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

Transcription

1 Healthcare Revenue Cycle Management - US Lab User Guide Part 1 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 3.4 Publication date: May 29, 2014 Document code: RCM-MSARL-34UG Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 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 Using Healthcare Revenue Cycle Management Launching Healthcare Revenue Cycle Management HRCM Workspace Work Queue Menu Bar Title Bar Toolbar Workspace Layout Dialog Boxes and Windows Basic Operation Tabs Input Fields Data Grid Grid Buttons Filtering displayed Records Shortcut Keys Online Help Selecting a Company Chapter 3 Registering Patients and Clients Adding a New Patient Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 3

4 Contents Using the New Patient Wizard Adding a New Client Using the New Client Wizard Chapter 4 Administering Patients Navigating Patient Accounts About the Task Pane Using the Work Queue Viewing Patient Account Details Searching for Accounts Re-Registering Patient Accounts Re-Registering a Patient Account Management Patient Information Patient Notes Document Entry Patient Diagnosis Assign to Transactions Payor Details Refund Request Refund Authorization Patient Summary Chapter 5 Administrating Clients Navigating Client Accounts Using the Work Queue Viewing Client Account Details Searching for Accounts Updating Client Accounts Account Management Client Information Client Notes Document Entry Client Summary Chapter 6 Managing Accounts Changing Payor Changing Patient Type Merging Accounts Merging Patients Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

5 Contents Restore Account Denial Management Review Types Maintenance Screen Denial Maintenance Screen Denial Resolution Codes Maintenance Screen Patient Denials Screen Posting of Denials Payment Batch Report Shows Denials Chapter 7 Creating Transactions and Claims Patient Accounts Adding a Transaction Adding a Claim Patient Claim Screen Client Accounts Adding a Transaction Adding a Claim Managing Transactions Transaction Grid Display Options Print Receipt Duplicate Entries Reverse Entries Rebill Entries Re-Apply Cash Write-Off Cash Refund Create Adjustment Chapter 8 Billing Manual Billing Demand Billing Mass Re-Billing Bill Processing Immediate Bill Processing Interim Bill Processing Monthly Bill Processing Refund Processing Print Refund Checks Reset Refund Check Requests Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 5

6 Contents Print Check Register Print Check Register Month-End Processing Month-End Close EDI File Processing Working with EDI Import Files Working with EDI Export Files Generating Billing Output Printing Billing Requests Generating Statements/Invoices to PDF and ing Account Rep Sending s Recurring Charges and Payments Setting Up Recurring Charges and Payments Processing Recurring Charges and Payments Re-Pricing Charges UB04 (Institution) Billing Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 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 1 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 for Healthcare Revenue Management 3.4 Release Notes Updates for Healthcare Revenue Management 3.4 User Guide Part 2. Related Documents Product documentation is available on 8 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 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 1 of 2 9

10 Introduction THIS PAGE INTENTIONALLY LEFT BLANK. 10 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

11 Chapter 2 Using Healthcare Revenue 2 Cycle Management Launching Healthcare Revenue Cycle Management To launch the HRCM front-end application: Select Start > Programs > Healthcare Revenue Cycle Management 3.4 or double-click the HRCM shortcut button on the desktop. The application will perform a search for new updates. Any available updates are automatically downloaded and installed. The status dialog box displays the update progress. Once the update is completed, the HRCM application is launched. In the HRCM - Login dialog box, select the Database, enter your Login Name and Password, and click OK. The HRCM main screen is displayed. You can check the version of the installed HRCM application by selecting Help > About on the menu bar. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 11

12 Using Healthcare Revenue Cycle Management You can check the version of the installed HRCM application by selecting Help > About on the menu bar. The following graphic will show as the waiting splash screen: 12 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

13 Using Healthcare Revenue Cycle Management HRCM Workspace Once the login information has been verified, the default HRCM window is displayed. It is the main workspace for performing all tasks in the HRCM front-end application. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 13

14 Using Healthcare Revenue Cycle Management The following sections describe key functional elements of the HRCM workspace, including: Work queue Menu bar Title bar Toolbar Work Queue The HRCM Work Queue on the left-hand side of the HRCM workspace provides a quick access to the stored data. It enables you to browse or search through the HRCM database to find a particular patient or client account. Menu Bar The HRCM menu bar provides access to various functions and tasks within the application, described in detail throughout this document. Underlined letters on the menu bar, menus and submenus represent access keys (activated by pressing the [Alt] key) that enable accessing menus using the keyboard. Pointing at a menu name (e.g., Tools) a menu with tasks and submenus is generated. Selecting a task from the menu launches the process by opening the associated window or dialog box. 14 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

15 Using Healthcare Revenue Cycle Management The following diagram shows the main tasks and commands accessible through the HRCM menus and submenus. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 15

16 Using Healthcare Revenue Cycle Management Title Bar The HRCM title bar provides information that is useful especially in environments comprised of multiple organizational units. It displays the currently selected company name followed by the application name, version and edition. For example, you can work on data belonging to Lawson Healthcare Laboratory in one HRCM window, while at the same time you can also access data from other companies in separate windows. The title bar information is an important visual guide that helps to prevent data entry errors. Toolbar The HRCM toolbar consists of shortcuts to the most commonly used tasks in HRCM to enable easier and faster access. To quickly determine what each button does, point on it to display the task name. Then, click the button to perform the desired action. The following table provides a list of tasks accessible through the HRCM toolbar. Button Task Name Description Select Company Patient Information Patient Notes Patient Account Management Patient Documentation Patient Diagnosis Patient Payors Patient Refund Patient Summary Patient Claims Choose your company Patient demographic information Notes related to patient account updates Account administration Claim-related documents Identified medical condition Who pays for the procedures Money refunded to patient Claim and Payor summary Details of patient claims 16 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

17 Using Healthcare Revenue Cycle Management Button Task Name Description Patient Transactions Client Information Client Notes Client Account Management Client Summary Client Claims Client Transactions Print Billing Requests Month-end Close Mass Re-billing EDI Filing Help for this Item Save Changes Undo Changes Refresh Previous Record Next Record Cut Copy Paste Details of patient transactions Client demographic information Notes related to client account updates Account administration Claim and Payor summary Claim-related documents Details of client transactions Send documents to a printer Calculate accounting for selected period Re-bill selected claims Process EDI files Description of a specific field Save changes to information Undo changes to information Refresh the presented data Move a record up on the list Move a record down on the list Clear the selected information Copy the selected information Paste the selected information Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 17

18 Using Healthcare Revenue Cycle Management Workspace Layout The HRCM user interface features a new look and feel consistent with the current generation of MS Windows applications and supports the Windows theme settings. Throughout this document, the Windows default theme is used for illustration purposes. Dialog Boxes and Windows Dialog boxes and windows consist of various user interface elements, such as data grids, fields and buttons, providing access to the HRCM data and enabling you to work with that data. In most cases, only several columns (database fields) are visible in a window due to space constraints. To view hidden columns, use the horizontal scroll bar beneath the data grid. Data in columns can be sorted according to the column header in either ascending or descending order by clicking on the column header. 18 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

19 Using Healthcare Revenue Cycle Management Basic Operation The behavior of HRCM user interface elements is consistent with standard Microsoft Windows applications. If there are multiple open windows, only the one currently being used and appearing in the forefront can be active, while other inactive windows are partially hidden by the active window and have a faded appearance. To activate another window, click on it to bring it to the forefront. Some windows and the Work Queue have context menus enabled. To display the list of options, right-click anywhere in the data grid When opening a new window before saving changes to information in the current active window, the following warning message is displayed. Click Yes to close all other windows without saving changes, or click No to return to the current active window. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 19

20 Using Healthcare Revenue Cycle Management Tabs Some windows, such as Patient Information, contain multiple tabs. Tabs are a practical way of organizing information relating to the same subject in a single window. Only one tab can be active at a time, and is highlighted by an orange bar. Once information is entered in a tab, clicking on another tab will not cause that information to be lost, unless the previous tab contained a button to save the changes and the changes were not saved. In most cases, once all required information on all tabs has been entered, it must be saved prior to exiting the window. Input Fields Information can be entered by typing in text boxes or it can be selected from (or typed into) dropdown lists. 20 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

21 Using Healthcare Revenue Cycle Management Certain text boxes do not accept user input and are greyed out. These fields are typically reserved to be filled automatically by the HRCM system based on other information provided by the user. Certain fields can appear in multiple windows, depending on whether the information is relevant for the given process or whenever user input is required to complete that process. Many input fields are limited to valid codes or to specific types of information. Valid codes must exist in the appropriate database table. Such fields are equipped with drop-downs, allowing users to select only valid information. There are two main types of drop-down fields: 1 List of valid options for a given field 2 Calendar for date selection To activate a drop-down list containing options, click the drop-down button and then select the desired option by clicking on the entry. The selected information is displayed in the text boxes above the list. The Find box in the dropdown can also be used to search for information. The text typed into the Find box is matched to all of the columns that are displayed and only matching records are shown. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 21

22 Using Healthcare Revenue Cycle Management To activate a drop-down calendar, click the drop-down button. Select the day of the current month by clicking on it or, using the choose the day of that month. buttons, select a previous or a following month and then When you drop it down, it will look like this: If you click on November 2012 you get this screen: If you click on 2012, you get this screen If you click on , you get this screen 22 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

23 Using Healthcare Revenue Cycle Management In addition, it is possible to enter a variable directly in the date drop-down field and press the Tab key to activate it. The following table lists the supported calendar variables. Variable Description (+/-) <integer> The date can be calculated by specifying a value to add/subtract days to/from the current day (today). For example, to specify a date five days from today, enter 5 or +5; to specify a date ten days ago, enter Next <weekday> Last <weekday> Tomorrow Yesterday Today Specify a day in the next/previous week, for example enter next Monday or last Wednesday. Specify a particular day before, after and including the current day. In addition to entering today, the current day can be specified as now or 0. Once a date has been selected, it is displayed in the drop-down field. NOTE: When making a change, such as adding a new transaction record, to see the change reflected in other windows, in some instances it may be necessary to press F5 (Refresh), [Ctrl+S] (Save), or exit the current window and open it again. Data Grid Certain windows feature a data grid and fields used to create or modify the records. Fields related to a specific task are contained within one window rather than being split across multiple windows and pop-ups. This new layout provides a quick, high-level view of all relevant data. Use the horizontal scroll bar to view hidden fields or use the Stretch Screen capability based on available display resolution to show more detail from the grid. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 23

