Healthcare Revenue Cycle Management - US Lab User Guide Part 2 of 2. Version

Transcription

1 Healthcare Revenue Cycle Management - US Lab User Guide Part 2 of 2 Version

2 Copyright 2014 Infor Important Notices The material contained in this publication (including any supplementary information) constitutes and contains confidential and proprietary information of Infor. By gaining access to the attached, you acknowledge and agree that the material (including any modification, translation or adaptation of the material) and all copyright, trade secrets and all other right, title and interest therein, are the sole property of Infor and that you shall not gain right, title or interest in the material (including any modification, translation or adaptation of the material) by virtue of your review thereof other than the non-exclusive right to use the material solely in connection with and the furtherance of your license and use of software made available to your company from Infor pursuant to a separate agreement, the terms of which separate agreement shall govern your use of this material and all supplemental related materials ("Purpose"). In addition, by accessing the enclosed material, you acknowledge and agree that you are required to maintain such material in strict confidence and that your use of such material is limited to the Purpose described above. Although Infor has taken due care to ensure that the material included in this publication is accurate and complete, Infor cannot warrant that the information contained in this publication is complete, does not contain typographical or other errors, or will meet your specific requirements. As such, Infor does not assume and hereby disclaims all liability, consequential or otherwise, for any loss or damage to any person or entity which is caused by or relates to errors or omissions in this publication (including any supplementary information), whether such errors or omissions result from negligence, accident or any other cause. Without limitation, U.S. export control laws and other applicable export and import laws govern your use of this material and you will neither export or re-export, directly or indirectly, this material nor any related materials or supplemental information in violation of such laws, or use such materials for any purpose prohibited by such laws. Trademark Acknowledgements The word and design marks set forth herein are trademarks and/or registered trademarks of Infor and/or related affiliates and subsidiaries. All rights reserved. All other company, product, trade or service names referenced may be registered trademarks or trademarks of their respective owners. Publication Information Release: Healthcare Revenue Cycle Management Healthcare Revenue Cycle Management 3.4 Publication date: May 29, 2014 Document code: RCM-MSARL-34UG Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

3 Contents Chapter 1 Introduction... 7 About this guide... 7 HRCM 3.4 US Lab User Guide Part 1 of HRCM 3.4 US Lab User Guide Part 2 of HRCM Application Overview... 8 Intended Audience... 8 Documentation Updates... 8 Related Documents... 8 Support... 9 Chapter 2 Batch Entry Payment Entry Creating a Payment/Adjustment Batch Screen Buttons Exiting Payment Entry Window Cash Locations Over/Under Account Manage Rep Info Default Cash Location Override Payment Batch Required Payment Profile Manager Non-AR Cash Entry Payment Entry for Batch# Screen Non-A/R Tab Screen Changes Donation Field Credits Block Printing a Payment Batch Delete Payment Batch Placing a Batch on Hold Viewing and Modifying a Batch Placed On Hold Posting a Batch Running Batch Totals Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 3

4 Contents Denial Management Denial Review Types Maintenance Screen Denial Maintenance Screen Denial Resolution Codes Maintenance Screen Posting of Denials Patient Denials Screen Charge Entry Creating a Charge Batch Charge Batch Import Viewing and Modifying Batches Placed On Hold Loading or Importing Batches Creating Trip Fee Batches Printing a Batch Report Placing a Batch on Hold Posting a Batch Deleting a Batch Chapter 3 Charge Batch Load (Sundry Load) Loading a Sundry File - Set-up Fixed Column Position Sample Script Comma Delimited Sample Script Add Load Layout Loading a Sundry File Chapter 4 Cashiering Cashiering Set-up Cash Balancing Screen Required Payment, Total Payment and Balance Cash buttons Denomination Screen Denomination Quantities Cash Balancing Screen Fields Money Counted Total Cash Total Cheques Total Debits Total Mastercard Total VISA Less Cash Float Total Counted Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

5 Contents US $ Counted Receipts Total Cash Total Cheques Total Debits Total Mastercard Total VISA Total Receipts US $ Receipts Canadian Currency Over/Under US Currency Over/Under Cash Balancing Screen Buttons Print Report Deposit Slip Parameter Screen Chapter 5 Maintaining Code Tables New Code Tables Currency Codes Denomination Codes US Dollar: Canadian Dollar: Euro: United Arab Emirates dirham: Cash Posting Screen Changes Company Codes Payment Over/Under Allowed Transaction Codes Code Table Management Opening Code Tables in Separate Windows Import Transaction Codes and Rates Export Transaction Codes and Rates Copy or Duplicate a Maintenance Table Line Chapter 6 Reporting Report Types Using the Report Explorer Loading Custom Reports Chapter 7 Managing HRCM Security Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 5

6 Contents Setting up Users Creating a Profile Creating a User Login Account Creating a Representative Account Resetting a User Password Changing a User Password Chapter 8 Other Processing Capitation Payor Set-up as Capitated Patient Capitation Processing Generic Payor/Client Set-up Set-up Generic Payor Processing Generic Payors Transaction Roll-ups Set-up Roll-up Processing Roll-up Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

7 Chapter 1 Introduction 1 About this guide This guide provides step-by-step instructions to perform various tasks using the Infor Healthcare Revenue Cycle Management (HRCM) 3.4 front-end application. It assumes knowledge of billing and accounts receivable administration terminology and concepts, and a familiarity with the functional aspects of HRCM gained either through prior training or using a previous version of the application. For information on HRCM functions and code tables, refer to the HRCM 3.4 Code Table Reference Guide. This document is available only in PDF file format and can be viewed using Adobe Reader ( ). HRCM 3.4 US Lab User Guide Part 1 of 2 HRCM 3.4 User Guide Part 1 is designed to be used with HRCM 3.4 User Guide Part 2 and contains the following Sections: Chapter 1: Introduction Chapter 2: Using Healthcare Revenue Cycle Management Chapter 3: Registering Patients and Clients Chapter 4: Administering Patients Chapter 5: Administrating Clients Chapter 6: Managing Accounts Chapter 7: Creating Transactions and Claims Chapter 8: Billing HRCM 3.4 US Lab User Guide Part 2 of 2 HRCM 3.4 User Guide Part 2 is designed to be used with HRCM 3.4 User Guide Part 1 and contains the following Sections: Chapter 1: Introduction Chapter 2: Batch Entry Chapter 3: Charge Batch Load (Sundry Load) Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 7

8 Introduction Chapter 4: Cashiering Chapter 5: Maintaining Code Tables Chapter 6: Reporting Chapter 7: Managing RCM Security Chapter 8: Other Processing HRCM Application Overview HRCM is a comprehensive patient billing and accounts receivable system that meets the needs of regions, districts, single or multi-site organizations and labs. It streamlines the billing processes, monitors and captures payments from government health departments and third-party insurance companies, and resolves payment delay issues. NOTE: This product has undergone a name change. Prior versions referred to name MediAR, Healthcare Revenue Management, or HRM. You may see this application referred to as MediAR, Healthcare Revenue Management (HRM), Revenue Cycle Management (RCM), or Healthcare Revenue Cycle Management (HRCM.) This HRCM product is synonymous with MediAR, HRM, and RCM. Intended Audience This is a high-level process document written for HRCM users, such as account representatives, responsible for managing patient and client account-related tasks. Documentation Updates The following updates to documentation are included with this release. Document Name RCM-MSARH_RCM-MSARL-34RN-01 RCM-MSARL-34UG Description Updates incorporated for Healthcare Revenue Management 3.4 Release Notes Updates for Healthcare Revenue Management Related Documents Product documentation is available on 8 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

9 Introduction Throughout this user guide, references to specific documents and Infor Knowledge Base articles may be provided to help you locate more detailed information. You can find documentation posted to the product records on the Product Downloads page. Look here first for installation guides and release notes. You can search for reference documentation on the Knowledge Base page. Support If you have an Infor Customer ID and you have access to InforXtreme.com: Please submit all technical support requests via Infor Xtreme Support at If you wish to speak to someone from Infor Xtreme Support, please refer to for a list of the support phone numbers and hours of operation. For U.S., call and enter your Infor Customer ID. If you do not have an Infor Xtreme Support login and you do not have access to InforXtreme.com: Please ask your company s Infor Administrator to setup access for you or if your company does not have an Infor Administrator, please visit click on First Time User and register. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 9

10 Introduction THIS PAGE INTENTIONALLY LEFT BLANK. 10 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

11 Chapter 2 Batch Entry 2 This chapter describes the RCM batch entry process, including entering payments, adjustments, and charges associated with patient and client accounts, as well as placing batches on hold. Batch entry is used to group payments or charges and apply them to various accounts. Batch entry tasks can be accessed using the Go > Batches submenu. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 11

