CFO User Manual. Version 5.0B

Transcription

1 CFO User Manual Version 5.0B

2 Table of Contents Chapter 1: Getting Started Login to CFO 1-2 Use the time clock feature 1-2 Login to Test Client 1-3 Navigate using the menu system 1-4 Use function keys and other blind options 1-10 Operate the online help system 1-12 Close your session 1-12 Chapter 2: Finding What You Need Guarantor Lookup 2-2 Patient Lookup 2-3 Patient Attachments 2-6 Invoice Auditing and Lookup 2-5 Finding Coded Libraries 2-7 Chapter 3: Adding New Patients Adding Guarantors 3-2 Adding Patients 3-2 Patient Insurance Policies 3-7 Patient Attorney Records 3-6 Patient Invoices 3-10 Patient Charges 3-15 Admission Records (Hospital) 3-17 Narrative Records (Ambulance) 3-20 Accident Records 3-23 Patient Adjustments 3-24 Chapter 4: Reconciling Charges & Adjustments Batch Overview 4-2 Viewing Your Batch 4-3 Correcting Errors 4-5 Approving Batches 4-5 Finalizing All Batches For A Billing Cycle 4-6 Batch Report Modules 4-7

3 Chapter 5: Follow -Up Queues Follow-Up Queue Overview 5-2 How To Choose A Follow-Up Queue 5-4 Working Accounts Within A Follow-Up Queue 5-4 Exiting The Work Queues 5-5 Chapter 6: Letters & Insurance Forms An Overview Of Statements And Letters 6-2 Creation Of A New Letter 6-2 HCFA 1500 Insurance Forms 6-5 Electronic Submission 6-8 UB92 Insurance Forms 6-9 Using The Letter Writer 6-10 Letter Summary and Exception Reports 6-13 Chapter 7: Using Printers Overview Of Options In The Printer Maintenance Menu 7-2 Accessing The Printer Maintenance Menu 7-2 Customizing Your Claim 7-3 Chapter 8: Additional Features Edits 8-2 History 8-3 Pop-Up Messages 8-4 User Messages 8-4 User Actions 8-6 Chapter 9: Coded Libraries General Overview 9-1 Action Code 9-2 Adjustment Code 9-3 Attorney Code 9-3 Bill Code 9-4 Charge Code 9-5 Client Invoice Status Code 9-6 Client Status Code 9-7 Commission Scale Code 9-7 CPT Code 9-8

4 Provider Department Code 9-9 Patient Desk Code 9-9 Diagnosis Code 9-9 Facility Code 9-9 Fee Schedule 9-10 Financial Class 9-11 History Code 9-12 Insurance Company Code 9-12 Insurance Contact Code 9-14 Insurance Type Code 9-14 Invoice Insurance Status Code 9-16 Patient Invoice Status Code 9-16 Letter Code 9-17 Patient Status Code 9-17 Payment Code 9-17 Payment Location Code 9-18 Provider Code 9-19 Provider Insurance Number Code 9-20 Responsibility Code 9-21 Write-Off Code 9-22 Chapter 10: Client Redirection Understanding Coded Library Redirection 10-2 Adding and Changing Redirection 10-2 Chapter 11: Using Collection Agencies Adding New Collection Agencies 11-2 Turning & Recalling Accounts 11-2 Receiving Payments 11-2 Tracking Collection Receivables 11-3 Import & Export Functions 11-3 Chapter 12: Field Defaults Understanding The Defaults 12-2 Adding New Defaults 12-2

5 Chapter 13: Fee Schedules An Overview On Fee Schedules 13-2 Creating A New Fee Schedule 13-2 Creating New Fee Schedule Provisions 13-2 Changing Insurance Policies 13-2 Chapter 14: Reports Report Archives 14-2 Actuary 14-2 Charge Usage 14-2 Diagnosis 14-2 Patient Listing 14-3 Provider Charges 14-3 Request For Review 14-3 Chapter 15: Report Writer Overview of the Report Writer 15-2 Output Options 15-3 Qualification Options 15-6 Running Reports 15-9 Taking Actions In Reports 15-9 Using Multiple Record Selection Chapter 16: Speed Utilities Capitation Payment Utility 16-2 Transaction Speed Utility 16-2 Memorize Transaction Utility 16-7 Remittance Posting 16-8 Chapter 17: Using the Scheduler Overview of the Scheduler Menu 17-2 Adding A Scheduler Provider 17-3 Adding A Scheduler Type 17-5 Adding Patient Appointments 17-6 Logging Scheduled Appointment Letters 17-7

6 Chapter 1 : Getting Started This chapter describes how to: Login to CFO Login to Test Client Use the time clock feature Navigate using the menu system Use function keys and other blind options Operate the online help system Close your session 1-1

7 Section 1: Login The first CFO screen you encounter will be the User Login area. Here you will be prompted with the message ENTER USER PASSWORD. At this point you must enter your User Password to proceed. You can get this password from your system administrator if you do not already have it. If you fail to enter a valid User Password three times, CFO will automatically close your session. Figure 1-1 shows this initial login screen. Figure 1-1 USER LOGIN SCREEN If you have lost or forgotten your USER PASSWORD you must contact your CFO Administrator to retrieve your old password or to assign to you a new password. Section 2: Time Clock After you have completed your user login, you will be sent to the Time Clock, if this feature is being used to track your time. If time tracking is not active, for your user record or if you are already clocked in for the day, this area will be skipped. If you have not clocked in and this feature is being used to track your time, you will be shown your time card for the day. Figure 1-2 shows what the time clock looks like when used for a full day. 1-2

8 Figure 1-2 TIME CLOCK By selecting the CLOCK IN option, you will be clocked in for the day. This will record the exact time you began your day s work. You can select the CANCEL option to exit the Time Clock and complete your login process. Pressing F10 while logged in to CFO will allow the user to view their time sheet at any time. Selecting CLOCK OUT will allow the user to clock out. This will bring up another screen that allows the user to select END OF WORK DAY, LUNCH BREAK, or SPECIAL DEPARTURE. Choose the appropriate selection for clocking out. A summary of the work-day will follow. Section 3: Client Password After you have successfully entered your USER PASSWORD, you will be prompted to enter the password for the client you want to begin working in. Each client setup within CFO will have a unique password and it must be entered completely for you to be allowed access to that client. Figure 1-3 shows this client password screen. 1-3

9 FIGURE 1-3 CLIENT PASSWORD Each user can also be restricted to a specific client. If you are restricted to a specific client you will see the name of that client on the second line of the CLIENT LOGIN prompt. After you have entered a valid CLIENT PASSWORD, CFO will check to see if the workstation is licensed to allow the user to select a batch. For example, lite users do not have to enter a batch. If the user is required to select a batch, then a list of valid batches will be displayed for you to select from. Working in batches within CFO allows your work to be separated from other users activity. Batches are covered in greater detail in the Reconciling Charges and Adjustments section of this manual. Section 4: Navigating the Menus After logging in, selecting the client to begin working in and clocking in, you will be sent to the Main Menu. This screen contains copyright information, as well as BillWorx Medical Billing Systems web address and information. This menu shows the broadest menu categories. Each of the menu options listed within the Main Menu will lead you into another menu containing more options. Figure 1-4 shows a screenshot of the Main Menu. 1-4

10 Figure 1-4 MAIN MENU In order to navigate through these menus, you need only enter the numb er to the left of the menu or menu item you wish to enter. Access to each menu item is controlled by user-level security and may not be available to all users. You should address questions regarding access to specific menu options to your CFO Administrator. After you select a menu or menu item you will be sent to the new area, provided that you have access to the selected item. Press the CTRL+X key to back up from any menu or menu item. You may also press the F2 function key to return to the Main Menu from most areas within CFO. All of the function keys are covered in detail in the Using the Function Keys & Blind Options section, later in this chapter. Section 5: Basics of Record Selection You will need to find and retrieve records of all types with nearly every time you use CFO. The records that you need to find and/or change can range from patients calling into your office with billing questions to provider records that need new contact information. In order to find these records you will need to use the appropriate record selection. These areas can be found by navigating through the menus or sometimes by using a blind option or a function key. Most menus and blind options will use record selection to allow you to specify which item you want to work with. Once you have entered a record selection window for the item you are searching for, you will be shown a list of all the available entries. If there are no entries for the type you are trying to view, you will see a message stating that no entries were found. This would happen, for example, if you were trying 1-5

11 to look up patients for a new client that had no patients yet. Figure 1-5 shows an example of the patient selection screen. FIGURE 1-5 PATIENT SELECTION SCREEN When you do get a lis t of available entries, there are two ways to select one of them. The first is to enter the number to the left of the entry you want to edit/view. This will send you to a new window showing you the selected item. Your other choice is to use the arrow keys or the options listed below to highlight an item. After you have the item you want to view/edit highlighted, you must then press the Enter key to select that item. From within most record selection areas you will have the following options, which will be listed or abbreviated on the prompt line: ACTION An action can be taken for a selected list of items within the Record Selection option. This option is accessed by selecting multiple items using the space bar (multiple record selections are covered in more detail later in this section) and then pressing the Enter key. This will open a window with a list of valid actions that have been defined for use within the current client. The actions are covered in more detail in the User Actions section of the Additional Features chapter. ADD This option will allow you to add a new record to the database. This option is accessed by typing the letter A and pressing the Enter key. This option is controlled by user-level security and may not be available to all users. Questions regarding access to this option should be directed to your CFO Administrator. The process of adding records is outlined in detail in the Basics of Record Editing below. This option will only appear for users who have Add Security enabled for the record type they are selecting. 1-6

12 CLT This option will allow you to change the data that is listed to include your current client (the client you logged into when starting your session), the current client s group or all clients. You can use this option by pressing the letter CLT followed by the Enter key. You will then be shown a list of the client restrictions that you are allowed to select from. You can use the arrow keys or the highlighted letter within each choice to select the option you need. This option is controlled by user-level security and may not be available to all users. This option will not appear for users that are restricted to a single client. EDIT This option will allow you to make changes to the selected record. Typing the letter E and pressing the Enter key will allow you to access this option. The edit option will only appear for users who have edit security enabled for the type of record they are viewing. FIND This option will allow you to jump to an entry that matches your input. After typing the letter F and pressing the Enter key, you will be prompted to type as much of an entry as you like. CFO will then attempt to place you at a matching record in the list. If no matching entry is located, CFO will give you a find failed message and return you to your previous position within the list. The value entered is only matched against the current sort field, which is the first field, listed for each entry. MULTIPLE SELECTIONS This option will allow you to select one, a few, many, or all the records listed. A record is selected by highlighting the desired record and pressing the Spacebar key. You will be unable to exit most selection areas while you have multiple items selected. The CTRL+A can be used to select all items within the list, while CTRL+U can be used to clear all the selected items. This selection option is mainly used from within the batch reports and for the user actions. QUIT This option will abort the selection process and return you to the previous area. By entering the letter Q, you will be forced to select a specific record to view and/or edit. RANGE The range option restricts the record selection list to any range you give. To use this option, type the letter R and press the Enter key. You will then be prompted to enter the start and the end of your range. CFO will then restrict the displayed listing to only those records whose sort field (the first field displayed for each entry) falls within your range. If you leave the starting from range blank, CFO will start at the first available record. Leaving the second to entry blank forces CFO to include all remaining records above your from range. REC# - This option will take you to a specific record number s entry. It is used by typing the # character and pressing the Enter key. You must then enter the record number you wish to move to in your record selection list. If the number you enter is not found, you will see no change in your record selection listing and you will get an error beep. SORT The sort option will allow you to pick from all available sorting orders. Some record types allow many sort options, while others will allow you fewer. By typing the letter S followed by the Enter key, you will be able to pick from all the sorts available. This section should be reviewed until thoroughly understood, as this manual will make reference to these options without going into further detail or additional reference to this section. Section 6: Basics of Record Editing Record editing is the process of adding and/or modifying data records. Most records, such as guarantors, patients, insurance policies, etc. are added/edited using the same interface. Once you understand the features and requirements of this interface, you will be able to add records of all types with ease. 1-7

13 In order to add new records, you must first get to the appropriate record selection window, as previously discussed in the Basics of Record Selection section of this chapter. If the item you are searching for does not exist, you can use the ADD feature of the record selection utility to create a new one. If you locate the record you wish to edit, you can use the arrow keys to highlight it and press E+Enter keys to begin editing. In most cases this will take you into an edit window, allowing you to make changes to the record. The other method of selecting an existing item is to type in the number that appears to the left of the entry, and press the Enter key. There are some cases where the selection of a record takes you to a summarizing utility called a view screen. A view screen is used for both the guarantor records as well as the patient records. This screen will allow you to see a summary of information and associated records. To enter the edit window from within a view screen you must enter the EDIT blind option by typing the letter E followed by the Enter key. Figure 1-6 shows the patient edit window. FIGURE 1-6 PATIENT EDIT SCREEN Once you have entered the edit window, you will have the following options: EDIT A FIELD - Type in the ID number to the left of any field and press the Enter key to edit that field s value. Each field within CFO is protected with user-level security and all users may not have access to every field. Questions regarding access should be taken to your CFO Administrator. 1-8

14 PAGE UP - This key will take you to the previous page of the record if you are not on page one (1). The page number that you are on, as well as the maximum pages for the record, is dis played in the upper right corner of the screen. PAGE DOWN - Some records contain more fields than can be displayed on a single page. Use this key to view the next page of the record. You will know if a record has more than one page by checking in the upper right corner for the maximum page number. ABORT CHANGES - When you need to abandon all of the changes that you made within this edit session (since entering the edit option) you can press the Escape or Control+X keys. This will cause CFO to ignore all of the changes made within your current edit window. If this option is used from within a field it causes the field to return to its previous value but does not abort any other change. SAVE - When you have completed all of your edits to the record you can press the Enter key to save them. There are certain fields within CFO that are required to be unique and setting one of these fields to a value that is already in use will cause the save function to fail. If this happens you will be required to change the unique field in order to complete your save. CLEAR A FIELD - While editing a specific field, typing Control+D will cause the value within a field to be blanked out. TODAY OR NOW - While editing a date or time field you can press the letter T to cause CFO to fill in the field with the current date or the current time. UP - The Up arrow and Shift+Tab keys can be used to select the previous field for editing. If you have not yet selected a field, you will be placed into the highest field number that you have security to edit. DOWN - The Down arrow and Tab keys can be used to select the next field for editing. If you have not yet selected a field these keys will have no effect. BEGINNING OF FIELD - You can use the Home key to go to the beginning of a field s value. This will allow you to edit the start of the value without backing up through the text. END OF FIELD - You can press the End key to skip to the end of a field s value. This will allow you to add text to the end of the current field value. BACKSPACE (destructive) - To backup over the field s value while deleting the text you can use the Backspace key. BACKSPACE (non-destructive) - To backup over the field s value while leaving the text unchanged you can press the Arrow left key. Some computers however, cannot tell the difference between the Arrow left and the Backspace key and therefore will always respond with a destructive Backspace. DELETE TEXT - You can delete the character that is directly under the cursor by pressing the Delete key. OPTION LOOKUP - You can press the F1 function key to see all available options for the field you are editing. This key is described in detail within the Using the Function Keys and Blind Options section of this manual. 1-9

15 Section 7: Using the Function Keys & Blind Options Blind options are those options that are available to you but not specifically listed on the prompt line. The function keys and other blind options will allow you to quickly and easily navigate through some of CFO s options. Various blinds, as well as the function keys, will be available from most areas within CFO. However, there are some options that have no blind options and/or do not allow the use of some or all of the function keys. Figure 1-6 shows a small portion of the blind options available from within the Patient Viewing window. FIGURE 1-7 PATIENT BLIND OPTIONS The function keys and their respective actions are: F1 This key will show you all the options you have available to you from your current location within CFO. You will be able to select any of the options that are displayed by entering the number listed at the left of each entry. You can also choose entries using your arrow keys to highlight the desired entry, and then pressing the Enter key. Shift+F1 - This key will allow you to view and browse through the manual using the online help feature. Online help is fully outlined in the Online Help section of this manual. F2 - The F2 home key will send you back to the main menu. This function will not work in certain circumstances for example, when pressed while an edit is being performed. 1-10

16 Shift+F2 - Show Command History. This option lists your previous activities. It will allow you to review where you have been and what records you have accessed. By selecting an entry you will be able to quickly return to that menu, list, or record. F3 - This key will take you back to the last area you visited. An area, in this case, is defined as a menu, a record list, or a specific record. F4 - When pressed, this key will send you forward, back to the area you just left. If you have not aborted any utilities or returned from any menus, this key will have no effect. F5 - This function key will allow you to view the history attached to any record you are viewing or editing. Shift+F5 - This function key will allow you to view all edits made to the record you have selected. The edit trail will allow you to understand how the record came to look as it does, showing what changes have been made. You will also see who made each change and when it was done. F6 This function key will allow you to view the record details for a coded entry. This key will only function within the edit screen for records containing coded entries, and at selection screens such as the patient and guarantor selection screens. When pressed, this key will allow you to choose from a list of all coded entries contained in the record you are editing. Once you have selected the coded entry you wish to view, you will be allowed to view the contents of its record. While viewing the contents you will be unable to make any changes to this record. F7 This key will send you directly to the record selection for guarantors. You will then be able to add a new guarantor record or select the guarantor you need to review. F8 This function key will send you directly to the record selection for patients. You will then be able to add a new patient record or select the patient you need to review. F9 This function key will send you to your message area. This area and its options are described in detail later in the Additional Features section of this manual. F10 This function key will send you into the time maintenance area, if this feature is set to track time. This area will allow you to review your time for the day, as well as allowing you to clock in or out. If the user is not set up to track time, a message will come up stating this. Shift+F10 This function key will allow you to setup and maintain client defaults. This function is controlled by user-level security and may not be available to all users. Problems accessing this feature should be directed to your CFO administrator. F11 This function key will send you directly to the first account in your queue. If you have not yet selected the queue you wish to work in, CFO will let you know and prompt you to cancel or to select the queue with which you wish to work. Shift+F11 This key will allow you to select or change the work queue you want to access. Once selected you will be sent to the first account within that queue. The queue system is described in complete detail in the Follow-up Queue section of this manual. F12 This function key will allow you to close your session. This function is detailed later in this chapter. Shift+F12 This function key will allow you to set and view security profiles. Access to this function is controlled by user-based security and may not be available to all users. Problems with access into this option should be brought to your CFO administrator. 1-11

17 Section 8: Operating Online Help There may be times when you may forget how to get into an option or how to perform a specific task. At these times you might find it useful to view this manual online. The online manual will be updated at regular intervals by BillWorx Medical Billing Systems staff. To view the online manual press shift+f1 at most any input prompt. This will take you into the keyword search of the online help system. From within the keyword search, you can type any keyword you wish to get information about. If you need a listing of the keywords that are available, press the F1 key. After selecting the keyword you need help with, the system will place you at that section of the online manual. You now have several options from within the online manual. You can press the Arrow and Page Up/Down keys to browse through the manual. Additionally, the following options are available from within the online help system: Page - This option will allow you to jump to any specific page number. Enter the letter A and CFO will then ask you what page number you want to go to. You then will be placed on the first line of that page, provided that the page number you entered is contained in the manual. Find - This option allows you to search through the online manual for specific text entries. This typically works better than using the Keyword option. This text search in not case sensitive therefore any combination of upper and lower case text within the manual will be found. To use the find, type in the letter F and press the Enter key. You will then be prompted to enter the text you want to search for. You will then be sent to the next line containing the text that you entered. When the end of the online manual is reached, a message will pop up that states that the search started at the beginning of the manual. Keyword - This option allows you to select a new keyword to search on. By entering the letter K you will be allowed to select a new keyword. You will then be sent to the next occurrence of that keyword. This may be a little more difficult than using the Find option. Next - This option takes you to the next occurrence of your search criteria. By entering the letter N you will be sent to the next matching entry in the online manual. For example, if you are searching the manual for the text LAST NAME, using the Next option will send you to the next line of the online manual containing that exact text. Previous - This option will take you to the previous occurrence of your search criteria. This option works in the exact manner as the Next option, except that it is invoked using the letter P and searches in the opposite direction. Section 9: Logging Out When you have finished your day s work or you are ready to head away from your station you will need to exit CFO and/or clock out. There are many reasons you should always remember to close your session. Foremost among these reasons, is system security. In order to maintain system security and prevent unauthorized access, you should close your session whenever you plan to be away from your computer for any extended period of time. In order to log out press the F12 function key. You will then be asked to verify that you intend to log out of CFO. Select OK by simply pressing the Enter key. This will send you into the Time Clock, if this feature is being used to track employee time. 1-12

18 Within the Time Clock you will want to select the appropriate option. If you are logging out for lunch or a break, then select the option that corresponds to the appropriate break. If you are simply closing your session for security or some other reason that has no effect on your hours worked, you can simply press Enter to continue closing your session. 1-13

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20 Chapter 2 : Finding What You Need This chapter will cover: Guarantor Lookup Patient Lookup Patient Attachments Invoice Auditing and Lookup Finding Coded Libraries 2-1

21 Section 1: Guarantor Lookup Guarantor records contain detailed information about the people that are ultimately responsible for any charges for the patient. You may need to lookup, verify and update guarantor records on a day-to-day basis. These records are vital to patient follow-up and billing, as they contain the billing address and most of the contact information. For detailed information about the guarantor fields, refer to the Adding Patients and Guarantors section of the Adding New Patients chapter. To search guarantor records, you can use the F7 function key or choose the Guarantor Lookup option within the Patient Maintenance Menu. Each of these options will open a standard selection window of all guarantor records in your current client s database. From within this selection screen use the standard options to select the guarantor record you want to work with. For more information on the use of the selection window, refer to the Basics of Record Selection section of the Getting Started chapter. Once you have selected the guarantor you want to see, press enter, and a window will open displaying the guarantor data. This screen is called the Guarantor Viewing window. Within this window, you will also see a highlighted line about midway down your screen. This is a heading line for the patient records that are attached to this guarantor. Under this heading line you will see one summary line for each patient record attached to the guarantor. Figure 2-1 shows a sample Guarantor Viewing window. FIGURE 2-1 GUARANTOR VIEWING WINDOW From the Guarantor Viewing window you have several options. These options include: editing the guarantor s record, viewing of any guarantor history, edits or patient records, adding a new patient to this guarantor, editing any of the listed patient records or requesting any guarantor letters. You can also use any valid function key and back up to the guarantor list. Entering the letter E accesses the edit option. This will open a window listing all of the guarantor fields and their current values. For detailed information on the usage of this type of window, refer to the Basics 2-2

22 of Record Editing section of the Getting Started chapter. Once you exit this edit window you will be returned to the Guarantor Viewing window. Guarantor history can be accessed using the F5 function key. This will show you a complete list of all user notes that have been added for this guarantor. The history entries will also show what user added them and when. Guarantor edits can be accessed with the Shift+F5 function key. This will show you a complete list of all edits made to the guarantor since it was created. Details on these and other function keys can be found in the Using the Function Keys & Blind Options section of the Getting Started chapter. If you want to view one of the guarantor s patient records, you can enter the ID number for the patient you want. This number is printed to the left of each of the patient entries. This will move you into the Patient Viewing window. This is covered in detail in the Patient Lookup section of this chapter. To edit one of the listed patients without opening it in view mode or to add a new patient, you will need to press the Tab key. This will toggle you into a mode that will allow you to directly add, delete, or edit patient records. To add a new patient, you can enter the letter A at this point. To delete a patient, you can enter the letter D when the correct patient is highlighted. To edit a listed patient you must highlight the correct patient and enter the letter E. Guarantor letters can be requested or printed using the Letter blind option. This can be accessed by entering the letter L. This will open a window listing all available guarantor letters. Use the standard record selection options to select the letter you want sent. Once the letter has been chosen, you will be asked whether you want to print the letter now or log it to print with the regular mail printing. You also have the option to cancel this letter request. Refer to the Using Printers chapter for more detailed information on using and selecting printers. To exit this guarantor record you can press the F2 function key, Control+X or, if no patient line is highlighted, you can simply press the enter key. Pressing the F2 function key will take you directly to the Main Menu. The other two options will both return you to the Guarantor Selection window. Section 2: Patient Lookup The patient records contain several types of information in addition to the patient demographics. These records contain several follow-up fields, aging categories, and many summary fields for the patient. For detailed information on all of the patient fields refer to the Adding Patients and Guarantors section in the Reconciling Charges & Adjustments chapter of this manual. To begin looking up patients you can press the F8 function key or enter the Patient Selection option from within the Patient Maintenance Menu. Either of these options will open the Patient Selection window. From within this window you will be able to select the patient that you want to work with. The Patient Selection window will be similar to Figure

23 FIGURE 2-2 PATIENT LOOKUP WINDOW Once selected, you will be placed into the Patient Viewing window. The Patient Viewing window will show you a summary of key patient fields. This screen will also display summary lines for the following record types: the patient s guarantor record, the patient s insurance policies, and the patient s attorney records. To the left of each summary line heading you will see a number that identifies how many of each type of record exist for the patient. The Patient Viewing window will be similar to Figure

24 FIGURE 2-3 PATIENT VIEWING WINDOW From within the Patient Viewing window, you have many options that will allow you to update and maintain the patient s account. These options include editing the patient record, editing of the patient guarantor record, and adding or editing any of the patient attachments. For more details on the patient attachments, refer the Patient Attachments and Viewing Patient Transactions sections of this chapter. In order to edit the patient s record you can enter the letter E. This will open a window with the patient record displayed. From within this window, you will be able to alter any of the patient fields you have the security to edit. Some fields are maintained by CFO and cannot ever be altered. These fields are indicated in bold. Section 3: Viewing Patient Transactions The View Transaction (VT) option will allow you to browse, add, and edit the patient s invoices. This transaction window can be reached using the VT blind option from within a Patient Viewing window, by an invoice follow-up queue, or by using any of the FIND menu options within the Patient Maintenance Menu. All patient invoice and the invoice attachments can be maintained from within the VT window. The record types that are attached to patient invoice records are: invoice charges, invoice adjustments (payments, write-offs, credits, debits, payment returns, refunds etc.), invoice history, invoice edits, invoice letters, invoice patient responsibilities, invoice narratives, invoice admission records, and letters. Figure 2-4 shows a sample VT window. 2-5

25 FIGURE 2-4 PATIENT VT WINDOW New invoice charges, adjustments, and patient responsibilities can be added using the letter A. This option will open a window containing an option to add each of these types. Use the highlighted letter or the arrow keys to select the type of transaction you wish to add and press the enter key. The addition of new transactions and invoices is covered in greater detail within the Adding Patient Invoices, Adding patient Charges and Adding Patient Adjustments s ections of the Adding New Patients chapter. From within the VT window, you also have the option to limit the types of invoice attachments you wish to see. By entering the + or key, you will be able to expressly state which types of records you want to be suppressed and which you want to show. You can suppress and allow any combinations of invoice attachments using this feature. Section 4: Patient Attachments Patient records have many different attachment records that are available. These attachments vary from records, to help you call or locate the patient or records that are required, in order to allow you to bill the patient s insurance company. Some of these attachments can be seen from within the Patient Viewing window. Using the VP blind option will allow you to add and view the remainder of the attachments. The different attachments that are available are listed and described below. Patient Accidents: These records are used to indicate worker s compensation or other accidents that are related to the services. The values within this type of record will affect the insurance forms and are required for certain types of billing. Patient Attorneys: The attorney records can be used to indicate when an attorney represents the patient. These records are mainly for reference and can be incorporated into letters. These fields can be added using the blind option AAT, and can be viewed with VA. The fields and descriptions for the attorney records are covered in the Adding Patient Attorney Records section of the Adding New Patients chapter. Patient Contacts: The patient contact records give you additional space to store contact names, phone numbers and addresses. This information can be added using the blind option AC viewed and edited 2-6