24 Using Healthcare Revenue Cycle Management For example, all patient demographic information is available in a single window. Fields that require a value for the record to be saved in the database are emphasized in bold letters. Grid Buttons All data grids that support data entry have additional buttons, described in the following table. The buttons are located on the right side of the data grid and are used to manage database records displayed in the data grid. Button Button Name Description New Add a new record to the HRCM database. Copy Delete Duplicate a selected record. Delete an existing record from the database. Filter Edit Revert Print Narrow down displayed list of records. Edit the selected record. Revert changes to current selection Print a complete list of records. Filtering displayed Records To filter displayed records: 1. Click the Filter button adjacent to the data grid. 2. In the Filter Fields window, select a Field from the drop-down list to be used for data filtering. In the example below, the Active Field is chosen. 24 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

25 Using Healthcare Revenue Cycle Management 3. Choose an Operator from the following options available for the Status field: Active Equals Symbol Does Not Equal Description < Less than value Number or phrase same as specified Number or phrase other than specified <= Less than or equal to value > Greater than value >= Greater than or equal to value Starts with Contains Is Between [record] Effective on Number or phrase begins with Field contains specified number or phrase Number within specified limits Only available on records that have effective dates. Validates that the record was effective as of the date entered 4. In the Value field, enter a query consisting of numbers or letters. 5. To add the filter, click Add. To remove a filter, select it and click Remove, or click Remove All to start over. Multiple filters can be added to narrow down the search results. 6. When finished, click OK to apply the filter. Only records that contain the specified search values are displayed. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 25

26 Using Healthcare Revenue Cycle Management To print a list of records (if this function is available): 1. Click the Printer button adjacent to the data grid. In the Print Preview window, the record list is displayed in table form. You can use the Zoom tool to preview the search records. 26 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

27 Using Healthcare Revenue Cycle Management 2. Click the Print button. The list is sent to the print queue of your computer s default printer. Export feature: Export takes the data and outputs it to a file in one of the two formats: Excel spreadsheet or Comma Separated Value text file. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 27

28 Using Healthcare Revenue Cycle Management Shortcut Keys All tasks in HRCM have associated keyboard shortcut keys, enabling quick access to various tasks and functions. For example, on the Go > Patient menu, you can use [Ctrl+I] to display the Patient Information window. The following table provides a complete list of HRCM menu shortcuts. Menu Task File > New > Patient Shortcut Keys Ctrl+W Description Launch Patient Wizard window File > New > Client Ctrl+Shift+N Launch Client Wizard window Icon File > New > Re- Register Patient Ctrl+R Launch the Re-register Patient Wizard File > Save Ctrl+S Save current changes Edit > Undo Ctrl+Z Undo current changes Edit > Cut Ctrl+X Cut the selected text or object Edit > Copy Ctrl+C Copy the selected text or object Edit > Paste Ctrl+V Paste the selected text or object Edit > Find Ctrl+F Launch the Search task pane 28 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

29 Using Healthcare Revenue Cycle Management Menu Task Shortcut Keys Description Icon Go > Batches > Charge Batches Ctrl+G Open Charge Batches window Go > Batches > Payment/Adjustment Batches Ctrl+J Open Payment/Adjustment Batches window Go > Batches > Place Batch on Hold Ctrl+B Open Hold Batch window Go > Patient > Information Ctrl+I Open Patient Information window Go > Patient > Notes Ctrl+O Open Patient Notes window Go > Patient > Account Management Go > Patient > Document Entry Go > Patient > Patient Diagnosis Go > Patient > Payor Detail Go > Patient > Refund Request Go > Patient > Refund Authorization Go > Patient > Summary Ctrl+A Ctrl+E Ctrl+Shift+D Ctrl+P Ctrl+Q Ctrl+H Ctrl+U Open Account Management window Open Document Entry window Open Patient Diagnosis window Open Payors window Open Refund Request window Open Refund Request Authorization window Open Patient Summary window Go > Patient > Claims Ctrl+L Open Claims window Go > Patient > Transactions Ctrl+T Open Transactions window Go-Patient>Denials Ctrl+D Open Denials window Go > Patient > Re- Register Go > Client > Information Ctrl+R Ctrl+Shift+I Launch Re-Register Patient Wizard Open Client Information window Go > Client > Notes Ctrl+Shift+O Open Client Notes window Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 29

30 Using Healthcare Revenue Cycle Management Menu Task Go->Client->Document Entry Go > Client > Account Management Shortcut Keys Ctrl+Shift+E Ctrl+Shift+A Description Open Client Document Entry window Open Account Management window Go > Client > Summary Ctrl+Shift+U Open Client Summary window Icon Go > Client > Claims Ctrl+Shift+L Open Claims window Go > Client > Transactions Tools > Account Changes > Payor Change Tools > Account Changes > Merge Account Tools > Account Changes > Merge Patient Ctrl+Shift+T Ctrl+Shift+P Ctrl+Shift+M Ctrl+M Open Transactions window Modify payor information Merge two separate accounts Merge two separate patients 30 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

31 Using Healthcare Revenue Cycle Management Online Help HRCM field help is a context-sensitive form of online help that provides a quick reference to assist users when entering or selecting information in fields. You can use the help on most fields, except in code tables. The information provided includes the source database table and column, and a message that you can customize to suit your needs. To use the built-in field help system: 1. Select a field in a window that you would like to get more information on. 2. Click the Help for this Item button on the toolbar. The Field Help window displays the source database table and column names, and a customizable description of the selected field. 3. To edit the field description, select the existing text and enter new text. 4. Click Close to exit the Field Help window. If the description was edited, a message is displayed asking whether to save changes. Click Yes to save changes, click No to exit without saving changes, or click Cancel to return to the Field Help window. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 31

32 Using Healthcare Revenue Cycle Management Selecting a Company Organizations comprised of multiple entities can designate each entity as a separate organizational unit (aka company) in HRCM. All entities within an organization share a database, but have separate accounting, code tables, and security settings. Multi-company capability allows for multiple business entity processing on a single system. To specify a company: 1. Select Go > Select Company on the menu bar, press [Ctrl+Y], or click the Select Company button on the toolbar. 2. In the Select Company dialog box, choose a Company from the drop-down list and then click OK. All actions performed using the same login ID will be associated with the selected company. 32 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

33 Chapter 3 Registering Patients and 3 Clients Account registration is a set of tools that enable account representatives to maintain up-to-date patient and client information in the system. HRCM simplifies the process of manually registering new patients or clients in the database by providing guided procedures accessed through the File > New menu. This chapter describes how to maintain patient and client accounts with the help of these features. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 33

34 Registering Patients and Clients Adding a New Patient The first step in the registration process is creating an account. New patient accounts are created using a wizard that ensures all the necessary information about a patient is captured and stored. Using the New Patient Wizard To add a new patient to the HRCM database: 1. Select File > New > Patient. on the menu bar or press [Ctrl+W]. The New Patient Wizard welcome dialog box is displayed to guide you through the process. Click Next to start the wizard. 34 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

35 Registering Patients and Clients 2. Enter a Patient Number and an Account Number, if using custom numbering. Otherwise, it is recommended to leave the fields blank for the system to automatically generate unique numbers. Click Next to continue. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 35

36 Registering Patients and Clients 3. In the Patient Information dialog box, enter the patient s Name and any additional optional information, or select it from drop-down lists. NOTE: Fields requiring user input, called Required Fields, have titles in bold letters (e.g., Name). Unless required information is provided, the procedure cannot continue and a message is displayed requesting user input. 4. On the Address and Contact Information tab of the Patient Information dialog box, click the New button or [Ctrl+N] to add a record. 5. Select the patient s Address Type and Relationship from the drop-down lists. Also, enter any other relevant information in the text boxes or select it from drop-down lists. To duplicate a record, click the Copy button. To delete a record, click the Delete button. 36 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

37 Registering Patients and Clients 6. On the Admission tab of the Patient Information dialog box, select Patient Type and any relevant optional information from drop-down lists. 7. Click Next to continue. 8. If you do not enter any information on the Admission tab before clicking Next, the following message is displayed. Click Go To Error to continue or click Cancel to return to the Patient Information dialog box. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 37

38 Registering Patients and Clients 9. On the Payors tab of the Payors dialog box, click New to add a record. Select C.O.B., Payor, Plan and Relationship from the drop-down list, as well as any other relevant optional information. To delete a record, click the Delete button. When all the information is entered, the Authorization tab can be selected to enter Authorization information or skipped if no Authorization information is available/required. 38 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

39 Registering Patients and Clients On the Authorization tab of the Payors dialog box, click New to add a record and then enter any relevant optional information or select it from the drop-down lists. To delete a record, click the Delete button. When all the information is entered, click Next to continue. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 39

40 Registering Patients and Clients 10. In the New Patient Wizard Complete dialog box, click Finish to exit the wizard. The new patient account is displayed in the task pane. 40 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

41 Registering Patients and Clients Adding a New Client The first step in the registration process is creating an account. New client accounts are created using a wizard, similar to the New Patient Wizard that ensures all the necessary information about a client is captured and stored. Using the New Client Wizard To add a new client to the HRCM database: 1 Select File > New > Client. on the menu bar or press [Ctrl+Shift+N]. The New Client Wizard welcome dialog box is displayed to guide you through the process. Click Next to start the wizard. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 41

42 Registering Patients and Clients 2 Enter the client s Account Number, if using custom numbering. Otherwise, it is recommended to leave the field blank for the system to automatically generate a unique account number. Click Next to continue. 42 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

43 Registering Patients and Clients 3 In the Client Information dialog box, click the New button or [Ctrl+N] to add a record and then enter any relevant optional information or select it from the drop-down lists. To revert changes to the selected record, click the Revert changes to current selection button. To duplicate a record, click the Copy button. To delete a record, click the Delete button. 4 Click Next to continue. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 43

44 Registering Patients and Clients 5 In the New Client Wizard Complete dialog box, click Finish to exit the wizard. The new client account is displayed in the task pane. 44 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

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46 Chapter 4 Administering Patients 4 HRCM simplifies workflow management by enabling account representatives to efficiently administer patient information using the task pane and the Go > Patient submenu. This chapter provides instructions on how to manage patient accounts with the help of these features. HRCM 3.4 US Lab User Guide Part 1 of 2 Version

47 Administrating Patients Navigating Patient Accounts About the Task Pane The task pane is located on the left-hand side of the HRCM workspace and consists of the following tools: Work Queue - displays a list of patient accounts that contain deficiencies and require the assigned account representative s attention. Information - provides a summary of key account information. Search - queries the HRCM database based on specific search parameters. The task pane navigator is used to switch among the three tools. Using the Work Queue To display patient accounts in the Work Queue: 1 Click the Work Queue button on the task pane navigator. The HRCM Work Queue is displayed. 2 Select the assigned account Representative (default is the current user) and a Review Date period from the drop-down lists. To clear the selections and return to the default state, click Reset. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 47

