Enterprise Health Management Suite Family Planning Queensland (FPQ) Training and Implementation Manual

Transcription

1 Enterprise Health Management Suite Family Planning Queensland (FPQ) Training and Implementation Manual Finance Manual

2 Developed and powered by Townsville-Mackay Medicare Local FPQ Project Team ABN: Townsville Office: Level 4, Clinical Practice Building, 1 James Cook Drive James Cook University Qld 4811 PO Box 7780 Garbutt BC QLD 4814 t f Mackay Office: Level 2, 123 Victoria Street, Mackay QLD 4740 PO Box 3033 North Mackay QLD 4740 t f Medicare Locals gratefully acknowledge the financial and other support from the Australian Government Department of Health (DoH)

3 FPQ Profile Finance Manual Page 1 of 28 FPQ Profile Finance Manual 1/21/14

4 Table of Contents EHMS access... 3 Create a desktop icon... 3 Log onto EHMS... 4 Log onto FPQ Profile... 5 Terminology... 6 FINANCE/ACCOUNTS ROLE... 7 Income... 7 Claims... 7 Deposits... 8 Find Accounts... 8 Collections... 8 Bad Debts... 8 Outgoing Messages... 9 REPORTING Stored Queries Find Objects Financial Reports ADMIN/RECEPTION ROLE: After Consultation Invoice an Appointment FINANCIAL Lunch Time Cash Up End of Day Banking Medicare Online Claiming Validate the invoices Create Batch Claims Process Verification Response reports Processing Claims Process EFT s Processing Exceptions Send a client claim to Medicare Changing fees and item prices SUPER USER TIPS AND FAQ Support Invoice does not display the services performed by the clinician Page 2 of 28 FPQ Profile Finance Manual 1/21/14

5 EHMS access Create a desktop icon EHMS (Enterprise Health Management Suite) is the site that is managed by TMML which users will go to when they want to log onto FPQ Profile. On your desktop, right click and select New/Shortcut The Create Shortcut window opens. Paste or type in the following address Click on the Next button In the next window, type EHMS in as the name for the shortcut and click on the Finish button An icon will now be visible on your desktop. The icon will represent your default internet browser e.g. a blue E for Internet Explorer or a tri-coloured lifesaver for Google Chrome Page 3 of 28 FPQ Profile Finance Manual 1/21/14

6 Log onto EHMS Double click on the icon and the EHMS site will open for you to log into. If you are shown a Security option on the login screen, select This is a private computer option, otherwise continue to log in. Each EHMS user will be issued a unique User Name based on their first initial and surname, and a generic password. Log onto the EHMS site with this username and generic password. Once you have logged on, the webpage will display the FPQ Profile icon and a link to change your password. This should be done immediately Page 4 of 28 FPQ Profile Finance Manual 1/21/14

7 Log onto FPQ Profile Click once on the FPQ Production icon and wait for the log in screen to appear. Enter your username (first initial and surname) and password If you only work at one location, you will open directly into Profile. If you work at more than one location, you will get this screen. Select the location you are working at today. Note: Your list will only show locations that you are authorized to work at When a user logs onto Profile for the first time, they will be prompted to change their password. It is essential that they change their password to something unique to them, so as to prevent unauthorized access. Enter password into the Current Password field, and then type in your new unique password in the next two fields and go ok You may want to have the same password for EHMS and Profile login s To change your password in the future, select Organisation/Change Password from the menu item on the top toolbar A record is kept of all activity undertaken by each unique user in Profile. A provider s signature is linked to their username and password. All entries under a username are the responsibility of that user, so do not share your password with anyone Page 5 of 28 FPQ Profile Finance Manual 1/21/14

