text or Excel file. Click this button to use CodeCorrect to view details and solutions for errors. For more information, refer to the section titled Checking Errors on Claims with CodeCorrect on page 75.

Prev (F9)

Copy Code Correct

68

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

Field/Option Recheck for Errors Next (F10)

Description Click this button to recheck the claim for errors after you have modified the appropriate information. The list of errors refreshes when you click this button. Click this button, or press the F10 key on your keyboard, to save the information entered on this claim and move on to the next claim in your list of My Claims.

Click the Claim Logs tab at the bottom of the window to view logs related to this claim:

The following fields and options are available on this tab:

Field/Option Rejections Log

Description A log of this claim's rejections is displayed in this section. To add a new error code, click the Add button and select the desired code from the Claim Error Codes window. To delete an existing error code, highlight the desired code in this section and click the Delete button.

Charges Log Adjustment Logs Claim Submission Log Claim Lock Log

Click this button to view a log of the charges for this patient. Click this button to view a log of the adjustments made on this claim. Click this button to view a log of the submission history for this claim. Click this button to view a log of the lock history for this claim.

CMS-1500 Form Mapping

The sections of the eClinicalWorks application that populate each field on the CMS-1500 claim form can be looked up using the CMS-1500 to ANSI 837P 4010A1 Mapping document.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

69

Professional (HCFA) Claims

Claims

About the Claim CPT Details Window

The Claim CPT Details window allows users to enter additional information about a CPT Code on a claim. To enter claim CPT details: 1. Open the claim for which you want to enter CPT details. 2. Highlight the CPT Code you want to enter details for and click the Update button. The Claim CPT Details window opens:

3. Use the following fields/options to enter the desired information for this CPT Code:

70

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

Field/Option CPT Code Detail

Description The name and description of the selected CPT Code display here. This information is read-only and is not editable. Click the More (...) button next to any of the fields in this section to select a modifier to apply to this CPT Code. Select the number of the ICD Code on this claim that you want to associate with this CPT Code from one of the drop-down lists in this section. If any anesthesia is associated with this CPT Code, select the start and end times from the Start Time and End Time drop-down lists. The Anesthesia/Oxygen Minutes field is automatically populated based on these selections.

Modifiers ICD Codes

Anesthesia

Place Of Service Type Of Service Start DOS and End DOS Units Unit Fee Unit Patient Portion Allowed Unit Fee Include in the Electronic/Paper submission to insurance

Select the place that service was rendered for this CPT Code using this drop-down list. Select the type of service associated with this CPT Code using this drop-down list. Select the date of service range for this CPT Code using these drop-down calendars. Enter the number of units for this CPT Code in this field. Enter the fee per unit for this CPT Code in this field. Enter the portion of the unit fee that the patient is responsible for in this field. Enter the allowed fee per unit for this CPT Code in this field. Check this box to include this CPT Code when submitting this code. If this box is unchecked, this code will not be included when submitting this claim.

4. To enter test results and measurements for this CPT Code: a. Click the Test Results/Measurements button. The Test Results/Measurements window opens. b. Click the Add button. The Test Result/Measurement Details window opens:

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

71

Professional (HCFA) Claims

Claims

c.

Click the More (...) button next to the Reference ID Code field to select a reference code for this result/measurement.

d. Click the More (...) button next to the Qualifier field to select a qualifier for this result/measurement. e. Enter the value for this result/measurement in the Measurement Value field. f. Click the OK button. The specified result/measurement is now associated with this CPT Code. 5. Click the Additional Information tab. The Additional Information fields and options display:

6. Use the following fields/options to enter the desired information for this CPT Code:

72

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

Field/Option EPSDT Indicator

Description Enter an EPSDT indicator for this CPT Code in this field. This information is used to indicate Well Child visits. Enter an emergency indicator for this CPT Code in this field. Some payers require this information to indicate if the services rendered were emergency in nature or not. Enter a Coordination of Benefits code in this field. Some payers require this information when a claim is filed with a primary payments already made. Enter a review indicator here if necessary. Click the More (...) button next to this field to select a Hospice Provider Indicator to associate with this CPT Code. Enter the CLIA ID number you want to associate with this CPT Code in this field. Enter the mammography certification number you want to associate with this CPT Code in this field. Enter the national drug code of any medication associated with this CPT Code in this field. Enter the number of units of the medication associated with this CPT Code in this field. Click the More (...) button next to this field to select a unit of measurement for the medication associated with this CPT Code. Enter the price of each unit of the medication associated with this CPT Code in this field. Enter a capitation vendor prescription order number in this field if necessary. The ID numbers and names of the providers associated with this CPT Code are displayed here. To select a new provider: 1. Click in the Name field of the desired row to expose a More (...) button on the right side of the selected row. Click the exposed More (...) button. The Practicing/Referring Providers window opens. Highlight the desired provider and click the OK button. The ID column is automatically populated with the selected provider's ID number. ID numbers can be edited by clicking in the ID column and modifying the text as desired.

Emergency Indicator

COB Indicator

Review By Code Indicator Hospice Employed Prov Ind CLIA ID No Mammography Cert No National Drug Code (NDC) National Drug Units Drug UOM

Drug Unit Price CAP Vendor Rx Order No Provider IDs

2.

3.

Additional Information...

Enter any miscellaneous notes concerning this CPT Code in this field.

7. To enter chiropractic information:

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

73

Professional (HCFA) Claims

Claims

a. Click the Chiropractic Data tab. The Chiropractic Data fields and options display:

b. Select the initial treatment date for this claim using the drop-down calendar here. OR If the initial treatment date is today's date, simply check the box in this field. Note: An Initial Treatment Date can be entered for the entire claim at once from Claim Data. For more information, refer to the section titled Completing Claim Data on page 78. 8. Click the OK button. The details you have entered for the selected CPT Code are now saved.

Viewing and Responding to Rule Validation Warnings

The rule warnings display from three locations: Progress Notes - If an invalid ICD/CPT combination is specified, a warning displays when the Done button is clicked from the Billing window within the Progress Notes. The rules are based on the CPT/ICD association and the patient's primary insurance. Out of Office Visits - If an invalid ICD/CPT combination is specified, a warning displays when clicking OK to save and close the Out of Office Visits window. The rules are based on the CPT/ICD association and the patient's primary insurance. Claim - If an invalid ICD/CPT combination is specified, a warning displays on the Errors tab and when clicking OK to save and close the claim. The Recheck for Errors tab displays the warning as well. When the warning displays: A dialog window opens and displays the rule and the offending codes. The dialog asks if you'd like to continue: Click Yes to override the rule and close the window. Click No to return to the previous window and make the necessary changes to the specified CPT/ICD associations.

74

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

CodeCorrect

Checking Errors on Claims with CodeCorrect

Errors on claims can be checked using CodeCorrect. Note: CodeCorrect® is a third-party product that requires a separate subscription fee. Contact eClinicalWorks Support for more information. To check errors on claims using CodeCorrect: 1. Open the claim for which you want to check errors. 2. Click the Errors tab. The Errors options display. 3. Click the CodeCorrect button. CodeCorrect performs a real-time review of the claims and checks them against the published Medicare edits. When the check is complete, CodeCorrect displays errors in one of two ways: If you configured CodeCorrect to check for errors automatically, error notification displays on the error tab along with other errors and CodeCorrect is added to the end of the text. If you use CodeCorrect manually, the CodeCorrect Viewer opens after you click the CodeCorrect button:

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

75

Professional (HCFA) Claims

Claims

4. Click the Print button to print the list of CodeCorrect errors. 5. Click the link or button titled Click here for the Legend to view explanations of CodeCorrect symbols.

Claim Header

Completing the Claim Header

Use this procedure to add information about the claim status, the patient, or the service type. For example, if you are resubmitting a claim for payment, you would indicate that status at this window. This window does not capture claim data related to the payment of a claim. To add information to the Claim Header: 1. Open the claim for which you want to enter a Claim Header. 2. Click the Claim Header button. The Claim Header window opens:

76

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

3. Enter the desired information in the following fields: Field Residence Type Student Status Employment Status Miscellaneous Services Claim Editing Indicator/Plan Type Claim Type Facility/Lab ID Number Facility Type Description Select the type of residence that this patient lives in from this drop-down list. Select the student status of this patient from this dropdown list. Select the employment status of this patient from this drop-down list. Check the appropriate box next to each of the services in this section. These options apply to Medicaid claims in certain states. Select the type of payment plan used for this claim. Information populates in this field automatically from the patient's demographics. Select the desired type of claim from this drop-down list. BCBS may require an ID number for inpatient/outpatient service. The ID number is associated with the hospital or ASC. Click the More (...) button next to this field to select a Provider ID Type Code associated with the facility at which this encounter was performed. Check this box if this claim has been submitted in the past and you are attempting to resubmit it. If this claim is a resubmission, enter one of the following resubmission codes in this field. 6 - Corrected Claim; Added to a claim resubmission to indicate that corrections have been made. 7 - Replacement Claim; Added to a new claim to indicate that the claim is to be considered as a replacement for a previously submitted, and paid, claim. 8 - Void/Cancel of Prior Claim; Added to a claim resubmission to indicate that the claim should be voided/cancelled. Resubmission Reference Number Reserved For Local Use (HCFA Paper Claims Only) Claim Note Provider Assignment Indicator (HCFA Box 27) Delay Reason If this claim is a resubmission, enter the resubmission reference number or ICN (Initial Correspondence Number) provided by the payer in this field. Enter any additional information to be included in boxes 10d and/or 19 if applicable. These fields apply to printed claims only. Enter a note for this claim in this field. Click the More (...) button next to this field to select an assignment indicator for this claim. This indicator is included in box 27 on the claim. If this claim was delayed before submission, click the More (...) button next to this field to select a reason for the delay.

Resubmittal Resubmission Code

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

77

Professional (HCFA) Claims

Claims

Field (Continued) OK Cancel

Description (Continued) Click this button to close this window and save the information you have entered here. Click this button to close this window without saving the information you have entered here.

Claim Data

Completing Claim Data

Use this procedure to add detailed data about the claim that may determine how the claim is paid. For example, at this window you can indicate that the claim is a result of an accident. You have the option of entering specific details about the accident. The insurance carrier responsible for the claim may decide to use this information when determining claim payment. To enter Claim Data: 1. Open the claim for which you want to enter Claim Data. 2. Click the Claim Data button. The Claim Data window opens:

78

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

3. Enter the desired information in the following fields: Field Employment? (Current or Previous) Accident? Description Check the appropriate box here to indicate whether this claim is related to an injury sustained during the course of employment. Check the appropriate box here to indicate whether this claim is related to an injury sustained due to a non-workrelated accident, and whether or not that accident occurred in an automobile. Select the state where the accident occurred from this drop-down list. Enter the hour of the day that the accident occurred in this field. Enter the cause of the accident in this field. Enter the indicator for the responsible party in this field. Click the More (...) button next to this field to select an indicator of the location of the document associated with this claim. Click the More (...) button next to this field to select a Provider ID Type Code associated with the facility at which this encounter was performed. Enter a control number related to the documentation attached to this claim in this field. This field is required if the Documentation Indicator value (also known as a Report Transmission Code) is one of the following: BM - By Mail EL - Electronically Only EM - E-Mail BF - By Fax Date Documentation Sent Release of Information Sig. Date HCFA Form Box 16 HCFA Form Box 18 Lab Charges If this claim is a resubmission, enter the appropriate resubmission code in this field. If this claim is a resubmission, enter the resubmission reference number in this field. The signature date that is recorded on the Patient Information window is populated here. Enter the dates that the patient is unable to work due to their condition in this field. Enter the dates that inpatient services are being billed for in this field. Check this box if specimens being billed on this claim are sent to an outside lab company, and enter the charges in the field here. Select the type of symptom date you want to enter in the Accident/Symptom Date field.

Place (State) Accident Hour External Cause of Accident Responsibility Indicator Documentation Indicator (Report Transmission Code) Documentation Type

Attachment Control Number

Symptom

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

79

Professional (HCFA) Claims

Claims

Field (Continued) Accident/Symptom Date Similar Symptom Similar Symptom Date Date Last Seen (for Podiatric claims)

Description (Continued) Enter the date that the accident or first symptom occurred in this field in mm/dd/yyyy format. The LMP date for OB encounters is also entered here. Select whether or not there is a similar symptom to the original symptom. Enter the date that a similar symptom occurred in this field in mm/dd/yyyy format. Enter the date that the patient was last seen by a provider in this field in mm/dd/yyyy format. This information is only for claims related to Podiatric services.

Initial Treatment Date

Enter the date that initial treatment for this accident/ symptom began in this field in mm/dd/yyyy format. This information is used for chiropractic claims. Different Initial Treatment Dates can be entered for each procedure from the Claim CPT Detail window. For more information, refer to the section titled About the Claim CPT Details Window on page 70.

Code

Click the More (...) button next to this field to select a code to indicate if this patient is part of a special program (such as EPSDT). Click the More (...) button next to this field to select whether or not an EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) referral was given to this patient. For more information on EPSDT, refer to the section titled Managing EPSDT on page 81.

Was an EPSDT referral given to this patient?

EPSDT Referral Code

Click the More (...) button next to this field to select an EPSDT referral code for this claim. For more information on EPSDT, refer to the section titled Managing EPSDT on page 81.

Provider ID Type Name ID OK Cancel

Click the More (...) button next to this field to select the ID type of the referring provider for this claim. The referring provider for this encounter displays here. Click the Select button to select a new referring provider. The ID number for the selected provider displays in this field. This information can be modified. Click this button to close this window and save the information you have entered here. Click this button to close this window without saving the information you have entered here.

80

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

4. Complete the fields as required: Filed Patient Condition Description Gives the provider with more information about the validity of the claim. Indicate whether illness or injury is related to some type of accident. Signature and Release information fields are populated from the Patient Demographics. The dates that the patient is unable to work maps to HCFA Form Box 16. Hospitalization Dates Lab Charges Symptom information Special Program These dates map to HCFA Form Box 18. Specify whether the lab is in-house or outside. Provide the date the symptom(s) appeared. You can also indicate if this symptom is similar to previous cases. You can indicate if the service is part of a special healthcare program like the (EPSDT) services offered to children covered by Medicaid. Referring Provider ID maps to HCFA Box 17A, and the name maps to Box 17.

Documentation information

Referring Provider

Managing EPSDT

The following comes from the Centers for Medicaid and Medicare Services: The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service is Medicaid's comprehensive and preventive child health program for individuals under the age of 21. EPSDT was defined by law as part of the Omnibus Budget Reconciliation Act of 1989 (OBRA '89) legislation and includes periodic screening, vision, dental, and hearing services. In addition, Section 1905(r)(5) of the Social Security Act (the Act) requires that any medically necessary health care service listed at Section 1905(a) of the Act be provided to an EPSDT recipient even if the service is not available under the State's Medicaid plan to the rest of the Medicaid population. The EPSDT program consists of two mutually supportive, operational components: (1) assuring the availability and accessibility of required health care resources, and (2) helping Medicaid recipients and their parents or guardians effectively use these resources. These components enable Medicaid agencies to manage a comprehensive child health program of prevention and treatment, to seek out eligibles and inform them of the benefits of prevention and the health services and assistance available and to help them and their families use health resources, including their own talents and knowledge, effectively and efficiently. It also enables them to assess the child's health needs through initial and periodic examinations and evaluations, and also to assure that the health problems found are diagnosed and treated early, before they become more complex and their treatment more costly. (Source: http://www.cms.hhs.gov/MedicaidEarlyPeriodicScrn/)

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

81

Professional (HCFA) Claims

Claims

To enable the EPSDT fields: 1. From the Claim Data window, click the More (...) button next to the Code field. The Special Program Codes window opens. 2. In the Special Program section, click the More (...) button to display the Special Program Codes window. 3. Select 01 - EPSDT or CHAP from the code list, and then click the OK button. The two EPSDT-related fields are now activated. 4. Click the More (...) button next to the question Was an EPSDT referral given to the patient? The EPSDT Referral Indicators window opens. 5. Click the appropriate radio button and then click the OK button. The selection is entered into the referral question field. 6. Click the More(...) button next to the EPSDT Referral Code. The EPSDT CRC Indicators window opens. 7. Select the appropriate EPSDT Referral Code and then click the OK button. The selected code is entered into the EPSDT Referral Code field. The information saved in the EPSDT fields will be sent electronically along with the claim. 8. Continue to complete the claim data window as necessary.

Claim Options

Viewing Claim Logs

Various logs related to the currently opened claim can be viewed from the Claim detail window.

Viewing the Claim Submission Log

A log of all the times a claim has been submitted can be viewed from the Claim detail window. To view the Claim Log: 1. Open the claim for which you want to view the submission history. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, hover over the View Logs option to open another drop-down list. 4. From this drop-down list, click the View Claim Submission Log option. The Claim Log window opens. 5. Click the Copy button to copy the information displayed here to a text or Excel file.

82

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

Viewing the Charges Log

A log of all the charges on a claim can be viewed from the Claim detail window. To view the Charges Log: 1. Open the claim for which you want to view the charges. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, hover over the View Logs option to open another drop-down list. 4. From this drop-down list, click the View Charges Log option. The Charge Logs window opens. 5. Click the Copy button to copy the information displayed here to a text or Excel file.

Viewing the Claim/CPT Adjustments Log

A log of the claim-level and CPT-level adjustments on a claim can be viewed from the Claim detail window. To view the Claim/CPT Adjustments Log: 1. Open the claim for which you want to view the adjustment history. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, hover over the View Logs option to open another drop-down list. 4. From this drop-down list, click the View Claim/CPT Adjustments Log option. The Adjustment Logs window opens, with the claim-level and CPT-level adjustment logs split into two sections. 5. Click the Copy button next to either section to copy the information displayed there to a text or Excel file.

Viewing the Line Refunds Log

A log of all the line-item refunds applied to a claim can be viewed from the Claim detail window. To view the Line Refunds Log: 1. Open the claim for which you want to view line-item refunds. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, hover over the View Logs option to open another drop-down list. 4. From this drop-down list, click the View Line Refunds Log option. The Refund Line Logs window opens. 5. Click the Copy button to copy the information displayed here to a text or Excel file.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

83

Professional (HCFA) Claims

Claims

Viewing the Claim/CPT Payment Posting Log

A log of the claim-level and CPT-level payments on a claim can be viewed from the Claim detail window. To view the Claim/CPT Payment Posting Log: 1. Open the claim for which you want to view the payment posting history. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, hover over the View Logs option to open another drop-down list. 4. From this drop-down list, click the View Claim/CPT Payment Posting Log option. The Payment Logs window opens, with the claim-level and CPT-level payment logs split into two sections. 5. Click the Copy button next to either section to copy the information displayed there to a text or Excel file.

Viewing the Claim Lock Log

A log of all the times a claim has been locked can be viewed from the Claim detail window. To view the Claim Lock Log: 1. Open the claim for which you want to view the claim lock history. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, hover over the View Logs option to open another drop-down list. 4. From this drop-down list, click the View Claim Lock Log option. The Claim Lock Status window opens. 5. Click the Print button to print this information

Viewing the Claim Status Log

A log of all the times a claim's status has been changed can be viewed from the Claim detail window. To view the Claim Status Log: 1. Open the claim for which you want to view the claim status log. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, hover over the View Logs option to open another drop-down list. 4. From this drop-down list, click the View Claim Status Log option. The Claim Status Logs window opens. 5. Click the Copy button to copy the information displayed here to a text or Excel file.

84

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

Viewing the Claim Transfer Log

A log of all the times a claim has been transferred to a new payer can be viewed from the Claim detail window. To view the Claim Transfer Log: 1. Open the claim for which you want to view claim transfers. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, hover over the View Logs option to open another drop-down list. 4. From this drop-down list, click the View Claim Transfer Log option. The Claim Transfer Logs window opens. 5. Click the Copy button to copy the information displayed here to a text or Excel file.

Viewing the Claim Assigned To Log

A log of all the times a claim has been assigned to a user can be viewed from the Claim detail window. To view the Claim Assigned To Log: 1. Open the claim for which you want to view claim assignments. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, hover over the View Logs option to open another drop-down list. 4. From this drop-down list, click the View Claim AssignedTo Log option. The Claim AssignedTo Logs window opens. 5. Click the Copy button to copy the information displayed here to a text or Excel file.

Viewing Finance Charge Logs

A log of all finance charges made on a claim can be viewed from the Claim detail window. To view the Finance Charges Log: 1. Open the claim for which you want to view the finance charges. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, hover over the View Logs option to open another drop-down list. 4. From this drop-down list, click the View Finance Charges Log option. The Finance Charges Log window opens. 5. Click the Copy button to copy the information displayed here to a text or Excel file. 6. Click the View Claim button to display the original claim.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

85

Professional (HCFA) Claims

Claims

Viewing the Claim Collection Log

A log of all the changes to the collections status of a claim can be viewed from the Claim detail window. To view the Claim Collection Log: 1. Open the claim for which you want to view the collections log. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, hover over the View Logs option to open another drop-down list. 4. From this drop-down list, click the View Finance Charges Log option. The Claim Collection Log window opens.

Viewing and Printing a Claim Summary

A summary of the information contained on a claim can be viewed and printed from the Claim detail window. To view and/or print a claim summary: 1. Open the claim for which you want to view and/or print a claim summary. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, click the Print Claim Summary option. The eClinicalWorks Viewer window opens with the claim summary displayed. 4. Click the Print button to print this information.

Reloading Insurances from Demographics to Claims

If the insurance companies associated with a patient have changed since they were applied to a claim, then they will need to be reloaded to the claim in order to ensure it includes the correct insurance companies. To reload insurance companies to claims: 1. Open the claim for which you want to reload insurance information. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, click the Reload Insurance(s) from Demographics option. A confirmation window opens. 4. Click the Yes button. The insurance companies from this patient's demographics are now reloaded to this claim.

86

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

Reapplying Modifier Percentages on Claims

If modifier percentages have changed since they were applied to a claim, then they will need to be reapplied to the claim in order to ensure it includes the correct percentages. To reapply modifier percentages on claims: 1. Open the claim for which you want to reapply modifier percentages. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, click the Reapply Modifier Percentages option. Modifier percentages are now reapplied to this claim.

Reassigning Provider Numbers on Claims

If a provider's numbers have changed since a claim that they are included on was created, then they will need to be reassigned to the claim in order to ensure it includes the correct numbers. To reassign provider numbers on claims: 1. Open the claim for which you want to reassign provider numbers. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, click the Re Assign Provider Numbers option. A confirmation window displays to notify you that the provider numbers have been successfully reassigned for this claim.

Converting HCFA Claims to UB Claims

Individual HCFA claims can be converted to UB claims directly from the Claim detail window. To convert a HCFA claim into a UB claim: 1. Open the HCFA claim you want to convert. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, click the Convert to UB option. This claim is now converted to a UB claim.

Converting HCFA Claims to Dental Claims

Individual HCFA claims can be converted to Dental claims directly from the Claim detail window. To convert a HCFA claim into a Dental claim: 1. Open the HCFA claim you want to convert. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, click the Convert to Dental option. This claim is now converted to a Dental claim.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

87

Professional (HCFA) Claims

Claims

Deleting a Claim from the Claim Window

Individual claims can be deleted directly from the Claim detail window. To delete a claim from the Claim window: 1. Open the claim you want to delete. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, click the Delete Claim option. A confirmation window opens. 4. Click the Yes button. This claim is now deleted.

Locking a Claim from the Claim Window

Individual claims can be locked directly from the Claim detail window. To lock a claim from the Claim window: 1. Open the claim you want to lock. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, click the Lock Claim option. This claim is now locked.

Unlocking a Locked Claim from the Claim Window

Individual claims that have been locked can be unlocked directly from the Claim detail window. To unlock a locked claim from the Claim window: 1. Open the locked claim you want to unlock. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, click the Unlock Claim option. This claim is now locked.

Configuring My Settings on Claims

The My Settings feature on the Claim detail window is separate from the My Settings feature under the File menu. The following settings can be configured from this window: The appearance of lab/diagnostic imaging/immunization information The criteria for checking claims for errors The method of selecting CPT Codes when there is more than one procedure with the same code

88

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

To configure My Settings on claims: 1. Open the claim for which you want to configure My Settings. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, click the My Settings option. The Claim - My Settings window opens:

4. To prevent lab tests, diagnostic imaging tests, and immunizations from being displayed on claims, check the Don't Display Labs/Diagnostic Imaging/Immunizations box. 5. To prevent claims from being automatically checked for errors whenever they are viewed, check the Don't Check for Claim Errors Automatically when a claim is viewed box. 6. To determine the method of selecting a CPT Code when there is more than one procedure with the same code, click the desired radio button in the Procedure Code... section. 7. Click the OK button. The My Settings for claims are now configured.

Printing HCFA Forms

Printing Claims Using the CMS 1500 Form

The default method of printing HCFA forms is the CMS 1500 form. To print the new HCFA 1500 form: 1. Open the claim you want to print using the CMS 1500 form. 2. Click the Print HCFA (New) button. The Select the Printer window opens. 3. Highlight the printer you want to use and click the Print button. The selected claim is now printed using the CMS 1500 form.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

89

Professional (HCFA) Claims

Claims

Viewing and Printing Claims on Other Forms

Claims can be viewed and/or printed on a variety of forms from the Claim detail window. Most forms (especially state Medicaid forms) need to be enabled before they can be selected. For more information on enabling these forms, refer to the section titled Selecting State Medicaid Forms on page 91. To view and/or print claims on other forms: 1. Open the claim you want to view and/or print. 2. Click the green arrow next to the Print HCFA (New) button to open a drop-down list. 3. From the drop-down list, click the desired Print... Form or View... Form option. The selected form is either opened in Microsoft Word or printed directly. Continue with printing the claim as you would normally.

Adding NY Medicaid Form Data

Users can now add information for NY Medicaid forms to a claim. To add NY Medicaid form data: 1. Open the claim to which you want to add NY Medicaid form data. 2. Click the green arrow next to the Print HCFA (New) button to open a drop-down list. 3. From the drop-down list, click the Add Additional McaidNY claim data option. The Medical Assistance Health Insurance Claim Form window opens, with the Fields 1 to 23B tab displayed. 4. To make the fields here editable, click the Make Fields Editable button. 5. To copy this information into a Microsoft Word file, click the Print to Word button. 6. Enter information into the fields and/or check the boxes as desired. 7. Click the Fields 24A to 35 tab. The Fields 24A to 35 options display. 8. Enter information into the fields and/or check the boxes as desired. 9. Click the Save button. The NY Medicaid form data is now saved for this claim.

90

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

Viewing and Printing ERAs Associated with a Claim

ERAs that have been associated with a claim can be viewed and/or printed from the Claim detail window. To view and/or print ERAs associated with a claim: 1. Open the claim that for which you want to view and/or print an ERA. 2. Click the green arrow next to the Print HCFA (New) button to open a drop-down list. 3. From the drop-down list, click one of the following options: Print ERA - The ERA associated with this claim is printed. View ERA - The ERA associated with this claim is opened for viewing.

