New York Workers Compensation Billing - C-4, MG-1 and MG-2

Transcription

1 New York Workers Compensation Billing - C-4, MG-1 and MG-2 The following are the New York Workers Compensation forms that Practice Manager allows you to fill out and print: C-4 Doctors Initial Report Use this form to report the first time you treated the claimant. To report continued treatment, use Form C-4.2. To report permanent impairment use Form C-4.3. C-4.2 Doctor s Progress Report Use this form to report continuing services. To report the first time you treated claimant use Form C-4. To report permanent impairment use Form C-4.3. C-4.3 Doctor s Report of MMI/Permanent Impairment Use this form when a patient has reached Maximum Medical Improvement and to render an opinion on permanent impairment, if any. To report the first time you treated the patient, use Form C-4. For continuing treatment, use Form C-4.2. C-4AUTH Attending Doctor s Request for Authorization and Carrier s Response - This form is used to confirm a telephone request for written authorization for special service(s) costing over $1,000 in a nonemergency situation. C-4AMR Ancillary Medical Report Use this form, as soon as possible, after ancillary treatment or services such as x-ray, pathology or diagnostic services are rendered. MG-1 Attending Doctor's Request for Optional Prior Approval and Carrier's/Employer's Response - Use this form to request confirmation from the Insurance Carrier that the procedure or test is based on a correct application of the Medical Treatment Guidelines. MG-2 Attending Doctor's Request for Approval of Variance and Carrier's Response Use this form to request testing or treatment that is outside or exceeds the Medical Treatment Guidelines. Prior to entering any NY Workers Compensation forms some setup is required. Use the following instructions to do the Provider and Patient setup. PROVIDER SETUP 1. Go to Administration Practice Tables Provider 2. Enter your Inhouse code for your provider or search for it by clicking the Lookup button, or pressing F3. 3. Click the Billing ID s button. 4. Click the New button and choose billing form WCPNY from the Billing Form drop down box. Fill the screen in as follows: Tax ID Number - Enter your Tax ID Number or Social Security Number SSN EIN - Enter EIN if you entered your Tax ID Number above or enter SSN if you entered your Social Security Number above. WCB Rating Code - Enter your WCB Rating Code. WCB Authorization Number Enter your WCB Authorization Number. 5. Click the Add to List button. 6. Click the Close button and then click the Save button. 7. Repeat the above steps for any all providers that bill NY Workers Compensation. Page 1

2 PATIENT SETUP When billing NY Workers Compensation claims for a patient, certain patient information must be configured for the system to properly bill these claims. Typically a new Workers Compensation (CMP) case is added to the patient's record to contain this information, and then, when adding charges, the CMP case is selected. If you would like to configure additional Workers Compensation case types you can go to Administration Code Tables Codes. Select Case Type and click the Maintain Code Table button to add additional Case Types. 1. On the Patient screen click the New Case button. 2. In the Type field select from the drop down box CMP Worker Comp. If additional Workers Compensation Case Types were entered select accordingly. 3. In the Open field enter the date that this Workers Compensation case record was opened for the patient. 4. In the Category field select NYW NY Workers Comp from the drop down menu. Please Note: If the Category is NOT set to NYW when saving a Workers Compensation charge the Additional Forms window will not be displayed. Also when you click the Forms button none of the C-4 forms will be visible in the Forms drop down box. 5. In the Onset Type field select from the drop down box the code that best describes the reason the patient originally required medical attention. 6. In the Onset Date field enter the date that the patient s condition first occurred. 7. Enter any other Case information as needed. 8. Enter any other Insurance information as needed. Please Note: The WCB Case Number can go into the Policy Number field and the Carrier Case Number can go into the Group Number field. After the setup is complete use the following instructions for adding charges, editing\printing a C-4 form for a patient, printing a batch of C-4 forms and reprinting a batch of C-4 forms. Page 2

3 ADDING CHARGES Be sure to select the case for which charges should be applied (The case having NYW as the Category). After all charges are entered in for the patient and you click the Save button the Additional Forms window will be displayed (if this screen is not displayed than the case category is not set to NYW and the charges entered will not be linked to any of the C-4 forms. Please refer to the Patient Setup section above.) On the Additional Forms screen you will choose the appropriate C-4 form by clicking the Form drop down box. The C-4 ~ Doctors Initial Report is the default C-4 form. Once you have chosen the form you want to fill out for this patient, click or tab into the fields and enter the Workers Comp information as needed. If on another encounter you have already filled out this form for this patient you can click the Get Last button. The system will enter the data as it was entered for that form and that encounter. Please Note: In fields where there is a drop down box you are able to use your up and down arrow keys on your keyboard to choose the appropriate option. The screen will auto scroll as you tab through the form. Provider field The program will use the Servicing Provider from the charge (encounter) for the Doctor s Information section of the C-4 forms unless a different provider is specified in this field. At the bottom of each C-4 form there is a Print Later check box which is automatically selected; this indicates to the system that you wish to print this form later from a batch. As charges are entered with this selected they are continuously added to the batch. For information about printing batches please see the section titled Printing a Batch of C-4 Forms. If you deselect the Print Later check box, the charge will not be added to the batch. When you are done entering the Workers Comp information, click the Save button. If you don t want to save any Workers Comp information you entered you can click the Cancel button. Page 3

