Practice Management/Billing V3B1 – Part 1, Claims

4010 Moorpark Avenue, Suite 222 San Jose, CA 95117

www.prognocis.com training@bizmaticsinc.com Copyright 2014 – Bizmatics, Inc.

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presentation

• User Interface Skin, Navigation, and Scalability • Login/Splash screen • Menu Tabs

• CMS-1500 02/12 • I-button Changes • Work Comp/Accident Claim logic • Claim Encounter Type • Billing Filters Master Setup & New Filters • IMO Search

• SNOMED-CT Codes • ICD-10 ready

• CCI Edits • Customizable Search Screens (Unprocessed Claims) • Patient Alert Settings

v3b1 – effective March 2014

PROMINENT FEATURES

PrognoCIS Login Screen

v3

v2

Multi-browsers supported e.g.: IE

v8 & higher, Safari (Mac & iPad)

Limitations w/Google Chrome (3rd

level pop-ups, editing templates at

encounter level, etc.)

GUI scalable/resizable per multiple

screen resolutions. (For IE users only

property prognocis.resize.applicable

can be set to N to disable it.)

If resized < than 1024 x 768, viewing

area will be reduced

PrognoCIS Login Screen Scrolling billboards to communicate events, news, features, training, etc.

Social Media links (Facebook, Linked-In, Twitter)

Quick links to Browser Settings, Contact Support, & Training Schedule/Webinar Registration page

Scrolling FYI Billboards (up to 3)

Social Media

Webinar Schedule & Registration

Client Resources

Browser Settings

System Skin & Navigation

Upper Left

icon replaces Home tab

icons replace Back / Forward icons; repositioned to the upper left

Upper Right

Icons are redesigned

v3

v2

User Training

issue

Redesigned Icons System Tray

provides a direct link to new version Release Notes

allows user to toggle between EMR & Billing modules per Role designation/property

invokes patient search to open selected patient’s account

allows user to compose a message within PrognoCIS to another user or patient chart

indicates the user has pending system alerts/notifications in the Inbox

opens the Client Resource Center

launches system Help Index per alphabetical TOC

displays System About details

locks current session for the current logged-in user

logs out/exits the system

Patient-level Icons

Case Management

Patient Alerts

Patient Notes

Secure Messaging (N2N)

PM/Billing Menu Tabs • Menu tabs and sub-menus remain accessible via vertical, drop-down menus • The overall look and feel is more contemporary and now reflects EMR side • Sub-menus are identified by the instead of the • No new menu options on claims side

v3

v2

Home Page

• The OpeEob # hyperlink now includes/displays patient name w/claim details

• Location button now enabled to allow for user to filter visits on Home Page by specific location (same as already available for providers)

Claim(s) left open in Single-Claim

Edit mode

CMS-1500 02/12 – The Conversion

• Though form supports ICD-10 now, for first six months, ICD-9 will still be submitted

• Prior to conversion, we recommend you hold the last week’s claims so you are able to send them on the correct (new) form

• After April 1, 2014, CMS-1500 08/05 will no longer be accepted at all

• After Oct. 1, 2014, ICD-9 will still be valid for Dates of Service prior to Sep. 30, 2014 while only ICD-10 will be acceptable for Dates of Service after Oct. 1, 2014 Note: As of April 2014, this timeline has been pushed forward to calendar year 2015.

• Post-conversion, any current custom 1500 forms (payer-specific) will be cleared from payer master, as only the new form will be accepted. If payers need custom forms still, they will be handled case-by-case.

https://resourcecenter.prognocis.com/wp-admin/pdf/pdf-d51c89-CMS1500%2002-12%20Compatibility%20in%20PrognoCIS%20v3b1.pdf

Conversion Alerts:

CMS-1500 02/12 – The Template • Custom CMS-1500 templates should be removed prior to submitting claims after April 1,

2014 (at the payer level, as applicable) • Run Report Tabular List of Insurances with Customized CMS1500 Template (ID TCMS301) • Select the applicable insurance • If CMS1500 is populated, press the Clear link to reset to system default • If payers require customizations after April 1, they will be handled case-by-case

• New default Template Names • billing.use.cms1500.ver.0212 • billing.cms1500.ver.0212.templatename • billing.sec.cms1500.ver.0212.templatename • billing.sec.cms1500.ver.0212.templatename

Settings Configuration Vendors Insurance

Conversion Alert: Existing CMS_1500 templates will be inactivated

and replaced with new standard ones.