12 Batch Entry Payment Entry The Payment/Adjustment entry function is used to enter multiple payments and adjustments in batches and apply them to multiple accounts. The following tasks can be performed as part of payment entry: Entering a new batch Printing a payment batch report Dropping a payment batch Placing a Batch on hold and editing an existing batch Posting a batch 12 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

13 Batch Entry Creating a Payment/Adjustment Batch To create a new payment/adjustment batch: 1 Select Go > Batches > Payment/Adjustment Batches from the menu bar or press [Ctrl+J]. In Payment/Adjustment Batches window, click the New button to create a new batch or select an existing Batch Number from the drop-down list. Depending on the batch number selected, or if this is a new payment/adjustment batch, certain fields will be automatically entered by the system. 2 Enter the Required Payment amount for a new batch. The Defaults area can be used to enter codes that will automatically populate the corresponding fields in the Payment Entry window. 3 Click the OK button to create a new batch or to open an existing one. If creating a new payment/adjustment Batch, the next sequential Batch Number will automatically be assigned. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 13

14 Batch Entry NOTE: It is not necessary to enter all the information at this point because it can be entered when new records are created later on in the Payment Entry window. 4 In the Payment Entry for Batch# screen enter the Acct# and the billed charges for the account (and claim if entered) will display. 5 The All Transactions button can be selected to also display unbilled charges as well as payments and adjustments. 6 The Pay All button can be used to copy all of the transactions displayed to the payment area. A window will appear asking if the Pay All should Automatically pay balance. If Yes is selected, then the generated payment records will automatically apply full payment amount for each line paying off its balance until the total Payment Amount has been applied. If No is selected, then the generated payment records will be created with blank payment amount requiring manual entry for each payment amount. 7 In the Transactions area, select a transaction record then click the Copy down button, the [ctrl-n] key or double click on the transaction record to transfer the transaction information down to the Payment, Adjustments and Write-offs area. 14 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

15 Batch Entry 8 In the Payments, Adjustments and Write-offs area of the Payments Entry window, the Audit Number and Claim Number fields are automatically entered by the system. These fields attach the payment to a line item and a claim. 9 Click the Delete button next to the Audit Number to clear the Audit Number field causing the payment to be posted against claim instead of the line item. Click the Delete button next to the Claim Number to clear the claim number field and apply the payment on account. The Audit Number in the transaction grid appears on the following screens and displays after the entry date: Patient Transaction Detail Patient Transaction Entry Patient Claims Client Transaction Detail Client Transaction Entry Client Claims 10 The Allowed Amount can be populated to indicate if the payor has provided an allowed amount for the charge. The difference between the allowed amount and the claim balance will automatically populate the Adjustment Amount as the contractual write off amount. 11 Once in the Payment Entry for Batch# screen, you can view the contents of an existing batch by clicking the Show Batch Contents button. 12 In the Show Batch Contents window payment lines can be removed by hitting the delete button. 13 Once in the Payment Entry for Batch# window, you can return to the header window by pressing the Header button. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 15

16 Batch Entry 14 Select Type and Code for Payment, Adjustment, or Write-off, depending on the type of operation(s) you intend to perform. 15 Select Denials, if appropriate. To add Denial Codes, click the Browse button. Click New button to add a record. Payor specific or internal Denial code can be selected. Choose a Denial code from one of the two drop down lists, enter an amount and click the OK button. The Status field can be populated to set the status on claim which the payment is being applied to. You can select from the following status options: 1-9 = COB of payor to bill. Claim will be forced to the selected COB and billing for payor with that COB will be generated. B = Re-Bill Current Payor. A billing for the current payor on the claim will be generated. D = Defer Payment Cycling. When set and a payment from current payor is received the automated Payment Cycling process will skip the claim and leave it due from current payor. H = Hold Claim. Will place claim on hold causing it to be ignored by collections and follow-up processes. P = Patient Bill. Will force claim to patient responsibility and generate a patient billing for the claim. R = Restart Claim. Will reset all transactions associated with the claim so they appear as unbilled and then start a brand new initial billing. S = Start Initial Bill. T = Transfer Claim. Typically only used by electronic Remittance process. When set will allow the claim to payment cycle, but will not produce billing for the claim (as primary payor has already transferred the claim to secondary payor). 16 To view notes click the Show Account Notes button. 16 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

17 Batch Entry 17 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) to save the entry or click New Entry (or press [Crtl+N]) to save current entry and clear screen for a new payment entry. Before you can save and complete the current entry, the total of the payments entered at bottom of screen must balance to the Payment Amount entered in upper right corner of the screen. As payments are entered, Amount Remaining will be updated showing the amount of payments that must still be entered at bottom of screen to balance out the payment. Screen Buttons Buttons shown at the top of the Payment Entry for Batch# screen include: Show Account Notes - which will allow the user to enter a payment note either for themselves or another representative. Print a receipt - if the Automatically Print Receipts check box on the Batch header is not used and a receipt was previously not printed or misplaced. The delete button - delete the payment from the batch and Patient or Client account. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 17

18 Batch Entry Exiting Payment Entry Window Before you can exit the Payment Entry window, you must post the batch, delete it, or place it on hold using the appropriate button. At the bottom of the Payment Entry for Batch# screen, there are Buttons for posting, deleting, or placing a batch on hold. Re-open the header or Enter H Insert a New payment entry or Enter N Print Batch or Enter P Delete the Batch or Enter D Place the Batch on Hold or Enter l 18 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

19 Batch Entry Post the Batch or Enter s NEW - Balance Cash received against Payment Required. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 19

20 Batch Entry Cash Locations The Cash Location screen defines where or to whom a payment is made. The Cash Location information appears on the Cash Locations, Manage Rep Info, and Payment Batch screens. Over/Under Account Tools>Manage Code Tables>Cash Locations On the Cash Locations screen the Over/Under Account field determines the account to which the amount of over/under will be written to as a transaction. Clicking Browse from which the user will select an available account from the records. will prompt a menu The Tran Type and Code fields on the Cash Locations screen are used to create the over/under transaction on the over/under account. The Type comes from the Transaction Types Table, and the Code comes from the Transaction Codes Table. The Bank Accounts section on the Cash Locations screen links with the Cash Locations table by the CashLoc code (internally, not a displayed field) and links with the Currency table by CurrencyCode field. Manage Rep Info Tools>Security>Manage Rep Info 20 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

21 Batch Entry The Cash Location field also appears on the Manage Rep Info screen. The field remains blank by default until a valid value is chosen from the Cash Location drop-down field on this screen. Once populated the value will appear in the Cash Location field on the Payment Batch screen and cannot be overridden. Default Cash Location If the Cash Location field on the Manage Rep Info screen is populated when a user launches the Payment/Adjustment Batches screen and starts a new batch, the Cash Location field will auto populate on the Payment/Adjustment Batches header screen and will not allow any update. If the Cash Location field on the Manage Rep Info is blank, the Payment/Adjustment Batches header screen defaults to a blank which can be changed by the user. Override Payment Batch Required Payment When the Cash Location field is populated on the Manage Rep Info screen, the Cash Location field on the Payment Entry for Batch# header screen will be pre-populated with that value and become disabled. If the Cash Location field on the Manage Rep Info screen is blank the Cash Location field on the Payment Entry for Batch# screen will be blank and enabled. Profile Manager The Profile Manager screen allows an Action Security Option to control who has access to change the Payment Entry for Batch# screen Total field by overriding amount of payment expected. Users with this security can manually enter the Required Payment total amount and those without this permission must use the Cash Balancing screen to populate the Required Payment Amount. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 21

22 Batch Entry Non-AR Cash Entry While in the Payment Batch Entry mode, payments can also be entered for Non-AR Cash, this is monies received over the counter that are not for a Patient or Client account. Click on the Non-AR tab and click on the New Entry button. Entry of the payor name will open up the Non-AR fields for entry. Enter the Payor Address, Cheque/Ref Number and the amount. Then click on the New icon and enter the payment information on the lower left portion of the screen under the Debits heading and the revenue information on the lower right portion of the screen under the Credits heading. Prior to saving the entry or printing the receipt, the debits and credits must balance with the total Amount entered. 22 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

