Pulse Complete EHR. Anesthesia Billing.

Transcription

1 Pulse Complete EHR Anesthesia Billing

2 About This Document The following document details the features and workflow of Anesthesia Setup available within the Pulse Complete EHR software. Functionality described within the document is intended for 4.1 or newer versions of the Pulse Complete EHR software. The Pulse Complete EHR software is under constant development and reference materials undergo frequent revisions. The most recent versions of all Pulse reference materials are always available online at Acknowledgments Writer: Corporate Training Department Date: September 27, 2013 Pulse Systems Inc 3020 N. Cypress Suite 200 Wichita, KS

3 Table of Contents 1. Anesthesia Setup in PulsePro Modifiers Table Procedure Table Time Units Table Insurance Table Example Posting Provider Time Tracking of 10

4 Anesthesia Billing 1. Anesthesia Billing in PulsePro Four areas need to be set up in the system tables before anesthesia billing can be used: 1. MODIFIERS 2. PROCEDURES 3. TIME UNITS 4. INSURANCES 1.1 Modifiers Table The following modifiers are used in anesthesia billing and must be set up in the system: RISK UNITS: Modifier code Description Unit value (+) P1 A normal, healthy patient 0 P2 A patient w/mild systemic disease 0 P3 A patient w/severe systemic disease 1 P4 P5 P6 A patient w/severe systemic disease w/constant threat to life A moribund patient who is not expected to survive w/o operation A declared brain-dead patient whose organs are being removed for donor purposes MEDICAL DIRECTION: When the anesthesiologist files: Modifier Factor Anesthesia services personally performed by the anesthesiologist AA No reimbursement reduction Medical direction of one CRNA by an anesthesiologist Medical direction of two, three, or four concurrent anesthesia procedures QY Reimbursement reduced 50% QK Reimbursement reduced 50% When the CRNA files Modifier Factor Anesthesia, CRNA medically directed QX Reimbursement reduced 50% Anesthesia, CRNA not medically directed QY No reimbursement reduction 4 of 10

5 Anesthesia Billing in PulsePro 1.2 Procedure Table Enter a new procedure code for anesthesia billing. Be sure to designate it as Type of Service 7 and select yes under use time units Under the allowable modifiers tab, click on the allowed modifiers icon and add the aboveadded anesthesia specific modifiers if you wish them to apply to this CPT. Be sure to click the save button on the toolbar before going on to the next CPT. Under the fee schedule tab, set up insurance fee schedules. Start with an entry for the standard fee schedule. Then, be sure to designate the number of units that is the base price for that CPT for each insurance that does not use the standard fee schedule. Remember, this is number of units, NOT PRICE by insurance for this CPT. 1.3 Time Units Table Start by entering a standard code --this will be the default time units schedule which will be used if it is not specifically set up differently by insurance. Enter the unit price -- this is the price for ONE TIME UNIT - regardless of the length of time of the unit. Decide how to handle periods of time that fall in the middle of a unit. The choices are: 1. Round off - if above the halfway point to the next fullest unit, will round up; if below the halfway point, will round down. 2. Round up - will round up to the next fullest unit 3. Round down - will round down to the last fullest unit 4. No round off - will calculate with decimals. Under the minutes per unit line at the bottom of the grid, designate how many minutes will equal ONE TIME UNIT at the beginning of the procedure. 5 of 10

6 Anesthesia Billing Under the 0 minute line at the top of the grid, designate the length of time that the previously set up units will apply to. For example, if you have set up the minutes per unit as 15 and this is to apply only for the first hour of a procedure, you would enter 60 in the first line under 0 minute at the top.if the Time Unit does not change during the entire duration of a procedure - regardless of the length - leave the top part of the grid blank. If the length of time to designate ONE TIME UNIT changes according to the length of a procedure, enter the number of minutes which will equal ONE TIME UNIT at the next space on the bottom line of the grid. Then enter the corresponding length of time above in the 0 minute line at the top. Look at the following example: This indicates that for the first 60 minutes of the procedure, one time unit equals 15 minutes (4 units for the first hour) and that for the remainder of the procedure, a time unit equals 10 minutes (6 units per hour). In the next example, during the first 60 minutes of the procedure one time unit equals 15 minutes (4 units for the first hour); for the next 120 minutes of the procedure, one time unit equals 10 minutes (6 units per hour for two hours); and for the remainder of the procedure, one time unit equals 5 minutes (20 units per hour). Therefore, the screen looks like this: 6 of 10

7 Anesthesia Billing in PulsePro 1.4 Insurance Table After selecting an insurance, click on the plan tab. Highlight which plan you wish to set up for anesthesia billing. In the area under EDIT Insurance Plan, Anesthesia select which Time Unit Fee Schedule you wish to use to charge with and collect using. In the following example, the Standard Time Units schedule is what will calculate the charges, and the MEDICARE Time Units is what will calculate the expected reimbursement. NOTE: if nothing is specified in these boxes, the system will default to the Standard Time Units schedule. So, based on the above criteria, each anesthesia procedure will show a price in the charge header based on the following formula: Upon entering the anesthesia CPT code in charge entry, the charge field will be the fee set up in the insurance tab of the cpt multiplied by the price set up under time units for the schedule selected under charge using in the anesthesia box of the plan tab in the insurance table. The fee showing in the exp. reimb field will be the fee set up in the insurance tab of the cpt multiplied by the price set up under time units for the schedule selected under collect using in the anesthesia box of the plan tab in the insurance table. Also, upon entering modifiers, the charge field and the exp. reimb fields should change according to the criteria set up in the modifier table. 7 of 10

8 Anesthesia Billing 1.5 Example Posting I have a patient who has Medicare, Plan TRAD. I have entered a charge for CPT code A2 -- which has a Medicaid base price of 5 units and a standard price of 10 units as set up in the CPT table. In the Time Units table, I have specified that the Medicare unit price is $20 and the Standard price is $40. Finally, I have set up for Medicare, Plan TRAD in the insurance table to charge using the Standard price, but collect using the Medicare price. Therefore, when I enter code A2 on the procedure line, the following should immediately display: Now, let s enter the actual length of the procedure: In addition to the above, I have set up that for Medicare in the Time Units table, one time unit is 15 minutes for the first 60 minutes of the procedure, and that for the duration of the procedure one time unit is 5 minutes. For the Standard price in the Time Units table, one time unit is 10 minutes during the first 120 minutes of the procedure, and that for the duration of the procedure one time unit is 15 minutes. So, let s say the procedure is 125 minutes long. Entering 125 in the units column should display the following: Now, let s add modifiers: Let s say that for the above procedure, the patient had a risk factor of P4. This modifier increases the units by two -- so the charge line should appear as follows: 8 of 10

9 Anesthesia Billing in PulsePro Now let s enter other modifiers. Assume that the Anesthesiologist will be filing the claim, but that he has medically directed one CRNA to perform the procedure. By entering the modifier QY this should reduce the price by 50%: 1.6 Provider Time Tracking The second phase of anesthesia billing involves different people monitoring the anesthesia throughout a procedure. Pulse handles this through provider track -- a right-click menu selection from the CPT detail line in charge entry. A dialog box will then pop up allowing you to enter the beginning and end time of the procedure, and the start and end times of each provider : Let s say a procedure is administered for 125 minutes -- one provider covers the first hour while another provider covers the last 2 hours. Using this scenario, you would enter the start time and end time for each provider and then click the button. After all providers have been entered, click save and this information will be attached to that CPT code and stored for later retrieval. 9 of 10

10 Anesthesia Billing To delete or change provider tracking information, just right-click, select provider track and make whatever changes are necessary. 10 of 10