Billing 101B - Part I Billing 101B - Part I Charge EntryCharge Entry

Introduction Introduction (Paul)(Paul)

Billing Cycle Overview Billing Cycle Overview (Paul)(Paul)

Charge Entry Overview Charge Entry Overview (Francesca)(Francesca)

Charge Entry Flow Process Charge Entry Flow Process (Francesca)(Francesca)

QuestionsQuestions

Billing TerminologyBilling Terminology

IDX vs. SMSIDX vs. SMSCoding (CPT/ICD-9)Coding (CPT/ICD-9)ChargeChargeTES EditsTES EditsEncounter/Encounter FormEncounter/Encounter FormInvoiceInvoiceClaim/StatementClaim/StatementA/RA/RPaymentPaymentCharge CorrectionCharge CorrectionLag Days (measuring metric)Lag Days (measuring metric)

THE BILLING CYCLE

Client Relations/ Services

A/R Analysis and Reporting

Billing Inquires (Customer Services)

QA and Training

1. Appointment Scheduling and Registration – The process of scheduling an appointment and obtaining and/or updating all current demographic, financial and insurance information.

2. Arrival/Check-In – The process of arriving patients, verify information and updating as necessary.

4. Coding and Encounter Form Batching – The process of coding a visit completing an encounter form and batching encounter forms.

5. Charge Entry – The process of entering charges, CPT codes, and ICD-9 codes into a billing system.

3. Patient Care

6. Edit Resolution – The process of data verifications using TES, Z-Claim and Pre-Bill edit systems.

7. Claims Submission and Patient Billing – The process of submitting claims to third-party payors and mailing patient statements (bills).

8. Payment Posting – The process of recording all types of payments and adjustments received in a timely manner.

9. A/R Follow-Up – The process of contacting third-party payors and self-pay patients to inquire about unpaid accounts

The billing cycle includes nine major steps and is supported by ongoing quality assurance and training, customer service, analysis and reporting and client relations

Charge Entry OverviewCharge Entry Overview

Functions and ResponsibilitiesFunctions and ResponsibilitiesIDX ComponentsIDX Components

MGBS Charge Entry MatrixMGBS Charge Entry Matrix

DermatologyDermatologyLakeshoreLakeshoreLakesideLakesideMedicine (some BA)Medicine (some BA)NeurologyNeurologyOrtho ApplianceOrtho AppliancePain ManagementPain ManagementProctor FoundationProctor FoundationWomen HealthWomen Health

EncounterEncounterFormForm

ExampleExample

Charge Slip Batch Control Charge Slip Batch Control DocumentDocument

Department

$Total of Charge Slips

No. of Charge Slips

Abstractor At:

Attention:

Date:

Date Completed

Batch Total

Signature

MGBS Process DefinedMGBS Process Defined

Charge Batches Received

From Department

Charge Batches Are Stamped Daily Logged In Binder

Encounter Forms Are Then Counted

Charges Are Entered Into

TES

After Charges AreEntered, The Batches Are

Then Logged OutFrom The Binder

Batch Proofs Are SentBack To The DeptFor Reconciliation

THE BILLING SYSTEM FLOW

The billing system flow includes four applications and is supported by ongoing quality assurance and training, customer service, analysis and reporting and client relations.

TES (Edit Checking)

Router

Pre-Bill (Edits)

IDX BAR

(Edits)

SMS (Edits)

Payor

Payor

Claims Claims

Payments Rejections

Payments Rejections

(Manual/Electronic) Payments Rejections

(Manual/Electronic) Payments Rejections

Encounter

Claims Claims

Payments Rejections

Payments Rejections

MGBS Charge Entry TeamMGBS Charge Entry Team

Liz, Marian, Terry, Molly, Maureen, Elsie, GailLiz, Marian, Terry, Molly, Maureen, Elsie, Gail

Questions?Questions?