Selecting State Medicaid Forms

In order to print a state Medicaid form, it needs to be enabled from the State Medicaid Forms window. To configure state Medicaid forms: 1. From the Claims window, open any claim. 2. Click the green arrow next to the Print HCFA (New) button to open a drop-down list. 3. From the drop-down list, click the Select State Medicaid Forms... option. The State Medicaid Forms window opens:

4. Check the box(es) next to the form(s) you want to use. 5. Click the OK button. The State Medicaid Forms window closes and the selected forms are now enabled for selection from the Print HCFA (New) drop-down list.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

91

Professional (HCFA) Claims

Claims

Entering Financial Adjustments

Make financial adjustments to a claim from the Financial Adjustments section of the Claims window or Payment Posting window. For example, you may want to offer a discounted amount, or you may want to write off a portion of a claim. This procedure describes making adjustments from the Claims window. The system provides two default adjustment codes: CD - Discount WO - Write Off You can use either of these two codes, and you can add your own codes. Note: Financial adjustments do not include contractual adjustments made during the payment posting process.

Entering an Adjustment on a Claim

Adjustments can be applied to entire claims or to individual line items on a claim from the Claim window. To enter an adjustment on a claim: 1. Open the claim for which you want to create an adjustment. 2. Click the Adjustment button. The Claims Adjustment window opens:

3. Enter a billing message concerning this adjustment in the Patient Statement Billing Message field. OR Click the More (...) button next to this field to select a Billing Message Code to add to this field. 4. Click the Add button. A new row displays in the Financial Adjustments section. The current date is automatically populated in the Date field. 5. Enter the desired code in the Code field. OR Click the More (...) button next to this field to select the desired adjustment code from the Adjustment Codes window.

92

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

6. Enter the desired amount of this adjustment in the Amount field. 7. To post adjustments to the CPT-level (optional): a. Click the Post CPT button. The Adjustment Posting window opens:

b. Highlight the line item to which you want to apply this adjustment. c. Click the OK button. The Adjustment Posting window closes. 8. To delete an existing adjustment: a. Highlight the adjustment you want to delete and click the Delete button. A confirmation window opens. b. Click the Yes button. The selected adjustment is now deleted. 9. Click the OK button. The Claim Adjustments window closes and your adjustment is applied to the claim.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

93

Professional (HCFA) Claims

Claims

My Claims

Claims can be assigned to staff members to work on and review using the My Claims feature.

Viewing the Assigned Claims Log

An Assigned Claims Log is now available, enabling users to view the entire history of a claim's assignments. To view the Assigned Claims log: 1. From the Claims window, open the claim for which you want to view the Assigned Claims log. 2. Click on the Options button to open a drop-down list. 3. Hover over the View Logs option to open a drop-down list. 4. Select the View Claim Assigned To Log option. The Assigned Claims log displays.

Entering Claim Follow Up Details

Follow-up information concerning a claim can be entered on the Claim Follow Up Details pane. Claims can be assigned to users for review from this pane. To use the Claim Follow Up Details Pane: 1. Open the claim you want to specify Follow Up Details for and click the Show > button in the upper-right corner of the window. The Claim Follow Up Details pane opens:

94

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Professional (HCFA) Claims

2. To assign this claim to a staff member, click the More (...) button next to the Assigned To field and select the desired staff member from the Staff Lookup window. 3. The Start Date field displays the day this claim was created. To modify this, click the More (...) button to open a pop-up calendar. 4. Select a priority for this claim from the Priority drop-down list. 5. Select a status for this claim from the Status drop-down list. 6. If desired, select an action that needs to be performed on this claim from the Claim Action drop-down list. Note: Claim Actions must be set up by the user before they are selectable here. For more information, refer to the System Administration Users Guide. 7. To recall this claim after a certain amount of days, enter the desired number of days in the Recall After field OR click the More (...) button next to the Due Date field to select a due date from a pop-up calendar. 8. Enter any miscellaneous notes concerning this claim in the Notes field. 9. To view the complete assignment history for this claim, click the View Follow Up Logs button. 10. Click the OK button to close this claim and save your changes.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

95

Professional (HCFA) Claims

Claims

Using the My Claims Window

Claims that have been assigned to a user can now be viewed from the My Claims window. To use the My Claims window: 1. Click the T Quick Link in the upper-right of the application to open a drop-down list:

2. Click on the Claims (#) option in this drop-down list. The My Claims window opens:

3. Click on one of the following tabs to view your claims by status: Open ­ Displays claims with a Due Date of the current day or earlier. In Progress ­ Displays claims with a Due Date after the current day. Completed ­ Displays claims that have been marked as completed. All Open ­ Displays all open claims, regardless of Due Date. Note: Claims past their Due Date are indicated by peach-shaded rows. 4. Click in any row to open that claim and make any necessary modifications.

96

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Institutional (UB) Claims

Institutional (UB) Claims

HCFA Uniform Bill claim forms - more commonly known as UB claim forms - are used to electronically submit claims for healthcare, and also used to exchange healthcare claims and payment information between payers with different payment responsibilities. There are three different types of UB services: Professional, Institutional, and Dental. Professional services typically include common procedures and visit performed at the practice, such as office visits and evaluations. Institutional services cover supplies, facility charges, and technical components of professional services. Dental services can also be submitted with a UB claim form, depending on the payer. UB billing is used by Federally Qualified Health Centers (FQHC), Rural Health Clinics, or by practices specializing in certain types of outpatient surgery. The UB interface supports paper UB billing and electronic billing. Electronic configuration is required for electronic billing. Note: New UB92 configuration for service line items can be performed using Insurance setup. For more information, refer to the System Administration Users Guide.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

97

Institutional (UB) Claims

Claims

About the Institutional (UB) Claim Detail Window

The UB Claim detail window is used for Institutional claims. It opens with the Fields 1-31 tab and General tab displayed:

98

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Institutional (UB) Claims

Fields 1-31 tab and General Tab

The following table describes the fields and options available from this window:

Field/Option Facility Information

Description The grayed-out field in the upper-left corner of the window displays some basic information about the facility at which this encounter was performed. This information is read-only and is not editable. Information specific to certain providers can be entered in these fields. The claim number is displayed in this field. This information is read-only and is not editable. Enter the bill type for this claim in this field, depending on the type of services that are being billed. This information is populated using information configured during the insurance setup process. The federal tax number is displayed in this field. This information is read-only and is not editable. Enter the information required by your payer into the fields in this section, if necessary. Basic demographic information concerning the patient this claim is for is displayed in this section. To view the Patient Information window for this patient, click the Info button.

LU (Local Use Field) Patient Control No Bill Type

Fed. Tax No. 6 - 10 Patient Name and Patient Address

Admission

Enter the information required by your payer into the fields in this section, if necessary. The Birthdate, Sex, MS, and Medical Record No. fields are read-only and cannot be edited.

Condition Codes

Enter the information required by your payer into the fields in this section, if necessary. These fields are used for straight hospital facility billing. If this claim is related to an accident, enter the state that the accident occurred in here. Select the status of this claim from this drop-down list. Enter any miscellaneous notes about this claim in this field. The patient's co-payment for this encounter can be entered in this field. The amount that is not covered by the patient can be entered in this field. The portion of the charges, payments, and balance that the patient is responsible for is displayed here. This information is read-only and cannot be edited. The total charges, payments/adjustments, and balance on this claim are displayed here. This information is readonly and cannot be edited.

ACDT State Claim Status Billing Notes Copay Pt. Uncovered Amt. Patient Portion

Total

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

99

Institutional (UB) Claims

Claims

Field/Option Prev (F9)

Description Click this button, or press the F9 key on your keyboard, to save the information entered on this claim and move back to the previous claim in your list of My Claims. Click this button to print the default UB form. To print other UB forms: 1. 2. Click the green arrow next to this button to open a drop-down list. Click the desired Print... option. The claim is printed using the selected form. Click the green arrow next to this button to open a drop-down list. From the drop-down list, hover over the View Logs option to open another drop-down list. Click the desired option to open the related log. For more information, refer to the sections titled Viewing the Batch Print Log on page 107 and Viewing Claim Logs on page 82.

Print UB

To view logs: 1. 2. 3.

OK Cancel Adjustments

Click this button to close the UB Form Details window and save the information you have entered. Click this button to close the UB Form Details window without saving any of the information you have entered. Click this button to enter adjustments for this claim. For more information, refer to the section titled Entering an Adjustment on a Claim on page 92.

Convert HCFA

Click this button to convert this claim to a HCFA claim. To convert a UB form to a Dental claim, it must first be converted to a HCFA claim by clicking this button. For more information, refer to the section titled Converting HCFA Claims to Dental Claims on page 87.

Next (F10)

Click this button, or press the F10 key on your keyboard, to save the information entered on this claim and move on to the next claim in your list of My Claims.

100

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Institutional (UB) Claims

Fields 32-49 Tab

Click the Fields 32-49 tab at the top of the window to enter information into these fields:

The following fields and options are available on this tab:

Field/Option Occurrence LU - A, B, and C Insert Resp Party Insert Payer Info 39, 40, and 41 42 - 48

Description Enter the information required by your payer into the fields in this section, if necessary. Enter the information required by your payer into the fields in this section, if necessary. Click this button to insert the Responsible Party from the selected patient's demographics into the LU fields here. Click this button to insert the payer information from the selected patient's demographics into the LU fields here. Enter the information required by your payer into the fields in this section, if necessary. Enter the information required by your payer into the fields in this section, if necessary. These fields are populated using the information configured during the insurance setup process, as well as the CPT Codes selected on the Progress Notes window.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

101

Institutional (UB) Claims

Claims

Fields 50-75 Tab

Click the Fields 50-75 tab at the top of the window to enter information into these fields:

The following fields and options are available on this tab:

Field/Option Bill to Patient Insurances (top pane)

Description Check this box to bill this claim to the patient. The insurance companies associated with this claim can be configured in this section. To add insurance companies from this patient's demographics, click the Add Pt Insurance button and select the desired insurance companies. To add an insurance company not associated with this patient, click the Add button. To update an existing insurance company, highlight the desired company and click the Update button. To remove an existing insurance company, highlight the desired company and click the Remove button.

Payments/ Adjustments/Refunds View CPT Pmts

The payments, refunds, and adjustments that have been applied to this claim are listed here. This information is read-only and cannot be edited directly. Click this button to view payments posted to the CPT level.

©

102

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Institutional (UB) Claims

Field/Option Add Pt Payment

Description Click this button to add payments from the patient to this claim. For more information on adding patient payments, refer to the section titled Adding Patient Payments on page 128.

View Detail

Highlight a payment in the Payments/Adjustments/ Refunds section and click this button to view the details of that payment. The ICD-9 Codes that were selected for this encounter are displayed in this section. To add new ICD-9 Codes to this claim: Click the Add button and select the desired code(s) from the Select Assessments window. OR Enter the desired code into the Code column for the * row. The name of the code you entered is automatically populated in the Name field, the next number in the list replaces the *, and a new * row displays beneath this row. To update an ICD-9 Code on this claim, replace the text in the Code field with the desired code. To remove ICD-9 Codes from this claim, highlight the code you want to remove in this section and click the Remove button.

ICD-9 Codes

LU

Enter the information required by your payer into these fields, if necessary.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

103

Institutional (UB) Claims

Claims

Fields 76-85 Tab

Click the Fields 76-85 tab at the top of the window to enter information into these fields:

The following fields and options are available on this tab:

Field/Option Adm Diag. CD E Code LU Principal Procedure and Other Procedures

Description Enter the information required by your payer into this field, if necessary. Enter the information required by your payer into this field, if necessary. Enter the information required by your payer into these fields, if necessary. Enter the following information for all appropriate procedures: Code - Enter the code associated with the procedure that was performed. Date - Enter the date this procedure was performed in mm/dd/yyyy format.

Attending Phys ID Insert Payer Information

Select the attending physician for this encounter from this drop-down list. Click this button to insert payer information from the selected patient's demographics into the fields below the button.

104

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Institutional (UB) Claims

Field/Option 81CC Provider Representative Date

Description Enter the information required by your payer into the fields in this section, if necessary. Enter the information required by your payer into this field, if necessary. Enter the information required by your payer into this field, if necessary.

Error Log Tab

Click the Error Log tab at the bottom of the window to view any potential errors on this claim:

Click the Check Errors button here to view any potential errors on this claim.

About the UB-04 Claim Form

The new UB-04 form will eventually replace the UB-92 form, but currently is only required by Medicaid and Medicare. The differences between the two forms are outlined below: Box Number Box 1 Description Facility Name, Address, and Telephone Number Used for the actual location address. Will only be captured if Box 2 is blank. Box 2 Facility Pay-to Name and Address Name and Address where payment should be sent. P.O. Box addresses are to be sent in this box. Box 3a Box 3b Box 8a Patient Control Number (Patient Account Number) Medical Record Number (UB-92 Box 23) Patient ID This is the patient's unique ID number, which will be captured for claims adjudication. If it is blank, the data will be captured from the old Box 60, which is the insured ID number on the UB-04. Box 8b Box 9a, b, c, d, Box 29 Patient Name (UB-92 Box 12) Patient Address, City, State, Zip Code (UB-92 Box 13) Accident State (new field)

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

105

Institutional (UB) Claims

Claims

Box Number Boxes 39-41

Description (Continued) Value Codes UB-92 Boxes 8, 9, 10 were deleted. Data must now be sent as value codes. All value codes will now be captured.

Box 42

Revenue Code and line-item level details Line 23 now consists of a Page Number field (ex. Page #X of X pages), a Creation Date field, and a Total Charge field. The Total Charge field eliminates the need for a Rev. Code 001.

Box 56 Box 57

NPI Facility NPI should be submitted in this field. Other Physician ID This field is for old legacy ID that the facility is currently submitting in Box 51 on the UB-92. Box 51 on the UB-04 has been changed to the Health Plan ID, which is a national number that has not been implemented at this date.

Box 66

DX Qualifier Not currently used, but will eventually distinguish between ICD-9 and ICD-10 codes.

Box 67 Box 69 Box 70

Diagnosis There is now a place for 18 codes. Admit Diagnosis Should be used by provider on all inpatient claims. Patient Reason for Visit For outpatient claims, this field contains the diagnosis code that indicates the reason for the visit. It should be used instead of an Admit Diagnosis field. This field will be keyed when the Admit Diagnosis field is blank, and it will populate in the Admit DX field in all systems.

Box 71 Box 72 Box 74a-e Box 81

PPS Code This is where you will locate the DRG code. External Cause of Injury Up to 3 E diagnosis codes can be submitted for accidents. Principal Procedure Code Code-to-Code Field This field is used to communicate any additional information that is not defined in a specific field.

While most of the data usage descriptions and allowable data values have not changed on the UB-04, many UB-92 data locations have changed. The UB-04 provides alignment with some of the additional data elements introduced with the 837 Institutional transaction. It accommodates the NPI, as well as prepares for the Health Plan Identifier. The new form also allows for the distinction of the diagnosis and procedure code set used, in order to accommodate the ICD-10 code set when it is adopted. (Source: himss.org)

106

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Dental Claims

Viewing the Batch Print Log

A log of all the changes to the status of UB batches can be viewed from the UB Form Details window. To view the Print Log: 1. Open the UB claim for which you want to view the print log. 2. Click the green arrow next to the Print UB button to open a drop-down list. 3. From the drop-down list, hover over the View Logs option to open another drop-down list. 4. From this drop-down list, click the View Print Log option. The Claim Logs window opens. 5. Click the Copy button to copy the information displayed here to a text or Excel file.

Dental Claims

Patient Setup for Dental Claims

Patients for whom a dental claim will be created must have both medical and dental insurance carriers applied to them in the system. The dental insurance needs to be applied to the appropriate visit from the Appointment window. For more information on adding insurance carriers from the Appointment window, refer to the Front Office Users Guide.

Configuring Insurance Companies for Dental Claims

Insurance carriers that accept Dental insurance must be set up as such before Dental Claims can be created for them. For more information on configuring insurance companies for dental claims, refer to the Insurances section of the System Administration Users Guide.

Creating Dental Claims

There is currently no dental EMR for eClinicalWorks, so Dental Claims must be created manually from the Claims window. Other than this, they created in the same way as Professional and Institutional Claims. Simply select the Dental radio button when creating the claim, and fill out any necessary information on the Dental Claim form.

Printing and Transmitting Dental Claims

Dental Claims are printed and transmitted in the same way as all other claims, except that WebMD/Emdeon is the only clearinghouse that can be used with these claims. Batches must be sent to a clearinghouse set up as Emdeon ANSI Dental (Dental must be in the receiver name).

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

107

Dental Claims

Claims

Downloading Dental Claims Reports

Dental Claims Reports are downloaded to the system in the same way as other WebMD/ Emdeon Reports. Just select the Dental option from the Download drop-down list on the Clearinghouse Claim Reports window instead of the Professional or Institutional options.

About the Dental Claim Detail Window

The Dental Claim detail window is used for claims related to dental procedures. It opens with the Patient Coverage Information tab and General tab displayed:

108

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Dental Claims

Patient Coverage Information Tab and General Tab

The following table describes the fields and options available from this window:

Field/Option Claim Number Claim Date Service Date Patient

Description The system-generated number for this claim is displayed in this field. This information is read-only and is not editable. The date that this claim is generated is displayed in this field. This information is read-only and is not editable. The date that services were rendered for this claim is displayed in this field. This information is read-only and is not editable. Basic demographic information about the patient this claim is for displays in this field. This information is read-only and is not editable. To view the Patient Information window for this patient, click the Info button.

Dentists Pretreatment Estimates Dentists statement of actual services Medicaid Claim EPSDT

Check this box if the charges on this claim represent the pretreatment estimates of the dentist. Check this box if the charges on this claim represent the actual services performed by the dentist. Check this box if this claim is for Medicaid. Check this box if this claim is part of the EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) program For more information on EPSDT, refer to the section titled Managing EPSDT on page 81.

Insurance Claim Status Bill to Patient Copay Pt. Uncovered Amt. Notes Patient Portion

Enter the prior authorization number for this claim in this field. Select the status of this claim from this drop-down list. Check this box to bill the remaining charges on this claim to the patient. The patient's co-payment for this encounter can be entered in this field. The amount that is not covered by the patient can be entered in this field. Enter any miscellaneous notes about this claim in this field. The portion of the charges, payments, and balance that the patient is responsible for is displayed here. This information is read-only and cannot be edited. The total charges, payments/adjustments, and balance on this claim are displayed here. This information is read-only and cannot be edited.

Total

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

109

Dental Claims

Claims

Field/Option Print

Description Click this button to print the default UB form. To print other Dental forms: 1. 2. Click the green arrow next to this button to open a dropdown list. Click the desired Print... option. The claim is printed using the selected form. Click the green arrow next to this button to open a dropdown list. From the drop-down list, hover over the View Logs option to open another drop-down list. Click the desired option to open the related log. For more information, refer to the sections titled Viewing the Batch Print Log on page 107 and Viewing Claim Logs on page 82.

To view logs: 1. 2. 3.

OK Cancel Adjustments

Click this button to close the UB Form Details window and save the information you have entered. Click this button to close the UB Form Details window without saving any of the information you have entered. Click this button to enter adjustments for this claim. For more information, refer to the section titled Entering an Adjustment on a Claim on page 92.

Convert HCFA

Click this button to convert this claim to a HCFA claim. To convert a UB form to a Dental claim, it must first be converted to a HCFA claim by clicking this button. For more information, refer to the section titled Converting HCFA Claims to Dental Claims on page 87.

110

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Dental Claims

Charges Tab

Click the Charges tab at the top of the window to enter information into these fields:

The following fields and options are available on this tab:

Field/Option Service Rendered

Description The services rendered for this claim are listed in this section. To add a new CPT Code, click the Add button and select the desired code from the Fee Schedule window. To remove an existing CPT Code, highlight the desired row and click the Remove button. The Tooth Number and Surface Number can also be entered here for each CPT Code, if desired.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

111

Dental Claims

Claims

Field/Option ICD-9 Codes

Description Any ICD-9 Codes associate with this claim are listed in this section. To add a new code, click the Add button and select the desired code from the Select Assessments window. To remove an existing code, highlight the desired row and click the Remove button. This section is used only for NY Medicaid. IMPORTANT! Claims for Medicaid must be converted to Institutional (UB) claims before they can be submitted. This can be done to each claim individually, or to several claims at once when they are in a batch. For more information on converting claims in a batch, refer to the section titled Billing Processes on page 39. When converting individual claims, they must be converted to HCFA first by clicking the Convert HCFA button at the bottom of the window before they can be converted to Institutional (UB). In order to avoid converting the claim twice, use the Filtered/Selected Claims options on the Claim lookup window. For more information on converting claims, refer to the section titled Converting HCFA Claims to Dental Claims on

Remarks for unusual services Missing Teeth Information

Enter any notes on services that were performed that are out of the ordinary. Check the boxes next to any teeth that are missing for this patient.

112

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Dental Claims

Billing Dentist Tab

Click the Billing Dentist tab at the top of the window to enter information into these fields:

The following fields and options are available on this tab:

Field/Option Facility Info

Description Information concerning the facility that this encounter occurred at is contained in this field. The information here can be modified or added to by clicking in this field and typing the desired text.

Dentist Info

Information concerning the appointment provider for this encounter is contained in this field. The information here can be modified or added to by clicking in this field and typing the desired text.

Place of Treatment Radiographs or models enclosed

Click the radio button next to the place that treatment occurred for this claim. Check this box if any radiographs or models are included along with this claim. Enter any information about these radiographs or models in the field to the right of this check box.

Occupational Injury

Check this box if this claim is for an occupational injury. Enter any information about this injury in the field to the right of this check box.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

113

Dental Claims

Claims

Field/Option Auto Injury

Description Check this box if this claim is for an automobile injury. Enter any information about this injury in the field to the right of this check box.

Other Accident

Check this box if this claim is for an accident not related to the patient's occupation or an automobile. Enter any information about this injury in the field to the right of this check box.

Prosthesis (Initial Placement)

Check this box if a prosthesis was placed during the encounter for this claim. Enter information related to this prosthesis in the following fields as applicable: Replacement Reason - If this prosthesis is a replacement for an earlier prosthesis, enter the reason for the replacement here. Prior Date - If this prosthesis is a replacement for an earlier prosthesis, enter the date of the initial placement of the prior prosthesis here.

Orthodontic Treatment

Check this box if this claim is for an orthodontic procedure: Enter information related to the orthodontic treatment in these fields as applicable.

Error Log

Click the Error Log tab at the bottom of the window to view any potential errors on this claim:

Click the Check Errors button here to view any potential errors on this claim.

114

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Miscellaneous Claim-Related Actions

Miscellaneous Claim-Related Actions

Recovering the NSF Fee Charged by the Bank

A new claim must be created to charge the patient for the NSF fee. To charge the NSF fee: 1. From the Claims window, click Claim button to open a drop-down list. 2. From the drop-down list, click the Create New Claim option. The Patient Lookup window opens. 3. Highlight the desired patient and click the OK button. The Create Claim window opens:

4. Enter or edit the information in the Provider, Facility, Service Date, Patient, or Place of Service (POS) fields. 5. Select the desired Claim Type using the radio buttons provided. 6. Click the OK button. The Claim window opens. 7. Use the Claim Date drop-down calendar to enter the date the check was received back from the bank. If the patient's claim includes a co-pay when a new claim is created, simply highlight the co-pay and delete it. 8. Add a dummy CPT code named NSF (example) with a description of NSF Fee:

For more information on creating new CPT codes, refer to the Billing Setup chapter of the System Administration Users Guide. 9. On the Insurance/Payments tab, check the Bill to Patient box, and change Claim Status to Patient:

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

115

Miscellaneous Claim-Related Actions

Claims

The patient's account should display the NSF check fee and the negative posting.

Moving a Credit

If a patient somehow overpays and incurs a credit, the credited amount can be applied to other claims if necessary. To move a credit: 1. From the Billing band in the left navigation bar, click Accounts Lookup. The Accounts Lookup window opens. 2. Locate the patient either by using the Patient Lookup filter or by using the filtering claims by balances with less than zero dollars:

3. Double-click on the payment that resulted in the overpayment. The Patient Inquiry Detail window opens. 4. Double-click on the payment that caused the overpayment in the Claims for the services provided... section. The Receive Payments window opens:

5. Adjust that payment on that claim line by the overpayment amount to create a balance of zero:

116

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Claims

Miscellaneous Claim-Related Actions

Note: The Amount and Date fields should not be changed. Only the amount applied to a specific Date of Service (Payment column) should be changed. 6. Click the Claims button. The Payment Posting window opens with the Patient Based tab displayed. 7. Use the Claim Balance filters and click Get Claims to locate a claim with a patient balance:

8. Once a claim with a balance is located, check the box next to that claim and click the OK button. The Payment Posting window closes and the selected claim is added to the Claims Paid section on the Receive Payments window. 9. Enter the Unapplied Amount in the Payment column for all desired claims until the Unapplied Amount equals zero dollars. OR

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

117

Claims

Miscellaneous Claim-Related Actions

a. Highlight the claim to which you want to apply the Unapplied Amount. b. Click the Post CPT button. The Payment Posting window opens. c. Enter the Unapplied Amount in the Paid column for each item until that item is paid off or the Unapplied Amount is used up. For more information on posting to the CPT level, refer to the sections titled Posting Patient Payments on page 140 and Posting Insurance Payments on page 148. d. Click the Post Payment button. The Payment Posting window closes and the Unapplied Amount is posted as specified. 10. Click the OK button. The patient credit has been resolved. Note: Patient statements cannot be processed for a patient with an outstanding patient credit.

Hard Closing Claims

Practices can enable and perform a financial hard close on all posted transactions by date range. The Hard Close feature allows the administrator or co-administrator to lock all claims, payments, refunds, and adjustments that fall within the specified time frame. The Hard Close feature can be used for any date range that a practice chooses, and should always be used to lock claims prior to running any financial reports for the period. No one, including the administrator, can edit financial information on hard-closed transactions after the date range has been closed. Selected non-financial information may be edited, and these areas are determined by the administrator during the setup process. For more information on hard closing financial information, refer to the System Administration Users Guide. The only way to alter financial information for a claim or claims that have been hard closed is to void the initial claim and recreate a new one using the Void and Recreate feature. For more information on voiding and creating claims that have been closed, refer to the section titled Voiding and Recreating Multiple Claims at Once on page 46. Claims: All claims through the To Date (end date) of the specified time period will be locked. If there are claims that are preventing a hard close due to a claims status designated during setup, you can move these claims into a future period to close the current period and continue with the hard close action. These claims will not be included in reporting for the current period.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

118

Claims

ANSI File Status

ANSI File Status

The ANSI File Status icon on the Billing band of the Navigation pane provides access to a feature that displays formatting errors in individual claims that have caused an entire batch of claims to be rejected.

Note: This feature is enabled by item key. Contact eClinicalWorks Support for more information. To view ANSI file status: 1. From the Billing band in the left navigation pane, click the 997 File Status icon. The ANSI File Status window opens:

2. Use the drop-down list to select a clearinghouse or to select File to browse for the ANSI 997 or ANSI 277 file. 3. Click the Import File button. 4. Click the More (...) button next to the Select Imported By field to sort the grid by the name of the people who imported ANSI files. 5. To sort the grid by date, select the date from the drop-down calendar on which the ANSI file you want to view was imported. 6. Check the All Imported Dates box to select all imported ANSI files. The ANSI File Status window opens and displays batch files of claims that were rejected because of formatting errors in one or more claims. The grid is sorted according to the filters set above. 7. Highlight the batch file you want to view and click the Detail button to view the individual claims in the batch. The Rejected Claims Detail window opens and displays all the claims in the batch you selected, as well as information about the claim and the error that caused the batch to be rejected. Click the Export Excel button to export the contents of the grid to an Excel spreadsheet and/or click the Print button to print a copy of this grid.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

119

Claims

ANSI File Status

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

120

PAYMENTS

About the Payments Window

Users can add and post payments, as well as look up and modify payments that have already been added to the system, from the Payments window. The Posted column shows the payment amounts that have been posted against a specific claim while the Unposted column shows those amounts not yet associated with a claim. To look up payments: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens:

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

121

About the Payments Window

Payments

2. Set the following filters as desired to look up payments: Field Payment From Description Select whether you want to look up payments from insurance companies, patients, or both from this drop-down list. To look up payments that were posted by a specific user, select the desired user from this drop-down list. To look up payments made with a specific check number, enter the desired number in this field. If you know the ID number of the payment you want to look up, enter it in this field. To filter payments by their amounts: 1. 2. Select an appropriate math symbol from the drop-down list. Enter an amount to use with this math symbol in the text entry field. Only payments with amounts that match the selected criteria are displayed (e.g., if > is selected from the drop-down list and 20 is entered into the text entry field, then only payments over 20 dollars are displayed).

