MedConnect Charge Reconciliation Procedure. Corporate Charge Services

Transcription

1 Procedure Corporate Charge Services

2 Table of Contents Introduction... 3 Charge Reconciliation Roles and Responsibilities... 4 Accessing and Using the MedConnect Reconciliation Report... 5 Checking for Charge Rejections... 9 The Charge Process: From MedConnect to Invision Departments and Charge Reports Charge Rejections (RTIF errors) MedConnect Reconciliation Report Subscription Setup FAQS

3 Purpose: To standardize the charge reconciliation process for all sites and departments charging out of MedConnect. Introduction: With the MedConnect 2 rollout taking place in 2013, many departments moved from entering charges directly in to Invision to charging out of MedConnect based on clinical documentation. Because revenue for these departments is based on charges being interfaced from MedConnect to Invision, the need to reconcile charges between these 2 systems is imperative. Because of this, Corporate IS has developed tools to help assist in this process. These tools give the user a summary of the charges being interfaced from MedConnect while also assisting users find which charges didn t post and why. This information then helps the charging departments address these issues so that they can maximize revenue while using the MedConnect Electronic Health Record (EHR) system. The following sections provide a guide for users to help reconcile their department charges. It goes through each of the tools available and their functions while also going through the different aspects of charging out of MedConnect to give users a better understanding of this process. Please forward any questions and or requests for clarification to the MedConnect Charge Services team using the address below. MedConnect-ISChargeServices@medstar.net 3

4 Charge Reconciliation Roles and Responsibilities Corporate Charge Services Support Expectations To ensure that the MedConnect Reconciliation report is functional and displaying accurate data. To acknowledge and resolve any reported incidents opened with the Help Desk due to possible MedConnect build or processing issues. (i.e. Reconciliation process failed to run, incorrect charge build) Assist departments with troubleshooting and resolution when departments are unable to determine why charges did not interface. Train department charging staff at each facility to use the MedConnect Reconciliation report, access the charge error documents, understand the data being displayed in the report, and understand how to correct errors when they occur. Department/Service Line Expectations Submit all charges daily. Review the MedConnect Reconciliation report and charge error documents to perform daily reconciliations of submitted department charges. Perform necessary adjustments and or corrections so that all patient charges are accurately reflected in both MedConnect and Invision. Contact Charge Services by logging a ticket with the Help Desk if you suspect systemic MedConnect charge issues or issues with the Reconciliation report (charge errors not noted as variance on Reconciliation report). Hospital Finance Expectations Develop an oversight process to ensure revenue generating departments/service lines adhere to the MedStar MC II Hospital Department Interface Charge Reconciliation Process. 4

5 Accessing and Using the MedConnect Reconciliation Report The MedConnect Reconciliation report is a tool created and supported by Corporate IS to help reconcile charges interfaced from MedConnect to Invision. It takes the department charge reports from both systems and then runs a comparison to determine the differences between them. (For more information on the charge process and charge reports, see pgs 13 and 14 respectively.) The report will always look at the previous date of service and allows the user to go back a maximum of 60 days. The report will then display the variances between the 2 reports and allow the user to display the details of the variances. In order to use this report, your user id must be added to an access list. (For more information on how to gain access, see the FAQs page at the end of this procedure.) The steps below show how to access and use the Reconciliation report. This should be done daily to ensure that all charges sent from MedConnect are accounted for in Invision. 1. Open the corporate StarPort page Hover over the Operations drop down menu and select, Decision Support Systems. 5

6 2. Once you choose Decision Support Systems, the screen below will be displayed. From this screen, choose MedConnect Reconciliation. Be sure to keep your internet browser s pop-up blocker off as the reconciliation report will open in a new window. 3. Select your facility and department(s) and change the date if applicable. In the screenshot below, we are looking for variances for MUMH Lab department for dates of service 6/16 to 6/20. 6

