[MT-L] COMBINED BILLING
Tammy McGary
This may sound like a strange question, but for our facility it is a bang of
a problem. We are a Magic 5.62 Critical Access Facility, moving to 5.64
this September, and we are running into issues with duplicate billing on
same day. For example, a patient presents to the lab for standing orders.
Later that day he ends up in the ER. The patient is registered twice with 2
different V numbers, but billing needs 1 bill to go out for that day. What
we were doing is in B/AR we were moving the charges for the lab to the ER
number thru RE-Batch and move, but Meditech is telling us that all these
corrections should occur in the clinical modules. For some accounts it
isn't an issue, but let's say the ASU dept ordered the charges on the wrong
number, so they make corrections in OE and Lab make corrections then before
that gets caught B/AR has already done the RE-batch and move, we then do not
have credits and debits that match. Also the question arises, what does the
EHR look like in Medical records?
Maybe we are looking into this way too deep, but are we the only facility
with this problem? I would really like to know how other facilities handle
this process and are you seeing issues with rejection batches from the
clinical modules? Sometimes when you get another view it just seems to make
more sense!
Enjoy the warm summer and remember "no question is a stupid question"!
Tammy McGary, MIS Director
Houlton Regional Hospital
20 Hartford St
Houlton, ME 04730
207-532-0923
ta...@houltonregional.org
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cbodn...@rcrh.org
We do have LAB and PHA correcting from the originating application, but this doesn't apply the same way for OE, ITS, and even ADM.... (and especially ADM! Which should always fix any rejections...)
I almost wonder if you have an ADM training issue, because if the patient has already presented once, then staff should receive a prompt that the patient has already registered.... but this prompt may be directly related to the 72 hour question... so if you don't use the 72 hour parameter, then there are no warnings....
HTH,
Cindy Bodnar-Anderson
IS, Regional Health
Good morning everyone,
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Gary Ring
Plus, from a clinical documentation and visit history perspective, you may not want to roll all of the registration/clinical activity from the old visit into the new visit. Certainly, if an ER patient came back to the ER in the same day, I don't think you'd even want to call up the prior ER registration and use if for the new ER visit so that it looks like 1 continuous visit from the medical record perspective.
It's been my experience that the catching and combining of activity with the 72-hour window for Medicare patients is done within BAR. And with the regulations that state you can bill for separate visits on the same day if they are not diagnostically related, I'm not sure this could be done on the Reg/Clinical side.
But as you indicate, Tammy, this is a huge problem and always has been. If anyone has the Magic bullet (no pun intended) to solve this problem, I'd love to hear about it.
Gary J. Ring
President
Ring Consulting, Inc.
978-807-1573
Cindy Olson
If there are two accounts that are to be billed as outpatient then the CAH
claim needs to be one as you have stated. Only when there is an Outpt claim
& an Inpt Claim then the 72 hour rule doesn't apply and two claims would be
submitted.
Training for admission staff is an on going work in progress -
ADM is NOT to ignore the notice that the patient as already been registered
once for that day.
Example: Patient ####### REG REF 07/13/10 has the same unit number? OK? "N"
Then ADM is to make a determination if an add'l "Location" should be added
and not another account. By having both locations (ex: LAB & ER) on the
same account we're hoping everyone can get the stats and reports needed and
billing can get one claim.
We have also setup some selection reports that different staff review to
hopefully catch duplicate accounts if missed by admissions. Some of these
accounts are frozen so the clinical module will get a Reject Batch if they
try to send charges to the incorrect account. When we freeze an account
Medical Records/ABS is also made aware of it. If possible the clinical
modules do the reverse and re-post. If they're unable able then a BAR data
entry staff does it.
Cindy Olson
Patient Account System Coordinator
West River Health Services
Phone: 701-567-6153
Email: cin...@wrhs.com
-----Original Message-----
From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com]
On Behalf Of cbodn...@rcrh.org
Sent: Tuesday, July 13, 2010 12:47 PM
To: ta...@houltonregional.org; medit...@mtusers.com
Subject: Re: [MT-L] COMBINED BILLING
Sheral Graham
Some of the clinical modules, not all, have a "move documentation/results" feature for when there are two accounts which should have been one. This frequently can happen with surgical patients who present for preop services, then for their surgery, and registration does not pick the "pre-surgical" account (training issue). LAB, ITS, RAD, PCS/NUR (at least from my experience) have this feature, not sure about EDM or ORM off the top of my head. Plus, you may need to search to add the routine to your menu, as some of the standard Meditech menus do not include it.
When a patient has two distinct services on the same day, i.e. a lab visit then an ER visit, they are two seperate encounters, not one. Statistics are driven off of these services, so moving the services to one account pre-billing is corrupting your statistics. However, Medicare does require one bill for services rendered within 72 hours, but it can include multiple encounters, which manually need to be combined in BAR. At least from my experience, someone needs to be running the 72 hour report every day, and adjusting the accounts accordingly.
Sheral Graham,PMP
Clnical Analyst
> Date: Tue, 13 Jul 2010 20:00:10 +0000
> From: garyr...@comcast.net
> To: cbodn...@rcrh.org
> CC: medit...@mtusers.com
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