Posted By Check # Payment ID Balance

Sort By Facility

Select the desired criteria for sorting your results from this drop-down list. To view payments made at a specific facility, click the More (...) button next to this field and select the desired facility from the Facility List window. To view payments made by a specific patient, click the More (...) button next to the Patient field and select the desired patient from the Patient Lookup window. To view payments made by a specific insurance company or all the members of an Insurance Group: 1. Select the criteria you want to filter results by (Insurance or Insurance Group) using the drop-down list. Click the More (...) button next to this field to select an insurance company from the Insurances window or an Insurance Group from the Select Insurance Group window.

Patient

Insurance / Ins. Grp

2.

Status Batch #

To view payments with a specific status, select the desired status from this drop-down list. To view payments in a specific batch, either enter the number of the batch in this field if you know it, or click the More (...) button next to this field and select the desired batch. To make the selected batch the default batch, check the Make Default Batch box. For more information on looking up payment batches, refer to the section titled Looking Up Payment Batches on page 125.

122

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

About the Payments Window

Field Rcvd Pmt Dt(s) / Pstd Pmt Dt(s)

Description To view payments that were added or posted in a specific date range: 1. Select the criteria you want to filter results by (Received Payment Date or Posted Payment Date) from the drop-down list. Select a date range that contains the payment(s) you want to look up using the two drop-down calendars.

2. Hide Options

Click this button to hide all the filters, providing more space to view search results. Once this button is clicked once, it changes to a Show Options button. Clicking this button restores the filters.

Lookup

Once all filters are set as desired, click this button to display the claims that match the selected criteria.

3. Once all the filters are set as desired, click the Lookup button. Payments that meet the specified criteria display with the following information: Column Lock Icon Paperclip Icon E Icon Payment ID Posted By Posted Date Payment From Check No Check Date Amount Posted Unposted Description A lock icon displays in this column for all payments that have been locked. A paperclip icon displays in this column for all payments that have had an EOB scanned into the system. An E icon displays in this column for all payments that are associated with an imported ERA. The payment ID number for each payment is displayed in this column. The user who posted each payment is displayed in this column. The date that each payment was posted is displayed in this column. The patient or insurance company that each payment is from is displayed in this column. The check number for payments made by check is displayed in this column. The date that a check is received for payments made by check is displayed in this column. The total amount of each payment is displayed in this column. The amount of this payment that has been posted to a claim is displayed in this column. The amount of this payment that remains to be posted is displayed in this column.

The results can be sorted using any available criteria by clicking the desired column heading. Clicking any heading once, sorts the results in descending order using that criteria. Clicking the same heading again re-sorts the results in ascending order using that criteria.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

123

Adding Received Payments

Payments

Adding Received Payments

Payment Batches

Starting Payment Batches

Payment Batches can be created from the Payments window. Payment Batches are optional and do not need to be created in order to post payments. To start a Payment Batch: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens. 2. Click the Payment Batch button to open a drop-down list. 3. From the drop-down list, click the Start Payment Batch option. The Create Payment Batch window opens with the Batch # field automatically populated:

4. Check the Default Batch box if you want the Batch # field to default to this batch every time you enter a payment until this batch is ended. 5. Select the date you are creating this batch on from the Date drop-down calendar. 6. Enter a name for this batch in the Name field. 7. Enter the total amount of all payments that are a part of this batch in the Batch Amt field. 8. Click the OK button. The Payment Batch is now started.

124

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Adding Received Payments

Looking Up Payment Batches

Payment Batches can be looked up by name and ID, as well as date range and status. To look up Payment Batches: 1. From the Payments window, click the More (...) button next to the Batch # field. The Payment Batch window opens:

2. Enter the name or ID you want to search for in the Look Up Batch field. 3. Select either Name or ID from the by drop-down list. 4. Select the date range you want to search in from the Batch Date drop-down calendars. 5. Select the status of the batches you want to look up from the Status drop-down list. 6. Check the All box next to the Created By heading to search in all staff members, or click the More (...) button here to filter results by a specific staff member. 7. Highlight the batch you want to use on the Payments window and click the OK button. The Payment Batch window closes and the selected batch is added to the Batch # field on the Payments window. Note: Checking the Make Default Batch box on the Payments window causes the selected batch to populate in the Batch # field automatically when entering payments, until this payment batch is ended.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

125

Adding Received Payments

Payments

Ending a Payment Batch

Once you are finished using a Payment Batch, it can be ended from the Payments window. To end a Payment Batch: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens. 2. Enter the number of the batch you want to end in the Batch # field, or select one by clicking the More (...) button next to the Batch # field. For more information on looking up payment batches, refer to the section titled Looking Up Payment Batches on page 125. 3. Click the Payment Batch button to open a drop-down list. 4. From the drop-down list, click the End Payment Batch option. The selected Payment Batch is now ended. Note: Payment Batches can also be ended from the Create Payment Batch window by clicking the End radio button in the Status section.

Fast Payments

The Fast Payments feature allows users to enter multiple patient payments quickly based on account numbers. Once the fast payments are entered, the system automatically applies them to any claims with outstanding balances, starting with the oldest claim. Any remaining amount is then marked as an Unapplied Amount.

Entering Fast Payments

Fast Payments can be entered for patients from the Payments window. Fast payments cannot be made for insurance companies. To enter fast payments: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens. 2. Click the Fast Pt Payment (F5) button. OR Press the F5 key on your keyboard. The Patient Payment - Rapid Entry window opens:

126

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Adding Received Payments

3. Select a batch to which you want this payment applied by clicking on the More (...) button next to the Batch # field. 4. Click in the Account Number section of the Hot Key Entry field at the top of the window and enter the desired account number. 5. Press the right arrow key on your keyboard to move to the Amount section of the Hot Key Entry field. 6. Enter the total amount of this payment. 7. If desired, press the right arrow key on your keyboard to move to the PmtMethod, CheckNo, and Memo sections of the Hot Key Entry field and enter the appropriate information in these sections. Note: Press the F3 key on your keyboard at any time to preview this payment and verify that all information is entered correctly. IMPORTANT! Enter the number of the payment method you want to use, not the text. For more information on configuring payment method codes, refer to the System Administration Users Guide. 8. Press the F3 key on your keyboard once to preview this payment, and a second time to save it. 9. Repeat steps 4 - 8 to enter additional payments for this batch. To update a payment after it has been saved, highlight it and click the Update button.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

127

Adding Received Payments

Payments

Patient Payments

Adding Patient Payments

Patient payments must be added to the system before they can be posted. For more information on posting patient payments that have already been added to the system, refer to the section titled Posting Patient Payments on page 140. To add payments from patients: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens. 2. Click the Add Pt Payment (F2) button. OR Press the F2 key on your keyboard. The Patient Lookup window opens. 3. Double-click the patient that this payment is from. The Receive Payments window opens:

The following table describes the information and options available on this window:

128

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Adding Received Payments

Field/Button/Option Patient

Description The selected patient's demographic information is displayed here. To select a new patient for this payment, click the Sel button next to this field and select the desired patient from the Patient Lookup window. To view the selected patient's Patient Information, click the Info button. To view the selected patient's Patient Hub, click the Hub button.

Facility

To select the facility where this payment is being made, click the Sel button next to this field and select the desired facility from the Facility List window. Enter a short description of this payment in this field. Select the date that this payment was made on using this drop-down calendar. Click this button or press the F5 key on your keyboard to scan in any documents associated with this payment (e.g., the check or credit card used to make the payment). Enter the amount of this payment in the field here. The button next to this field displays the amount of the co-payment for the primary insurance company. You can click this button to enter that amount into this field automatically.

Memo Date Scan (F5)

Amount

Pmt. Method Check No.

Select the method that this patient is using for this payment. If this payment is being made by check, enter the number of the check in this field. Optionally, this field can be used to record other information, such as the last four digits of the credit card number used for the payment.

Patient Insurance(s) Batch #

The insurance companies and co-payments associated with this patient. To associate this payment with a Payment Batch, click the More (...) button next to this field and select the desired batch. If a default batch has been specified for the user that is logged in, it is automatically populated in this field. For more information on looking up payment batches, refer to the section titled Looking Up Payment Batches on page 125.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

129

Adding Received Payments

Payments

Field/Button/Option Auto Post Gr. Clms (F3)

Description To post this payment to the selected patient's guarantor's claims automatically, click this button or press the F3 key on your keyboard. Clicking this button automatically posts the payment to the oldest claims with patient balances for the selected patient's guarantor. The payment could be posted to claims for the selected patient, the guarantor, or for other patients with the same guarantor.

Auto Post Pt. Clms (F4)

To post this payment to the selected patient's claims automatically, click this button or press the F4 key on your keyboard. Clicking this button automatically posts the payment to the oldest claims with patient balances for the selected patient only.

Auto Post

Click this button to post the payment to the claims you have selected on this window automatically, starting with the oldest claims. To print a receipt for this payment, click this button. To view the payment logs for this patient: 1. 2. Click the green arrow next to the Print Receipt button to open a drop-down list. From the drop-down list, click the View Payment Logs option. The Patient Payment Logs window opens, displaying all the past payments from this patient. Click the Copy button here to copy this information into a text or Excel file. Click the green arrow next to the Print Receipt button to open a drop-down list. From the drop-down list, click the Lock Payment option. A confirmation window opens. Click the Yes button. This payment is now locked. Click the green arrow next to the Print Receipt button to open a drop-down list. From the drop-down list, click the Print Billing Summary and Receipt option. The Print window opens. Select the desired printer and click the Print button. A Billing Summary is printed for this patient and a receipt is printed for this payment.

Print Receipt View Payment Logs

3. Lock Payment

To lock this payment: 1. 2.

3. Print Billing Summary and Receipt

To print a billing summary and receipt at one time: 1. 2.

3.

130

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Adding Received Payments

Field/Button/Option Visits

Description To select the visit(s) that you want to apply this payment to: 1. 2. 3. Click the Visits button. The Patient Visits window opens. Check the box(es) next to the visit(s) to which you want to apply this payment. Click the OK button. The selected visits are added to the Receive Payments window.

Claims

To select the claim(s) that you want to apply this payment to: 1. 2. Click the Claims button. The Payment Posting window opens. Click one of the following tabs: Patient Based - Look up claims for a specific patient. Insurance Based - Look up claims for a specific insurance company or Insurance Group. Guarantor Based - Look up claims for a specific guarantor. Set the filters as desired and click the Get Claims button. The claims that match the selected criteria display. Check the box(es) next to the claim(s) to which you want to apply this payment. Click the Apply button. The selected claims are added to the Receive Payments window. Repeat steps 2-5 until all desired claims have been applied. Click the OK button. The Payment Posting window closes and any claims that are currently selected are also added to the Receive Payments window.

3.

4. 5.

6. 7.

Delete

To remove a visit or claim from the Claims paid (with this payment) section, highlight the desired visit or claim and click this button. To post this payment to the CPT level on a claim: 1. 2. Highlight the claim you want to post this payment to in the Claims paid (with this payment) section. Click the Post CPT button. The Payment Posting window opens. For more information, refer to the section titled Posting Payments on page 140.

Post CPT

Payments can be configured to be automatically posted to the CPT level from the Billing menu. For more information, refer to the Miscellaneous Configuration Options (Billing) section of the System Administration Users Guide.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

131

Adding Received Payments

Payments

Field/Button/Option Save & New (F7)

Description To save the information entered here and create another patient payment at once, click this button or press the F7 key on your keyboard. To save the information entered here and close the Receive Payments window, click this button or press the F8 key on your keyboard. To close the Receive Payments window without saving any of the information entered here, click this button or press the F9 key on your keyboard.

OK (F8)

Cancel (F9)

Adding Paper Payments from Insurance Companies

Payments from insurance companies must be added to the system before they can be posted. This section describes how to add payments made on paper (with EOBs). Payments made electronically (with ERAs) are added using a different method. For more information on adding electronic payments, refer to the section titled ERA (Electronic Remittance Advice) on page 157. For more information on posting payments from insurance companies that have already been added to the system, refer to the section titled Posting Insurance Payments on page 148. To add paper payments from insurance companies: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens. 2. To add payments from insurance companies for multiple claims: a. Click the Add Ins Payment (F3) button. OR Press the F3 key on your keyboard. The Insurances window opens. b. Highlight the insurance company that this payment is from and click the OK button. The Payments window opens. 3. To add payments from insurance companies for a single claim: a. Click the Single Ins Payment (F4) button. OR Press the F4 key on your keyboard. The Single Insurance Payment window opens:

132

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Adding Received Payments

b. Enter the number of the claim to which this payment is being applied in the Claim No field. c. Click the Lookup button. The Insurance companies associated with the specified claim display in the Insurances section. d. Highlight the insurance company that this payment is from and click the OK button. The Payments window opens:

The following table describes the information and options available on this window:

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

133

Adding Received Payments

Payments

Field/Button/Option Unposted

Description The balance of unposted payments for the selected entry is displayed here. This field is read-only and cannot be modified. The name of the selected insurance company displays in this field. This field is read-only and cannot be modified directly. Selecting a new insurance company changes the information in this field automatically. To select a new insurance company for this payment, click the Sel button next to this field and select the desired company from the Insurances window.

Insurance

Address

The street address of the selected insurance company displays in this field. This field is read-only and cannot be modified directly. Selecting a new insurance company changes the information in this field automatically. The city of the selected insurance company displays in this field. This field is read-only and cannot be modified directly. Selecting a new insurance company changes the information in this field automatically. The state of the selected insurance company displays in this field. This field is read-only and cannot be modified directly. Selecting a new insurance company changes the information in this field automatically. The phone number of the selected insurance company displays in this field. This field is read-only and cannot be modified directly. Selecting a new insurance company changes the information in this field automatically. To select the facility where this payment is being made, click the Sel button next to this field and select the desired facility from the Facility List window. Enter the amount of this payment in the field here. The button next to this field displays the amount of the co-payment for the primary insurance company. You can click this button to enter that amount into this field automatically.

City

State

Phone

Facility

Amount

Check No.

If this payment is being made by check, enter the number of the check in this field. Check numbers should be entered exactly as they appear on the EOB or check, including all leading zeros. Optionally, this field can be used to record other information, such as the last four digits of the credit card number used for the payment.

134

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Adding Received Payments

Field/Button/Option Batch #

Description To associate this payment with a Payment Batch, click the More (...) button next to this field and select the desired batch. If a default batch has been specified for the user that is logged in, it is automatically populated in this field. For more information on looking up payment batches, refer to the section titled Looking Up Payment Batches on page 125.

Received Dt Type Check Date EOB Date Notes

Select the date that this payment was received by your practice using this drop-down calendar. Select the method used to make this payment from this drop-down list. If this payment is made using a check, select the date on the check from this drop-down list. Select the date that the EOB for this payment was received from this drop-down list. Enter any miscellaneous notes concerning this payment in this field. To add keywords to this field, click the Browse... button and select the desired keyword from the Keywords window. To add a time stamp to this field, click the Time Stamp button.

Payment Advisory

To post this payment to claims, click this button. For more information, refer to the section titled Posting Insurance Payments on page 148.

View Payment Logs

To view the payment logs for this patient: 1. 2. Click the green arrow next to the Payment Advisory button to open a drop-down list. From the drop-down list, click the View Payment Logs option. The Insurance Payment Logs window opens, displaying all the past payments from this insurance company. Click the Copy button here to copy this information into a text or Excel file. Click the green arrow next to the Payment Advisory button to open a drop-down list. From the drop-down list, click the Lock Payment option. A confirmation window opens. Click the Yes button. This payment is now locked.

3. Lock Payment

To lock this payment: 1. 2.

3.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

135

Performing Actions on Payments

Payments

Field/Button/Option Unlock Payment

Description To unlock a payment that has been locked: 1. 2. Click the green arrow next to the Payment Advisory button to open a drop-down list. From the drop-down list, click the Unlock Payment option. A confirmation window opens. Click the Yes button. This payment is now unlocked.

3. OK Cancel

To save the information entered here and close the Payments window, click this button. To close the Payments window without saving any of the information entered here, click this button.

Performing Actions on Payments

Updating Payments

Payments that have been entered into the system can be updated at any time from the Payments window. To update payments: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens. 2. Set the filters at the top of the window as desired and click the Lookup button. The payments that match the selected criteria display. 3. Highlight the payment you want to update and click the Update button. OR Double-click the payment you want to update. If the selected payment is from a patient, the Receive Payments window opens. If the selected payment is from an insurance company, the Payments window opens. 4. Modify any of the information here as desired. For more information on the Receive Payments window, refer to the section titled Adding Patient Payments on page 128. For more information on the Payments window, refer to the section titled Adding Paper Payments from Insurance Companies on page 132.

136

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Performing Actions on Payments

Deleting Payments

Unlocked payments can be deleted from the Payments window. To delete payments: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens. 2. Set the filters at the top of the window as desired and click the Lookup button. The payments that match the selected criteria display. 3. Highlight the payment you want to delete and click the Delete button. A confirmation window opens. 4. Click the Yes button. The selected payment is now deleted.

Copying the Payment List to a Text or Excel File

The list of payments from any search can be copied to a text or Excel file, depending on your settings. To copy the payment list to a text or Excel file: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens. 2. Set the filters at the top of the window as desired and click the Lookup button. The payments that match the selected criteria display. 3. Click the Copy button. The payment list is copied to a text or Excel file.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

137

Performing Actions on Payments

Payments

Configuring Payment Default Options

You can customize the date and the default option for receiving payments from patients (cash, check, or credit card) that appear on the Receive Payments window. To customize the Payment window options: 1. From the Billing band, click Payments. The Payments window opens. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, click the select New Payment Defaults option. The My Payment Defaults window opens:

4. Click one of the following radio buttons in the Choose Default Payment Date for New Payments section: Today's Date - The current date is automatically selected for new payments. Date on the Payment Screen - The date selected in the left-most drop-down calendar on the Payments window is automatically selected for new payments. 5. Select the method of payment you want to use by default for new patient payments by clicking the desired radio button in the Choose Default Payment Method for New Patient Payments section. 6. To suppress the warning message that pops up when the posting date and service date are different, check the Suppress message Posting Date and Service Date... box. 7. Click the OK button. The payment default options are now configured.

138

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Performing Actions on Payments

Locking Payments

You can lock payments so that no one in the practice can change them. Typically, payments are locked at the end of the day after you tally the cash box and reconcile payments with cash. Payments can only be unlocked by users with security privileges. Payments can also be locked in batches from the Billing menu. For more information, refer to the System Administration Users Guide. To lock payments: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens. 2. Set the filters at the top of the window as desired and click the Lookup button. The payments that match the selected criteria display. 3. Check the box(es) next to the unlocked payment(s) you want to lock. You can also lock payments on the Receive Payments window (for patient payments) and Payments window (for insurance payments). 4. Click the Lock Payment(s) button. A confirmation window opens. 5. Click the Yes button. If the payments you are attempting to lock have unposted amounts, a second confirmation window opens. Click the Yes button here if you want to lock the payments anyway. The payments are now locked and a lock icon displays in their row(s) on the Payments window.

Unlocking Payments

Payments that have been locked can be unlocked from the Payments window. Users must have security permission to unlock payments. To unlock payments: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens. 2. Set the filters at the top of the window as desired and click the Lookup button. The payments that match the selected criteria display. 3. Check the box(es) next to the locked payment(s) you want to unlock. When only payments with a lock icon displayed in their row are selected, the Lock Payment(s) button changes to an Unlock Payment(s) button. 4. Click the Unlock Payment(s) button. A confirmation window opens. 5. Click the Yes button. The selected locked payments are now unlocked.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

139

Posting Payments

Payments

Posting Payments

Payments from insurance companies and patients can be posted against specific claims from the Payment Advisory and Payment Posting windows. On this window, insurance payments are posted from EOBs (Explanation of Benefits). For more information on posting payments from ERAs (Electronic Remittance Advice), refer to the section titled ERA (Electronic Remittance Advice) on page 157. Note: On the Payment Posting window, pressing the Enter key on your keyboard tabs through fields in the same manner as the Tab key. The process for posting payments differs depending on the source of the payment. The two payment sources are: Insurance Companies Patients

Posting Patient Payments

When you receive payments from patients, you can post them to a particular visit or to a claim. Payments may be regular payments or co-payments. To post payments from patients: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens. 2. Add a new patient payment, or update an existing payment. For more information on adding a new payment, refer to the section titled Adding Patient Payments on page 128. For more information on updating an existing payment, refer to the section titled Updating Payments on page 136. The Receive Payments window opens. 3. Once all appropriate visits and/or claims have been associated with this payment, highlight the desired payment and click the Post CPT button. Note: Payments can be configured to be automatically posted to the CPT level from the Billing menu. For more information, refer to the Miscellaneous Configuration Options (Billing) section of the System Administration Users Guide. The Payment Posting window opens:

140

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Posting Payments

4. The following table describes the information and options available on this window: Field/Button/Option Account Inquiry Description Click this button to view the Patient Inquiry Detail window. For more information on this window, refer to the section titled Viewing a Patient Account on page 179. Various forms can be printed by clicking this menu and selecting the desired form from the drop-down list. To delete a CPT line-item posting: 1. 2. 3. Highlight the line you want to delete in the CPT Payments section. Click the Options menu to open a drop-down list. From the drop-down list, click the Delete CPT Posting option. A confirmation window opens. Click the Yes button. The selected CPT line-item posting is now deleted.

Print Options

4. Payment

The ID number for this payment displays here. This information is read-only and is not editable.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

141

Posting Payments

Payments

Field/Button/Option Claim No

Description The number of that claim that this payment is being posted to is displayed here. This information is read-only and is not editable. To view or modify this claim, click the View Claim button. For more information on claims, refer to the section titled Claims on page 23.

Patient

The name of the patient that this claim is for is displayed here. This information is read-only and is not editable. To view the Patient Information for this patient, click the Info button. To view the Patient Hub for this patient, click the Hub button.

Provider Insurance(s)

The billing provider for this claim is displayed here. This information is read-only and is not editable. A list of insurance companies associated with this patient are displayed here. Indicators include P (Primary Insurance), S (Secondary Insurance), and T (Tertiary Insurance). This information is read-only and is not editable. Payments currently posted to this claim number are displayed here. This information is read-only and is not editable. To view the details of a posted payment, highlight the desired payment in this section and click the View Payment button.

Payment(s)

Check

If a fee schedule is associated with this claim, click this button to reconcile the posted payment with allowable amounts on the fee schedule. The step will catch any errors before you post the payment. If a fee schedule associated with this claim, it is displayed here. Click this button to view which payers are responsible for each line item. To select different payers for different line items: 1. 2. 3. 4. 5. Click the CPT Payers button. The Line Item Payers window opens. Check the Enable different payers for different line items box. Click in the Bill To column for the desired CPT/HCPCS code to expose a drop-down list. Select the insurance company you want to bill for this line item from the Bill To drop-down list. Click the OK button. The Line Item Payers window closes and your changes are saved.

Fee Schedule CPT Payers

142

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Posting Payments

Field/Button/Option CPT Adjs

Description Click this button to view any CPT adjustments on this claim. To add new adjustments: 1. 2. Click the CPT Adjs button. The Additional CPT Adjustments window opens. Click the More (...) button next to the Claim Adjustment Group Code field and select the desired group code from the Group Codes window. Click the More (...) button next to the Claim Adjustment Reason Code field and select the desired reason code from the Claim Adjustment Reason Codes window. The following information explains proper usage of these codes: CO (Contractual Obligations) - This group code should be used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment. Generally, these adjustments are considered a write-off for the provider and are not billed to the patient. CR (Corrections and Reversals) - This group code should be used for correcting a prior claim. It applies when there is a change to a previously adjudicated claim. When correcting a prior claim, CLP02 (Claim Status Code) must be 22. Refer to ASC X12N Health Care Claim Payment/Advice Implementation Guide (835) section 2.2.8 for complete information about corrections and reversals. OA (Other Adjustments) - This group code should be used when no other group code applies to the adjustment. PI (Payer-Initiated Reductions) - This group code should be used when, in the opinion of the payer, the adjustment is not the responsibility of the patient, but there is no supporting contract between the provider and the payer (i.e., medical review or professional review organization adjustments). PR (Patient Responsibility) - This group should be used when the adjustment represent an amount that should be billed to the patient or insured. This group would typically be used for deductible and co-pay adjustments. Enter the amount of the adjustment in the Adjustment Amount field. Click the Add New Adjustment button. The adjustment is added as specified to the CPT Adjustments section.

3.

4. 5.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

143

Posting Payments

Payments

Field/Button/Option CPT Adjs (Cont'd)

Description To delete adjustments: 1. From the Additional CPT Adjustments window, enter the row number of the adjustment you want to delete (displayed in the No column in the CPT Adjustments section) in the Adjustment Row Number field. Click the Delete button. A confirmation window opens. Click the Yes button. The specified adjustment is now deleted.

2. 3. CPT Pmts Show Msg Codes

Click this button to view a report of all line-item payments that have been posted to this claim. Click this button to open the ERA Reason Codes window, which includes a list of the Claim Reason Codes that are associated with this claim, as well as a list of all ERA Reason Codes available in the system. To print this list, click the Print button. Enter the EOB information by CPT and service date in the following fields: Allowed amount - The amount allowed by the insurance company. Deduct - The deductible amount (if any). CoIns - The co-insurance amount (if any). CoPay - The co-payment amount (if any). Paid - The amount paid by the insurance company. Adjust - The calculated amount between the Paid amount and the Billed amount. Withheld - The amount the insurance company withheld from the payment (if any). Code - (Optional) The code from the EOB that identifies this payment. The rest of the columns displayed here are read-only and cannot be edited.

CPT Payments

Use CPT Totals

Check this box to use update the totals in the Total Payment Posted for Claim from Current EOB section each time you add an amount to the CPT payments row. Check this box to add the Balance column to the CPT Payments section in front of the Allowed column. Information concerning CPT balances displays here. Check this box to add the FS Allowed column to the CPT Payments section in front of the Allowed column. Information concerning the allowed amount on the fee schedule displays here.

Show CPT Balances

Show FeeSch Allowed

144

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Posting Payments

Field/Button/Option BP (F5)

Description To bill this claim to the primary insurance for this patient, perform one of the following actions: Check the BP box in the section to the left of this button. Click the BP (F5) button. Press the F5 key on your keyboard.

BS (F6)

To bill this claim to the secondary insurance for this patient, perform one of the following actions: Check the BS box in the section to the left of this button. Click the BS (F6) button. Press the F6 key on your keyboard.