48 Administrating Clients 3 Select Show Patients and click Show Queue. The patient list is displayed. To display the hidden columns, click the arrow button. NOTE: The patient list can be sorted by clicking on a column heading. Sort order is indicated with the in the column header row. 48 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

49 Administrating Patients Viewing Patient Account Details To display the summary of a patient s account information: 1 Select the patient s account in the Work Queue. 2 Click the Information button on the task pane navigator. The HRCM patient account information is displayed. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 49

50 Administrating Clients Detailed information found in the Work Queue includes Name, Birth Date, Balance owed, Admitted date, Deficiencies and Follow-up as well as other information specific to each patient or client account. Deficiencies indicate different issues detected on the account. Follow-up indicates if various processes or other Account Representatives have found issues that are detailed in notes on the account. The code after fup- will indicate the process or Account Representative that logged the issue. Note: If the follow-up field is blank, this is an indication that the account is in the users work queue for deficiencies only. 50 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

51 Administrating Patients Searching for Accounts To find a specific patient account in the HRCM database: 1 Click the Search button on the task pane navigator or press [Ctrl+F]. 2 The HRCM Search tool is displayed. 3 Specify any of the following search parameters: Name Company Clinic Account # Social Security Patient ID Insurance Alternate ID Policy Number Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 51

52 Administrating Clients Status NOTE: To broaden the search to include similar sounding names, select Sounds Like. This is especially useful if you are not certain how a name is spelled, or if a name is entered incorrectly in the database. 4 Click Search. All matching accounts are displayed in the Search Results window, sorted by Name in ascending order. 5 To display a list of all patients, leave all search fields blank and click Search. 6 Click Yes to confirm and continue the search without any parameters. Click No to discontinue the search. 52 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

53 Administrating Patients 7 To further narrow down the search results, in the Search Results window click the Filter button. In the Filter Fields window, select a Field, an Operator, and enter a Value. 8 To add the filter, click Add. To remove a filter, select it and click Remove, or click Remove All to start over. You can add multiple filters. When finished, click OK to apply the filter. The filtered results are displayed. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 53

54 Administrating Clients 9 Once the patient s account is located, click it to display the account information summary in the task pane. 54 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

55 Administrating Patients Re-Registering Patient Accounts Re-registering a Patient Account allows you to create a new Patient Account/Case from an existing one, copying details including payor information and then building new Patient Account with different Account level information such as Patient Type, Clinic, Admit/Discharge information, etc. Re-Registering a Patient To Re-Register a Patient Account from an existing Patient Account 1 Select File > New > Re-Register Patient or Go > Patient > Re-Register on the menu bar, or press [Ctrl+R]. The Re-Register Patient Wizard welcome dialog box is displayed to guide you through the process. 2 Click Next. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 55

56 Administrating Clients 3 The Current Account Number will default to the current patient account. It can be overridden, or click the Browse button to locate it in the database. Then, enter the New Account Number, or leave the field blank for the system to automatically generate the number. 4 Click Next to continue. NOTE: It is recommended to leave the New Account Number field blank for the system to automatically generate a unique account number. 5 If you use the Browse button, the Filter Fields dialog box is displayed. Select filter parameters from the drop-down lists and enter a value to narrow down the search results. 6 Click Add to create filter entries list. To remove a filter, select it and click Remove, or click Remove All to start over. You can add multiple filters. 7 When finished, click OK to apply the filter. 8 The filtered results are displayed. In the Patient Query dialog box, select a patient and click OK. The patient s account number is displayed in the Current Account Number field. 56 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

57 Administrating Patients Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 57

58 Administrating Clients 9 In the Patient Information dialog box, make any intended updates on all tabs or leave the information unchanged. Information on the Admission tab will not be copied from prior account. Patient Type and Clinic on the Admission tab must be populated. Click Next to continue. 58 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

59 Administrating Patients 10 In the Payors dialog box, make any intended updates on all tabs or leave the information unchanged, and then click Next to continue. 11 In the Re-Register Patient Wizard Complete dialog box, click Finish to exit the wizard. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 59

60 Administrating Clients The patient information is updated in the task pane. 60 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

61 Administrating Patients Account Management To set patient account status, specify an account representative, and add deficiencies: 1 Select the patient in the Work Queue or search the HRCM database. 2 Select Go > Patient > Account Management from the menu bar, press [Ctrl+A], or click the Patient Account Management button on the toolbar. The Account Management window opens and the selected patient s account information is displayed on the task pane. 3 In the Account Management window, enter any relevant information or select it from the dropdown lists. 4 In the Deficiencies area, click New to add a record and then select a Deficiency code from the drop-down list then Save or [Ctrl+S]. To delete a record, click the Delete button. Deficiency codes are used to store deficiencies and information about a patient. The codes are listed under Account Information on the task pane for an Account Rep to resolve. Multiple deficiencies can be set on an account. NOTE: During the End of Day process, the system clears all deficiency codes for resolved deficiencies and checks for any new deficiencies to be applied. 5 When finished, click Save on the toolbar or select File > Save Changes (or press [Ctrl+S]) and close the Account Management window. The updates are immediately reflected in the Account Information on the task pane. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 61

62 Administrating Clients Patient Information To update a patient s demographic information: 1 Select the patient in the Work Queue or search the HRCM database. 2 Select Go > Patient > Information from the menu bar, press [Ctrl+I], click the Patient Information button on the toolbar, or double-click the patient account in the Work Queue. 3 On the Address and Contact Information tab of the Patient Information window, click the New button or [Ctrl+N] to create a new patient record. 4 Enter the patient s name (format: Last Name, First Name), select the Address Type and Relationship from the drop-down lists, and enter any other optional information or select it from drop-down lists. 5 To duplicate a record, click the Copy button. To revert changes to the selected record, click the Revert changes to current selection button. To delete a record, click the Delete button. NOTE: Fields requiring user input, called Required Fields, have titles in bold letters (e.g., Name). If required information is not provided before closing a window, a message is displayed asking for user input. 62 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

63 Administrating Patients 6 On the Admission tab of the Patient Information window, select Patient Type and any other optional information from the drop-down lists. 7 Select the Credit Card tab to enter the Patient Credit Card type, Name, Number and Expiration date. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 63

64 Administrating Clients 8 Use the Additional ID s tab to add patient ID s used for another Clinic. Click the New button to add an additional ID and Clinic code. To delete a record, click the Delete changes to the selected record, click the Revert changes to current selection button. To revert button. 64 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

65 Administrating Patients The UB Fields tab contains institutional billing fields required for billing on UB forms or institutional EDI billing. Fields will be defaulted from billing rules when new account is registered and are then used to default UB Fields on claims that are billed. 1 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Patient Information window. The updates are immediately reflected in the account information on the HRCM task pane. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 65

66 Administrating Clients The UB Conditions tab contains condition codes required for institutional UB or EDI billing. Condition codes are defaulted from billing rules when a new account is registered. Codes can be added or removed. These condition codes will default to the Claim level condition codes for each Claim that is billed. 1 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Patient Information window. The updates are immediately reflected in the account information on the HRCM task pane. 66 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

67 Administrating Patients The UB Occurrence tab contains Occurrence codes and dates that will be used for billing institutional UB or EDI claims. When a new account is registered, occurrence codes will be defaulted from the billing rules. Dates and new codes can be added or codes can be removed. Each claim that is billed will default with the Occurrence codes and dates on this tab. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 67

68 Administrating Clients The UB Values tab contains Value Codes and dollar amounts required for institutional UB or EDI billing. The Value Codes will be defaulted from billing rules when a new account is registered. Dollar amounts or new codes can be added or codes can be removed. When claims are billed, the value codes and amounts will default to the claim. 68 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

69 Administrating Patients The Other tab is user definable fields for additional data fields. Additional data fields can be set-up in Code Table Maintenance User Defined Fields. 1 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Patient Information window. The updates are immediately reflected in the account information on the HRCM task pane. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 69

70 Administrating Clients Patient Notes To create notes associated with a patient account: 1. Select the patient in the Work Queue or search the HRCM database. 2. Select Go > Patient > Notes from the menu bar, press [Ctrl+O], or click the Patient Notes button on the toolbar. 3. In the Patient Notes window, click the New button to add a record. To revert changes to the selected record, click the Revert changes to current selection button. To filter records, click the Filter button. 4. Enter any relevant information or select it from the drop-down lists. To associate a note with a specific claim, enter a Claim Number. To make a note appear in the Work Queue, select Active. 5. When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Patient Notes window. 70 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

71 Administrating Patients The Note tab on the detail block at bottom of the Patient Summary screen shows the notes attached to a selected account and claim. When a different account and claim is picked in the middle Claim Summary block, the bottom note block will display notes attached to that account and claim. Notes in this block are view only and not enterable or updatable. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 71

72 Administrating Clients Document Entry To attach documents to a patient account: 1 Select the patient in the Work Queue or search the HRCM database. 2 Select Go > Patient > Document Entry from the menu bar, press [Ctrl+E], or click the Patient Documentation button on the toolbar. 3 In the Document Entry 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. 4 Enter any relevant information or select it from the drop-down lists. Files containing images, PDF or other document types can be attached by entering the full directory path and file name or selected using the Browse button to select from file browser. Once attached, image, PDF or other document can be viewed in its windows assigned viewer by hitting the Open button. Files that are attached should be stored on a file server that is accessible to all users who will be viewing the document. 5 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Document Entry window. 72 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

73 Administrating Patients Patient Diagnosis The Patient Diagnosis window is used to enter diagnosis and procedures that apply to the entire Patient Account. This screen can also assign diagnoses to transactions that do not have a diagnosis assigned. To specify and assign a patient s diagnosis: 1 Select the patient in the Work Queue or search the HRCM database. 2 Select Go > Patient > Patient Diagnosis from the menu bar, press [Ctrl+Shift+D], or click the Patient Diagnosis button on the toolbar. 3 In the Patient Diagnosis 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. 4 Select a Diagnosis from the drop-down list and optionally specify a priority sequence determining the order of adding diagnoses to transactions. 5 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Patient Diagnosis window. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 73

74 Administrating Clients Assign to Transactions To assign Patient Account level diagnosis to transactions which do not currently have diagnosis assigned: 1 When finished adding diagnosis records, click Assign to Transactions button. A message is displayed asking you to save new diagnoses. Click Yes to save changes first or click No to proceed without saving changes. 2 A message is displayed confirming the diagnosis assignment. Click OK to return to the Patient Diagnosis window. NOTE: Only unprocessed transactions without assigned diagnoses will be affected when assigning a single diagnosis. When assigning multiple diagnoses, only transactions with fewer diagnoses than you are assigning will be affected. For example, when assigning four diagnoses to a transaction that has one assigned diagnosis, only diagnoses 2-4 will be assigned. A maximum of four diagnoses can be assigned to a transaction. Diagnosis will be assigned to transactions based on the Transaction Diagnosis Mapping table. To assign a diagnosis to a specific transaction, use the Transaction Detail window. The Procedures tab is for future development. 3 Exit the Patient Diagnosis window. 74 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