Custom pre-printed issues to Billing

Tech Support

CMS-1500 02/12 – The Comparison

v3 v2

Effective April 1, 2014

CMS-1500 02/12 – The Form

Effective April 1, 2014

• New form can be purchased from Amazon* • Identified by the header (upper left corner)

• “QR-code” – smart phone compatible

• …and the footer (lower right corner)

*http://www.amazon.com/CMS-1500-Revised-Claim-Form-forms/dp/B00BZ6NHUI/ref=sr_1_7?ie+UTF8&qid=1373045492&sr=8-7&keywords=version+1500+Claim

*Please Note: Alignments of pre-printed forms may

vary per manufacturer.

CMS-1500 02/12 – The Changes

Effective April 1, 2014*

http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02.pdf

• Cell 8 – Patient Status removed* • Cell 9b – Other Insured DOB removed* • Cell 9c – Employer/School Name removed* • Cell 10d – New name/data • Cell 11b – New name/data • Cell 14 – Qualifiers now included w/dates • Cell 15 – New name/data • Cell 17 – Qualifier now included w/provider • Cell 17a – Referring Provider Other ID • Cell 21 – New field for ICD Indicator + now

allows up to 12 ICD Codes & alpha pointers^ • Cell 24E – DX pointer now A-L (not 1-4) • Cell 24H – Reason code for EPSDT service • Cell 24I – Qualifiers now included w/number • Cell 24J – Accepts additional ID for the

Rendering Provider (as per insurance need) • Cell 30 – Balance Due removed*

*Cells where previous requirement is now removed have been renamed as “For NUCC Use”

CMS-1500 02/12 – Cells 8 and 9

Revisions to the Cells • Cell 8 Reserved for NUCC Use – formerly Patient Status • Cell 9b Reserved for NUCC Use – formerly Other Insured DOB • Cell 9c Reserved for NUCC Use – formerly Employer/School Name

v3 v2

No data-entry required in PrognoCIS.

New Labels; Discontinued

1

1

CMS-1500 02/12 – Cell 10d v3 v2

• Required for Work Comp as applicable • Entered via the button on the claim • See www.nucc.org Code Sets for complete list.

New field name

Revision to the Cell • Cell 10d Claim Codes (Designated by NUCC) – formerly Reserved for Local Use

• Required as applicable per payer-specific requirements to identify details of the patient’s condition

1

User Training

issue

v3 v2

CMS-1500 02/12 – Cell 11b

Revisions to the Cells • Applicable when a payer requires a secondary identifier on a claim • Qualifier is now required to indicate which ID code is being reported

• Y4 – Property Casualty Claim Number

• New property* allows user to define which ID in PrognoCIS will be reported in this cell • Patient Insurance Group Number (current default, V2) • Case Number (for those using Case Management screen) • Subscriber ID (for those who do not require a second identifier that is unique)

• Required for Workers Comp and Property & Casualty claims

*billing.accidentclaim.otherclaimid.from

New field name

CMS-1500 02/12 – Cell 14

Revision to the Cell • Cell 14 Date of Current Illness, Injury, or Pregnancy – formerly Date was sufficient by itself

• Qualifier is now required to dictate what service the Date represents • 431 – Onset of current symptoms/illness • 484 – Last Menstrual Period

• Date format can be 6 digits (MM|DD|YY) or 8 digits (MM|DD|CCYY) • Date must represent 1st date the illness was onset or injury occurred and for pregnancy

related claims, the date must be LMP (qualifier 484)

v3 v2

New field labeling

CMS-1500 02/12 – Cell 15

Revision to the Cell • Cell 15 Other Date - formerly If Patient Has Had Same or Similar Illness, Give First Date was suffice

• Qualifier is now required to indicate what Other Condition/Service the Date represents • 454 – Initial Treatment • 304 – Latest Visit or Consultation • 453 – Acute Manifestation of Chronic condition • 439 – Accident • 455 – Last X-ray