26 using the View Patient Contacts blind option by entering VC. This information is for reference only and cannot be used to send letters. Figure 2-5 shows a sample Patient Contact record. FIGURE 2-5 PATIENT CONTACT RECORD Patient Edits and History: Edit and history records are available for the patient records, as with most record types. Patient History can be viewed by pressing the F5 function key while Patient Edits can be viewed by entering Shift+F5. These items are covered in detail within the Using the Function Key & Blind Options section of the Getting Started chapter. Patient Guarantors: To edit the patient s guarantor record you can use one of three options. The first option is to use the Tab key to highlight the guarantor record and then press the enter key. The second option is to use the View Guarantor blind by entering VG. You can also press the F7 function key. All three of these options will take you to the Guarantor Viewing window. This option is detailed within the Guarantor Lookup section of this chapter. Patient Insurance Policies: These records are critical for insurance billing. The insurance policies allow CFO to identify and bill the appropriate insurance company. Insurance policies can be viewed by entering the AI blind option. From this point, a new insurance policy can be added using A to add, or an existing insurance policy can be edited using E to edit. The policy records are outlined in detail within the Adding Patient Insurance Policies section of the Adding New Patients chapter. Patient Invoices: The patient invoices contain the specific charge and adjustment information for each of the patient s visits. The invoice records will determine the amount that the patient and the insurance companies owe. These records are outlined in detail within the Adding Patient Invoices section of the Adding New Patients chapter. Section 5: Finding Coded Libraries 2-7

27 The coded libraries will allow you to restrict and customize the options that are allowed for some fields. These libraries range from options for charge diagnoses to lists of valid patient status codes. Details on specific coded libraries can be found within the Coded Libraries chapter. You can use the Coded Library Menu to add or edit existing coded libraries. From within the menu you must select the sub-menu for the code with which you wish to work. The coded libraries are split into several menus due to the number of available codes. With the proper access privileges, you can also add these codes when needed using the standard selection options from within the F1 lookup window. Once you have selected the sub-menu, you will see a list of all coded libraries that can be accessed fro m the new menu. This menu will look similar to Figure 2-6. FIGURE 2-6 CODED LIBRARY MENU After locating the appropriate sub-menu, you can select the library with which you wish to work. This will put you into a standard selection window for the coded library you chose. The features and usage for the selection screen is outlined within the Basics of Record Selection section in the Getting Started chapter. 2-8

28 Chapter 3 : Adding New Patients This chapter will cover adding the following items: Guarantors Patients Patient Insurance Policies Patient Attorney Records Patient Invoices Patient Charges Patient Adjustments Admission Records (Hospital) Narrative Records (Ambulance) Accident Records 3-1

29 Section 1: Adding Patients and Guarantors The first step in the addition of new charges is to locate or add the patient record. In cases where the patient record does not yet exist, it will be necessary for you to add it. Since all patient records must be attached to a specific guarantor record, you must first locate or add that patient s guarantor record. Typically, you will know you have a new patient when you receive a patient registration form along with the patient s new charges. The registration form will often be accompanied by the patient s insurance information. This patient registration information will sometimes include photocopies of insurance cards. This will be used to setup the patient s insurance policies after the patient is added. Before you add any type of record to CFO, you must be sure that the record does not already exist. For most types of records, CFO will not allow you to duplicate them. However, since many names and addresses are similar and some are exactly the same, CFO cannot keep you from duplicating guarantor and patient records. For this reason, it is important that you double-check the existing patients and guarantors prior to adding any new ones. To locate a patient that may possibly already be in the system, press the F8 function key. This will send you directly into the patient record selection area. Each time you enter the patient selection window, you will be placed at the top of the list. Since that patient you are about to add will not always be at the top of the list, you will want to go to the area in the list that corresponds to your patient. The easiest way to get right to your patient is by using the FIND command and entering the patient s name, beginning with the last name. You can also search for the patient using other fields, such as social security number. These other searches are available using the SORT command to sort the patient s by the appropriate field and then using the FIND command to search on the new first field. If no match is found for the patient you are searching for, you can add the new patient record. To begin adding the new patient record, use the ADD command at the patient record selection prompt. At this point, you will have the opportunity to attach your new patient to an existing guarantor record. If the guarantor you need to attach your new patient to has not yet been added, then you will need to create a new record to which the patient record will attach. Since the guarantor could be responsible for several patients and may already be in CFO, you should take care to search for the patient s guarantor record, so that you do not create a duplicate. To search for the guarantor record, repeat the same process as you did when searching for the patient record. Keep in mind that additional search options are available from the SORT command. If you are able to locate the guarantor that the new patient belongs to, you can simply enter the number to the left of the record or press the Enter key when the proper guarantor is highlighted. If, however, you are unable to locate the guarantor, then you will need to use the ADD command to create a new one. Figure 3-1 shows a sample of the Guarantor Edit window. 3-2

30 FIGURE 3-1 GUARANTOR EDIT WINDOW Using the ADD command at the guarantor record selection prompt will send you to a blank guarantor record template. Here you will be allowed to fill in the guarantor fields for your new record. Simply fill in all relevant and known fields for this record. Remember that pressing the F1 function key will show you a list of all the options available to you for each field. If the guarantor s CITY or STATE fields are left blank, the ZIP CODE that is entered will automatically look-up and populate those fields with the appropriate values. If you chose to enter the CITY or the STATE manually, the ZIP CODE will NOT override your entry. The guarantor fields and their descriptions are as follows: LAST NAME, FIRST NAME, MIDDLE NAME, SUFFIX These are the guarantor name fields and must contain complete and accurate information. ADDRESS, CITY, STATE, ZIP CODE These are the address fields for the guarantor and should contain the billing address. BAD ADDRESS This is an indication of whether mail has returned from the guarantor s address. If the value of this field is YES, letters can be set to avoid being logged. HOME PHONE This field should contain the home telephone number for the guarantor. POE, POE PHONE These fields are used to store the guarantor s place of employment and work phone number. 3-3

31 SSN, DOB These fields can be used to store the guarantor s social security number and date of birth. SPOUSE, SPOUSE POE, SPOUSE PHONE These fields are used to store the spouse s name, place of employment, and work phone number. SPOUSE SSN, SPOUSE DOB These fields can be used to store the spouse s social security number and date of birth. NOTE (3). These fields are for reference notations. This field is used to store the address of the guarantor. CLIENT ACCOUNT # This field is used to store the client s account number for this guarantor. After you have past the final guarantor field, you will be prompted to enter field id to edit. At this point you should review all the guarantor data fields for accuracy, editing those that you find problems with. When you are satisfied with your data, press the Enter key to add the new guarantor record. After adding the new guarantor record you will be sent back to the guarantor record selection area, with the new guarantor highlighted. Simply press the Enter key and you will be sent to a blank patient record template to begin adding the new patient record. When adding a new patient record, the patient record LAST NAME field will automatically default to the guarantor record LAST NAME field s value. If you do not change this default value, the FIRST NAME will also default to the guarantor record s value. If all three of the patient name fields match the guarantor s name, then the patient fields six through ten will also be filled in for you. They are filled in using the information you entered in the patient s guarantor record since the patient and guarantor are the same person. The patient fields and their descriptions are as follows: LAST NAME, FIRST NAME, MIDDLE NAME, SUFFIX These fields must contain the patient s name. These fields will initially default to the corresponding guarantor fields until any are modified and no longer match the guarantor s corresponding fields. SEX, DOB, SSN These fields should contain the patient s sex, date of birth, and social security number. These fields are used in various letters as well as for the completion of the insurance claims and should be present if known. HOME PHONE This field is used to store the patient s home telephone number. POE, POE PHONE These fields are used to store the patient s place of employment and work number. STATUS CODE This code is used as a quick reference for you to see what needs to be done to this patient s account or to give you some critical piece of information about the account. This field can also be used within the Report Writer and the follow-up queue system to help you separate your accounts into manageable groupings. BILL CODE This code tells CFO what letters, if any, to send to the patient s guarantor on the date a statement is sent out. For more detailed information on this field, refer to the Bill Code section of the Coded Libraries chapter. 3-4

32 F CLASS This is the patient s financial class. This field can be used for the reporting and sorting of patients and patient activity within the work queues or system reports. DESK CD This code is used to separate the patients into manageable and assignable groups. This code can be used in reporting or in managing and assigning the work queues. MAIN PHY This field is used to track the patient s usual or preferred provider. This field is used as the default when adding new invoices for the patient. REF PHY This field is used by CFO as the default referring physician for new invoices. This field is used as the default when adding new invoices for the patient. CHART# This field is the number that has been assigned to this patient by any external system. It can be used in reports, and printed on letters. The chart number can be used in place of the CFO record number as a reference to the patient. BILL CYCLE This field determines when the guarantor will be sent the letter indicated within the BILL CD field. If this field is left blank, the patient BILL CD field will then determine the frequency of correspondence. This field should only be used for patients that want to get their statements on a specific date. All other patients should use the BILL CD field to determine when they receive their bills. This will make maintaining your billing cycles much easier. FOLLOW-UP DT This field is used by the work queues to determine the next date this patient will be in need of follow-up. Although work queues can be set up to review patients whose follow-up date has not passed, this field should reflect the date that action will be needed. SIG ON FILE This is the latest date the patient s signature was taken. This is necessary for filing claim forms for insurance purposes. It releases the patient s information for the necessity of getting the claim paid. INSURANCE DUE This field, along with the insurance aging fields, shows that amounts are still pending insurance payments. The aging of the insurance amounts is from the date of the initial claim submission to the responsible insurance. This means that the aging can re-start when the secondary is billed. PATIENT DUE This field along with the patient aging fields, show what amounts the patient is currently responsible for. These amounts come from the patient responsibility records, for patients with insurance coverage, and from charges, for patients without coverage. The aging of the patient due is the date that the patient becomes responsible. TOTAL DUE This field, along with the balance aging fields, shows the total amounts due for the patient. The aging is calculated from the service dates. LAST BILLED DATE, LAST BILLED AMOUNT These fields show the date and patient amount of the last guarantor statement sent. REMAINING FIELDS The fields on page two (2) will show you detailed transaction information. Each line shows the number, total dollar amount, and latest date for a different transaction type. The patient fields that are in bold are protected by CFO. This means that no user will ever by allowed to make any manual change to their value. These fields are maintained by CFO and contain various important and critical pieces of information. These fields will be skipped when you are adding a new patient. 3-5

33 Once you have completed the patient record, you will again be asked to enter the id number for any field you wish to alter. At this point, you should review the new patient record carefully for input errors. Any mistakes that are made here will more than likely remain for a long time to come, be difficult to locate, and may cause payment delays and denials. When you are satisfied that your data entry is complete, press the Enter key to continue. This will add the new patient record into CFO. Section 2: Adding Patient Attorney Records The patient attorney record contains information to help you keep track of any attorneys that are involved in the patient s case. These records can indicate attorneys both for and against the patient. Most fields within these records are used for reference only and are used by CFO only when included in letters and reports. Figure 3-2 shows an example Attorney Edit window. FIGURE 3-2 PATIENT ATTORNEY WINDOW The patient attorney records have the following fields: CODE This is the identifying code for this record. This field should convey to you some idea of the record s contents. This field is required to be present and unique for all records of this type. PATIENT S ATTY This field will tell you if the attorney is representing the patient. If this field is set to NO it is an indication that the attorney does not represent your patient. 3-6

34 CONTACT PERSON This field is used to store the name of any individual at the law office that should be contacted with questions regarding this patient. BILL CODE This code will allow you to send out letters to the attorney s office on a regular basis. This field can also be used to send the attorney a letter series. NEXT STATEMENT This field contains the date when the next statement is due to be sent to this attorney s address. If blank, the attorney is not scheduled to receive any letters regarding this patient. LOP DATE This is the date of the latest letter of protection received from this attorney, if any. LIEN DATE This field should contain the date of the latest lien filed to this attorney. NOTES (3) The notation fields are for any reference data you need to enter regarding the record. You are also able to add history to the patient attorney record. Section 3: Adding Patient Insurance Policies At this point you have learned to add a new patient and are ready to add the patient s insurance policies. If the patient has no insurance policies, then you will simply skip this section for this patient. Patients that have no insurance will automatically get billed for the full amount (100%) of their treatment costs. For patients that have insurance coverage, the process of adding the insurance records is simple. The first step is to pull up the patient record in view mode. There are only two types of records that have view modes, the guarantor and the patient records. The view mode is the first screen you see after you select a patient or guarantor from the record selection area. For the patients, it displays both a guarantor summary line as well as a patient insurance area to show the patient s current insurance policies. Once you are in the patient view mode for the patient you need to add the insurance policy to, press the Shift +Tab keys. This will move your active area to the patient s insurance policies. From here, type the letter A to add a new record. You will then be sent to a new patient insurance template to begin entering the insurance information. Figure 3-3 shows a patient insurance edit window. 3-7

35 FIGURE 3-3 PATIENT INSURANCE EDIT WINDOW From the Patient Viewing area, there are two other methods for adding new patient insurance policies. First, you can enter the AI blind option to open a list of current insurance policies. From within this window, use the standard selection option to add a new policy. Also, you can enter the VP blind option and use the standard selection options to add a new policy from there. The patient insurance fields are as follows: INSURANCE This is the coded entry that points to the patient s insurance company. All billing information will be pulled from this record. CONTACT If used, this code contains the follow-up company for billing questions. FEE SCHEDULE This dictates the fee schedule, if any, that the charges will conform to. If you use this field, CFO will allow you to use the fee schedule as a default for the charge amount. POLICY TYPE This is the type of policy you are adding. Your choices are Primary, Secondary, and Tertiary. ACTIVE If field is set to NO, the policy is completely ignored by CFO. ACCEPT ASSIGNMENT This field, along with a flag within each company record, will be used by CFO to determine whether insurance forms are sent to this insurance company. 3-8

36 EFFECTIVE This is the first date this policy became effective. If it is left blank, CFO assumed this policy has been effective since the dawn of time. No two policies of the same type can have an overlapping effective range. TERMINATED This is the last date this policy will cover. If it is left blank, CFO assumes this policy will be effective indefinitely. No two policies of the same type can have an overlapping termination range. PATIENT S NAME The name of the insured patient. PATIENT S RELATION This is the relationship of the patient to the policyholder. This field is required in order to file certain insurance forms. POLICYHOLDER This is the individual who owns this policy. This field is required in order to file certain insurance forms. INSURED SSN This is required in order to file certain insurance forms. POLICY NUMBER - This item is assigned by the insurance comp any and is required in order to file certain insurance forms. GROUP NUMBER This item is assigned by the insurance company and is required in order to file certain insurance forms. PLAN NAME - This item is assigned by the insurance company and is required in order to file certain insurance forms. PER-CERT REQ This field indicates whether or not this policy requires a pre-certification prior to services. CO-PAY/CO-INS This field indicates what dollar amount or percent, if any, is due for each visit. This field is only used by CFO when you add a new invoice. After you have added a new invoice, you will be prompted whether you want to add a patient responsibility for this co-pay amount. The amount will be filled in by default. DEDUCTIBLE This fie ld indicates what, if any, the patient s yearly deductible amount is. This field is not used by CFO and is for your reference only. MAX BENEFITS This field indicates the maximum benefits this policy will pay. This field is not used by CFO and is for your reference only. PRIM CARE PHY This field is where you would place the coded entry for the primary care physician. NOTE This field is available for you to enter any notations regarding this policy. This field is not used by CFO and is for your reference only. LIEN DATE This is the field to store the date you last filed a lien against this policy. This field is not used by CFO and is for your reference only. CAP: FIELDS The remaining CAP: fields are used within the Capitation Payment Utility, which is described within the Speed Utilities Chapter of this manual. 3-9

37 After you have completed all the fields in the new policy, you will be prompted to enter the id of the field you want to edit. At this point, you should take the time to review your data and to correct any mistakes that you might have made. Remember that this record will dictate how the insurance will be filed and, in some cases, what amounts will be charged to the patient. It is vital that all the information is correct and that the record is complete. After you have verified that the patient s new policy is correct, press the Enter key to add it to the patient. You will now be returned to the Patient Viewing area, where you should see the new policy listed under the insurance summary line. Section 4: Adding Policy Pre-certifications When pre-certification is required by the patient s policy, CFO will warn you if any charges exist for a period of time that does not have an existing pre-certification record. This is true for both primary and secondary patient policies requiring pre -certification. This warning will occur for every user every time that the patient s record is accessed. This option can be accessed using the VP blind option from within the Patient Viewing area. Use your arrow keys to highlight the policy that you want the new pre-certification record to be added to. Now use the Add option to get a listing of available record types that can be added and select the Patient Pre - certification option. This will open a window allowing you to add a new pre-certification record to the patient policy that you had highlighted. The policy pre-certification fields are as follows: DATE This field is used to store the date that the pre-certification was received. PRECERT# This is the number issued by the insurance carrier. This field will print on the HCFA (field #23) and UB92 (field #60) insurance forms. CHARGES FROM This field helps determine what service dates this pre-certification will cover. If left blank, this pre-certification will cover all service dates. CHARGES TO This field helps determine what service dates this pre-certification will cover. CHARGE CODE The charge code that is required for pre-certification. ALLOTTED This field documents the total number of units authorized by this pre-certification. REMAINING This is the number of remaining authorized items. NOTE (3) These three fields are reserved for user commentary. Section 5: Adding Patient Invoices The patient invoice records contain detailed information regarding a specific or a series of patient visits or incidents. In addition to the data contained within the patient invoice record itself, other records can be attached to the invoice, such as the patient charges, adjustments, patient responsibilities, admission records, and visit history. These records are used throughout CFO to generate insurance forms, detail provider actions, summarize diagnosis usage, and allow for organized follow-up and many other functions. 3-10

38 In order to add new patient invoices, you must pull up the patient record in which you want to add the invoice. Your patient can be selected using the F8 function key or the Patient Selection menu option. The finding and selecting of patients and guarantors is covered in greater detail within the Finding Patients and Finding Guarantors sections of the Finding What You Need chapter of this manual. Once you have the patient pulled up in view mode, you can enter the AT blind option to add transactions. You may find that it is sometimes more helpful to enter the VT blind option. This will open the View Transaction window, allowing you to review the existing invoices for the patient prior to adding your new visit. This will allow you to verify that the invoice you are about to add does not already exist for the patient. This is especially helpful if you are not the only person that adds new patient invoices. If you choose to use the VT blind option, you will need to use the ADD option to begin adding new patient invoices. The View Transaction window will look similar to Figure 3-4 below. FIGURE 3-4 PATIENT VT WINDOW After entering the AT blind option, or entering the letter A for the ADD option from the VT window, you will be ready to add a new patient invoice. The items that you can add at this point include adjustments, admission records, charges, history, letters, narratives, and patient responsibilities. For adding new invoices, you will choose the Charge option. You can do this by entering the numb er that appears to the left of the charge option or by using your arrow keys to select the line beginning with CHARGE. Figure 3-5 shows what options are available from within the AT and VT windows. 3-11

39 FIGURE 3-5 VIEW TRANSACTION ADD LIST After selecting the option for charges, CFO will send you to an edit window for a new invoice. Many of the fields within the patient invoice are completely maintained by CFO and these will be skipped. The other fields should be filled out as completely as possible as most of these fields are used throughout CFO. After adding the new invoice record, you will then be sent to an edit window for a new patient charge. Instructions for adding the charge entries are outlined in the next section of this manual, Adding Patient Charges. The Patient Invoice window will look similar to Figure 3-6 below. 3-12

40 FIGURE 3-6 PATIENT INVOICE WINDOW The patient invoice record contains the following fields: DATE FROM This is the earliest date of service for this patient invoice. This field is updated by CFO when new charges are added to this patient invoice and will be blank for invoices that do not yet have charges. You will be unable to edit this field, as it is maintained by CFO. DATE TO This is the latest date of service for this patient invoice. This field is updated by CFO when new charges are added to this patient invoice and will be blank for invoices that do not yet have charges. You will not be able to edit this field, as it is maintained by CFO. FACILITY This fie ld should contain the facility code for the facility where the services for this patient were performed. This field is always required, as information about this facility is used by CFO for many functions, including the creation of insurance forms. PROVIDER This field must contain the code for the provider that performed the services contained in this patient invoice. This field is always required, as information about this provider is used by CFO for many functions, including the creation of insurance forms. This field uses the provider code library, which is defined in detail within the Coded Libraries section of this manual. DEPARTMENT The value of this field is taken from the provider for this invoice. You will not be able to edit this field, as it is maintained by CFO. 3-13

41 REF PHYS This field should contain the code of the referring physician for this patient invoice. This field uses the provider code library, which is defined in detail within the Understanding Coded Libraries section of this manual. SUBST PHYS This field is used for the provider code of the Locum Tenes physician. This is the substitute physician that is temporarily filling in for the provider. This field is necessary to properly bill for this type of arrangement. CLIENT REF# This field can contain any reference number external to CFO. If used, this number will replace the CFO assigned reference for this invoice for reports and letters. INSURANCE NOTE The value entered into this field is used to populate the HCFA field 19. This field is reserved for some very specific remarks to insurance companies. PLACE DATE This field can be used to reference the date that the invoice was received. This field is not used by CFO and is strictly for internal reporting or user reference. SCALE This field restricts the types of payments and payment reversals to those with matching commission scales. FORCE PAPER If the value of this field is set to YES, CFO will bypass all electronic submission and force the insurance forms to print as paper. INVOICE STATUS This field is used to separate your invoices into manageable groups. This field uses the patient invoice status code library, which is defined in detail within the Coded Libraries section of this manual. FOLLOW-UP DATE This is the date the invoice will need review. This date is initially set based upon the INVOICE STATUS selected for the invoice. It is used by CFO to help manage the work queues and should always be set with care to coincide with needed follow-up. PRIM INS This field contains the primary insurance name for this invoice. This is assigned and maintained by CFO based on the invoice s DATE FROM and DATE TO fields and the patient s primary insurance policy effective dates. PRIM CODE This field contains the primary insurance code for this invoice. This is assigned and maintained by CFO based on the invoice s DATE FROM and DATE TO fields and the patient s primary insurance policy effective dates. PRIM STATUS This field will contain the status of the primary insurance. Based upon its value, you will know whether the insurance company has been sent a bill, paid its portion of the bill, paid a disputed portion, rejected the bill, as well as other conditions. You will not be able to edit this field, as it is maintained by CFO. PRIM DATE This field will contain the date CFO last updated the prim status field. You will not be able to edit this field, as it is maintained by CFO at all times. SEC INS, SEC CODE, SEC STATUS, SEC DATE These fields are the same as the primary fields except that they deal with the patient s secondary insurance policy. TERT INS, TERT CODE, TERT STATUS, TERT DATE These fields are the same as the primary fields except that they deal with the patient s tertiary insurance policy. COLL DATE, AGENCY, AMT, BAL These fields will contain the date the invoice was sent to collections, the code for the collection agency that this invoice has been turned to, the total amount 3-14

42 sent for collections, and the current balance outstanding. If these fields are blank, this invoice is not currently in collections. You will not be able to edit these fields, as they are maintained by CFO at all times. INSURANCE DUE This field contains the dollar amount that is still pending insurance payment for this invoice. This amount combined with the PATIENT DUE field s amount will always equal the amount within the TOTAL DUE field for each invoice. PATIENT DUE This field contains the dollar amount of this invoice that has been determined to be the responsibility of the patient. You will not be able to edit this field, as it is maintained by CFO. TOTAL DUE This field contains the total dollar amount due for the invoice. This amount includes funds due from the patient but will not include amounts that are in collections. You will not be able to edit this field, as it is maintained by CFO. TOTAL CHARGES, LAST CHG DATE These fields store the net charges to date and the latest charge date for this invoice. This date should always match the INVOICE FROM DATE for this invoice. These fields can be used to quickly identify these totals and for faster reporting. TOTAL PAYMENTS, WRITE-OFFS, OTHER, & DATES These fields will contain the total net adjustments of the listed types. The corresponding date fields indicate the latest occurrence for each adjustment type. PAT PAYMENTS, WRITE-OFFS, & DATES These fields indicate the net amounts paid and written-off, for the patient only. The dates indicate the most recent occurrence for each type of adjustment. PRI/SEC PAYMENTS, WRITE-OFFS, & DATES These fields contain any net amounts paid and written-off for both the covering primary and secondary insurance policies for this invoice. The dates indicate the most recent occurrence of each of the adjustment types. Section 6: Adding Patient Charges Patient charge records contain the billable information for the services rendered to your patients. The patient charge records are used to generate insurance forms, patient statements, and reports that affect just about every area of CFO. These records are attached to specific patient invoices and cannot be added without selecting the patient invoice to use. In order to add your new charge, you must first select the patient and invoice. If the charge is to be added to an old invoice, press the ESC key when the Adding New Patient Invoice Screen comes up. This will take you to a list of invoices that already exist for this patient. Instructions for getting to a new patient charge window are contained in the Adding Patient Invoice section of this chapter. You will need to complete this section before continuing. Once you have a blank charge record open, you are ready to begin adding your new charge. Figure 3-7 shows an example of what the patient charge window will look like. 3-15

43 FIGURE 3-7 PATIENT CHARGE WINDOW The DATE FROM field will default with the earliest charge date on the invoice. Your new invoice should have no other charges as yet, so this field will be empty. After entering the DATE FROM date, you will see that the DATE TO date will default to the same date. If your patient charge spans more than one day, you will need to change this date to the ending date for the charge. Next you will need to pick the charge code that corresponds to the charge you are adding. This code will determine the default cost and description. There are two special cases to consider with regard to patient charges that are described next. First, if the patient has a primary that covers this service date and that primary policy has a fee schedule, the cost for this patient charge will be maintained and protected by CFO. You can make changes to the cost, but it will determine what the default amount is going to be. Keep in mind that this cost is for one unit only, so if the quantity field is filled in, the amount will change accordingly. The modifiers may also make changes to the default price in the fee schedules. If the charge code is not found in the patient s primary fee schedule or the patient has not primary insurance fee schedule you will have the option to alter the default cost for this patient charge. After entering the modifiers, quantity, insurance note, and diagnoses, you will have completed the addition of your patient charge. The second special case results if the charge code you choose for this patient charge has any value in its NEXT CODE field. If this is true, CFO will automatically fill in the next patient charge record with the charge code from this field. You do have the ability to change or even cancel the addition of this patient charge, as CFO does not enforce the addition of this next charge code. 3-16

