Cases Karen J. Kuhn Revenue Cycle Management Consultant.
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Transcript of Cases Karen J. Kuhn Revenue Cycle Management Consultant.
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Cases
Karen J. Kuhn
Revenue Cycle Management Consultant
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Using, building, managing, attaching and maintaining cases to streamline billing.
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Objectives of this Session
• Assess when cases should be used• Learn how to build cases• Maintaining Cases• Closing Cases• Setting up patient accounts with
multiple cases• Case building within your workflow• When cases go wrong…
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Assess the Need for Cases• Multiples Lines of Business
– Medical– Dental– Mental Health– Any other Specialty Care– Workers Compensation– Third Party Liability (TPL) such as auto
accidents– Inbound authorizations– Visit Limitations– Outcomes of OB Care for UDS reporting
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Multiple Primary Insurances
• Any time your medical insurance differs from the insurance for another service
• Leave the Medical Insurances active on the Patient Registration
• Specialty insurances are inactive on the Patient registration
• Handle the other insurances within the appropriate case
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Registration Examples
• In the Patient registration only payors for Medical services are active
• Dental is not active on registration, but is in the case.
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Specialty insurances are Inactive in the Patient
Registration
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Who Builds the Case?
1. Registration
2. Scheduling
3. Front Desk
4. Billing
Once a case is built it should be attached at scheduling to all appropriate visits.
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Case Building – Naming Conventions
• Naming convention is important• Make a policy for name creation based on
your CHC• Suggested Info to Include
Line of Business Insurance Carrier Date of Injury or Delivery Injured Body PartExamples: Dental DentaQuest, OB Aetna EDD 4/2015, Dental SFS B, WC SIF 4/24/15 R arm, MVA Geico 1/1/15 Neck
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Building a Case
• From within Registration: Edit, Case Management…
• Click New
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• Name the Case
• Activate the correct carrier(s) in Insurance tab
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• Make sure Allocation Set and Financial Class are set correctly on the Visit Info tab within the case
• Say OK • This is the basic case set up
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Case Information overrides patient registration
information
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Attach the Case – Patient Registration
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Attach the Case - Scheduling
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Attaching Cases to the Visit
From the Billing Component, once the visit is double clicked…
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Managing Cases from the Visit
• From within a visit you can perform all case management functions
• Go into the Visit, Charges tab
• Double click the case field and you are back to Select Case criteria
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Adding Case Management Button to the Billing Toolbar
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Viewing Cases from the Billing Spreadsheet
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Different Functions within a Case
• Workers’ Comp – once you check WC box, your menus change
• From:
• To:
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Worker’s Compensation Registration
Configure the Employer Attach to Registration
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Workers’ Comp Tab
• By capturing the Employer Info, the Ins Carrier Info populates:
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Case Information Overrides Registration Information
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Authorization/Referral Numbers
• Authorization numbers needed on claims can be stored in the case
• Insurance Carrier tab, click on insurance, click on Edit, complete pop up box, OK
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Visit Limit Types
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Adding Procedure Code Limits
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Patients with Multiple Cases
• Naming conventions make it easy to choose the right case
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Specialty Insurances are Inactive in Registration
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Perinatal Data
• Within the OB Delivery case, click Perinatal button
• The following screen shows the capture of Perinatal data for UDS from within the case
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UDS Required Fields
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Managing OB/Perinatal Cases
• Use the Visualutions Button on the Main Menu to access the Perinatal Cases. In the case field, type OB and search to modify your OB cases.
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Case Information Overrides Registration Information
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Closing Cases
• From within the case, check the Closed box
• I closed a case, I still need it. Show Closed Cases
• Then uncheck the Closed box, it’s open again
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Modify v. Close & Rebuild
• Modify a case that has not been attached to a ticket
• Modify a case when it was set up wrong to begin with and all tickets attached need to change to the modification
• Close a case when the insurance for that patient, that line of business, changes – example: from Delta Dental (close) to DentaQuest (new case)
• Close a case that is no longer needed
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What happens when the case is wrong?
• If the ticket won’t approve correctly, the case is wrong
• If the case is wrong, the ticket is wrong because…
• When you delete a case from a visit, the insurances from the patient account populate that visit
• Cases on the visit overrule the registration screen of the patient
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Case Management Summary
Why Use Cases?Tracking multiple primary insurances
Authorizations/Referrals, Visit Limits
Reporting i.e. UDS OB/Perinatal
How To Build Cases Verify coverage needed for the case.
Create the Case using a standard naming convention.
Attach the case to the appointment or visit.
Managing Cases A d d C ase M an agemen t B u tt o n t o B i l l i n g C o mp o n en t fo r easy access.
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But if I can leave you with only two thoughts:
• Case Information Overrides Registration Information
• Specialty Insurances are Inactive in Registration
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