Cases Karen J. Kuhn Revenue Cycle Management Consultant

Using, building, managing, attaching and maintaining cases to streamline billing.

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…

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

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

Registration Examples In the Patient registration only payors for Medical services are active Dental is not active on registration, but is in the case.

Specialty insurances are Inactive in the Patient Registration

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.

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 Part Examples: Dental DentaQuest, OB Aetna EDD 4/2015, Dental SFS B, WC SIF 4/24/15 R arm, MVA Geico 1/1/15 Neck

Building a Case From within Registration: Edit, Case Management… Click New

Name the Case Activate the correct carrier(s) in Insurance tab

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

Case Information overrides patient registration information

Attach the Case – Patient Registration

Attach the Case - Scheduling

Attaching Cases to the Visit From the Billing Component, once the visit is double clicked…

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

Adding Case Management Button to the Billing Toolbar

Viewing Cases from the Billing Spreadsheet

Different Functions within a Case Workers’ Comp – once you check WC box, your menus change From: To:

Worker’s Compensation Registration Configure the EmployerAttach to Registration

Workers’ Comp Tab By capturing the Employer Info, the Ins Carrier Info populates:

Case Information Overrides Registration Information

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

Visit Limit Types

Adding Procedure Code Limits

Patients with Multiple Cases Naming conventions make it easy to choose the right case

Specialty Insurances are Inactive in Registration

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

UDS Required Fields

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.

Case Information Overrides Registration Information

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

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

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

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 Modify Case to apply changes to all attached tickets. Close cases once complete or insurance carrier changes. Add Case Management Button to Billing Component for easy access. Manage OB Cases within the Visualutions menu of CPS.

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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