44 After you have added your patient charge, you will be taken to another blank patient charge record. When you have added all the charges for the invoice, you simply press Control-X to exit. You will then be sent back to the view transaction area. You will now see the new invoice and charges you just added. Patient charges contain the following fields: DATE FROM This field should contain the earliest date that this patient charge covers. The default date is the invoice date. DATE TO This field should contain the latest date that this patient charge covers. The default is the same date as above. CHARGE CODE This field should contain a valid charge code. This field defines the service that was rendered and determines many of the default values for this patient charge. This field also determines the insurance form to generate for this patient charge. COST This is the amount to be charged for this service. The initial value is pulled from the charge code used for this patient charge. If the patient s primary insurance policy contains a fee schedule that specifies the cost for this charge code, the code will be pulled and maintained using that schedule. DESCRIPTION This is the description of the service that is being charged. This value will default to the description contained within the charge code selected for this patient charge. MODIFIER (4) These fields should contain any modifiers needed to fully detail the procedure. Adding single character modifiers will result in every two characters being combined into a new two-character modifier on the insurance claims (used for special billing types such as ambulance billing). QUANTITY This field should contain the number of units for this patient charge. DIAGNOSIS (4) These fields should contain all the diagnoses that lead up to this patient charge. TIME FROM System field that is used in conjunction with anesthesia charges. Used to calculate hourly charges for anesthesia that was administered. TIME TO System field that is used in conjunction with anesthesia charges. Used to calculate hourly charges for anesthesia that was administered. REFERENCE This field can contain any reference number external to CFO. PROVIDER This field contains the code for the provider that performed the services for which this patient is being charged. This field uses the provider code library, which is defined in detail within the Coded Libraries section of this manual. Section 7: Adding Admission Records The patient admission record holds the information required for completing the UB92 insurance form. If any of the charge codes for the patient charges on an invoice indicate that the UB92 insurance form is to be sent to CFO, you will have to add an admission record. This will happen after you have finished adding all your charges for the invoice. The addition of the admission record can be aborted but the admission record will have to be added before any UB92 forms can be created for the invoice. 3-17

45 To add a new admission record, you can simply add new charges that require it and CFO will take you to a new admission record for the invoice. If you have aborted the prompted admission record, you can highlight any invoice record within the view transaction area for your patient and enter the blind option AAD. This will only work from the Patient Screen. You can also use the standard ADD option from within VT Screen. You will then have to choose the invoice from a list of invoices. After you have selected the invoice, you will be placed into the admission record edit window to begin adding the new record. If the invoice has no admission record, this will take you to a new admission record for the highlighted invoice. Only one admission record can exist for each invoice, so if the invoice already has an existing admission record, you will be told Only One Patient Admission Allowed. Figure 3-8 shows an example of what the admission record should look like. FIGURE 3-8 PATIENT ADMISSION RECORD The process of adding the admission record is the same as the other records you have added so far. The fields contained within the patient admission record and a brief definition follows. BILL TYPE This field contains the bill type for this admission. The Type of Bill field provides specific information about the bill for payer billing purposes. The first digit of the three-digit number identifies the type of facility. The second digit classifies the type of care being billed. And the third digit indicates the sequence of the bill for a specific episode of care. ADMIT DATE, TIME These fields should contain the date and time the patient was admitted to the provider for inpatient care, outpatient services, or the date and time other care was begun. 3-18

46 DETAIL LEVEL The level of detail printed out on the UB-92 Form. TYPE This field contains a code that reflects the priority of the inpatient admission. This field is required for Medicare billing of inpatient and swing bed claims. SOURCE This field is required for Medicare billing and should contain the code indicating the source of the admission or outpatient services. DX This field should contain the complete ICD-9-CM code that describes the patient s diagnosis or reason for their visit at the time they were admitted or registered for the service. OCCURRENCE CODE, DATE These fields indicate a significant event that relates to this claim and that may affect payer processing. The codes are used to help determine liability, coordinate benefits, and to administer subrogation clauses in benefit programs. OCCURRENCE SPAN CODE, DATE FROM, DATE TO These fields identify an event that relates to payment of the claim. These codes identify occurrences that happened over a length of time. DISCHARGE DATE, TIME These fields should contain the date and time the patient was discharged from inpatient care. This field is not required for Medicare claim filing, but is sometimes required for other payers on inpatient claims. STATUS This field contains a code indicating the patient s disposition at the end of service or discharge. COVERED DAYS The value in this field will be printed out in Field 7 of the UB-92 Form. This field stores the number of days covered by the primary payer. This field is required for Medicare inpatient claims and is invalid for outpatient care. NON-COVERED DAYS The value in this field will be printed out in Field 8 of the UB-92 Form. This field should contain the number of days of care that are not covered by the primary payer. This field is required for Medicare inpatient claims and is invalid for outpatient care. C-I D, L-R D The value in this field will be printed out in Fields 9 and 10 of the UB-92. For example, Coinsurance Days: will contain the number of inpatient Medicare days occurring after the 60 th day and prior to the 91 st day within a single illness period. Lifetime Reserve Days: contains the number of days remaining of a beneficiary s 60 lifetime reserve days. These can be used after the 90 days of inpatient care for a given illness, have been used. These fields are also required for Medicare inpatient claims. CONDITION CODE These fields contain codes that help to identify conditions that will affect the payer s processing of this claim. The codes will help to determine patient eligibility and benefits and are used to administer primary or secondary insurance coverage. VALUE CODE, VALUE These fields contain values and related dollar amounts that are relevant to the claim and sometimes required for claim processing. PRINCIPLE DIAGNOSIS This field contains the full ICD-9-CM diagnosis code that describes the condition established after study to be chiefly responsible for causing the hospitalization or use of other hospital services. PRINCIPLE PROCEDURE, DATE This field should contain the charge code and date of the principle procedure that was performed for this claim. 3-19

47 OTHER PROCEDURE, DATE These fields allow for the reporting of additional procedures that relate closely to the primary procedure. These fields are required for Medicare when filing surgical claims. ATTENDING PHYSICIAN This field is required and is reserved for the licensed physician who normally would be expected to certify and re-certify the medical necessity of the services and/or the physician who has primary responsibility for the patient s medical care and treatment. Provider numbers from within this provider code s record are used to fill out the UB92 record. OPERATING PHYSICIAN This field is reserved for the physician that performed any operations for this admission. OTHER PHYSICIAN This field is reserved for additional physicians, other than the attending physician, involved in the services for this admission. E-CODE This field should contain any relevant ICD-9-CM code indicating the external cause of injury, poisoning, or some other adverse effect. Section 8: Adding Narrative Records The narrative record is used with ambulance billing and contains the additional information required for the insurance billing of these claims. You will be prompted to add narrative records automatically when the Charge Code requires it. The narrative record contains information that must be provided by the paramedics or ambulance service. Figures 3-9 and 3-10 show an example narrative record. 3-20

48 FIGURE 3-9 PATIENT INVOICE NARRATIVE (PAGE 1) DATE OF SERVICE The date that the service was performed. TYPE OF TRANSPORT Determines whether the patient was transported for admission, discharge, emergency, or outpatient services. DESCRIPTION Provides a brief description of the narrative. ORIGIN FACILITY The name of the facility where the transport began. ORIGIN ADDRESS The address of the facility where the transport began. DEST FACILITY The name of the facility where the transport ended. DEST ADDRESS The address of the facility where the transport ended. MILES The total number of miles traveled to complete the transport. COST PER MILE The cost of the transport per mile. MILEAGE CHARGE The total charge of the mileage. This is not calculated automatically by CFO because the number of miles or the cost per mile may not always be known. BASE RATE The basic rate that is charged for the transport. SPECIAL CHARGE Any special charges that are to be included in the narrative. SPECIAL DESC (2) Additional fields used for any additional description. FIGURE 3-10 PATIENT INVOICE NARRATIVE (PAGE 2) 3-21

49 When charges are added that require a narrative attachment you will be prompted to add a new narrative record for the invoice. They can also be added onto an invoice manually from within the view transaction area by highlighting the invoice and use the ADD option. Highlight NARR and press enter. After selecting an invoice to attach the narrative to, press enter. This can also be achieved by entering the AN blind option at the View Patient Window. Invoices that require the narrative attachment will not be printed or sent electronically without this attachment present. The fields contained within the patient narrative records are as follows: NARRATIVE (6) These fields contain the actual body of the narrative report. ORIGIN ADD, CITY, ST This field contains the physical address for the origin of the incident. DESTINATION This field contains the facility code of the facility where the patient was delivered. MILES This field lists the number of miles traveled from the scene to the destination. PAT WEIGHT This field contains the patient s weight at the time of the incident. HOSP ADMIT This field contains YES if the patient was admitted to the hospital as a result of this incident. TYPE TRANS This field defines the type of transport for this incident. BED/BEFORE This field indicates whether the patient was bed-bound prior to this incident. BED/AFTER This field indicates whether the patient was bed-bound following this incident. UNCONC/SHOCK This field indicates whether the patient was unconscious or in shock during this incident. EMERGENCY This field indicates whether the transportation was an emergency. RESTRAINTS This field indicates whether the patient was restrained during transportation. BLEEDING This field indicates if the patient was bleeding as a result of the incident. TRAN TO/FOR This field indicates the reason that the destination was picked. NECESSARY This field indicates whether the transportation was medically necessary. PAT ADMIT This field indicates whether the patient was admitted to the hospital after the transport. PAT DISCH This field indicates whether the patient was discharged immediately prior to the transport. ROUND TRIP This field indicates whether the patient was returned to the original location. REASON If the transport was a round trip, this field describes the reason(s) why this was necessary. 3-22

50 STRETCHER This field indicates if a stretcher was used during this incident. REASON If the stretcher was used, this field describes the reason(s) that this was necessary. Section 9: Adding Accident Records This type of record is used to document accident information, including work-related injuries. It is used to help complete insurance forms for patient charges resulting from accidents. These records can be added using the AAC blind option from within any patient record. You will then be placed into a record selection window that will display all the patient s accident records. If no accident records are found, you will be told this. From within this window, you can use the standard selection options to add, edit, and view the patient s accident records. When present, these records can influence the insurance forms under certain circumstances. Figure 3-11 shows an example of the patient accident record. FIGURE 3-11 PATIENT ACCIDENT RECORD The fields contained in the patient accident records are as follows: TYPE INCIDENT This field defines the type of accident this record is regarding. 3-23

51 DATE OF INCIDENT This is the date on which the incident occurred. STATE This is the state where the incident occurred. UNABLE TO WORK FROM, UNABLE TO WORK TO These fields should contain the dates within which the patient was unable to work. NOTE This field is reserved for any user notation or comments. SERVICES FROM, SERVICES TO These fields indicate the service dates relevant to this incident. EMPLOYER NAME, EMPLOYER ADDRESS (2), EMPLOYER CITY, EMPLOYER STATE, EMPLOYER ZIP CODE, EMPLOYER PHONE These fields contain employer information. Section 10: Adding Patient Adjustments The patient adjustment records will allow you to adjust the amount due on patient invoices. There are several types of patient adjustment types including payments, payment returns, write-offs, general credits, general debits, collection amounts, collection payments, and collection returns. In order for you to add patient adjustments, you will need to pull up the patient that you wish to work with. Detailed instructions on finding and opening patient records can be found in the Finding Patients section of the Finding What You Need chapter. When you have your target patient pulled up, you can enter either the VT or the AT blind options. The VT option will display all current invoices for that patient, allowing you to browse through them. You will then need to enter the letter A to begin adding your new adjustment. The AT option will immediately prompt you for the type of transaction you wish to add, skipping the browsing phase. You will then be presented with several transaction types and other record types to add to the patient s invoices. These will include history entries, adjustments, charges, and patient responsibilities. You must select the Adjustment option to begin adding a new patient adjustment. You will now be placed into a patient invoice selection window where you will need to pick the appropriate invoice for your adjustment. After selecting or adding the invoice you want the adjustments to affect, you will then be placed into a window with a new patient adjustment template. Figure 3-12 shows an example of the patient adjustment window. 3-24

52 FIGURE 3-12 PATIENT ADJUSTMENT WINDOW The fields contained within the patient adjustment are as follows: DATE This field is for the date of the adjustment. TYPE This field has multiple components, which can consist of adjustment codes, location, and a modifier. The adjustment code defines the basic type of adjustment. The location is used for payment and write-off types and indicates where the adjustment occurred. The modifier indicates the type of payment or write-off. CHECK NUMBER This field contains the check number for check payments. AMOUNT This field holds the amount of the adjustment. INSURANCE This field is used for payments and should hold the name of the patient insurance making the payment. If this field is left blank, the payment is assumed to be from the guarantor. 3-25

53

54 Chapter 4 : Reconciling Charges & Adjustments This chapter will cover the following items: Batch Overview Viewing Your Batch Correcting Errors Approving Batches Finalizing All Batches For A Billing Cycle Batch Report Modules 4-1

55 Section 1: Batch Overview The goal of the batch system is to allow you to produce a report that reflects a specific set of work. This work can be a known block of new charges or payments or it can be an unknown number of corrections to existing data. By maintaining and using the appropriate batches, you can clearly and precisely acknowledge your work when required, as well as enhance and track user performance. Figure 4-1 shows an example of what the batch record will look like. FIGURE 4-1 USER BATCH RECORD The batch system allows you to add and modify records without waiting on other users to finish their own modifications. It separates your activity from all other batches so that you can compare what you intended to do with what you actually did. There are four states that any given batch can be assigned. These are: Open, Pending, Closed, and Finalized. Once a batch has been reconciled against its source documentation, it can be set to the Pending or Closed state using one of the batch report options found within the Patient Maintenance Menu. Pending batches can be re-opened by the act of a user choosing to work in that batch or moved to a Closed state using the Batch Closing option within the Patient Maintenance Menu. Closed batches can be included in a final batch report, which will then move it to the Finalized state. There are many ways to use the batch system. The variations that will be described here include using only one batch per client, using separate batches for each user, using separate batches for each service date, using separate batches for some or all transaction types, and making corrections in separate batches. 4-2

56 Using one batch per client is by far the simplest batch system, but is the least helpful and is not recommended. This method will force each user to use the current batch. This means that all transactions added for the client are placed within this batch. When the client transactions are ready to be reconciled, the batch is reviewed, corrected, and closed. All future users will have to login to the new user batch. Using separate batches for each user allows you to do your work without concern for the other users who might be working in your client. Your charges and adjustments are separated from all other users. When you have completed your work and are ready to reconcile, you are free to proceed without synchronizing with the other users. Using separate batches for each service date will allow you to proceed to a new service date without requiring you to reconcile and close your current batch. Using the batch system in this way will keep you from having to wait on transaction questions and will keep you from failing to follow-up on missing transaction data from your providers. When a problem arises with the transactions in your batch, you can simply leave the batch open and proceed to your next service date. When your question or the missing data is received, you can login to the proper batch and complete it. If your question does not get answered and the batch stays open, it will cause a warning to be displayed when the final batch report is being prepared. Using separate batches for different transaction types can be very useful if you are responsible for one type of transaction only, such as charges or payments. This will allow you to work without concern for what any other users are doing. When you have completed your work, whether you are adding payments, writeoffs, or charges, you can proceed to reconcile without having to wait for other users to finish and balance their work. The final method to discuss here is using separate batches for new transactions and transaction adjustments. Some providers will prefer that an acknowledgment be supplied to them that will match what they submitted for a specific day or period. For this type of acknowledgement to be accurate, only the new transactions should be included within the batch report. In order to accomplish this, you would need to have a separate batch to contain all other adjustments and corrections. If these adjustments and corrections were included within the batch containing the new charges, the number of patients and amounts charged and/or paid would not match what the provider is expecting from you. By separating them into another batch, the adjustments and corrections can be printed and acknowledged separately from the new transactions. Section 2: Viewing Your Batch At some point in your work, you will want to verify that you have entered all of your patient transactions or other data correctly. When this time comes, you will need to view your batch. Your batch report will list everything that has been done, and will allow verification that it was done it accurately and completely. Things included within the batch report might vary by client, but they will always include any guarantor records, patient records, patient insurance policies, patient invoices, patient charges, patient adjustments, and history entries that have been added while logged into the included batches. To view the batch, you must enter the VB blind option, or chose the Batch Viewing option within the Patient Maintenance Menu. This will take you into the batch selection area. Here you will need to select the batch or batches that you wish to view from a list of all open and pending batches for your current client. This is done using the multiple selection feature of the selection screen. After selecting the batch you wish to view, you will be asked whether you wish to include all users. If you choose not to include all users, you will be allowed to select the users that you wish to include. Only activity done within the batch or batches that you chose, by the users that you selected to include, will appear. At this point, there will be a pause while the information you requested is retrieved and summarized. You will then be sent to the overview window. This window will show each record type that was modified or added by the selected users within this batch. The fields displayed for these items are not all visible on the 4-3

57 screen at the same time. You can review then all by using your arrow keys to scroll right and left as well as up and down. The batch overview looks similar to Figure 4-2, shown below. FIGURE 4-2 BATCH OVERVIEW WINDOW The fields displayed within this window and their meanings are as follows: DESCRIPTION This field will give a brief description of the record type. ADDED This field will indicate how many of this record type have been added within this batch. For patient charges and adjustments, this field will also contain the original total dollar amounts for the transactions added. MODIFIED This field will tell you how many of the newly added records were subsequently changed within this batch. For patient charges and adjustments, this field will also contain any dollar amount modifications. TOTAL NEW This field will be the same as the added field except for patient charges and adjustments. For these types of records, this field will also contain the difference between the added and the modified dollar amount for the transactions. EDITED This field will display the number of records of this type that were edited within this batch, but were added in another batch. 4-4

58 DELETED This field will show the number of records within this batch that were deleted. CURR SESS This field will show the number of edit sessions within this batch for only those records that were added by a user that was logged into this batch. An edit session is added each time the record is opened in an edit window and any changes are saved. CURR FLDS This field will show the number of fields that were edited for this record type while a user was logged into this batch. This count applies only to those records that were added within this batch. PREV SESS This field will show the number of edit sessions within this batch. This count applies only to those records that were not added within this batch. An edit session is added each time the record is opened in an edit window and any changes were saved. PREV FLDS This field will show the number of fields that were edited for this record type while a user was logged into this batch. This count applies only to those records that were not added within this batch. Section 3: Correcting Errors Once you are within the overview section of the batch, you will have several correction and review options. By selecting any of the record summary lines within the overview, you will be taken to a more detailed listing of that record type. You can select any item listed by highlighting the line using the arrow keys and pressing the Enter key or by typing in the number that corresponds to the item you wish to review. This new window will show you all the edits and additions to the record type selected. Selecting any of these itemized lines will open an edit window for that record, allowing you to make additional corrections. From within this itemization, you should be able to make any necessary corrections. Once you have reviewed the itemization and made any necessary changes, you can press Enter to save the change, or the Esc or Control + X keys to return to the overview page without saving the change. Errors can also be corrected by exiting the batch viewing utility and pulling up the target record in the normal fashion. This will sometimes be faster and easier if you have multiple corrections to make to your batch prior to accepting it. Section 4: Accepting Your Batch (Closing) When you are ready to accept your batch, you will have to enter the Patient Maintenance Menu and select the Batch Pending or the Batch Closing option. This will open a window containing all of the open and pending batches for this client. Use the standard multiple selection option by using the arrow keys to highlight the batches you wish to set to pending or closed and press the Spacebar. Repeat this for all other batches you wish to include and then press the Enter key to continue. You will now have the option to have the batch report continue without additional prompting. This can be helpful for large batch reports such as automated data imports that might take a while to complete. Unless you have already reviewed the batch totals for accuracy, you should answer NO to this question. Answering YES here will cause CFO to process and complete the pending or closing without additional user input. At this point, CFO will process all the activity within the batches selected. You will then be placed into an overview window containing a summary for all of the record types that were added or modified within the 4-5

59 selected batches. After reviewing the overview, you must determine whether you wish to proceed. The moving of batches to a closed state is a one-directional process. Once you have closed a batch, you cannot make additional changes to that batch. If you accept the overview and wish to continue with the pending or closing of the batches, highlight and select the [accept] line. This is on the last line of the batch summary. After you have accepted the batch summary, you will be asked to verify that you wish to close the batches. If you elect to continue with your pending or closing, you will be asked to select your printer. This is the printer you want the batch report to print on, but you can also select your screen or the archive only option. Aborting the printer selection will cause the batch report to abort as well. You will then be asked to select the pages you wish to print. For more information on using the print functions, refer to the Using Printers section of this manual. Whether you chose the archive only option or not, CFO will save a copy of all batch reports within CFO s archives for your review. After you have printed the report, you will see a window telling you how many batches have been moved to a pending or closed state. Press the Enter key to exit the batch report. If you selected the pending option instead of the close option, the batch will need to be closed in order to be included within the final batch report. The closing of batches is sometimes reserved to the account managers for each client. Section 5: Preparing the Period Batch (Finaling) This is the process of reviewing and finalizing the period statement or client bill. This report will combine all of the closed batches that you select into one comprehensive batch report. This report will generate all of the necessary invoices and can show all activity for the period, including all of the items that appeared within your regular batch reports. To begin your period batch report, you must have access to and enter the Client Maintenance Menu. From within this menu, select the Batch Finaling option. You will now be placed into a window listing all of the closed batches for the client you are logged into. All of the batches within the oldest period oldest month period for the batches based on the batch date, will be automatically selected for you. These selected batches will have an Asterisk to either side of their summary line. The selected list can be edited by selecting or de-selecting (highlighting and pressing the Spacebar key on any batch summary line) any batch that you wish to exclude from the batch closing report. After you have selected the list of closed batches to include within the batch closing report, press the Enter key to continue. You will now be asked to verify that the final date for your batch closing is correct. This date will show on the batch closing report as a reference date for the period and can be altered to the date of your choice. After you have accepted or altered this date to a desired value, press the Enter key once again to continue. You will now be asked if you want to process and archive the batch final report without additional user prompting. If you answer YES to this question, CFO will complete the batch finaling without any additional user input and save the report within CFO s archives as usual. CFO will now process all the data contained in the batches that you have selected and display for you a summary of all activity. If you do agree with the summary information, you must abort the period batch and make your corrections. If you abort the period batch, you will be given the opportunity to go ahead and print the report for review. If you abort the printer selection, you will be returned to the menu system with no changes made to any of the selected batches. 4-6

60 If changes are required for your batch final report, you must create a new batch, make your changes and close the new batch. This is required because only closed batches can be included within the batch closing. After reviewing and accepting this period batch summary, you can select the final accept line to continue. You will then be asked to verify that you want to continue finalizing the period batch; select YES to continue. You must now select the printer that you want the report to go to. After this printout is complete, you will be told how many batches were finalized. Section 6: Batch Report Modules There are many modules of the batch report. There are also many sections that can be included at your option. These can be included for all clients or within the specific clients that you specify. To add optional modules to your batch reports, enter the Batch-Setup Modules option. This option is available from within the Client Maintenance Menu. This option will open a window displaying a listing of all the batch modules that are currently included for this client. Use the standard record selection options to add, edit, or remove modules from this listing. The fields contained within the batch module records are as follows: STATUS This field determines the type of batch this module will appear within. If the batch being printed matches the status listed here, the module listed in the MODULE field will appear in the report. ORDER This field defines the printing position for this module within the batch report. MODULE This field determines the module to be included. DESCRIPTION This field will default to the description contained within the module record. Some modules present a listing of records that have been added and/or edited within the batches included in the report. These modules present certain of these items by default. For example, the number of new patient records added is always shown within the Overview module. Although you cannot remove the patients from this listing, you can add your own choices into the list. To add record types that you want to appear within the modules that have this functionality, you should use the Batch Setup Print Order option within the Client Maintenance Menu. By adding new batch file order records, you will cause the modules that have this behavior to include them. All of the available batch modules and a brief description of each are as follows: ACTIVITY BY FINANCIAL CLASS This module presents the charges, payments, and adjustments categorized by financial class. ACTIVITY BY INSURANCE TYPE This module presents the charges, payments, and adjustments categorized by insurance type. ACTIVITY BY INVOICE STATUS This module presents the charges, payments, and adjustments categorized by invoice status. ADJUSTMENT CODE TOTALS SUMMARY This module presents an adjustments only code total summary for all adjustments within the selected batches. 4-7

61 ADJUSTMENT DETAILED ITEMIZATION This module presents an adjustments only detail itemization for all adjustments within the selected batches. BASIC TOTALS SUMMARY This module presents only the totals. CHARGE & ADJUSTMENT INV. ACKNOWLEDGEMENT This module presents a charge and adjustment acknowledgement. CHARGE AND ADJUSTMENT ITEMIZATION This is one available variation of charge and adjustment itemization. This module presents all of the charges and adjustments for each invoice on a single line. The charges are in one column with adjustments split into debit and credit columns, as appropriate for each adjustment. CHARGE & ADJUSTMENT ITEMIZATION BY DATE Variation of the charge and adjustment itemization, by date. CHARGE & ADJUSTMENT ITEMIZATION BY INS Variation of the charge and adjustment itemization, by insurance. CHARGE & ADJUSTMENT ITEMIZATION BY PROV Variation of the charge and adjustment itemization, by provider. CHARGE & ADJUSTMENT ITEMIZATION BY REF # - Variation of the charge and adjustment itemization, by reference number. CHARGE & ADJUSTMENT ITEMIZATION W/ NET Charge and adjustment itemization with a net calculation. CHARGE & ADJUSTMENT PAT ACKNOWLEDGEMENT This module presents the charge and adjustment patient acknowledgement. CHARGE DETAILED ITEMIZATION This module presents a charge only detail itemization for all charges within the selected batches. CHARGE DETAILED ITEMIZATION (CLIENT REF) This module presents a charge only detail itemization for all charges within the selected batches, present in the following order: Client Reference #, Quantity, Diagnosis, and CPT Code. CLIENT INVOICE This module will create client invoices based upon the transactions contained within the batches included. This also includes invoices to any collection agencies. This module will always be present within all period batch reports. COLLECTIONS: ADJUSTMENT REPORT This mo dule presents an adjustment report for collections. COLLECTIONS: ADJUSTMENT/RETURN REPORT This module presents an adjustment return report for collections. COLLECTIONS: ALPHA NEW BUSINESS This module presents an alpha new business report for collections. COLLECTIONS: COLLECTION STATEMENT This module presents a collection statement for collections. 4-8