• Date format can be 6 digits (MM|DD|YY) or 8 digits (MM|DD|CCYY)

v3 v2

• 471 – Prescription • 090 – Report Start (Assumed Care Date) • 091 – Report End (Relinquished Care Date) • 444 – 1st visit or consultation

New field name

Revisions to the Cells • Cell 17 Referring Provide or Other Source – remains the same-referring source name & credentials

• Qualifier now required to define the provider’s (non-NPI) credentials • if multiple providers are involved, use the following priority order:

• DN – Referring Provider • DK – Ordering Provider • DQ – Supervising Provider

• Cell 17a Referring Provider Other ID (non-NPI) • 0B – State license number • 1G – Provider UPIN • G2 – Provider Commercial Number • LU – Location Number (Supervising Provider only)

CMS-1500 02/12 – Cells 17, 17a v3 v2

FYI Alert! • If not already, be sure to start capturing credentials

for Settings Configuration Refer Docs • 17b is always the NPI number of the provider

Revisions to the Cells • Cell 21 Diagnosis or Nature of Illness or Injury – remains the same as for the data/purpose

• ICD Indicator (new segment of this cell to accommodate version of ICD code reported) • 9 is valid prior to October 1, 2015 to indicate ICD-9 Codes reported • 0 is valid after October 1, 2015* when ICD-10 Codes are reported

• Now accommodates up to 12 individual ICD Codes; pointers A-L replace former 1-4

CMS-1500 02/12 – Cell 21 v3 v2

Multi-page CMS claims • Based solely upon number of charge rows (if > 6, a second page will print)

• All ICDs (up to 12) will thus print on all pages as applicable

CMS-1500 02/12 – Cells 24 & 30 v3 v2

• LU – Location number of Supervising Provider • ZZ – Provider Taxonomy code

C

Revisions to the Cells • Cell 24E Diagnosis Pointer – remains the same as for the purpose; however, the values are

changed as per ICD-10 requirements; codes now A-L rather than 1-4 • Cell 24H EPSDT reason code – 2-digit reason code right-justified in the shaded area or 24H • Cell 24I Rendering Provider ID Qualifier (if reporting non-NPI)

• 0B – State license number • 1G – UPIN • G2 – Provider commercial number

• Cell 24J Rendering Provider ID Number – accepts a secondary ID number for rendering provider as per insurance company specific requirement (in shaded area of the cell) along with NPI

• Cell 30 Reserved for NUCC Use – formerly Balance Due

I – Button Changes • Last Seen/Supervising Doc formerly Last Seen by Doc • Pri Resubmission Code former Send to Prof Primary

• Corrected has been removed from the pick-list, as it is no longer valid w/CMS-1500 02/12 • Send to Prof Secondary field has been removed, as its function is combined into Pri Resubmission Code

• Claim Codes replaces Cell 10d (which remains in-tact for claims prior to 4/1/2014 on old CMS-1500 08/05) • EPSDT Indicator used to be required only at the charge row level (cell 24H, via CMS Flag)

• Now required at the claim level in the shaded area of cell 24H when applicable

• Employer has been added and is applicable for Employer Billing and Work Comp claims • When part of an assigned case, this field will be disabled and cannot be changed • Defaults initially from Patient Register but is locked to a claim one Billed in case employer changes in future

• Other Claim ID has been added & is applicable for Work Comp (cell 11b) • Cell 10D (Old CMS) remains for old CMS claims only, as it is replaced with new Claim Codes field • Claim’s Encounter Type has been added and lists all valid (i.e.: > 0 minute) encounter types

v3 v2

I – Button – EPSDT Reason Code (24H-shaded) • EPSDT Indicator is required on i-button when also used at charge row level under CMS Flag ( )

Claims Edit I-button & Claim Page Charge Row CMS Flag

If 24H applies to the charge row (white space)

…EPSDT Reason Code applies to shaded space.

http://www.nucc.org/images/stories/PDF/claim_form_manual_v9-0_7-13.pdf

Claim Encounter Type • Link an encounter type to the claim • Creates a “DB” encounter (Dummy Bill) that does

not show in EMR at all • Billing Home Page display:

• Visit Type = reflect actual Encounter Type • V2, this defaulted as Claim New for all (“DB”)

• Visit Status = Done (never changes) • Bill Status = per scenario (same as all)

Claims New or Claim I-button

v3

v2

Encounter Type Setup

Settings a Configuration a Clinic a Enc Types *Works in conjunction w/billing.splcode.noshow & .appointment.mark.noshow.afterdays

• Don’t Bill No Show check box* – allows clinic to specify encounter types that will not auto-generate a Penalty Invoice (i.e.: No-show claim) when an appointment is flagged as a No-show.

