1. Gathering the Facts; Analyzing SoftA/R
Presented By: Ann Hage
May 10, 2018

2. Unsolved Mysteries .... SoftA/R
Missing Orders / Charges
New Invoices
Payors
Modifiers

3. MISSING CHARGES

4. Missing Charges
The topic of Missing Charges is a broad one and its one that we continue to see in support tasks asking about orders not making it into SoftAR, missing charges in the HIS, overall decreases in revenue and everything in between.
The underlying reason behind missing charges can typically be found in one of the first three phases of the revenue cycle: Posting, Invoicing and Billing.

5. Phase 1: Posting
The basic operational flow of events begins when orders are posted into SoftA/R.
Within each Soft Integrated module, tests and orders will qualify for scheduled billing jobs or real time data transfers, which are then transmitted to SoftA/R through a billing interface or a Posting Web Service.

6. Phase 2: Invoicing
Once the orders are posted into SoftA/R, they will then qualify for our Invoicing process.
This is a scheduled process that is responsible for executing the user defined billing rules and prices.

7. Phase 3: Billing
Once an order has been successfully invoiced, it will qualify for the next scheduled billing job for the invoiced payor.

8. PHASE 1: POSTING

9. Troubleshooting Posting Issues
Posting Monitor
APEX Comparison and Reconciliation Reports
APEX Errors Report

10. Posting Monitor
The vehicle within SoftA/R that is used to view incoming orders is the Posting Monitor, accessible from the A/R desktop and the ‘Tools’ menu.

11. Posting Monitor: Message Content
To view the content of a message, enter the order# using the search filter at the bottom of the dialog.

12. Posting Monitor: Message Content
Once the qualified order appears, double click on the message to open the data repository.

13. Posting Monitor: Errors
Although the recommended tool for monitoring Errors is the APEX Errors Report, Posting Monitor can also be used to view errors that were encountered when posting an order.
To view Posting Errors, select Tools>Error Viewer

14. Posting Monitor
From the dialog, conduct your search by order number or date range.

15. Posting Monitor
Qualified errors can then be reviewed in the results grid.

16. APEX COMPARISON AND RECONCILIATION REPORTS

17. Comparison/Reconciliation Reports
APEX offers an extensive menu of reports to assist lab and billing personnel in identifying tests and orders in the LIS that are not present in the SoftA/R database.
The reports also identify test and order level discrepancies, as well as potential setup issues.

18. Comparison/Reconciliation Reports
Although these reports reside in the APEX package accessible from SoftA/R, it is recommended that LAB managers and department leads be introduced to this set of reports and participate in the monitoring and management of the data.
It is recommended that these reports are reviewed regularly in order to identify potential problems in setup, interfaces or processes within the lab that could lead to manual correction and/or revenue loss.

19. LAB Comparison Reports
The first set of reports resides in the “Lab–SoftBill Order Comparison” folder.

20. LAB Comparison Reports
Lab–SoftBill Order Comparison: Report Menu
Test Status Discrepancy Report
Order Discrepancy Report
Blood Bank Pending Report
Wrk-Dep-Loc Discrepancy
Test Status Discrepancy – Cancellations
Units Discrepancy

21. LAB Reconciliation Reports
The next set of reports resides in the “Lab-Mic-BB Reconciliation” folder.

22. LAB Reconciliation Reports
Lab-Mic-BB Reconciliation: Report Menu
Reconciliation Report
Order Lookup
Orders per Category
Lab-Mic-BB Procedure Lookup

23. LAB Reconciliation Report

24. LAB Orders per Category Report

25. Gene Calculation Reports
The third set of reports resides in the “Gene Calculation” folder.

26. Gene Calculation Reports
Report Menu
Completed, No IBCs
Calculated, Never Transmitted
Completed, Non-Billable Panels
Cancelled, Charge Exists

27. Gene Reconciliation Report
The final report resides in the “Gene Reconciliation” folder.

28. Gene Reconciliation Report

29. Completed, No IBCs Report

30. PHASE 2: INVOICING

31. Invoicing Process
The key to ensuring that orders do not get lost in the Invoicing process is regular review and correction of errors.

32. Invoicing Errors / Issues
Invoicing Message Viewer
Job Manager
APEX Errors Report
Bulk Utility

33. Invoicing Message Viewer
The Invoicing Message Viewer is available from the “Tools” menu on the Invoice Details tab in the Patient Account Module as well as the toolbar.

34. Invoicing Message Viewer
Any errors claimed during the Invoicing process for the focused visit will appear at the end of the trace.

35. Invoicing Message Viewer
The Invoicing Trace also provides information to assist in determining why a particular billing rule, price or payor redirection rule was applied.
Pre Invoicing RBS Rules that were applied
Final payor resulting from the execution of Payor Redirection Rules.
System Parameter Settings that were used during the Invoicing process.
Billing Rule and Price Redirections that were applied
Test Repeat Options
Outcome of various phases of the Invoicing process such as Bundling / Unbundling / CCI / Frequency Limits

36. JOB MANAGER

37. Job Manager: A Steadfast Tool
Job Manager is the Application in which all scheduled and on demand jobs are registered. For each job executed, files are created as follows:
Output Files contain any data pertaining to the successful execution of the job.
Error Logs contain any Errors or Warnings that were claimed during the processing of the Job.
Execution Logs contain Job Statistics.