75 Administrating Patients 4 To verify that the diagnosis was assigned to transactions, open the Transactions window (press [Ctrl+T]). In the Transactions window, select a transaction and click the Edit double-click the record) to display the Transaction Detail window. button (or Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 75

76 Administrating Clients Payor Details To associate payors with a patient account: 1 Select the patient in the Work Queue or search the HRCM database. 2 Select Go > Patient > Patient Payors from the menu bar or click the Patient Payors button on the toolbar. 3 On the Payors tab of the Payors window, click the New button to add a record. 4 Select a C.O.B., Payor, Plan and Relationship, and enter any other optional information or select it from the drop-down lists. To delete a record, click the Delete button. When all the information is entered, select the Authorization tab. NOTE: Records cannot be added or deleted if there are transactions on the patient account. In such cases, the Add and Delete buttons, as well as C.O.B., Payor and Plan fields, are inactive (grayed out). To make changes to Payor after transactions have been added to an account, use the Tools- >Account Changes-> Payor Change option in the menu. 5 On the Authorization tab of the Payors window, click the New button to add a record. Enter any relevant optional information or select it from the drop-down lists. To delete a record, click the Delete button. 76 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

77 Administrating Patients 6 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Payors window. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 77

78 Administrating Clients Refund Request To specify a patient s refund: 1 Select the patient in the Work Queue or search the HRCM database. 2 Select Go > Patient > Refund Request from the menu bar, press [Ctrl+Q], or click the Patient Refund button on the toolbar. 3 In the Refund Request 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. 1. Pick a refund type of either I=Insurance, P=Patient or N=Note. 2. For Refund Type I=Insurance, select a Payor and a Plan. For Refund Type N=Note, the Payor being refunded must be detailed in the note field. The Refund can be associated with a claim. 3. Enter the Amount being refunded. 4. When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Refund Request window. 78 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

79 Administrating Patients Refund Authorization To authorize a patient s refund: 1 Select the patient in the Work Queue or search the HRCM database. 2 Select Go > Patient > Refund Authorization from the menu bar or press [Ctrl+H]. 3 In the Refund Request Authorization window, select a refund record that you wish to authorize. 4 Select Refund Status A=Approve Refund or P=Pass on Refund. 5 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Refund Request Authorization window. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 79

80 Administrating Clients Patient Summary To display a patient s payor and claim summary: 1 Select the patient in the Work Queue or search the HRCM database. 2 Select Go > Patient > Summary from the menu bar, press [Ctrl+U], or click the Patient Summary button on the toolbar. In the Patient Summary window, the Payor Summary pane displays records with payorspecific information, and the Claim Summary pane displays records with claim-specific information. The transactions for each claim are listed in the bottom pane. Clicking on a Payor row will display claims data for that payor. Clicking on a Claim will display transactions associated with that claim. Double clicking on a transaction will open the transaction details. 3 To filter transaction records, click the Filter button. To revert changes to a transaction click the Revert changes to current selection button. The Note tab on the detail block at bottom of the Patient Summary screen shows the notes attached to a selected account and claim. When a different account and claim is picked in middle Claim Summary block, the bottom note block will display notes attached to that account and claim. Notes in this block are view only and not enterable or updatable. 80 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

81 Administrating Patients 4 When finished reviewing the information, close the Patient Summary window. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 81

82 Administrating Clients THIS PAGE INTENTIONALLY LEFT BLANK. 82 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

83 Chapter 5 Administrating Clients 5 HRCM simplifies workflow management by enabling account representatives to efficiently administer client information using the task pane and the Go > Client submenu. This chapter provides instructions on how to manage client accounts with the help of these features. HRCM 3.4 US Lab User Guide Part 1 of 2 Version

84 Administrating Clients Navigating Client Accounts Using the Work Queue To display client accounts in the Work Queue: 5 Click the Work Queue button on the task pane navigator. The HRCM Work Queue is displayed. 6 Select the assigned account Representative (default is the current user) and a Review Date period from the drop-down lists. To clear the selections and return to the default state, click Reset. 7 Select Show Clients and click Show Queue. The client list is displayed. To display the hidden columns, click the arrow button. 84 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

85 Administrating Clients NOTE: The client list can be sorted by clicking on a column heading. Viewing Client Account Details To display the summary of a client s account information: 1 Select the client s account in the Work Queue. 2 Click the Information button on the task pane navigator. The HRCM client account information is displayed. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 85

86 Administrating Clients Searching for Accounts To find a specific client account in the HRCM database: 1 Click the Search button on the task pane navigator. The HRCM Search tool is displayed. NOTE: To broaden the search to include similar sounding names, select Sounds Like. This is especially useful if you are not certain how a name is spelled, or if a name is misspelled in the database. 2 Specify any of the following search parameters: Name Company Clinic Account # Social Security Client ID Insurance Alternate ID 86 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

87 Administrating Clients Policy Number Include Closed Accounts 3 Click Search. All matching accounts are displayed in the Search Results window. 4 To display a list of all clients, leave all search fields blank and click Search. The warning message will display. Click Yes to continue search or No to quit. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 87

88 Administrating Clients 5 If you wish to further narrow down the search results, in the Search Results window click the Filter button. In the Filter Fields window, select a Field, an Operator, and enter a Value. 1. To add the filter, click Add. To remove a filter, select it and click Remove, or click Remove All to start over. You can add multiple filters. When finished, click OK to apply the filter. The filtered results are displayed. 2. Once the client s account is located, click it to display the account information in the task pane. 88 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

89 Administrating Clients Updating Client Accounts HRCM client information is administered through the Go > Client submenu or the corresponding toolbar buttons. Account Management To set client account status, specify an account representative, and add deficiencies: 1 Select the client in the Work Queue or search the HRCM database. 2 Select Go > Client > Account Management from the menu bar, press [Ctrl+Shift+A], or click the Client Account Management button on the toolbar. The Account Management window opens and the selected client s account information is displayed on the task pane. 3 In the Account Management window, enter any relevant information or select it from the dropdown lists. 4 In the Deficiencies area, click New to add a record and then select a Deficiency code from the drop-down list. To delete a record, click the Delete button. Deficiency codes are used to store deficiencies in information about a client. The codes are listed under Account Information on the task pane for an Account Rep to resolve. Multiple deficiencies can be set on an account. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 89

90 Administrating Clients NOTE: During the End of Day process, the system clears all deficiency codes for resolved deficiencies and checks for any new deficiencies to be applied. 5 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Account Management window. The updates are reflected in the account information on the task pane. 90 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

91 Administrating Clients Client Information To update a client s demographic information: 1 Select the client in the Work Queue or search the HRCM database. 2 Select Go > Client > Client Information from the menu bar, press [Ctrl+Shift+I], or click the Client Information Queue. button on the toolbar, or double-click the client account in the Work 3 In the Client Information window, make the intended updates on the Address and Contact Information and Admission tabs. To add a new record, click the New button. To duplicate a record, click the Copy button. To revert changes to the selected record, click the Revert changes to current selection button. To delete a record, click the Delete button 4 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Client Information window. The updates are reflected in the Account Information on the task pane. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 91

92 Administrating Clients Client Notes To create notes associated with a client account: 1 Select the client in the Work Queue or search the HRCM database. 2 Select Go > Client > Notes from the menu bar, press [Ctrl+Shift+O], or click the Client Notes button on the toolbar. 3 In the Client Notes window, click the New button to add a record. To revert changes to the selected record, click the Revert changes to current selection button. To filter records, click the Filter button. 4 Enter any relevant information or select it from the drop-down lists. To associate a note with a specific claim, enter a Claim Number. To make a note appear in the Work Queue, select Active. 5 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Client Notes window. Document Entry To attach documents to a client account: 1. Select the client in the Work Queue or search the HRCM database. 2. Select Go > Client > Document Entry from the menu bar, press [Ctrl+E]. 92 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

93 Administrating Clients 3. In the Document Entry 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. 4. Enter any relevant information or select it from the drop-down lists. Files containing images, PDF or other document types can be attached by entering the full directory path and file name or selected using the Browse button to select from file browser. Once attached, image, PDF or other document can be viewed in its windows assigned viewer by hitting the Open button. Files that are attached should be stored on a file server that is accessible to all users who will be viewing the document. 5. When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Document Entry window. Client Summary To display a client s payor and claim summary: 1. Select the client in the Work Queue or search the HRCM database. 2. Select Go > Client > Summary from the menu bar, press [Ctrl+Shift+U], or click the Client Summary button on the toolbar. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 93

94 Administrating Clients In the Client Summary window, the Payor Summary pane displays records with payor-specific information, and the Claim Summary pane displays records with claim-specific information. The transactions for each claim are listed in the bottom pane. Double clicking on a transaction will open the transaction details. 3. To filter transaction records, click the Filter button. To revert changes to the transaction click on the Revert changes to current selection button. 4. When finished reviewing the information, close the Client Summary window. 94 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

95 Chapter 6 Managing Accounts 6 HRCM provides account representatives with additional tools to make specific changes to patient and client accounts using the Tools > Account Changes submenu. This chapter describes how to modify account-related information, such as changing payors and patient types, and merging patient or client accounts. HRCM 3.4 US Lab User Guide Part 1 of 2 Version

96 Managing Accounts Changing Payor Payor change is a complex process. When the payor is changed on an account, or when effective dates of one or more payors are changed, it may require re-pricing of the charge transactions or re-assigning GL (revenue) codes to the charges and, depending on the options selected, it may change the payor on the claim. When a client account has any transactions on it, use the Tools->Account Change->Payor Change screen to make this change To change a payor associated with a patient or client account: 1 Select Tools > Account Changes > Change Payor from the menu bar or press [Ctrl+Shift+P]. 2 In the Payor Change window, click the New button to add a record or select an existing one. To delete a record, click the Delete button. To revert changes to the selected record, click the Revert changes to current selection button. 3 Select a Payor and a Plan that you wish to use from the drop-down lists. 4 Select From and To dates from the drop-down calendars to specify the effective coverage dates by that payor. 5 In the Change Coverage Service Dates area, select From and To dates from the drop-down calendars, defining a range of service dates to be changed. 6 Click OK to proceed or click Cancel to exit. 7 If there are existing payments, adjustments, or credit charges associated with the account, a message is displayed. Click Yes to continue payor change, or click No to return to the Payor Change window. 96 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

97 Managing Accounts NOTE: A payor change can be applied to charges with service dates within the date range specified. Any charges outside the service date range would not be affected by a payor change. 8 When finished, in the Payor Change window click OK. A message is displayed confirming that payor change was successful. Click OK to exit. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 97