23 Batch Entry Payment Entry for Batch# Screen Non-A/R Tab Screen Changes Donation Field A new check box has been added to the Non-A/R screen entitled Donation. When checked, payment will be flagged as a donation. Donation flag can be used to print Charity number instead of Tax Id number on payment receipt. Flag can also be used to generate letters. Added fields PAYHEADERD.DONATION, PTTRANS.DONATION varchar2(1). Check box Y/N field captured in PAYHEADERD and then copied to PTTRANS when batch is posted. Credits Block The right block of the Non-A/R screen displays Transaction information. Pop-up on Transaction Code allows for query of Transaction Code by code, description and/or GL code (add GL to This trancode pop-up) When transaction code is entered, Unit Price populated from the Transaction Code Tech Amount field if populated (may need new field for unit price). Quantity will by multiplied by Unit Price to give amount of charge (quantity is new field). Unit Price can be manually overridden or entered if Trancode table does not have a Tech amount for the transaction code. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 23

24 Batch Entry Printing a Payment Batch To print a payment/adjustment batch: 1 In the Payment Entry for Batch# window, click the Print Batch button. If a current payment entry is in progress, that entry must be completed before you can print the batch. 2 After hitting Print Batch button, the following payment batch report will be displayed on screen: 24 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

25 Batch Entry Delete Payment Batch To Delete a Payment/Adjustment Batch: 1 In the Payment Entry for Batch# window, click the Delete Batch button. The following window will display to ensure you do want to delete this batch: 2 Click No to keep the batch. Click Yes to delete the batch. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 25

26 Batch Entry Placing a Batch on Hold Placing a batch on hold allows you to temporarily stop entry into the batch and then access the batch at a later time to continue working with it. To Place a batch on hold: 1 In the Payment Entry for Batch# window, click Hold Batch button. In the message dialog box, click Yes to place the batch on hold, or click No to return to the Payment Entry window. A confirmation message is displayed. Click OK to exit. 26 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

27 Batch Entry Viewing and Modifying a Batch Placed On Hold To view or modify an existing payment/adjustment batch that was placed on hold: 1 Select Go > Batches > Payment/Adjustment Batches from the menu bar or press [Ctrl+J]. 2 In the Payment/Adjustment Batches window, select an existing Batch Number from the dropdown list. Batches that appear in the list have been placed on hold. You can only modify a batch that you placed on hold. Once you open a batch from the list to view or modify, that batch is now in an open status and is no longer on hold unless you place it on hold again. 3 Click OK to open the selected batch. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 27

28 Batch Entry 4 In the Payment Entry for Batch# window, you can view or modify the existing records, view or add notes and new records, as well as print, delete, hold, and post the batch. 28 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

29 Batch Entry Posting a Batch NOTE: Ensure that the total in the Amount field of the Payment Entry for Batch # window equals the Account Balance field before posting a batch. After all payments have been entered, to close a batch and post it to the appropriate accounts: 1 In the Payment Entry for Batch # window, click Post Batch. 2 In the message dialog box, click Yes to close the batch, or click No to return to the Payment Entry window. 3 A confirmation message is displayed. Click OK to exit. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 29

30 Batch Entry Running Batch Totals The batch total fields are located at the bottom of the Payment Entry for Batch# screen and include required payment, total payments and amount remaining. 30 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

31 Batch Entry Denial Management Clients receive denials of charges/claims billed to payors either electronically or manually. Based on these denials, various actions may need to take place, some which can be dealt with automatically, some requiring human intervention. The turnaround time on the response to these denials is critical. This function: Captures denials in 835 electronic remittances and uses a cross reference with payor denial codes to assign an internal denial code. The logic to capture these is already built into the 835 programs. The Payment Entry screen allows for entry of denials using either payor specific denial (which is cross referenced to internal denial code) or internal denial code. The amount of denial is also captured. When payments are posted, denial information is populated into a PTREMIT table which creates data for the Patient Denials screen and may auto resolve denials as well. Some denials will have an auto resolution code indicated. This resolution code will have actions associated with it which will perform things like, adjust/reverse charge, re-bill, etc. Denials that are unresolved should create work queue items. A new Patient Denial screen is then used to resolve denials in work queue. o The denials screen lists details from the PTREMIT table showing denial info as well as data from PTTRANS table (charge that was denied). o A resolution field can be populated which may cause actions to occur based on actions identified in the resolution table. These actions would occur when resolution code is populated and screen is saved. o The screen also needs to be able to bulk resolve. So a user would use filter to limit the records to be bulk resolved, then populate a bulk resolution field and hit bulk resolve button to cause all filtered transactions to be resolved with that code. Again, if necessary, resolution actions should be performed on each line. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 31

32 Batch Entry Denial Review Types Maintenance Screen Multiple different review types can be created to define how denials are assigned to accounts. Denials will be associated with review types, then the different review types can be used to pick work queue to assign denial to. 32 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

33 Batch Entry Denial Maintenance Screen Denial codes are set up in the Denial Maintenance screen. These can be internal denial codes or denial codes which will be received from payors. Denial Code = Internal or Payor Denial Code Description = Description to display in list boxes Abbreviation = Short name for Denial Auto Resolution = To automatically Resolve Denial when it is posted Review Type = Type of Work Queue to assign Denial to HIPAA Code = Standard HIPAA denial code for billing EOB information Discontinue = Date when Denial code is no longer used Payor Denial Code Cross Reference = mapping of internal denial codes to Payor specific denial codes. When posting payments from payors, the cross reference will be checked to see if the payors denial code maps to an internal denial code. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 33

34 Batch Entry Denial Resolution Codes Maintenance Screen Denial Resolution codes are used to resolve denials. They may have automated actions associated with them which are triggered when the resolution is saved. The Resolution code NEW defines what actions to take when a new Denial is added. Resolution Code = Code used to resolve denial Description = List box description for resolution code Claim/Bill Action = automated actions that can be take on a claim or billing when denial is resolved o R = Rebill entire Claim Claim is rebilled o L = Rebill line item only the line denied is re-billed o C = Cycle claim to next payor Claim is billed to supplemental (next) payor o P = Cycle claim to patient Claim is billed to patient o 0 = Bill line to client only the line denied is billed to client (COB=0) payor Transaction Type + Code = Adjustment or Write off Transaction type and code indicating balance of line denied should be written off. Review Days = Used to indicate when denial should drop into account reps work queue. Will contain number of days after denial is posted to drop into queue. Request Code = Used to trigger queuing of a Billing Request Code for the Denial Request Type = Letter or Bullet item to be printed in the Billing Request 34 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

35 Batch Entry Posting of Denials Denials can be loaded in 835 ANSI x12 standard remittance files thru EDI process or they may be manually entered to a payment during payment posting. 1 To add a denial to a payment hit the Denial button in the Payment Entry portion of the screen. This will invoke the Denial Codes window. In this window you can select a Payor specific Denial or an internal Denial code and a Denial Amount if applicable. 2 Payment Batch Report Shows Denials When payment batch is printed it will show Denials. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 35

36 Batch Entry Patient Denials Screen The Patient Denials screen (ctrl-d) shows denials posted. Top block shows claims on account. Selecting a claim line will display any denials on the claim. Actions can be taken on claims (e.g. R Restart claim, B ReBill claim, P Bill Patient) or collection credit status and date can be changed on the claim. Bottom block shows charge detail for each denial posted. If a charge has more than one denial, the line will display once for each denial. The show option can change the view. Unresolved Denials = Denials which do not have resolution code populated Active Denials = Denials with Review Rep and Date attached for the current user All Remittance/Denial = All Denials Picking a denial line, user can enter Resolution Code for the denial in field below the Denial block. Denial Lines displayed can be Bulk Resolved by entering Bulk Resolution code and pressing the Bulk Resolution button. This will attached Resolution code entered to each denial shown. When resolution codes are entered and saved, actions will be taken for the resolutions based on actions identified in the Denial Resolution maintenance screen. 36 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

37 Batch Entry Charge Entry The Charge Entry program is used to enter multiple patient or client charges (transactions) in batch and apply them to multiple accounts. The following tasks can be performed as part of charge entry: Entering a new batch or editing and existing batch Posting a batch or placing it on hold Previewing a batch receipt and printing a copy Closing a current batch Creating a Charge Batch To enter a new charge batch: 1 Select Go > Batches > Charge Batches from the menu bar or press [Ctrl+G]. 2 In the Charge Batches window, click New to create a new batch or select an existing Batch Number from the drop-down list. If you leave the field blank, the system will assign the next sequential batch number. Depending on the batch number selected, or if this is a new charge batch, certain fields will be automatically entered by the system. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 37

38 Batch Entry 3 Click OK to create the batch. NOTE: It is not necessary to provide all information at this point because it can be entered when new records are created later on in the process. The Transaction Date and Transaction Code default values will be entered automatically by the system as transactions are entered. 38 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