BT (F7)

To bill this claim to the tertiary insurance for this patient, perform one of the following actions: Check the BT box in the section to the left of this button. Click the BT (F7) button. Press the F7 key on your keyboard.

PT (F8)

To bill the remainder of this claim to the patient, perform one of the following actions: Check the PT box in the section to the left of this button. Click the PT (F8) button. Press the F8 key on your keyboard.

Auto Assign Claim

To update this claim's assignment and status automatically, check this box. The claim will now be automatically updated in the following manner: If the payment from the patient's primary insurance carrier is posted and there is a balance, the system automatically assigns the claim to the secondary insurance (if applicable) and the claim status is changed accordingly. If the patient does not have a secondary insurance, then the balance is automatically assigned to the patient and the claim status is changed accordingly. If a payment from the secondary insurance is posted, any new balance will be assigned to the patient if the patient does not have tertiary insurance.

Set Claim Status

Use this drop-down list to select the status of the claim when assigning it to a different payer. For example, if you resubmit the claim to a secondary insurance company, set the status here to Claims Ready for Electronic Submission or Claims Ready for Paper Submission.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

145

Posting Payments

Payments

Field/Button/Option Financial Adjustments

Description Financial adjustments allow you to write off or discount a designated portion of a claim. The system provides two default codes: CD (Discount), WO (Write Off). To write off the co-payment for this claim: 1. Click the Write off... (F9) button. OR Press the F9 key on your keyboard. The Adjustment Codes window opens. Enter a name for this code in the Name field. Click the OK button. This adjustment is added to the Financial Adjustments section. The information displayed in this section can be modified by clicking in the field you want to modify.

2. 3.

To update the adjustment code for an existing adjustment: 1. Highlight the adjustment you want to update the adjustment code of in the Financial Adjustments section. Click the More (...) button next to the Write off... (F9) button. The Adjustment Codes window opens. Highlight the desired adjustment code and click the OK button. The selected adjustment is now updated as specified. Click the Add button. A blank row is added to the bottom of the Financial Adjustments section with today's date selected for the Date field. Click in any of the fields here to modify the information. Highlight the adjustment you want to post to the CPT level in the Financial Adjustments section. Click the Post CPT button. The Adjustment Posting window opens. Enter the amount you want to adjust each line in the Amount column for each CPT code. Click the OK button. The selected adjustment is now posted. Highlight the adjustment you want to delete in the Financial Adjustments section. Click the Delete button. A confirmation window opens. Click the Yes button. The selected adjustment is now deleted.

2.

3.

To add new adjustments: 1.

2.

To post the adjustment to the CPT level: 1. 2. 3. 4.

To delete existing adjustments: 1. 2. 3.

146

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Posting Payments

Field/Button/Option Current Balance New Balance

Description The amount still unpaid on the claim is displayed here. This information is read-only and is not editable. This field reflects any payments and adjustments that have been posted against the current balance. This information is read-only and is not editable. Click this button, or press the F2 key on your keyboard, to post the payment to the CPTs on this claim automatically, starting with the top of the list. Click this button, or press the F3 key on your keyboard, to save the information entered here and display the next claim for this insurance payment in one click. Click this button, or press the F4 key on your keyboard, to post the payment to this claim as specified and close the Payment Posting window. Click this button, or press the F5 key on your keyboard, to close the Payment Posting window without saving any of the information that has been entered. Enter any miscellaneous notes in the field here. To associate a billing message code with this note: 1. Click the More (...) button next to the Patient Statement Billing field. The Billing Message Codes window opens. Highlight the desired code and click the OK button. The selected code is added to the Patient Statement Billing field and the name of the code is added to the Notes field.

Auto Post (F2)

Save & Next (F3)

Post Payment (F4)

Close (F5)

Notes

2.

Line Item Posting Details

Historical payment-posting details from previous payments for the CPT highlighted in the CPT Payments section displays here. Payments are displayed here by date. Use the arrow keys to scroll through the list of payments.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

147

Posting Payments

Payments

Posting Insurance Payments

Insurance payments that have been added to the system must be posted to specific claims, preferably to the CPT-level, in order to keep accurate books. To post payments from insurance companies: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens. 2. Add a new insurance payment, or update an existing payment. For more information on adding a new payment, refer to the section titled Adding Paper Payments from Insurance Companies on page 132. For more information on updating an existing payment, refer to the section titled Updating Payments on page 136. The Payments window opens. 3. Click the Payment Advisory button. The Payment Advisory window opens:

4. The following table describes the information and options available on this window:

148

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Posting Payments

Field/Button/Option Add Claims (F2)

Description To select the claim(s) that you want to apply this payment to: 1. Click the Get Claims (F2) button. OR Press the F2 key on your keyboard. The Payment Posting window opens. Click one of the following tabs: Patient Based - look up claims for a specific patient. Insurance Based - look up claims for a specific insurance company or Insurance Group. Guarantor Based - look up claims for a specific guarantor. Set the filters as desired and click the Get Claims button. The claims that match the selected criteria display. Highlight the claim to which you want to apply this payment. Click the Apply button. The selected claims are added to the Receive Payments window. Repeat steps 2-5 until all desired claims have been applied. Click the OK button. The Payment Posting window closes and any claims that are currently selected are also added to the Receive Payments window.

2.

3.

4. 5.

6. 7.

Claim ID / Go (F3)

If you know the number of the claim you want to post this payment for, enter it in the Claim ID field and click the Go (F3) button or press the F3 key on your keyboard. To post payments to the CPT level: 1. 2. Highlight the claim you want to post this payment to in the Claims Posted section. Click the Post CPT (F4) button. OR Press the F4 key on your keyboard. The Payment Posting window opens. Post the payments to the CPT level as desired. For more information, refer to the section titled Posting Patient Payments on page 140.

Post CPT (F4)

3.

Scan (F5)

Click this button, or press the F5 key on the keyboard, to scan the EOB for this payment.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

149

Posting Payments

Payments

Field/Button/Option Delete

Description To delete a posted claim: 1. 2. 3. Highlight the claim you want to delete in the Claims Posted section. Click the Delete button. A confirmation window opens. Click the Yes button. The selected claim is now deleted from this window.

Show Msg Codes

Click this button to open the ERA Reason Codes window, which includes a list of the Claim Reason Codes that are associated with this claim, as well as a list of all ERA Reason Codes available in the system. To print this list, click the Print button. Click this button to copy the information displayed here to a text or Excel file. To view the payment logs for this patient: 1. 2. Click the Options button to open a drop-down list. From the drop-down list, click the View Payment Logs option. The Insurance Payment Logs window opens, displaying all the past payments from this insurance company. Click the Copy button here to copy this information into a text or Excel file. Click the Options button to open a drop-down list. From the drop-down list, click the Lock Payment option. A confirmation window opens. Click the Yes button. This payment is now locked. Click the Options button to open a drop-down list. From the drop-down list, click the Unlock Payment option. A confirmation window opens. Click the Yes button. This payment is now unlocked.

Copy View Payment Logs

3. Lock Payment

To lock this payment: 1. 2.

3. Unlock Payment

To unlock a payment that has been locked: 1. 2.

3. Lock OK Cancel

Click this button to lock this payment. Click this button to close the Payment Advisory window and save the information you have entered. Click this button to close the Payment Advisory window without saving any of the information entered here.

150

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Posting Payments

Posting Capitation Payments

Bulk capitation payments are not posted to the individual patient. The check is posted in bulk to one claim. To post capitation payments: 1. From the File menu, click the Insurances option. The Insurances window opens. 2. Locate the insurance from the list and double-click on the row. The Update Insurance window opens. 3. Click the Capitation tab. The Capitation options display 4. Check the Managed Care/Capitation Plan box. The Capitated CPT/HCPCS Codes section displays. 5. Select a capitation write-off code by clicking the More (...) button next to the Capitation Write Off Code field. 6. Click the All Codes radio button. OR a. Click the Selected Codes radio button. The Capitated CPT Codes section displays. b. Click the Add button to add all desired CPT Codes. 7. Leave the Payment per Patient field blank:

8. Click the OK button. The Update Insurance window closes and your changes are saved. 9. Create a dummy patient for the insurance company capitation (e.g., Aetna Capitation):

For more information on creating new patients, refer to the Front Office Users Guide. 10. Add a dummy CPT Code to the system named CAP (example) with a description of Capitation Payment:

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

151

Posting Payments

Payments

For more information on creating new CPT codes, refer to the Billing Setup chapter of the System Administration Users Guide. 11. Create a claim for the dummy patient set up in step 9 and select the appropriate provider and facility. 12. Set the service date as the first day of month of capitation. For example, for the July capitation payment, use 07/01/2007. If the check received covers more than one physician and the EOB indicates a breakdown by physician, you can create a claim for each provider. This allows you to credit each provider for their portion of the capitation payment. 13. Add the dummy CPT Code set up in step 10:

14. Click the OK button. The Claim window closes and this claim is saved. 15. Add an insurance payment for the capitated insurance company with the amount of the capitation payment:

152

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Posting Payments

For more information on posting insurance payments, refer to the section titled Posting Insurance Payments on page 148. 16. Click the Payment Advisory button. The Payment Advisory window opens. 17. Add the dummy claim created in steps 11 - 14. 18. Highlight the dummy claim and click the Post CPT button. The Payment Posting window opens. 19. Enter the amount of the capitaiton payment in the Paid column for the dummy CPT Code. This will result in a credit balance on the claim. 20. Enter a financial adjustment using the capitation write-off code: a. Click the Add button in the Financial Adjustments section. b. Click the More (...) button in the Financial Adjustments section. The Adjustment Codes window opens. c. Highlight the capitation write-off code and click the OK button. The selected code is added to the Payment Posting window. d. Enter a negative amount equaling the amount entered into the Paid column in step 19. This will result in a zero balance on the claim:

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

153

Hard Closing Payments

Payments

21. Click the Close button. A confirmation window displays. 22. Click the Yes button. The capitation payment is now posted.

Hard Closing Payments

Practices can enable and perform a financial hard close on all posted transactions by date range. The Hard Close feature allows the administrator or co-administrator to lock all claims, payments, refunds, and adjustments that fall within the specified time frame. The Hard Close feature can be used for any date range that a practice chooses, and should always be used to lock claims prior to running any financial reports for the period. No one, including the administrator, can edit financial information on hard-closed transactions after the date range has been closed. Selected non-financial information may be edited, and these areas are determined by the administrator during the setup process. For more information on hard closing financial information, refer to the System Administration Users Guide. Payments: All payments must be completely posted, preferably to the CPT level, before closing a time period. Modifications to the Received Date, and changes to the choice of claim(s) the payment is posted to, are not allowed once a period, which includes the Received Date, is closed. Note: A Hard Close cannot be performed if there are existing unposted patient or insurance payments. In the case of patient pre-payments, patient pre-payments can be posted to a dummy claim until a claim with true charges is created.

154

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Payments

Miscellaneous Payment-Related Actions

Miscellaneous Payment-Related Actions

Charging for Returned Checks

If a patient payment is drawn against insufficient funds, the patient's check is returned to the practice and an overdraft or non-sufficient fund (NSF) fee is charged by the patient's bank. Use this procedure to reinstate the previous patient balance, and to include the bank fee in the new balance if necessary. To reinstate the previous patient balance and charge for the returned check (if necessary): 1. From the desired patient's Hub, click the Account Inquiry button. The Patient Inquiry Detail window opens. 2. Locate and make a note of the date and amount of the original payment:

3. Close the Patient Inquiry Detail and Patient Hub windows. 4. From the left navigation pane, click the Billing band. The Billing icons display. 5. Click the Payments icon. The Payments window opens. 6. Click the Add Patient Payment button at the bottom of the window. The Patient Lookup window opens. 7. Locate and select the desired patient. The Receive Payments window opens. 8. If necessary, use the Date drop-down calendar feature to change the current date to the date the check was received back from bank. 9. In the Amount field, post a negative payment to offset the original amount. 10. Select the Check option from the Pmt. Method drop-down list. 11. Enter the original check number in the Check No. field:

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

155

Miscellaneous Payment-Related Actions

Payments

12. Click the Claims button at the bottom of the window. The Payment Posting window opens with the Patient Based tab displayed. 13. Set the Claim Balance filter to >= 0:

14. Click the Get Claims button. The list of claims for the patient displays. 15. Check the box next to the claim(s) paid with the return check and click the OK button. The selected claim is added to the Claims Paid (with this payment) section on the Receive Payments window. 16. Click in the Payment field for the desired claim. If the original payment encompasses more than one claim, the amounts must be adjusted accordingly across the multiple claims. 17. Enter the negative amount into the Payment field:

18. Click the OK button. A dialog message displays warning that the Payment Date and the Service Date are different. 19. Click the Yes button. This balance is back on the patient's account. Note: If payments are posted to the CPT level, you must post the returned check to the CPT level as well.

156

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

ERA

ERA (Electronic Remittance Advice)

eClinicalWorks, in conjunction with your clearinghouse, allows you to receive electronic remittance advice (ERA). ERA is a statement of payments (but not the actual payment itself) that details the claims that are being reimbursed. ERAs are typically generated by large payers, such as Medicare and Blue Cross/Blue Shield, and sent directly to your clearinghouse, which in turn forwards them electronically to you.

About ERAs

ERA provides the following benefits: Speed up posting - ERA considerably reduces the remittance posting time. eClinicalWorks uses the Electronic Remittance Advice to streamline and automate the electronic posting process. For example, when you download from your clearinghouse an advice of a check from Medicare that covers two claims and click ePost, eClinicalWorks automatically posts the payments to the two claims. Balance Day Sheets - ERA helps you manage your day sheet balances by showing you remittance totals by payer, by date, or by other selection criteria. You can use ERA printouts to help you reconcile your day sheets.

Which Payers Provide ERA?

Not all insurance payers are set up to use ERA. To be sure your payers are ERA-enabled, check the WebMD/Emdeon site (or the site affiliated with the clearinghouse you use), and check their Payer lists. For each payer for each state (for example, Blue Cross/Blue Shield of Maryland), the list will show whether it accepts ERA or only claims.

How are Payments Posted?

During ERA payment posting, the payments are posted by comparing the following parameters of ERA file with those on the claim in the eClinicalWorks database: CPT Code Modifiers Service Date IMPORTANT! If the parameters mentioned above in the ERA file do not match with those in the claim, then the corresponding CPT (line item) payment will not be posted. Payers will occasionally send additional CPT/modifiers in the ERA file. Normally, these payments are not posted as those additional CPT/Modifier combinations are not present in the claim that was originally created.

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

157

ERA (Electronic Remittance Advice)

ERA

But now when using Insurance Based payment posting, the application first compares the CPT/Modifiers combination in the ERA file with the claim, and if the combination does not match, then the application will compare only CPT codes and post the payment towards the corresponding CPT.

Setting Up ERA within eClinicalWorks

Contact eClinicalWorks Support to set up ERA in eClinicalWorks. The Support specialist will ensure that your clearinghouse and ERA connection work properly.

Using ERA with WebMD/Emdeon

If your clearinghouse is WebMD/Emdeon, a direct connection is established between WebMD/Emdeon and eClinicalWorks. This direct connection allows you to download the ERA directly into eClinicalWorks, where one-click automatic posting takes place by using the ePost button.

Importing an ERA from WebMD/Emdeon

To import an ERA from WebMD/Emdeon, eClinicalWorks Support must first set up ERA capabilities on your system. For more information on this setup, refer to the System Administration Users Guide. To import an ERA from WebMD/Emdeon: 1. From the Billing band, click the ERA icon. The ERA window opens:

158

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

ERA

ERA (Electronic Remittance Advice)

2. Select the WebMD option from the ERA Process drop-down list. 3. Click the Import ERA button. The system automatically logs into the Emdeon mailbox for the practice, retrieves the ERA files, and imports them into the eClinicalWorks application.

Importing an ERA from another Clearinghouse or Third-Party Vendor

To import an ERA, eClinicalWorks Support must first set up ERA capabilities on your system. For more information on this setup, refer to the System Administration Users Guide. To import an ERA from another clearinghouse: 1. Download the ERA file to your local system. 2. From the Billing band, click the ERA icon. The ERA window opens: 3. Select the File option from the ERA Process drop-down list. 4. Click the Import ERA button. A system window opens. 5. Browse your system to locate the desired ERA file to import and click the Open button. The ERA file is imported into eClinicalWorks.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

159

ERA (Electronic Remittance Advice)

ERA

Exporting ERAs

ERAs that have been imported into the system can be exported to other locations. To export ERAs: 1. From the Billing band, click the ERA icon. The ERA window opens. 2. Set the filters at the top of the window as appropriate to display the ERA you want to export. 3. Click the green arrow next to the Import ERA button to open a drop-down list. 4. From the drop-down list, click the Export ERA option. The Save As window opens. 5. Navigate to the location on your system where you want to save this file. 6. Enter the name you want to save this file as in the File Name field. 7. Click the Save button. The selected ERA is now saved to the specified location.

Posting ERAs

To post from an ERA, the ERA must exist within eClinicalWorks. If the ERA is external, it must first be imported into eClinicalWorks.

Posting Payments Using the ERA

Payments can be posted from an ERA. To post payments using the ERA: 1. From the Billing band, click the ERA icon. The ERA window opens. 2. If necessary, import the ERA following the instructions in the section titled Importing an ERA from WebMD/Emdeon on page 158 or the section titled Importing an ERA from another Clearinghouse or Third-Party Vendor on page 159. 3. Select the Unposted option from the Select Posting Status drop-down list to display only Unposted ERAs. All unposted ERAs display in the list with the following information: Status - Indicates whether the ERA is posted (P) or unposted (U). File ID - Indicates the file number from the clearinghouse. Payer - Indicates the insurance company that this ERA is from. Posted By - Indicates the user who posted this ERA. Posted Date - Indicates the date this ERA was posted. Method - Indicates the method of payment, which can be any of the following: Check - Check, with check number showing in the Trace column.

160

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

ERA

ERA (Electronic Remittance Advice)

Automated Clearinghouse (ACH) - Direct deposit, with the ID showing in the Trace column. Non-payment data - Information only; no dollars have been moved. Federal Reserve Funds/Wire Transfer - Wire transfer. 4. To view ERAs from a specific payer, click the More (...) button next to the Select Payer field and select the desired insurance company. 5. Select the facility you are using to post this ERA from the Facility drop-down list. 6. Optionally, check the Make this as Default box if you want the selected facility to be selected by default on this window. 7. Highlight the ERA you want to post and click the ePost button. eClinicalWorks processes the ERA and opens a window displaying all the postings, with any exceptions listed along with the reason why they did not post. You can print the information here by clicking the Print button. 8. Click the Payments button. The Payment Posting window opens. Examine the individual claims. Notice that if secondary insurance has been submitted by the payer, a flag is already set in the claim as Ready to Submit Paper or Ready to Submit Electronic. To see dollar totals, highlight them and then look at the Page Amt. and Total Amt. Unposted and Posted columns. The Posted column shows totals of the ERAs selected using the Selection criteria. You can highlight ERAs posted by a particular staff person. 9. To view the contents of a specific ERA, highlight it and click the View ERA button. For more information on posting payments, refer to the section titled Posting Payments on page 140. When ePosting ERAs, if the system encounters any voided claims, it automatically replaces them with the recreated claims. The ERA Exception Report then displays the list of voided (original) claims.

Marking an ERA as Posted

ERAs that have already been posted manually can be marked as posted so that they are not entered into the system twice. You may need to mark an ERA as posted if the advice is expected later and you've already received the physical check, or to avoid duplicate posting in cases when the EOB is already posted. To mark an ERA as posted: 1. From the Billing band, click the ERA icon. The ERA window opens. 2. If necessary, import the ERA following the instructions in the section titled Importing an ERA from WebMD/Emdeon on page 158 or the section titled Importing an ERA from another Clearinghouse or Third-Party Vendor on page 159. 3. Select the Unposted option from the Select Posting Status drop-down list to display only Unposted ERAs. 4. Highlight the ERA you want to mark as posted and click the Mark as Posted button. Note: The check number and the check amount on the manually posted payment must be an exact match to the trace number and the payment amount on the ERA file. If these areas of information do not match, the ERA will not be marked as posted.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

161

ERA (Electronic Remittance Advice)

ERA

Viewing ERAs

Viewing an ERA

Any ERAs that have been imported can be viewed. An ERA file may have information about multiple checks. The green arrow next to the View ERA button on the ERA window allows you to view the complete ERA file with information about all checks in the file corresponding to the check you select. To view an ERA: 1. From the Billing band, click the ERA icon. The ERA window opens. 2. Set the Filter ERA filters to display the ERA(s) you want to view. 3. To view individual checks in an ERA: a. Highlight the check you want to view. b. Click the View ERA button. The ERA window opens with information on the selected check displayed. 4. To view all checks in an ERA file: a. Highlight the ERA you want view. b. Click the green arrow next to the View ERA button to open a drop-down list. c. From the drop-down list, click the View Complete ERA option. The ERA window opens with information on the selected ERA displayed. 5. To view an ERA file in an Excel spreadsheet: a. Highlight the ERA you want view. b. Click the green arrow next to the View ERA button to open a drop-down list. c. From the drop-down list, click the View ERA in Excel option. An Excel window opens with information on the selected ERA displayed.

Viewing an ERA Exception Report

Exception reports can be viewed for any ERA from the ERA window. To view an ERA exception report: 1. From the Billing band, click the ERA icon. The ERA window opens. 2. Set the Filter ERA filters to display the ERA(s) you want to view. 3. Highlight the ERA that you want to view the exception report for and click the Exception Report button. The Posting Status window opens with the exception report for the selected ERA displayed.

162

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

ERA

ERA (Electronic Remittance Advice)

Using ERAs with Claims

Showing ERA Reason Codes

Message codes for payments can now be viewed on both the Payment Advisory and Claim Payments windows:

After an ERA has been ePosted, an ERA Reason Code is populated in the Code column for each line item. Highlight the desired line item and click the Show Msg Codes button on either of these windows to display a description of that code, as well as a listing of all ERA Reason Codes:

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

163

ERA (Electronic Remittance Advice)

ERA

Printing ERAs from the Printed Claims Window

ERAs for electronic claims can be printed from the Printed Claims window. To print ERAs for electronic claims from the Printed Claims window: 1. From the Billing band on the left navigation pane, click the Printed Claims icon. The Printed Claims window opens:

2. Select the date range for the claims from the drop-down calendars for the Date(s) and to fields. 3. Click the Lookup button. 4. A list of printed claims displays for the selected date range. 5. Check the boxes next to the claims for which you want to print ERAs. 6. Click Print ERA. The individual EOB for each claim prints as an individual print job. If a claim cannot be printed because it is not electronic, a pop-up window displays with the claims that are causing errors indicated.

164

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

ERA

ERA (Electronic Remittance Advice)

Printing ERAs at the Claim Level

ERAs can be printed at the claim level from the Claims window. To print ERAs at the claim level: 1. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens. 2. Double-click on a claim to open it. 3. Click the green arrow next to the Print HCFA button to open a drop-down list. 4. From the drop-down list, click the View ERA option. The ERA displays, split at the claim level. 5. Click the green arrow next to the Print HCFA option to open a drop-down list. 6. From the drop-down list, click the Print ERA option. The selected ERA is printed.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

165

ERA (Electronic Remittance Advice)

ERA

166

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

REFUNDS

Refunds

The Refunds feature lets you issue refunds to patients or to insurance companies. The refund feature of eClinicalWorks is flexible, and accommodates different workflows. For example, if your workflow requires you to generate refunds and post them at a later date, you can do this easily with eClinicalWorks. Also, you can add remittance notes, lock and unlock refunds, and view a log of your practice's refund activity.

About the Refunds Window

Let's take a closer look at the functions available from the Refund window. To open the Refunds window, click the Refunds icon from the Billing band in the left navigation pane:

Sort a refund list by given to, date range, individual facility, facility group, all facilities, or Refund ID. The refunds that match the search criteria are displayed in the list. The refund amount and posting status appears in the list.

The Copy button downloads the refunds to Notepad or Excel (depending on the Local Settings for the workstation).

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

167

Refunds

Refunds

Looking Up Refunds

The appropriate refunds must be looked up before the desired action can be performed on them. To look up refunds: 1. From the Billing band in the left navigation pane, click the Refunds icon. The Refunds window opens with today's date in the To and From date fields. 2. Select the type of refund you want to look up using the Given To drop-down list. 3. Select the date range for the refunds you want to look up using the Date(s) drop-down calendars. 4. To filter refunds by facility or Facility Group: a. Select either Facility or Facility Group from the gray drop-down list. The Facilities or Facility Groups window opens. b. Highlight the desired facility or Facility Group and click the OK button. 5. If you know the ID number of the refund you want to look up, enter it into the Refund ID field. 6. Click the Lookup button. The refunds that fit the selected criteria display.

Refund Procedures

Generating a Refund

The Refunds feature lets you issue refunds to patients or insurance companies. To generate a refund: 1. From the Billing band in the left navigation pane, click the Refunds icon. The Refunds window opens with today's date in the To and From date fields. 2. Click the Add button. The Refund window opens:

168

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Refunds

Refunds

3. Select the type of entity you are issuing this refund to from the Given To drop-down list. 4. Click the Select button to add the insurance or patient/guarantor name. The name and address of the selected insurance company or patient/guarantor fills the Name field on the Refund window. 5. Click the Facility... button to select the facility at which this refund was give. 6. If necessary, select the date this refund was given from the Date drop-down calendar. 7. Enter the amount of the refund in the Amount field. 8. Select the method of payment used for this refund from the Pmt. Method drop-down list. 9. If the payment method is by check, enter the check number in the Check No. field. 10. If required, add any applicable remittance notes in the Notes field. 11. Continue with posting the refund. OR Click the OK button to close this refund without posting it. The refund you created shows on the Refunds window with the amount of the refund Unposted. Verify that the amount and the posted are the same. For more information about posting refunds, refer to the sections titled Posting a Refund Associated with a Claim on page 170 or to Posting a Refund Associated with a Payment on page 172.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

169

Refunds

Refunds

Viewing a Log of Refund Activity

Users can view the history of refunds made to an insurance company or patient from the Refund window. To view a log of refund activity: 1. From the Billing band in the left navigation pane, click the Refunds icon. The Refunds window opens with today's date in the To and From date fields. 2. Set the filters at the top of the window as desired to display the refunds for which you want to view logs. 3. Highlight the refund you want to view the logs for and click the Update button. The Refund window opens. 4. Click the green arrow next to the Post Refund button to open a drop-down list. 5. From the drop-down list, click the View Refund Logs option. The Refund Logs window opens:

6. Click the Copy button to copy the refund log to a text or Excel file. 7. Click the OK button once you are done reviewing this information. The Refund Logs window closes.

Posting a Refund Associated with a Claim

Use this procedure to post refunds associated with a claim that have already been generated but not posted. To post a refund associated with a claim: 1. From the Billing band in the left navigation pane, click the Refunds icon. The Refunds window opens with today's date in the To and From date fields. 2. Set the filters at the top of the window to display the refunds you want to post. 3. Highlight the refund you want to post and click the Update button. The Refund window opens. 4. Click the Post Refund button. The Refund Posting window opens with the Claim Based tab displayed:

170

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Refunds

Refunds

5. To add a claim: If you ... know the claim number do not know the claim number Then ... 1. 2. 1. 2. 3. 4. 5. Enter it in the Claim Number field. Click the Go button. The claim fills the window. Click the Add Claims button. The Payment Posting window opens. Click the tab corresponding to the method you want to use to look up claims. Set the filters at the top of the window as desired and click the Get Claims button. Click the box(es) next to the claim(s) for which you are issuing a refund. Click the OK button. The claim fills the Refund Posting window.