98 Managing Accounts In the Payors window, the new payor shown in the Payor Detail area is associated with the specified claims and transactions. 98 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

99 Managing Accounts Changing Patient Type In some cases, it may be necessary to change the patient type on a patient account. The Patient Type Change window enables you to select another patient type. To change a patient type associated with an existing account: 1 Select Tools > Account Changes > Change Patient Type from the menu bar. 2 In the Patient Type Change window, from the drop-down list select a New Type of patient that you wish to use. 3 The Change Coverage Service Dates can be populated to indicate specific service date from and thru to be changed by the Patient Type Change. Leaving the fields blank will change all service dates on the account. 4 When finished, in the Patient Type Change window click OK. A message displays confirming that patient type change was successful. 5 Click OK to exit. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 99

100 Managing Accounts 6 Verify that the Patient Detail information in the task pane is updated. 7 On the Admission tab of the Patient Information window, the Patient Type information should be updated as well. 100 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

101 Managing Accounts Merging Accounts Two patient or client accounts can be merged together. All data from the source account is moved over to the target account. To merge two different accounts: 1 Select Tools > Account Changes > Merge Account from the menu bar or press [Ctrl+Shift+M]. 2 In the Merge Account dialog box, enter the Source account number or click the Browse button to locate it in the HRCM database. 3 Enter the Target Account number or click the Browse button to locate it in the HRCM database. 4 Click OK to proceed, or click Cancel to exit the Merge Account dialog box. A message is displayed asking whether to merge the selected accounts. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 101

102 Managing Accounts 5 Click Yes to continue, or click No to return to the Merge Account dialog box. A message is displayed confirming that the accounts were merged. 6 Click OK to finish. 102 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

103 Managing Accounts Merging Patients A patient can have multiple accounts. By merging two patients, all accounts from the source patient are moved to the target patient. To merge two different patients: 1 Select Tools > Account Changes > Merge Patient... from the menu bar or press [Ctrl+M]. 2 In the Merge Patient window, enter the Source ID number or click the Browse button to locate it in the HRCM database. 3 Enter the Target Account number or click the Browse button to locate it in the HRCM database. 4 Click OK to proceed, or click Cancel to exit the Merge Patient window. A message is displayed asking whether to merge the selected patients. 5 Click Yes to continue, or click No to return to the Merge Patient window. A message is displayed confirming that the patients were merged. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 103

104 Managing Accounts 6 Click OK to finish. 104 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

105 Managing Accounts Restore Account A History Purge process which runs in dayend can be configured to migrate closed accounts to Historical Tables to improve processing speed in active tables. If it is necessary to make changes to an account after it has been migrated to history, the account must be restored by moving it from history tables back to active tables first. To restore an account from history: 1 Select Tools > Account Changes > Restore Account... from the menu bar. 2 In the Restore Account window, enter the Acct# or click the Browse button to locate it in the HRCM database. 3 Click OK to proceed, or click Cancel to exit the Restore Account window. A message is displayed asking whether to restore the selected patient. 4 Click Yes to continue, or click No to return to the Restore Account window. A message is displayed confirming that the account was restored. 5 Click OK to finish. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 105

106 Managing Accounts 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 posting 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. 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 the work queue to assign denial to. 106 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

107 Managing Accounts Denial Maintenance Screen Denial codes are set up in 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 1 of 2 107

108 Managing Accounts 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 108 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

109 Managing Accounts Patient Denials Screen The Patient Denials screen (ctrl-d) shows denials posted. Top block shows the claims on an 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 the 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, a user can enter the Resolution Code for the denial in the field below the Denial block. Denial Lines displayed can be Bulk Resolved by entering a Bulk Resolution code and pressing the Bulk Resolution button. This will attach the 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. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 109

110 Managing Accounts 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. 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. Payment Batch Report Shows Denials When a payment batch is printed it will show Denials. 110 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

111 Creating Transactions and Claims Chapter 7 Creating Transactions and Claims 7 This chapter describes how to create patient or client transactions and claims. These tasks can be accessed using the Go > Patient or Go > Client submenus. Transactions (or charges) are any items that affect the balance of a patient s or client s account and are entered based on transaction code. Entered transactions are added by the system to the account billing record and become associated with claims. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 111

112 Creating Transactions and Claims 112 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

113 Creating Transactions and Claims Patient Accounts Adding a Transaction To create new transactions associated with a patient s account: 1 Select the patient in the Work Queue or search the HRCM database. 2 Select Go > Patient > Transactions from the menu bar, press [Ctrl+T], or click the Patient Transactions button on the toolbar. 3 In the Transactions window, active transactions are displayed by default. Click the New button to add a record. If there are existing transactions, you can edit a selected transaction by clicking the Edit button. To filter the existing records, click the Filter button. In addition, you can filter the displayed transaction records based on the following parameters in the Show drop-down list: All, Active (default), Payment/Adjustment, or Summarized. a b c d All = Show all transactions including reversals (j-outs). Active = Show only active (non-reversed/non-j-out) transactions. Summarized = Show only active transactions suppressing rolled and exploded charges to only show summary of roll-up/explosion. Payment/Ajdustment = Show only Payments and Adjustments e When adding or editing a record, the Transaction Detail window is displayed by double clicking the appropriate transaction line. 4 To create a new transaction, in the Transaction Detail window select the Transaction Date, Clinic, Lab, Transaction Code, and C.O.B. (Coordination of Benefits) from the drop-down lists, and specify any other relevant optional information. To associate the transaction with a specific claim, enter a Claim Number. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 113

114 Creating Transactions and Claims 5 To add a new transaction record, click the New button or [Ctrl+N]. To duplicate 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. NOTE: Leaving the Claim Number field blank will result in the transaction being treated as unbilled and will be included with the next claim that is billed. 114 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

115 Creating Transactions and Claims When editing an existing transaction, only specific fields in the Transaction Detail window can be updated, including Status, Billing Code, Diagnoses, Accession Number, Note and Stop Date. The Check No and Receipt No fields are read-only during a new transaction entry. The display of a roll-up flag is also read-only on the transaction grid on the Patient Transaction Entry, Detail and Claims and Client Transaction screens. 6 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Transaction Detail and Transactions windows. Adding a Claim NOTE: The billing procedure running in the database will not generate a bill or claim for transactions that have deficiencies. Transaction deficiencies must be removed first. However, a bill or a claim can be manually generated if there are account level deficiencies. For more information on deficiencies, refer to Re-Registering a Patient. To open a new patient claim: 1 Select the patient in the Work Queue or search the HRCM database. 2 Select Go > Patient > Claims from the menu bar, press [Ctrl+L], or click the Patient Claims button on the toolbar. 3 In the Claims window, click the New button or [Ctrl+N] to add a record. To revert changes to the selected record, click the Revert changes to current selection button. 4 To filter records, click the Filter button. To print a transaction receipt, click the print button. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 115

116 Creating Transactions and Claims 5 Enter any relevant optional information or select it from the drop-down lists. When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]). Claim Action when populated will initiate various actions to be taken on a claim. When a new claim line is inserted, this field will default to S to indicate Start Initial Bill for new claim. Start Initial Bill will generate the next claim number for the claim, gather transactions billable to the payor identifled and generate a billing to that payor. This action must be taken for all new claim records. The following actions may be taken on existing claim records: 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. T = Transfer Claim. Typically only used by electronic Remittance process. When set will allow claim to payment cycle, but will not produce billing for the claim (as primary payor has already transferred the claim to secondary payor). 116 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

117 Creating Transactions and Claims 6 To add transactions to the claim, click the New button in the Transactions area. When finished, click Save Changes and close the Claims window. on the toolbar or select File > Save (or press [Ctrl+S]) 7 The billing process is initiated in the background, gathering any unbilled charges for that payor, generating a claim number and creating a billing. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 117

118 Creating Transactions and Claims Patient Claim Screen The Patient Claim screen shows details for each claim. The screen shows original and current payor billed, original and last bill date, and collection status code and date. When new claims are billed, the UB tabs will be populated with information required for billing institutional UB or EDI claims from the information on the corresponding UB tabs on the Patient Information screen. This UB information can be modified or corrected before printing the claim as needed. 118 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

119 Creating Transactions and Claims Client Accounts Adding a Transaction To create new client transactions: 1 Select the client in the Work Queue or search the HRCM database. 2 Select Go > Client > Transactions from the menu bar, press [Ctrl+T], or click the Client Transactions button on the toolbar. 3 In the Transactions window, click the New button or [Ctrl+N] to add a record. If there are existing transactions, you can edit a selected transaction by clicking the Edit button. To filter the existing records, click the Filter button. To print a receipt, click the Print button. In addition, you can filter the displayed transaction records based on the following parameters in the Show drop-down list: All, Active (default), Payment/Adjustment, or Summarized. All = Show all transactions including reversals (j-outs). Active = Show only active (non-reversed/non-j-out) transactions. Summarized = Show only active transactions suppressing rolled and exploded charges to only show summary of roll-up/explosion. Payment/Ajdustment = Show only Payments and Adjustments When adding or editing a record, the Transaction Detail window is displayed by double clicking the transaction line. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 119

120 Creating Transactions and Claims 1. To create a new transaction, in the Transaction Detail window select the Transaction Date, Clinic, Lab, Transaction Code, C.O.B. (Coordination of Benefits) from the drop-down lists, and specify any other relevant optional information. To associate the transaction with a specific claim, enter a Claim Number. 2. To add a new transaction record, click the New button or press [Ctrl+N]. To duplicate a record, click the Copy button. To revert changes to the selected record, click the Revert changes to current selection button. To delete a record, click the Delete button. To filter the existing records, click the Filter button. To print a transaction, click the Print button. NOTE: Leaving the Claim Number field blank will result in the transaction being associated with a newly created claim. 120 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

121 Creating Transactions and Claims To edit an existing transaction, only specific fields in the Transaction Detail window can be updated, including Status, Billing Code, Diagnoses, Accession Number, Note and Stop Date. 3. When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Transaction Detail and Transactions windows. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 121

122 Creating Transactions and Claims Adding a Claim To open a new client claim: 1 Select the patient in the Work Queue or search the HRCM database. 2 Select Go > Client > Claims from the menu bar, press [Ctrl+Shift+L], or click the Client Claims button on the toolbar. 3 In the Claims window, click the New button or [Ctrl+N] to add a record. To revert changes to the selected record, click the Revert changes to current selection button. To filter records, click the Filter button. 4 Enter any relevant information or select it from the drop-down lists. Claim Action when populated will initiate various actions to be taken on a claim. When a new claim line is inserted, this field will default to S to indicate Start Initial Bill for new claim. Start Initial Bill will generate the next claim number for the claim, gather transactions billable to the payor identifled and generate a billing to that payor. This action must be taken for all new claim records. The following actions may be taken on existing claim records: 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. 122 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