62 COLLECTIONS: DAILY CASH RECEIPTS This module presents a daily cash receipt report for collections. COMPLETE EDIT DETAIL This module creates a printed itemization of all user edits contained within the batches selected. The edits are listed alphabetically by file type. Before adding this module to the client s period batch report, consider that it can easily be longer than the rest of the report. COMPLETE HISTORY DETAIL This module will print a complete itemization of all history records added within the selected batches. CPT USAGE BY FACILITY This module presents a report on CPT usage itemized by facility. CPT USAGE BY PROVIDER This module presents a report on CPT usage itemized by provider. CUSTOMIZED COMPLETE EDIT DETAIL This module is a variation of the Complete Edit Detail. The difference is that the edits to files within the client s batch file order records are shown first, with all other file edits listed after. CUSTOMIZED COMPLETE HISTORY DETAIL This module is a variation of the Complete History Detail. The difference is that the history records are added to the files within the client s batch file order records are shown first, with all other files history listed after. CUSTOMIZED EDIT DETAIL This module is a variation of the Complete Edit Detail module. Within this module, only edits in the client s batch file order records are shown. CUSTOMIZED HISTORY DETAIL This mo dule is a variation of the Complete History Detail module. However, this module only shows history records that were added to the files in the client s batch file order records. DEBIT AND CREDIT ITEMIZATION This module is a variation of the transaction itemization. This module presents the invoice transactions in two columns, as either credits or debits. EARNINGS AND PAYTMENT ORIGIN This module will print the amounts paid according to where the invoice is currently being worked. This can include the billing service and any collection agencies. OVERVIEW BASIC This module will print the standard batch overview. This is the overview that the user is presented with when asked to review and approve of the batch report. OVERVIEW BY ADJUSTMENT CODE This module will print an overview of adjustments only, sorted by adjustment code. OVERVIEW BY PAYMENT LOCATION This module will print an overview of payments only, sorted by the location where the payment was received. OVERVIEW BY PAYMENT TYPE This module will print an overview of payments only, sorted by payment type. PAYERS BY PROVIDER SUMMARY This module presents payments itemized by payer and subtotaled by provider. PAYMENT DETAIL LISTING This module presents a payment detail listing. 4-9

63 PAYMENTS BY PAYMENT LOCATION This module presents the batch payments subtotaled by the location receiving the payment. PAYMENTS BY PAYMENT ORIGIN This module presents the payments for the batch separated by where the payment s invoice is currently being worked. PROVIDER FINANCIAL CLASS SUMMARY This module presents payments subtotaled by patient financial class. PROVIDER FINANCIAL CLASS SUMMARY BY CPT This module presents payments subtotaled by CPT code. SERVICE/ACCOUNTING PROFILE This module presents the service accounting profile. 4-10

64 Chapter 5: Follow-Up Queues This chapter covers: Follow-Up Queue Overview How To Choose A Follow-Up Queue Working Accounts Within A Follow-Up Queue Exiting The Work Queues 5-1

65 Section 1: Overview of Follow -up Queues The follow-up queues will allow you to see each patient or patient invoice that is in need of follow-up. When a patient, or one of the patient s invoices, is due for follow-up the account will be opened for you to view, edit, and update. When you have completed the necessary follow-up, you simply assign the new follow-up date and you are shown the next account. There are several pre -set follow-up queues that will allow you to follow-up your past-due patients and pastdue insurance companies. These are organized to allow you to do follow-up based upon the age of the delinquency and to do patient follow-up separate from insurance follow-up. The queues that deal with insurance are also designed to pull up the invoices so that those with the same responsible insurance company are grouped together. New follow-up queues can also be added for any special follow-up needs that you have. These queues can be set up to show you patients, or they can show you patient invoices. In both cases, you are able to define the required fields and values for the accounts you wish to view. Section 2: System Follow -Up Queues CFO comes with many pre-defined follow-up queues. These include both patient queues and invoice queues. The main difference between these two types of follow-up queues is that the patient queues will bring up patients for review while the invoice queues will bring up individual patient invoices. Most insurance follow-up will require you to use an invoice queue. The insurance work queues are designed to give you patient invoices in order by that invoice s insurance company. This will allow you to follow-up for multiple invoices while you have a given insurance agent on the line. Several patient follow-up queues are also included. These are designed to allow you to contact patients who are past due and in need of some action. The patient work queues will be much smaller than the insurance follow-up queues. This is due to the fact that a patient will likely only appear within one of the patient follow-up queues, even if that patient has multiple invoices. Figure 5-1 shows some of the predefined follow-up queues. 5-2

66 FIGURE 5-1 PRE-DEFINED FOLLOW-UP QUEUES The pre-defined follow-up queues and their qualifications are as follows: All Primary This queue will bring up all patient invoices whose follow-up date is past and whose primary insurance has been filed provided the following are true for the invoice: the PRIM DATE field (date the primary insurance was actually filed) is at least 30 days in the past, the P STAT field has a value of PEND, RFLD, or DISP, and the INS DUE amount is $0.01 or greater. All Secondary This queue will bring up all patient invoices whose follow-up date is past and whose secondary insurance has been filed provided the following are true for the invoice: the SEC DATE field (date the secondary insurance was actually filed) is at least 30 days in the past, the S STAT field has a value of PEND, RFLD, or DISP, and the INS DUE amount is $0.01 or greater. All Tertiary This queue will bring up all patient invoices whose follow-up date is past and whose tertiary insurance has been filed provided the following are true for the invoice: the TERT DATE field (date the tertiary insurance was actually filed) is at least 30 days in the past, the T STAT field has a value of PEND, RFLD, or DISP, and the INS DUE amount is $0.01 or greater. Patient Past Due (30, 60, 90, 120, 150) Days These follow-up queues will bring up all of the patients whose follow-up date has passed, provided the patient has an amount due in the corresponding past due field. Primary Ins (30, 60, 90, 120, 150) Days These follow-up queues are the same as the All Primary queues except that the PRIM DATE must fall within the appropriate date range for the queue selected. 5-3

67 Secondary Ins (30, 60, 90, 120, 150) Days These follow-up queues are the same as the All Secondary queues except that the SEC DATE must fall within the appropriate date range for the queue selected. Section 3: Choosing A Follow -Up Queue To choose the follow-up queue that is appropriate, you must have in mind exactly what type of follow-up work you intend to do. For example, if you are going to be calling patients who are late with payments, you would select a different queue than if you wanted to contact insurance companies that have not responded to your insurance bills. By pressing the Shift+F11 function key and selecting FOLLOW UP, you will be able to see all available follow-up queues for your current client. This will open a selection window containing a listing of all the follow-up queues that you can access. Select the follow-up queue that best describes the type of follow-up you want to do and you will be sent to the first qualifying record. If there are no records that match the follow-up queue s criteria, you will see a window explaining that you have reached the end of the queue. After working through the accounts within any given queue, you will eventually get this message. A very important step to take before beginning to work within a queue is to verify that you are in an appropriate batch. All work within the follow-up queues is tracked just like the work done outside the work queues. In most cases, this follow-up work should be done within it s own batch to avoid confusion. Section 4: Working Follow -up Queue Accounts Working your way through the follow-up queues is simple. As the accounts are opened on your screen, you will be able to browse through the account and to take whatever follow-up action is called for. Since you can press the F11 function key to be returned to the current follow-up account at any time, you are free to exit the account and navigate freely within CFO while working within any follow-up queue. After you have completed your follow-up for the current patient or invoice, make all of the appropriate changes or additions within CFO. The last step is to add your notes into history by pressing the F5 function key and entering the letter A. After entering the letter A, you will be placed into a new history window. Enter the history code that corresponds to the action you took on the account, and fill out the NOTE fields as appropriate. After you have completed this history entry, you will be prompted to enter a new status code and follow-up date. For additional information on history, you can refer to the Additional Features section of this manual. The follow-up date that you enter here will determine the next time this account will appear in the queues. You are now ready to press the F11 function key to pull up your next account for follow-up. Keep in mind that the F11 function key will return to you the first qualifying account for the queue you are logged into. Therefore, if you left the status code and follow-up date of the previous account unchanged you may get this same account each time you press the F11 function key. Section 5: Adding New Follow -Up Queues The addition of new follow-up queues will become necessary as your follow-up procedures get more detailed. The addition process involves only a single record and can be completed and tested within just a few minutes. 5-4

68 Before adding a new follow-up queue, you must decide whether you want users within all clients to have access to the new queue. If you want the follow-up queue accessible from within all clients, you will need to be sure that you are currently logged into your main, BILL client. If the follow-up queue is to be limited to usage from within a specific client, you must login to that client. To begin the addition of a new follow-up queue, press the Shift+F11 function key. This will open a window displaying all of the available work queues. From within the selection area, use the standard Add feature to get a blank follow-up template. The fields and their descriptions for the follow-up queue record are: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. NAME This field should tell the user a little about this follow-up queue. It should help the user to tell the difference between this work queue and any other. CLIENT RANGE This field will determine whether or not accounts or invoices from other clients will also be included within this work queue. This can be very confusing for a user and should only be set to GROUP or ALL for very specific work queues. TYPE This field will determine whether the queue is based upon patient records or on patient invoices. This field also controls what follow-up queue sorts are available. MAIN SORT This field determines the order that the qualifying patients or invoices are pulled up. By pressing the F1 function key, you will be able to see a list of the sort options that are available. The selection made here also sets the first two fields that can be restricted for this follow-up queue. For example, if the MAIN SORT is set to PRIMARY CODE and PRIMARY DATE, then the invoices within this queue will appear to the user in order by the invoice s primary insurance (starting with A through Z ) and then by the filing date (earliest through most recent). REVERSE ORDER This field allows you to reverse the order that the patients or patient invoices will be opened for the user. FIELD, RANGE (8) These fields determines what patients or invoices will show up in this follow-up queue. For example, if you want only patients with a last name that begins with the letter A through D and the letter J, you would set one of the FIELD fie lds to PATIENT: LAST NAME and the following RANGE field to a value of A-D, J. The first two FIELD values are automatically set by the MAIN SORT that you chose for this queue. Section 6: Exiting The Follow -Up Queue To exit the follow-up queue you are working in, you can log out or abort the selection of a new queue. If you still have work to do within CFO, and are not ready to log out, you will want to abort the selection of a new queue. This is done by pressing the Shift+F11 function key and then pressing the Control + X keys or entering the letter Q. If your current client is not set to use the default batch, you will be prompted to select the batch that you wish to continue working in. This is necessary because each follow-up queue can cause your work to be placed into a specific batch. Forcing the user to re-select the batch helps to prevent the user from accidentally adding transactions into the incorrect batch. 5-5

69

70 Chapter 6: Letters & Insurance Forms This chapter covers: An Overview Of Statements And Letters Creation Of A New Letter HCFA 1500 Insurance Forms UB92 Insurance Forms Electronic Submission Using The Letter Writer 6-1

71 Section 1: Statements And Letters Statements and letters can be created, removed, copied, and customized. They can be sent to guarantors, patients, providers, attorneys, and insurance companies. The statements can contain fields from most all of the data contained within CFO. Statements can be printed onto pre-printed forms or they can be designed to print a graphical form with the letter. They can be used to bill the guarantor or to thank your client s referring physicians as well as a host of other things. Section 2: Creating a New Letter There are three steps you must take to create a new letter. These are to create a new letter code, create the new letter, and to add the letter to the list of allowed letters for the target client or clients. Once you have completed these three steps, you will be able to request and print the new letter. Creating a new letter code can be done from within any record that can receive a letter. However the most direct way to do this is from within the Mail Menu. This menu is available from the Main Menu. From within the Mail Menu, select the Letter Writer option. A window will open displaying all available letters within CFO (this list is not restricted to your current client). Select the add option to begin the addition of a new letter code. Figure 6.1 shows an example of the fields contained within the letter code. FIGURE 6-1 LETTER CODE CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. 6-2

72 TYPE This field determines where this letter is available from. If the value is set to Attachment, this letter would only be allowed to print for a patient invoice. The REGULAR option will allow the letter to be used for all other cases. DESCRIPTION This field is used to store a brief and printable description of this letter. PRINT DESTINATION This is the default printing destination for the letter. In most cases, this will be set to PRINTER, but may also be set to be outsourced. PRE-PRINTED FORM This indicates the paper type to be used if printing to pre-printed forms. POST-PRINTED FORM This is the image to be used when printing the entire form or letter. FORMS ALLOWED This field determines whether to use the Pre-Printed or the Post-Printed forms as a default. If set to the BOTH, option you will be prompted to choice Pre or Post-printed when you print the letter. DEFAULT PITCH This is the default character size to use for this letter or claim. This is a system field, and cannot be edited. FIRST LINE This is the line numb er of the first printable line of the letter. This is a system field, and cannot be edited. LAST LINE This is the line number of the last printable line of the letter. This is a system field, and cannot be edited. LETTER BASIS This field determines what type of record the letter is about or what type of record for which the letter can be requested. For example, a HCFA 1500 claim is about a patient invoice. LETTER ADDRESSEE This field is used for claim type letters to determine which patient policy the claim is to be directed to. LETTER REQUIREMENT (4) This field is used to force certain requirements to be met before the letter can be requested. For example, you want the patient to have a positive balance before you send them a statement. SORT FIELD This field is used to determine the printing order when printing several logged letters. HISTORY TO ADD If this field is used, it will cause the history code here to be added to the record every time this letter is logged or printed. After you have finished adding the new letter code, you will be returned to the list of available letter codes with the record you just added will be highlighted. Select that record to begin the second step in adding your new letter. You will now be placed into the letter writer. Here, you will be able to customize your new letter. For detailed instructions on the use of the letter writer, refer to the Using the Letter Writer section later in this chapter. After you have completed your new letter, you are ready to proceed to the third and final step in your letter setup. This can also be done from within the Mail Menu by selecting the Letters Allowed menu item and choosing to add a new record. Remember that this list is specific to the client you are currently logged into. 6-3

73 If the letter is to be allowed for all clients, you must add it to the allowed letters for the master client (password: BILL). Figure 6.2 is a screenshot of the Allowed Letter record and field descriptions for the letters allowed records are listed below. FIGURE 6.2 ALLOWED LETTERS CODE This is the letter code of the letter you wish to allow within this client. LETTER CODE This field must contain a letter code from any available letter within CFO. DESCRIPTION This field will default to the description supplied in the letter code record. PRINT DESTINATION This is the default printing destination for the letter. In most cases, this will be set to PRINTER, but may also be set to be outsourced. PRE-PRINTED FORM This indicates the paper type to be used if printing to pre-printed forms. POST-PRINTED FORM This is the image to be used when printing the entire form or letter. FORMS ALLOWED - This field determines whether to use the Pre-Printed or the Post-Printed forms as a default. If set to the BOTH, option you will be prompted to choice Pre or Post-printed when you print the letter. 6-4

74 LETTER BASIS This field will determine what type of record the user must have pulled up to request this letter. This field is protected and cannot be altered by the users. LETTER ADDRESSEE This field will determine to which address this letter will be sent. This field is protected and cannot be altered by the users. LETTER REQUIREMENT (4) This field is used to force certain require ments to be met before the letter can be requested. For example, you want the patient to have a positive balance before you send them a statement. SORT FIELD This field is used to determine the printing order when printing several logged letters. Section 3: HCFA 1500 Insurance Forms The HCFA 1500 insurance form is the standard billing form for most non-facility charge components. This insurance form is included within CFO and is available to all clients that require this type of billing form. The HCFA 1500 insurance form is automatically logged in cases where any charges added require this form and where the patient has an active primary insurance policy for the service date. The HCFA 1500 sometimes requires customization by the state or insurance carriers in order to handle specific billing requirements. Some of these customizations are handled by adding attachments to your provider records. Others are handled by the insurance company s type. This form can be sent via electronic mail for those primary insurance companies that can receive electronically. All HCFA 1500 forms can also be forced to print locally, regardless of the payer s default behavior. The HCFA can be requested manually from within the view transaction (VT) option of the Patient Viewing screen. This is done using the L blind option and selecting the HCFA form. From within the VT window, you will be able to see other HCFA forms that have been requested. When a HCFA 1500 is printed for an invoice, it can have several impacts on that invoice record. If it is the first insurance form that has been printed for the policy type (primary, secondary, or tertiary) the printing will update the appropriate policy filed date as well as updating the appropriate insurance status field will be moved to PEND the first time it is printed and to RFLD for any other printings. The fields of the HCFA 1500 are listed below with a brief description of the logic and fields used to populate each of the fields. CARRIER ADDRESS The address is printed at the top of the form on the left side on 4 lines. These fields are pulled from the patient s insurance record. FIELD 1 This field is chosen based on the insurance company s INSURANCE TYPE field. FIELD 1A INSURED S ID: This field is pulled from the patient s policy record for the insurance carrier. FIELD 2 PATIENT S NAME: This field is pulled from the patient record as Last, First, Middle, Title FIELD 3 PATIENT S BIRTH DATE: This field is pulled from the patient record as MM/DD/CCYY. The patient s sex is also taken from the patient record. 6-5

75 FIELD 4 INSURED S NAME: This field is pulled from the patient s policy record for the insurance carrier. FIELD 5 PATIENT S ADDRESS & TELEPHONE: These fields are pulled from both the patient and guarantor records. FIELD 6 PATIENT RELATIONSHIP TO INSURED: This field is determined based on the patient s policy record unless the insurance type dictates an over-ride value. Any value other than Self, Spouse, and Child will translate to Other. FIELD 7 INSURED S ADDRESS: If a patient accident record exists and is worker s compensation, the address and phone number within the accident record is used. Otherwise, the guarantor s address and phone are placed here. FIELD 8 PATIENT STATUS: The patient is considered single, unless they are their own guarantor and there is a spouse indicated, or if their relation to the insured indicates a spouse. FIELD 9 OTHER INSURED S NAME: If another insurance policy will apply after this one, the insured s name will print from that record. FIELD 9A OTHER INSURED S POLICY OR GROUP NUMBER: If another insurance policy will apply after this one, the ID NUMBER is pulled from that record. If that insurance type indicates, the word Secondary will be added. FIELD 10 PATIENT S CONDITION: If the patient has an Accident Record, that record will be used to determine which to mark. Otherwise, nothing is marked. FIELD 11 INSURED S POLICY GROUP OR FECA NUMBER: This is pulled from the patient s policy record. If this value is blank and a fee schedule is indicated by the patient s policy record, it is pulled from the fee schedule record. If both of these still yield blank any default within the insurance company s TYPE is used (such as NONE for the type MC, used for Medicare). FIELD 11A INSURED S DATE OF BIRTH AND SEX: This field is pulled from the guarantor record as MM/DD/CCYY. The guarantor s sex is also taken from the guarantor record. FIELD 11B EMPLOYER S NAME OR SCHOOL NAME This is the name of the employer or school of the insured. FIELD 11C PLAN NAME: This field is pulled from the patient s policy record. FIELD 11D ANOTHER PLAN: This field is marked only if the insurance company s TYPE field indicates. FIELD 12 PATIENT S SIGNATURE: SIGNATURE ON FILE and the current date are printed here. FIELD 13 AUTHORIZED SIGNATURE: SIGNATURE ON FILE is printed here. FIELD 14 DATE OF CURRENT: The earlier of the service date or the accident, if any exists, is printed here. FIELD 16 UNABLE TO WORK: These fields are taken from the patient s accident record, if any exists for the patient. 6-6

76 FIELD 17 REFERRING PHYSICIAN: If any referring physician is indicated within the invoice, their name is printed here as Last, First, Middle, and Title. FIELD 17A REFERRING ID NUMBER: This field is pulled from the referring physician s insurance number record for this type of insurance. FIELD 18 HOSPITALIZATION DATES: If the facility code used for this invoice has a place of service of: 21 INPATIENT HOSPITAL, 51 INPATIENT PSYCHIATRIC FACILITY, 52 PSYCHIATRIC FACILITY PARTIAL HOSPITALIZE, 55 RES SUBSTANCE ABUSE TREATMENT FACILITY, 56 PSYCHIATRIC RESIDENTIAL TREATMENT CENTER, or 61 COMP INPATIENT REHABILITATION FACILITY, then the earliest service dates for the invoice are printed here. FIELD 19 RESERVED: This is pulled from the invoice INSURANCE NOTE field and the provider s insurance number record 1500 FIELD 19 (LEFT) and 1500 FIELD 19(RIGHT) fields. FIELD 20 OUTSIDE LAB: If any of the charge codes used within the invoice indicate outside lab, this field is checked YES and the full amount is printed. Otherwise, NO is checked and the amount is left blank. FIELD 21 DIAGNOSES LIST: The first 4 diagnosis codes to be referenced within the invoice charges are printed here. If the insurance type uses the Actual diagnosis style, this box is left unpopulated. FIELD 22 MEDICAID RESUBMISSION CODE: This is pulled from the insurance type field 25 within CFO. This can be set by changing the value in field 25, or if the charge code says MK. FIELD 23 PRIOR AUTHORIZATION: If a pre-certification record exists for the patient policy record, it is printed here. If the charges are for outside lab work, the CLIA # from the provider s insurance numbers record prints here. If the charges are for a substitute provider (locum tenens), the provider s insurance number record lists a value to print here. FIELD 24A FROM DATE: The charge DATE FROM fields print here. FIELD 24B PLACE OF SERVICE: The invoice s facility code PLACE OF SERVICE field prints here. If this field is blank, 11 will print. FIELD 24C TYPE OF SERVICE: The charge code s TYPE OF SERVICE value is printed here. FIELD 24D CPT CODE: The charge code s CPT code field is printed here. As many of the charges modifiers as will fit, are then printed with one space separation. Any special modifiers are then printed, space permitting. FIELD 24E DIAGNOSIS CODE: There are 3 possible styles that can be used for this field based on the insurance company s TYPE field. REFER ALL will cause the reference numbers in field 21 of this form to appear for each diagnosis code listed there that applies to this charge. REFER 1 will cause only the primary (first) diagnosis for this charge to be referenced to the list in field 21 of this form. ACTUAL will cause the primary diagnosis for this charge to print in this field, without reference to field 21 of this form. 6-7

77 FIELD 24F CHARGES: The charge amount is printed here. FIELD 24G DAYS OR UNITS: The QUANTITY field from the charge will print here. FIELD 24K RESERVED: This value is pulled from the provider s insurance number record for the policy s insurance type. FIELD 25 FEDERAL TAX I.D. NUMBER: This field will print and indicate either a Federal Tax ID Number, or a Social Security Number. The number that prints, is determined in the following order, stopping with the first number found: Invoice s facility AUX:FED TAX ID# field, Invoice s facility AUX:SSN field, Client record EIN field, and lastly, Client record SSN field. FIELD 26 PATIENT ACCOUNT #: The patient s CHART NUMBER field is printed here, unless blank. If blank, the patient record number is printed. Then the invoice record number is printed, separated by a colon. FIELD 27 ACCEPT ASSIGNMENT: This value can be forced to Yes or No by the insurance company s INSURANCE TYPE field. Otherwise, the value indicated within the ACCEPT ASSIGNMENT field for the insurance policy is used. FIELD 28 TOTAL CHARGE: The total for the charges that appear on this form is printed unless this is not the last page of the form. CONTINUED is printed for the multiple paged forms except on the last page. FIELD 29 AMOUNT PAID: The total net adjustments for insurance companies are printed here unless this is not the last page of the form or the insurances TYPE indicates not to show prior insurance payments. CONTINUED is printed for multiple paged forms except on the last page is always printed for insurance types that indicate not to show prior insurance payments. FIELD 30 BALANCE DUE: The difference between field 27 and field 28 is printed here unless this is not the last page of the form. CONTINUED is printed for multiple paged forms except on the last page. FIELD 31 PHYSICIAN: The provider s name and the current date are printed here. FIELD 32 FACILITY: The facility name and address is printed here on 4 lines. FIELD 33 PHYSICIAN, SUPPLIER S BILLING NAME: The client s statement name and address fields are printed here. These fields can each be independently over-ridden by the AUX fields within the invoice s facility record. FIELD 33-PIN PIN #: This field is taken from the provider s insurance number record for the insurance company s TYPE. FIELD 33-GRP GRP #: This field is taken from the provider s insurance number record for the insurance company s TYPE. Section 4: Electronic Submission 6-8

78 Electronic submission is the sending of medical bills to the insurance companies in a pre-defined data format. This method is preferred over paper submissions because the insurance companies will typically respond much faster. The end result is that clean or correct claims are paid much faster when sent via electronic submission. However, not all insurance claims can be submitted in this manner. All electronic mail is sent out nightly by CFO. Response files from your clearinghouse are picked up at the same time. When response files are available for printing, CFO will generate an for that client s CLEARING HOUSE contact. This contact is defined within CFO s Messages menu option within the Management Menu. If this field is left blank, no message is delivered to announce the arrival of new response files. Electronic mail can be sent manually by entering the Transmit to Clearinghouse Manually option from within the Custom Utility Menu. This option will cause the electronic mail utility to attempt to contact your clearinghouse and send/receive the appropriate files. Whether sent during the nightly processes or manually, the electronic mail will be placed into an archive for printing and re-submission. These archives can be retrieved using the archive utility within the System Archives menu. Instructions for using the archive utility can be found within the Report Archives section of this manual. Section 5: Electronic Remittance Electronic submission is a service that some insurance companies will provide for you. This service is sometimes referred to as Electronic Remittance Advice, or ERA. This service provides you with a data file that contains detailed payment and adjustment information. Receiving your payment and adjustment data in this manner will greatly reduce the time it takes you to manage a client. The setup process for new ERA files has two steps. The first step is to get the insurance companies ERA file onto your server. This is a highly customized process that depends heavily on what systems you and the insurance company has in place for electronic traffic. The second step is to setup a new ERA Payer code for the client. These records are accessible from within the Client Library menu, found in the Coded Library menu. This is a very simple record that identifies the insurance company and the Receiver ID. The Receiver ID is a unique identification number that is supplied by the insurance company. All remittance files are imported nightly and placed into unique batches that must be reviewed and accepted. CFO s containing summaries and batch names for the remittance files are sent to the user(s) listed in the ERA CONTACT fields of the System Messages menu for any client who has new remittance files. These batches must then be verified and closed to be included in the next period batch. Section 6: UB92 Insurance Forms The UB92 is a standard insurance bill that is used when billing for facility or hospital charge components. The local paper printing of this type of insurance form requires that you have the pre-printed UB92 forms appropriate for your printer(s). The UB92 insurance form is included within CFO and is available to all clients that bill using this type of form. The UB92 insurance form is automatically logged in cases where any patient charges added require this form. The patient must also have a valid and active primary insurance policy for that invoice s service date. 6-9