6. To enter a refund for an entire claim: a. Click in the Refund field of the claim for which you want to post this refund. b. Enter the desired amount of the refund. c. Click the OK button. On the Refunds window, the refund now shows in the Posted column. 7. To enter a refund for a line item on a claim: a. Enter the total amount of the refund for all line items on this claim in the Refund field. b. Highlight the claim you want to post the refund for and click the Post CPT button. The Refund Line Posting window opens showing the dates of service, the CPT codes, and service descriptions. c. Entering the refund amount for each line item into the corresponding Amount field.

d. Click the OK button. On the Refunds window, the refund now shows in the Posted column.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

171

Refunds

Refunds

Posting a Refund Associated with a Payment

Use this procedure to post refunds associated with payments that have already been generated but not posted.

Note: This feature is enabled by item key. Contact eClinicalWorks Support for more information. To post a refund associated with a payment: 1. From the Billing band in the left navigation pane, click the Refunds icon. The Refunds window opens with today's date in the To and From date fields. 2. Set the filters at the top of the window to display the refunds you want to post. 3. Highlight the refund you want to post and click the Update button. The Refund window opens. 4. Click the Post Refund button. The Refund Posting window opens. 5. Click the Payment Based tab. The Payment Based options display. 6. Click the Add button. The Refund Payment to Posting window opens. 7. Enter the ID number for the payment you want to post this refund for in the Payment Id field. 8. Click the Lookup button. The payer name is automatically populated. 9. Enter the refund amount in the Amount field. 10. Click the OK button. The refund is added to the Refund Posting window. 11. Click the OK button. On the Refunds window, the refund now shows in the Posted column.

172

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Refunds

Refunds

Voiding a Refund

Refunds can be voided from the Refunds window. This allows users to remove any postings for this refund automatically. To void a refund: 1. From the Billing band in the left navigation pane, click the Refunds icon. The Refunds window opens with today's date in the To and From date fields. 2. Set the filters at the top of the window as desired to display the refund(s) you want to void. 3. Highlight the refund you want to void and click the Update button. The Refund window opens. 4. Click the green arrow next to the Post Refund button to open a drop-down list. 5. From the drop-down list, click the Void Refund option. The selected refund is now voided.

Deleting a Refund

Existing refunds can be deleted from the system. This is typically performed for duplicate refunds, or refunds that were entered erroneously. To delete a refund: 1. From the Billing band in the left navigation pane, click the Refunds icon. The Refunds window opens with today's date in the To and From date fields. 2. Set the filters at the top of the window as desired to display the refunds you want to delete. 3. Highlight the refund you want to delete and click the Delete button. A confirmation window opens. 4. Click the Yes button. The selected refund is now deleted.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

173

Refunds

Refunds

Locking a Refund

eClinicalWorks lets you lock a refund so that unauthorized individuals will not be able to make changes. You can lock a refund only when you are not actively working on the file. You can easily identify a locked refund on the Refunds window because a lock icon appears next to the locked refund. To lock a refund: 1. From the Billing band in the left navigation pane, click the Refunds icon. The Refunds window opens. 2. Set the filters at the top of the window as desired to display the refunds you want to lock. 3. Check the box(es) next to the refund(s) you want to lock. OR Check the box at the top of the window to select all displayed refunds at once. 4. Click the Lock Refund(s) button. A confirmation window opens. 5. Click the Yes button. The selected refunds are now locked.

Unlocking a Refund

Locked refunds can be unlocked by users with the appropriate security access when you need to make changes. For more information on setting security access for users, refer to the System Administration Users Guide. To unlock a refund: 1. From the Billing band in the left navigation pane, click the Refunds icon. The Refunds window opens. 2. Set the filters at the top of the window as desired to display the refunds you want to unlock. 3. Check the box(es) next to the locked refund(s) you want to unlock. OR Check the box at the top of the window to select all displayed refunds at once. 4. Click the Unlock Refund(s) button. A confirmation window opens. 5. Click the Yes button. The selected refunds are now unlocked.

174

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Refunds

Refunds

Hard Closing Refunds

Practices can enable and perform a financial hard close on all posted transactions by date range. The Hard Close feature allows the administrator or co-administrator to lock all claims, payments, refunds, and adjustments that fall within the specified time frame. The Hard Close feature can be used for any date range that a practice chooses, and should always be used to lock claims prior to running any financial reports for the period. No one, including the administrator, can edit financial information on hard-closed transactions after the date range has been closed. Selected non-financial information may be edited, and these areas are determined by the administrator during the setup process. For more information on hard closing financial information, refer to the System Administration Users Guide. Refunds: All refunds must be completely posted, preferably to the CPT level, before closing a time period. Modifications to the Date, and changes to the choice of claim(s) the refund is posted to are not allowed once a period that includes the Date is closed. Note: A Hard Close cannot be performed if there are unposted refunds.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

175

Refunds

Refunds

176

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

ACCOUNTS LOOKUP

The Accounts Lookup window allows users to perform the following actions: Generate patient statements. Search for accounts that need to be moved to collections.

About Accounts Lookup

Looking Up Patient Accounts

Sophisticated filter options let you easily find patient accounts. The more filters you select, the narrower or more specific your search becomes. To find more accounts, limit your filter selections. To look up patient accounts: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens:

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

177

About Accounts Lookup

Accounts Lookup

2. Set the following filters as desired: Field Appt Provider(s) / Pay To Provider(s) Description Accounts can be looked up by providers who conduct encounters or by providers who are paid for an encounter. Select the desired type of provider from the gray dropdown list and then check the All box to select all providers of that type, or click the More (...) button and select a specific provider. Service Date(s) Select a date range containing the encounters you are looking up accounts for using these drop-down calendars. To filter results by a specific place of service, select the desired POS code from this drop-down list. To filter results by facility or Facility Group, select the desired option from the gray drop-down list and click the More (...) button to select a facility or Facility Group. To filter results by their status in the collection management system, select the desired status from this drop-down list. To apply or ignore the patient statement cycle configured from the Billing menu, select the desired option from this drop-down list. This filter should normally be set to Apply. Sort Order Insurance / Insurance Grp Select the method you want to use to sort your results from this drop-down list. To filter results by insurance company or Insurance Group, select the desired option from the gray dropdown list and click the More (...) button to select an insurance company or Insurance Group. To filter results by a specific patient, click the More (...) button next to this field and select the desired patient. To filter accounts by statements that are due from the patient, check this box. To filter results by their place in the collection cycle, select the desired status from this drop-down list. To add dunning messages to any patient statements that are generated, check this box. To include unposted payments in the calculations for the Amount, Payments, Balance, and Pt Balance fields, check this box.

Place of Service Facility / Facl. Grp

Collection Status

Patient Stmt Cycle

Patient

Show Patient Statement Claims Only Collection Cycle Dunning Messages Include Unposted Payments

178

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Accounts Lookup

About Accounts Lookup

Field (Continued) Claim Balance / Patient Balance

Description To filter results by claim or patient balance: 1. 2. 3. 4. Select the desired type of balance from the gray drop-down list. Select an appropriate math symbol from the leftmost drop-down list. Enter an amount to use with this math symbol in the left-most text entry field. To combine this equation with another equation, select either And or Or from the center-left dropdown list. Select the desired math symbol from the centerright drop-down list. Enter the amount you want to use with this second equation in the right-most text entry field.

5. 6. `Don't Send Statements' Patients Deceased Consider claims from facilities marked as `Exclude Charges from Statements' Name Filter

To include patients in the results that have the Don't Send Statements box checked in their Patient Information, check this box. To filter results by patients marked as deceased, check this box. To include claims in the results from facilities that have had the Exclude Charges from Statements box checked during their Facility setup, check this box. To filter results by the name of the account name enter an alphabetic range into these fields (e.g., F and H to view only the accounts that have names beginning with F, G, or H). This is helpful if your workflow generates patient statements alphabetically (e.g., On Monday, you generate all statements for patients with the last names beginning with the letter A through the letter G).

3. Click the Lookup button. Patient accounts that meet your search criteria are now displayed.

Viewing a Patient Account

Patient Accounts can be viewed from the Accounts Lookup window. Note: Patient accounts can also be looked up from the Patient Hub. If you know the name of the account you want to look up, accessing it through the Patient Hub may be easier than attempting to set the filters on this window appropriately. To review a patient's account: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria are now displayed.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

179

About Accounts Lookup

Accounts Lookup

3. Highlight the account you want to view and click the View Account button. The Patient Inquiry Detail window opens:

Patient (and/or guarantor) balance, and aging insurance balance

Service dates, and patient and account information

Detailed account information by claim number. Highlight a row and click View Details to see detailed claim information

Buttons that invoke a function

4. Set the following filters as desired: Service Date(s) Select a date range containing the transactions you are looking up accounts for using these drop-down calendars. To filter results by a specific facility, click the More (...) button next to this field and select a facility. To filter results by their assigned status, select the desired option from this drop-down list. To filter results by insurance company or Insurance Group, select the desired option from the gray dropdown list and click the More (...) button to select an insurance company or Insurance Group. This filter is only active if the Insurance Only option is selected from the Assigned To drop-down list. Claim Balance / Patient Balance To filter results by claim or patient balance: 1. 2. Select the desired type of balance from the leftmost drop-down list. Select the desired balances from the drop-down list on the far right.

Facility Assigned To Insurance / Insurance Grp

180

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Accounts Lookup

About Accounts Lookup

Patient

To filter results by a specific patient, click the Sel button next to this field and select the desired patient. Once a patient is selected, their demographic information can be viewed by clicking the Info button, or their Patient Hub can be viewed by clicking the Hub button.

Collection Status

To filter results by a specific collection status, click the More (...) button next to this field and select the desired collection status. To display claims that are not in the collection management system, check this box. To filter results by claims with statements greater than or equal to a certain number, enter that number in this field. To display individual payments that have been posted to the CPT-level for claims in this list, check this box. To display the totals of payments that have been posted to the CPT-level for claims in this list, check this box.

Show Claims Not in Collection Only Show Claims with No. Of Statements >= Show CPT Payments Show CPT Payment Totals 5. Click the Lookup button.

Claims that meet your search criteria are displayed below the filters. 6. Perform one of the following tasks as desired: To... change service dates for this accounts look at account details for another patient view patient demographics look up additional patient information, for example: Progress Notes view claim detail Then... 1. 2. 1. 2. 3. 1. 2. 3. 1. 2. Select the desired date range from the Service Dates drop-down calendars. Click the Lookup button. Click the Sel button. Search for and highlight the desired patient. Click the OK button. Click the Info button. View and update demographics as needed. Click the OK button. Click the Hub button. Click the required button to view additional information. Highlight the desired row (Details are only applicable for claims, payments, and refunds. Details cannot be viewed when CPT Totals or Financial Adjustment rows are highlighted). Click the View Details button. The Claim window opens. View the claim details as needed. Click the OK button. Click the Alerts button. Enter the required alert. For more information about alerts, refer to the section titled Billing Alerts on page 217.

1.

2. 3. 4. add an alert 1. 2.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

181

Accounts Lookup Procedures

Accounts Lookup

To... view a previous patient statement review payment and refund history

Then... 1. 2. 1. 2. 3. Click the Statements button. Click the Print button to print the statement that was previously generated. Click the Pt Payments button. Review the history, or click the Copy button to copy the history to a text editor. Click the OK button.

copy the patient account to a text editor

Click the Copy button. The patient account information opens in your default text editor, for example Notepad.

7. Click the Close button when done. The Patient Inquiry Detail window closes.

Accounts Lookup Procedures

Viewing Payor Invoices

Payor invoices can be viewed from the Accounts Lookup window. This feature is used for practices that need to send invoices to certain payers instead of the CMS 1500 claim form.

Note: This feature is enabled by item key. Contact eClinicalWorks Support for more information. To view payor invoices: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria are now displayed. 3. Click the green arrow next to the Patient Statements option to open a drop-down list. 4. From the drop-down list, click the Payor Invoices option. The Payor Invoices window opens.

182

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Accounts Lookup

Accounts Lookup Procedures

Viewing Guarantor Statement Jobs

The generation status of guarantor statements can be viewed from the Accounts Lookup window. To view guarantor statement jobs: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria are now displayed. 3. Click the green arrow next to the Patient Statements option to open a drop-down list. 4. From the drop-down list, hover over the eGuarantor Statements All Filtered Accts. option to open another drop-down list. 5. From this drop-down list, click the Show Patient Statement Jobs option. The Guarantor Statement Generation Jobs window opens with the status of all jobs displayed.

Setting Patient-Specific Alerts from Accounts Lookup

Patient-specific alerts can be set for accounts from the Accounts Lookup window. To set patient-specific alerts from the Accounts Lookup window: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria are now displayed. 3. Highlight the account for which you want to set an alert. 4. Click the Set Alert button. The Patient Specific Alert window opens. 5. Specify the alert information as you would normally. For more information on setting alerts, refer to the EMR Users Guide.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

183

Accounts Lookup Procedures

Accounts Lookup

Copying the Patient Account List

The list of patient accounts displayed on the Accounts Lookup window can be copied to a text or Excel file at any time. To copy the patient account list: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria are now displayed. 3. Click the Copy button. Your default text editor or spreadsheet application opens with the list of Patient Accounts displayed.

Creating Patient Refunds from Accounts Lookup

Refunds can be created for patient accounts directly from the Accounts Lookup window. This feature must be enabled from the Billing menu before it can be used. For more information, refer to the Miscellaneous Configuration Options (Billing) section of the System Administration Users Guide. To create refunds for patient accounts: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria display. 3. Check the box(es) next to the account(s) for which you want to create refunds. OR Check the top-most box to select all displayed accounts at once. 4. Click the Options button to open a drop-down list. 5. From the drop-down list, click the Create Patient Refunds option. The Create Patient Refunds window opens:

184

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Accounts Lookup

Accounts Lookup Procedures

6. Enter the maximum refund per patient in the Maximum Refund Amount Per Patient field. 7. Check the boxes next to the accounts to which you want to post this refund. 8. Click the Auto Post button. The specified refund amount is now applied to the selected accounts. 9. Click the OK button. The Create Patient Refunds window closes and your changes are saved.

Collection Management from Accounts Lookup

Transferring Patient Accounts to Collections

Patient accounts can be transferred to the collection management system from the Accounts Lookup window. To transfer a patient account to collections: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria display. 3. Check the box(es) next to the account(s) you want to transfer to collections. OR Check the top-most box to select all displayed accounts at once. 4. Click the Collections button to open a drop-down list. 5. From the drop-down list, click the Transfer Account to Collections option.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

185

Accounts Lookup Procedures

Accounts Lookup

If there are any potential errors in the selected account(s), a confirmation window opens to notify you. Click the Yes button to proceed anyway if desired. A confirmation window opens. 6. Click the Yes button. A confirmation window opens. 7. Click the OK button. A CO indicator appears in the Collection column indicating that the selected accounts are now included in the collection management system.

Removing Patient Accounts from Collections

Patient accounts can be removed from or transferred out of the collection management system from the Accounts Lookup window. To remove a patient account from collections: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria are now displayed. 3. Check the box(es) next to the account(s) you want to remove from collections. OR Check the top-most box to select all displayed accounts at once. A patient account in collections has a C indicator in the Collections column. C indicators can be C0, C1, C2, C3, or C4. 4. Click the Collections button to open a drop-down list. 5. From the drop-down list, click the Remove Account from Collection option. If there are any potential errors in the selected account(s), a confirmation window opens to notify you. Click the Yes button to proceed anyway if desired. A confirmation window opens. 6. Click the Yes button. A confirmation window opens. 7. Click the OK button. The selected accounts are now removed from the collection management system.

186

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Accounts Lookup

Accounts Lookup Procedures

Excluding a Patient Account from a Collection Run

Patients can be excluded from any collection runs from the Accounts Lookup window. To exclude a patient account from a collection run: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria are now displayed. 3. Check the box(es) next to the account(s) you want to exclude from collection runs. OR Check the top-most box to select all displayed accounts at once. A patient account in collections has a C indicator in the Collections column. C indicators can be C0, C1, C2, C3, or C4. 4. Click the Collections button to open a drop-down list. 5. From the drop-down list, click the Exclude Account from All Collection Runs option. If there are any potential errors in the selected account(s), a confirmation window opens to notify you. Click the Yes button to proceed anyway if desired. A confirmation window opens. 6. Click the Yes button. A confirmation window opens. 7. Click the OK button. The selected accounts are now removed from the collection management system.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

187

Accounts Lookup Procedures

Accounts Lookup

Transferring Claims in an Account to Collections

Specific claims contained in a patient account can be transferred to the collection management system from the Accounts Lookup window, instead of transferring the entire account at once. This feature must be enabled from the Billing menu before it can be used. For more information, refer to the Miscellaneous Configuration Options (Billing) section of the System Administration Users Guide. To transfer claims from a patient account to collections: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria are now displayed. 3. Check the box(es) next to the account(s) that contain the claim(s) you want to transfer to collections. OR Check the top-most box to select all displayed accounts at once. 4. Click the Collections button to open a drop-down list. 5. From the drop-down list, click the Transfer Claims to Collections option. The Account Claims window opens. 6. Check the box(es) next to the claim(s) you want to transfer to collections. OR Check the top-most box to select all displayed claims at once. 7. Click the OK button. A confirmation window opens. 8. Click the Yes button. The Collection Codes window opens. 9. Highlight the collection status you want to enter the selected claim(s) into and click the OK button. A confirmation window opens. 10. Click the OK button. An indicator appears in the Collection column indicating the current collection cycle that the selected claims are in.

188

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Accounts Lookup

Accounts Lookup Procedures

Generating Statements

Configuring Patient Statement Options

Patient statement options can be configured from the Accounts Lookup window. To configure patient statement options: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria display. 3. Click the green arrow next to the Patient Statements option to open a drop-down list. 4. From the drop-down list, hover over the eGuarantor Statements All Filtered Accts. option to open another drop-down list. 5. From this drop-down list, click the Show Patient Statement Jobs option. The Patient Statement Options window opens:

6. Check the following boxes as desired: Include Accounts with Unposted Payments/Refunds - Include accounts with payments and/or refunds that have not been posted in search results. Include Patients whose age is greater than 18... - Include patients over the age of 18 that have a guarantor other than themselves. Include Accounts with Incomplete Guarantor Address - Include accounts for patients' whose guarantor does not have a complete address entered into their Patient Information. 7. Click the OK button. Patient statement options are now configured.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

189

Accounts Lookup Procedures

Accounts Lookup

Generating Printed Patient Statements

Use this procedure to generate a printed patient statement. For more information, refer to the section Generating Electronic Patient Statements on page 191. To generate printed patient statements: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria are now displayed. 3. Check the box(es) next to the account(s) you want to print statements for OR Check the top-most box to select all displayed accounts at once. 4. Click the Patient Statements button. A confirmation window opens. 5. Click the Yes button. Several different set of edits are checked against the statements. If any errors are detected for an edit, a validation window opens. This can happen multiple times if multiple edit errors are detected. From these windows, click the Copy button to copy this information into a text or Excel file. Click the Close button when you are done with each window to close them. The statement opens in the Report window. 6. To print these statements: a. Click the printer icon at the top of the window to print the statement. A confirmation window opens asking if you would like to track these statements. b. Click the Yes button in order to be able to track past statements. The statements are now printed.

190

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Accounts Lookup

Accounts Lookup Procedures

Generating Electronic Patient Statements

Use this procedure to generate a patient statement that you can send to a company to print and process eStatements. To generate an electronic patient statement: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria are now displayed. 3. Check the box(es) next to the account(s) for which you want to print statements. OR Check the top-most box to select all displayed accounts at once. 4. Click the arrow next to Patient Statements button to open a drop-down list. 5. From the drop-down list, click the ePatient Statements option. A confirmation window opens. 6. Click the Yes button. If there are any errors in generating this statement: Several different set of edits are checked against the statements. If any errors are detected for an edit, a validation window opens. This can happen multiple times if multiple edit errors are detected. From these windows, click the Copy button to copy this information into a text or Excel file. Click the Close button when you are done with each window to close them. The Generate Patient Statements window opens:

7. Click the desired radio button. If there are an issues detected with the patient's responsible party (e.g., the patient is over 18 years of age, but someone else is listed as the responsible party), the Patients Responsible Party List window opens. From this window, click the Copy button to copy this information into a text or Excel file. Click the Close button here when you are done to close this window. A confirmation window opens. 8. Click the Yes button. The Save As window opens.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

191

Accounts Lookup Procedures

Accounts Lookup

9. Enter the desired name for this file in the File Name field. 10. Click the Save button. If your practice uses ExpressBill, a confirmation window opens asking if you want to upload the statement file to the ExpressBill site. Click the Yes button to upload the file automatically. This generates a file that is then sent to the company or clearinghouse that will print your statements and send them to you.

Generating Paper Guarantor Statements

Use this procedure to print guarantor statements. This option is only available if the Guarantor Name, Patient or Guarantor Zip, Guarantor, Patient option is selected from the Sort Order drop-down list when looking up accounts. To generate paper guarantor statements: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria are now displayed. 3. Check the box(es) next to the account(s) for which you want to print statements. OR Check the top-most box to select all displayed accounts at once. 4. Click the green arrow next to the Patient Statements button to open a drop-down list. 5. From the drop-down list, click the Guarantor Statements option. A confirmation window opens. 6. Click the Yes button. If there are any errors in generating this statement, a validation window opens. From this window, click the Copy button to copy this information into a text or Excel file. Click the Close button here when you are done to close this window. The statement opens in the Report window. 7. Click the printer icon at the top of the window to print the statement.

192

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Accounts Lookup

Accounts Lookup Procedures

Generating Electronic Guarantor Statements

Use this procedure to generate a guarantor statement that you can send to a company to print and process eStatements. This option is only available if the Guarantor Name, Patient or Guarantor Zip, Guarantor, Patient option is selected from the Sort Order drop-down list when looking up accounts. To generate electronic guarantor statements: 1. From the Billing band in the left navigation pane, click the Accounts Lookup icon. The Accounts Lookup window opens. 2. Set the search filters at the top of the window as desired and click the Lookup button. The patient accounts that meet your search criteria are now displayed. 3. Check the box(es) next to the account(s) for which you want to print statements. OR Check the top-most box to select all displayed accounts at once. 4. Click the arrow next to Patient Statements button to open a drop-down list. 5. From the drop-down list, click the eGuarantor Statements option. A confirmation window opens. 6. Click the Yes button. If there are any errors in generating this statement: A validation window opens. a. Click the Copy button to copy this information into a text or Excel file. b. Click the Close button to close this window. The Generate Guarantor Statements window opens. c. Click the desired radio button. The Patients Responsible Party List window opens. From this window, click the Copy button to copy this information into a text or Excel file. Click the Close button here when you are done to close this window. A confirmation window opens. 7. Click the Yes button. The Save As window opens. 8. Enter the desired name for this file in the File Name field. 9. Click the Save button. This generates a file that is then sent to the company or clearinghouse that will print your statements and send them to the patients/guarantors.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

193

Transferring Patient Balances into eClinicalWorks

Accounts Lookup

Transferring Patient Balances into eClinicalWorks

Transferring Patient Debit Balance

Use the following procedure to transfer patient debit balances from another Practice Management system into eClinicalWorks. To transfer a debit of balance: 1. Create a dummy CPT code (e.g., BT, with a description Balance Transfer) for transferring patient balances.

For more information on creating new CPT codes, refer to the Billing Setup chapter in the System Administration Users Guide. 2. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens. 3. Click the Claim button to open a drop-down list. 4. From the drop-down list, click the Create New Claim option. The Patient Lookup window opens. 5. Highlight the desired patient and click the OK button. The Create Claim window opens. 6. Edit the information as necessary and click the OK button. The new claim opens. 7. Create a claim for the patient. Note: To prevent this amount from appearing in the A/R in eCW Reports, use a date prior to the practice's eCW Go Live date. 8. Delete the amount in the Copay field, if any:

9. On the ICD-9 & CPT tab, add the dummy CPT Code created in step 1. 10. Change the Billed Fee amount to the old balance owed by the patient:

194

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Accounts Lookup

Transferring Patient Balances into eClinicalWorks

11. On the Insurances & Payments tab, check the Bill to Patient box.

12. Click the OK button. This amount will be billed on the patient's statement.

Transferring Patient Credit Balance

Use the following procedures to transfer patient credit balances from another Practice Management system into eClinicalWorks. To transfer a credit balance: 1. From the Billing band in the left navigation pane, click the Payments icon. The Payments window opens. 2. Click the Add Patient Payment button. The Patient Lookup window opens. 3. Highlight the desired patient and click the OK button. The Receive Payments window opens. 4. Select a date prior to your practice's eClinicalWorks Go-Live date using the Date dropdown calendar. 5. Enter the amount of the credit balance in the Amount Field. 6. Select the method of payment from the Payment drop-down list. 7. If applicable, enter the check number in the Check Number field:

8. Post the payment against any applicable visits, claims, or procedures in eClinicalWorks. Note: If there are no claims available, to post this payment create a dummy claim so the payment does not remain unposted. Note: For more information on posting patient payments, refer to the section titled Posting Patient Payments on page 140.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

195

Transferring Patient Balances into eClinicalWorks

Accounts Lookup

196

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

BATCHES

Batch Creation

Creating and Submitting a Batch

After claims have been created, they can be submitted electronically to a clearinghouse. Typically, claims are submitted electronically on a daily or weekly basis. All electronically submitted claims must be sent via batches. When claims are submitted electronically, eClinicalWorks will: Gather all claims with a Claims Ready for Electronic Submission status. Create a text or zip file that contains all the claim information for the submitted batch of claims. Change the status of each claim to Submitted. eClinicalWorks can then be used to upload the text file to the clearinghouse. Note: A maximum of 500 claims or less per batch can be generated. To create and submit a batch: 1. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens. 2. Set the filters at the top of the window to return the desired encounters and/or claims and click the Lookup button. Note: Claims must be set to the Ready to Submit status in order to be included in batches. 3. Click the Billing button to open a drop-down list 4. From the drop-down list, click the Create Batch option. The Claims Receivers List window opens:

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

197

Batch Creation

Batches

5. To configure payer IDs for a receiver: a. Highlight the desired receiver and click the Configure Payer IDs button. The Receiver Configuration window opens. Note: Payer IDs cannot be configured for the primary receiver (highlighted in bold). b. To add an ID, click the Add button and select a desired insurance company from the Insurances window. c. To remove an ID, highlight the desired ID and click the Remove button.

d. Click the Close button once all IDs have been configured as desired. Payer IDs are now configured for the selected receiver. 6. Highlight the desired receiver in the list and click the OK button. The Batch Claims (Electronic) window opens, showing the claims ready for electronic submission:

Note: When creating a batch of claims, if the Facility Group or Insurance Group has been selected as part of the Claims filter, this criterion is carried forward to the Batch Creation window. 7. Use the filters at the top of the window in the same manner as you would on the Claims window to filter the claims submitted with this batch as desired. 8. Uncheck the boxes next to any claims you do not want to submit with this batch. 9. To view CodeCorrect errors and suggestions on claims:

198

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Batches

Batch Creation

a. Click the CodeCorrect button. The Medicare Claims window opens. b. Highlight the claim you want to check and click the Submit to CodeCorrect button. The CodeCorrect Viewer window opens. c. To view a legend of the various symbols' meanings, click the Click Here for the Legend button or link.

d. To print the information that is displayed here, click the Print button. 10. To view and/or modify an individual claim in the batch: a. Highlight the claim you want to view. b. Click the View Claim button. The Claim window opens. c. Modify the claim as necessary.