123 Creating Transactions and Claims 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. T = Transfer Claim. Typically only used by electronic Remittance process. When set will allow a claim to payment cycle, but will not produce billing for the claim (as primary payor has already transferred the claim to secondary payor). 5 To add transactions to the claim, click the New button or [Ctrl+N] in the Transactions area. 6 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Claims window. 7 The billing process is initiated in the background, gathering any unbilled charges for that payor, generating a claim number and creating a billing. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 123

124 Creating Transactions and Claims Managing Transactions From the transaction grids, several features are available to manage payment, adjustment and charge transactions. To open this menu, select one or more transactions and click the right mouse button to invoke the menu of features shown below. Transaction Grid Display Options The transaction grid display options control the type of transactions that are displayed by the transaction grid. Any of the following display options can be selected. All = Show all transactions including reversals (j-outs). Active = Show only active (non-reversed/non-j-out) transactions. Summarized = Show only active transactions suppressing rolled and exploded charges to only show summary of roll-up/explosion. Payment/Adjustment = Show only Payments and Adjustments Print Receipt The Print Receipt option is not currently supported in the US Lab version. 124 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

125 Creating Transactions and Claims Duplicate Entries The Duplicate Entries feature can be used to copy existing Charge transactions and create a new charge transaction. 1 After selecting this feature, the following message will be displayed: 2 Select No to cancel the copy. Select Yes to continue the copy. 3 The current transaction will be copied into a new transaction in the Transaction Entry window. All fields will be copied except the Transaction Date which must be populated to complete the entry. Any other fields which are enterable when creating a new transaction may be modified as needed. 4 Click Save to complete the entry and save the duplicate transaction. Reverse Entries The Reverse Entries option can be used to back out Charge transactions. 1 When selected, the following window is displayed: 2 Click No to cancel the reversal. Click Yes to complete the reversal. 3 When a transaction is reversed, a duplicate of the transaction is created with the amount and quantity negated to back out the dollar and quantity of the charge. Both the original and reversing entry are flagged with a J in the status field to indicate that the transaction has been Journaled out. The reversing entry will also contain the current date and the ID of the Account Rep who performed the reversal creating an audit of the reversal. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 125

126 Creating Transactions and Claims Rebill Entries Rebill Entries feature can be used to re-bill one or more Charges to any payor associated with the account based on COB (Coordination of Benefits Payor Sequence Number). 1 After selecting this feature, the following message will be displayed: 2 Click No to cancel the re-bill and return to the claim grid. Click Yes to continue the re-bill. 3 After clicking yes, the following screen will appear allowing selection of the COB to be billed. 4 Click Cancel to quit the re-bill and return to the transaction grid. Click OK once COB has been selected. The re-bill process will then remove the select charges from the claim, create a new claim for the charges and generate a bill for the claim to the new payor indicated by the COB selected. If the account does not have a payor with the selected COB, the next higher COB or COB 9 (for Patient) will be selected. 5 When the re-bill has completed, the following screen will be displayed. 126 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

127 Creating Transactions and Claims Re-Apply The Re-Apply option can be used to Re-Apply one or more Payments to other accounts or claims. To Re-Apply a Payment: 1 Right click on the payment(s) and select the Re-Apply option. A Payment Batch will automatically be created and invoked. 2 Post payments to accounts, claims, and line items as needed. If payment batch is dropped, the re-apply will be canceled. 3 Once the payment batch is posted, the original payments will be reversed by creating reversing entries flagged with J (Journal out) status. The reversing entry will have current entry date and Rep ID. 4 New payments created in the posted batch will be posted to accounts and claims as indicated in the payment batch. Cash Write-Off The Cash Write-Off option can be used to reverse out a Payment. To Write off a Payment: 1 Right click on the payment to be written off and select the Cash Write-Off option. 2 The following window will be displayed. 3 Select the Transaction Code to use for the Write-Off and click OK to continue. 4 A reversing entry for the payment will be created using the Write-Off transaction code indicated and the associated GL coding. The transaction will contain the current entry date and Rep ID. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 127

128 Creating Transactions and Claims Cash Refund The Cash Refund option can be used to produce a refund for a Payment. To refund a payment: 1 Right click on the payment to be refunded and select the Cash Refund option. 2 The following window will be displayed. 3 Select the Transaction Code to use for the Refund and click OK to continue. A refund transaction will be created using the Refund Transaction Code indicated and the associated GL coding. The transaction will contain the current entry date and Rep ID. Create Adjustment The Create Adjustment option can be used to create an adjustment for a Charge. To create an adjustment: 1 Right click on the charge to be adjusted and select the Create Adjustment option. 2 The following window will be displayed. 3 Select the adjustment Transaction Type, Code and Amount and hit OK to continue. An adjustment transaction will be created using the adjustment Type and Code and the associated GL coding for the Amount indicated. 128 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

129 Billing Chapter 8 Billing 8 This chapter describes billing procedures in HRCM. Data processing functions are used to process bills automatically or manually. Billing-related tasks are grouped together and can be accessed using the Tools > Processing >Process Billing submenu. Manual Billing In addition to automated billing, which occurs on clean accounts/accessions at specific intervals (e.g., daily, monthly), HRCM enables you to bill manually at any time using defined or payor-specific rules. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 129

130 Billing Demand Billing To create a billing form and manually submit it: 1 Select Tools > Processing > Demand Billing Forms from the menu bar. 2 In the Demand Billing window, the Account number will default to the current client/patient account, if one is selected. The patient or client Account number can also be manually entered, or click the Browse button to locate it in the HRCM database. 1. Select a Billing Form ID from the drop-down list. The Billing Form ID will be associated with a billing format in the Billing Request maintenance screen. Available Formats include: 837 I/P, UB92, HCFA 1500, invoices, statements, client list billing, etc. The Billing Request code will also define what type of address is appropriate for the selected billing and if Letter codes apply as well. 2. If Letter codes apply to the billing form, a Letter code can be selected to indicate either text to appear on the letter or invoice/statement message to be included. 3. Some billing forms will have a predefined Address Type in which case the Address Type field will be prepopulated and not updatable. Other billing forms will allow selection of Address Type to indicate if the billing should be address to: A = Patient Address I = Insurance Address 4. When Insurance Address Type is selected, a Payor and a Plan from the drop-down lists must be selected to indicate what payor the billing is being generated for. 5. When Patient Address Type is selected, an Address number must be selected to indicate which Patient Address to direct the billing to. 6. Enter the associated Claim Number, unless already automatically entered. 130 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

131 Billing 7. Entering a number of Review Days will cause a work queue tickler to be generated as well to show on Account Rep s work queue in the number of days indicated. 8. Click OK. A message is displayed informing you that the billing succeeded. 9. Click OK to exit. 10. A billing will be queued up in the Print Billing Requests queue and a note will be attached to the account indicating that a demand billing was produced. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 131

132 Billing Mass Re-Billing The Mass Re-Billing function is used to select a subset of claims for re-billing to a specific payor. To re-bill specific claims: 1. Select Tools > Processing > Mass Re-Billing from the menu bar or click the Mass Rebilling button on the toolbar. 2. In the Mass Rebilling window, select a Financial Class or All Financial Classes, a Payor and a Plan or All Payors & Plans, From and To dates, a Transaction Code, and a Representative or All Representatives from the drop-down lists. Optionally, select Rebill Claims with Existing Payments. 3. Click OK to proceed or click Cancel to exit. A message is displayed confirming that mass re-billing has completed successfully. 4. The System will search for claims matching the parameters entered and re-queue billing for those claims. The following window will display once completed. Click OK to exit. 132 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

133 Billing Bill Processing Processing of billing information is done automatically by the system at predefined intervals, but it can also be done manually in one of the following ways: Billing accounts immediately. Generating interim bills. Generating bills for unbilled charges for patient or client accounts that are flagged with a deficiency status of M (i.e., monthly billing). NOTE: Accounts and charges (transactions) to be billed are selected based on the parameters entered during this procedure. Immediate Bill Processing To process bills immediately: 1. Tools > Billing > Process Billing > Immediate from the menu bar. 2. In the Immediate Bill Processing window, select Transaction and Entry cut-off dates from the drop-down calendars. For transaction date, select the last service date to be selected for billing (defaults to the current month-ending date). For entry date, select the last entry date to be selected for billing (defaults to the current date). 3. In the Processing area, select all relevant optional information to specify the scope of bill processing. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 133

134 Billing 4. Click OK to process the bills. A message is displayed informing you that billing has completed. Click OK to exit. 134 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

135 Billing Interim Bill Processing When patient stays exceed a month in duration they can be interim billed, to bill for the prior month leaving current month charges unbilled. To process interim billing: 1. Select Tools > Billing > Process Billing > Interim from the menu bar. 2. In the Interim Bill Processing window, select Transaction and Entry cut-off dates from the drop-down calendars. For transaction date, select the last service date to be selected for billing (defaults to the current month-ending date). For entry date, select the last entry date to be selected for billing (defaults to the current date). 3. In the Processing area, select the Admission date from the drop-down list. Only Patient s which were admitted prior to this date will be selected for billing. In the Processing area, select all relevant optional information to specify the scope of bill processing. 4. Click OK to process the bills. A message is displayed informing you that billing has completed. Click OK to exit. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 135

136 Billing Monthly Bill Processing Monthly Bill process can be used to invoke a periodic billing. This is typically performed at Month End, but be performed mid-month or other periods as well. To process bills scheduled for monthly/periodic billing: 5. Select Tools > Billing > Process Billing > Monthly from the menu bar. 6. In the Monthly Bill Processing window, Cut-off Dates area, select Transaction and Entry dates from the drop-down calendars. For transaction date, select the last service date to be selected for billing (defaults to the current month-ending date). For entry date, select the last entry date to be selected for billing (defaults to the current date). 7. In the Processing area, select any relevant optional information. Bills scheduled for monthly billing that correspond to the selected parameters will be processed. Specific Payors and Plans can be included as well as exclusionary selections are provided. 8. Accounts defined to be billed on a Monthly/Periodic basis will have a specific deficiency to indicate that daily billing should skip the account and it should be billed in the Monthly Bill process (eg M = Monthly Billing). The Deficiency must be populated with this specific deficiency to bill these accounts. 136 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

137 Billing 9. Click OK to process the bills. A message is displayed informing you that billing has completed. Click OK to exit. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 137