8 Terminology Client Clinic Cases EMR Plans Follow ups Recall Services Encounter Contact Entry Form Client Context EHMS A person who uses the healthcare service (aka client or client). There is only one set of demographic information per client kept in Profile, regardless of where they engage with the service. The Place of Service or location of the Clinic. In Profile, this is sometimes referred to as POS A case is opened to cover all activities delivered during the time the client is engaged at the Clinic. In profile, we also refer to the clinical file as the case. (e.g. write your notes into the case of the client). Access to cases in other clinics is restricted. The Electronic Medical Record combines and contains all the data from all cases in one location. Access to the EMR is restricted by access rules and is Read Only. A set of follow ups (AKA Interventions) that have been designed for the client s needs One or more reminder s that relate to actions that need to be done. These are based on a client s needs and they could be clinical or admin related. For FPQ, these are mainly PAP follow ups A reminder for when a client should be recalled to the service Describes what items to invoice the client for. Services are determined by the provider of the service and are assigned during the consultation when the encounter is recorded. A clinical note and MDS data that is recorded at the time of the consult or interaction with the client This is the name of the form that is used when you enter your encounter When the client is in context, any actions you do will relate to that client. You can bring a client into context by highlighting their appointment on the appointment view. For example, highlight client appointment then click on the Invoice icon will open an invoice prepopulated with that clients information Stands for Enterprise Health Management Suite. This is the secure website that is hosted by TMML and provides secure access to the FPQ Profile database Page 6 of 28 FPQ Profile Finance Manual 1/21/14

9 Finance/Accounts Role The Finance/Accounts role has ability to run reports, view financial transactions and manage the outgoing messages for Medicare submission. Business Rules: Finance/Accounts staff will not change or add any data relating to the clients attendance Income The Income view in the Control Centre lists invoices and payments by provider or Clinic. This helps to understand the amount of income created by the Clinic. It lists all providers with income in the defined filter summarising the number of invoices and the main financial elements. It also shows the aged balance. Tip: Clicking on the graph will display the transactions in the bottom panel Change filters to display the required information Claims The Claims view in the Control Centre is a means of tracking and auditing electronic claims as they progress through the system. This enables a batch to be resubmitted in part or in full if necessary. The claims are processed as per Process Verification Response reports, Process EFT s, and Processing Exceptions Change filters to display the required information Page 7 of 28 FPQ Profile Finance Manual 1/21/14

10 Deposits The Deposits view in the Control Centre is a means of tracking the stages of payments, from the time they have been entered into the system, through to when several cash and cheque payments are bundled together and taken to the bank (this is known as a deposit), to when they are finally reconciled against the bank statement. Find Accounts Use the Find Accounts view to monitor due and overdue accounts, and to print monthly statements Collections The Collections view in the Control Centre provides a way to understand the management of funds for the Clinics, as it helps to see issues associated with management of outstanding accounts. Bad Debts The Bad Debts view lists transactions which have been adjusted by a credit journal. These can be viewed either by provider or by Clinic. Page 8 of 28 FPQ Profile Finance Manual 1/21/14

11 Outgoing Messages The Outgoing Messages view in the Control Centre enables the management and tracking of outgoing messages The Message List shows outgoing messages matching the filter criteria. The Preview of Selected Message shows a preview of the selected message. The Message Recipient list shows a list of recipients for the selected message, and the current transmission status for each recipient. The Message Attempt list shows a list of message transmission attempts for the recipient selected in the Message Recipient list Page 9 of 28 FPQ Profile Finance Manual 1/21/14

12 Reporting Stored Queries From Report menu, select Stored Queries These are queries that have been created using the Find Objects tool. You can change the query to suit your requirements e.g. date range or Clinic. Highlight a query and click on the Green arrow to run it. The results will be displayed and you can save, print and export them to excel if you require If you need to change the reporting parameters, click on the Edit icon to open the query In the Where panel, change the parameter in this example, the clinic name can be changed After running the query, export it to excel by clicking on the excel icon. Close the query without saving the changes you made. If you want to save the changes, then in the Query tab, select Save and enter a new name for the query Page 10 of 28 FPQ Profile Finance Manual 1/21/14