79 The UB92 insurance forms can be sent via electronic mail for those payers that receive electronically. All UB92 forms can also be forced to print locally, regardless of the payer s default behavior. The UB92 can be requested manually from within the view transaction (VT) option of the Patient Viewing window. This is done using the L blind option and selecting the UB92 form. From within the VT window, you will also be able to see other UB92 forms that have been requested. When a UB92 is printed for an invoice, it can have several impacts on that invoice record. If it is the first insurance form that has been printed for the policy type (primary, secondary, or tertiary), the printing will update the appropriate policy filed date as well as updating the appropriate insurance status to PEND. If the printed HCFA is a re-filing, then the appropriate insurance status field will be moved from PEND to RFLD. These changes are very important in terms of follow-up. If these fields the filed dates and the status codes are not properly maintained, you will not be able to effectively use CFO s follow-up queues. Section 7: Using the Letter Writer The Letter Writer will allow you to add new letters and to edit existing ones. With this utility, you will be able to copy and modify existing letters, saving them with a new name. You will also be able to create completely customized letters with specific messages. To launch this utility, you must choose the Letter Writer option from with the Mail Menu. Once you have selected this option, a window will open showing you all of the available letters. This list is not restricted to your current client, but is a list of all the letters on your system. Making changes to the letters in this list will alter that letter for all clients that are allowed to use it. Changes to existing letters should be made with great caution. Any changes made and saved are permanent and immediate. If your letters are sent to an outsourcing company for printing, the company must be consulted before and after making changes to any of the letters they print. Failure to do so may generate data mapping proble ms for your outsourcing company that could cause printing errors. These errors will likely go unnoticed until you begin to get phone calls from the letters recipients. Select the letter that you wish to edit from the list of system letters. If you are adding a new system letter, use the standard ADD option to create a new letter record. The fields and descriptions of the letter code record are detailed within the Letter Code Libraries section of the Coded Libraries chapter of this manual. After you have created and saved the new letter code, or have selected an existing letter from the listing, you will be sent into the Letter Writer to begin defining what the letter will say. The special function within the letter writer and a brief description of each are listed below. Many of these functions can be typed directly into the letter, but others may have to be accessed using the F1 function key. {BLACK} This function changes the current printing color of the text to black. This color is the default printing color. {BLUE} This function changes the current printing color of the text to blue, for color printers. This color will remain in effect for this letter until it is changed. {BODY} This function allows you to define the body of your letter. If no {HEADER} or {FOOTER} functions are included within your letter, this function is not necessary. The text following this function will not be repeated for multiple page documents. {BOLD} {BOLD OFF} These functions turn bold printing on and off. When set, bold will remain active for this letter until it is turned off. 6-10

80 {CENTER} This function will center the text that follows it within the defined print margins. This justification will continue for this letter until it is turned off. {FOOTER} This function defines what your footer will be for all pages within the letter. Once defined, this footer will be printed at the bottom of each page until changed or cleared. Each letter will have a default footer unless specifically altered. When you included this function within your letter, you must follow it with the {BODY} function. {FORMFEED} This function will cause any text that follows to be printed on a new page. {GREEN} This function will change the current printing color of the text to green for color printers. This color will remain in effect for this letter until changed. {HEADER} This function defines what your letter header will contain. This header will repeat for each page of the letter. When you include this function within your letter, you must follow it with the {BODY} function. {INCLUDE filename} This function will allow you to print another letter from within your current letter. The filename must match the letter code for the letter you wish to include. {ITAL} {ITAL OFF} These functions will allow you to toggle the italics printing on and off for this letter. When set, the italics printing function will continue for this letter until turned off. {ITEMIZE x [TYPE]} This feature will allow you to include one of several types of patient itemizations within your letter. Simply replace type of invoice you want to use. The types are as follows: NEW shows detailed itemization for all patient invoices regardless of balances. PAT shows a detailed itemization for all invoices with a non-zero patient balance. OPEN shows a detailed itemization for all invoices with a non-zero patient balance due. The CHART feature is an optional argument that will replace the CFO patient number with the patient s CHART number and the CFO invoice number with the invoice s CLIENT REF number. {LEFT} This function will set your justification to the left side. This justification will remain in effect for this letter until another justification command is used. {LEFTMARGIN xx.xx} This function will reset the left margin to the number of inches you specify. Simply replace xx.xx with the number of inches that you wish to set the new left margin at. This new margin will remain in effect for this letter until changed. {PITCH xx} This function will change the current print pitch (size) to the size you specify. The available sizes, from largest to smallest, are 5, 10, 12, 16. These are available for most common printers. If a size is specified that your printer does not support, the next smaller print size will be used. Simply replace xx with the print size you wish to use. {RED} This function will change the current printing color of the text, to red for color printers. This color will remain in effect for this letter until changed. {RIGHT} This function will set your justification to the right side. This justification will remain in effect for this letter until another justification command is used. {RIGHTMARGIN xx.xx} This function will reset the right margin to the number of inches you specify. Simply replace the xx.xx with the number of inches that you wish to set your new right margin at. This new margin will remain in effect for this letter until changed. 6-11

81 {TAB xx.xx} This function will cause the current print position to move the specified number of inches right from the current left margin. If the print position is already past the specified tab point, no action is taken. Simply replace xx.xx with the number of inches from the current left margin you want to tab to. {TAB xx.xx} This function will cause the current print position to move the specified number of inches left from the current right margin. If the print position is already past the specified tab point, no action is taken. Simply replace xx.xx with the number of inches from the current right margin you want to tab to. {ULIN} {ULIN OFF} These functions will allow you to toggle the underlining printing on and off for this letter. When set, the underline printing function will continue for this letter until turned off. $CLIENT This function will allow you to print the appropriate client code within your letter. $CLIENTCODE This function will allow you to print the appropriate client name within your letter. $DATE This function will allow you to print the current date within your letter. The date will be formatted as MM/DD/CCYY. $PAGE This function will print the current page number for the letter. $USER This function will allow you to print the user code of the user that is generating the print job. This will not necessarily be the user that requested the letter. $USERNAME This function will allow you to print the user name of the user that is generating the print job. This will not necessarily be the user that requested the letter. $TIME This function will allow you to print the current time within your letter. The printed format for the time will be HH:MM AM/PM. Import The import function is the function that is probably used most often. This function will allow you to import and print a field from within your letter. The fields that can be imported will vary with the letter s addressee. This function can be accessed using the F1 function key and selecting the Import Field option. When you have completed the new letter or the changes to the letter you are editing, you will have several options. These options are accessed using the F1 key. When pressed, you will see the following options: LOAD This option will allow you to load in the contents of another letter. This option can be used to make a slightly different version of an existing letter. SAVE If changes have been made, this option will allow you to save those changes. Once saved, your alteration will take immediate effect. NEW Creates a new letter that can be edited, saved, and printed. PRINT Allows the letter to be printed in its present state. QUIT This option will allow you to exit the Letter Writer. If you attempt to exit without first saving any changes that you have made, you will be prompted to verify that you do not want to save your changes. 6-12

82 HELP Shows the editor keyboard shortcuts. FORMATTING RELATED Document related items such as the document settings, page layout, tabs and justifications, text formatting, and variables such as the page number, date time, and client. FIELDS Client, guarantor, patient, other, and special fields are listed under each of these categories. ITEMIZATION Allows patient itemization such as: ITEMIZE ALL NEW CHARGES, ITEMIZE ALL OPEN INVOICES, ITEMIZE PATIENT REPONSIBLE INVOICES, ITEMIZE NEW PATIENT RESPONSIBLE INVOICE, ITEMIZE ALL INVOICES, ITEMIZE NEW INVOICES (WITH CLIENT NUMS), ITEMIZE OPEN INVOICES (WITH CLIENT NUMS), ITEMIZE PATIENT INVOICES (WITH CLIENT NUMS), ITEMIZE NEW PATIENT RESPONIBILTIES, ITEMIZE ALL INVOICES (WITH CLIENT NUMS), and CUSTOMIZED ITEMIZATION. Section 8: Letter Summary and Exception Reports After printing the logged letters from the Print Logged Letters option in the Mail Menu, two reports will be printed as well - the Letter Summary Report, and the Letter Exception Report. The Letter Summary Report outlines which letters were printed, and to what destination printer. Other fields listed in the report include the chart number, total patient charges, patient balance, date of service, client reference number, invoice charges, invoice balance, and insurance code. Other information relevant to the letter is also printed on this report. The Letter Exception Report details the letters that could not be printed and gives an explanation as to why this was so. Other fields listed in the report include the chart number, total patient charges, patient balance, date of service, client reference number, invoice charges, invoice balance, insurance code, and number of errors caused the failure to print. 6-13

83

84 Chapter 7: Using Printers This chapter will cover: Overview Of Options In The Printer Maintenance Menu Accessing The Printer Maintenance Menu Customizing Your Claim Form Fields Profile to Fit Pre-Printed Forms 7-1

85 Section 1: Printer Maintenance Menu Overview The Printer Maintenance Menu includes several utilities and options you may choose for adding and testing a wide range of electronic and print media. You ll find a brief overview of each option available on this menu below. However, since CFO provides standard installations for how your server and workstation printers are set up, this chapter will primarily focus on how to set up claim-form profiles that you can adjust to fit to preprinted forms. To perform these functions, you ll only be using two options from this menu: the Claim- Form Field Positions option and the Print Form Test Page option. Later in this chapter, you ll find detailed explanations of these two options followed by exercises for how to perform functions using these two options. An overview of the all options displayed on the Printer Maintenance Menu follows next: Claim Form Field Positions - Used to add a new claim letter (i.e., UB92 or HCFA 1500) profile and edit/adjust field forms to exactly fit pre- or post-printed forms. Destinations - Allows for the customization of up to five destinations for where your company claim forms may be sent. Installed Printers - Lists all available printers that may be installed on your server and workstations. This allows you to maintain installed printer profiles. Print Alignment Grid - Allows for the selection of the number of characters per inch (CPI) for the typeface output on the print or electronic media you choose. Print Form Test Page - Allows for the selection of a claim form (i.e., UB92, HCFA 1500, etc.), the output type being printed on, and whether the form will be pre- or post-printed. It then allows the selection of a specific printer or electronic media that is already installed on your workstation. Once ready to test, the user will be prompted to select a range of pages to print (all, page range, or test page). Printer Drivers Allows the choice of which printer drivers you wish to install. Reset CFO Printers Allows the user to stop all CFO printers from printing. It also clears the printer queue for each printer and restarts the printer daemon. NOTE: All print jobs interrupted by this process cannot be resumed and will have to be reprinted. It is strongly suggested that the use of this option be restricted to office managers or system administration. Test Printer Codes - Allows for the selection and testing on which media you wish to print or view forms. Section 2: Accessing the Printer Maintenance Menu To access Printer Maintenance Menu functions, follow these steps: From CFO s Main Menu, select the Utilities Menu option. Either use your arrow keys (??) to highlight and select this option, or type in its corresponding option number and press Enter. From the Utilities Menu, select the Printer Maintenance Menu option. Again, either use your arrow keys (??) to highlight and select this option, or type in its corresponding option number and press Enter. A Printer Maintenance Menu similar to the following should display: 7-2

86 Section 3: Customizing Claim-Form Fields Normally, there are two reasons for adjusting claim form profiles: Adjusting Forms to Different Printers - Some printers may need to have paper loaded differently than other printers. You may use these exercises/instructions for making paper-alignment form adjustments customized to certain printers. Standard Claims Forms Modified by Other Companies At times, you may need to adjust specific field lengths or positions on the form to fit a claim form that has been modified by an insurance company. We ll go through how to adjust specific field size or positions in these exercises also. There are three steps you must take before creating customized claim-form profiles: 1. Adding your claim-form profile 2. Setting up your claim-form profile test printer 3. Editing/adjusting your new claim-form profile to fit pre-printed forms We ll go through a set of exercises/instructions for these procedures next. 7-3

87 EXERCISE 1: Adding Your Claim-Form Profile OBJECTIVE: Practice adding a claim-form profile from the Printer Maintenance Menu. This is the first step in setting up a form customized to your workstation printer for printing pre-printed forms. Outline: Login to USER TRAINING CLIENT database Access the Printer Maintenance Menu Add your claim-form profile. Instructions: 1. Login to the USER TRAINING CLIENT. Be sure you are logged into your USER TRAINING CLIENT database. Press F2 to ensure you are at the Main Menu. If you do not see the client name, USER TRAINING CLIENT at the bottom-left side of your screen, STOP and contact your CFO Administrator. 2. Access the Printer Maintenance Menu. To access the Printer Maintenance Menu functions, follow these steps: From CFO s Main Menu, select the Utilities Menu option. From the Utilities Menu, select the Printer Maintenance Menu option. The Printer Maintenance Menu should display. 3. To begin adding your new claim-letter profile, select the Claim Form Field Positions option from the Printer Maintenance Menu. Either use your arrow keys (??) to highlight and select this option, or type in its corresponding option number and press Enter. 4. A window similar to the Adding New Claim Letter Profile, shown below, will display. 5. Type in a new CODE (up to ten alpha-numeric) characters that will have meaning for you and press Enter. (You ll be using this code to access and identify this profile setup when you need to adjust field placement on pre- or post-printed forms.) 6. Type in a LETTER CODE. Then press F1 to list and select which form to base your form on. 7. Type in a longer DESCRIPTION of the letter code describing this form. 8. Use the vertical, horizontal, and micro adjustment fields to enter adjustments to specific fields on the form..explain the micro-adjustments more in the details portion of screen Once you have your profile set up, you ll be using the Edit function in this profile to horizontally or vertically offset characters in fields or to the form itself. 7-4

88 9. Once the Enter Field ID to Edit prompt displays at the bottom of the screen, press Enter to save. The Printer Maintenance Menu displays. 7-5

89 EXERCISE 2. Setting Up Your Claim-Form Profile Test Printer OBJECTIVE: Practice the following: Outline: Login to USER TRAINING CLIENT Access the PRINTER MAINTENANCE MENU Instructions: 1. Login to USER TRAINING CLIENT. Be sure you are logged into your USER TRAINING CLIENT database. Press F2 to ensure you are at the Main Menu. If you do not see the client name USER TRAINING CLIENT at the bottom-left side of your screen, STOP and contact your CFO Administrator. 2. Access the Printer Maintenance Menu. To access the Printer Maintenance Menu functions, follow these steps: 3. Select (highlight) the Printer Test Form Page option from the Printer Maintenance Menu and press Enter. 4. A window similar to the following should display, allowing you to select a claim form type you will be using for basing your profile on for testing. 5. Select (highlight) the type of form to test and press Enter. In our sample above, we chose the UB92 form. The Print Destinations window, shown below, displays. 7-6

90 6. Select (highlight) the media on which you wish to perform your test. In our sample above, we selected the Printer option and pressed Enter. A Print Form Test pop-up window, shown below, displays. 7. Use your arrow keys (?? ) to select PRE-PRINT or CANCEL. Then, press Enter. PRE-PRINTED Use this option to adjust a form or specific fields to a pre-printed form that you load into your printer s manual feed tray. POST-PRINTED This option prints the actual form and field data as it currently exists in this system. Do NOT select this option. CANCEL Abort and exit this function. 8. A window similar to the one shown below should display, allowing you to select a printer for the form on which you chose to base your claim form. NOTE: Normally, you should select the printer hooked up to your PC workstation. If uncertain about which printer to choose, consult your office manager or system administrator. 7-7

91 9. Use your arrow keys to highlight (select) the printer you want. In our sample above, we chose option 10 wksupport #4-2, our printer hooked up to our workstation. ONE-TIME ONLY STEP : The first time you set up your printer profile, you will need to edit one field on an Editing Printer screen for how this specific printer is set up for your profile. Follow these steps each time you set up a separate printer: Type E at the SELECT prompt and press Enter. An Editing Printer screen will display. NOTE: You'll only be editing field 9 CLAIM LETTER PROFILE on this screen for now. In the future, you may select fields 9 through 12 (up to four different profiles) for this same printer if you wish. Type 9 at the bottom ENTER FIELD ID TO EDIT prompt and press Enter. Press F1 to bring up a list of your latest CLAIM LETTER PROFILES. Use your arrow keys to select your profile and press Enter. In this example, we chose the TESTUB92 profile. 10. The screen allowing you to select your printer again displays. Select your printer and press Enter. 11. The Print Range pop-up window shown below displays, allowing you to select which pages you wish to print. 12. You may choose which pages to print from this pop-up window by entering any of the following: Press Enter to print all pages Type in TEST and press Enter, or type in TEST, then type in specific pages or a page range, and press Enter. To print specific pages, type in page numbers separated by commas and press Enter. Example: 1,3,6 <Enter>. To print a range of pages, type in the page numbers separated by hyphens and press Enter. Example: 1-10 <Enter>. PRINT NOTES : CFO is aware of the type of paper needed for all your printers. At this time, it may prompt you to load specific printer paper. If you are sure your printer paper is correct, just select OK and press Enter. Next, CFO will process your printouts (or media output) and send it to the appropriate destination (normally, your PC workstation printer). Printing time will vary, based on your print-size job and printer speed. After your job has printed, CFO will prompt you with various options for what you may wish to do next: o Would you like another printout? Yes, No. If you select Yes (and you previously selected a post-print form), your form will 7-8

92 o o print and this prompt will display again. If you select Yes (and you previously selected a pre-print form), you ll be asked to select another printer and print range again. If you select No, a Test Complete message displays. Test complete. Print another test? OK, or Cancel. Cancel is the default setting. Simply press Enter to return to the Printer Maintenance Menu. Selecting OK and pressing Enter will return you to a selecting a form for printer test window. Did your test page print correctly? Yes, No, Quit. This prompt only appears if you decided to print a TEST page. Selecting No and pressing Enter will prompt you with a message to align the paper in the printer, choose OK, and to try and print again. Selecting Yes and pressing Enter twice returns you to the Printer Maintenance Menu. If you wish, you may press Enter once after selecting Yes here and decide to print another test. 7-9

93 EXERCISE 3. Editing/Adjusting Your New Claim-Form Profile to Fit Pre-Printed Forms Normally, there are two reasons for adjusting claim form profiles: Adjusting Forms to Different Printers - Some printers may need to have paper loaded differently than other printers. Standard Claims Forms Modified by Other Companies At times, it may be necessary to adjust specific field lengths or positions on the form to fit a claim form that has been modified by an insurance company. The following exercise is divided into two sub-exercises explained in the objective that follows. OBJECTIVE: Practice the following: Edit your form vertically or horizontally for adjusting the paper alignment on your printer. Edit field positions vertically or horizontally to adjust field modifications that might have been made by other insurance companies. Outline: Login to USER TRAINING CLIENT database Access the Printer Maintenance Menu. Instructions: 1. Login to USER TRAINING CLIENT. Be sure you are logged into your USER TRAINING CLIENT database. Press F2 to ensure you are at the Main Menu. If you do not see the client name USER TRAINING CLIENT at the bottom-left side of your screen, STOP and contact your CFO Administrator. 2. Access the Printer Maintenance Menu. To access the Printer Maintenance Menu functions, follow these steps: From CFO s Main Menu, select the Utilities Menu option. From the Utilities Menu, select the Printer Maintenance Menu option. The Printer Maintenance Menu should display. EXERCISE -3.1 Edit Your Form Vertically or Horizontally 3. To begin editing your form vertically or horizontally, select the Claim Form Field Positions option from the Printer Maintenance Menu. Either use your arrow keys (??) to highlight and select this option, or type in its corresponding option number and press Enter. 4. A window similar to the one shown below displays, prompting you to select a claim letter profile. 7-10

94 5. Use your arrow keys to highlight the profile you previously created. Type E at the bottom-right command line and press Enter to edit this profile. 6. A screen similar to the Editing Claim Letter Profile screen shown next should display: 7. For practice, let s see how the form will shift when using fields f4 and 5 VERTICAL and HORIZONTAL SHIFT. 8. First, go ahead and accept the edits as they now exist without any adjustments. Press Enter to save. Press the Esc key to return to the Printer Maintenance Menu. 9. To vertically shift the entire form up or down, type 4 at the bottom command line and press Enter. 10. To shift the form up vertically, type Sample of using field 4 and putting 2 in, message below appears. 7-11

95 11. Since no adjustments have been found, you will need to do a find (or an ADD) and select a particular field to edit. ADD ---by letter item Use F1 to find the CLAIM LETTER ITEM 7-12

96 Pressing F1 in the first CLAIM LETTER ITEM field above will display an on-line help window, showing you all field items listed within this form. Page Up / Page Down Scroll the screen page up or down ten lines. Home Scroll to the top of list End Scroll to the bottom of list Arrow Keys (? ) Scroll page to right or left to view more field information. It is possible to do a find on a specific row in a form (Example: Row 60 Find). FIND - By Letter Code 7-13

97 Select 4, 5, 6, and 7 to edit field positions. Note: 6 and 7 are not functional yet, but go ahead and try to document them. 7-14

98 Chapter 8: Additional Features This chapter describes: Edits History Pop-Up Messages User Messages User Actions 8-1

99 Section 1: Edits The edits show when records were added and what changes have been made to them. This feature is vital for account auditing and for tracking down and correcting data input problems. There are a few record types that do not have edits. All other record types will keep a complete accounting of every change that was made. Figure 8-1 shows what an edit record looks like. FIGURE 8-1 EDIT WINDOW Each time a new record of almost any type is added (some records do not contain edits) or a change is made to an existing record, an edit is created that shows the following information: DATE, TIME These fields contain the exact date and time at which the edit was completed. EDIT This field contains the actual change that occurred. USER This field contains the name of the user responsible for this edit. BATCH This field contains the name of the batch in which the edit was completed. This is used by the batch reports to track user activity. The edits for a given record can be viewed at any time by pulling up the record and pressing the Shift + F5 function key. This will open a standard lookup window listing all of the edits for the record. Remember to use the right arrow key to view the additional fields. 8-2

100 In addition, the edit records themselves are protected from being altered. This will ensure that each edit record accurately reflects the action that was taken. All attempts to change the edit record fields will result in the following message: System Field THIS FIELD CANNOT BE EDITED. Section 2: History History is a way for you to document your activities for any record within CFO. History can be added to patients, insurance companies, client records, and almost anything else. The history entries you add can also be included within your batch reports, allowing you to document the work you have done. Each history item contains a history code that defines what type of action was taken and a user-entered notation. These history codes are described in detail within the Coded Libraries section of this manual. To view the history that is attached to any record, simply press the F5 function key. This will open a standard lookup window containing all the history for the current record. If you need to add a new item, simply use the add option and complete the new history record. After you have saved your new entry, you will be returned to the listing of the record s history. Your new entry should now be displayed at the bottom of the history listing. Figure 8-2 shows an example of the patient history window. FIGURE 8-2 PATIENT HISTORY WINDOW Each history entry contains the following fields: DATE, TIME These fields contain the exact date and time the history was added. 8-3

101 HISTORY CODE This field contains the history code which determines the type of history and any client costs for the entry. NOTE These fields contain the user notation for the entry. This should be kept as brief as possible. USER (Off-screen above) This field contains the user that entered or caused the history entry. BATCH (Off-screen above) This field contains the batch that the history was added in. Section 3: Pop-Up Messages The pop-up messages will give you the ability to dis play a message to all of the users who open a specific record. The pop-up messages can be attached to any type of record and can contain a message of your choosing. To alter the pop-up messages, you must first open a window with the record you wish to change. Then simply enter the POST blind option. A window will open, listing all of the pop-up messages attached to your current record. You can now use the ADD option to add a new pop-up message, or the DELETE option to remove any unwanted pop-up messages. Section 4: User Messages The CFO will allow you to send messages to anyone else on your CFO server. Your message can be set to deliver at a future date and time as a reminder or it can be setup to go immediately. Pressing the F9 function key will open a window listing all of the messages you have received and not deleted. This list order will default to delivery date and time, showing who sent the message and the subject that they assigned the messages. Selecting any of your messages will allow you to read the contents. Figure 8-3 shows a sample user message. 8-4

102 FIGURE 8-3 USER MESSAGE WINDOW You can create a new message by selecting the add function. This will open a window with a partially completed message. To send the new message, fill out the record and save it. The fields contained within the message record and their descriptions are as follows: FROM This field will contain the user code of the user who created the message. ORIGIN DATE, ORIGIN TIME These fields will contain the exact date and time the message was sent. TO This field must contain the user code of the user who is to receive the message. DELIVER DATE, DELIVER TIME These fields must contain the date and time the message is to be delivered. The user referenced in the TO field will be notified of this the next time the user logs into CFO after this date and time have passed. This message will appear in the user s message list immediately even if this date and time have not passed. NOTIFY DATE, NOTIFY TIME These fields contain the exact date and time the user was first given notice of this message. READ DATE, READ TIME These fields show the exact date and time the message was first read. SUBJECT This field is used to give the receiver some idea of the contents of the message. 8-5

103 REFERENCE If this message was created within a record (i.e. you were at a patient record and pressed F9), this field would put in a reference to that record so that the receiver would just have to enter a hot key to go directly to the record to which the message was referring. IMMEDIATE If this field is set to YES, the message will force the recipient to read it immediately upon delivery. MSG These fields contains the text of the message. You can also delete any of your messages using the DELETE function. When you are finished browsing and sending messages, select the QUIT option to exit. Section 5: User Actions The user actions are designed to allow you to quickly select items from the standard lookup windows and perform a user-defined action on them. The actions allowed can vary by client and by record type. There is a pre-determined list of available actions. For example, if you want the ability to print mailing labels for your patients, this action can be added to the desired client. When patients are selected using the multiple selection method (covered in detail within the Basics of Record Selection section of the Getting Started chapter) labels can then be printed for only those patients selected. Section 5.5: Adding User Actions The addition of user actions consists of adding an Action Code to the client you want the action to be allowed within. The new actions can be added from within the Miscellaneous Library Menu within the Coded Library Menu. This menu option will open a standard selection window displaying any actions that exist for this client. The fields and their definitions are covered within the Coded Library chapter of this manual. The basic action types that can be setup are lis ted below: ADD HISTORY allows the user to define a history type and the message you wish to add. CLAIM REQUEST allows the user to force invoice to be re -filed. When performed on patients, this action will re-send insurance forms for all of the patient s invoices. This action requests all insurance forms regardless of past filings. COLLECT INVOICE sends an individual patient invoice to the collection agency of your choice. The collections system is covered in great detail within the Using Collection Agencies chapter of this manual. COLLECT PATIENT allows the user to send an all of the patient s outstanding invoices to the collection agency of your choice. The collections system is covered in great detail within the Using Collection Agencies chapter of this manual. EDIT FIELD allows the user to define a field within a specific file type to be altered to a new value that is user-supplied. For example, the user could set up an action to change the guarantor s Bad Address flag to YES. Then, select the guarantors with mail return and take this action only on them. 8-6

104 LABEL allows the printing of labels for a variety of record types. These types include guarantors, referring physicians, attending physicians, insurance companies, and attorneys. LETTER KILL allows a user to define a specific letter to remove from the outgoing mail. If the letter has already printed, no action will be taken for that patient or invoice. LETTER LOG allows the user to define a specific letter to log on the records that are selected. PAYMENT RETURN allows the user to quickly select a list of patients that has payment returns. The action will then prompt you for each of the individual payment return s information and post the return for you. RECALL INVOICE allows the user to recall a specific patient invoice from collections. The collections system is covered in greater detail within the Using Collection Agencies chapter of this manual. RECALL PATIENT allows the user the recall all of the patient invoices from collections that are currently at agencies. The collections system is also covered in greater detail in within the Using Collection Agencies chapter of this manual. 8-7

105

106 Chapter 9: Coded Libraries This chapter explains the following subjects: General Overview Action Code Adjustment Code Attorney Code Bill Code Charge Code Client Invoice Status Code Client Status Code Commission Scale Code CPT Code Provider Department Code Patient Desk Code Diagnosis Code Facility Code Fee Schedule Financial Class History Code Insurance Company Code Insurance Contact Code Insurance Type Code Invoice Insurance Status Code Patient Invoice Status Code Letter Code Patient Status Code Payment Code Payment Location Code Provider Code Provider Insurance Number Code Responsibility Code Write-Off Code 9-1