Select this option for any encounters you do not

want to bill for No Shows

Billing Filters

Settings Configuration Workflow Billing Filter Setup

Billing Filter Setup Master

New Billing Filters

Set which filters will be available within individual search screens & report filters

To suppress a filter as an option, select it in the master file & it will not be in the icon

• Filter icon ( ) lets user create custom lists • Defined filters can be saved & used again • Active (applied) filter displays green: • New filters added: Claim Encounter Type,

Collection Agency, Assign To • Rendering Doctor filter now includes Org

Type providers

The Claim Page

Claims Edit or Home Page .

v3

Filters new options

I-button changes

Injury button changes

v2

ICD display and selection

New IMO Search option

New Ready to Send edits

Injury Button Place of Accident changed to State of Accident pick list

Case Management and Injury button are bi-directional

Exception ICD codes can now be defined by range in

applicable property* as a hyphenated grouping

^billing.accident.templatename *billing.injury.exception.dxcodes

Bi-directional data

Injury and Illness Details specialty template will

always map to Injury button even if it is Inactive

This is the original alternative to Case Management

Check box now independent of Enc Type per

Defined As

Workers Comp Insurance • New properties to govern proper behavior as per requirements both CMS-1500 and EDI

• Defined As must = WorkerComp • Relation must = Employer

• Employer None means that an employer has not been selected from the Employer Master.

• Employer Name initially pulls from Patient Register and is locked to the claim once it is Billed.

1. I-button must show Employer as per Work Comp check box on main claim page

2. Default value will be set to Yes* during conversion & can be reverted to No on a case-by-case basis per need

3. Address is mandatory for W/Comp. Some states (TX for instance) requires it be the Employer address. If n/a, patient’s address will be sent instead.

Patient Insurance Defined As WorkComp

Workers Comp Claims (cont’d) • New edits on Ready to Send as per properties and requirements • Employer address will go by default; however, if none is present, then the patient’s address will go

in its place (because address is a required field to be populated)

• Above properties may not have to be set this way if they are using P2P

• When filing a duplicate claim or appeal, appropriate Condition Code is required in cell 10d (see I-Button Changes noted above) along with the original Reference Number in cell 22

New Case reflects current employer.

Case Management Employer

Current Employer has changed since

Last DOS

Saved Case retains original employer.

Patient Employer remains default for new

cases & for claims (Work Comp)

Previously saved cases & claims will not be

modified to refresh new employer

Patient Register Case Management

New Case reflects current employer.

Case # takes priority for employer and

insurance when applicable

Case Management

Claims ICD Codes ICD Table

Supports up to 12 ICD codes as per property*(to mirror EDI requirements)

Pointers are now alphabetical (A – L) rather than numerical (1-4)

Displays ICD-9 & -10; no longer permits data-entry of the code directly (must use Search icon )

ICD-10 code mapping included; only ICD-9 are currently in use pending CMS implementation

Data entry directly no longer allowed – you must use the binocular for assigning the pointer

Tooltip shows both ICD-9 & ICD-10 code as well as their common description

*Property: cms1500.max.icds ^ see Appendix A – IMO Search & SNOMED-CT Codes

v3 v2

v3 v2

IMO Search Tabs • Preferred tab displays pre-populated with applicable “Pref Lists” • All tab auto-invokes a universal, alpha-numeric search of all fields (descriptions and codes) regardless where the string occurs. (Resides outside of PrognoCIS.) • Custom tab displays a separate list of locally-defined codes within standard ICD Master (in V2,

these were included in the All search; in V3, they are still resident within ICD Master.)

Only available for providers

Only available for providers

v2

v3

Not mapped in V2; pre-educate self on ICD-10/SNOMED.