13 Find Objects From Report menu, select Find Objects and select the object from the list Note: You cannot change objects during the query creation. If you need to use items from a different object, you will need to click on the new icon to start a new query Once you have selected the object, a series of folders will be displayed which you can then open to drill down further into the data. The Grey dots are items that relate to the main object or folder item You will need to familiarize yourself with the data contained in the various objects. Select the type of data you want (in most cases it will be the description) and drag it into the Select panel on the right at the top If you want to use a parameter e.g. appointments only of type xxx, then drag the item into the Where panel on the bottom right and enter the parameter e.g. contains breast Run the query with the green arrow after adding each item to ensure you are building the data you want Saving the query will allow you to go back to stored queries and run it again at a later stage Page 11 of 28 FPQ Profile Finance Manual 1/21/14

14 Financial Reports From Report menu, select Financial Reports Select a report from the list. A Report Parameters window will open for you to enter the required parameters TIP: If you want to save the parameters for next time, click on the save button. Click on the Preview report to view the output prior to running the report. Page 12 of 28 FPQ Profile Finance Manual 1/21/14

15 Click on the Export button to save the data in the location you want The file will be saved in notepad as a txt file Copy and paste the output into excel for further analysis Page 13 of 28 FPQ Profile Finance Manual 1/21/14

16 Admin/Reception Role: After Consultation When the clinician consults with a client, they will set up what items/services the client is to be charged for and create a task to tell you when to book a follow up or any other request/message. Business Rules: The clinician will add the services/items to the encounter prior to closing it The clinician will send a task if a follow up appointment or other request is required The clinician will save and close the encounter prior to the client being invoiced this is signalled by the arrival of the task or the client at the front desk Supplementary item codes should always be checked to ensure the correct code is applied as per clinic location (this especially for Ipswich) Invoice an Appointment Business Rules: All interactions with a client will be invoiced, even if there is No Charge, to ensure accurate reporting A client is only invoiced when they have been seen by the clinician In the appointment screen on the current day, highlight the client to be invoiced then click on the Invoice icon on the top toolbar The invoice screen opens, with the client s name, appointment attendance, POS (Clinic), Date and Provider prepopulated. The Alert window will open if there are any alerts for the client. The clinician will already have set up the items that are to be charged for, so in most instances they will pre-populate Check that the payer is correct in the top left corner. If the client is the payer, then select Client and ensure that the rate is set to S for Standard Rate If a discount or Assist is given, then select the value of the Assist in the Discount column If the appointment is to be billed to Medicare, select Medicare as the Payer (See below for Non- Medicare invoicing) Click on the Pay later Button. Select the required printer Page 14 of 28 FPQ Profile Finance Manual 1/21/14

17 The client signs the printed Assignment form Receive cash payment for appointment Invoice non Medicare appointments as above, but select the Client as the Payer and select Pay Now button. The Payment window will open Tick the Print With Invoice box Select the payment method from the drop down box. Tick the box for Print with invoice. Expand the + sign and place a Tick next to the item to be paid. Go ok. The invoice and receipt will print out. Page 15 of 28 FPQ Profile Finance Manual 1/21/14

18 Financial Cash Banking Procedure and Trial Balance Reception START STEP 1 Invoice Client STEP 2 Receipt Payment STEP 3 Lunch Time Review Attendances Report check all appointments for the morning have been invoiced. (Can print attendance report from appointment screen) STEP 4 Move to Deposits, create new deposit Select the invoice that relates to the invoiced appointment and using single green arrow move from available payments down to deposit window. FINISH STEP 7 After balancing cash, cheque, EFT amounts in deposit window, and cash float select CASHUP and complete deposit Repeat Steps 3-5 at end of day STEP 6 Place these EFT receipts and cash in bank bag. Balance cash float. STEP 5 Column totals will now reflect EFT, Cash, etc. receipts taken for the morning Lunch Time Cash Up At lunch time, or when applicable, monies receipted need to be deposited and cash up report printed. Go into Control Centre/Financial/Deposits and click on the New icon for Create New Deposit The New Deposit window will open, listing all available payments. Check each entry, highlight it and click on the single green arrow. The payment will be moved into the bottom panel. Once all the available payments have been moved down, click on the print icon and print out the Cash Up report to keep for end of day banking Page 16 of 28 FPQ Profile Finance Manual 1/21/14