107 Section 1: Overview of Coded Libraries There are two basic functions of all coded libraries within CFO. The first is to reduce the amount of redundant typing you are forced to endure. The second is to reduce the number of places within CFO you would be forced to update if a change to information contained in a coded library was necessary. The following example might help you to understand some of the benefits of coded libraries. Assume that you must enter one thousand patients insurance policies. Without coded libraries, you would be forced to type in each insurance company address and name one thousand times. With coded libraries, you simply pick its code from a list of available insurance company codes, allowing CFO to extract the address, name, and other needed data from that record. Now, assume that a change is made to one of your insurance company s address. Without coded libraries, you would be forced to update each patient that has that insurance. With the coded library, you need only make a single change to the insurance code. Because CFO will look up the code and get the address from the master record each time the insurance address is needed, you only need to make one change. Another feature of the coded libraries is the ability to select the lists of multiple clients for use as an integrated list. This process is called re -direction and can be set up within the client record. All coded lists will, by default, contain any re-directed entries provided for system functionality. In most cases, you will be able to add to, and edit these libraries. The alteration of each library is controlled by user-based security and all users may not be given permission to alter all libraries. Questions regarding access into specific coded libraries should be directed to your CFO Administrator. Section 2: Action Code The action codes are used within the bill codes, record selection areas, and some of the reports to allow some special functions. The functions available include the sending of accounts to collections, requesting letters, logging notations, as well as other options. CODE identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION briefly describes the action to be taken for this code. TYPE tells CFO what action to take. Your options here are supplied with CFO and may not be added to, or edited. ARGUMENT 1 DESC (3) provides the description of the first argument required by the action. Not all actions require arguments, but those that do will give you a description here of what the argument will be used for. If the argument is required, you will enter it in the next field. ARGUMEN T 1 (3) used to store the first of three potential arguments needed for the action. Examples would include the collection agency (payment location) for actions that send accounts to collections. ALLOW CHANGE (3) used by CFO to disallow user modification of the argument value. RESTRICTED TO FILE usually maintained by CFO to restrict the types of records this action can be taken on. In some cases, the user creating the action might want to add a restriction as well. This will prevent the action fro m being taken on any other file type. NEXT ACTION allows this action code to spawn another action. 9-2

108 Section 3: Adjustment Code These codes are used to define the type of invoice adjustment that you are adding to the patients invoice. They are defined in the Transaction Library Menu, found in the Coded Library Menu under the Main Menu. These adjustment codes can cause the invoice adjustment to increase or decrease the invoice total, based on the type of the adjustment code. The fields contained within the adjustment codes are: CODE the identifying code for the record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. BASIC TYPE defines the effect this adjustment code will have on the invoice. The eight options for this field are credit, debit, payment, refund, write-off, collection amount, collection payment, and collection refund. DESCRIPTION used to describe the code and is shown in the lookup window when selecting adjustment codes. SPECIFIC AMOUNT when set to YES, CFO will force the use of the DEFAULT AMOUNT for invoice adjustments using this code. DEFAULT AMOUNT the amount that will default for invoice adjustments using this code. You will be able to change this amount provided that the SPECIFIC AMOUNT field for this code is not set to YES. SCALE used for adjustment codes with the BASIC TYPE of payment (P) or refund (R). It defines the commission rate due for these adjustment codes. Section 4: Attorney Code The attorney codes are used within patient attorney records to indicate which attorney the record is referencing. Patient attorney records are only used within statements and reports. Other than these two areas, attorney records are for your reference only. The fields within the attorney code record are: CODE the identifying code for the record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. FIRM NAME contains the name of the law office. ADDRESS, CITY, ST, ZIP contains the mailing address for the attorney. CONTACT PERSON contains the individual to whom you should address your phone calls. PHONE NUMBER attorney s telephone number FAX NUMBER attorney s fax number ADDRESS attorney s address if available WEB ADDRESS attorney s web-site if available 9-3

109 NOTE (2) used to store any additional information Section 5: Bill Code The bill codes are used to indicate which statements are to be sent and are used by the patient and attorney records. These codes will allow you to set up a single letter to be sent on a recurring basis or you can send multiple letters in a series. You will also be able to change the letter series based upon payments on the patient s invoices. The fields within the bill code record are outlined below. It is important to remember that all the actions described take place during the nightly processing on the date contained in the patient s CYCLE field or the patient s BILL CODE s CYCLE field. CODE identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION description of the bill code. This should convey some idea of what this bill code s function is. IMMEDIATE STATEMENT checked to see if a letter is to be generated when adding new charges to a patient. If this field is set to NONE or left blank CFO will log a statement on the cycle defined in the bill code. If this field is set to a value of DAY OF CHG, CFO will prompt to log the letter contained in the LETTER field after a charge is entered. If this field is set to a value of NEW CYCLE CFO will change the BILL CYCLE field in the patient s record to be the nearest cycle. LETTER indicates what letter is to be sent for this code. This letter will only be requested if the PATIENT DUE AMOUNT for the patient meets or exceeds the greater of the MINIMUM PATIENT DUE within the client record and the MINIMUM PATIENT DUE in the bill code. CYCLE (4) define when and the number of times per month this bill code will be evaluated. If the patient BILL CYCLE field indicates a specific cycle, it overrides these fields behavior. THROUGH (3) determine the beginning of the patient last name that will be given the following cycle. These are used to spread the printing of the letters out throughout the month to avoid sending them all on the same day of the month. MINIMUM PAT DUE sets the minimum the patient must owe for the evaluation of this bill code to continue. If the patient owes less than this amount, CFO will set the new bill code to the BELOW MIN NEXT CODE field s value and execute the BELOW MIN ACTION. (The minimum patient due can be set client wide as the lowest possible value for bill code to be evaluated in the client record s MINIMUM PAT DUE field.) ALWAYS SEND LETTER set this to yes if you always want to log a statement regardless of the balance due. BELOW MIN NEXT CODE the next bill code that will be assigned if the patient owes less than the value contained in the MINIMUM PAT DUE field for this code. This code will replace the current code during the nightly processing, after the letter for this bill code has been requested. BELOW MIN ACTION the action that CFO will take if the patient owes less than the value contained in the MINIMUM PAT DUE field for this bill code. This action will be taken by CFO during the nightly processing after the letter for this bill code has been requested. 9-4

110 EXPECTED PAYMENT allows the specification of the greater or lesser of the AMOUNT and PERCENTAGE fields in determining whether the required payment was made by the patient. AMOUNT, PERCENTAGE allows the assigning of the required patient payment amount or percentage of the patient due at the time of the last statement. It is used in conjunction with the EXPECTED PAYMENT field.to determine whether an appropriate payment was made. IF PAID NEXT CODE if patient makes a payment that meets or exceeds the required payment amount, this bill code will be assigned during the nightly processing. IF PAID ACTION if the patient makes a payment that meets or exceeds the required payment amount, this action will be assigned during the nightly processing. NOT PAID NEXT CODE if the patient fails to make the required payment, this bill code will be assigned during the nightly processing. NOT PAID ACTION if the patient fails to make the required payment, this action will be taken during the nightly processing. MINIMUM DAYS TO WAIT this is the minimum number of days that must pass before a second or subsequent letters will be logged. Section 6: Charge Code The charge codes are used when you add new patient charges. These records contain vital insurance and descriptive information for the services that your patients will receive. Many of the charge code fields are pulled from the record s corresponding CPT code. The fields contained in the charge code are: CODE This is the identifying code for the record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. NOTE: It is a common practice to set this field to the CPT code that this record uses. NEXT CODE If this field is used, CFO will start you adding the charge code contained here. This can be used to help you remember to add associated charges on common procedures. Although you will be prompted to add this next code, CFO will not force you to do so and it can be aborted. HCPCS /CPT CODE This field must contain the CPT code you wish this charge to reference. Many of the following charge code fields get their initial value based upon the record you select here. DESCRIPTION When this charge code is used for new patient charges, this field will be the default description for that charge. This field s initial value comes from the CPT code used in this record. CHARGE AMOUNT This field is the amount normally charged for each unit of this service. Although this field will be the default, new patient charges amounts can be altered from this amount. TYPE OF SERVICE This field is used by the HCFA 1500 insurance form and should be accurate to insure proper payment from insurance companies. This field s initial value comes from the CPT code used in this record. 9-5

111 CLAIM LETTER This field tells CFO what type of insurance form, if any, should be generated when this charge code is used. This field s initial value comes from the CPT code used in this record. CLAIM ATTACHMENT LETTER (2) These fields determine what, if any, attachments are required for this charge code. FORCE PAPER This field will cause all insurance forms to print paper instead of going electronic when available. REVENUE CODE This field is required for the UB-92 insurance form. This field s initial value comes from the CPT code used in this record. LAB CHARGE This field is used on the HCFA 1500 insurance form to indicate that the charge includes inside or outside lab costs. PRINT DESC ON HCFA If this field is set to YES, the description contained in the patient charge for this charge code will print on all HCFA 1500 insurance forms. MODIFIER 1 This field can contain the first modifier for this charge code. If present, this value will default for the modifier field of new patient charges using this code. MODIFIER 2 This field can contain a second modifier for this charge code. If present, this value will default for the modifier field of new patient charges using this code. SEX REQUIREMENT If used, this field will verify that only patients of the appropriate sex are allowed to have this charge code added to their account. This field s initial value comes from the CPT code used in this record. AGE REQUIREMENT If used, this field will verify that only patients of the appropriate age are allowed to have this charge code added to their account. This field s initial value comes from the CPT code used in this record. VALID THROUGH If this field is populated, you will not be allowed to add this charge for services after this date. This field s initial value comes from the CPT code used in this record. ANESTH BASE UNITS This field is used for anesthesia charge codes to determine the proper cost. WORK CREDITS This field is used with the Work Credit batch module to show relative work credits earned by each provider. The value within this field is multiplied by the charge s quantity and summed up for each provider. This allows for practices to track the relative work done for their providers. Section 7: Client Invoice Status Code Libraries These codes are used to identify the status of the client invoices. These are for reference only and you should use them to help manage your client s bills. The basic codes are LATE, NEW, and PAID. Fields within the client invoice status codes are: CODE This is the identify code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. 9-6

112 DESCRIPTION This is description of the status code. This should convey some idea of what this status code s function is. FOLLOW-UP DAYS This field will define the number of days the client invoice FOLLOW-UP date is set ahead when this code is assigned to the client invoice. ALLOW DIFFERENT DAYS If this field is set to a value of NO, you will not be allowed to change the FOLLOW-UP date for the client invoice. The FOLLOW-UP date for the client invoice would be restricted to the value in the FOLLOW-UP DAYS field in this record. MAX FOLLOW-UP DAYS If you are allowed to alter the FOLLOW-UP date for the invoice, this is the maximum number of days ahead you will be allowed to assign. Section 8: Client Status Code Libraries This field is used to identify the status of the client record. It can be used to restrict reports based upon the client s status or as a flag indicating special requirements. The fields contained in the client status codes are: CODE This is the identifying code for this record. This field should convey to you some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This is description of the client status code. This should convey some idea of what this client status code s function is. FOLLOW-UP DAYS This field will define the number of days the client FOLLOW-UP date is set ahead when this code is assigned to the client. ALLOW DIFFERENT DAYS If this field is set to a value of NO, you will not be allowed to change the FOLLOW-UP date for the client. The FOLLOW-UP date for the client would be restricted to the value in the FOLLOW-UP DAYS field in this record. MAX FOLLOW-UP DAYS If you are allowed to alter the FOLLOW-UP date for the client, this is the maximum number of days ahead you will be allowed to assign. Section 9: Commission Scale Code Libraries The commission scale codes contain all of the valid commission rates allowed. These codes are used within the patient invoices records and the patient invoice adjustment records to determine the commission, if any, to be paid. The fields within the commission scale codes are as follows: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This field should briefly describe when this code should be used. COMMISSSION This is the commission percentage paid for this code. MIN PER INVOICE If filled in this determines the minimum commission to charge per invoice. 9-7

113 MAX PER INVOICE If filled in this defines the maximum commission to charge per invoice. Section 10: CPT Code Libraries The CPT code records give specific information regarding the CPT code that you are allowed to use within new charge code records. Each charge code will contain a specific CPT code and will get some of its information from this record. The fie lds contained within the CPT code records are as follows: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This field should contain the actual description to be printed on the insurance forms. The contents of this field are used as a default for charge codes that use this CPT code. TYPE OF SERVICE This field is used for the HCFA insurance forms and should be complete and accurate for all codes using this insurance form type. The contents of this field are used as a default for charge codes that use this CPT code. CLAIM LETTER This field will determine the type of insurance form that CFO generates for new patient charges that use this code. This field also defines the insurance form this charge is allowed to print on. The contents of this field are used as a default for charge codes that use this CPT code. CLAIM ATTACHMENT LETTER (2) These fields determine the default attachments that are required for this CPT code. The value here is copied into any charge code that used this CPT code. FORCE PAPER This field is used as the default for any charge codes that use this CPT code. If set to YES, the insurance forms will print to print paper instead of going electronic when available. REVENUE CODE This field is required for charge codes used in the UB-92 insurance form. The contents of this field are used as a default for charge codes that use this CPT code. SEX REQUIREMENT This field defines any patient sex restrictions for this CPT code. The contents of this field are used as a default for charge codes that use this CPT code. AGE REQUIREMENT This field defines any patient age restrictions for this CPT code. The contents of this field are used as a default for charge codes that use this CPT code. VALID THROUGH This field determines the latest date of service for which the CPT code is allowed. The contents of this field are used as a default for charge codes that use this CPT code. ANESTH BASE UNITS This field is used for anesthesia CPT codes to determine the proper cost. This value is used as the default for charge codes that use this CPT code. WORK CREDITS This field is used with the Work Credit batch module to show relative work credits earned by each provider. The value within this field is multiplied by the charge s quantity and summed up for each provider. This allows for practices to track the relative work done for their providers. This value is used as the default for any charge codes that use this CPT code. 9-8

114 Section 11: Provider Department Code Libraries The department codes allow for the providers to be separated into distinct groups for reporting purposes. Both the batch reports and the standard CFO reports dealing with providers will allow separation by provider department. The department codes contain the following fields: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This field should contain a brief, printable description of the department. Section 12: Patient Desk Code Libraries The patient desk code is designed to allow for the grouping of patients into desk assignments. The desk codes should define what user or group of users is responsible for the management or follow-up of the patient. The desk codes consist of the following fields: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This record is required to be present and unique for all records of this type. DESCRIPTION This field should contain a brief, printable description of the patient desk code. Section 13: Diagnosis Code Libraries The diagnosis codes are HCFA defined codes that define the diagnosis that lead to the services rendered. These codes are used within the patient charges and the charge code records. The fields contained within the diagnosis codes are as follows: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This field should contain a brief, printable description of the patient desk code. NOTE This field is reserved for any additional notation regarding this diagnosis. SPECIFIC This is set to yes if this is the most specific this diagnosis code can get. UPDATED This is the date this code was updated. EXPIRED This is the date this code is set to be expired. Section 14: Facility Location Code Libraries These codes will allow you to easily enter the physical location where services where rendered. These codes are used within patient invoice records and are used to fill out insurance forms as well as in reports. 9-9

115 The fields contained in the facility records are as follows: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This field should contain a brief, printable description of the patient desk code. ADDRESS, CITY, STATE, ZIP CODE These fields should contain the physical address of this facility. PHONE This field should contain a phone number to be used to contact this facility. PLACE OF SERVICE This field is used to complete insurance forms. It must contain the place of service code to be used for all treatment at this facility. BC/BS # This field must contain the Blue Cross/Blue Shield number assigned to this facility. MEDICARE # This field must contain the Medicare number assigned to this facility. MEDICAID # This field must contain the Medicaid number assigned to this facility. AUX FIELDS When used, these fields will override the client fields of the same name. For example, if the facility code contains a value for the AUX:CO NAME field, CFO will replace the client name field with this value for all insurance forms on invoices containing this facility code. Section 15: Fee Schedule Libraries The fee schedules are contracts that specify the reimbursement you can expect for specific insurance policies. There is a single fee schedule record for each unique contract. This fee schedule record has a list of records attached that describe the details of the contract. These records are called fee schedule provisions and they supply the actual reimbursement for each charge. Additional information on how the fee schedules work can be found in the Fee Schedules section of this manual. Fields contained within the fee schedule are as follows: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. GROUP # This field is used to reference the fee schedules group number. This field is only for user reference and is not used by CFO. TIMELY FILING This field should contain the number of days allowed for timely filing under the contract. FLOOR TIME This field should contain the number of days the payer has to pay clean claims. The contract will usually allow for some remedy if claim remain unpaid beyond this number of days. FEE SCHEDULE TYPE this is the behavior that CFO takes to implement the fee schedule. If this field is set to CHG ADJUST then an adjustment is added to subtract the difference. If this field is set to CHG AMOUNT the default amount is changed in the CHARGE record to the 9-10

116 agree rate. If this field is set to PRI ADJUST an adjustment is made when the primary pays. If set to INACTIVE the fee schedule is ignored. ADJUSTMENT TO ADD if the fee schedule type indicates that an adjustment needs to be added than this field is the adjustment to be added. Section 16: Fee Schedule Provisions The fee schedule provisions define the amounts to be paid for specific fee schedules. Each CPT code within a fee schedule can be set to a specific amount or to a percentage of another fee schedule. The fields used within fee schedule provisions are as follows: CPT FROM This field should contain the beginning range of the CPT codes included within this provision. CPT TO This field should contain the ending range for the CPT codes covered by this provision. If the CPT code in the CPT from field is the same as the CPT code in this field, this provision will apply only to the single CPT code. MODIFIER If this field is used, this provision will only apply to patient charges that contain this modifier as the FIRST patient charge modifier. DATE FROM This date determines the earliest date of service to which this provision will apply. If patient charges using CPT codes within this provision s range are performed for dates of service prior to this date, they WILL NOT be bound by this provision. DATE TO This date determines the latest date of service to which this provision will apply. If patient charges are performed for dates of service after this date, they WILL NOT be bound by this provision. AMOUNT This field will determine the cost to be charged and billed for patient charges falling within this provision s restrictions. This fie ld can be set to contain a dollar amount or a percentage. The field automatically defaults to a dollar amount and can be forced to a percentage by entering the % character following the number. OF FEE SCHEDULE This is the fee schedule CFO will use to set the patient charge cost, if a percentage is used in the AMOUNT field. If no fee schedule is entered here, the amount charged would be the percentage of the default cost contained in the charge code. STATE ID If the area of billing contains more than one billing area than using the state id fields always different rates for different areas. Section 17: Financial Class Libraries The financial class is an indication of the patient s financial responsibility. This field can be used within reports or work queues to help manage your patient accounts and follow-up. The fields for the financial class records are as follows: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. 9-11

117 DECRIPTION This field should contain a brief, printable description of the financial class. Section 18: History Code Libraries The history codes allow you the opportunity to split your history remarks into manageable groups. By creating a code for each of the history entries, you avoid the need for lengthy history notations. Each history code has the added functionality for charging a fixed cost for each occurrence of the code. The fields contained within the history code records are as follows: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This field should contain a brief, printable description of the history code. This is the description you will see when choosing a history code. PRINT AS This field should contain a brief, printable description of the history code. This field will print on the batch reports in place of the DESCRIPTION field. RESTRICTED TO FILE This field will allow you to restrict what type of record is allowed to use this history code. ATTACHMENTS ALLOWED This field allows you to specify whether attachments (scanned documents or files) can be attached to the history. ATTACHMENT TYPE If ATTACHMENTS ALLOWED is set to ALLOWED or REQUIRED than this field specifies whether the attachment is a scanned document or a file. ATTACHMENT VERSIONS This field determines how many versions of a document of which CFO keeps track. If this is set to 0 or blank CFO will keep track of all versions. MANAGEMENT ONLY When set to YES only management security profiles can view any attachments. ALLOW DELETION There are three settings for this field. ALWAYS allows deletion of any the history code, NEVER keeps the history from being deleted, and OPEN which only allows deletion of history in open batches. ALLOW MANUAL ADDITION If set to NO this code can only be added by an action and not by a user adding it manually. Section 19: Insurance Company Code Libraries The insurance company codes are the records that contain the detail information about the insurance companies you deal with. These records are vital and are used throughout CFO for reporting, insurance form filing, work queues, and many other areas. Access to these records is strictly controlled and all users may not have access to alter this data. The fields contained within the insurance company codes are as follows: 9-12

118 CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. COMPANY NAME This field should contain the name of the insurance company. This field is required by CFO and you will not be allowed to leave it blank. ADDRESS, CITY, STATE, ZIP These fields should contain the insurance company s mailing address. These fields are vital to insurance form filing and should always be as complete and accurate as possible. PHONE (2) These fields are for user reference and can contain any phone numbers used to reach the insurance company. CONTACT (2) The contact fields are used as reference to store any contact person s name. NOTE (2) The note fields can be used to store any additional information about this insurance company. DEFAULT CLAIM DESTINATION This is the default method of claim filing for this insurance company. This destination will override any destination contained within the insurance claim form. For additional information on insurance claims, refer to the Letters and Insurance Forms section later in this manual. CLAIM FORM EXCEPTION, FORM, DESTINATION (2) These fields can contain any claim form that needs to be redirected to a destination other than the one contained in the default claim destination field. If used, this will cause this insurance form to be sent to the corresponding destination. MEDIGAP # - For electronic claims only. When filing a claim to the primary and the secondary has a medigap # then it is filled in on the primaries claim. CLEARINGHOUSE # (PROF.), CLEARINGHOUSE # (INST.), CLEARINGHOUSE # (DENT.) These fields are used by claim clearinghouses to identify insurance companies. Refer to the Electronic Submission section of this manual for detailed instructions according to clearinghouse INSURANCE TYPE This field is used to help complete the insurance forms, including determination of the provider numbers to include. CONTACT ONLY If this field is set to YES, the insurance record will only be allowed as an insurance contact. This means that no insurance claims will be sent to this insurance company. ACCEPT ASSIGNMENT This field is used as the default value for new patient insurance policies using this insurance company. This default can be overridden within the patient insurance record. CLAIM FORM DESCRIPTION TYPE There are three settings for this field. The NO PRINT setting means that no description is printed, the NORMAL setting uses the charge code to determine whether or not a description is printed, and the PRINT setting always prints the description. EXCEPTION PROFILE If this field is filled in this is the charge exception profile to use for the insurance company. DEFAULT FINANCIAL CLASS For custom imports only. This field can override the logic for setting the patient s financial class for this insurance. 9-13

119 CAP: ACTIVE YES or NO depending on whether or not capitation is active for this insurance company. It is a default value when entering a patient insurance. CAP: FACILITY, CAP: PROVIDER, CAP: REF PROVIDER - When posting payments with the Capitation Utility these fields determine the fields named in the added invoice. CAP: ADJUSTMENT TYPE This is the adjustment type to post on the new invoice when using the Capitation Utility. CAP: CHARGE CODE This is the charge code added to the new invoice when using the Capitation Utility. Section 20: Insurance Contact Codes Some insurance companies may pay claims yet take no phone calls regarding their policies. These calls must be directed to companies hired to handle claim and policy issues. Within CFO, these companies are called insurance contacts. A given insurance company can have any number of insurance contacts. These are available for the users to choose from within the patient insurance policy record. The field contained within the insurance contact code is: INSURANCE CODE This field must contain a valid insurance company code. Section 21: Insurance Type Codes Each insurance company record has a TYPE field. The value for this field will determine some of the default behavior for billing that insurance company. The insurance type codes that ship with CFO will handle most of your billing needs, but you will still need to be familiar with the effect this field will have on your insurance carriers bills. The fields contained within the insurance type code record are: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This field should indicate the type of insurance company that should be assigned to this code. HCFA SHOW PRIOR INS PAYMENT If set to NO, this field will force Box 28 (Total Charge) of the HCFA 1500 to always print HCFA 1500 FIELD 1 TYPE This field will allow you to select the type of insurance that will be indicated in Box 1 of the HCFA HCFA FORCE PATIENT RELATION This field will force Box 6 (Patient Relationship To Insured) of the HCFA 1500 to always be this value. This should only be used in very specific cases, as this could cause all of your 1500 claims to be rejected. HCFA INSURED S POLICY DEFAULT This field can be used to force a default value into Box 11 (Group) of the HCFA Anything entered here will be placed directly in the HCFA 1500 for this insurance company. 9-14

120 HCFA SHOW SECONDARY INDICATION If set to YES, this field will cause the word SECONDARY to print in Box 9a (Other Insured Policy) of the HCFA HCFA 11d ANOTHER BENEFIT PLAN If used, this field will force the value of Box 11d (Another Health Benefit Plan) of the HCFA 1500 to either YES, NO, or BLANK. In addition, you have the option AFTER, which will populate 11d with YES if the patient has subsequent insurance coverage and the option OTHER, which will populate 11d if the patient has any other insurance coverage. HCFA DIAGNOSIS STYLE This field will allow for the selection of the style required by this insurance company for the reporting of diagnosis codes on the HCFA REFER ALL will cause the HCFA 1500 to print the reference number in Box 24e for each of the diagnosis codes listed in Box 21 that are associated with each charge listed on the form. REFER 1 will cause only the primary diagnosis code s Box 21 reference number to print in Box 24e for the charge. ACTUAL will cause the actual diagnosis code to print in Box 24e for each charge. The most commonly accepted style is REFER ALL. HCFA FORCE ACCEPT ASSIGNMENT This field can be used to override any setting for Box 27 (Accept Assignment) of the HCFA If set to YES or NO, this value will always be set for HCFA 1500s going to this insurance type. HCFA 9A NONE INDICATION This field can be set to NONE, which will display NONE when there is no subsequent insurance coverage or BLANK, which will leave field 9a blank if there is no subsequent insurance coverage. The following fields change the default behavior of the HCFA 1500 or the UB92, and should set the with the advise of BillWorx Support. FORCE HCFA 1500 FIELD 11 FORCE ABOVE ONLY IF PRIMARY 4 CHAR UB92 REV CODES PREPEND TO 1500 FIELD 10D STRING TO PREPEND TO 10D LEAVE 1500 FIELD 14 BLANK LEAVE 1500 FIELD 31 BLANK EMG INDICATOR FOR POS=23 NEW HCFA FIELD 11 EXCEPTION LEAVE 1500 FIELD 18 BLANK DEFAULT FINANCIAL CLASS HCFA A SAME AS 1A HCFA SAME AS 33 HCFA 1500 FLD 22 DEF ST LIC IN 33PIN (ELEC) 9-15