7 3. Click the View Report button to view the summary level of the report. This level will display the number of records MedConnect interfaced for a specific date (Cerner Recs) and compare that to the number of records received by Invision (SMS Recs) for that same date of service. (Note: Cerner Recs and SMS Recs are calculated using the post date of the charge, where as the Cerner Qty and SMS Qty are based on the service date of the charge. This means that the Qty on a particular date of service can change based on a charge s service date.) In the screenshot below, we see that Cerner sent a total of 2483 records while Invision received 2482, giving us a record variance of 1 for DOS 6/17/2014. (Note: Because the quantity variance is based on the service date and takes the charge quantity in to consideration, it is not unusual to see the quantity variance differ from the record variance, especially in departments like pharmacy or surgery) 3. In order to view the variance details for that date, click on the Qty Variance of 1. Clicking on the variance enables the user to drill down to see the specifics of the charge(s) contributing to the variance. The details will include the patient fin number and CDM code to facilitate investigation if necessary. Clicking on the Qty Variance of 1 displays the screen below. 7

8 4. Clicking on the patient number will display the patient information as well as the charge information associated with the Cerner CDM code. In the screenshot below, a Fungitel, Blood-Mayo charge was sent by Cerner for the patient listed but did not post to Invision. The information above shows the charges that did not interface but it doesn t give the reason. In order to determine why a charge did not post to a patient s account, use the steps in the next section, Checking the Charge Rejections. (Note: you may need to go back to Cerner to determine when the charge was sent as this may assist in finding the correct rejection document. The Interfaced date and time in CSChargeviewer will give you this info.) Note: Users also have the ability to set up a subscription to the report. This enables the user to have the department(s) summary either ed to them OR have an Excel file showing the summary delivered to a shared drive on a specified schedule. This can be helpful in tracking variances and totals. For steps on how to do this, see pg 16. 8

9 Checking for Charge Rejections When charges interfaced from MedConnect reject from Invision, Invision creates a text document showing the details of the rejected charge as well as the reason it rejected. (For more information on charge rejections see pg.15) These error documents are then forwarded to a shared drive where they can be retrieved and reviewed so that users can address them as needed. The information that these error documents contain will match the variances found on the MedConnect Reconciliation report. (Note: Users should ALWAYS check the drive for charge rejections even if there is no variance for the date of service being reconciled. This will ensure that all rejected charges are addressed if for some reason the report totals are incorrect.) The steps below show how to access the shared drive and retrieve/view the error documents. It is imperative that these rejections be reviewed on a daily basis so that all rejected charges are addressed in a timely manner. For more information on how to gain access to the drive below, see the FAQs page at the end of this document. 1. In order to view the error reports, the user must have the network drive shown below mapped on their PC or laptop. This may require an ASAP submission from your manager to IT security. \\msh00231\smsreports 2. Once the network drive is mapped accordingly, open the network drive and then open your facility s folder. Open the U0KC folder to find the error that goes with the variance of 1 for DOS 6/17/2014. Facility codes are below- F0KC MFSMC G0KC MGSH H0KC MHHC M0KC MGUH NRH MNRH U0KC MUMH W0KC MWHC 9

10 3. After opening the U0KC folder, the RTIF_Errors folder will be displayed. Opening this folder will display a list of folders with the same department codes shown in the table on page Choose your department s folder to check for any errors created on the previous day. Since this variance was under the lab department, open the LBC folder. (For more information on departments and department codes, review pg 14.) Note: Clicking on the name column in the window above with put all department folders in alphabetical order. 10

11 5. Opening the LBC folder above will display a window like the one shown below. Since we are looking for an error that was sent out of MedConnect on 6/17, we want to sort by the Date Modified column and then look for any errors with a modified date of 6/17/2014. As you can see in the screenshot below, there is 1 error with that modified date. Note: The name of the file will always be OROSUPF1_yyyymmdd_####. The date will be the day the charge rejected and the number will be the numbered instance for the date of service (note: numbered instances will start at 0000 not 0001). This will make up the file name for the rejection. For date of service 6/17/2014 in the screenshot above, there was 1 rejection that created the file named OROSUPF1_ _