19 End of Day Banking At end of day all monies receipted need to be banked. Go into Control Centre/Financial/Deposits and click on the New icon for Create New Deposit. The New Deposit window will open, listing all available payments in the top panel and all deposited payments (from the morning cash up) in the bottom panel. Check each available payment entry, highlight it and click on the single green arrow. The payment will be moved into the bottom panel. The new deposit window will close, and the deposit will now appear in the Deposits window. Once all the available payments have been moved down, click OK and print the Receipts and Cash up Reports the Cash Up report goes with the checks and cash to the bank Page 17 of 28 FPQ Profile Finance Manual 1/21/14

20 Medicare Online Claiming Suggested Workflow: Keep all printed Assignment forms together. At the end of the day, do your invoice validation and batch claiming and print off the Cover sheet (DB1N form) Staple the DB1N form on top of the Assignment forms and get it signed off by the Provider as soon as able. Use the EOB (acknowledgement of claims and decision) report to reconcile and attend to any previously submitted claims. Refer to the Assignment forms where necessary to rectify any rejected claims. Once the EFT (Confirmation of payment and transfer notice) has been received and attended to where necessary, attach both EOB and EFT to the Cover sheet and shred all Assignment forms. Batch Claims - Batch claims refers to the process of electronic claiming for payment of services, from the Government or other funding agencies. Batch claiming can be performed for Medicare Bulk Billing and Veteran's Affairs. This is to be done at the end of every day in order to have an efficient flow of payments being received from Medicare. Once Invoices have been created (client invoiced) there is then a 3 part process Validate Invoices (Assignment Forms DB4) Create & sign a BATCH Confirm it is accepted When transmitting for new providers for the first time only include one invoice in the batch, then call the Medicare e-business Service Centre to confirm they have received your claim. Ph Validate the invoices To Validate the invoices, gather the signed Assignment forms together. From Financial/Batch Claims, select the Validate item Select the Provider and the POS and go OK Only perform Validation for one provider at a time to ensure each batch goes through individually and if there is an error, it will be only one claim. Page 18 of 28 FPQ Profile Finance Manual 1/21/14

21 In the Batch Claim Validation window, the list of un-batched claims for clients that require sending to Medicare will be listed. Go through each assignment form and check it is complete with a signature, referring practitioner (for items 80110/80100) etc. Match the appropriate assignment form (those for the provider you are batching) with the Validations list. Tick off each individual client s name whose signed form you have in your hand. If you do not have a signed form you will have to leave unselected until the assignment form has been located. Go through until each client has a tick beside their name then click on the Validate icon Enter your password and click ok. The Batch Claim Validation window closes. Repeat the process for each provider NB: Only perform Validation for one provider at a time to ensure each batch goes through individually and if there is an error, it will be only one claim. Proceed to create and sign a batch process Further information is available in the Profile Help File. Search for the word CLAIM Page 19 of 28 FPQ Profile Finance Manual 1/21/14

22 Create Batch Claims Go to Financial/Batch Claims and select the Create item Click onto the + (plus) box beside Active Financial on the left hand side of the window to display the drop down list of all providers. Left click the provider you have just batched claims for and drag over to Medicare under the PAYER tab on the right hand side. Ensure the providers name now shows under the Medicare heading. (If you accidently drop the Provider into a different heading, highlight the providers name and press delete at the top to remove their name from any section. ONLY Medicare is to be populated) Click on the green Process button The Batch Claim Summary window opens. Check the information is correct and the green e is present Click on the Create Claims button Go ok to the following message. During the above steps an easy claim error can be experienced. PLEASE READ IT CAREFULLY. This is informing you that there is incorrect or incomplete details for a client and you must go into that clients record to fix the details before sending. Some of the most common causes for this are 1. No ref number in the Medicare details for the client 2. Spaces in the Medicare number for the client 3. Expiry dates in the Medicare details for the client Page 20 of 28 FPQ Profile Finance Manual 1/21/14