4 It is not necessary to complete the whole form at this time. You can click the Cancel button and enter the Workers Comp information at a later time or partially fill out the form and click the Save button to save what you entered. For information on editing and\or printing a C-4 form see the section titled Editing\Printing a C-4 Form for a Patient. Until you print either a batch of claims or print the claims individually, these claims will not be marked as billed. The claims will not be billed using the Insurance Billing or Patient billing tab. When the charge is entered, Defer Ins Bill and Defer Pat Bill are checked automatically. Instead the charge is billed when the C-4 form is printed. You can only have one C-4 form (excluding the C-4AUTH, MG-1 and MG-2) filled out per encounter. If you select another C-4 form (excluding the C-4AUTH) from the Form drop down box you will get the following message: If you click OK any data from the previous form that you may have entered will be lost and you will be taken to the form you chose to fill out. If you click Cancel you will be returned to the previous form you were on before you chose another form from the Form drop down box. If you accidentally clicked OK then you can click the Cancel button at the bottom of the Additional Forms window and your data will not be lost. Please Note: A C-4, C-4.2, C4.3 or C-4AMR must be filled out along with the C-4AUTH, MG-1 or MG-2 form. The C-4AUTH, MG-1 and MG-2 don t contain a Billing Information area so if this form is the only one attached to the encounter the system will set a billed date for those claims even though they didn t print on the form. EDITING\PRINTING A C-4 FORM FOR A PATIENT 1. Click the Charge Tab. 2. Click the Review Charges Tab. 3. In the Account # field, enter the patient s account number, or search for it by clicking the Lookup button, or pressing F3. 4. Double-click the Date of Service that you want to print a C-4, C-4.2, C-4.3, C-4AMR, C-4AUTH, MG-1 or MG-2 Form for and click the Edit button. 5. Click the Forms button and from the Form drop down box chose the applicable C-4 Form you want to print. Please be mindful of the following message if it s unknown what C-4 Form was filled out for this patient: For example: If you filled out the C-4.2 form and you choose the C-4 form from the Form drop down box you will get this message. If you click OK your C-4.2 will be lost and you will be taken to the C-4 form. If you click Cancel you will be returned to the CMS-849 form (first form in Form drop down list) where you can click on the Form drop down box again and choose the C-4.2. If you accidentally clicked OK then you can click the Cancel button at the bottom of the Additional Forms window and your data will not be lost. Page 4

5 6. Click the Save button once you have made any applicable changes to the form as needed. Then click the Save button to save the charge. This must be done before printing the form. 7. To print this C-4 form double click the date of service, click the Forms button at the bottom of the Edit a Charge screen and from the Form drop down box chose the applicable C-4 form you want to print then click the Print button. 8. In the Printer section of the NY Worker s Compensation Report screen place a checkmark in the Print HP-1 Form checkbox if you would like to print a HP-1 along with your C-4 Form. This form is required if requesting for a decision on unpaid bills. 9. In the Report Criteria section, the Reset Bill Dates on Charge option can be checked as needed. If checked it will reset the Date Billed to the current date. If not checked the Date Billed will stay the date the charge was first billed however in Billing History it will show that a C-4 form was printed. 10. In the Copies section, select the Number of copies you wish to print and select the proper paper format. Please Note: The paper format will default to the C-4 form you have filled out for this patient. Please Note: If you choose C-4AMR, C-4, C-4.2 or C-4.3 you will only get one Date of Service (Encounter) per C-4 Form. If you choose C-4AMR by case, C-4 by case, C-4.2 by case or C-4.3 by case multiple Dates of Service (Encounters) will print on the C-4 Form. The C-4 forms will print on plain paper. The system no longer has an option to print on pre-printed C-4 forms. 11. In the Billing field, select Billing Provider or Practice. This applies to the Billing Address in the Doctors Information section on the C-4 forms. If you chose Billing Provider the Billing Provider s address will print, if you chose Practice the Practice s address will print. 12. Click the OK button to print the C-4 Form for the patient. Please note: A C-4.1 (Continuation to Carrier\Employer Billing Portion) form will print when more than six dates of service must be shown in the billing portion of Form C-4, C-4.2 and C-4.3. A MG-1.1 (Continuation to form MG-1) form will print when more than one Treatment\Procedure is requested and an MG-2.1 (Continuation to form MG-2) form will print when more than approval is requested. Page 5