12 6. Once the file is located, double-click to open it. You want to confirm that the rejection has the same patient and charge information than the Reconciliation report displayed. (For more info on reading charge rejections, see pg 15). In the screenshot below, we see that the Fin# as well as the CDM code (SM Primary Key) matches the variance information from the Reconciliation report. The error text field in the document below states the reason the charge was rejected. The rejection below states the charge was rejected for Patient Not Found. In this particular case, this was due to the charge being submitted on a test patient account that did NOT exist in Invision. More often charges will be rejected with this reason when charges are submitted on old or incorrect patient FIN#. -In order to correct the charge above so that the variance falls off of the Reconciliation report, the user must go back and credit the charge on the incorrect account and then submit it on the correct encounter if one exists. Other rejection reasons require different action. (For additional details and information on rejection reasons and how to resolve them, see the document titled, Invision Rejection Reasons and Resolutions ) -If you are unable to find an error document OR unable to determine why a charge rejected, open a ticket/incident with the Help Desk for the MedConnect Charge Services team (Affected item: Invision Charge Rejections) so that they can assist in the investigation. Please add all pertinent information to the ticket you create such as charge in question, patient account #, date of service, etc. 12

13 The Charge Process: From MedConnect to Invision MedConnect Charge Process: Charge creation within MedConnect (Cerner) is based on taking the clinical activity and documentation within the system and creating charges based on that activity. A CDM representing a specific charge will then post to the patient s account in MedConnect. Cerner will then interface the charges to Invision at specific times throughout the day. (Note: all charges being sent to Invision to post to a patient s account will be sent out of Cerner with a $0 price attached. This is because ALL pricing for technical charges takes place in Invision.) MedConnect gives users the ability to view charges on a specific account or across a department through the application, CSChargeviewer. Charges in Cerner are sent to Invision via a batch method. This means that once an item meets all charging requirements in Cerner, it moves to a pending status until the charge job runs and sends it over to Invision. The charge jobs are ops jobs, meaning that they are scheduled to automatically run throughout the day. These jobs start at 5am every day and run every 3 hours until 11pm. This means that a charge in a pending status will stay in that status until the next charge job runs. Once the job is complete, the status of the charge will change to interfaced in CSChargeViewer. This also means when you see a charge in a pending status, you can assume that the charge will be interfaced over to Invision when the next charge job runs. Invision Charge Process: Invision receives charges throughout the day as Cerner sends them. Most charges will be accepted through front-end Invision and then post to Patient Accounting (backend Invision) after the day-end process runs. Invision checks certain information when a charge is interfaced from MedConnect such as the financial number, CDM (service code), date of service, and quantity. If any of this information does not meet what Invision is expecting to see, Invision will reject the charge and create an error document. The error document will list the details of the rejected charges as well as the reason the charge was rejected. 13

14 Departments and Charge Reports: Every morning between the hours of 12 and 5am, both Invision and MedConnect create charge reports for the previous day. Invision s charge reports, also referred to as A2s, show all of the charges that Invision received for a specific department for the previous day. MedConnect also creates a charge report for each of the charging departments showing all of the charges that MedConnect sent out for a specific department for the previous day. The Reconciliation report then uses these charge reports to display the variances for each of the charging departments if they exist. The charge reports are based on the MedConnect cost center also known as the Invision department code. The list below shows the departments charging out of MedConnect, the associated department code or cost center for each department, as well as the department name that these charges will be displayed under in the Reconciliation report. Department Cost Center/Dept Code CRVR Department Cardiology (All) EKG Cardio Emergency EMR Emergency Blood Bank/Blood bank Product LBC Laboratory General Lab LBC Laboratory Micro LBC Laboratory Anatomic Pathology LBC Pathology HLA (MGUH) LBC Laboratory Pharmacy PHC Pharmacy Respiratory RSP Respiratory Sleep Studies/Neurology EGC Sleep/Neuro Surgery (time/case level) AMS Surgery 3 rd Floor OR (WHC Only) 3OR 3OR (MWHC Only) Baltimore Surgery Supplies C/S Supplies Washington Surgery Supplies O/R DC Surgery Supplies Non OR Supplies (GUH Only) 808 NON OR Supplies Endoscopy AMS Surgery Endo Supplies(WHC/GUH) GIS Endo Supplies OT/PT/SLP RHC Therapy Burn Therapy (WHC Only) RHC WHC Burn Center Vascular Cardiology VSC Vascular 14