23 Print the DB1N form for the Created Batch Claim Go to Financial/Batch Claims and select the Batch you want to print. Click on the Print icon Staple the DB1N form to the associated assignment forms and get the provider to sign it, and you sign as witness staple this to the Assignment forms. Page 21 of 28 FPQ Profile Finance Manual 1/21/14

24 Process Verification Response reports Every morning, in the Control Centre/Financial tab/claims view, click on the white box (process response report icon) to process the Verification Response reports. Reports received will be displayed in the Open EOB panel. If the difference is $0, the entire claim has been accepted and will be paid. For non $0 claims, these need to be managed as resubmissions. Refer to Resubmission process below Processing Claims Process $0 EOB s Highlight the $0 claim in the EOB panel and double click to open it. In the EOB Advice window, click Print and then select the Process icon. Staple this printout to the DB1N and shred the Assignment forms. For non $0 claims, these need to be managed as resubmissions. Refer to Resubmission process below Click ok to the following two confirmation prompts Tip: the column in the Exceptions panel of the EOB advice window displays a code relating to the card details for the exception line. When the line is selected, the code description is displayed in the footer. For example, the description 'Medicare issue number' appears in the footer for an exception with 'I' showing in the column. Note: if payments from a payer have not been allocated to a specific batch, they will appear as unmatched in the top right hand corner of the Payment window for the payer. Follow the normal procedure to allocate these amounts. Note: The symbol in the exception line indicates that the exception has already been dealt with. This is set automatically when the exception is processed by following one of the methods described below, or when the exception is only warning about a Medicare number expiry, however, it can be set or unset manually by selecting the relevant exception line and clicking, or by double-clicking on the column. Page 22 of 28 FPQ Profile Finance Manual 1/21/14

25 Process EFT s The EFT tab shows the payments that Medicare Australia has paid into your bank account, when they were paid and what batches they were for. In the EFT tab, highlight the claim to be processed and double click to open. Select Print and then Close. Staple the Batch Statement Info printout to the EOB and DB1N forms In the EFT tab, highlight the claim again and click on the green tick and then on the green arrow to process the claim. Refresh this screen after each EFT claim has been processed (F5) Complete this process for each of the claims. In the Outstanding Claims window you should see the batch and batch number and the status of the claim If Status is ACCEPTED the claim has been sent and received by Medicare Status Definitions: File This batch needs to be signed and sent Created The batch has been created it needs to be signed and sent. Signed The batch has been created and signed, it now needs to be sent. Sent The claim has been sent on our end but Medicare has not confirmed receipt as they may not have it at their end. Accepted Medicare have received the claim and sent an auto response but have not yet attended to it. Received Medicare have got it. Processing Medicare are looking at the batch. When transmitting for new providers for the first time call the Medicare e-business Service Centre to confirm they have received your claim. Ph Page 23 of 28 FPQ Profile Finance Manual 1/21/14

26 Processing Exceptions Note: a symbol in the exception line, indicates that the exception has already been dealt with. This is set automatically when the exception is processed by following one of the methods described below, or when the exception is only warning about a Medicare number expiry, however, it can be set or unset manually by selecting the relevant exception line and clicking, or by double-clicking on the column. if... the amount allowed is less than the amount claimed, and you think Medicare is not going to pay for the difference the amount allowed is less than the amount claimed, and you want to resubmit the claim the amount allowed is more than the amount claimed (the difference is a negative amount) then... in the EOB Advice window, select the line click on Write-Off Select the appropriate journal annotation, for example MA - Medicare Adjustment. Go OK in the Credit Journal vs Income for the payer, enter relevant text in the Annotation field, if applicable and click OK in the EOB Advice window, select the line click on Resubmit Note: See Resubmit electronic claim for more information about resubmitting. select the line click on Credit-Off in the Credit-Off window select the appropriate journal annotation, for example MA - Medicare Adjustment and click OK in the Debit Journal vs Income window for the payer, enter relevant text in the Annotation field, if applicable and click OK. Tip: the column in the Exceptions panel of the EOB advice window displays a code relating to the card details for the exception line. When the line is selected, the code description is displayed in the footer. For example, the description 'Medicare issue number' appears in the footer for an exception with 'I' showing in the column. Note: if payments from a payer have not been allocated to a specific batch, they will appear as unmatched in the top right hand corner of the Payment window for the payer. Follow the normal procedure to allocate these amounts. Page 24 of 28 FPQ Profile Finance Manual 1/21/14