38. Job Manager: Daily Routine
Job Manager should be reviewed daily for any terminations and a support task entered for investigation.

39. Job Manager: Daily Routine
To quickly identify terminated jobs, change the view to ‘Status/Category’ Select ‘Terminated’ in the tree

40. Job Manager: Daily Routine
Job Manager Error Logs are one way to identify problems that occurred during scheduled job processing.
To quickly identify jobs in an erroneous status, select ‘Errors’ in the tree.

41. Job Manager: Daily Routine
Job Manager Filtering - .NET

42. Job Manager: Daily Routine
If the preferred method of Error review is the Job Manager Error Logs, it is important to look for “Additional” logs.
A Job with multiple Error Logs can be identified by the presence of a checkmark in the ‘E+’ column in the grid.

43. Job Manager: Daily Routine
When the grid focus is on a job with multiple error logs, the ‘Additional Log’ icon in the toolbar becomes enabled. When depressed, the following dialog appears.

44. APEX ERRORS REPORT

45. APEX Errors Report
The APEX Errors report resides in the “Daily Monitoring” folder.
The Report is available in both Summary and Detailed Views

46. APEX Errors Report
The APEX Errors Report provides flexible search criteria and can be generated for Posting, Invoicing or Billing Errors by utilizing the “Error Group” filter.

47. APEX Errors Report
The report qualifies the same errors that are available from the Job Manager Error Logs in a comprehensive, easy to view format that is exportable to excel.

48. Skip vs Warning
Errors whose Action=Warning did not stop a process from completing successfully, however, should not be ignored as they can indicate potential setup and/or process related issues.
Errors whose Action=Skip stopped the visit / invoice from moving through the Revenue Cycle and should be given the highest priority when reviewing errors.

49. APEX Errors Report
The “Error Action” filter provides the ability to manage errors whose action = Skip

50. Not Invoiced Visits
The APEX Errors Report enables you to manage errors claimed during the Invoicing process; however, it is also important to know if there are visits in the system that are not even qualifying for one of your scheduled Invoicing jobs.

51. Bulk Utility
The right combination of search criteria in Bulk Utility will enable you to identify visits that are not qualifying for the scheduled Invoicing job.

52. Bulk Utility
In the “Visit” frame, select status = “Not Invoiced”

53. Bulk Utility
In the “Other” box, enter custom search criteria

54. PHASE 3: BILLING

55. Billing Process
As with Invoicing, the key to ensuring that orders do not get lost in the Billing phase is regular review and correction of errors encountered during this process.

56. Troubleshooting Billing Issues
Daily review of Job Manager for terminations and jobs resulting in an erroneous status.
Monitoring and correction of billing errors identified in the Job Manager error logs and / or APEX Errors Report

57. NEW INVOICE AFTER BILLING HOW DID IT HAPPEN????

58. Reinvoicing after Billing
Topic / areas of setup discussed in the next segment include:
Visit Alteration
System Parameter, DoNotCreateSameInvoice
Item Significance Setup

59. Visit Alteration
The Visit Alteration table enables you to define the number of days, from the date of service, that a billed visit can alter due to an update in one of the pre-defined fields.

60. Visit Alteration
Using Patient Type as an example, a setting of ‘30’ tells the system that it is OK to alter a billed visit based on changes to the patient type for up to 30 days from the date of service.

61. Visit Alteration – What Next?
Simply allowing alteration of a visit does not necessarily mean that a new invoice extension will be created.
By allowing a visit to alter, you are enabling the system to re-evaluate the new data in order to determine if a new invoice should be created.

62. Visit Alteration – What Next?
Factors in determining if a new invoice will be created:
Billing Rules, Prices, Payor Redirection Rules
System Parameter setting for DoNotCreateSameInvoice
Item Significance Setup

63. Visit Alteration – Payor Redirection
If Visit Alterations for patient type are not allowed, or if the update took place after the maximum number of days from the date of service permitted by setup had passed, the system updates the patient type on the record in A/R, but will not alter the visit. In this case, the opportunity to re-evaluate the new patient type and apply one of the above payor redirection rules is missed.
The same scenario can occur for any other data element in price setup, payor redirection or billing rules.

64. DoNotCreateSameInvoice
The System Parameter, DoNotCreateSameInvoice is used during reinvoicing to determine if a new invoice should be created. Possible Settings: 0 - Always create a new invoice. 1 - Only create a new invoice if significant change or any change and invoice was already billed. 2 - Only create a new invoice if significant change For options 1 and 2, if the change is not considered to be significant, the existing invoice is updated and a new extension is not created.