ICD and CPT/HCPC Searches Refer to Appendix A – IMO / SNOMED-CT Codes

User Navigation

Alert

IMO Search Screen • Includes mapping across all code types (i.e.: SNOMED-US, SNOMED-Int’l, ICD-9, and ICD-10) • ICD-10 are displayed; however, they are not in effect until October 1, 2015

ICD and CPT/HCPC Searches

Universal string search all codes and descriptions

Search is invoked automatically (w/o pressing ENTER key)

Individual string search by codes or

descriptions

v3

v2

Comprehensive : 64616/20552

Mutually Exclusive: A9500/A9512

*billing.cciedit.warning

• Charge and/or modifier combinations validated upon Save and/or Ready to Send status* • Rules are defined by CCI to ensure against billing for incorrect charge combinations • CCI edits are updated quarterly and are automatically embedded within PrognoCIS (no user UI)

CCI Edits (Correct Coding Initiatives) http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/How-To-Use-NCCI-Tools.pdf

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html?redirect=/NationalCorrectCodInitEd

Correcting Claims Already Generated (from EMR) • New property* introduces a new behavior when Assessment data has changed on EMR

side after the claim is created. • No longer have to delete the claim in Billing, go into EMR & re-open the encounter,

recreate the claim, then re-close the encounter • If claim is E (Entered) status, the modified data will auto-refresh and post on the claim • If claim is H status (On Hold), this feature is in not applicable

• If claim is B (Billed) or S (Ready to Send) status, the revisions will not auto-populate; however, the system will still prompt that changes have occurred so you can manually correct them.

• ICD Table A button • Charges Table EMR Codes button

*billing.encclose.repost.charge

Insurance Master Extra Info button

v3

v2

Additional fields for defining default

Qualifiers required at payer level

Flag payers who require Referral to

prompt front desk as needed

Insurance Master

See Patient Insurance at time of registration

• User can customize the search screen as to content, size, sort, etc. • Applicable properties, which will be added during V3 conversion:

• Claims.unprocessed.titles • Claims.unprocessed.widths • Claims.unprocessed.fieldcount

Unprocessed Claims – Custom UI

Claims Unprocessed

Icon to open claim replaces

hyperlink

• Claims.unprocessed.fields • Claims.unprocessed.sort

Requires PrognoCIS Administrative

assistance*

v3

v2

*showalert.for.menus – define which billing screen alert should auto-display for PM users ^facesheet.showalert.fortypes – determines whether alerts auto-display at all anywhere ^patient.alert.aeb.default – selects Appt, Enc, or Bill options by default for new alerts ~appointment.show.patientalert - applicable for EMR only when confirming appointments

Patient Alert • Patient level alerts are shared between PM/Billing and EMR • System-wide properties^ govern the enabling and behavior of patient alerts; while some properties

are specific to EMR~ or to Billing* only

• New to v3, specific for the PM/Billing side, you can now define what billing screen the alert* will auto-display upon screen load, e.g.: Claim, EOB, or Patient Account.

Etcetera… • Fee Schedule requirements once the PM/Billing module is enabled for the clinic:

• At least 1 fee schedule is required to be Active at all times • Encounter cannot be closed/claim cannot be created I no fee schedule is present

• Special Billing Codes (Group Types: BC) will now pull value only from Self Pay Fee Schedule; amount is no longer stored under Group Type record. This is applicable for No Shows, Bounced Checks, etc.

• CPT codes can now be assigned to Billing Groups, which behave as an Order Set/Panel for local use. Note: Applicable only for custom CPT Codes feeschedule.allow.nonstd.codes must = Y).

• For Employer Billing, if copay is collected, an error will display upon Ready to Send status • New edits based upon DOS = or after Jan. 1, 2014 per newly inactivated CPT/HCPC codes • When deleting a claim for a Dummy Encounter, it will no longer allow you to delete if there is a

Copay posted against it or if there is a supplementary claim for DMERC or UB04 • Global Alert messages text modified to now include DOS, Assigned ICDs, and Rendering Doctor

along with the CPT that is in the global period • For Puerto Rico clients, provision made for applicable clearinghouses (e.g.: Assertus and Inmediata)

• 3-digit payer IDs • 837 modifications (suppress ISA02 and ISA04; include Billing Provider # in segment GS02)

• Tertiary payers now validated by DOS per Expiration Date & can also be changed even if Billed status via Ter hyperlink. In addition, it cannot be deleted if it is part of posted claim.

