1. Billing 101B - Part I Charge Entry
Introduction (Paul)
Billing Cycle Overview (Paul)
Charge Entry Overview (Francesca)
Charge Entry Flow Process (Francesca)
Questions

2. Billing Terminology IDX vs. SMS Coding (CPT/ICD-9) Charge TES Edits
Encounter/Encounter Form
Invoice
Claim/Statement
A/R
Payment
Charge Correction
Lag Days (measuring metric)
FSC: Financial Status Classification: Code used to group similar types of payors (contracted and commercial) or large individual payor types (Medicare, Blues, Brown and Toland, and others) . Dictionary 19.
IMF: Insurance Master File: This database matches three or four digit code that is assigned to a payor. Each visit in IDX system must have an IMF plan code attached (this allows insurance, primary medical group, grant, fund or individual to be billed for a service).
EDITS: TES edit work files are reviewed and cleared by the departments. Each department should have a designated staff member who has access to the TES Edit Workfile. It is the department’s responsibility to clean these files daily, otherwise the charge is stuck in TES until corrected – they will never be extracted into BAR for billing. There is no time limit to these edits – charges may sit there forever…
Who works TES Edits? Do you want to share your process?
Charge Reconciliation: MGBS processes were discussed earlier. Each department that does their own charge entry should have their own reconciliation process. Who does charge entry in their own shop? How do you reconcile your charges?
Charge Correction: Charge corrections are needed when charge data in IDX or needs to be corrected – wrong provider, incorrect DOS, CPT Code, Units. This function is performed through the Function 2 screen within IDX. MGBS performs a majority of these corrections.
Lag Days: This simply measures the number of days between DOS and the date the charge is posted in IDX. Two components are (1) Days from DOS to when received at MGBS and (2) days from date received to posting date within IDX.

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4. Functions and Responsibilities IDX Components
Charge Entry Overview
Functions and Responsibilities
IDX Components

5. MGBS Charge Entry Matrix
Dermatology
Lakeshore
Lakeside
Medicine (some BA)
Neurology
Ortho Appliance
Pain Management
Proctor Foundation
Women Health

6. Encounter Form Example

7. Charge Slip Batch Control Document
Department
Abstractor At:
$Total of Charge Slips
Attention:
Date:
No. of Charge Slips
Date Completed
Batch Total
Signature

8. MGBS Functions Batch Count And Logging Enter Charges Into TES
Verification Of CPT Codes, ICD-9 Codes
Verification Of Pertinent Billing Information
Provider Information, Patient Information (Label), Department Information (BA)
Communication With Staff At The Departments Regarding Charges
Batch Proofs Are Reconciled And Sent Back To The Department For Reconciliation
Centralized Process only. Decentralized departments may have own processes.
Batch Count: Batch Header Check (top completed COMPLETELY) Department, Number (Count), Date, Abstractor, Attention. No more than 30 charge slips per batch. Completed batches are stored on site for six months. All batches are logged in upon receipt and logged out when sent back to the department
Enter Charges into TES: We will go over actual screens later. We have five FTE entering charges for nine departments into TES (Transaction Editing System).
Verification: Verifying that ICD-9 and CPT codes are marked on encounter forms.
Verification: Billing info: Patient Information, Provider, Department Information (BA)
Communication: New information (Billing Areas, Providers…) General Information from the department to MGBS AND from MGBS to departments
Batch Proofs Back to Departments: Staff complete charge entry and batch proof is generated for reconciliation. The batch header and batch proof is then sent back to department (yellow header and copy of batch proof) within a week (for department reconciliation).

9. IDX Components ADT (Admission Discharge Transfer) SCHED (Scheduling)
aka VM (Visit Management)
SCHED (Scheduling)
TES (Transaction Editing System)
MCA (Managed Care Application)
ADT (Admission Discharge Transfer) also VM (Visit Management): Allows for collection of patient demographic and visit related information for a pre- admission (pre-registration), regular admission or both. This information is then used to populate patient “label” data that is used with all charge entry encounter forms. (FRONT END APP)
SCHED: Application within IDX for scheduling appointments in ambulatory departments. Charge Entry uses this function to verify patient visits when there is a discrepancy with the encounter forms. (FRONT END APP)
TES: Application within IDX for creating new batches, perform charge entry for both pro-fee and tech-fee transactions. As we will discuss later, it is also used for correcting errors (edits). (BACK END APP)
MCA: Application within IDX used to track referrals and authorizations. - Used to enter, edit, view, and link referrals and authorizations (FRONT END APP)

10. MGBS Process Defined Charge Batches Are Stamped Charge Batches
Received
From Department
Charge Batches Are Stamped
Daily Logged In Binder
Encounter Forms Are Then
Counted
After Charges Are
Entered, The Batches Are
Then Logged Out
From The Binder
Charges Are
Entered Into
TES
Batch Proofs Are Sent
Back To The Dept
For Reconciliation

11. Router: If a charge has a pro- tech- component, the router will rout the pro fee component to IDX BAR and the tech fee to SMS. This is a general rule. A table exists that explains the VARIOUS routing methodologies. An in-depth presentation might be presented at a future Billing 102 session if there is enough interest.
In the most general terms: IDX bills out the pro-fee component and SMS bills out the technical component. However, there some exceptions with this routing methodology.
All invoices go through Pre-Bill (the claims scrubber) before they go out the door.
Claims (Pre-Bill back to IDX): missing SAR, missing TAR, other additional fixes, missing patient information

12. Liz, Marian, Terry, Molly, Maureen, Elsie, Gail
MGBS Charge Entry Team
Liz, Marian, Terry, Molly, Maureen, Elsie, Gail

13. Questions?