121 Section 22: Invoice Insurance Status Code Libraries The invoice insurance status codes are used to describe the last activity on the patient invoice as it relates to the specific patient policy. The values allowed for these fields are NONE, PENDING, RE-FILED, PAID, DISPUTED, and DENIED. You will not be allowed to directly edit or set these fields at any time. However, you will be able to define new insurance status codes that can be assigned when patient responsibility records are added. CFO will also update this field based on your actions for each invoice when appropriate. Section 23: Patient Invoice Status Code Libraries There are two basic status code types that should be used. The first will tell you what action has just been completed on an invoice, such as the filing of an insurance claim. This usually means that some period of time must elapse before any follow-up action should be taken on the invoice. The second type of status code is an indicator of what action needs to be taken on the invoice. This type of code means that the follow-up action is known due to a response from another party, such as an insurance company paying their portion of the invoice. The patient invoice status codes are used to manage patient invoices both in the CFO reports as well as the work queues. For this reason, they should be maintained at all times and given the most accurate and complete values possible. By keeping your patient invoice status codes up-to-date, you will make your patient follow-up that more effective and productive. The fields contained in the patient invoice codes are: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This field should tell you what the code means about the patient invoice. FOLLOW-UP DAYS This field will define the number of days the patient invoice FOLLOW- UP date is set ahead when this code is assigned to the patient s invoice. ALLOW DIFFERENT DAYS If this field is set to a value of NO, you will not be allowed to change the FOLLOW-UP date for the patient invoice. The FOLLOW-UP date for that patient invoice would be restricted to the value in the FOLLOW-UP DAYS field in this record. MAX FOLLOW-UP DAYS If you are allowed to alter the FOLLOW-UP date for the patient invoice, this is the maximum number of days ahead you will be allowed to assign. Section 24: Allowed Letter Code Libraries The allowed letter codes give you the option of selecting what letters can be sent from within each client database. Any letters not set up within the allowed letter codes will not show up in any lists of available letters. This restriction includes the insurance forms all BillWorx supplied letters and any customized letters. Additional information regarding letters can be found in the Letters and Insurance Forms section of this manual. Section 25: Printer Forms Code Libraries 9-16

122 The printer paper codes determine the type of paper your letters can be printed on. Each of your printed letters is assigned a paper type that they need to be. These codes make up the list of valid paper types. Additional detail regarding letters can be found in the Letters and Insurance Forms section of this manual. The fields used in the printer paper codes are as follows: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This field should contain a brief, printable description of the paper type. PRINT PLAIN TEXT If this field is set to NO, CFO will assume the paper is a pre-printed form and will print only field values. This means that all heading and non-imported information will be suppressed. This field should be set to YES, unless the letter is using a pre-printed form. Section 26: Letter Code Libraries The letter codes hold the information necessary for each available letter within CFO. Each letter code defines what is required to produce the letter. These are the codes that must be chosen within the allowed letter records to allow the letter to be requested for a given client. Additional detail regarding letters can be found in the Letters and Insurance Forms section of this manual. Section 27: Patient Status Code Libraries As with the other status code types, patient status codes should be used to indicate the action that has just been taken, or what action needs to be taken. Patient status codes can be used to better manage your patients both through reports and work queues. Keeping these codes accurate and complete is vital to your successful follow-up. The fields of the patient status code are: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This field should tell you what the code means about the patient. FOLLOW-UP DAYS This field will define the number of days the patient FOLLOW-UP date is set ahead when this code is assigned to the patient. ALLOW DIFFERENT DAYS If this field is set to a value of NO, you will not be allowed to change the FOLLOW-UP date for the patient. The FOLLOW-UP date for the patient would be restricted to the value in the FOLLOW-UP DAYS field in this record. MAX FOLLOW-UP DAYS If you are allowed to alter the FOLLOW-UP date for the patient, this is the maximum number of days ahead you will be allowed to assign. Section 28: Payment Code Libraries The payment codes allow you to separate your payments into groupings. You can create as many payment types as you need as they are mainly for your internal usage. These payment codes are only used by CFO 9-17

123 within the batch report s most detailed summary. Additional details regarding the batch report are available within the Reconciling Charges and Adjustments section of this manual. Fields contained within the payments codes are as follows: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This field should contain a brief, printable description of the payment code. This is the description that will appear on the batch report. Section 29: Payment Location Code Libraries The payment location records describe the companies or facilities that are authorized and/or paid to accept and process payments. These can include client sites, billing service sites, and collection agencies. Each record contains detailed information about the location and is vital in order for CFO to track where all funds are at any given time. The fields contained within the payment location codes are as follows: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. TYPE This field determines the basic type of payment location. The basic types are: Billing Service, Client, and Collection Agency. NAME This field should contain the name of the payment location. ADDRESS, CITY, STATE, ZIP CODE These fields should contain the billing address for the payment location. PHONE (2) These fields can be used to hold any contact phone numbers for the payment site. FAX This field should contain the facsimile number for the payment location. This field can be used for any address for the payment location. ACTIVE This field indicates whether this payment location is still an active site. If there is no activity from this site and this field is set to NO, this payment location will not appear on the batch report. COLLECTION REDUCES AR If this payment location is a collection agency, this field determines the action of collection write-offs to patient invoices. If this field is set to YES, a collection write-off will cause the invoice balance and the client accounts receivable to be reduced. AGENCY COMMISSION For payment locations whose type is Collection Agency, this field should contain the collection agency s commission rate. TRACKING COMMISSION This field is only valid for payment locations whose type is Collection Agency. This field should contain any commission that the billing service charges for tracking payments on collection accounts. 9-18

124 CLIENT PAYS AGENCY This field is only valid for payment locations whose type is Collection Agency. This field determines whether commissions due the collection agency are paid by the billing service or the client. If this field is set to YES, no commissions due the collections agency are withheld from the billing service. 100% REMIT This field is only valid for payment locations whose type is Collection Agency. This field indicates whether the agency is required to remit all monies received and bill for their commissions. RECALL INVOICE STATUS This field is only valid for payment locations whose type is collection agency. This is the patient invoice status that will be assigned to invoices being recalled from this collection agency. Section 30: Provider Code Libraries The provider code records contain all the information needed to contact and bill for the providers. These records also contain attachments that define some of the behavior within the HCFA-1500 utility. The data contained within the provider records is vital and is used throughout CFO. The provider codes can be accessed through the Transaction Library Menu from within the Coded Library Menu. The fields contained within the provider records are as follows: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. TYPE This field defines whether this provider code used to bill charges is to be restricted to a referring physician only. DEPARTMENT This field determines the provider s department. This field is used within the batch report to break out services by department. The provider s department is also pulled into all invoices that contain this provider code. This will allow for reporting and word queues based upon department. LAST NAME, FIRST NAME, MIDDLE NAME, SUFFIX These fields must contain the provider s full name. These fields are used throughout CFO and should be as accurate and complete as possible. CONTACT This field can be used to specify a contact at this provider s office. ADDRESS, CITY, STATE, ZIP CODE These fields should contain the full mailing address for this provider. PHONE, FAX, These fields can be used to store additional contact information for this provider. UPIN #, TAXONOMY CODE These fields are used to store the identified numbers for the provider. NOTE (4) Used to store other information about the provider. ANESTH UNIT CHARGE The provider s rate for a unit of anesthesia. MINUTES INCLUDED This is the number of minutes that the provider takes into account in the base charge. 9-19

125 MINUTES PER UNIT, MINIMUM PER UNIT, MINUTES MAX In most cases only the first field MINUTES PER UNIT needs to be filled in with 15, since Medicare treats every 15 minutes as a unit. For more complicated anesthesia billing please contact BillWorx Support. SPECIALTY CODE For Medicaid claims filed electronically this indicates the doctor s specialty. ST LICENSE # - This number is required by some clearinghouses. Section 31: Provider Insurance Number Libraries The provider insurance numbers allow you to alter the behavior of the HCFA-1500 based upon the type of insurance being filed. The HCFA-1500 utility will lookup the provider s insurance numbers based upon the insurance type and the state fields of the insurance carrier. A provider must have an insurance number record to use with the HCFA The insurance number record to use is determined by trying to match some of the insurance carrier s fields against the provider s insurance number records. The match is made in the following order: INSURANCE TYPE and STATE, INSURANCE TYPE only, and then STATE only. If none of these are found, the insurance number record with a blank TYPE and a blank STATE will be used. If this blank record is not found, the HCFA-1500 will be rejected and placed into the error report. The provider insurance numbers can be accessed through the Insurance Library Menu, from within the Coded Library Menu. The fields contained within the provider records are as follows: INSURANCE TYPE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. A blank INSURANCE TYPE should be set up to handle the default insurance form behavior. INSURANCE STATE If used, this field can force the behavior of the HCFA to vary by state for the same type of insurance carrier. For example, if Medicaid of Florida requires a different provider number to appear within Box 33-PIN, you can set up another Medicaid insurance number record for the state of Florida. Within this new record, you would simply change the value within 1500 FIELD 33-PIN# to reflect this requirement FIELD 24-K This field can force the value that you want to print within Box 24-K of the HCFA-1500 insurance form FIELD 33-PIN# This field can force the value that you want to print within Box 33-PIN of the HCFA-1500 insurance form FIELD 33-GRP# This field can force the value that you want to print within Box 33-GRP of the HCFA-1500 insurance form FIELD 24-K (WC) This field can force the value that you want to print within Box 24-K of the HCFA-1500 insurance form for worker s compensation claims. The claim is considered worker s compensation if there is a patient accident record covering the dates of service for the invoice. 9-20

126 1500 FIELD 33 PIN# (WC) This field can force the value that you want to print within Box 99- PIN of the HCFA-1500 insurance form for worker s compensation claims. The claim is considered worker s compensation if there is a patient accident record covering the dates of service for the invoice FIELD 33-GRP# (WC) This field can force the value that you want to print within Box 33- GRP of the HCFA-1500 insurance form for worker s compensation claims. The claim is considered worker s compensation if there is a patient accident record covering the dates of service for the invoice FIELD 17A (REF) This field can force the value that you want to print within Box 17a of the HCFA-1500 insurance form. This value is only used when this provider is a referring physician FIELD 19 (LFT) This field can force the value that you want to print within Box 19 of the HCFA-1500 insurance form. This value will be left justified within Box 19 followed by any values within the invoice s INSURANCE NOTE field and ending with any value contained within the 1500 FIELD 19 (RGT) field FIELD 19 (RGT) This field can force the value that you want to print within Box 19 of the HCFA-1500 insurance form. This value will be right justified within Box 19 preceded by any values within the 1500 FIELD 19 (LFT) field and the invoice s INSURANCE NOTE field FIELD 23 (SUB) This field can force the value that you want to print within Box 23 of the HCFA-1500 insurance form for substitute provider (Locum Tenens) billing FIELD 23 (LAB/CLIA) This field can force the value that you want to print within Box 23 of the HCFA-1500 insurance form for laboratory charges. UB92 PHYSICIAN ID The physician ID for the UB92. ADA FIELD 18 SSN OR TIN Used for field 18 of the ADA dental form. ADA FIELD 19 LIC # - Used for field 19 of the ADA dental form. ADA SIGNATURE PR Used for license number on the signature line of the ADA dental form FIELD 31 (EXTRA) This allows for data specific to a payer to be inserted into the upper right corner of the signature of physician fie ld. This is uncommon. SPECIALTY CODE The specialty code is required for some clearinghouses. Section 32: Responsibility Code Libraries The patient responsibility codes are used within the patient responsibility records to define the type or the reason for the responsibility transfer. The transfer of responsibility is from the patient s insurance policies to the guarantor and these codes can define almost any type of transfer. Examples of responsibility transfers are the patient co-pay and the patient deductible. The fields contained within the patient responsibility codes are as follows: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. 9-21

127 DESCRIPTION This field should contain a brief and printable description of the responsibility code. ADD VALUE? This field can be used to reverse the effects of patient responsibilities that were generated due to fee schedules. However, most normal responsibility codes should have a value of YES. AMOUNT This field determines the default amount to be used with this responsibility code. This field can be modified within the patient responsibility record only if the allow change field is set to YES. ALLOW CHANGE? This field can be used to protect the amount listed in the AMOUNT field of this responsibility. If this value is set to NO, no user will be allowed to alter the amount for this patient responsibility code. NEW INSURANCE STATUS This field can be used to set the insurance s status to a new code when the responsibility is added. Section 33: Write-Off Code Libraries The write-off codes are used within patient adjustments to specify the type of patient write-off. These codes are used for reporting and can also be displayed within your letters. The fields of the write-off codes are as follows: CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This field should convey exactly what this write-off code means. This is the field that will print on reports and other output for this write-off code. TYPE This field is used to determine the basic type of the write-off code. There are 5 types: administrative, bad debt, contractual, indigent, and other. Section 34: Zip-Code Libraries The zip code records are used to auto-fill the city and state fields for records that contain addresses. If the zip code you enter is not found within the library, the city and state fields will not be auto-filled. The fields of the zip code records are as follows: ZIP CODE This is the identifying code for this record. This field is required to be present and unique for all records of this type. CITY This field must contain the city for this zip code. This field is required. STATE This field must contain the state for this zip code. This field is required. AREA CODE This optional field can contain the area code for this zip code. This area code will be defaulted for all phone number fields for this record. COUNTY This optional field can contain the count of this zip code. 9-22

128 9-23 STATE ID This field determines in which Medicare area a zip code belongs.

129

130 Chapter 10: Client Redirection This section contains: Understanding Coded Library Redirection Adding and Changing Redirection 10-1

131 Section 1: Coded Library Redirection The redirection options within CFO will allow you to set up a master library of codes to be used from within any number of client databases. This will centralize updates, reduce errors, and help to eliminate redundancy. The redirections are set within each client record and are specific to each of the coded libraries. This means that a client can use the same or a different source database for each of its coded libraries. CFO has several automatic redirections that cannot be changed by the users. All coded library entries that are placed into both your master client (client code BILL ) and CFO s master client (client code SYS ) are available from within all other client databases. This means that adding coded records to your master client will cause them to override any coded record of the same name (or code) that currently exists within any client databases. For this reason coded records should be added into your master client with caution. Coded records that are contained within the CFO master client are required for normal system operation and cannot be duplicated or altered under any circumstance. In addition to the system-required coded records CFO contains several comprehensive lists of coded records that can be used for any client. These libraries are listed below and can be found within the CFO client REFERENCE LISTS ; whose client code is ZREF. Section 2: Adding and Editing Redirection Settings Adding and editing of the redirections is done from within the client records. The client records are located in the Client Lookup option in the Client Maintenance Menu, under the Main Menu. This is a listing of all available client records. Choose the client you wish to redirect and a window will open displaying the client fields. The fields to alter are contained on the third page of the client record. You can see next page by pressing the Page Down key. Enter the field number you want to alter and enter the client code for the client whose database you wish to use for the coded library. Remember that pressing the F1 function key will show you a listing of all available clients. After completing the changes to the redirections, save the client record. After the record has been changed and saved, the new redirections will take affect for all new users immediately. 10-2

132 Chapter 11: Using Collection Agencies This section covers: Adding New Collection Agencies Turning & Recalling Accounts Receiving Payments Tracking Collection Receivables Import & Export Functions 11-1

133 Section 1: Adding New Collection Agencies Sending unpaid and past-due accounts for collections is a vital part of protecting and recovering receivables. There are several steps to this process, all of which are outlined here. These include: Adding the New Agency, Assigning/Recalling Accounts, Receiving Payments, Tracking Your Receivables, and Electronic Import/Export options. Once you have found the collection agency to which you wish to turn accounts, you must set up the collection agency on CFO. In addition to setting up the collection agency, folders must be set up for the account to go into once they are turned over to collections. The collection agency may then pick up the files from this folder. To begin adding the new collection agency, you must add a new payment location of type X. To do this, from the Main Menu, enter the Coded Library Menu and pick the Transaction Library Menu. From within this menu select the option for Payment Location Codes. This option will open a window showing all available payment locations allowed for this client. The new agency can be added or the existing list of locations can be edited using the standard record selection options. Complete your new payment location remembering to select a value of X for the payment location TYPE field. The other payment location fields and their descriptions are outlined within the Coded Libraries section of this manual. Section 2: Turning and Recalling Accounts Turning accounts to a professional collection service is vital to the recovery of your past-due receivables. However, this will not be worthwhile if your accounts are not placed for collections in a timely manner. Remember that the longer you wait to send unpaid accounts for collections the less collectable they become. To manually send any invoice to collections you need only open the invoice in an edit window and type the COLLECT blind option. To be turned over for collections, the invoice must have a positive balance due and cannot be currently turned over to collections. After entering the COLLECT blind option, you will be prompted for the collection agency to send the invoice to and asked to verify your choice. After completing this, the invoice will now be sent to collections. All new accounts going to collections are also placed into the collections output file. This file can be sent to your collection agency to allow them the option of electronically uploading the accounts into their collection system. Agencies that you are dealing with on a manual basis will need to be given the section of the batch report that deals with collection accounts. Invoices sent for collections in error can be recalled from collections by opening the invoice in an edit window and entering the RECALL blind option. This option will ask you to verify that you want to recall the account from collections before doing so. Recalling an invoice from collections will add an entry into the collection output file to inform your collection agency. Agencies that you are dealing with on a manual basis will need to be given the section of the batch report that deals with collection accounts. Invoices that are recalled from collections can get normal adjustments posted against them, as though they were never in collections. Section 3: Receiving Collection Payments The receipt of payments and other adjustments on collection invoices is simple to handle. You need only use the special adjustment codes that are allowed within the normal adjustment procedure. These can be seen by pressing the F1 function key when you are prompted to select one. 11-2

134 Invoices that are currently in collections are restricted from having normal adjustment types added to them. When adjustments are added, only the collection-type adjustment codes will appear as options. This will keep you from accidentally adding a non-collection adjustment to a collection invoice. All adjustments added to invoices currently in collection will also cause the collections output file to be updated with the adjustment. This file can be used to transmit the adjustments to the collection agency electronically. For more detail on this process refer to the Import and Export section of this manual. Agencies that you are dealing with on a manual basis will need to be given the section of the batch report that deals with collection accounts. Section 4: Tracking Collection Agency Receivables Tracking the activity of your collection agencies is vital in helping to ensure that your receivables are getting the attention they need. CFO offers several reports that can be run to show the activity of your agencies. The reports that can be used include the Collections optional batch section and the Collection Agency report. These are outlined in detail within the Reconciling Charges and Adjustments and Reports sections of this manual. Section 5: Import and Export Options As mentioned throughout this chapter, all activity on collection invoices is tracked and placed into collections export files. These files can be sent to your collection agency or agencies for use in automating their placement process. The setup for this export varies based upon the collection software in use by your collection service. Using a professional collection service that operates on a supported collection package can save you time and expense. Each of the supported collection packages is fully setup to receive imports from CFO, including new business, recalls, local and direct payments, local and direct payment reversals, and non-payment adjustments. A list of supported Collection packages is available from BillWorx Medical Billing Systems support. 11-3

135

136 Chapter 12: Field Defaults This section covers Understanding the Defaults Adding New Defaults 12-1

137 Section 1: Understanding the Defaults The defaults are designed to help you save time and avoid errors. They will allow you to pre-set the value for a field, force a field to always be filled in, force a field to always be left blank and more. Each default is client specific unless it is set up in the BILL client. There are many examples of defaults that are maintained by CFO and cannot be altered. An example is forcing the guarantor s name to be completed. If this default did not exist, you would be able to add a guarantor without a LAST NAME. In this same way you will be able to add defaults to CFO to enforce your own unique rules. An exa mple of the more advanced default is the patient s FOLLOW-UP DATE. This field is computed by CFO using the patient s STATUS CODE field. The default tells CFO to look up the patient s STATUS CODE and pull out the value for the FOLLOW-UP DAYS field. This value is used to calculate the patient s own FOLLOW-UP DATE field. In addition, if you attempt to edit the patient s FOLLOW-UP DATE field, you will only succeed if the patient status, ALLOW DIFFERENT DAYS field is set to a value of YES. Section 2: Adding New Defaults The easiest way to add a new default or to edit an existing one is to pull up a record that contains the field to which you wish to add the default. Once within this record, you can press the Shift+F10 function key to get a list of the fields to which you can add defaults. Simply choose the field you wish to work on, and you will be placed into a window containing that field s default template. The fields contained within the field defaults are as follows: FIELD This field contains the description of the field that this default will affect. ACTION (15) These fields contain the action that CFO will take for the given field. The default will only take its action when the field is being added or edited. Therefore, if another field within the record or any other record contains a default action that refers to a field you are editing, the other field will not be re-evaluated. For example, if you are adding a new patient that has the same first, middle and last name as its guarantor record, CFO will lookup the guarantor s SSN field and place the same value into the patient s SSN field. If you later alter the guarantor s SSN field, CFO will not update the patient s SSN field. You should also be aware that any CFO defaults that exist will be enforced first and may conflict with any client default you add. In addition to this, any defaults that are defined in the client you are working in will be used, instead of the defaults in the BILL client. 12-2

138 Chapter 13: Fee Schedules This section covers: An Overview on Fee Schedules Creating a New Fee Schedule Creating New Fee Schedule Provisions Changing Insurance Policies 13-1

139 Section 1: Understanding Fee Schedules Fee schedules are contracts or agreements between your company and the insurance companies detailing what rates will be paid for specific procedures. Each fee schedule can have any number of provisions that itemize the exact amounts to be paid for each type of charge added. The fee schedule fields and their descriptions can be found within the Coded Libraries section of this manual. Section 2: Creating New Fee Schedules To create a new fee schedule you need to have access to and enter the Insurance Library Menu. This menu can be found from the Main Menu within the Coded Library Menu. Once within the Insurance Library Menu, select the Fee Schedules option, and a selection window for all available fee schedules will open. The only consideration to make when adding a new fee schedule is whether to add it for all clients or to a specific client only. The advantage to adding the new fee schedule to all clients is that you will have access to it from within all future clients. The only disadvantage would be if you have too many fee schedules to choose from within each client. Once you have decided where to add the new fee schedule and logged in appropriately, select the ADD option and fill out the blank fee schedule template. Section 3: Creating New Fee Schedule Provisions The fee schedule provisions are the items that determine the contracted or expected reimbursement for your procedures. These records are simple to add, but the consequences are worth taking a minute to understand. For each provision added, the charge code or range of codes within it will be maintained by CFO for all patients whose primary policy uses that fee schedule. Each time a charge is added for these patients the amount charged will be determined by the provision record instead of the charge record. If the charge code being added is not found within the fee schedule then the usual amount will be charged. New provisions can be added from within the Insurance Library Menu. This menu can be found from the Main Menu within the Coded Library Menu. Once within the Insurance Library Menu, select the Fee Schedule Provisions option and a selection window for all available fee schedules will open, allowing you to choose the fee schedule to work with. After you have selected the fee schedule you want to work with, you will be placed into a window displaying the provisions it contains. These can be opened and edited by using the standard options. The fields contained within the policy provisions and their descriptions can be found within the Coded Libraries section of this manual. Section 4: Changing Insurance Policies Making changes to patient policies can have severe and irreversible consequences on that patient s invoices. If a patient policy is changed to remove or to include a fee schedule, CFO will not recalculate the amounts due for each of the patient s invoices that occurred within the policies effective dates. 13-2

140 Chapter 14: Reports This section covers the following items and reports: Report Archives Actuary Charge Usage Diagnosis Insurance Review Patient Listing Provider Charges Request for Review 14-1

141 Section 1: Report Archives Most reports executed within CFO are saved in the archives. This will allow you to retrieve and re-print or review any report that has been run. The archives can be accessed from within the System Archives from the Main Menu. Choose the Reports option and you will be placed into a window displaying all of the available reports. Choose the type of report you wish to review and you will be placed into a new window showing all available archives. After selecting the archived report you want to review, CFO will prompt you for the printer you wish to use. At this point you can select a printer to get a hard copy of the report. You can also send it to your screen for review without printing. For additional information on your printing and editing options refer to the Using Printers section of this manual. Section 2: Actuary This report will show all of the activity that has occurred on charges that fall within a given service date range. The activity, such as payments and write-offs, can be of any date so long as they apply to charges that fall within the defined service date range. This report has the following options: INVOICE DATE OF SERVICE RANGE TO INCLUDE INVOICE FACILITY RESTRICTION ALLOWED PROVIDER RESTRICTION ALLOWED REFERRING PHYSICIAN RESTRICTION ALLOWED Section 3: Charge Usage This report will count and total the charged amounts for each included charge code. This can be used to help your providers to manage their staff and schedule by showing the number and cost of their procedures. This report has the following options: SERVICE DATE RANGE TO INCLUDE CHARGE CODE RESTRICTION ALLOWED Section 4: Diagnosis This report will show the diagnoses used within a user specified date range. It can also be restricted to only show the most used diagnoses within the range specified. The number of the most used diagnoses to show is also user specified. This report has the following options: INCLUDE CURRENT, GROUP, OR ALL CLIENTS RESTRICT LISTED DIAGNOSES TO DATE OF SERVICE RANGE 14-2

142 RESTRICT QUALIFIERS TO SPECIFIC PROVIDER INVOICES SHOW USER SELECTED NUMBER OF MOST USED DIAGNOSES Section 5: Patient Listing Patient listing reports can be generated using the patient lookup utility. This can be accessed from the Patient Selection option within Patient Maintenance Menu or by pressing the F8 function key. Once within the patient selection area you can use the Sort and Range options to restrict the patient list. These options will allow you to generate an almost limitless number of patient listing reports. Once you have the list restricted appropriately, use the Print option to print it. Section 6: Provider Charges This report can be used to detail the charges and charge codes billed by specific or all providers. This report has the following options: PROVIDER RESTRICTION ALLOWED ADJUSTMENT AND CHARGE DATE RESTRICTION ALLOWED CHARGE CODE RESTRICTION ALLOWED Section 7: Request for Review This report generates a listing of past due patient invoices grouped by the patient s insurance company. This list can then be printed for manual insurance follow-up. It is important to note that the follow-up queues will allow for similar types of follow-up online. Details for using the follow-up queues can be found in the Follow-Up Queues chapter of this manual. This report has the following options: RESTRICT TO PRIMARY/SECONDARY/TERTIARY POLICIES ONLY RESTRICT TO SPECIFIC INSURANCE COMPANY OR LIST OF COMPANIES RESTRCIT BASED ON PAST DUE AGING BY INVOICE OR BY DATE BILLED RESTRICT BASED ON INVOICE AMOUNT DUE FROM INSURANCE COMPANY The report will include contact information for each insurance company as well as for each patient that his included within the report. The patient invoices are grouped alphabetically by patient name within insurance company. 14-3

143

144 Chapter 15: Report Writer This section covers: Overview of the Report Writer Output Options Qualification Options Running Reports Taking Actions In Reports Using Multiple Record Selection 15-1

145 Section 1: Understanding the Report Writer The Report Writer will allow you to create customized reports that include the guarantors, patients, invoices, charges, adjustments or several other CFO records that you want, and to display the fields that are significant to you. You will be able to create, name, and save as many reports as you like. Each of the reports can be as detailed or as general as you like. Any field included in your printout can be counted, totaled, or used to sub-total the report. Each time one of your custom reports is run, the output can also be archived for future reference. These archives are available from within the standard archiving menu. For details on the archives refer to the Report Archives section of the Reports chapter. The Report Writer will allow you to restrict on and print fields within the guarantor, patient, patient insurance policies, patient invoices, and patient charge/adjustment. By defining qualifications for the specific fields within these records you will be able to restrict the included items for a given report. This component of the Report Writer is referred to as a Query. Figure 15-1 illustrates a sample Query. Figure 15-1 REPORT WRITER QUERY In addition, you can specify the fields that you want to print for your customized report. This will allow you to customize your report output according to client, provider, or any number of other ways. Each of these customized print formats is referred to as an Output Format. Figure 15.2 illustrates a sample Output Format. 15-2