6 PRINTING A BATCH OF C-4 FORMS As described earlier, claims that are saved with the Print Later option selected will be added to a batch for printing. The batch consists of all charges entered since the last time the batch was printed. Printing the batch clears out the claims so newly entered claims will be included in the batch. Even though claims will clear out of this batch when it is printed, you can still print them individually, see the section titled Editing\Printing a C-4 Form for a Patient or reprint a batch, see the section titled Reprinting a Batch of C-4 Forms. 1. Click Add-Ins NY Workers Compensation Batch Print. 2. In the Report Criteria section of the NY Worker s Compensation Report screen, the For Operator pcadmin only and Reset Bill Dates on Charge options can be checked as needed. If For Operator pcadmin only is checked it will print C-4 forms only for the operator pcadmin. If Reset Bill Date on Charge is checked it will reset the Date Billed to the current date. If not checked the Date Billed will stay the date the charge was first billed however in Billing History it will show that a C-4 form was printed. You can also change the Batch Name if desired. 3. In the Copies section, select the Number of copies you wish to print. Select NYW from the drop down box and select the proper paper format (ALL Forms or ALL Forms by case). Please Note: If you choose ALL Forms you will only get one Date of Service (Encounter) per C-4 Form. If you choose ALL Forms by case multiple Dates of Service (Encounters) will print on the C-4 Form. The C-4 forms will print on plain paper. The system no longer has an option to print on pre-printed C-4 forms. 4. In the Billing field, select Billing Provider or Practice. This applies to the Billing Address in the Doctors Information section on the C-4 forms. If you chose Billing Provider the Billing Provider s address will print, if you chose Practice the Practice s address will print. 5. Click the Listing button to view and\or print a report of all claims included in the batch. To print, click the printer icon and click the OK button. To close out of the report click the X in the upper right corner of the window. 6. Click the OK button to print the batch of C-4 forms. Please note: A C-4.1 form (a Continuation to Carrier\Employer Billing Portion) will print when more than six dates of service must be shown in the billing portion of Form C-4, C-4.2 and C4.3. A MG-1.1 (Continuation to form MG-1) form will print when more than one Treatment\Procedure is requested and an MG-2.1 (Continuation to form MG-2) form will print when more than approval is requested. Page 6

7 REPRINTING A BATCH OF C-4 FORMS Use the following steps to reprint a batch of C-4 Forms. 1. Click Add-Ins NY Workers Compensation Reprint Batch. 2. In the Report Criteria section of the NY Worker s Compensation Report screen, select from the drop down list the batch you wish to reprint. 3. In the Copies section, select the Number of copies you wish to print. Select NYW from the drop down box and select the proper paper format (ALL Forms or ALL Forms by case). Please Note: If you choose ALL Forms you will only get one Date of Service (Encounter) per C-4 Form. If you choose ALL Forms by case multiple Dates of Service (Encounters) will print on the C-4 Form. The C-4 forms will print on plain paper. The system no longer has an option to print on pre-printed C-4 forms. 4. In the Billing field, select Billing Provider or Practice. This applies to the Billing Address in the Doctors Information section on the C-4 forms. If you chose Billing Provider the Billing Provider s address will print, if you chose Practice the Practice s address will print. 5. Click the Listing button to view and\or print a report of all claims included in the batch. To print, click the printer icon and click the OK button. To close out of the report click the X in the upper right corner of the window. 6. Click the OK button to print the batch of C-4 forms. Please note: A C-4.1 form (a Continuation to Carrier\Employer Billing Portion) will print when more than six dates of service must be shown in the billing portion of Form C-4, C-4.2 and C4.3. A MG-1.1 (Continuation to form MG-1) form will print when more than one Treatment\Procedure is requested and an MG-2.1 (Continuation to form MG-2) form will print when more than approval is requested. Page 7

8 PRINTING AN OLD C-4AUTH FORM The C-4AUTH form was updated to include the Medical Treatment Guidelines in January, If a C-4AUTH that was dated prior to January, 2011 was filled out for this patient and you need to reprint the form use the following steps to do so. 1. Click the Charge Tab. 2. Click the Review Charges Tab. 3. In the Account # field, enter the patient s account number, or search for it by clicking the Lookup button, or pressing F3. 4. Double-click the Date of Service that you want to print an old C-4AUTH form for and click the Edit button. 5. Click the Forms button and from the Form drop down box chose OLD C-4AUTH Request for Authorization. 6. Click the Print button. 7. Click the OK button to print the old C-4AUTH form for the patient. PRINTING AN OLD C-4 FORM 1. Click Add-Ins NY Workers Compensation Worker Comp Forms. 2. In the Account # field, enter the patient s account number, or search for it by clicking the Lookup button, or pressing F3. 3. Double-click the Date of Service that you want to print an old C-4 Form for. 4. Click the Print button. 5. In the Report Criteria section of the NY Worker s Compensation Report screen, the Reset Bill Dates on Charge option can be checked as needed. If checked it will reset the Date Billed to the current date. If not checked the Date Billed will stay the date the charge was first billed however in Billing History it will show that a C-4 form was printed. 6. In the Copies section, select NYW. Also select the proper Paper format (Plain Paper Form or Plain Paper Form by Case. If you will be printing to a Preprinted C-4 form choose Preprinted Form or Preprinted Form by Case.). Please Note: If you choose Plain Paper Form you will only get one Date of Service (Encounter) per C-4 Form. If you choose Plain Paper Form by Case multiple Dates of Service (Encounters) will print on the C-4 Form. 7. In the Billing field, select Billing Provider or Practice (determines what will print in Box 23 of the C-4 form). 8. Click the OK button to print the old C-4 Form for the patient. Page 8