39 Batch Entry 4 In the Charge Entry for Batch # window, click the New button (press Ctrl-N) to add a charge line. NOTE: The Account Number can be either a patient or a client number. 5 Enter an Account Number, or click the Show Accounts button to locate it in the RCM database. 6 Select Transaction Date, Clinic, Lab, Transaction Code, Quantity and any relevant optional information from the drop-down lists. See Patient/Client Transaction Entry section. 7 Enter a Quantity value, specifying the number of transactions. The Amount field is automatically entered based on the Transaction Code selected. The Total amount is calculated based on Amount and Quantity values. The Total Charges are calculated based on Total amount and Transaction Count. 8 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]). 9 The Total Charges field in the lower-right corner is automatically updated based on the amount and quantity entered. 10 Before you can exit the Charge Entry for Batch # window, you must post the batch, delete it, or place it on hold using the appropriate button. The specified transactions (charges) will be generated when the batch is posted. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 39

40 Batch Entry Charge Batch Import This is an Import feature in charge batch for the loading of charge files into a Charge Batch. 1 Pressing the Import button opens the Import Charges window for entry of a charge file and the selection of layout. Load Data File Directory path and file name of charge file to be loaded. Layout Parameters Load Layout. This load layout must be mapped to a database SQLload file definition. See documentation for Sundry Load Process. Load Layout table cannot be found in maintenance tables. It must be populated via SQLPlus. 2 Enter file and layout then press Begin Load. File will be loaded into temporary table and number of records read displayed. 40 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

41 Batch Entry 3 Press Continue to load records into a Charge Batch and edit for missing/incorrect data. Viewing and Modifying Batches Placed On Hold To view or modify an existing charge batch that was placed on hold: 1 Select Go > Batches > Charge Batches from the menu bar or press [Ctrl+G]. 2 In the Charge Batches window, select an existing Batch Number from the drop-down list. Batches that appear in the list have been placed on hold. You can only modify a batch that you placed on hold. Once you open a batch from the list to view or modify, that batch is no longer on hold unless you place it on hold again. 3 Click OK to open the selected batch. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 41

42 Batch Entry 42 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

43 Batch Entry Loading or Importing Batches Charge batches may be loaded via backend processes which read batch files and build charge batches. There is also an import button which will import files of charges into a batch. When charges are loaded or imported their records will be edited to locate any records with errors. Then number of errors found in the batch will be displayed on the Charge Batch Header screen. A charge batch cannot be posted until all of these errors have been corrected. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 43

44 Batch Entry In the Charge Entry for Batch# window, any charge records with errors will be flagged by check mark in the Errors column on the grid. Specific fields with missing or invalid values will have field titles in red. Correct the charge populating missing fields and when finished, uncheck the error flag in lower left corner of the screen to indicate the charge no longer has errors. You can filter the grid to select only the records with errors by pressing the filter button creating a filter on the errors field with value equal to TRUE. and 44 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

45 Batch Entry Creating Trip Fee Batches Some providers travel to clinics, nursing homes or offices to collect test specimens. In some cases, a charge can be billed for the travel and collection of these specimens. Trip fees are charged by the number of miles and the number of stops. Two corresponding transaction charge codes have to be setup in the Code Table Management (Tools > Manage Code Tables > Transaction Codes), such as TRIPMILE and TRIPSTOP. For more information on code tables, refer to the RCM 3.4 Code Table Reference Guide. To use the automated generation of trip fees for draws, a flag must added to the Transaction Code table to identify charges that require a draw. To create a charge batch for trip-related expenses: 1 Setup the related transaction codes in Transactions->Codes table with Specimen Draw Flag checked. 2 Select Go > Batches > Charge Batches from the menu bar or press [Ctrl+G]. 3 In the Charge Batches window, click Trip Fees. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 45

46 Batch Entry 4 In the Trip Fees window, select Clinic (or choose All Clinics), Physician (or choose All Physicians), and Draw Date from the drop-down lists. Draws are automatically calculated by the system by counting the number of individual accounts with specimen draw charges (charges flagged as specimen draw in the Transaction Code maintenance) on the date indicated for the Physician and Clinic indicated. 5 Enter the number of Miles traveled and Stops required to make those draws, and select appropriate Charge Codes for miles and stops (e.g., TRIPMILE; TRIPSTOP) from the dropdown lists. The Rate for miles and stops is calculated based on the information provided. 6 To create a miles charge batch, click the Create Miles Batch button. To create a stops charge batch, click the Create Stops Batch button. 7 The system will automatically build a batch of either Mile or Stop charges based on the information provided, creating one Trip or Stop charge for each account with specimen draws on the date indicated. 8 The header window will redisplay showing the number of charges created and the total dollar amount. Click OK to view/edit the batch. 46 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

47 Batch Entry In the Charge Entry for Batch # window, create new records or edit existing entries in the same way as any other charge batch. You have the option to print, delete, hold, and post the batch. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 47

48 Batch Entry Printing a Batch Report To print a report for a charge batch: 1 In the Charge Entry for Batch# window, click the Print Batch button to print the selected batch record. The report will open in the Report Viewer. You can preview the batch report in the right pane and print it by clicking the Print Report button on the toolbar. 48 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

49 Batch Entry Placing a Batch on Hold A charge batch can be placed on hold to temporarily suspend it and allow it to be re-opened later for additional entry or posting. When a Payment/Adjustment or Charge batch is opened, it is flagged with an open status to prevent other users from opening and manipulating the same batch. If a batch is open and the system or desktop hangs, that batch will remain stuck in an open status. This function may be used to place the suspended batch on hold so it can be reopened. After all charges have been entered, to post an existing charge batch: 1 In the Charge Entry for Batch # window, click the Hold Batch button. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 49

50 Batch Entry 2 In the message dialog box, click Yes to place the batch on hold, or click No to return to the Charge Entry for Batch # window. 3 You will receive a message indicating the batch was placed on hold. Click OK. 50 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

51 Batch Entry Posting a Batch After all charges have been entered, to post an existing charge batch: 1 In the Charge Entry for Batch # window, click the Post Batch button. 2 In the message dialog box, click Yes to close the batch, or click No to return to the Charge Entry for Batch # window. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 51

52 Batch Entry Deleting a Batch To delete an existing charge batch: 3 In the Charge Entry for Batch # window, click Delete Batch. 1. In the message dialog box, click Yes to delete the batch, or click No to return to the Charge Entry for Batch # window. NOTE: Deleting a batch will delete all charges entered in the batch. 52 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

53 Chapter 3 Charge Batch Load (Sundry Load) 3 Loading a Sundry File - Set-up Take the following steps for Sundry Load Set-up Create SPOOL Working Directory: 1. Log into SQLPlus using application login and enter the following command to create an Oracle directory called V34_CDNSPOOL. This directory is where working files will be located. The directory indicated (d:\hrcm34\prod\spool) must exist on the Oracle Database server. 2. Create or replace directory v3_cdnspool as d:\hrcm34\prod\spool ; 3. Create Script for Load Layout. Creation of this script, depending on the complexity may require the assistance of an Oracle Developer. Script associates an Oracle table to a data file. It maps each of the locations of fields on the data file with columns in an Oracle table. Below are two sample load scripts. NOTE: The table created CANNOT match name of any other table in the database (it must be unique). The table name will be the name used for the load layout. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 53

54 Charge Batch Load (Sundry Load) Fixed Column Position Sample Script The following script will load data from a file which has data in defined column locations. It is for loading fixed position data files. drop table sunintf; CREATE TABLE SUNINTF ( ACCTNO VARCHAR2(20), CAMPUS VARCHAR2(2), TRANDATE VARCHAR2(15), TRANCODE VARCHAR2(20), TRANQTY VARCHAR2(5), TRANAMT VARCHAR2(20), GSTFLAG VARCHAR2(1), PSTFLAG VARCHAR2(1), BUNIT VARCHAR2(20), DEPTNO VARCHAR2(20), GLACCT VARCHAR2(20), TRANTYPE VARCHAR2(1), INVOICEFLAG VARCHAR2(1), MAXBILLAMT VARCHAR2(20), ATTPHYS VARCHAR2(8), RPHYSNO VARCHAR2(8), DIAG VARCHAR2(9), ) NOTE VARCHAR2(2000) ORGANIZATION EXTERNAL ( TYPE ORACLE_LOADER DEFAULT DIRECTORY "V34_CDNSPOOL" ACCESS PARAMETERS ( fields missing field values are null ( acctno position(1:20) char, 54 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