11. To generate this batch in ANSI format, check the Generate ANSI Batch box. If this box is not checked, the batch will be generated in NSF format. IMPORTANT! This box is checked automatically and should never be unchecked, as clearinghouses no longer accept claims in NSF format. 12. To copy this batch to a text or Excel file: a. Highlight the batch you want to copy. b. Click the View button. This batch's information is copied to a text or Excel file, depending on your settings. 13. Click the Submit Batch button. If there are any errors in your submissions, a confirmation window notifies you of the claims that contain errors and asks whether you want to continue with submission. To halt the generation of this batch in order to go back and fix the errors, click the No button. To uncheck the claims with the errors and continue with submitting the rest of the batch, click the Yes button. A confirmation window opens. 14. Select the desired option to create the batch. The Save As window opens. 15. Navigate to the folder on your system where you want to save this batch file. 16. Enter the desired name for this batch in the File Name field. 17. Click the Save button. A confirmation window states that the files were correctly created. 18. Click the OK button. A pop-up window now asks whether you want to update the status of the claims. 19. Click the Yes button. The system now automatically changes the status for the submitted claims from Ready to Submit Electronically to Submitted. A pop-up window opens, prompting the user for a batch name. 20. Enter a unique file name (e.g., the current date, or the number of claims).

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

199

Batch Creation

Batches

21. Click the OK button. A pop-up window confirms that the status codes have been successfully updated. 22. Click the OK button. The system displays the batch file showing the submitted claims. 23. To print this file for your records, click the Print button. For WebMD: 1. A pop-up window opens asking whether you want to perform the upload to the clearinghouse. 2. Click the Yes button. For other clearinghouses: 1. Log on to your clearinghouse's website. 2. Navigate to the area that allows you to upload a batch. 3. Browse for the batch file you created on your system. 4. Select and upload the batch. The system now automatically connects to the clearinghouse using the settings you established during the Administrative setup. Note: When creating a batch of claims, if the Facility Group or Insurance Group has been selected as part of the Claims filter, this criterion is carried forward to the Batch Creation window.

200

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Batches

Batch Management

Batch Management

Saving Batch Files Locally

Batches that have already been generated can be saved as files on your local system from the Batch Management window. To save batch files locally: 1. From the Billing band in the left navigation pane, click the Batches icon. The Batch Management window opens:

2. Select the desired date range from the Date(s) drop-down calendars. 3. Click the Lookup button. The window displays batches that exist in the specified date range. 4. Highlight the batch you want to save and click the Save Batch File Locally button. The Save As window opens. 5. Navigate to the folder on your local system where you want to save this file. 6. Enter the desired name for this batch file in the File Name field. 7. Click the Save button. The selected batch is now saved as a file on your local system.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

201

Batch Management

Batches

Previewing Batches

Batches that have already been generated can be previewed from the Batch Management window. To preview batches: 1. From the Billing band in the left navigation pane, click the Batches icon. The Batch Management window opens. 2. Select the desired date range from the Date(s) drop-down calendars. 3. Click the Lookup button. The window displays batches that exist in the specified date range. 4. Highlight the batch you want to preview and click the Preview button. The eClinicalWorks Viewer window opens with the selected batch displayed. 5. To print this batch preview, click the Print button.

Changing the Claims Status of Batches

The claims status of batches that have already been generated can be changed from the Batch Management window. To change the claims status of batches: 1. From the Billing band in the left navigation pane, click the Batches icon. The Batch Management window opens. 2. Select the desired date range from the Date(s) drop-down calendars. 3. Click the Lookup button. The window displays batches that exist in the specified date range. 4. Highlight the batch you want to change the claims status of and click the Change Claims Status button. The Change Claims Status window opens. 5. Select the status you want to change this batch to using the Reset Claims Status To drop-down list. 6. Click the OK button. The claims status of the selected batch is now updated as specified.

202

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Batches

Batch Management

Regenerating a Batch

Batches that have already been generated can be regenerated from the Batch Management window. To regenerate batches: 1. From the Billing band in the left navigation pane, click the Batches icon. The Batch Management window opens. 2. Select the desired date range from the Date(s) drop-down calendars. 3. Click the Lookup button. The window displays batches that exist in the specified date range. 4. Highlight the batch you want to regenerate and click the Regenerate Batch button. If there are errors on any of the claims in this batch, a confirmation window opens. Click the Yes button here if you want to ignore the errors and continue with regenerating the batch. The Batch Claims window opens. 5. Re-submit the batch as you would normally. For more information on submitting batches, refer to the section titled Creating and Submitting a Batch on page 197.

Copying Batch Information to a Text or Excel File

Batches that have already been generated can be copied to a text or Excel file from the Batch Management window. To copy batch information to a text or Excel file: 1. From the Billing band in the left navigation pane, click the Batches icon. The Batch Management window opens. 2. Select the desired date range from the Date(s) drop-down calendars. 3. Click the Lookup button. The window displays batches that exist in the specified date range. 4. Highlight the batch you want to copy and click the Copy button. Information from the selected batch is displayed in a text or Excel file, depending on your settings.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

203

Batch Management

Batches

Viewing the ITS Transaction Log

A log of the ITS transactions for each batch can be viewed from the Batch Management window. This log is only applicable for practices using WebMD/Emdeon. To view the ITS transaction log: 1. From the Billing band in the left navigation pane, click the Batches icon. The Batch Management window opens. 2. Select the desired date range from the Date(s) drop-down calendars. 3. Click the Lookup button. The window displays batches that exist in the specified date range. 4. Highlight the batch you want to view the ITS log for and click the ITS Log button. The ITS Transaction Log window opens. 5. Select the desired date range from the Log Date(s) drop-down calendars. 6. Click the Lookup button. A log of ITS transactions for the selected batch in the specified date range is displayed.

Assigning Tracking Numbers to Batches

Tracking numbers can be assigned to batches that have already been generated from the Batch Management window. To assign a tracking number to a batch: 1. From the Billing band in the left navigation pane, click the Batches icon. The Batch Management window opens. 2. Select the desired date range from the Date(s) drop-down calendars. 3. Click the Lookup button. The window displays batches that exist in the specified date range. 4. Highlight the batch you want to assign a tracking number to and click the Track button. The Tracking Number window opens:

5. Enter the desired tracking number for this batch in the Tracking Number field. 6. Enter any notes about this batch in the Notes field. 7. Click the OK button. The specified tracking number is now assigned to the selected batch.

©

204

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

COLLECTION MANAGEMENT

The Collection Management feature allows the user to transfer overdue patient accounts to the collections cycle, and then generate customized collection letters according to collection cycle status. These letters contain Mail Merge letter tags that automatically populate the patient name and address fields from Patient Demographics, and the provider and facility name from system data. These automated letter templates are editable, and they allow you to generate and send collection letters with minimal effort. If an account with an unpaid balance reaches the final stage of the collection cycle, it is flagged for transfer to a collection agency. A billing alert is also automatically generated for that patient, which includes the collection information.

About the Collection Management Console

The Collection Management console lets you generate collection letters and perform other patient-related actions.

Using the Collection Management Filters

To access the Collection Management window, click the Collection Management icon from the Billing band in the left navigation pane:

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

205

About the Collection Management Console

Collection Management

eClinicalWorks provides the following management filters: Look Up By - This drop-down list allows the user to look up accounts by Collection Cycle or Patient Name. The option selected here determines the name of the filter directly below it. Collection Cycle / Patient Name - Click the More (...) button here to filter results by a specific part of the collection cycle or a specific patient. Collection Rule - Use this drop-down list to apply/ignore any collection rules defined during the collection setup. For example, to send collection letters to a patient right away, bypass the 30-day rule and print the collection letter for the patient. For more information on setting up collections, refer to the System Administration Users Guide. Name Filter - To filter results by the name of the account name enter an alphabetic range into these fields (e.g., F and H to view only accounts with names beginning with F, G, or H). This is helpful if your workflow generates patient statements alphabetically (e.g., On Monday, you generate all statements for patients with the last names beginning with the letter A through the letter G.). Balance - Select a math symbol from the drop-down list and then enter a value into the field here to filter by the amount in patient balances. For example, select > and enter 25.00 to show all patients with a balance greater than $25.00. Ex Status - Select an external status to filter results by from this drop-down list. Facility / Facl Grp - To filter results by facility or Facility Group, select the desired option from the gray drop-down list and click the More (...) button to select a facility or Facility Group. Check the All box if you want to include all facilities or Facility Groups. Note: This filter is only available if the Collection Cycle option is selected from the Look Up By drop-down list.

Using Other Collection Management Features

Additional the options are available at the bottom of the Collection Management console.

1

2

3 4

The following table describes these additional management features: Field 1. 2. 3. 4. Page Results Previous/Next Records Displayed Totals Summary Description Used to select the number of results per page. The results can be selected in increments of 25, with a limit of 100. Used to scroll between multiple pages of data. A selectable drop-down list of the record segments. Displays the total number of records, the page balance, and the total balance for the patients in that specific collection stage.

206

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Collection Management

Collection Management Procedures

Collection Management Procedures

Generating Collection Letters

Collection letters can be generated for patients and guarantors whose payments are past due from the Collection Management window. Note: The 2007 Microsoft Office system introduced a new file format based on Extensible Markup Language (XML). When using the 2007 Office release with eClinicalWorks, save the MS Word file in the 97-2003 file format. Files saved in the MS Word 2007 format (with a .docx suffix) are not currently recognized by eClinicalWorks, which looks for files saved in MS Word 97-2003 (with a .doc suffix). Files saved in the MS Word 2007 format will cause errors when attempting to generate letters. To generate collection letters: 1. From the Billing band in the left navigation pane, click the Collection Management icon. The Collection Management window opens. 2. Set the filters at the top of the window as desired. Note: To generate letters for accounts that have just been moved to collections, select the Ignore option from the Collection Rule drop-down list. 3. Click the Lookup button. The patients/guarantors that match the selected criteria are displayed. 4. Check the box(es) next to the patient(s)/guarantor(s) for which you want to generate collection letters. 5. To generate letters using the default template: a. Click the Generate Letters button. The Letter Verification window opens. b. Uncheck the box(es) next to any patient(s) for which you do not want to generate letters. c. Click the OK button. Letters are now generated for the selected patients and they are automatically moved to the next collection cycle. Accounts that were deselected remain in their current cycle. 6. To select a document on your local system to use for the collection letters: a. Click the green arrow next to the Generate Letters button to open a drop-down list. b. From the drop-down list, click the Select Local Document option. The Open window opens. c. Navigate to the folder containing the document you want to use.

d. Highlight the desired document and click the Open button. A confirmation window opens asking if you want to track this letter. e. Click the Yes button to mark in the system that this letter has been sent. The selected document is opened. f.

©

Modify and print these documents as desired.

207

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Collection Management Procedures

Collection Management

7. To select a letter template to use for the collection letters: a. Click the green arrow next to the Generate Letters button to open a drop-down list. b. From the drop-down list, click the Select Letter Template option. The Letter Templates window opens. c. Highlight the letter template you want to use and click the OK button. For more information on letter templates, refer to the Front Office Users Guide. The selected template name is inserted into the Collection Cycle field. A dialog message displays asking if you want to track the letters. d. Click the Yes button to mark in the system that this letter has been sent. Individual versions of the letter template display in Microsoft Word with the patient's information on each one. e. Modify and print these documents as desired. Note: Claims in collection management are automatically moved from one collection cycle to another whenever a collection letter is generated.

Searching for Accounts Ready for Collection Management

Accounts ready for collections can be searched for on the Accounts Lookup window. For more information, refer to the section titled Collection Management from Accounts Lookup on page 185. Running an APL aging A/R report can also help locate overdue patient accounts. IMPORTANT! Review each account before moving it to Collection Management. The Account Lookup feature returns results on all of the patient's statements--the final determination of overdue accounts must be made by the biller.

Using Patient Details Options

Patient Details options can be used to view the Patient Hub, add payments, look up account details, print and transmit statements, and manage collection cycle statuses. 1. From the Billing band in the left navigation pane, click the Collection Management icon. The Collection Management window opens. 2. Set the filters at the top of the window as desired. 3. Click the Lookup button. The patients/guarantors that match the selected criteria are displayed. 4. To perform an action on a patient, check the box next to the patient(s) name. 5. Click the Patient Details button to view the Patient Hub for the selected patient. 6. Click the green arrow next to the Patient Details button to open a drop-down list.

208

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Collection Management

Collection Management Procedures

7. From the drop-down list, click one of the following options: Option Add Patient Payment Description Launches a patient payment dialog. For more information on payments, refer to the section titled Adding Patient Payments on page 128. Launches the Patient Inquiry Detail window for the selected patient. For more information, refer to the section titled Viewing a Patient Account on page 179. Prints the selected patients' statements. For more information, refer to the section titled Generating Printed Patient Statements on page 190. Transmits the selected patients' statements. For more information, refer to the section titled Generating Electronic Patient Statements on page 191. Removes the patient from collections. For more information, refer to the section titled Removing Patient Accounts from Collections on page 186. 1. Click this option if you want to transfer this patient's account to a different collection cycle manually. The Move patients between collections window opens with the current collection cycle status displayed. Select the desired status from the New Status dropdown list. Click the OK button. The selected patient's collection status is now updated as specified.

Patient Account Inquiry Print Patient Statement Print ePatient Statement Remove from Collection Move to Different Collection Cycle

2. 3.

Entering Collection Status Notes for a Patient

Miscellaneous notes on the collection status of a patient can be entered from the Collection Management window. To enter collection status notes for a patient: 1. From the Billing band in the left navigation pane, click the Collection Management icon. The Collection Management window opens. 2. Set the filters at the top of the window as desired. 3. Click the Lookup button. The patients/guarantors that match the selected criteria are displayed. 4. Check the box next to the patient for which you want to enter collection status notes. 5. Click the Status button. The Patient Collection Status window opens:

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

209

Collection Management Procedures

Collection Management

6. To select keywords to use for this patient's collection status, click the Browse button and select the desired keyword(s). 7. Enter any additional notes manually in the Collection Status field. 8. Click the OK button. The text entered here displays in the Status column on the Collection Management window.

Viewing and Setting Patient Alerts from Collection Management

Patient alerts can be viewed and set from the Collection Management window. To view or set a Patient Alert: 1. From the Billing band in the left navigation pane, click the Collection Management icon. The Collection Management window opens. 2. Set the filters at the top of the window as desired. 3. Click the Lookup button. The patients/guarantors that match the selected criteria are displayed. 4. Check the box next to the patient for which you want to view and/or set alerts. 5. Click the View Alert button. The Reminders window opens. 6. View and set the alert(s) as you would normally. For more information on alerts, refer to the EMR Users Guide.

210

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Collection Management

Transworld Collection Management

Transworld Collection Management

Configuring Transworld Information

Before integration with Transworld can be done, information concerning the Transworld Web site and your account must be configured in the system. For more information on these features, refer to the System Administration Users Guide.

Setting Up Collection Cycles for Transworld

Collection cycles must be specified as external to utilize the Transworld integration. To set up collection cycled for Transworld: 1. From the Billing menu, click the Setup Collection option. The Collection Account - Preparation window opens:

2. One collection cycle must have the Description Final, and have the Is External Agency box checked, although it may have any Code or Document Name you want. If one does not contain this description, you can either add a new cycle with the Add button, or update an existing cycle by highlighting it and clicking the Update button. Accounts must be in this cycle to be considered by the Transworld integration. All other cycles are ignored by Transworld.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

211

Transworld Collection Management

Collection Management

Transmitting Accounts to Transworld

Accounts can be sent to and removed from Transworld collections from the Collection Management window. To send accounts to Transworld: 1. From Billing band in the left navigation pane, click the Collection Management icon. The Collection Management window opens. 2. Look up the accounts in the Final collection cycle that you want to transmit to Transworld. The transmission status of each account is displayed in the External Status column. Accounts that have been sent to Transworld collections have START displayed, while those that have been removed have STOP displayed:

3. Check the box(es) next to the account(s) you want to send to Transworld. 4. Click the green arrow next to the Patient Details button to open a drop-down list. 5. Click the Upload START File to Transworld Collection Agency option. A confirmation window opens to notify you of any accounts that have zero or negative balances, are missing address information, or that have already been uploaded. The Save As window opens. 6. Navigate to the desired location in your system and enter the desired file name before clicking the Save button. A local copy of the collection file is now saved in your system. A confirmation window opens asking if you are sure you want to upload the file to Transworld. 7. Click the Yes button. A confirmation window opens to inform you that the file transmitted successfully. 8. Click the OK button. A pop-up window opens asking if you want to update the External Status of the selected patients to START. 9. Click the Yes button if the file was transmitted successfully. The External Status of the selected accounts is now set to START.

212

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Collection Management

Transworld Collection Management

Removing Accounts from Transworld

Accounts that have been transmitted to Transworld can be removed from the collections service from the Collection Management window. To remove accounts from Transworld: 1. From the navigation pane on the left, click the Billing band. The Billing icons display. 2. Click the Collection Management icon. The Collection Management window opens. 3. Look up all accounts in the Final collection cycle. 4. Click the green arrow next to the Patient Details button to open a drop-down list. 5. Click the Upload STOP File to Transworld Collection Agency option. The List of Stop Patients window opens with a list of accounts previously sent to Transworld that have had a change in account balance since the last STOP file was transmitted (this includes unposted payments):

6. Check the box(es) next to the account(s) you want to stop. 7. Click the OK button. The Save As window opens. 8. Navigate to the desired location in your system and enter the desired file name before clicking the Save button. A local copy of the collection file is now saved in your system. A confirmation window opens asking if you are sure you want to upload the file to Transworld. 9. Click the Yes button. A confirmation window opens to inform you that the file transmitted successfully. 10. Click the OK button. A pop-up window opens asking if you want to update the External Status of the selected patients to STOP. 11. Click the Yes button if the file was transmitted successfully. The External Status of the selected accounts is now set to STOP.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

213

Claim-Based Collection Management

Collection Management

Another pop-up window opens if any accounts have been paid in full, asking if you want to remove this patient from collections entirely. 12. Click the Yes button if you want to remove this account from collections. This account is now removed from Collection Management and a Thank You letter is prepared in the system.

Note: Claims with a zero or negative balance can be automatically set to a STOP status. This feature is enabled by item key. Contact eClinicalWorks Support if you want to use this feature.

Claim-Based Collection Management

Using Claim-Based Collection Management

Before claim-based collection management can be used, it must first be enabled. For more information on enabling this feature, refer to the System Administration Users Guide. Once claim-based management has been enabled, three new filters related to collection management are displayed on the Claims and Patient Inquiry Detail windows:

214

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Collection Management

Claim-Based Collection Management

Collection Status - Click the More (...) button here to filter the search by a collection status. Show Claims Not in Collection - Check this box to filter by claims not in collections. No. of Statements >= - The number entered here filters the list based on the number of statements issued for a claim. The total patient charges in various collection cycles also displays on the Patient Inquiry window in the Collection Cycle Balance section.

Transferring Claims into and out of Collections

Once claim-based management has been enabled, individual claims can be transferred into and out of collections. To transfer claims into and out of collections: 1. From the Claims window, check the box(es) next to the claim(s) you want to move into or out of collections. 2. Click the Billing button to open a drop-down list. 3. From the drop-down list, hover over the Selected Claims option to open another dropdown list. 4. Click one of the following options: Transfer to Collection - Transfer the selected patients' entire account to collections. Remove from Collection - Remove the selected patients' entire account from collections. Transfer Claims to Collection - Transfer the selected claims to collections. Remove Claims from Collection - Remove the selected claims from collections. The selected action is now performed. Note: Claims in collection management are automatically moved from one collection cycle to another whenever a collection letter is generated.

Claim Collection Logs

Collection logs can now be viewed for specific claims. To view a claim's collection log: 1. Open the claim for which you want to view a collection log. 2. Click the Options button to open a drop-down list. 3. From the drop-down list, hover over the View Logs option to open another drop-down list. 4. From this drop-down list, click the View Claim Collection Log option. The collection log for this claim is now displayed.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

215

Collection Management

Claim-Based Collection Management

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

216

ALERTS

Billing Alerts

eClinicalWorks provides the option of setting alerts, which are essentially electronic reminder notes.

Billing Alert Recalls

About the Billing Alert Recall Window

The Billing Alert Recall window can be used to look up existing alerts, create new alerts, and generate letters for patients. To access the Billing Alert Recall window: 1. From the Billing band in the left navigation pane, click the Billing Alert Recall icon. The Billing Alert Recall window opens:

2. Set the following filters at the top of the window as desired:

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

217

Billing Alerts

Alerts

Field Look Up By

Description Select the method you want to use to look up alerts from this drop-down list. Depending on the option you select, different filters are displayed below this dropdown list. Select the Protocol option from the Look Up By dropdown list to view this filter. Click the Sel button next to this field and check the box(es) next to the protocol you want to use to look up alerts.

Protocol - Select Protocol

Protocol - Date(s) From and To

Select the Protocol option from the Look Up By dropdown list to view this filter. Select the date range you want to view alerts for using these drop-down calendar.

Appointment Date Date

Select the Appointment Date option from the Look Up By drop-down list to view this filter. Select the date of the appointment you want to view alerts for using this drop-down calendar.

Appointment Date Provider

Select the Appointment Date option from the Look Up By drop-down list to view this filter. Select the provider whose appointment you want to view alerts for using this drop-down list.

Patient - Select Patient

Select the Patient option from the Look Up By dropdown list to view this filter. Click the Sel button next to this field to select the patient for which you want to look up alerts.

Global Alerts - Radio Buttons

Select the Global Alerts option from the Look Up By drop-down list to view this filter. Click the radio button next to the type of alert you want to look up.

Global Alerts - Select Alert

Select the Global Alerts option from the Look Up By drop-down list to view this filter. Select the alert you want to look up from this drop-down list.

3. Click the Lookup button. The alerts that meet the selected criteria are displayed. 4. Use the following buttons at the bottom of the window to perform actions as desired:

Button Choose Letter (...)

Description Click the More (...) button next to this field to select the letter template you want to use to send letters to patients. Click this button once a letter template has been selected and the box(es) next to the desired patient(s) have been checked to generate letters.

Run Letter

218

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Alerts

Billing Alerts

Button Patient Details New Appointment

Description Highlight the desired patient and click this button to open the Patient Hub for the selected patient. Check the box next to the patient you want to create an appointment for and click this button to create a new appointment. For more information on creating new appointments, refer to the Front Office Users Guide.

Status Alerts

Highlight the desired patient and click this button to enter a status for this patient. Click this button to create a new alert, or update existing alerts, for the selected patient. For more information, refer to the section titled Setting Billing Alerts for Patients on page 219.

Copy

Click this button to copy the information displayed here to a text or Excel file.

Setting Billing Alerts for Patients

Billing alerts can help you manage patient accounts, billing, and account receivables efficiently. Use alerts to flag patient accounts that are overdue or as a tickler file for follow up on insurance claims. To set a billing alert: 1. From the Billing band in the left navigation pane, click the Billing Alert Recall icon. The Billing Alert Recall window opens. 2. From the Look Up By drop-down list, select the Patient option. 3. Click the Sel button. The Patient Lookup window opens. 4. Highlight the desired patient. 5. Click the OK button. The Patient Lookup window closes and the selected patient's name appears in the list on the Billing Alert Recall window. 6. Check the box next to the patient's name, and then click the Alerts button. The Patient Specific Alert window opens:

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

219

Billing Alerts

Alerts

7. Click the Billing radio button in the Alert Type section. 8. Click the Sel button next to the Name field. The Keywords window opens. Default (30 Days, 45 Days, 90 Days, and 120 Days) and previously defined Alerts display in the list. 9. Select the desired keyword from the left pane. The selected alert displayed in the right pane. 10. Click the OK button. The Keywords window closes and the new alert name displays in the Name field on the Patient Specific Alert window. 11. In the Recall After fields, define the time frame that will elapse before the account is recalled: Click the Day(s), Week(s), Month(s), or Year(s) radio button. Enter the number of days, weeks, months, or years in the blank field. The Due Date changes based on the established recall criteria. 12. To display only alerts that are currently due for this patient, check the Due Only box. 13. To display existing EMR alerts for this patient, check the Show EMR Alerts box. 14. To display existing Billing alerts for this patient, check the Show Billing Alerts box. 15. To view existing alerts: a. Highlight the alert you want to view in the Review Billing Alerts section.

220

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Alerts

Billing Alerts

b. Click the View button. The selected alert is now displayed. 16. To suppress existing alerts: a. Highlight the alert you want to suppress in the Review Billing Alerts section. b. Click the Suppress button. A confirmation window opens. c. Click the Yes button. The Suppress window opens. d. Enter a reason for this suppression here. e. Click the OK button. The selected alert is now suppressed and removed from the Review Billing Alerts section. 17. To add a new note to this alert: a. Click the Add button. The Additional Notes Detail window opens. b. Enter any notes related to this alert in the field here. c. Click the OK button. This note is now added to this alert. 18. To update an existing note for this alert: a. Highlight the note you want to update in the Add New/Review Notes section. b. Click the Update button. The Additional Notes Detail window opens. c. Modify the information here as desired.

d. Click the OK button. The selected note is now updated. 19. To delete an existing note from this alert: a. Highlight the note you want to update in the Add New/Review Notes section. b. Click the Delete button. The selected note is now deleted. 20. To set demographic alerts for this patient: a. Click the Demographic Alert button. The Billing Alert window opens with the Billing Alert tab selected. b. Check the Show Billing Alert box to display this alert whenever this patient is accessed. c. Enter the desired alert in the Billing Notes field.

d. Click the OK button. A red exclamation point (!) displays as an indicator of this alert on the Billing Alert button on the Patient Hub window, and also on the Patient Lookup window for this patient.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

221

Billing Alerts

Alerts

Recalling Patient Accounts using Billing Alerts

Specific patient accounts that may need to have action taken on them can be looked up from the Billing Alert Recall window. To recall a patient account using billing alerts: 1. From the Billing band in the left navigation pane, click the Billing Alert Recall icon. The Billing Alert Recall window opens. 2. From the Look Up By drop-down list, click the Protocol option. 3. Click the Sel button next to the Protocol field. The Protocol List window opens. 4. Check the box(es) next to the protocol(s) that you want to use to recall patient accounts. Select one box, multiple boxes, or all boxes in the list. To select all boxes, click the box next to Name. 5. Click the OK button. The Protocol List window closes and the selected protocol settings display on the Billing Alert Recall window. 6. Select a date range from the Date(s) From and To drop-down calendars. 7. Click the Lookup button. The list of patients who have billing alerts for the selected protocol in the date range displays. The billing alert due date is shaded in red. 8. To perform a task on a selected patient, check the box next to the patient name and use the tools at the bottom of the window: To... send the patient a letter Then... 1. Click the More (...) button to select a letter. The Letter Templates window opens. You can view and update the letter template and the letter tags. Select the letter you need and click OK. The letter you select shows in the Choose Letter field. Click the Run Letter button. MS Word opens and displays the patient information in the letter template. You can edit, save, print, and perform other MS Word functions as needed. Click the Patient Details buttons. The Patient Hub opens. Select a button to view detailed information. Click the New Appointment button. The Appointment window opens. Complete the required fields to schedule an appointment for your patient.