15 MedConnect Charge Reconciliation CHARGE REJECTIONS (RTIFs) Interface Rejections are charges that have been sent out of MedConnect but have been rejected by the Invision charge interface. Charge rejections can occur for a number of reasons with some of the most common being service code errors (service master # errors), patient account # errors, as well as quantity errors. Invision will reject a charge if the details of the transaction does not match what Invision is expecting to see. When charges are rejected, a text file is created by Invision and then forwarded to a shared drive that should be monitored by staff. Below is a sample charge rejection created by Invision. The text file contains important pieces of information which will assist the user investigate why the charge didn t post to Invision. Error#: in this case the error # is E4416 which refers to rejection reason Exceeds the Maximum Orderable Quantity. Each error # corresponds to a specific rejection reason which will dictate what actions need to be taken in order for the charge to post to Invision. Patient#: Refers to the Acct# or FIN# of the patient. SM Primary Key: This is the MedConnect CDM# OR Invision service code. The first 3 characters represent the Invision department code OR MedConnect cost center. Note: All interface rejections (RTIFs) will have an Interfaced status in MedConnect. 15

16 MedConnect Reconciliation Report Subscription Set up -Setting up a subscription to the reconciliation report allows the system to you the charge totals for a specific department or departments on a daily/weekly basis. The will give you the same summary cube that you see when you access the report via the StarPort link. Below are the steps you can follow to set up your subscription. 1. Access the report via the Corporate StarPort page: StarPort Corporate page -> Decision Support Systems- >MedConnectReconciliation 2. On the screen below, you want to click, New Subscription. 3. Clicking on new subscription will display the screen below. For this example, we will use Union Memorial Lab (you can select 1 department or multiple departments). Most of the fields will default but you want to make sure you determine the schedule and choose the facility and the department at the bottom of the screen. 16

17 -Besides , you also have the option of sending the summary to a file share as well. In order to use this option, drop down the Delivered by: option and choose File Share. Using this option will send you an Excel file showing a summary of charge totals for the departments you selected to the shared drive you specify (summary will look like the one below). The summary will contain the same drill-down links that the report contains when accessing from StarPort. 4. Clicking the Select Schedule button will display the screen below. Here you can select when and how often you receive the totals for the facility and department you selected. Once you have chosen the options that you want, click OK. 17

18 5. Once you have chosen the facility and department and made any changes to default selections, hitting OK will take you back to the report main page. You can check your subscription from this page by clicking on the subscriptions tab. You can make changes to your subscription by clicking on the Edit link. 18

19 MedConnect Charge Reconciliation FAQs 1. What should I do if the report is missing totals for previous day s charge totals? A: If you notice that the report is missing charge totals for a specific department or date of service, open a ticket via the help desk ticket with the Applications Development Team so that this can be investigated. 2. How do I get new users access to the MedConnect Charge Reconciliation Report? A: If you have a new user that needs access to the Reconciliation report, please send an to the address below with the user s name and user id (ex: xxx01). MedConnect-ISChargeServices@medstar.net 3. What should I do if I have a variance but can t determine what caused it? A: If you can t determine what is causing the variance for a specific date of service on the Reconciliation report, you can open a ticket via the help desk with the MedConnect Charge Services team using affected item, Reconciliation Report. Please include the department and date of service you are investigating as well as any other pertinent information you feel should be included. The more information, the better. 4. How do I get access to the shared drive that stores Invision error documents? A: If you need access to this drive, submit an ASAP for access to the drive below. When completing your ASAP, choose other under the System dropdown and then include the pathway below in the comments section. \\msh00231\smsreports 5. Do I have to call the help desk? A: No, You can send your information to the help desk via , using the ISD_Help Desk address from the outlook address book. Be sure to include the nature of your issue, examples, your contact information and the group name that should receive the ticket. 19