2015 user conference fixing patient accounts april 23 & 24, 2015 presented by: kim gingras and...
TRANSCRIPT
2015 User Conference
Fixing Patient Accounts April 23 & 24, 2015
Presented by:
Kim Gingras and Becky LynchEHR Training Specialist - RCM Manager
PM Session
2015 Office Practicum User Conference
Objectives
• Identify the most common errors and their causes
• Acquire the tools necessary to correct the issues
• Learn about tools to document corrections made in accounts
• Identify strategies to decrease the number of occurrences
2015 Office Practicum User Conference
Fixing Patient Accounts
Lets take a look at the usual suspects….
2015 Office Practicum User Conference
Incorrect Insurance Responsibility #1
We have posted a charge for a Well Visit and allocated $25 to patient responsibility. We realize our mistake and need to transfer the money to insurance responsibility.
Example
2015 Office Practicum User Conference
Incorrect Insurance Responsibility #1
Lets Review the Claim in the Account
2015 Office Practicum User Conference
Insurance Responsibility
Keep in mind….this is about responsibility not balance
PATIENT INSURANCE
2015 Office Practicum User Conference
Correcting Insurance Responsibility
Revert Patient Responsibility
Revert Pat RespClaim and Line Ability
● Highlight the Claim or Charge line● Click Revert Pat Resp button● Responsibility has been transferred from the patient to
insurance.
2015 Office Practicum User Conference
Let’s Try It!
2015 Office Practicum User Conference
Incorrect Insurance Responsibility #2
We posted an adjudication from UHC, noticing we were underpaid. We corrected and resubmitted, resulting in an additional payment and reduced adjustment. How should we post it?
Example
2015 Office Practicum User Conference
2015 Office Practicum User Conference
Steps to Fix
● Highlight the Adjustment Line● Click on Void button to Void the original Adjustment
● Post Additional insurance payment with reduced adjustment
2015 Office Practicum User Conference
Let’s Try It!
2015 Office Practicum User Conference
Transferring Patient Responsibility
No more transferring money to patient from the Edit Pencil in Claims window
2015 Office Practicum User Conference
Transferring Patient Responsibility
Go to Add Payments and Adjustment window
Select Adjustment Only in the Payment Method dropdown
Post $0 in pay amount, $0 in the insurance adjustment and the amount of patient responsibility in patient adjustment
2015 Office Practicum User Conference
Transferring Patient Responsibility
Why do we have this new workflow?
To provide an Audit log of changes made to the patient account.
2015 Office Practicum User Conference
Let’s Try It!
2015 Office Practicum User Conference
Over Adjustments on Patient Accounts
Have you seen these “Reverse overpayments”?
2015 Office Practicum User Conference
Over Adjustments on Patient Accounts
Why do these Reverse Overpayments occur?
● Posting Additional payments on a previously paid claim due to resubmission for additional money.
● Posting Duplicate claim adjustments from ERA ● Posting Secondary Claim payments and
adjustments
2015 Office Practicum User Conference
Correcting Over Adjustments
● Ensure you have the paper EOB for these payments.
● Void the payments/adjustments in the Claims tab, which will place money into the credits tab
● Go and post payment using Payer credit and reduce the adjustment amount.
2015 Office Practicum User Conference
Let’s Try It!
2015 Office Practicum User Conference
Out of Proof Patient Accounts
● Highlight the claim in question ● Click the Rebuild button to fix the account.
2015 Office Practicum User Conference
Out of Proof Patient Accounts
● How does it happen?○ Excessive voiding○ Deleting a claim with payments (Ins or Pt)
attached. ● When to call Support?
○ When rebuild doesn’t work, or if rebuild does work, but after running a daysheet, the discrepancy comes back.
● When not to call Support?○ When rebuild works
2015 Office Practicum User Conference
Tools for documenting corrections/changes in OP Accounts
● Billing Notes
● Claim Notes● Tasks
● Messages
What are some of the tools we can use to document the patient account after making corrections.
2015 Office Practicum User Conference
Resources
OP Help: Correcting Patient Claim Errors
https://help.connexinsoftware.com/display/OP140/Correcting+Patient+Claim+Errors
2015 Office Practicum User Conference
Questions?
2015 Office Practicum User Conference
We want your feedback!