2.

3.

4. view detailed patient information schedule a follow up appointment for the patient 1. 2. 1. 2.

222

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Alerts

Billing Alerts

Using Billing Alerts for Insurance Follow-up

Use the Billing Alert Recall feature as a tickler file for follow up on Insurance Claims. A Billing Alert can be set up on patient accounts to flag them for follow up at a specified time frame. To set a billing alert for Insurance follow-up: 1. From the Billing band in the left navigation pane, click the Billing Alert Recall icon. The Billing Alert Recall window opens. 2. From the Look Up By drop-down list, click the Protocol option. 3. Click the Sel button next to the Protocol field. The Protocol List window opens. 4. Check the Insurance Follow Up box. 5. Click the OK button. 6. Select a date range from the Date(s) From and To drop-down calendars. 7. Click the Lookup button. The list of patients who have Insurance Follow Up alerts for the selected date range displays. 8. To view the alerts for a specific patient, check the box next to the patient name and click Alerts. The alerts and notes display for the patient.

Recalling Patient Accounts with Payment Plans

Patient accounts with payment plans can be looked up easily from the Billing Alert Recalls window. To recall patient accounts with payment plans: 1. From the Billing band in the left navigation pane, click the Billing Alert Recall icon. The Billing Alert Recall window opens. 2. From the Look Up By drop-down list, click the Protocol option. 3. Click the Sel button next to the Protocol field. The Protocol List window opens. 4. Check the Payment Plan box. 5. Click the OK button. The Payment Plan alert name displays in the Name field on the Billing Alert Recall window. 6. Select a date range from the Date(s) From and To drop-down calendars. 7. Click the Lookup button. The window displays list of patients who have Payment Plan alerts for the selected date range. 8. To view the alerts and notes that have been set for a patient, check the box next to the patient's name and click Alerts. Note: Perform this procedure weekly to review upcoming alerts.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

223

Billing Alerts

Alerts

224

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

CLEARINGHOUSES

McKesson Reports

Reporting is an integral part of the electronic processing services provided by McKesson. Reports provide updates on the status of transactions in process, particularly those that encountered errors. McKesson provides comprehensive reports that allow you to monitor the flow of data through our process. For claims customers, McKesson is also able to provide payer reports when they are available. All McKesson reports, and most payer reports, are available for electronic distribution via the Electronic Mailbox Facility (EMF). The reports are in print image format and, once placed in your mailbox, can be downloaded anytime. You may receive reports from the EMF without submitting a claim or statement file. If you do not contact the EMF on a daily basis, your reports will be stored for you in your mailbox for 14 days. You will need to contact the EMF on a regular schedule to ensure that you have received all of your reports. You must also ensure that you have a sufficient amount of space on your system before downloading report files. Lack of sufficient space may result in incomplete receipt of reports. For those customers who are not able to take advantage of electronic report delivery via the EMF, McKesson is able to deliver the reports to you via Federal Express. (Please note that all shipping costs associated with manual delivery of reports will be passed to you.) You must register with McKesson when you wish to begin receiving electronic reports via the EMF. If you wish to change the method of reports delivery for you or your customers, please contact McKesson. Claim, Document Outsourcing, and Remittance Advice Reports McKesson offers a standard package of claims reporting. Electronic reports are available to support all available transactions, including claims, medical statements, and electronic remittance advice. McKesson reports can be printed on 8½" x 11" paper using the default options available on most printers. The standards used in designing the reports are 80 characters per line by 66 lines per page. Each line in the report is followed by a carriage return plus a line feed control character or just a line feed control character. No other special control characters are used. The first three lines and the last three lines of each report page are blank leaving a maximum of 60 printed lines on each report. The Insurance Monthly/Weekly and Statement Monthly Billing Reports are in a 132 characters per line format with 50 lines per page. The following outlines the file naming conventions used for mailbox files on the EMF so you may easily identify individual reports. Reports samples have all Patient Health Information (PHI) de-identified. Report Name Transaction Type: Claims 277 Claim Status for 837 Claims Submission XSnnnnnn.* (nnnnnn = submitter number) (This file is generated from McKesson's frontend process) File Naming Convention

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

225

Clearinghouses

Report Name (Continued) 277 Claim Status Reject Report

File Naming Convention XJnnnnnn.* (nnnnnn = submitter number) (This report is generated from McKesson's front-end process containing totals and rejected claim data) XPnnnnnn.* (nnnnnn = submitter number) (This report is generated from McKesson's front-end process) X2nnnnnn.* (nnnnnn = submitter number) (This file is received from the payer and will contain data in the ANSI X12 277 format) XAnnnnnn.* (nnnnnn = submitter number) F3nnnnnn.* (nnnnnn = submitter number) F4nnnnnn.* (nnnnnn = submitter number) F5nnnnnn.* (nnnnnn = submitter number) F6nnnnnn.* (nnnnnn = submitter number) F7nnnnnn.* (nnnnnn = submitter number) FZnnnnnn.* (nnnnnn = submitter number) CAnnnnnn.* (nnnnnn = submitter number) CAnnnnnn.* (nnnnnn = submitter number)

277 Claim Status Report

277 Healthcare Claim Status Notification 997 Acknowledgment for 837 Claims Submission Claim print images for 01/84 HCFA 1500 form without barcode Claim print images for 12/90 HCFA 1500 form without barcode Claim print images for UB-92 form Claim print images for 01/84 HCFA 1500 form with barcode Claim print images for 12/90 HCFA 1500 form with barcode Claim print images for unique forms Claims Acknowledgment Report (CPI651.01) Claims Acknowledgment Report (REC651.01) Daily Packing Slip (CPI240.01) E2000 Daily Claims Summary File Electronic Transmission Acknowledgement Exclusion Claims Report (CPI652.01) Exclusion Claims Report (REC652.01) File Acknowledgment Report

AKnnnnnn.* (nnnnnn = TSH-assigned submitter number)

ECnnnnnn.* (nnnnnn = submitter number) ECnnnnnn.* (nnnnnn = submitter number) MMDDhhmm.SS (MM = month, DD = day, hh = hour, and mm = minute the file was sent; SS = sequence number) PPnnnnnn.* (nnnnnn = payer billing number) BDnnnnnn.*(nnnnnn = TSH-assigned billing ID) F2nnnnnn.* (nnnnnn = billing ID) PNnnnnnn.* (nnnnnn = billing ID)

McKesson TSH Participating Payer Billing Report (#CPIB40.01) Monthly Billing Data File Monthly Insurance Billing Report (CPI115.01) Monthly Flat Fee Per Provider Billing Report

226

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Clearinghouses

Report Name (Continued) Notification Report Payer reports Receipt Report

File Naming Convention FXnnnnnn.* (nnnnnn = billing ID) CRnnnnnn.* (nnnnnn = submitter number) 1. 2. 3. 4. report reportNN (NN = two digit sequence number) report.ctl rpt.MMDDhhmm (MM = month, DD = day, hh = hour, and mm = minute the file was sent)

System Reject Claims Report (CPI657.01) Test X12 Exclusion Claims Rpt (CTI652.01) UB Audit/System Reject File Weekly Insurance Billing Reports Transaction Type: Remittance Monthly Billing Data File Provider Remittance Data Report (CPR401) Provider Remittance Data Report (Check Number Order) (CPR405) Remittance ANSI 4010 Report Remittance Daily Summary Report (CPRX300) 4010 HIPAA-Compliant Format Remittance Report - Claims with Zero Dollars Paid (CPR431) Transaction Type: Statements Address Correction Report File Acknowledgment Report

RJnnnnnn.* (nnnnnn = submitter number) EXnnnnnn.* (nnnnnn = submitter number) AUnnnnnn.* (nnnnnn = submitter number) F2nnnnnn.* (nnnnnn = submitter number)

BDnnnnnn.* (nnnnnn = TSH-assigned billing ID) REnnnnnn.* (nnnnnn = submitter number) REnnnnnn.* (nnnnnn = submitter number) ZZnnnnnn.* (nnnnnn = submitter number) RSnnnnnn.* (nnnnnn = submitter number)

REnnnnnn.* (nnnnnn = submitter number)

SAnnnnnn.* (nnnnnn = submitter number) MMDDhhmm.SS (MM = month, DD = day, hh = hour, and mm = minute the file was sent; SS = sequence number) STnnnnnn.* (nnnnnn = submitter number)

File Summary Report Move/Update Report Receipt Report

1. 2. 3. 4.

report reportNN (NN = two digit sequence number) report.ctl rpt.MMDDhhmm (MM = month, DD = day, hh = hour, and mm = minute the file was sent)

Fast Forward Move Update Report Fast Forward 500 Byte Record Report

Mnnnnnn* (nnnnnn = bill ID) Mnnnnnn* (nnnnnn - bill ID)

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

227

Clearinghouses

McKesson's claim reports (Claims Acknowledgment Report, Exclusion Claims Report, and System Reject Claims Report) are available by 7:00 AM CST one day following the day on which files are received. The Acknowledgment/Exclusion Reports require an additional day. Additionally, many payers affiliated with McKesson offer claim status reports, payer acknowledgment reports, or electronic remittance advice via McKesson. Format, content, and frequency of reports and remittance data vary by payer.

Medical Statement Reports

McKesson offers a standard reporting package designed to support our customers who send statement data for printing and distribution. Medical Statement Reports are available one day following the day on which a statement file is received. Address Correction Report Electronic Transmission Acknowledgement File Acknowledgment Report Move/Update Report Receipt Report Totals Report

Payer Reports (CPR601.01)

Payer acknowledgment reports vary in format. These reports are distributed by McKesson in the format in which they are received from the payers. Generally, payers format their reports to print on the wider data processing paper (132 bytes long). Payer-specific guides can be referenced for payer-specific reports. Reports samples have all Patient Health Information (PHI) de-identified.

Claim Category Status

The following list describes the various category statuses that claims can be in for McKesson: A0 Acknowledgement/Forwarded - The claim/encounter has been forwarded to another entity. A1 Acknowledgement/Receipt - The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication. A2 Acknowledgement/Acceptance into adjudication system - The claim/ encounter has been accepted into the adjudication system. A3 Acknowledgement/Returned as a claim that cannot be processed - The claim/encounter has been rejected and has not been entered into the adjudication system. A4 Acknowledgement/Not Found - The claim/encounter cannot be found in the adjudication system. A5 Acknowledgement/Split Claim - The claim/encounter has been split upon acceptance into the adjudication system.

228

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Clearinghouses

A6 Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected. A7 Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected. A8 Acknowledgement/Rejected for relational field in error.- The claim/encounter has an error in a relational field and has been rejected.

Uploading Claims to McKesson

To uploaded claims to McKesson from their website, follow these steps. To upload claims to McKesson Reporting: 1. Create a batch and save it to the following location on the system: <drive>:Clearinghouse/send Note: The <drive> listed in the path above is the drive on which eCW is installed. In most cases, the installed drive is the C: drive, but an alternate drive (e.g., D:) can also be used in some cases. 2. Open a browser window and go to the McKesson website: https://mbox.transactions.mckhboc.com 3. Enter your username and password. 4. Click Send. 5. Browse for text (.txt) files in C:/Clearinghouse/send folder. 6. Choose Text file format on the McKesson page. 7. Click Send. Note: Page not Displayed appears if the attempt was not successful; try again with same file. A green check mark indicates the file has been sent correctly.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

229

Clearinghouses

Downloading Reports from McKesson

To download McKesson Reports from their website, follow these steps. To download reports from McKesson: 1. Open a browser window and go to the McKesson website: https://mbox.transactions.mckhboc.com 2. Enter your username and password. The report files displayed should show some or all of the following: Report Name NO FILES RECEIVED Description The sender will receive this result for each Page not Displayed error returned when sending reports they got the day of submittal. These results are simply failure notifications and they can be deleted. This report is named for the date and time sent and acknowledges that the file has been received and queued for processing. Available within about 30 minutes. This report displays any syntactical errors in the file. Available within about 30 minutes. The first A means the file was accepted. If the whole file is rejected, it will display R-AK9. XS... report - Unsolicited Claims Status Report This report will display any other errors preventing the entire claim file from being processed. These errors must be corrected and ALL claims resubmitted. This report is only viewable through ANSI Viewer. Available within about 30 minutes. The XJ Report is same as XS but is viewable. CA... report - Claims Acknowledgement Report This report lists all the claims received by McKesson. Available the day after the file was sent (if transmitted by 4:00pm CST). Generated only if the 997 report indicates that all claims were accepted. This report lists all claims received with errors. Available the day after the file was sent (if transmitted by 4:00pm CST). Generated only if the 997 report indicates that all claims were accepted. This report is generated by the payer and made available (forwarded) by McKesson. Format and information provided by payer. Claims with errors must be corrected and resubmitted. This report displays claims on EC reports and are given as a courtesy in HCFA printable format (with bar code). This report displays claims on EC reports and are given as a courtesy in HCFA printable format (NO bar code).

mmddhhmm.oo

XA... report - 997 Functional Acknowledgement Report

EC... report - Exclusion Report

CR... report - Payer Report

F7...report

F4...report

230

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Clearinghouses

Saving McKesson Reports

To save McKesson Reports on your local system, follow these steps. To save a McKesson report: 1. Choose a report by clicking on the (paper) report shown. 2. Save it to the following location on the system: <drive>:Clearinghouse/receive Note: The <drive> listed in the path above is the drive on which eCW is installed. In most cases, the installed drive is the C: drive, but an alternate drive (e.g., D:) can also be used in some cases. Note: Changing the file format to text (.txt) at the end of the file name before saving will allow this file to open easily as a text document.

Reviewing the McKesson Reports

To review McKesson Reports that have been downloaded to your system, follow these steps. To view the McKesson report: 1. Right-click on the Start menu, then click Explore. A tree view of your system displays. 2. Locate the following folder: <drive>:Clearinghouse/receive Note: The <drive> listed in the path above is the drive on which eCW is installed. In most cases, the installed drive is the C: drive, but an alternate drive (e.g., D:) can also be used in some cases. 3. Double-click to open a report. Note: It may be helpful for the practice to rename the file so they know to which batch it refers. To rename a file, right-click on file name and choose Rename. Suggested convention: Retain XA, EC, CR prefix, date saved, any suffix (McKesson adds if there is more than one file of a type for a given day) on original file. Save this file as a text file with the .txt extension; for example, XA04262006AB.txt

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

231

Clearinghouses

Clearinghouse Dashboard

Accessing the Clearinghouse Dashboard

The Clearinghouse allows users to access your clearinghouse's website from directly within the eClinicalWorks application. The login information for your clearinghouse must be configured before this dashboard can be used. For more information, refer to the System Administration Guide. To access the Practice Management Dashboard: 1. From the Navigation pane on the left, click the Billing band. The Billing icons display. 2. Click the Clearinghouse Dashboard icon. The Clearinghouse Dashboard window opens. 3. Perform actions for your clearinghouse as you would normally from their website.

232

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

ACCOUNTS RECEIVABLE MANAGEMENT

AR Management

The primary objective of managing your accounts receivable (AR) is to collect money due to your practice by insurance companies and by patients. An effective accounts receivable workflow helps you with the timely collection of these outstanding debts. Establishing an effective accounts receivable workflow using eClinicalWorks consists of viewing aging reports and using filter options to sort aging claims.

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

233

AR Management

Accounts Receivable Management

Account Analysis Summary Reports

The Account Analysis Summary reports consist of three reports to provide aging account balances for the following: Summary of all accounts for the entire practice Patients Guarantors IMPORTANT! All account analysis aging reports are dynamic. As a result, information in these reports constantly changes as any charge, payment, or adjustment activity occurs.

Account Summary Aging

The accounts summary aging schedule is a listing of the customers making up your total accounts receivable balance. Most businesses prepare an accounts receivable aging schedule at the end of each month. Analyzing your accounts receivable aging schedule may help you identify potential cash flow problems.

Patient Balance Aging Summary

The Patient Balance Aging Summary Report displays the outstanding patient balances and the aging categories for these balances filtered by patient and/or provider. Patient balances can be either self-pay balances or balances after insurance payments. Generate the Patient Balance Aging Summary Report at the end of the month or as needed using the billing or claim creation date. The date range defaults to two years before the current date. You can set other filters as needed.

Guarantor Summary Aging

The Guarantor Summary Aging Report displays a summary analysis of one or more account balances. Analyses can be performed per patient, per range of patients, or per provider. This aging report displays patient subtotals, billed insurance totals, provider totals, and total percentages. Reports can be generated based upon billing dates (the date the claim was created) or service dates.

234

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Accounts Receivable Management

AR Management

Insurance Analysis Reports

The Insurance Analysis reports consist of two aging reports that let you view outstanding account balances.

Insurance Claim Aging - Summary

The Insurance Claim Aging Summary Report is a summary of outstanding claims filtered by insurance, provider, provider type, and date range. This report displays the aging of the outstanding insurance balances, and allows you to determine which insurances have the largest, oldest balances that need to be resolved. The Insurance Claim Aging Detail report can then be generated for information that is more specific. Generate the Insurance Claim Aging Summary Report at the end of the month or as needed using the billing or claim creation date. The date range defaults to two years before the current date. You can set other filters as needed.

Insurance Claim Aging - Detail

The Insurance Claim Aging Detail Report displays a detailed analysis of outstanding claims filtered by insurance, provider, insurance type, provider type, and date range. In some cases, this report may exceed 300 pages for larger practices. To refine this information, go to Claims in eClinicalWorks and use the appropriate filters to display old balances. This report also provides patient-specific information such as procedure codes, patient insurance information, bill numbers, and billing status. Generate the Insurance Claim Aging Detail Report at the end of the month or as needed using the billing or claim creation date. The date range defaults to two years before the current date. You can set other filters set as needed. This report displays the claim detail for the outstanding balances that fall into the parameters that were set by the filters. Details include some patient demographics, claim number, charge details, and number of aged days.

Managing AR using Claim Filter Options

Although the reports provide detailed information for your aging accounts, some of the reports, like the Insurance Claim Aging-Detail, may be hundreds of pages long and impractical to use on a daily basis to resolve outstanding accounts. A more useful way to track outstanding balances is to use the filter options at the Claims window.

Finding Aging Accounts Using Filter Options

The sophisticated Claims Filter Options allow you to search for aging claim balances. Use the filter options to narrow or broaden your search, depending on the type of aging accounts to find.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

235

AR Management

Accounts Receivable Management

To find aging claims: 1. From the Billing band in the left navigation pane, click the Claims icon. The Claims window opens. 2. Select the filter options that will provide you with a manageable list of aging claims to resolve: To find aging accounts by... Date

Then... Enter the date range when the encounter or the claim occurred. You can also enter the date or date range the claim was submitted. Click the Assigned To drop-down list and make the required selection. Click the More (...) button and enter an insurance company or insurance group name, or leave these fields blank to search on all insurances and groups. Click the drop-down list and select the status of the claims you are searching for, example, you want to view all claims with Submitted status. Click the drop-down list and select facility or facility group. Then enter the name, or leave these fields blank to search on all facilities. Enter the numeric balance and select the appropriate mathematical operators >, <, <=, >=, or =.

Assignment Insurance Company or Group Claim Status

Facility

Outstanding balance 3. Click the Lookup button.

The aging claims that match your filter selections are displayed. 4. Double-click each claim to see detail about the claim and why it may not be paid (look for errors in ICD-9 and CPT detail). 5. Click the Summary tab and add notes about the claim in the Billing Notes field if required. 6. Continue to resolve each claim, or export the list of aging claims to a spreadsheet program. To export the list of aging claims: 1. Click the Billing button to open a drop-down list. 2. From the drop-down list, click the View Claims Report option. The list of aging claims opens in the default spreadsheet program installed on your system, for example: Microsoft Excel. 3. Edit print, or save this list as required.

236

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

REPORTS

Report Sets

There are two sets of reports available within eClinicalWorks: Crystal reports APL reports

End of Day Reports (Crystal Reports)

Crystal Reports are typically run each day by the practice to check the daily totals and balances.

Accessing Crystal Reports

To access the Crystal reports: 1. Click the Reports menu to open a drop-down list. 2. Select the desired report from the drop-down list:

The selected report's filter options display.

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

237

Report Sets

Reports

Day Sheet - Payments

The Day Sheet Payments report is accessible from the Reports menu, and a summary report can be run based upon date range, facility, and user. The report results display all payments made within the selected date range, and the method and type of payment received. The Day Sheet Payment report displays all payments that have been entered into the system on that day, even if the payment has not been posted to a claim (unposted payment). This report should be run daily at the end of the business day, and each staff member that posts payments should run this report to balance the amounts they collected to the amounts they posted. In addition, the office manager or supervisor should run this report for the entire staff to balance all money collected to the deposit for the day.

Provider Payments Based on Posting

The Provider Payments Based on Posting report is accessible from the Reports menu, and a summary report can be run based upon date range, facility, provider, and payment type. The report results display all provider payments based on posting made within the selected date range, and the method and type of payment received.

Day Sheet - Charges

The Day Sheet Charges reports are accessible from the Reports menu, and reports on specific charges can be run based on a number of filters: Note: Day Sheet - Charges reports pull their information from Claims. If a claim has not been generated from an encounter, then that encounter will not be reflected in this report.

Charges by Service Date

Displays a summary and/or detail of procedure totals and related charges, with date, provider, and facility filter options. This report can be run as needed by the office manager or supervisor, and it displays charges for the service date(s) specified, regardless of the date the charges were entered.

Charges by Service Date and User

Displays a summary and/or detail of procedure totals and related charges, with date, provider, and facility filter options. An additional filter allows the report to display charges entered by a particular user or staff member. The Charges by Service Date report can be run as needed by the office manager or supervisor. This report displays charges for the service date(s) and user(s) specified, regardless of the date the charges were entered.

238

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Reports

Report Sets

Charges by Claim Date

Displays a summary and/or detail of procedure totals and related charges by the date the claim was created. Filter options include date, provider, and facility, and the report displays the claim totals by patient, provider, and facility. The Charges by Claim Date report should be run daily by the office manager or supervisor. This report displays all charges entered into the system on the date(s) specified, regardless of the date of service.

Charges by User

Displays a summary and/or detail of procedure totals and related charges by user and the date the claim was created. Filter options include date, provider, and facility, and the report displays the claim totals by patient, provider, and facility. The Charges by User report should be run as needed by the office manager or supervisor. This report displays all charges entered into the system on the date(s) specified, sorted by by the user who entered the charges. Reports are based on claim date, not the date of service.

Adjustment by User

Note: This report displays information on financial adjustments only. Contractual adjustments performed during insurance payment posting are not included. Displays a summary and/or detail of adjustments by user and the date the claim was created. Filter options include date, facility, and user, and the report displays the adjustment totals by provider, user, and facility. The Adjustment by User report should be run as needed by the office manager or supervisor. This report displays all adjustments entered into the system on the date(s) specified, and is arranged by the user who entered the charges. Reports are based on claim date, not the date of service.

Refund Summary

The Refund Summary report displays a summary of refunds for a facility or group of facilities within a specific date range. The results can be filtered by the entering user or user group. The summary lists refund totals and details by insurance and patient. The Refund Summary report should be run daily by the office manager or supervisor. The report displays all refunds that were processed on the date(s) specified, and the report is organized by user, then by insurance or patient refund.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

239

Report Sets

Reports

Billing Summary

To view the Billing Summary, hover over the Billing Summary option on the Reports menu to open a drop-down list, and then click the View Billing Summary Option. The Billing Summary displays a day-by-day summary of encounters and their charges for a selected provider on a specific date. The report displays the patient information, facility, all procedures performed on that date, and the related charges. The Billing Summary report should only be used by practices that use a billing service for their billing. This report is run as needed by an office manager or supervisor. The report displays all information from the Progress Notes for each patient seen in the date range specified. This information includes patient demographic information, provider information, and CPT and ICD-9 codes.

Configuring Billing Summary Options

Options for the Billing Summary report can be configured from the Reports menu. To configure Billing Summary options: 1. From the Reports menu, hover over the Billing Summary option to open a drop-down list. 2. From the drop-down list, click Configure Billing Summary Options. The Billing Summary Options window opens:

3. Check the boxes next to the information you want to be included on the Billing Summary report. 4. Click the OK button. The Billing Summary options are now configured.

240

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Reports

Report Sets

Out of Office Billing Summary

The Out of Office Billing Summary is nearly identical to the standard Billing Summary except it displays all procedures performed by the selected doctor at facilities other than the doctor's designated primary facility. This report uses the same filters and features as the standard Billing Summary. The Out of Office Billing Summary report should only be used by practices that use a billing service for their billing. This report is run as needed by an office manager or supervisor. The report displays all information from the Out of Office Encounters for each patient seen in the date range specified. This information includes patient demographic information, provider information, and CPT and ICD-9 codes.

OB - Active Pregnancies

The Active Pregnancies report can be accessed from the Reports menu by hovering over the OB option to open a drop-down list, and then clicking the Active Pregnancies option. The Active Pregnancies report opens directly after clicking the Active Pregnancies option. The provider's name, and the patient's name, date of birth, estimated delivery date, phone number, address, and insurance information displays for the default provider. To view this information for a different provider, select the desired provider from the Provider drop-down list. To view this information for all providers at once, check the All Providers box. This information can be previewed, printed, or faxed using the buttons at the bottom of the window.

Labels

The Labels report opens directly after clicking the Labels option from the Reports menu. All the labels that have been printed for the default provider on today's date display, along with the information that was printed on them. To view this information for a different provider, select the desired provider from the Provider drop-down list. To view this information for only encounters that are incomplete or locked/done, select the desired status from the Encounter Status drop-down list. To view this information for a different date, select the desired date from the Date/Date Range drop-down calendar. This information can be previewed, printed, or faxed using the buttons at the bottom of the window. To print this report by patient, check the Print Report/Patient box.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

241

Report Sets

Reports

Reminders

The Reminders report opens directly after clicking the Reminders option from the Reports menu. All the reminders that have been sent for the default provider on today's date display, along with the information that was included on them. To view this information for a different provider, select the desired provider from the Provider drop-down list. To view this information for only encounters that are incomplete or locked/done, select the desired status from the Encounter Status drop-down list. To view this information for a different date or date range, select the desired date or date range from the Date/Date Range drop-down calendars. This information can be previewed, printed, or faxed using the buttons at the bottom of the window. To print this report by patient, check the Print Report/Patient box.

Transactions Reports

The Transaction Reports feature is accessible from the Reports menu, and it offers users a simple-to-use tool for generating transaction reports on Charges, Charges by Provider, Payments, Refunds, Adjustments, and more specific transactions, such as: Claim Level Payments Claim Level Adjustments Claim Level Withheld Claim Level Refunds Line Item Level Payment Posting - Paid Line Item Payment Posting - Contract Line Item Payment Posting - Withheld Line Item Refunds Line Item Adjustments

EMR Reports

Reports related to the Electronic Medical Records area of the program can be accessed from the Reports menu by hovering over the EMR menu to open a drop-down list, and then selecting one of the following options:

Cancelled Visits

To view all the visits for a provider that use non-billable Visit Status codes, select the desired provider from the Provider drop-down list. Then select the desired date range from the drop-down calendars here. Once all filters are set as desired, click the Get Report button. The appointment provider, date and time, and the patient address and phone number display for each cancelled visit. This information can be previewed or printed by clicking the appropriate button at the bottom of the window.