55 Charge Batch Load (Sundry Load) campus position(21:22) char, trandate position(23:37) char, trancode position(38:49) char, tranqty position(50:52) char, tranamt position(53:61) char, gstflag position(62:62) char, pstflag position(63:63) char, bunit position(64:68) char, deptno position(69:78) char, glacct position(79:88) char, invoiceflag position(89:89) char, trantype position(90:90) char, maxbillamt position(91:110) char, attphys position(111:118) char, rphysno position(119:126) char, diag position(127:135) char, note position(136:2135) char ) ) LOCATION ( "V34_CDNSPOOL":'sunintf.dat' ) ); Comma Delimited Sample Script The following script will load data from a file which is comma delimited. NOTE: All columns on the SUNLOAD table need to be referenced in the load layout. Since the external table does not contain all of the columns, we are creating SBSULOAD_EXT as our external table and then using a view SBSULOAD to define the missing fields as null values. drop table sbsuload_ext; CREATE TABLE SBSULOAD_EXT ( ACCTNO VARCHAR2(20), Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 55

56 Charge Batch Load (Sundry Load) CAMPUS VARCHAR2(2), TRANDATE VARCHAR2(15), TRANCODE VARCHAR2(20), TRANAMT VARCHAR2(20), BUNIT VARCHAR2(20), DEPTNO VARCHAR2(20), GLACCT VARCHAR2(20), NOTE VARCHAR2(2000) ) ORGANIZATION EXTERNAL ( TYPE ORACLE_LOADER DEFAULT DIRECTORY "V34_CDNSPOOL" ACCESS PARAMETERS ( RECORDS DELIMITED BY NEWLINE FIELDS TERMINATED BY ',' MISSING FIELD VALUES ARE NULL (ACCTNO, CAMPUS, TRANDATE, TRANCODE, BUNIT, DEPTNO, GLACCT, NOTE, TRANAMT) ) LOCATION ( "V34_CDNSPOOL":'sbsuload.dat' ) ) ; CREATE OR REPLACE VIEW SBSULOAD (ACCTNO,CAMPUS, TRANDATE, TRANCODE, TRANQTY, TRANAMT, GSTFLAG, PSTFLAG, BUNIT, DEPTNO, GLACCT, TRANTYPE, INVOICEFLAG, MAXBILLAMT, ATTPHYS, RPHYSNO, DIAG,NOTE) AS SELECT ACCTNO, CAMPUS, TRANDATE, TRANCODE, NULL, TRANAMT, NULL, NULL, BUNIT, DEPTNO, GLACCT, NULL, NULL, NULL, NULL, NULL, NULL, NOTE FROM SBSULOAD_EXT; 56 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

57 Charge Batch Load (Sundry Load) To execute in SQLPlus to Build External Table log into v3.4 database and execute the Load Layout script. Add Load Layout 1. Open Tools -> Manage Code Tables -> Load Layouts and add the new Load Layout with a description. Layout = name of layout table (or view) created in step 1b. Description = any text to describe the layout. Directory = the Oracle server directory created in 1a. Data File = file indicated in the LOCATION command of script in 1b. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 57

58 Charge Batch Load (Sundry Load) Loading a Sundry File Take the following steps to load a Sundry File: 1 Select menu option Go -> Batches -> Charge Batches 2 Press the Import button on bottom of screen This will open Import Charges window. 3 In Load Data File enter name of file to be loaded or use button to right of field to browse and select file. 4 Enter Load Layout Set-up in step 1-d above. 5 Press Begin Load This will cause the Load Data File to be copied to the Oracle Server Directory using the name indicated in the Load Layout parameters. From the Oracle Server Directory, the file will then be mapped to the Oracle Load table and loaded into the application. The Import Charges screen will show the number of records successfully loaded. A log file of the load will be created in the Oracle Server Directory named {External Table Name}_9999_9999.log. If the data file contained any records that could not be loaded, those will 58 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

59 Charge Batch Load (Sundry Load) appear in a bad file in the Oracle Server Directory named {External Table Name}_9999_9999.bad. 6 If you are satisfied with the number of records that have been loaded, press the Continue button. The data loaded will be edited and loaded into a charge batch. The Charge Batch Header screen will display showing totals for the batch loaded. If errors were found, you will see the number of records with errors displayed in the Error field. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 59

60 Charge Batch Load (Sundry Load) 7 Pressing the OK button on Header screen will display batch detail. Records with errors will display error flag checked and will show the field with error in red. Data should be corrected and error flag lifted. When complete, batch can be posted. 60 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

61 Chapter 4 Cashiering 4 Cashiering Set-up 1 Setup default Cash Location for a representative: Open Tools>Security>Manage Rep Infor screen and populate Cash Location field 2 Setup Over/Under Allowed amount limit: Open the Tools>Manage Code Tables>Company Codes>Options maintenance screen and enter a positive amount in Payment Over/Under Allowed field which will be used to restrict payment batch posting. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 61

62 Cashiering 3 Setup Cash Location: Open Tools>Manage Code Tables>Cash Location maintenance screen to setup followings: a. Over/Under Acct#: Enter an account# to be used to post over/under payments, the actual discrepancy between total payment received total money counted b. Over/Under Tran Type and Code: Select applicable Transaction Type and Transaction Code to be used for Over/Under credit amount. The Over/Under amount would typically be set-up as an expense type transaction code (trantype A.) c. Over/Under Bank Type and Code: Select applicable Bank Type and Bank Code to be used for Over/Under debit amount d. Bank Accounts: Enter bank account information to be displayed on the deposit slip e. All transaction codes are used in this screen should have proper GL. 62 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

63 Cashiering 4 Setup Currency: Open Tools>Manage Code Tables>Currency Codes maintenance screen and enter applicable currencies, for example: CAD, US or other. 5 Setup Payment Type: Open Tools>Manage Code Tables>Payment Type maintenance screen and enter applicable payment types for currencies. For example: CASH for CAD currency. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 63

64 Cashiering 6 Setup Transaction Code for a Payment Type: Open Tools>Manage Code Tables>Transactions>Codes maintenance screen to setup a transaction code of Transaction Type P and populated applicable Payment Type. 7 Setup various Denominations: Open Tools>Manage Code Tables>Denomination maintenance screen and enter applicable denominations for currencies. For example: COINs, NOTEs etc. 64 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

65 Cashiering Cash Balancing Screen Required Payment, Total Payment and Balance Cash buttons The Required Payment, Total Payment and Balance Cash buttons appear on the Payment Entry for Batch # screen. The Balance Cash button is used to open the Cash Balancing screen. 1 Click the Balance Cash button on the Payment Entry for Batch# screen. 2 The Cash Balancing screen will open and cause any current payment entry to be completed and saved. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 65

66 Cashiering The amounts entered in the Cash Balancing screen are totaled and appear in the Payment Required field and at the bottom of the Payment Entry for Batch# header screen. The Required Payment is calculated as the sum of each of the entries made on the left side of the Cash Balancing screen: Total Canadian = Total Cash + Total Cheques + Total Debits + Total EFT + DirectDeposit + MasterCard + VISA - Cash Float Total US = US Cash + US Checks + Exchange Sum of Canadian + US = Required Payment value When the absolute value of a payment batch is the Required Payment minus payments and is greater than the company table Over/Under Allowed amount a batch out of balance error message is received and the payment batch will not post. If the value of a payment batch is within the Over/Under Allowed amount the batch will post. 66 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

67 Cashiering Denomination Screen The Denominations Button is located in the top right of the Cash Balancing screen. It opens a pop-up dialog window in which the user enters a breakdown of cash found in their cash drawer by denominations. The denominations on left side are hard coded or listed Canadian cash denominations. User enters quantity for each and screen calculates the total. The total from this screen when screen is closed populates Total Cash field on Cash Balancing screen. 1 Click the Balance Cash Button in the bottom right of the Payment Entry for Batch # screen. The Cash Balancing screen will appear and provide on opportunity to enter the payment type. 2 If payment has been made in cash, Click the Denominations Button in the top right of the Cash Balancing screen. The Cash Counted screen will appear, providing for the input of the number of bills and coins received. 3 Click Done when all cash is accounted for and return to the Cash Balancing screen. From here a Report or Depsit Slip can be printed. Denomination Quantities Quantity of each denomination is entered and the screen calculates the total dollar value for that denomination. The sum of all of the denominations will appear in the Total Cash field. See Total Cash field above. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 67