65. What is considered “Significant”??

66. Item Significance - Setup
The Item Significance table enables the user to determine which data fields, when modified, are significant enough to warrant a new invoice.

67. Item Significance - Invoicing
At the end of the Invoicing process, the system compares items on the existing invoice with items on the “to be created” invoice.
If all items are the same (diagnosis, modifier, facility, etc), the system claims error code WRN18 (New invoice would duplicate the previous one, not created) and a new invoice is not created.
If some items are different, but the item significance value is set to “Non significant, do not create new invoice”, the system claims WRN26 (WRN26: New invoice not created, items on previous invoice updated) and updates values on the existing invoice.
If some items are different, and the item significance value is set to “Significant, create new invoice”, the system claims WRN37 (New invoice ext created. Original invoice voided), voids the existing invoice and creates a new one.

68. Item Significance - Invoicing Traces
Information regarding the outcome of the Item Significance phase of the invoicing process can be reviewed in the Invoicing Traces.
The applicable invoicing warning (WRN18, WRN26 and WRN37 ) appear at the end of the trace as well as changes to “significant” items that resulted in the creation of a new invoice.
Example:
New invoice extension created: Values on old invoice and new invoice that differ:
- item GLU(LAB) – itfclty: old = 'HACH', new = 'ALB1'
***** Voiding active invoices *****
** Invoice with extension 1 ***
VOID [BINS $-16.00]

69. Auditing Changes
When investigating changes that resulted in an altered visit or new invoice, Audit Trail provides information related to the old vs new values for a given database field, the date/time of the change and the user/process responsible for the change.
The Audit Trail icon is available on various dialogs throughout the system.

70. Audit Trail Example

71. PAYORS

72. Payors
Topic / areas of setup discussed in the next segment include:
Payor Tab vs Invoice Details
System Parameter Review
Payor Redirection

73. Payor Tab vs Invoice Details
Policies that appear on the ‘Payor’ tab in the Patient Account Module represent all policies for the patient, both current and historical, and should be thought of as “Patient Level” policies.

74. Payor Tab vs Invoice Details
4.0 Line: Payor Tab Policies are created / updated in the SoftAR database based on information received in posting, update and ADT messages. Policies can also be directly added to this level by a user with proper security access.
4.5 Line: Payor Tab Policies are created / updated in a common, shared database based on information received in new order and ADT messages. Policies can also be directly added to this level by a user with proper security access.

75. Payor Tab vs Invoice Details
Policies that appear on the ‘Invoice Details’ tab in the Patient Account Module immediately after the visit record is created in SoftA/R represent policies assigned to the order, received in the PV1 segment.

76. “Empty Payor” Visits
The term “Empty Payor” refers to visits created for orders for which PV1 / Order Level policies were not received.
The system provides the ability to define payor redirection rules for “Empty Payor” visits to assist in the automation of payor assignment when a pre-defined set of conditions is met on a visit.

77. “Empty Payor” Visits
If, after Payor Redirection rules are executed, the visit being processed is still considered an “Empty Payor” visit, the system parameter, InvDefaultPayor, instructs the system how to proceed.
InvDefaultPayor Possible Values:
F: Primary payor (On the Payor tab)
I: First non-client (On the Payor tab)
P: Private
E: Generate IN81 error

78. MODIFIERS

79. Modifiers
Topic / areas of setup discussed in the next segment include:
Test Repeat Modifier
Modifiers in Billing Rules

80. Test Repeat Modifiers
The ‘Modifiers’ dictionary in SoftA/R setup allows you to designate a modifier as the ‘System Defined Repeat Modifier’

81. System Parameters
TestRepeatedLogic
TestRepeatOption
CheckCDMforRepeatMod

82. TestRepeatedLogic
The system parameter, TestRepeatedLogic instructs the system when it is permissible to add the test repeat modifier during Invoicing. This setting controls modifiers that would be added as a result of CCI logic as well as test repeat options.
Possible options include:
0 = do not place globally defined modifier on item unless modifier is defined on procedure level (=billing rule)
1 = place modifier on the item

83. TestRepeatOptions
The system parameter, TestRepeatOptions instructs the system how to create billable items for multiple instances of a test.
Possible options include:
0: First no mod, other with mod, multiple units (82310, x 2)
1: First no mod, other with mod, single units (82310, , )
2: All with mod, single units ( , , )
3: All with mod, multiple units( x 3)
4: All no mod, multiple units (82310 x 3)
6: All no mod, single units (82310, 82310, 82310)
These options can also be defined at the billing rule or payor levels.

84. CheckCDMforRepeatMod
The system parameter, CheckCDMforRepeatMod instructs the system whether or not CDM should be considered when applying test repeat modifiers.
Possible options include:
0 - add modifier when CPT and CDM are the same
1 - add modifier when CPT is the same (do not check CDM)

85. Modifiers in Billing Rules
The system provides the ability to define modifiers at the billing rule level.

86. THE END THANK YOU