138 Billing Refund Processing To create and print refund checks for the currently selected company: 1 Select Tools > Processing > Process Refunds from the menu bar. 2 In the Refund Processing window, select one of the following options. Print Refund Checks To print refund checks for the refund requests, pick the Print Refund Checks option and fill the Starting Check# with the first check that will be printed on. Hitting the OK button will run the Refund Check print report to produce output in a format that can be printed on pre-printed checks. When printed, each approved refund should be populated with the check# that the refund will be printed on (in BILLREQ table). Sample of default check print: After printing, number of requests will show zero (refunds already printed). 138 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

139 Billing NOTE: The check print Crystal report program must be set-up in the Billing Request Code table with request code = RF. The default set-up for RF should look like this: Reset Refund Check Requests After refund checks have been printed, they cannot be printed again. To reset refunds for re-printing, select the Reset Refund Check Requests option and fill in the check from and through the number of the printed refund requests that should be reset for re-printing. The Number of Requests field will display how many refund requests this check from/thru range covers. After hitting OK, the refund requests are reset so they can be re-printed. Print Check Register After refund checks have been printed, selecting the print check register will display Number of Requests that were printed. Hitting OK button will print a report of all printed refund checks. Sample Report: Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 139

140 Billing Print Check Register When the Clear Refund Checks option is selected, Number of Requests will display the number of refund requests which have been previously printed. Pressing OK will cause the printed refund requests to have their status set to P for later clean out by the end of day (removed based on SYSTABLE.BILLREQ_DAYS requests deleted after number of days has passed). 1 Click OK to initiate processing. 140 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

141 Billing Month-End Processing The Month-End Close function is used to enter parameters to process your end of month/period, including closing the month/period-end and generating extract and aging summary reports. Month-End Close To initiate the month-end close process for a specific period: 1 Select Tools > Processing > Month-End Close from the menu bar or click the Month-End Close button on the toolbar. 2 In the Month-End Close window, click the New button to add a record or select an existing 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 Select a month-end close Period, Period End and Close Date from the drop-down lists. 4 To generate the month-end extract, click Run Month End Extract. The record and the Date Extracted field are updated with the extraction date. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 141

142 Billing 5 To generate the month-end aging summary, click Run Month End Aging Summary. A confirmation message is displayed. Click OK to continue. 6 When finished, click Save Changes on the toolbar or select File > Save (or press [Ctrl+S]) and close the Month-End Close window. 7 To initiate the GL interface, click Run GL Interface. Select the desired output and click OK to initiate processing. 8 To view the Month End Aging Summary, select Tools > Reports > Select Report. In the Report Explorer, expand the Month End folder, select Aging Summary (or Aging Detail for detailed information) and click Open. 142 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

143 Billing The Month End Aging Summary is displayed in the Report Viewer. You can also print the report the from Report Viewer by clicking the Print Report button on the toolbar. NOTE: To display the selected report in Report Viewer, Crystal Reports Viewer component must be installed on your computer. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 143

144 Billing EDI File Processing The EDI File Processing program is used to create EDI output files and process EDI input files. An option is provided to print a report without posting any changes or updates to the database. Working with EDI Import Files To initiate EDI Import file processing: 1 Select Tools > Processing > EDI File Processing from the menu bar or click the EDI Filing button on the toolbar. 2 In the EDI File Processing window, select the File Type to process from the drop-down list. To preview the end result in a report without the actual processing, select Run as a Test. 3 NOTE: Depending on the EDI file type selected, either the Import tab or the Export tab is activated and some of the displayed fields are automatically adjusted. 4 To import EDI files, on the Import tab, enter the Import File Path & Name (or click the Browse button to locate it), and the Output Report Name. 5 For certain EDI file types there is an option to select Post <File Type> Writeoff. This process will use write off parameters to write off any charges with balances after applying remittances. 144 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

145 Billing 6 Click OK to proceed or click Cancel to end the process. The EDI Processing Status window displays the status and the output information. 7 Click Notepad to open output in Notepad for view, edit or print. 8 Click Print to print output to default printer. 9 Click OK to exit. Working with EDI Export Files Typically, EDI export processing will be initiated from the Print Billing Request screen during the printing of a Billing Request queue which corresponds to an EDI output. Once invoked from that screen, the process below will be followed. It is also possible to initiate an EDI export directly from the EDI processing screen using the steps below. To initiate EDI Export file processing: 1 To export EDI files, on the Export tab, select a Representative from the drop-down list (or select All) and a Request Code. Enter the default Server Directory, the File Name, and the Client Directory for the file output (or click the Browse button to locate it). Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 145

146 Billing NOTE: The Server Directory default is based on entry of the File Type field or the Request Code field. When the File Type field is entered, this field defaults to the path entered in the Server Directory field. If the Request Code field is entered, this field defaults to the directory entered in the File Name field in the Billing Request code table. The File Name default is based on entry of the File Type field or the Request Code field. When the File Type field is entered, this field defaults to the file name entered in the File Name field in the EDI Parameters code table. If the Request Code field is entered, this field defaults to the file name entered in the Filename field in the BillingRequest code table. 2 Click OK to Create EDI File or Cancel to end the process. The EDI Processing Status window displays showing summary of EDI file(s) produced. 146 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

147 Billing 3 Click Notepad to open output in Notepad for view, edit or print. 4 Click Print to print output to default printer. 5 Click OK to exit. 6 Files created can be picked up in the client directory indicated in the EDI Processing screen and transmitted to Clearinghouse or Payors. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 147

148 Billing Generating Billing Output The Print Billing Requests function is used to preview or print billings, invoices and statements automatically created by the system during the End of Day process or manually created by a user. It is also used to produce electronic submission files, such ANSI x Claim Submissions. Printing Billing Requests The Print Billing Requests window displays the queued bill requests for the current user by default. It shows all the billing request codes created in the Billing Request Codes code table (e.g., electronic bills, statements, refunds, etc.) and a predefined target printer (output device). To generate billing request output: 1 Select Tools > Processing > Print Billing Requests from the menu bar or click the Print Billing Requests button on the toolbar. 2 In the Billing Requests window, select a Representative and a Clinic from the drop-down lists (defaults are the current representative and All Clinics) or select All Representatives and All Clinics to show all requests. NOTE: To be able to print billing requests, there have to be items in the queue for the specified representative and clinic. 148 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

149 Billing Generating Statements/Invoices to PDF and ing You can also generate statements or invoices to PDF, attach them to client/patient accounts and then them to the client/patient. This feature allows you to generate and billing forms generated from the Print Billing Requests window. It will allow you to specify the subject and text, and send s without requiring setting up mail profiles or requiring Microsoft Office to be installed. Note: This function does not support receive functionality or bounce control 1 Set-up Server Information server information must be set-up to allow the software to statements/invoices. Note: You will need your IT support to provide the information necessary to set-up your server. Server Name = your server name Server Port = server port Use SSL = indicate if Secure Sockets Layer (SSL) should be used when sending Username and Password = authentication for mail server Verify Setup when button is pressed, screen will connect with server and determine if server set-up is valid. NOTE: If the organizational server address changes (either the DNS name or the IP address if the server is accessed directly by IP) it also needs to be updated in the HRCM server settings dialog. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 149

150 Billing 2 Set-up in System Printers In the System Printers maintenance table, a Printer Code called is required to send invoices and statements via . The Printer Path field must be used to indicate the root directory to which statement/invoice PDF files will be written. This root directory must be on a file server accessible to all HRCM users who will print and/or view these statement/invoice PDFs. 150 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

151 Billing 3 Set-up Letter Code to Provide Subject and Text In Letter Code maintenance, create a new letter code to contain the subject line and text to be sent when ing statement/letter. a b c Code = Letter Code to attach to Billing Request Code Description = subject Text = body Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 151

152 Billing 4 Set-up Billing Request Code for Statement/Invoice A Billing Request Code should be created to hold billing requests. Code = Billing Request Description = Request Code Description Program Name = Invoice/Statement Crystal Report program name Program Type = R for Crystal Report Sequence Type = A to queue up and print statements by Addresses Print Device = Letter = Letter Code containing subject and body Custom Report = check box if Crystal invoice/statement is custom CC Representative = Copy Account rep on the 152 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

153 Billing Account Rep The Account Rep is found in the security account rep set-up screen. 1 Set-up Document Code Matching Billing Request Code In Document Code maintenance screen, create document code matching Billing Request Code. When statement/invoice PDF file is attached to account in the Patient/Client Documents screen, the document will be attached to this code. 2 Entered on Patient/Client Address Record The address to be sent statement/invoice should be entered on the client/patient s Address information in the field. If the statement/invoice needs to be sent to more than one address, multiple addresses can be listed separating each address with a semi-colon (eg [email protected]; [email protected]; [email protected]) Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 153

154 Billing 154 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

155 Billing 3 Billing Types Added to Billing Rules Screen The Billing Rules can be set-up to indicate billing request code to be used when billing a patient/client that has address. Sending s 1 Queue up and/or bill patient/client accounts as normal. billing requests can be demand billed or generated from any of the standard billing processes (dayend, claim screen, monthly billing, collections, etc). 2 Run the Print Billing Requests as usual to generate s. 3 As the Print Billing Requests is executing, a progress screen will display showing each account that is being generated. The function will cycle thru each queued up billing request executing the Crystal statement/invoice program for account indicated. The statement/invoice will be generated to a PDF file. The PDF files will be stored in separate directories for each account and subdirectory for each year statement is executed within the root directory identified on the System Printers maintenance screen. A patient/client document entry will be created with Document Code = Billing Request Code and a link pointing to the PDF file created. The PDF will be ed to the address provided on the patient/client account. NOTE: Custom Invoices and Statements must be modified adding Account Number parameter before they can be used to generate or separate PDF files. 4 To display queue details for any of the listed records, double click on the line or click the Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 155

156 Billing Edit button. The Queue Detail window will display showing detailed information on existing billing requests in that queue record. 5 To remove a record from the queue, select it and click the Delete button. 6 A message is displayed asking whether to proceed. Click Yes to remove the record, or click No to cancel. 7 In the Queue Detail window, click OK to exit. 8 In the Queue for the selected criteria data grid, select a billing form to be printed by placing a check mark in the Selected check box. 9 In the Billing Requests window, click OK. 10 The program associated with the Billing Code in the Billing Requests maintenance screen will launch and produce output for the billing. The method of output will depend on the billing program itself. 11 Billing programs which execute database procedures (e.g. H1500 program) will immediately execute and direct output to the specified printer. 156 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

157 Billing 12 EDI billing programs will automatically open the EDI export window and prepopulate parameters based on the Billing Request selected. See Working with EDI Export files section. 13 Report based billing programs will launch Crystal Reports and display parameter screen allowing selection of Printer Destination. Output may be directed to: Screen Runs billing to the screen Default Runs billing to default printer Other defined printer Directs output to defined printer Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 157