• Changes made for 837/EDI support (Loop 2330BREF sends primary payer pre-auth and payer name in SEC-EDI claims and will be suppressed from 2300REF with SEC Ins name)

• 837 EDI creation can now use Business Unit code as prefix for the generated file (ref: Tracking notes)

IMO (Intelligent Medical Object) – a privately-held company staffed with groups of physicians who

specialize in developing, managing, and licensing medical vocabularies through EMR interfacing.

Home Page: https://www.e-imo.com

Partners Page: https://www.e-imo.com/partners#ERM-Partners

SNOMED-CT (Systematized Nomenclature of Medicine Clinical Terminology)

Recognized in the USA and internationally as a common language for communication amongst

medical providers of all specialties and Electronic Medical Records Systems (EMRS)

Improves accuracy of patient data analysis and increases quality of patient care

Reduces the barriers of specialty-specific boundaries which allows data to be universal

SNOMED-CT vs. ICD • Both are standardized and used within EHRs • SNOMED-CT is designed to capture/represent patient data for

clinical purposes during patient care while ICD is used for secondary purposes.

• ICD is designed to produce data for statistical analysis and reimbursement allocation.

• Though ICD-10 is included in this search, they are not being utilized as of v3b1 (March 2014)

http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20140222.pdf

Appendix A – IMO / SNOMED-CT Codes

• SNOMED-CT codes consist of 4 primary core components: • Concept Codes – numerical codes that identify clinical terms, organized into 19 hierarchies,

e.g.: • Body structure • Clinical finding • Environment or geographical location • Event • Linkage concept • Observable entity • Organism • Pharmaceutical/biologic product • Physical force • Physical object

• Descriptions – textual descriptions of the concept codes; multi-lingual. • Relationships – interactions between concept codes that have similar meaning • Reference Sets – groups of concepts or descriptions with cross-maps to other classifications

and standards (e.g.: ICD, HL7, etc.) • Reduces the barriers of specialty-specific boundaries which allows data to be universal

• Procedure • Qualifier value • Record artifact • Situation w/explicit context • Social context • Special concept • Specimen • Staging and scales • Substance

http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20140222.pdf

Assessment and PMH Searches

Appendix A – IMO / SNOMED-CT Codes (cont’d)

• Appointment History is now sorted by DOS and then by Edited Date (descending order)

All modifications for 1 appt are sorted by DOS

• Appointment Report can now reflect Case Management data per new appointment-level tags pulling structured data from Case Management table

Appointment History ) .

Appendix B – Patient Tab EMR

Feature

Address Tab:

New field for County/Parrish Code

Set No Preference as Primary Contact method

Decline to receive reminder preference (i.e.:

suppress patient from Patient Reminders List;

will be excluded from MU w/o penalty.)

Patient Registration patient.default.sex

Patient Details:

Provision to keep both Title and Sex fields blank by default per property* (e.g.: when adding a new

patient via Quick Register and the gender is unclear or unknown).

Appendix B – Patient Tab (cont’d) EMR

Feature

*Property rp.dob.mandatory

Billing Info Tab:

Labels in bold red font will inform when the patient has been handed over to Collection Agency

Disabled at patient level

Patient Insurance:

As per flag set in Insurance Master (payer-specific), Need Referral check box will be selected so

front desk knows to get a referral

Guarantor DOB now optional*

Enabled at patient level

Assigned at payer level

Appendix B – Patient Tab (cont’d) EMR

Feature

Insurance Master Import (FDB) • Import specific insurances via a UI rather than the former back-end process

• All insurances supported by a specific clearinghouse • State-specific insurances • Individual specific insurances

Internal Use only

Sugar a Assign: Sheena a Notify: Kumar

Remember…. 7-days advance notice of scheduled upgrade Browser settings may be impacted with any technical upgrade Temporary Internet Files/Cookies may have to be cleared Some features may require Administrator access to activate/modify Contact Technical Support for guidance

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