27 Resubmit electronic claim This procedure describes how to resubmit a rejected claim. Go to Organisation/Control Centre/Claims In the Open EOBs panel, double-click on the claim you wish to resubmit. The EOB advice for claim window opens. In the Exceptions area, select the invoice you wish to resubmit. Click on the Resubmit button or right-click and select Resubmit from the pop-up menu. The Credit Invoice Authorisation window comes up. Enter your password and edit the text in Reason field, if required and click ok The Invoice (Resubmission) window appears. If no changes need to be made, click on Pay Later. Go to Financial/Batch Claims/Validate on the menu bar. In the Select Provider or POS window, enter the appropriate criteria and click OK In the Batch Claim Validation window, check the invoice line that you with to resubmit. Click on the Validate button, or right-click and select Validate from the pop-up menu. In the Bulk Invoice Validation Authorisation window, enter your password and click OK. Go to Financial/Batch Claims /Create on the menu bar and submit the claim again. Page 25 of 28 FPQ Profile Finance Manual 1/21/14

28 Send a client claim to Medicare This topic shows how to turn an invoice into a Medicare Client Claim. The Client must have registered their banking details with Medicare Create an invoice for the Client Ensure that: the Payer field is 'Client' the 2nd Payer field is 'Medicare' the Provider and POS fields are correct in the invoice line, the service code, description, and rate are correct Click Pay Now. The Payment window will appear. Ensure that: the correct payment method is selected in the as field the correct provider is entered in the Paid to field Match the payment to the relevant invoice by clicking the column in the invoice row. Click OK. The Process Client Claim window appears. Ensure that: the client and provider details are correct the items in the 'Payment' panel, if required, are entered correctly the box is ticked for Send the claim in the Interactive (Real Time) mode Click Send. Note: Once the claim is sent, Profile will print the lodgement advice. Page 26 of 28 FPQ Profile Finance Manual 1/21/14

29 Changing fees and item prices Business Rules: Only one designated person will have the ability to change item prices or fees A change record will be kept by the designated person to document any changes made and the date thereof From Maintain/Services, enter the name of the service/item you want to change and select from the list if offered The item will open on the General tab. Click on the Financial tab Click on the Financial tab Make changes to charge rates or discount rates by highlighting the existing rate, making the change and clicking Change to save Page 27 of 28 FPQ Profile Finance Manual 1/21/14

30 Add a new rate by selecting the cost code in the field and entering the amount. The Add button will become available for you to save the new rate. The following Charge rates and Discount rates are available for selection. If you require more to be available, please contact EHMS Super User Tips and FAQ Support Support will be provided by the designated Super User for your clinic. If the Super User is unable to resolve an issue, the Super User will contact TMML by ing the TMML Support at ehms@tmml.com.au If the issue is related to connectivity (you cannot get onto the webpage with the FPQ Production icon, contact your IT department. Your IT department will check connectivity at FPQ, and they will phone TMML on if they are unable to resolve the issue Invoice does not display the services performed by the clinician Prior to ending a consultation with a client, the clinician will add the services they performed to the CEF, which will display on the invoice. If the invoice does not prepopulate with the services, it could be because: 1. The clinician did not add any services during the encounter 2. The clinician did not tick the Bill the Service and Force onto next invoice tick boxes To resolve, either ask the clinician to edit the encounter to fix the above problem/s or enter the services manually onto the invoice. Page 28 of 28 FPQ Profile Finance Manual 1/21/14