146 Figure 15-2 REPORT WRITER OUTPUT FORMAT Each Query and Output Format is created independently, although each Query contains a set of default Output Formats the user can choose from. When you choose to begin a Report, you must select one of each of these components. The Report Writer then uses the Query you selected to qualify the guarantors, invoices, patients etc. to be included on the report and the selected Output Format to determine what fields are to be displayed and subtotaled for your custom report. The steps involved in adding new qualifications and output formats is described in great detail within the next few sections of this chapter. With all of the functionality and flexibility the Report Writer provides, it should be easy to imagine that it is no simple affair to master. Learning to use the Report Writer for the first time will be easier if you read and follow the directions outlined in this chapter. Section 2: Adding New Output Formats The Output Formats determine what data will be displayed for a given report. This section is covered before the addition of Queries, because it is sometimes easier to create a new report if you know exactly what information you want to print. You can begin creating a new Output Format from the Report Writer Menu within the Reports Menu. From within this menu, choose the Reports Output Format option. This will open a window containing all of the current Output Formats. Use the standard selection options to select an Output Format to alter, or to begin adding a new one. These options are described in detail within the Basics of Record Selection section of the Getting Started chapter. 15-3

147 The fields within the Output Format record are listed and described below: CODE the identifying code for this record. This field should convey to other users as well as to you, some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION the identifying field to assist users in quickly distinguishing one Output Format from another. TYPE whether or not this is a user or system report. You should always leave this as a user report else you will not be able to view this report. TITLE the field at the top of each page of the report. It is used as the title for the report and to identify and distinguish it from other, similar reports. ARCHIVE used in determining if reports run using the selected Output Format are to be archived. By setting this value to NO, you will override the default behavior of archiving the report. REPORT LEVEL determines how specific the report is to be. The level options from least to most specific are: client, guarantor, patient, patient invoice, charge, and adjustment. Query levels that do not match Output Format levels will result in a conversion from one level to the other. For example, if your Query level is GUARANTOR and the Output Format level is PATIENT, your printout will contain each patient that is attached to the qualified guarantors. ITEMIZATION STYLE if you have a report about invoices with itemization this determines the format. INCLUDE DETAIL LINES determines whether you will see each line of the output or just the counts and totals. SECTION PAGE BREAKS provides each section of the report to be printed as one report with page breaks at the end of each section. A subtotal is also printed at the bottom of each section. INCLUDE FOOTER determines whether or not to display a footer in the report. HEADINGS EACH PAGE if this is set to YES, when a section of the output goes on to a new page the headings will be displayed on that new page. INCLUDE OUTPUT FMT this can be filled in to link output formats together. PROMPT FOR CUSTOM HEADER if set to yes you will be prompted for a header when this output format is used. DEFAULT CUSTOM HEADER this is the default value filled into the prompt if the PROMT FOR CUSTOM HEADER field is set to yes. USE CUSTOM FOOTER if you want to use a footer different than the default this can be set to yes to use your own custom footer. CUSTOM FOOTER these fields are used for the layout of your custom footer. 15-4

148 After the main Output Format record has been added or if you wish to alter an existing record, highlight it within your list of available Output Formats. Press the Enter key to begin specifying the fields that you want to print. You should now see a window with a heading that begins REPORT FIELDS FOR REPORT OUTPUT FORMAT # See Figure 15-3 for an example of this window. Figure 15-3 REPORT W RITER OUTPUT FORMAT FIELDS Use the letter A to add a new Output Field to your printed report. You can use the standard record selection options to edit existing Output Fields. You can add as many of these fields as will fit within the four lines available to you. There is a special case for Date output options. If you want your report output to be grouped by date you have 3 options. The first is to group them by the full date, in order by this date. This means that items dated 12/01/2003 will be separated from items dated 12/02/2003, and so on. The second option is to group based upon both the month and year of the date in question. This would mean that the previous example would not be in separate groups. The last date grouping option is to separate items only when the dates years differ. In all three of these cases, the way to set this option is using the LENGTH field within the Output Field. To group using the full date, use a length of 10. For the month and year option, use a length of 7. For the year, only use a length of 4. The fields for each Output Field are outlined and described below: PLACEMENT determines which line of the report the REPORT FIELD will be forced to print on. If this is set to Heading than the report will group the output according to the Heading fields. This is a required field. 15-5

149 ORDER determines the order the REPORT FIELD will print on the report. This is also a required field. PREFIX allows you to add a text value to the beginning of the REPORT FIELD each time it is printed. DESCRIPTION overrides the default description for the REPORT FIELD. If left blank, the default description for the field will be used. REPORT FIELD determines the field that is to be printed. This field is required and should not be repeated within the same Output Format. ADD L HEADER INFO allows you to print an additional field from within a coded record that is used as a report sub-heading. For example, you could include the FOLLOW-UP DAYS field value along-side each of the Patient Status code fields you print by entering the value of Patient Status Code: Follow-up Days into the field. LENGTH overrides the default field length for the REPORT FIELD. If this field is used, the Report Writer will truncate any field value that exceeds this new length. SUPPRESS DUPLICATES causes each new line within the same heading to suppress the printing of duplicate information when set to YES. This is only true if there is no change from the left side of the line. Once anything about the line changes, the rest of the line will print regardless of additional duplication. COUNT This field will allow you to force the REPORT FIELD to be counted and displayed. The SUB option will cause the count to print after each heading, the GRAND option will print counts at the end of the report and the BOTH options will print the counts at both the end and when each heading changes. TOTAL This field will allow you to force the REPORT FIELD to be summed and displayed. Only numeric and dollar amounts will be totaled. The options for this field work similar to the COUNT options. AVERAGE This field will allow you to force the REPORT FIELD to be averaged and displayed. Only numeric and dollar amounts will be averaged. The options for this field work similar to the COUNT options. Section 3: Adding New Queries The report Queries contain the restrictions that determine which records will appear within the report. The more restrictions or qualifications that you add to a Query, the fewer items you will get included within your report. You can create any number of restrictions for each Query. To begin adding or editing a Query you must enter the Report Writer Menu from within the Reports Menu. From this menu select the Query Qualifications option. When you select this option, a window will open, showing you all of the existing Queries. Use the standard selection window options to select or begin adding a new Query. These options are described in detail within the Basics of Record Selection section of the Getting Started chapter. The Query fields and their definitions are: 15-6

150 CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. DESCRIPTION This field will display to help the users to quickly identify the purpose of this Query. ARCHIVE This field will determine if reports run using this Query are to be archived. By setting this value to NO, you will override the default behavior of archiving the report. MAIN TITLE This field prints at the top of each page of the report. It is used as the title for the report and to identify and distinguish it from other, similar reports. REPORT LEVEL This field will determine how specific the report is to be. The level options from least to most specific are: guarantor, patient, patient invoice, invoice charge and adjustment. Query levels that do not match Output Format levels will result in a conversion from one level to the other. For example, if your Query level is Guarantor and the Output Format level is Patient your printout will contain each patient that is attached to the qualified guarantors. REPORT FORMAT This is the default Output Format to use for this Query. The user that actually launches the Report Writer can override this field at runtime. Once the new Query record has been added or if you want to edit an existing Query, highlight it within the list. Press the enter key to begin adding the qualifications and actions for this Query. This will open a window listing all of the current qualifications for this Query. Figure 15-4 shows a Query qualification sample. Figure 15-4 REPORT WRITER QUERY QUALIFICATIONS 15-7

151 To add new qualifications press the letter A followed by the Enter key. This will open a window prompting you for the type of restriction or action that you want to add. Figure 15-5 shows this window. Figure 15-5 REPORT WRITER QUERY QUALIFICATION/ACTION When adding new Query restrictions, you must begin by adding a new Qualifier. This will determine the file and field that you will be able to restrict. After selecting the file and field you wish to restrict on, it will be displayed in the Query window. The Qualifie rs will be displayed on lines beginning with the QUAL prefix. You are now ready to add an Item or Range to the Qualifier. These will determine what values are going to be allowed for the Qualifier field. Highlight the Qualifier you want to restrict and enter the letter A. You should now see the same option box as before, prompting you for the type of restriction that you want to add. Select the Item option if you want to include or exclude an individual value. Select the Range option to include or exclude a range of values. The included and excluded Ranges and Items will be displayed following the Qualifier that they modify. If no inclusion is specified for a Qualifier, then all values not expressly excluded will be allowed for the Query. If an inclusion is specified, then only those within the included Ranges and Items that are not expressly excluded will be allowed for the Query. You can repeat the above steps as many times and in as many variations as required. After you have added all of the Qualifiers and their associated Items and Ranges, you are ready to use the Run Report option. At runtime, the user can manually override any of the restrictions for a given Query. The changes made here are not saved to the system. 15-8

152 Section 4: Actions While setting up the Query restrictions, you will be able to select a number of system actions to take on the qualifying records. The Report Writer will execute the action(s) that you select after the report output is created and archived, but prior to sending that output to the user-selected print destination. The setup and maintenance of actions is covered in detail within the User Actions section of the Additional Features chapter. The user running the Report Writer can manually suppress any default actions for the Query. If you are going to use actions within the Report Writer, you should keep a few things in mind. First is that you should be aware that the actions will happen for all of the qualifying records. This means that if you choose the wrong or inappropriate action(s) you could cause a lot of damage in a very short amount of time. For this reason you should be very careful when using the Action option within the Report Writer. If you are unsure of a Query s qualifications or of the number of qualifiers you will get, you might want to run the report without any actions first. You can always re-run the Query after you have verified the results. The next step would be to verify that you are logged into an appropriate batch. Each of the changes that are made due to the actions you select will show up in your current batch. You should be sure that these edits belong in your current batch and that they will not cause the other activities within the batch to become confused. Section 5: Running Reports Before you can successfully run the Report Writer, you must have both the Query and the Output Format components completed. These are covered in detail earlier within this chapter. If you have not yet created any Queries or Output Formats you must do so prior to continuing with this section. The launching of the Report Writer involves several quick and easy steps. First enter the Run Report option from within the Report Writer Menu to launch the Report Writer. You will then be asked to select the Query you wish to use. You will then be placed into a window displaying the current qualifications for the Query you selected. You can now edit these qualifications in any way you like without fear of altering the initial Query you selected. Figure 15-4 shows an example of what this window will look like. When you are satisfied with the qualifications for your report, press the Enter key to continue. You will now be asked to verify that you wish to continue with the Report Writer. If you cancel this process you will be returned back to the Report Writer Menu. If you choose to continue and the Query you selected has a value of NO for the RESTRICTED FORMAT or there are multiple Output Formats within the Query, you will be asked to select your desired Output Format. This will determine what fields are printed and in what order. For additional information on the Output Formats refer to the Adding New Output Formats section of this chapter. The list of Output Formats will be limited to only those listed within the Query if RESTRICTED FORMAT is set to YES. This selection will be skipped altogether if there the value is YES and only one Output Format is listed within the Query. After you have selected the Output Format to use, you will be prompted with the standard printer options. After answering these questions the Report Writer will take over and begin to create your report. When the report has been built the output will be sent to the printer you selected earlier. You will then be prompted as usual for additional printouts. After completing all of your printouts you will be returned to the Report Writer Menu. The first page of every Report Writer will contain a detailed listing of the final qualifications for the report. This page can be very useful in explaining and understanding your custom reports. 15-9

153 Section 6: Multiple Record Selection From within the standard lookup windows you can select and send specific records to an Output Format of your choice. You can do the record selection using the normal multiple record selection options. Multiple Record Selection is outlined in detail within the Basics of Record Selection section of the Getting Started chapter. Press the Enter key after you have selected all of the records that you want included in the Output Format. You will then be sent to the standard action list. The Print Report option will be highlighted by default. Choose this option and then enter the name of the Output Format you wish to use. To complete the report, you must then select a print destination and the pages and/or page ranges to print. After the printing is complete you will be returned to your initial selection window. The items previously selected will still be highlighted, allowing you to take additional actions if required. When you are finished you can press Control+X keys to exit the selection window or press Control+U keys to de-select your list of records

154 Chapter 16: Speed Utilities This section covers the following items and reports: Capitation Payment Utility Transaction Speed Utility Memorize Transaction Utility Remittance Posting 16-1

155 Section 1: Capitation Payment Utility A capitated insurance plan is one where the provider or facility is paid a set amount per month for each patient within the plan. In exchange for this payment, the provider or facility must supply the patients within the plan specific medical care. The medical care that is covered by the flat fee will vary with the insurance plan. Some capitation plans will pay additional sums for services outside of the covered medical services. Typical capitation plans require that all charges performed be billed using the standard HCFA-1500 or UB92 insurance forms. This includes charges that are covered within the capitation and will be written-off. There will typically be no obvious billing difference between the covered and non-covered charges within the capitation policy. The Capitation payment utility will allow you to quickly post the debits and payments included within an insurance capitation check. The check from the insurance company will include a list of patients and the amount being paid for each patient. New guarantors and patients will need to be added to CFO before they can be included in the Capitation Utility. This addition of new patients can be handled from within the Capitation Utility. Once added, the patient must also be given an insurance policy with the proper insurance code for this capitation policy. Insurance company codes must be specifically setup as a capitation code. This requires that the capitation fields within that insurance code be populated. The capitation fields within the insurance code will determine the exact nature of the payment as well as the provider and type of offsetting charge that is to be added. These fields are covered in detail within the Insurance Company Code Libraries section of the Coded Libraries chapter. The patient policy s capitation fields must also be setup appropriately. Patients can be easily placed within a capitation policy and quickly removed or altered. This is done using the CAP: fields within the patient s policy record. Detailed descriptions of the patient fields can be found within the Adding Patients and Guarantors section of the Adding New Patients chapter. The Capitation Utility can be accessed through the Patient Maintenance Menu by selecting the Capitation Payment Utility option. Selecting this option will open a window containing all of the valid capitation policies for your current client. Select the policy that is submitting the payment using the standard record selection options. Once you have selected the capitation policy that the payment covers, you will be prompted for the detail check information. After you have entered the check data you will see a partial listing of patients that have this insurance policy. Patients whose CAP: ACTIVE field is set to a value of NO will not appear within this listing. You must now compare your on-screen listing with the itemization provided by the insurance company. If a patient is within your on-screen list and is not on the insurance listing, that patient must be removed from your list. Conversely, those patients not within your on-screen listing must be added. All included patients must have the proper CAP:AMOUNT value. This value must match the amount paid by the insurance company for each patient. Patients that are on-screen and should not be can be removed by selecting that patient and pressing the delete key. This will not delete the patient, but will automatically set that patient s CAP: ACTIVE field to NO. This will cause that patient to disappear from your listing. Patients that should be within your on-screen list and are not can be added by pressing the letter A. This will take you to another window displaying all the patients with this policy that have their CAP: ACTIVE field set to NO. Simply highlight the patient to add into your list and press the Enter key. This will automatically set that patient s CAP: ACTIVE field to YES. When you are finished adding patients to your on-screen list press the Control+X keys. This will return you to your list of included patients. 16-2

156 When your on-screen list matches the insurance company s listing press the enter key to continue. If the CAP:AMOUNT fields for your included patients does not match the actual check amount you will see a warning message. You will then be able to abort the utility, correct your check amount or re-enter and correct your included list of patients. When you have matched the check amount with the patient list you will be asked to verify that you indeed want the Capitation Utility to proceed. If you choose to continue the utility will post a payment and an offsetting charge for each patient. The net effect of this utility on Accounts Receivable will always be zero, as the payments will exactly offset the charges. These payments and charges will show up within your current batch just as if you have done it all manually. Section 2: Transaction Speed Utility This option will provide users with the ability to quickly add many items such as charge or adjustment transactions that have similar field values. This utility is accessed using the SHIFT+F7 function key, which will bring up the window shown in Figure Figure 16-1 TRANSACTION SPEED UTILITY ADJUSTS This will help the users to quickly identify the purpose of this recurring transaction. Figure 16-2 shows the defaults that you will be prompted to enter. These are the values and logic that the system will use to help post your adjustments. 16-3

157 Figure 16-2 DEFAULTS REQUIRED FOR SYSTEM TO AUTOPOPULATE ADJUSTMENT FIELDS CHARGES This field will allow you to quickly disable this item without removing it permanently. Figure 16-2 shows the defaults required with the speed charge entry. Figure 16-3 DEFAULT FIELD INFORMATION REQUIRED FOR SPEED CHARGE ENTRY 16-4

158 HISTORY This option will allow users to post multiple histories that have the same text onto patients or invoices. Figure 16-4 shows and explains the options for this speed utility. Figure 16-4 DEFAULT FIELD INFORMATION REQUIRED FOR SPEED CHARGE ENTRY LETTER This option will allow users to request multiple letters of the same variety on invoices or patient accounts. Figure 16-5 shows a screenshot of the options available for the letter utility. 16-5

159 Figure 16-5 INFORMATION NECESSARY FOR LETTER SPEED UTILITY MAIL - This option will allow you to quickly process your mail returns and has an option to add a pop-up message to the patient s account. This pop-up message can help to remind staff to get a current address if and when the patient is contacted. Figure 16-6 shows the setup screen for this option. Figure 16-6 OPTIONS AVAILABLE WITH SPEED MAIL RETURN UTILITY 16-6

160 RESP This option will allow users to post multiple patient responsibilities. Figure 16-7 shows the setup screen for this speed utility. Figure 16-7 INFORMATION NEEDE FOR SPEED PATIENT RESPONSIBILITY UTILITY Section 3: Memorize Transaction Utility Charges and patient invoices can be memorized in order to be reposted automatically. This will allow you to flag any patient invoice or charge to recur daily, weekly, monthly, bi-monthly or almost any other combination needed. The memorized transactions can also be set to recur for a specific period or to continue indefinitely. The addition of new memorized transactions can be done from within the patient VT screen. Use your arrow keys to highlight the appropriate charge or patient invoice and type the MEM blind option. If the selected item is not currently memorized you will be sent to a blank Memorize Item window. The dates on the recurring charges will conform to one of the following cases: Memorized charges have a DATE FROM and DATE TO of the first day of the month: recurring charges DATE FROM and DATE TO will be set to the first day of each month they occur within. Memorized charge has a DATE FROM and DATE TO that span the entire month: recurring charges DATE FROM and DATE TO will be set to the first and last days of each month they occur within. Memorized charges have a DATE FROM and DATE TO of the last day of the month: recurring charges DATE FROM and DATE TO will be set to the last day of each month they occur within. 16-7

161 Other memorized charges: recurring charges DATE FROM and DATE TO will be set to the date the new charge is added. The Memorize Item fields and their definitions are: DESCRIPTION This field will display to help the users to quickly identify the purpose of this recurring transaction. ACTIVE This field will allow you to quickly disable this item without removing it permanently. FROM DATE This field determines the first possible date for this transaction to recur. TO DATE This field determines the last possible date for this transaction to recur. HOW OFTEN This field will determine when the memorized item will be added. TYPE This field is filled in based upon what type of item you have selected. The options are CHARGE and INVOICE. This field is protected and will always be populated for you. REFERENCE This field is filled in based upon the actual record you are memorizing. It will be filled in for you and you will not be able to adjust this value. If you need to remove a memorized transaction or add an additional memorized item to a charge or patient invoice you will need to again select the charge or invoice from within VT. Once the item to be removed is highlighted enter the MEM blind option. This will open a window giving you the options to add an additional memorized item or to remove the existing item. By choosing the REMOVE option the memorized item will no longer recur. Section 4: Remittance Posting Remittance posting is available for cases where an insurance company supplies an electronic remittance file for their payments and write-offs. This file is typically posted onto the insurance company s computer system and must be retrieved. When active for a given insurance company, the automated remittance posting utility can be accessed through the Custom Utility Menu. This menu is available from the Main Menu and its content will vary with different CFO installations. Although the remittance file will be downloaded nightly (where possible) the actual importing of the payment and adjustment information must be run manually. The primary reasons the import must be manual are that you might want to alter the batch name that the import will use and that you must then review the import for any errors/exceptions and balance the import with any insurance supplied documentation. The first step in importing a new insurance remittance file is to enter the Custom Utility Menu and select the remittance import for the insurance from which you are expecting an import file. The specific insurance company import must be setup by BillWorx staff, and will then appear within the list of available custom imports. You will then be placed into a window showing your first set of import options. This first window will ask you to verify that you intend to run the import utility. After you have selected the Continue option you will be shown a list of the ERA files that have not yet been imported for this insurance company. Select the file that you want to import and you will be given the chance to alter the batch name that the imp ort will use for all its activity. Once you have selected a batch 16-8

162 name the import will prompt you for the printer you want the progress/errors/exceptions report to be sent to. The import will then proceed automatically to post the payments, adjustments and notes within the ERA file. The final step in the ERA import is to review the actions of the import, make any corrections needed and final the batch. In order to review and audit the import you must have the documentation from the insurance company. There will be various rejection/error codes from the insurance carrier that will require you to audit the invoice, make corrections, re-file claims and possibly file disputes with the carriers. 16-9

163

164 Chapter 17: Using the Scheduler This chapter contains: Overview of the Scheduler Menu Adding A Scheduler Provider Adding A Scheduler Type Adding Patient Appointments Logging Scheduled Appointment Letters 17-1

165 Section 1: Overview of the Scheduler Menu The Scheduler Menu allows medical professionals to schedule appointments for patients and to manage these appointments around their scheduled work times. In addition to scheduling appointments, time periods can be blocked off for special appointments or other obligations that the medical professional may have. Scheduler reports can also be run showing scheduled appointment times for each provider. The Scheduler Menu can be accessed from the Main Menu, and is shown below. FIGURE 17-1 SCHEDULER MENU From within the Run Scheduler, the Scheduler Maintenance Options give you the ability to: add and maintain scheduler provider records for keeping track of a provider s work schedule and setting up patient reminder flags on co-pays, pre-certification, etc. set up concurrent appointments for providers based on their level o f procedural complexity book new appointments and move existing appointments to a future date block off scheduled times for providers generate and print scheduled appointments for providers The Scheduler Maintenance Options window can also be accessed by pressing Shift + F8 from the Main Menu. The Scheduler Maintenance Options window will look similar to the following: 17-2

166 FIGURE 17-2 SCHEDULER MAINTENANCE OPTIONS WINDOW There are three steps you must do when initially setting up your scheduled appointments: First, add record information for the scheduler provider(s). Section 2: Adding A Scheduler Provider From the Scheduler Menu, select the Scheduler Provider. The scheduler provider window for the batch you are in will display, reminding you of how many scheduler providers were found. 17-3

167 FIGURE 17-3 LIST OF SCHEDULED PROVIDERS To add a new provider, type A, and press Enter. The Adding New Scheduler Provider window will display. This will look similar to FIGURE FIGURE 17-4 ADDING NEW SCHEDULER PROVIDER WINDOW 17-4

168 o The fields in the Adding New Scheduler Provider window are detailed below. ACTIVE Whether or not the provider is active. If the active field is set to NO, no appointment will be allowed to be scheduled. CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type. NAME The name of the provider for which appointments are being scheduled. DAILY CO-PAY REMINDERS YES/NO field indicating whether there should be a daily co-pay reminder. DAILY PRE-CERT REMINDERS YES/NO field indicating whether there should be a daily pre-certification reminder. DAILY BAD ADDRESS NOTICE This field determines which letter will be printed as a daily bad address notice. PATIENT REMINDER LETTER This field determines which reminder letter will be sent out to patients. REMINDER DAYS This field states how many days prior to the appointment should the letter be logged. NO-SHOW CHARGE (2) States the CPT Code(s) that will be charged if the patient does not show for the appointment. SUNDAY, MON, TUES, WED, THURS, FRI, SAT FROM/TO (3) Allows the scheduler to allow appointments only for certain time periods each day. MAX APPTS PER SLOT States the maximum allowable appointments that can be scheduled for each time slot. Section 3: Adding A Scheduler Type Second, add information for the types of scheduled appointments that the provider accepts such as: new patient, established patient, consultations new/established patients (minor, low, moderate, intermediate, high); conference consultations expanded, detailed, complicated moderate, complicated high; special reports medical testimony, special reports, and special service. Prior to adding a scheduled appointment type, you will be forced to select the provider who will carry out this appointment. Using the standard selection keys, add the new scheduler appointment types from the Schedule Types Option. The fields in the Adding New Scheduler Provider window are detailed below. CODE This is the identifying code for this record. This field should convey some idea of the record s contents. This field is required to be present and unique for all records of this type MINUTES The length of time that the appointment is scheduled to last. CLASS The class or level of the appointment. This is used in determining the level of procedural complexity. 17-5

169 RETURN APPT LETTER The letter that will be logged for the returning appointment. FIRST/LAST START TIME 1/2/3 The earliest and latest times when this type of appointment can be scheduled. EXCLUDED WEEKDAY 1/2/3/4/5/6 The days that this type of appointment cannot be scheduled. ALLOW OVERRIDE Manual override to disable the concurrent matrix. MISSED APPT LETTER States which letter should be logged if the appointment is missed. DAY OF APPT LETTER States which letter should be logged on the day of the appointment. Section 4: Adding Patient Appointments The third and last step for the initial adding of appointments is to actually add the appointments for existing patients. This is done in the following order: 1. First, select Run Scheduler from the Scheduler Menu. 2. Secondly, select Appointments and press Enter. 3. Next, select (highlight) a provider to view and press Enter. 4. Fourthly, select (highlight) the appointment type for the new appointments and press Enter. A pop-up message will ask for the schedule date that you wish to view. The pop-up message will look similar to FIGURE FIGURE 17-5 APPOINTMENT DATE LOOK-UP WINDOW 5. Next, enter the date for the appointment and press Enter. 6. After the date is added, FIGURE 17-6 will be displayed. This screen shows all available appointment times for the provider. To set a patient s appointment, you must highlight an available time in the provider s work schedule and press Enter. 17-6

170 FIGURE 17-6 AVAILABLE APPOINTMENT TIMES o After selecting an available time, the screen listing existing patients will appear. To set a patient s appointment, you must highlight that specific patient and press Enter. This will bring up a modified patient screen showing all of the patient s information. Any additions or changes made to the patient s information on this screen will not change the patient s information outside of the scheduler. The changes or additions made here are for notes purposes only. Make sure to verify the information on this screen to ensure that the correct patient has been picked. The APPT STATUS field determines: CANC - whether the appointment was canceled, KEPT - whether the patient kept the appointment, MISS - whether the patient missed the appointment, PEND or whether the appointment is still pending. o After all necessary changes are made, press Enter. This will take you back to the providers schedule for that specific day. The appointment that was just added will now be on the schedule. Section 5: Logging Scheduled Appointment Letters From the Scheduler Menu, all letters can be logged for a specified date at one time. This can be done by choosing the Log Scheduled Appt. Letters option in the Scheduler Menu. All you will have to enter to use this utility is the date for appointment letters to log. The default is set to the current date. Section 6: Blocking Off Time Often, a provider will not be available for appointments. This can occur for a number of reasons. These time periods can be blocked off to prevent appointments from being scheduled that would occur concurrently. To view a list of blocked times, or to block off new times, select Block Time from the Scheduler Maintenance Options window. You will then see a list of blocked times sorted by provider. If 17-7