158 Billing If SCREEN is selected as the Print Destination, the report displays in Report Viewer. You can also print the report from Report Viewer by clicking the Print Report button on the toolbar. When report has printed or the Report Viewer is closed, this message displays. 1. Click No to leave the billing requests in the Request queue for re-printing. 2. Click Yes to clear the billing requests from the Request queue. 158 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

159 Billing Recurring Charges and Payments Either Patient or Client Charges and Payments can be setup to recur at various intervals. Setting Up Recurring Charges and Payments To setup charges or payments to recur: 1. In the Patient or Client Transaction Entry screen, enter or update transaction selecting a Recurring Status value in the Status field. The Stop Date can be used to indicate when the payment or charge will stop recurring. Status codes starting with an R are fixed so recurred charges and payments will have the same dollar amount and GL information as the original starting charge/payment. Status codes starting with a V are variable. Charges with statuses starting with V will look-up new charge rate each time the charge recurs. Statuses available: RA - RECUR ANNUALLY New charge created each year on same date RD - RECUR DAILY New charge created daily RM - RECUR MONTHLY New charge created each month RQ - RECUR QUARTERLY New charge created each quarter RS - RECUR SEMI-ANNUALLY New charge twice a year Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 159

160 Billing RT - RECUR TWICE(SEMI)-MONTHLY New charge twice a month VM - RECUR MONTHLY(RATE) New variable charge created monthly VQ - RECUR QUARTERLY(RATE) - New variable charge created quarterly Processing Recurring Charges and Payments By request, a process can be installed in the End of Day processing to trigger recurring of payments and charges. This process will create recurring charges and payments up to the current date. The processing of recurring payments and charges can also be started manually from within the application. To process recurring charges or payments: 1. Select Tools > Billing > Recurring Charges and Payments option from the menu. 2. Enter or select screen parameters. Representative will select only accounts assigned to indicated Account Rep or select All Representatives to select all accounts. Date to Process indicates what date to recur payments or charge thru. 3. Type or select either Charges or Payments for recurring. 4. To generate a listing of payments or charges that will recur, press the Report button. 5. Press Cancel to cancel the recur process or press OK to begin the recur process. The process will take a copy of charges or payments flagged for recurring and based on the transaction date and recurring status selected; determine the next date for payment/charge to be created. If that next date is on or prior to the processing date indicated in the parameter screen, the recurring charge/payment will be generated. Charges flagged with a recurring status starting with V will be created at the current dollar amount indicated in the transaction code and rate tables. 160 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

161 Billing Payments and Charges flagged with a recurring status starting with R will be created at the dollar amount indicated on the original line flagged to recur. Additional recurring payments or charges may be created up to the processing date indicated depending on the recurring type indicated (eg RD once daily would create one charge/payment record per day up to the processing date). Payment and Charge recurring on an account will stop if any of the following conditions occur: The Recurring status is removed from the payment/charge The stop date indicated on the recurring payment/charge is reached. The discharge date indicated on the account is reached. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 161

162 Billing Re-Pricing Charges When pricing of charges is changed retroactively (with an effective date in the past) it may be necessary to re-price charges that have already been generated in the system so they pick up the new rates. To trigger re-pricing of charges: 1. Open Tools > Billing > Re-Price option from the menu. 2. Enter parameters to select charges to be Re-Priced. Cut Off Dates indicate starting service date (Transaction Cut Off) and entry date (Entry Cut Off) for selection of charges. Only charges with service dates on or after the transaction cut off and entry date on or after the entry cut off will be re-priced. 3. Select specific clinic or to re-price charges for all clinics. 4. Enter Charge code to be re-priced or leave blank to re-price all charges codes. 5. Select specific patient type or 99 to re-price charges for all patient types. 6. Enter fee schedule to be re-priced or leave blank to re-price all fee schedules. 7. Enter or select Acct# to perform re-price on a single patient/client account or leave blank to reprice all accounts. 8. Check Re-price Billed Charges to force re-price on charges that have already been billed. Unchecked will cause re-price of only charges that have not been billed. 9. Check Re-Bill Invoices with Price Changes to trigger re-billing of claims which have charges that are re-priced. 10. Click Cancel to exit Re-Price process or Click OK to execute Re-Price. Re-price will search for any transactions that match the parameters entered and look-up new pricing for the transaction. If the pricing has changed, the original transaction will be reversed (Journal out) and new transaction will be generated with the new price. If the re-priced charge 162 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

163 Billing was on a billed claim and the re-bill claims flag is set, the system will generate a re-billing of that claim. 11. Once completed the following message will display. Click OK to exit the screen. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 163

164 Billing UB04 (Institution) Billing UB04 is the standard form for billing Institutional Claims in the US. The following instructions add the capability of billing US Institutional claims. 1. UB/Institutional Admission Type Maintenance This is the Maintenance screen to set up Admission Types specific to UB/Institutional billing Type = admission type Description = admission type description 2. UB Admission Source Maintenance This is the Maintenance screen to set up Admission Sources specific to UB/Institutional billing. Source = admission source Description = admission source description 164 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

165 Billing 3. National Revenue Code Added The National Revenue Code (NRC) to be used on UB/Institutional billing will be selected based on transaction Billing Code rules. NRC will not appear on patient transactions. Instead, it is dynamically selected by the billing format at time of printing. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 165

166 Billing 4. UB Codes The is the Maintenance screen used to define Condition Codes, Occurrence Codes and Value Codes needed for UB/Institutional billing. Code Type = Defines which category the code belongs to o CC = Condition Code o OC = Occurrence Code o VC = Value Code Code = Condition, Occurrence or Value Code value Description = description of code to appear in list boxes 166 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

167 Billing 5. UB Relationship Code field UB/Institutional billing uses its own relationship type codes. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 167

168 Billing 6. Mapping of UB/Institutional Fields by Billing Rules UB/Institutional billing format will be selected based on the Billing Type in the Billing Rules screen. Use the UB Fields tab on the Billing Rules screen to define the format and coding values to be used when billing using UB/Institutional format. Bill Type = defines billing format to use for billing rule Print NDC = indicates if NDC information will be found in the transaction Unit field and should be formatted and printed on UB/837I. UB Fields Tab = Detail Definition of Codes to be used for UB/Institutional billing rule. 168 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

169 Billing 7. Billing Rule UB Fields Tab The UB Fields tab will define default values for UB specific fields to be assigned to accounts based on billing rule. When new accounts are registered, these codes will be populated on the account UB fields tab as defaults for the account. Bill Type = UB/Institutional Billing Type default UB Admit Type = Admission Type default UB Admit Source = Admission Source default UB Codes = selected Condition, Occurrence and Value Code defaults to include when billing UB/Institutional format o Code Type = type of code CC = Condition Code OC = Occurrence Code VC = Value Code o Sequence# = Order in which code should appear in billing (1 first, 2 second, 3 third, etc). o UB Code = Condition, Occurrence or Value code to default on billing o Deficiency Code = Deficiency to assign to account if code not found on account or missing corresponding date or amount. NOTE: this feature has not yet been implemented with this release. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 169

170 Billing 8. Patient Information Screen UB Fields When a new Patient Account is created through manual registration or interface process or a payor change is performed on the account, the process will look-up Billing Rules based on patient type, payor, etc and copy default UB fields to the Patient account Information screens. The UB tabs on the Patient Information screen can be used to enter and modify these default values. When billing occurs, this information will be copied to claim for billing. a. UB Fields Tab Bill Type = UB Bill Type default value for first claim Admission Type = UB Admission Type Admission Source = UB Admission Source Description = UB Remarks 170 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

171 Billing b. UB Conditions Tab Condition Code = UB Condition Codes Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 171

172 Billing c. UB Occurrences Tab Occurrence Code = UB Occurrence Code Occurrence Date = UB Occurrence Date Occurrence Span Code = UB Occurrence Span Code Occurrence Span From/Thru Dates = UB Occurrence Span From/Thru Dates 172 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

173 Billing d. UB Values Tab Value Codes = UB Value Codes Value Amount = UB Value Dollar Amounts Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 173

174 Billing 9. Patient Claim Screen UB Fields As new claims are billed, UB fields are copied from the Patient Information screen UB fields. Additional updates can be made on the Patient Claim screen UB tabs and the updated data will be carried into UB/Institutional billings. a. UB Fields Tab Contains UB information fields defaulted from Patient Information UB fields. Information can be updated to print specifically for the claim. Bill Type = UB Billing Type. As new claims are generated, UB Type is defaulted from Patient Information UB Bill Type field and then last character is calculated based on admit/discharge dates and prior claims. o o o o If the discharge date is populated and there is a prior claim on the account, the last digit is changed to 4 for discharge billing. If the discharge date is populated and there is no prior claim on the account then the list digit is changed to 1 initial billing. If there is no discharge date and there is a prior claim on the account then the last digit is changed to 3 for interim billing. If there is no discharge date and there are no prior claims on the account then the last digit is not changed. Left as value set in Patient Information screen. Admission Type = UB Admission Type default from Patient Information Admission Source = UB Admission Source default from Patient Information Description = UB remarks default from Patient Information 174 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

175 Billing b. UB Conditions Tab Contains UB Condition codes defaulted from Patient Information. Condition codes can be added or removed to print differently for the individual claim. Condition Codes 1-10 UB Condition Codes c. UB Occurrence Contains UB Occurrence codes defaulted from Patient Information. Occurrence codes and dates can be updated to print differently for the individual claim. Occurrence Code 1-6 UB Occurrence Codes Occurrence Date 1-6 UB Occurrence dates for corresponding code d. UB Occurrence Span Contains UB Occurrence Span information defaulted from Patient Information. Occurrence span codes and dates can be updated to print differently for the individual claim. Occurrence Code 1-4 UB Occurrence Span Codes Occurrence From/Thru Dates = UB Occurrence Span dates (from/thru) for the corresponding occurrence span code. e. UB Values Contains UB Value Codes and Amounts defaulted from Patient Information. Value Codes and amounts can be updated to print differently for the individual claim. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 175

176 Billing Value Code 1 6 UB Value Codes Amount 1 6 Amounts for corresponding Value Codes 10. UB/Institutional Billing Programs a. UB Billing Form Set-up UB Billing Request code to run the UB04 program. Print from Print Billing Requests as other forms. The program will generate text-only output which is intended to be printed on preprinted UB-04 paper. Specific printer and printer settings (margins, CPI, spacing, font, etc) can be set-up in the System Printers maintenance screen. 176 Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2

177 Billing b. ANSI x Institutional Billing Set-up EDI Parameters for 837I2 copy of 837P2 Set-up Billing Request code for 837I2 Print from Print Billing Request screen which will launch EDI processing screen to produce EDI file. Infor Healthcare Revenue Cycle Management 3.4 US Lab User Guide Part 1 of 2 177