68 Cashiering Cash Balancing Screen Fields Money Counted These fields are manually entered. As entered, totals will be calculated. Total Cash Not enterable. It will be calculated based on quantity of each denomination entered. To enter denomination quantities, press the $$$ button next to Total Cash title. This button can also be navigated to by pressing Tab and hit enter once cursor located on button to bring up denominations screen. See Denominations screen below. Total Cheques Manually entered. Dollar value of cheques collected. Total Debits Manually entered. Dollar value of debits collected. Total Mastercard Manullay entered. Dollar value of Mastercard transactions collected. Total VISA Manually entered. Dollar value of VISA transactions collected. Less Cash Float Manually entered. Cash float amount (amount of cash contained in the drawer prior to opening the payment batch). Total Counted Not enterable. Will be calculated by system as the total of Cash + Cheques + Debits + Mastercard + VISA Cash Float. Should be total amount of Canadian dollars collected/posted in the batch. US $ Counted Manually entered. The dollar value of US funds collected. Receipts These fields will be sum of amounts posted in the batch at time of opening Cash Balancing screen. 68 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

69 Cashiering Total Cash Not enterable. System will sum up all posted payments with payment type (see new Transaction code field Pay Type) equal to CASH. Total Cheques Not enterable. System will sum up all posted payments with payment type equal to CHEQUE or CHECK. Total Debits Not enterable. System will sum up all posted payments with payment type equal to DEBIT. Total Mastercard Not enterable. System will sum up all posted payments with payment type equal to MASTERCARD. Total VISA Not enterable. System will sum up all posted payments with payment type equal to VISA. Total Receipts Not enterable. System will sum up all Canadian funds (Cash + Cheques + Debits + Mastercard + VISA) US $ Receipts Not enterable. System will sum up all Payments posted in US funds. Canadian Currency Over/Under Not enterable. System will display the amount posted Canadian payments are Over/Under the amount of Canadian money counted. US Currency Over/Under Not enterable. System will display the amount posted US payments are Over/Under the amount of US money counted. The sum of the Total Counted and US Counted will be brought back to the Payment Amount field in the Payment Header screen. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 69

70 Cashiering Cash Balancing Screen Buttons Print Report Prints Balancing report shows details from the Cash Balancing screen and the break down of cash by denominations. Deposit Slip Prints Deposit Slip prints Cash break down and total of cheques. Only prints payments of type CASH and CHEQUE. Parameter Screen Transit# - will print on deposit slip in Transit# field Institution# - will print on deposit slip in Institution# field 70 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

71 Cashiering Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 71

72 Cashiering THIS PAGE INTENTIONALLY LEFT BLANK. 72 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

73 Chapter 5 Maintaining Code Tables 5 This chapter provides an overview of code table maintenance. Code tables are used to define fields in the HRCM database. The Code Table Management window in the HRCM front-end enables you to specify values that populate application drop-down lists by manually adding records to the various tables. For more detailed information on code tables, refer to the HRCM 3.4 Code Table Guide. New Code Tables HRCM 3.4 has two new tables associated with the Cash Posting enhancements. Currency Codes Denomination Codes Currency Codes Tools>Code Table Management>Currency Codes The Currency Codes screen allows the user to choose the currency in which a payment is being made. This provides the correct conversion rate from a preconfigured table. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 73

74 Maintaining Code Tables Denomination Codes Tools>Code Table Management>Denomination On the Denomination Codes table and screen the prefixes and formatting for a variety of currencies can be determined. Examples of common currency formats: US Dollar: Coins Freq. used 1, 5, 10, 25 Rarely used 50, $1 Banknotes Freq. used $1, $5, $10, $20, $50, $100 Rarely used $2 Canadian Dollar: Coins Freq. used 1, 5, 10, 25, $1, $2 Rarely used 50 Banknotes Freq. used $5, $10, $20, $50, $100 Euro: Coins 1c, 2c, 5c, 10c, 20c, 50c, 1, 2 74 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

75 Maintaining Code Tables Banknotes 5, 10, 20, 50, 100, 200, 500 United Arab Emirates dirham: Coins Banknotes 25 fils, 50 fils, 1 dirham 5, 10, 20, 50, 100, 200, 500, 1000 dirhams Cash Posting Screen Changes Several new fields have been added to a variety of screens to reflect the enhancements to Cash Posting capabilities. Company Codes Tools>Code Table Management> Company Codes>Options tab. Payment Over/Under Allowed The Payment Over/Under Allowed field appears in the Company Codes table on the Options tab. When posting a payment that is an amount within the allowable Over/Under Amount as defined within the Payment Over/Under Allowed field on the Options tab, the payment batch will close successfully Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 75

76 Maintaining Code Tables Negative values are not allowed, and if the Payment Over/Under Allowed field is blank the amount is assumed to be zero. If the payment posted amount is outside of the Payment Over/Under Allowed amount an out of balance error message will be received. Transaction Codes Tools>Code Table Management>Transaction>Codes US Lab: On the Transaction Codes screen the Payment Type field is defined by the following options: Cash, Check, Debit, MasterCard, VISA, DirectDeposit or EFT. Canadian: On the Transaction Codes screen the Payment Type field is defined by the following options: Cash, Cheque, Debit, MasterCard, VISA, DirectDeposit, EFT, USCASH, USCHEQUE or USEXCHANGE. Code Table Management To update field-specific information using code tables: 1 Select Tools > Manage Code Tables from the menu bar. 76 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

77 Maintaining Code Tables 2 In the Code Table Management window, select a code table from the list in the left pane by clicking on it. Records and fields of the selected code table are displayed in the right pane. 3 In the Code Table Management - <Table Name> window, update existing records by entering all required information or selecting it from the drop-down lists, and specifying any relevant optional information. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 77

78 Maintaining Code Tables 4 To add a new entry/code, click the New button. To copy a record, click the Copy button. To delete a record, click the Delete button. To revert changes to the selected record, click the Revert changes to current selection button. To filter the existing records, click the Filter button. To print the selected record, click the Print button. 5 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]). 78 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

79 Maintaining Code Tables Opening Code Tables in Separate Windows Code tables can also be peeled off the Code Table Management window and opened in separate windows. To open a code table in a separate window: 1 Right click on the Code table in the left pane of the window causing the Open in new window option to appear. 2 Click on Open in new window to open the code table in a separate window. This process can be repeated to open additional individual code table windows. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 79

80 Maintaining Code Tables Import Transaction Codes and Rates The Import button allows importing data into rates tables from a spreadsheet. 1 Pressing the Import button will open Import from Excel Window. Enter or browse to find the spreadsheet to be loaded. This will reveal how the columns in the spreadsheet will be mapped to table columns and indicate which columns are required. 80 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

81 Maintaining Code Tables 2 If needed, mapping can be corrected. Highlight or add a new mapping line and then pick the Excel spreadsheet column that contains the data using the drop down to the right and then map that to a table column using the drop down to the left. Mapped lines can also be removed by hitting the grid delete button. 3 Press the Validate button to determine if data is correct or needs to be modified. Errors discovered will be shown in a validation window. 4 The effective date will default to the current date. If needed, a different effective date can be entered to make the new codes/rates effective on a different date. Hit the Import button to load the spreadsheet. 5 A validate window will display showing if the import has completed successfully and rows that it updated. 6 Key data in the spreadsheet will be used to locate old code/rate lines. Data from the old line will be copied into new and then overlaid with mapped data fields from the spreadsheet. The effective from date of the new row will have the date indicated by the effective date parameter. The effective thru date of the old row will be set to the parameter date minus one day. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 81

82 Maintaining Code Tables Export Transaction Codes and Rates Data can also be exported from the rates tables by first filtering the data then using print button: 1 From the print window, press the Export button and choose Excel spreadsheet for editing. 2 After exporting, the spreadsheet can be modified as needed. After modifications, data in the spreadsheet can be loaded using the Import button. Copy or Duplicate a Maintenance Table Line The Copy button to left side of maintenance screens allows the user to copy or duplicate a Maintenance Table line. When pressed, the current row is copied into new row of data in the maintenance screen. If the table has a primary key associated with it (e.g. Address Code in Address Codes maintenance screen), then the key field will be blank in the new row. Key field(s) must be populated on the new row with new values that do not conflict with current key values in the table. 82 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

83 Chapter 6 Reporting 6 HRCM includes a set of standard reports to help you better manage your facility. Reports provide a customizable summary view of database entries for various tasks that can be previewed and printed. To use this feature, Crystal Reports Viewer component must be installed on your system. Reports are accessed through the Tools > Reports menu. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 83