242

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Reports

Report Sets

Patient Data Logs

The logs of all the times a patient's information was accessed can be viewed by patient, date range, and staff member. The user that accessed the patient, the patient's name, the action taken, the date and time of the access, and the IP address that the access originated from are displayed. This information can be printed by clicking the Print button once the report is generated.

Unlocked Visits Report

To view the unlocked visits for a provider, select the desired provider from the Provider drop-down list. Then select the desired date range from the drop-down calendars here and, if desired, click the Sel button next to the Facility field to filter results by a specific facility. Once all filters are set as desired, click the Generate Report button. The visit number, patient name, appointment date and time, provider the patient was seen by, and the facility the patient was seen at are displayed for each unlocked visit. This information can be previewed or printed by clicking the appropriate button at the bottom of the window.

Access Log Report

A log of the times an action was taken on a patient can be viewed by date range, patient, staff member, and user action. The date of the encounter that an action was performed on, the section of the system that the action was performed on, the action that was taken, the user that performed the action, the date and time the action was performed, and the IP address where the action originated are displayed for each action taken. This information can be printed by clicking the Print button once the report is generated.

Day Sheet - Pathology Detail

The Day Sheet for pathology details can be viewed by date range and provider. The order date, specimen, method of collection, location, rule out information, and notes are all displayed for each order. This information can be printed and exported using the icons at the top of the window.

Scheduling - Provider Productivity Report

The Provider Productivity report can be accessed from the Reports menu by hovering over the Scheduling option to open a drop-down list, and then clicking the Provider Productivity Report option. This report can be filtered by provider, facility, date range, and appointment length, and it can be generated based on the selected facility (as opposed to the provider-based default). The standard working hours, worked hours, percentage of hours worked, appointments booked, appointments seen, unique patients seen, appointments cancelled, percentage of no-show appointments, productivity rate, and number of appointments above and below a user-defined time limit are all displayed for the selected provider(s). This report can be printed by clicking the Print button at the bottom of the window.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

243

Report Sets

Reports

Using the Report Console

Certain reports can also be accessed from the Report Console. To use the report console: 1. From the Reports menu, click the Reports Console option. The Reports window opens:

2. Click one of the following links to open the desired report: Transaction Mismatch Report Payments Posting for Associated Service Date Report Primary Payments Posted Allowed vs. Fee Schedule Allowed Clinical Utilization Report 3. To print the information contained in any report, click the Print button. Patients Not Seen Report Populate Dummy CPT Code and Modifier Values for RVU Report Provider Productivity Report

PM Scheduled Tasks Status

Practice management scheduled tasks can be viewed by date range and status. A description of the task, the date and time range in which that the task was run, and the current status of the task are all displayed. This information can be printed by clicking the Print button.

244

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Reports

Report Sets

View Claim Scrub Logs

A log of the times claims have been scrubbed can be viewed by patient, insurance company, job date, facility, and provider. The claim status, claim number, service date, patient, payer, and provider for each job are displayed in this report.

View Security Logs

A log of failed login attempts can be viewed by date range and staff member. The user, message, status, action, failed logins, date and time, and IP address are all displayed in this report.

Reconcile Transactions

eClinicalWorks provides a one-time utility for reconciling all transactions within the system. This utility should be run before running any transaction-based reports. This will set transaction information for all items that were generated before the system began tracking data at a transaction level, and it will capture any differences that need to be corrected for the transaction reports. Note: This reconciliation process needs to be performed only once. It is system resource intensive and will take some time to perform. It is recommended to perform this function after hours. This process should be performed before using the transaction-based reports found under Reports > Transactions. To reconcile all transactions within the system: 1. Click the Billing menu and select Reconcile to display a drop-down list. 2. From the drop-down list, select Reconcile Transactions. The Reconcile Transactions window displays. 3. Select the top check box to select all transaction types, or select individual transaction types using the check boxes. 4. Select the check box titled Post Difference Amounts during Reconciliation on the original transaction date (not today's date). Note: This option is recommended only once during first-time reconciliation. It should not be checked subsequently. 5. Select the Analyze button. The system will review all of the transaction types and populate the Difference column with any differences at the transaction level that need to be adjusted. 6. Click Reconcile. A warning displays to indicate that this process should be performed after hours. 7. Click Yes to begin the reconciliation. The reconciliation amounts appear in the Amount Reconciled column as they system completes the process.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

245

Report Sets

Reports

End-of-Month Reports (APL Reports)

The APL reports are typically used by practices to view end-of-month and end-of-year results on a range of office information. The APL Reports application is installed during the eClinicalWorks software installation process, and can be accessed through the Start menu, or from the desktop shortcut that is created during the installation. The APL application has a large number of highly specific report options available to practices. Below are the most common reports run by practices to manage their charge, payment, and claim information. For more information on all APL reports, refer to the APL Reports Guide.

Accessing APL Reports through eCW

Users can now access APL Reports directly from within the eCW application. Note: Contact eClinicalWorks Support to enable this feature. To access APL Reports through eCW once setup is complete: 1. From the Reports menu, hover over Additional (APL) Reports to open a drop-down list:

2. From this drop-down list, click one of the two options: View Reports: launches the APL Reports module. Reports Configuration: provides access to the APL Configuration window. eCW Support sets up the default values for the configuration:

Day Sheet Summary

The Day Sheet Summary Report displays a summary of charges, payments, adjustments, and withheld amounts for a given date range. Reports can be generated based upon billing dates (the date the claim was created) or service dates. This report must be run per billing date.

246

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Reports

Report Sets

Charges-Payment Summary

The Charges/Payment Summary Report displays a summary of actual charges and all associated payments, adjustments, and withheld amounts for a given date range. The Charges/Payment Summary Report should be run at the end of the month by setting the date range for the month, and using Billing Date ONLY. Leave the Provider field blank to return a report for all providers. Select either Appointing, Rendering, or Pay to Provider. The report returns a result for each provider, which displays the total of actual charges entered, the payments posted that are ASSOCIATED with these charges, insurance adjustments, insurance withheld, financial write-offs that were processed in the system during the selected date range. This report should be generated by the office manager or staff member responsible for month-end reporting.

Insurance Claim Aging Detail

The Insurance Claim Aging Detail Report displays a detailed analysis of outstanding claims filtered by insurance, provider, insurance type, provider type, and date range. It also provides information regarding patient-specific information such as procedure codes, patient insurance information, bill numbers, and billing status. The Insurance Claim Aging Detail Report should be run at the end of the month or as needed, using Billing Date ONLY. The date range defaults to two years prior to the current date, and other filters can be set as needed. This report displays the claim detail for the outstanding balances that fall into the parameters that were set by the filters. Details include some patient demographics, claim number, charge details, and number of aged days. This report should be generated by the office manager or staff member responsible for resolving outstanding claims. Note: In some cases, this report can exceed 300 pages for larger practices. To refine this information, go to Claims in eClinicalWorks and use the appropriate filters to display old balances. IMPORTANT! All aging reports are dynamic. As a result, information on these reports will constantly change as any charge, payment, or adjustment activity occurs.

Insurance Charges-Payments

The Insurance Charges/Payment Report displays a cross-tabulation analysis of one or all insurances. The report calculates the actual charges billed, and associated payments, adjustments, and withheld amounts. Reports can be generated based upon billing dates (the date the claim was created) or service dates, with the option to display month-to-date and year-to-date totals.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

247

Report Sets

Reports

Insurance Cross-Tab Analysis

The Insurance Cross-Tab Analysis Report displays a cross-tabulation analysis of one or all insurances. The report calculates the actual charges billed, actual payments received, adjustments and withheld amounts based on a variety of filter options. Reports can be generated based upon billing dates (the date the claim was created) or service dates, with the option to display month-to-date and year-to-date totals.

Procedure Code Production Analysis

The Procedure Code/Production Analysis Report displays an analysis of all procedure codes per provider and per facility. The report also displays procedure codes, procedure units, charges, unassociated payments, contractual adjustments, and insurance withheld amounts. Reports can be generated based upon billing dates (the date the claim was created) or service dates, and can be created using a variety of filter and delivery options.

Charges-Payment/Claim Rendering Provider

The Charges-Payment/Claim Rendering Provider Report displays total charges, payments, insurance adjustments, insurance withheld amounts, and write-off amounts per provider or group of providers. Filter options allow linking provider types to a specific provider and can display payments associated to charges or unassociated payments. The Charges-Payment/Claim Rendering Provider Report should be run at the end of the month or as needed. Set the desired date range and the type of provider to link with the Claim Rendering Provider. Select a Rendering Provider or leave the field blank to see all providers. Select payments associated with the charges or unassociated payments. The report displays the total charges, payments, insurance adjustments, insurance withheld, and write-off amounts for each Claim Rendering Provider. The Claim Rendering Provider information displays all service information for the Appointing/Servicing Provider. This information includes all services for the Appointing/Servicing Providers that were performed for the Claim Rendering Provider. This report should be generated as needed or on a monthly basis to monitor the activity of the different providers that are being included in the activity for the Claim Rendering Provider. Note: All aging reports are dynamic. As a result, information on these reports will constantly change as any charge, payment, or adjustment activity occurs.

Unposted Payments

The Unposted Payments Report displays the amount received, posted amount, and unposted amount totals per provider or group of providers. Payment information such as payment ID, payment type, and account number is also included. Reports are generated based upon service dates. Practices typically run this report once a week for cleanup purposes.

248

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Reports

Report Sets

Payments without Claims

The Payments without Claims Report displays payments made without an associated claim. The report includes payment ID, facility, service date, patient name and date of birth, and the amount received. Filters allow the report to be filtered by facility and/or provider. Reports are generated based upon payment dates.

List Refunds

The List Refunds Report displays all posted and unposted refunds per provider. Reports are generated based upon billing dates.

List Write-offs/Adjustments

The List Write-offs/Adjustments Report displays the write off and adjustment details per facility and/or provider. The report includes code description, code, claim information, patient name and date of birth, and adjustment totals. Reports are generated based upon billing dates.

A/R Management Report

The A/R Management Report displays a complete summary of all charges, receipts, adjustments, and monthly Accounts Receivable totals per provider and/or facility. Filter options allow users to group reports by various facility/provider combinations, and to run reports based upon billing and payments to various provider types. Reports can be generated based upon billing dates (the date the claim was created) or service dates. The A/R Management Report should be run at the end of the month or as needed. Set date range and the facility and/or providers information. This report displays the Net Charges, Net Payments, Net Adjustments, and ending A/R per month for each provider selected. This report should be generated by the office manager or staff member responsible for month-end reporting.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

249

Report Sets

Reports

Daily Financial Summary

The Daily Financial Summary Report displays current, month-to-date, and year-to-date charges and payments totals for a selected date range. Filter options allow users to group reports by various facility/provider combinations, and to run reports based upon billing and payments to various provider types. Reports can be generated based upon billing dates (the date the claim was created) or service dates. The Daily Financial Summary Report should be run daily by the office manager for the previous day. This report displays: the A/R at the beginning of the day all charges, payments, adjustments, and write-offs for the day A/R balance at the end of the day The information is also sorted by month-to-date and year-to-date, and categorized by provider with a practice total at the end. Note: An Excel (.csv) file is created each time this report is generated, and the file is saved to a folder on your system. Also, each time a new file is created, it overwrites the previous version. If you wish to save these individual files, you must rename them before generating this report again.

250

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

APPENDIX A: STATE BILLING EXCEPTIONS

State AZ Exceptions Medicare: Requires the letter Z before Individual and Group Numbers. BC/BS: Requires AZ0 followed by 5-digit number, followed by 0 (zero). CA BC/BS: Electronic-payer ID 47198 (WebMD) Individual number is the state license number, followed by a 0 with N5 ID type. Group Number is the Tax ID with G2 ID type Paper-uncheck default: HCFA 24K license HCFA 33: PIN license HCFA 33: Group Tax ID BC/BS of LA: Payer ID 23728 (WebMD/Emdeon) Now a commercial payer and ID type is G2 (not 1B). FL Health Options of FL (SX030): (really a BCBS plan but WebMD/ Emdeon commercial) - Requires ACD for setup though no application. Medicare: When submitting to Florida Direct, the practice must notify Medicare that they will be using eCW and they must be in Production mode. Failing to do so will put them in Test mode and claims will not be paid. GA BC/BS: Electronic-(Web MD) Provider Number must be 6 digits. Group Number must be 6 digits. Uncheck electronic default: BAO-2 requires a 5-digit Submitter ID (BS gives to practice). CAO-28 must be a 6-digit number. McKesson: Submitter Number is linked automatically and therefore, it is not required. GA requires an 11-digit NDC Number Vaccine Lot Number in box 24A on new HCFA (CPT-update). Medicare: No Social Security Numbers are accepted. Use Tax ID (even with S.S. Number) on Admin Provider Page (Uncheck the default on insurance). IL BC/BS: Electronic (WebMD) Payer ID SB621 Individual Number State License (9 digits) ID type 1B (corrected 10/ 23/06 from OB) Group Number: ID Type 1B IN KY Medicaid: 2-digit Certification code required in Box 19 Ken Pac Number Medicaid Referring Phys-Billing info-Ken Pac Number Insurance tab-check off Medicaid Claim edit

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

251

State LA MA

Exceptions (Continued) BC/BS of Louisiana: Requires Provider Type G2 for both Individual and Group. Medicaid: The HCFA claim form is only acceptable with MC EOB if Medicare approves the amount. If Medicare denies the claim, submit the EOB with a MassHealth claim form. Referrals are needed for Harvard Pilgrim (G2) and Medicaid (1D). Needs provider numbers in referring directory and tech enables this to pull to Box 17 and 17A.

MD

BC/BS Carefirst (WebMD): Payer ID SB580 Uncheck HCFA default-HCFA 24 K blank HCFA 33 pin Group Number HCFA 33 Group Number BC/BS (Web MD): Payer ID SB690: Individual Number must be an 8-digit numeric-only number with 1B ID type. Group Number must be 5 or 6 digits with 1B ID type.

MI

BC/BS (McKesson): Referring Provider Number and Rendering Provider Number have an OB qualifier that consists of first initial of the first name, first initial of the last name, and last 6 digits of their state license number. Group Number should be 10 digits and should include a 1B qualifier. Medicare Plus Blue/Medicare Advantage Plan: Source of Payment-BL but Rendering Provider ID and Group ID Type is 1C. Medicaid: Requires a 2-digit provider type preceding the Provider Number.

NC

Carolina Access Code will not show on eCW HCFA but will print and go electronically in Box 19. This feature must be enabled by eCW Support BC/BS Horizon: Both Admit and Discharge dates are required on claims. Medicare: Add the letter V before number for electronic 33 Pin if Individual Number only (no Group Number) No 24K or PIN Group Number Medicare Empire: following format: Requires a 10-digit Provider Number using the

NJ NV

NY

Doctor's 2 initials + 0 + 6-digit Provider Number + 0. XX0XXXXXX0 Group Number same if Individual or if Group Number same format BC/BS Empire: also 10 digits; same format as Medicare but with 6digit BS Provider Number. Medicaid: No 24K, Group Number should consist of the 8-character License Number preceded by License Type (01 for MD&DO) If License Number is less than 8 characters, it must be padded to the left with zeros Example: NY License Number 123456 and License Type 01: Group Number would be 0100123456. Upstate Medicare: (SMNY1)

252

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

State RI

Exceptions (Continued) Blue Chip: Must use Individual Provider Numbers. Needs referring physician Blue Chip Individual provider on all claims in Box 17, 17A with ID type 1B. This feature must be enabled by eCW Support. BC/BS of RI: For electronic submission to McKesson, use 5 zeros plus 5-digit Provider Number (e.g., 00000NNNNN). May only need Group Number in both Ind and Group fields. Needs referring provider State License with 0B id type in 17, 17A. This feature must be enabled by eCW Support. Neighborhood Health Plan OF RI: Individual Number consists of 3-8 numeric characters with N5 qualifier; Group Number is alphanumeric with G2 qualifier up to 8 digits.

SC TX

Medicare: The Provider Number is comprised of the UPIN + Group Number. The Group Number consists of 4 digits. Medicaid-EPSDT: Set up a separate Medicaid insurance for EPSDT. EPSDT Provider Number goes in Box 24K AND in Box 33 (same number). Claim Data: Special Program code 01, EPSDT referral code NU Claim Header: Miscellaneous Services: check box Healthy Kids, Claim Type: EPSDT Claim CPT Detail: CPT - additional info-EPSDT Indicator-Y Modifier for EPSDT: AM-Physician, SA-Nurse Practitioner, TD-Nurse R.N.

Note: If insurance needs 1C qualifier for Supervising Physician, make sure the Enable Referral Number in Referrals/Claim Insurances box is checked on the EDI/ANSI tab for that particular insurance company.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

253

254

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

APPENDIX B: NOTICES

Trademarks

eClinicalWorks is a trademark of eClinicalWorks, LLC. All other trademarks or service marks contained herein are the property of their respective owners.

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

255

256

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

e-Prescription

GLOSSARY

The following lists important terms used throughout the product and documentation. Words displaying in Italics are also defined glossary terms.

Appointment Toolbar - Permanently displayed toolbar at the top of the Appointment window-- provides quick access to the Encounters window, Appointment Search & Multiple Appointment Booking window, Patient Information logs, patient outgoing and/or incoming referrals, patient orders, the Process Bubble Sheet document window, and to delete the appointment. Bands - Rectangular gray buttons on the left side of the eCW navigation pane that contain icons. There are six bands (seven for administrators): Admin (displayed for administrators only), Practice, Registry, Referrals, Messages, Documents, and Billing. Button - Small raised areas containing text, most often rectangular, that open a new window when clicked. Chart Panel - Tabbed Pane at the far right of the Progress Notes. Clicking these tabs displays useful information concerning a patient, often allowing users to import information into the encounter. Provides access to an UpToDate search (Optional). CDSS Quality Measures - Clinical Decision Support System (CDSS) Alerts based on Quality Measures definitions that are triggered by diagnoses, gender, and age, for the appropriate treatment and care of patients and preventative screenings. Check box - A square box, that when selected displays a check mark indicating the associated feature is enabled. Clicking a selected check box clears the check mark and disables the associated feature.

Confirmation Window - A window that pops up to either inform users of an action's status, or to obtain confirmation from the user before the eCW system executes a requested action. Drop-Down Calendar - Date-related Fields with adjacent downward-facing arrows. Clicking in these fields opens a calendar, used in the same manner as the calendar on the Resource Schedule window. Drop-Down List - Fields with adjacent downwardfacing arrows. Clicking the arrow in these fields opens a list of options, used to select and populate the field. Editable Drop-Down Lists - Add and deleted text from these drop-down lists. To open the drop-down list, click the adjacent arrow. Clicking in the Field itself inserts a text cursor, used to add or delete text from that point. These fields may be populated manually by typing, automatically by selecting an option from the drop-down list, or by a combination of the two. Non-Editable Drop-Down Lists - Contents of these fields must be selected from the options provided in the drop-down list and cannot be added to or deleted. Click in any area of these fields to open the drop-down list. Table Drop-Down Lists - These lists display in table fields, usually hidden until the field is clicked. To use these drop-down lists, click in the field to display the downward-facing arrow, and then click that arrow to open the drop-down list. e-Prescription - (Optional) an eCW extra feature used to write and send prescriptions electronically to local pharmacies. e-Prescription uses a service called SureScripts to forward prescriptions from the physician to the pharmacist. e-Prescription uses the Multum drug database.

©Copyright

eClinicalWorks, LLC 2009, Billing Users Guide

257

Glossary Field Patient Hub

Field - Rectangular space allocated for a particular item of information. These can also be called Text boxes. A field can be required, optional, or calculated. Data must be entered into a required field, while an optional field may be blank. The eCW system automatically determines the value of a calculated field. eCW presents two types of fields: Read-Only fields - Non-editable fields; display with a grey tint. Editable fields - These fields display with a white background. Change, add, or delete the information in these fields by clicking in the white area; a cursor displays at the insertion point. Flowsheets - Flowsheets are spreadsheet-like documents that contain a set of patient information you track over time. Hot keys - Buttons that have a letter underlined have hot keys associated with them. In most cases, pressing the Alt key and the underlined letter on your keyboard at the same time clicks the associated button. If the same letter is used more than once on a window, holding the Alt key and pressing the underlined letter multiple times rotates the focus through the associated buttons. In this case, once the focus is on the desired button (indicated by a box of dots around the text on the button) users can press the Enter key on their keyboard to click that button. Icon - Picture representing a window or status. Status Icon - Indicates a status of the associated item. For example, the W Status icon in the Web Column on the Patient Lookup window indicates the patient is Web enabled. Window Icon - An icon that is also a button. Clicking this icon opens the window associated with that icon. For example, the Resource Schedule icon in the left navigation pane is a window icon. Jelly Beans - see Quick-Launch Buttons. Left Navigation Pane - Permanently displayed pane on the far left side of the eCW application. This pane contains bands, which in turn contain the icons used to access the various windows in the system. Link - Text that when clicked opens a new window-- often underlined.

Menus - Permanently displayed text in the light blue section at the very top of the application that when clicked, offer lists of options generally related to setup and administration. There are 11 menus: File, Patient, Schedule, EMR, Billing, Reports, Fax, Tools, Community, Lock Workstation (clicking this locks your computer directly), and Help. More (...) button - Displays next to some fields. Clicking the ellipsis (...) opens selection dialogs, usually lookup windows, which allow users to populate the associated field with the information selected. Mouse Over - - Hovering the mouse cursor over an item on the window. Medical Record Numbers (MRN) - A method of identifying a patient and patient/medical record information based on the use of Medical Record Numbers. Each provider organization maintains a Master Patient Index (MPI) and the Medical Record Number is issued and maintained through this index. The MPI contains the patient's information. The MRN is unique only within the same organization. Navigation Toolbar - Permanently displayed dark blue toolbar near the top of the application, just beneath the Menus. This toolbar contains the Patient Lookup icon, the Show/Hide Buttons, the QuickLaunch Buttons, and the Quick-Launch Links. Order Sets - A group of treatment options (prescriptions, labs, diagnostic imaging, procedures, referrals, etc.) pre-configured to ensure all necessary elements for a particular condition are ordered. Option - Selectable items in drop-down lists and menus. Pane - Rectangular areas of windows clearly separated from each other by borders. Patient Dashboard - Dark blue pane at the top of the Progress Notes, Telephone Encounter Document Review, and Lab Results/Diagnostic Imaging window. This pane displays basic information about a patient and contains buttons to access detailed patient information, Sticky Notes to record miscellaneous information about a patient, Links to access areas of their Progress Notes, and various drop-down lists. Do not confuse with the Progress Notes Dashboard. Patient Hub - Patient-specific window containing basic information about a patient and many buttons to access more detailed information about a patient and modify it as necessary. Access this window from both the Patient Lookup and Progress Notes Dashboard.

258

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Glossary Patient Information Super Bills

Patient Information - Window containing a patient's demographic information, accessed from the Patient Lookup, Patient Hub, Progress Notes Dashboard, and Progress Notes Menus (Pt. Info menu). Patient Lookup - Window that allows users to search for any patient in the system. Access this window from the Patient Lookup icon, Progress Notes Dashboard, Patient Hub, and the More (...) buttons associated with many Patient and Name fields. Patient Lookup Icon - Permanently displayed icon displaying a human torso and magnifying glass on a white background, located near the top of the application in the Navigation Toolbar. Pop-Up Window - Small windows that open when a button or link is clicked. Progress Notes Dashboard - Section of icons near the top of most Pop-Up windows accessed from the Progress Notes. Clicking these icons allows users to navigate quickly between the various sections of the Progress Notes. Progress Notes Menus - Section of text at the very top of most Pop-Up windows accessed from the Progress Notes. Clicking these menus opens lists of Options related to the current patient. There are three Progress Notes menus: Pt. Info, Encounter, and Physical. Progress Notes - Provides a secure, central location to access all patient data. There are four different Visit Types: Physical, Regular, Intervention, and OP Report. Each type of visit that you select determines the format and content of the Progress Notes for the corresponding visit. Quick-Launch buttons - Located on the Patient Dashboard taskbar, the Quick Launch buttons consist of lettered menus and buttons that provide direct access to areas of the application practices use most often. Each menu includes a companion button to the right; these Quick Launch buttons display the numerical real-time totals for the various sections, such as checked-in patients, referrals, and documents ready for review. Quick-Launch Link - Permanently displayed links, to the left of the associated Quick-Launch button, near the upper-right of the application in the Navigation toolbar. Clicking any of these links opens a Drop-Down List with options that allow users easy access to commonly used areas of the system.

Radio Button - Used to select the associated item from a group of displayed options. One item in the group of radio buttons must be selected. To deselect a radio buttons, click another item in the group. They cannot be clicked again to deselect the associated item--as is true with Check boxes. Read-Only - Information that displays on the window but cannot be edited directly. Resource Schedule - Offers the options for viewing and managing staff schedules and patient appointments. Centralized scheduling allows you to make appointments for providers based on the facility selected. Facility-based scheduling makes it easier to manage appointments for providers who switch between facilities. The facilities appointment slots are color coded, indicating appointments scheduled at different facilities. Show/Hide Buttons - Three permanently displayed green octagonal buttons with dark green circles in their centers, located in the Navigation toolbar near the top of the application. Clicking one of these buttons once hides the associated feature and turns the circle in the center red, and clicking that button again shows the associated feature and turns the circle back to dark green: Left Show/Hide button - Shows/hides the navigation pane. Middle Show/Hide button - Shows/hides the Patient Dashboard. Right Show/Hide button - Shows/hides the Chart Panel. Smart Forms - Specialty forms containing structured data. Smart Forms measure the severity of select conditions and interact with the Progress Notes using structured data. Specialty Forms - Specialty Forms are standardized medical forms for a wide variety of medical situations, and they are included in the eCW installation process. Use these forms to document a patient's condition quickly and accurately or to create a standardized letter for a patient. Sticky Notes - Yellow and pink boxes in the Patient Dashboard. Clicking in these boxes opens Pop-Up windows, from which users may enter miscellaneous notes about a patient. Super Bills - An electronic bill used to select commonly used ICD, CPT, and E/M codes.

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

259

Glossary Table Visit Types

Table - Grid of fields that contain information, mostoften entered by the user. Column - Vertical line of fields in a Table. Row - Horizontal line of fields in a Table. Text box - See field. Tooltip - A Popup window that displays useful information about an item on the window when you Mouse Over that item. UpToDate - A clinical reference service that is separate from eClinicalWorks. A license must be obtained from the UpToDate website (www.uptodate.com) to use it with eClinicalWorks. Visit Codes - Appointment types created to fit the needs and schedules of each provider. These codes are associated with specific functions of the practice, have an assigned duration, and are associated with one of the four Visit Types. For example, a general practice creates Visit Codes called Pregnancy Visit and Preschool Visit. These new Visit Codes are associated with a Physical Visit Type. Visit Types - Defines the length of time for an appointment type (or Visit Code) and the format for the type of Progress Notes attached to the visit. There are four different Visit Types: Physical, Regular, Intervention, and OP Report. Each type of visit determines the format and content of the Progress Notes for the corresponding visit. You can customize Visit Types to meet the needs of your practice.

260

©

Copyright eClinicalWorks, LLC 2009, Billing Users Guide

Information

eClinicalWorks Billing Guide V 8.0.47

260 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

15843


You might also be interested in

BETA
Getting Started With Medisoft
Microsoft Word - NDCMedisoft11.doc
eClinicalWorks Billing Guide V 8.0.47
Microsoft Word - NDCMedisoft11.doc