84 Reporting Report Types The following reports can be generated by specifying any number of parameters that determine the range and type of information to be included: Credit claim and client credit information Current Aging based on financial class, insurance, name, and rep Insurance Analysis billed and unbilled charges Misc. Reports assortment of various reports Month End end of month adjustment details, transactions, service analyses, and aging summary Statement patient and client statement reports Custom Reports various customized reports See the Reports Dictionary for detailed listing of standard reports. Using the Report Explorer To view and print RCM reports: 1 Select Tools > Reports > Select Report from the main menu. The Report Explorer is launched. Reports are organized into folders according to type. 84 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

85 Reporting 2 In the Report Explorer window, expand the folders to view the individual reports. Select a report from the list and click Open. Depending on the type of report selected, a standard or a customized window is launched requiring user input to determine the requested records (i.e., filtering of records). Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 85

86 Reporting 3 Some reports use standard Crystal Reports parameter screens. The Enter Parameter Values window is displayed consisting of a number of fields that require a value to be specified. Enter any relevant values or select them from drop-down list options. When finished, click OK to generate the report or click Cancel to exit. 86 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

87 Reporting 4 Other reports have more sophisticated parameter screens with entry fields and drop down lists of values from code tables. Select the parameters to define your query. For longer lists of values, use Select All and Select None. Optionally, specify whether to include or exclude particular records. When finished, click Generate Report or click Cancel to exit. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 87

88 Reporting 5 The Extract Data button is used to create a summarized table of data to report on allowing reports to be run more quickly. To refresh or re-extract data, press the Extract Data button. A Previously Saved Extract can be reloaded by selecting the Previously Saved Extract button and then selecting Available Saved Tables from drop down list. Drop down list will contain listing of all tables starting with AGEDET. After selecting Previously Saved Extract, hit Extract to reload it for viewing in current reports. A New Extract can be created by selecting New Extract button and entering extract parameters (Company, Campus, Transaction Date and Entry Date cut offs). Save Suffix can be entered to save a copy of the extract so it is available in the future in the Available Saved Tables list for reloading. Save Suffix should only contain Alpha and Numeric characters which can be used to build a table name. Entering non-alpha/numeric characters (eg space, colon, comma, and other special characters) will cause an error. After entering parameters, hit Extract button to extract data for reporting. 88 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

89 Reporting 6 In the Report Viewer window, the reports may have break groups which create a tree of values in the left pane of the Report Viewer window. You can click on a break group in this tree to move quickly to the page containing that grouping of data. The report details are displayed in the right pane. To adjust the view, use Zoom button on the toolbar 7 To export a report to a file, click the Export Report button on the toolbar. Various file formats are supported, including RPT, XLS, DOC, RTF, and PDF. 8 In the Export Report dialog box, select the location to save the file, the type of file, and specify the file name. Click Save. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 89

90 Reporting 9 In the confirmation message click OK to exit. 10 To print a report, click the Print Report button on the toolbar. 90 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

91 Reporting Loading Custom Reports HRCM allows you to add your own custom Crystal Reports into a specific a custom report directory. Because custom reports can be executed by multiple different users, this directory should be located on a file share that is accessible to all application uses. To specify the custom reports directory: 1 Select Tools > Reports > Settings from the menu bar. 2 In the Report Settings dialog box, click the Browse button. 3 In the Browse For Folder dialog box, select the target folder and click OK. To create a new folder, click Make New Folder. 4 Once the target folder is selected, click OK to accept the setting. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 91

92 Reporting 5 Once the custom report directory is created, Crystal Reports you build yourself can be moved into this directory and sub-directories to build a menu of your own custom reports that is accessible from within the application. The following graphic is an example of a Custom Reports Directory with Sub-Directories. Report Explorer also creates Custom report menu tree in HRCM. 92 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

93 Chapter 7 Managing HRCM Security 7 This chapter provides an overview of RCM security features and maintenance procedures. All tasks related to security can be accessed using the Tools > Security submenu. NOTE: RCM application security management is restricted only to authorized personnel. Therefore, features described here are not available to general users and are reserved for security administrators. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 93

94 Managing HRCM Security Setting up Users Login management enables you to create HRCM user accounts and assign access permissions to those accounts. To be able to use the new account, an associated representative account must also be created. Representative management enables you to create account representatives responsible for administering patient and client accounts. Profile management allows you to define security access profiles for roles/tasks that are common amongst users. Multiple profiles can be assigned to one user. Creating a Profile To create a Profile: 1 Select Tools > Security > Manage Profiles from the main menu. 2 In the Profile Manager window click the New button to add a record. To delete a record, click the Delete button. To revert changes to the selected record, click the Revert changes to current selection button. To filter records, click the Filter button. 3 Enter a Profile Name and either tab or click in the Description. The Screen Security, Code Table Security, Report Security and Action Security tabs are enabled. 94 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

95 Managing HRCM Security 4 On the Screen Security tab select Read or Write access for specific screens within the application. To give the user read access to all listed screens and tables select Read-Only from the drop-down list and click the Set Selection button. To provide read and write access to all screens listed select Full Access and then click the Set Selection button. To remove access to all listed activities, select No Access followed by the Set Selection button. 5 On the Code Table Security tab select Read or Write access for specific Code Table Maintenance screens within the application. To give the user read access to all listed screens and tables select Read-Only from the drop-down list and click the Set Selection button. To provide read and write access to all screens listed select Full Access and then click the Set Selection button. To remove access to all listed activities, select No Access followed by the Set Selection button. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 95

96 Managing HRCM Security 6 On the Reports Security tab select Allow to give full access for specific reports. To give the user full access to all listed reports, select Full Access and click the Set Selection button. To remove access to all listed reports, select No Access and click the Set Selection button. 7 On the Actions Security tab select Allow access for specific activities. To give the user full access to all listed activities, select Full Access and click the Set Selection button. To remove access to all listed activities, select No Access and click the Set Selection button. 8 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Profile Manager window. The user profile has been created. NOTE: Assign Profile to user in the Manage Logins screen. For more information, refer to Creating a User Login Account. 96 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

97 Managing HRCM Security Creating a User Login Account To create a user login account: 1 Select Tools > Security > Manage Logins from the main menu. 2 In the Manage Logins window, click the New button to add a record. To delete a record, click the Delete button. To revert changes to the selected record, click the Revert changes to current selection button. To filter records, click the Filter button. 3 Enter a User Name and the full Name of the new user. 4 You can set the User Account Type to Classic RCM Authentication or Active Directory Authentication. Classic RCM Authentication a b Set the Account Type to C for Classic RCM Authentication To create a new user login password, click the Set button. NOTE: The password must be 5 to 10 characters long. c In the Change Password dialog box, enter a New Password for the user and then enter it again under Confirm New Password. Click OK. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 97

98 Managing HRCM Security d In the confirmation message, click OK to continue. The Password field displays the encrypted password. 98 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

99 Managing HRCM Security Active Directory Authentication a b Set the Account Type to A for Active Directory Authentication Enter the Domain User name to be used for Authentication. c In the Profile Membership tab assign one or more profiles to the user If Administrator access is set to allow use of Advanced User Permissions Editor, additional access can be granted on screens, code tables, reports or actions to the individual user. d When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Manage Logins window. The user account has been created. NOTE: Before a new user login account can be used, an associated representative account must also be created. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 99

100 Managing HRCM Security Creating a Representative Account To create a representative account: 1 Select Tools > Security > Manage Rep Info from the main menu. 2 In the Manage Rep Info window, click the New button to add a record. To delete a record, click the Delete button. To revert changes to the selected record, click the Revert changes to current selection button. 3 Enter a Representative identification (maximum is 3 characters), select the Login Name from the drop-down list, and enter the Name of the new representative. Select any other optional information from the drop-down lists. 100 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

101 Managing HRCM Security 4 On the Security tab click the ellipsis button to enter specific Patient types, Campus codes, and Company codes that the user is allowed access. Check the All option box if the user is to have access everything. NOTE: If access to one or more Patient Types, Campus Codes and Company codes is not indicated, user will not be able to access accounts in the application. 5 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Manage Rep Info window. The representative account is added to the system. The new representative is added to the Representatives drop-down list on the task pane. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 101

102 Managing HRCM Security 6 To use the new user and representative accounts, exit RCM and then start it up again. Select the appropriate Database, and enter the newly created user Login Name and Password. 102 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

103 Managing HRCM Security The application is launched, defaulting to the newly created account representative s work queue. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 103

104 Managing HRCM Security Resetting a User Password When using Classic HRCM Authentication, a user s password can be set from within the application. To reset a user s password: 1 Select Tools > Security > Manage Logins from the main menu. 2 In the Manage Logins window, click the Reset button. 3 A message is displayed asking whether to reset the password. Click Yes to proceed, or click No to return to the Manage Logins window. 4 The Password is by default reset to match the user name (e.g., for a user name cdoe, the password would be reset to cdoe). To change the password to something else, click the Set button. 104 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

105 Managing HRCM Security Changing a User Password When using Classic RCM Authentication, users can change their password from within the RCM application. To change the password of the currently logged in user: 1 Select Tools > Change Password from the main menu. 2 In the Change Password dialog box, enter the Current Password, the New Password, and then re-type the new password in the Confirm New Password field. Click OK. 3 A message is displayed informing you that the password was changed. Click OK to exit. NOTE: It is recommended that user passwords be changed periodically to maintain a highly secure RCM environment. Password expiry parameters are set in the Manage Logins screen. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 105

106 Managing HRCM Security THIS PAGE INTENTIONALLY LEFT BLANK. 106 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

107 Chapter 8 Other Processing 8 Capitation Payors can be configured as capitated. Patients that have capitated payor will have capitated charges that are zero priced. At end of month, a capitation charge is generated on the patient account to be billed to the payor along with any non-capitated charges. Payor Set-up as Capitated To set-up a Payor as capitated: 1 Enter a capitation charge code on the Payor Plan screen. 2 Set-up capitated charges for the payor in the rate table as zero priced. 3 Set-up non-capitated charges with contracted rates. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 107

108 Other Processing Patient Capitation Processing To run capitation: 1 SYSTABLE.CAPDAY must be populated with day of the month on which capitation process should be executed. Leave SYSTABLE.CAPDAY blank to skip processing capitation. 2 Patients must be set-up with capitated payor. Charges that are capitated for the payor should price with a rate of zero. Non-capitated charges should receive a payor specific rate. 3 On the day indicated in SYSTABLE.CAPDAY, the process will execute in dayend and search for any patients with a capitated payor. If the patient has charges in the prior month (or current month if processing on last day of month) and does not already have a capitation charge, then a capitation charge will be generated to bill to the payor. 108 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

109 Other Processing Generic Payor/Client Set-up Generic payor/clients can be set-up then assigned to patients. At time of billing, a specific payor will then be selected based on the Clinic or Lab of the charges being billed. Generic payors would typically be used in one of the two following cases: 1 Medicare generic payor which must be billed based on the location of the lab where tests/services are provided. 2 Client generic payor picking which client to bill based on client associated with charges being billed. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 109

110 Other Processing Set-up Generic Payor To set-up a generic payor: 1 Set-up payor plan with plan code = and pick Plan indicator to identify if detailed payor should be picked based on L=Lab or C=Clinic. 110 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

111 Other Processing 2 Set-up detail payors for each Lab or Clinic with the payor matching the generic payor code and the plan code matching the clinic or lab code (depending on whether plan indicator is L=Lab or C=Clinic). Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 111

112 Other Processing Processing Generic Payors To use generic payors: 1 Assign generic payor to patient account. 2 Charges added with Clinic and COB of payor. 112 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

113 Other Processing 3 Claim billed to specific payor (instead of Generic payor) based on clinic assigned to charges. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 113

114 Other Processing Transaction Roll-ups Charges on Patient Accounts can be rolled up prior to billing to produce a single charge for billing. Set-up Roll-up Roll-up rules are configured in the Transaction Roll-up maintenance table. To configure a roll-up rule: 1 Open Transaction > Roll-up Codes maintenance screen. 2 Enter a roll-up header record. Company is the company identifies the Company the rule will be used by. Rule ID is a unique name used to Identify the Roll-up Rule. Tran Code indicates the new charge that will be generated by the Roll-up. Roll-up Rule defines when the rollup should occur: o 1 = Old Code Amount > New Code Amount roll-up will occur if the sum of the rates of the rolled up codes is greater than the rate of the new code to be created. o 2 = All Codes Exist roll-up will occur if all non-optional charges to be rolled-up are found. o 3 = All COB roll-up will occur if all non-optional charges to be rolled-up are found and are billable to the same COB (Cordination of Benefits). Backout Code defines how the rolled-up codes should be backed out when the roll-up occurs. o o 1 = Reverse Old Codes will reverse out (Journal Out/J-out) the rolled-up transactions. This method is not recommend as it prevents ability to perform a subsequent Payor Change and backing out the roll-up. 2 = Back Out Dollar Amount will create reversing transactions flagging the old and reversing transaction with a U status to indicate it has been rolled-up instead of J status indicating it has been reversed. Transactions are still seen by screens, reports and billings as active. 114 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

115 Other Processing o o 3 = Prorate by Dollar Amount will create reversing transactions flagged with U status and then generate new transactions for the rolled-up charges which have the dollar amount of the New Transaction Code spread across them based on each charges dollar percent of total rolled-up charges. The New Transaction will have a zero dollar rate assigned. 4 = Prorate by Quantity will create reversing transactions flagged with U status and then generate new transactions for the rolled-up charges with which have the dollar amount of the New Transaction Code spread across them based on each charges quantity percent of the total rolled-up charges. The New Transaction will have a zero dollar rate assigned. 3 Enter Details of charges to be rolled up for the rule. Each line of detail represents charges that should be included with the roll-up. Charges will be indentified for the roll-up by matching the detail rule. o o o o Price List can be used to select charges which are all of the same price list. Price list will typically be used with Tran Code = (all transactions of a particular price list) and with the Quantity field to indicate that a certain quantity of the rolledup charges must exist on the account to match the roll-up requirement rule. Price List will also be used with the Optional flag to indicate that all charges belonging to a certain price list are optional, but should be rolled-up when then roll-up occurs. Quantity can be used to indicte if a minimum quantity of this charge or set of charges must exist for the roll-up rule to apply. Tran Code can be used to indentify a single charge to be required or included with the roll-up or the Tran Code can be set to to indicate that all charges in particular Price List are included. Patient Type can be used to indicate if the detail rule line only applies to a single Patient Type or 99 for All Patient Types. o Financial Class can be used to indicate if the detail rule line applies to only one Financial Class or 99 for All Financial Classes. o Payor + Plan can be used to indicate the detail rule line applies to only one Payor + Plan or 9999 for All Payors and/or for All Plans. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 115

116 Other Processing o o Effective From/To can be used to indciate that the detial rule only applies to service dates within a specific period of time. Optional is used to indicate if the rule is required (unchecked) meaning the rule must be met for the roll-up to occur or optional (checked) meaning the indicated charges will be rolled up, but do not need to exist for the roll-up rule to apply. 4 Enter Roll-up Rule Priorities. Multiple roll-up rules can apply depending on the details in the roll-up. The Priorities define what order the roll-ups should take. These priorities are identified by Financial Class and/or Payor + Plan. o Financial Class can be used to indicate which Financial Class this priority belongs to. o Payor + Plan can be used to indicate priority for a specific Payor and/or Plan. o Priority defines the priority of this rule for the indicated Financial Class and Payor + Plan rule. Priority of 0 indicates the rule should be ignored. Priority of 1 is highest priority, 2 is second highest, etc. 116 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

117 Other Processing 5 Flag transaction rate rules for charges which should be considered for roll-up. Flag should be set for all detail charges which should be considered for the roll-up. o o o o Roll-up A, B, D and F are client specific Bundling Roll-ups. These roll-up types should not be used unless indicated by Implementation Specialist. Roll-up Y indicates the charge should roll-up. Roll-up X indicates the charge should explode into other charges. Blank indicates the charge should not roll-up. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 117

118 Other Processing 6 The Roll Flag field is a display-only field in Transaction Entry and the Transaction Grid. It appears before the In/Out field, on the Patient Transaction Entry, Detail screen, and on the Claims and Client Transaction screens. 118 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2

119 Other Processing Processing Roll-up Charges will be added to a Patient Account and if flagged in the Transaction Rate rules will have Roll-up flag set to Y to indicate it should be included with roll-ups. In the End of Day Process, prior to billing, roll-up will be checked to determine which if any roll-ups should apply. Accounts with new unbilled charges entered since the last End of Day Process which haven t already been rolled-up will be checked. The roll-up process will look for charges which are flagged for roll-up, but have not been rolled up or billed yet. Using the priorities identified, each roll-up rule will be checked to see if it applies based on the rule type and the details identified. If the rule applies, the transactions identified as the roll-up detail will be backed out in the method indicated and if necessary, re-applied with new dollar amounts. All of the backed out transactions will be flagged with either a J status for reversal or a U status to indicate they have been rolled up. The new transaction will be generated. Roll-up Flagged Transactions before Roll-Up Process: After roll-up, flagged charges reversed with a U status. New charge created is highlighted: Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 2 of 2 119