Demographic and Billing Interface Guide for Medisoft

Transcription

Title page
e-MDs Practice Choice
Demographic and Billing Interface Guide for Medisoft
February 2015
Copyright notice
Copyright notice
Copyright © 2015 McKesson Corporation and/or one of its subsidiaries. All Rights
Reserved.
Use of this documentation and related software is governed by a license agreement. This
documentation and related software contain confidential, proprietary, and trade secret
information of McKesson Corporation and/or one of its subsidiaries, and is protected under
United States and international copyright and other intellectual property laws. Use,
disclosure, reproduction, modification, distribution, or storage in a retrieval system in any
form or by any means is prohibited without the prior express written permission of
McKesson Corporation and/or one of its subsidiaries This documentation and related
software is subject to change without notice.
Publication date
February 2015
Product
e-MDs Practice Choice®
Corporate address
e-MDs, Inc.
7800 Shoal Creek Blvd.
East Wing 100E
Austin, Texas 78757
512-257-5200
e-MDs Practice Choice Demographic and Billing Interface Guide for Medisoft
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February 2015
Table of Contents
Table of Contents
Chapter 1 - Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 2 - Demographic and Billing Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Creating Patient Records in Medisoft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Creating Appointments in Practice Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Transferring Charges in Practice Choice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Processing Charges in the Practice Management Application . . . . . . . . . . . . . . . . . . .
3
3
4
4
5
5
Chapter 3 - Billing Transfer Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Creating Patient Records in Practice Choice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Creating Appointments in Practice Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Transferring Charges in Practice Choice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Processing Charges in the Practice Management Application. . . . . . . . . . . . . . . . . . . . 8
Create Patient Records in Medisoft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Chapter 4 - Billing Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Considerations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Failure to Transfer Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Auditing Billings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reviewing Charge Details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
13
14
14
Appendix A - Making Fields Required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Creating a Patient Template . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Appendix B - Data Transferred Between Applications. . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Billing Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
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Table of Contents
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List of Figures
List of Figures
Figure 1 Data Flow diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Figure 2 Unprocessed Charges screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Figure 3 Data Flow diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Figure 6 Patient Entry Template (new) screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Figure 7 Add Fields List screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Figure 8 Patient Entry Template (new) screen populated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Figure 9 Patient Entry Template (new) screen with check boxes selected . . . . . . . . . . . . . . . . . . . . . . . 13
Figure 10 Patient List screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Figure 11 Patient Quick Entry screen.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
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List of Figures
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Chapter 1 - Overview
The purpose of the e-MDs Practice Choice® EMR option is to allow users of a practice
management billing system, such as Medisoft, to keep their current billing configuration and
methods, while adding a robust charting solution. You can keep your billing workflow and even
existing clearinghouse, while taking advantage of a flexible SaaS-based solution like Practice
Choice for managing your clinical workflow and meeting meaningful use. If you already use
Medisoft, you can have billing and clinical solutions from a single company.
The purpose of this guide is to provide workflow guidance for using e-MDs Practice Choice EMR
for Medisoft. Depending on your needs, you will either use a demographic and billing workflow or a
billing-only workflow.
• Use the demographic and billing workflow when Medisoft is installed locally as part of your
office’s practice management application.
• Use the billing-only workflow when Medisoft is remote and your billing is handled by an outside
organization
Use the table below to go to steps for workflow guidance for using this feature:
If you are
Go to page ...
Using Practice Choice EMR with both Patient Demographics and
Billing
3.
Using Practice Choice EMR with Billing only
7.
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Chapter 1 - Overview
2
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Chapter 2 - Demographic and Billing Transfer
When your VAR and e-MDs’s implementation specialist configured Practice Choice with Medisoft,
they created an initial transfer of your patient records from Medisoft to Practice Choice. In addition,
they have configured Medisoft to transfer charges from Practice Choice to Medisoft.
Overview
Use the diagram below to see the workflow for the Demographics and Billing transfer. Details for
each procedure are provided in the remainder of the chapter.
Figure 1. End to End Workflow diagram
Creating Patient Records in Medisoft
To create patient records in Medisoft:
1. On the Lists menu, select Patients/Guarantors and Cases. The Patient List screen appears.
2. Click the New Patient button. The Patient (New) screen appears.
3. Enter data for the patient.
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Recommendations
4. Click the Save Button.
Recommendations
Practice Choice requires that certain information for patients be filled out to create and save a
patient record (for details, see “Patient Data” on page 19, the Required column). However, these
fields may not be required by the practice management system. If you attempt to transfer patient
records from the practice management system to Practice Choice without completing these fields
in the practice management system, you will receive errors in the Validation log of McKesson
Practice Interface Center and the records will not be transferred. Therefore, e-MDs recommends
that you establish a workflow in your office and educate your staff to complete all of the required
fields while creating a new patient record.
If you are using Medisoft and have been using Patient Quick Entry to ensure that certain fields are
always completed prior to saving a new patient record, e-MDs recommends that you continue to
use this method. For information on customizing either Medisoft to require these fields, see
“Making Fields Required” on page 15.
If you are updating certain meaningful use fields in Medisoft, make sure you update them in
Practice Choice as well, since they do not transfer as part of the sync.
Creating Appointments in Practice Choice
Whenever you create appointments for patients, use Practice Choice. If you do scheduling in
Medisoft, print a list of appointments so that you can re-enter them in Practice Choice.
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Transferring Charges in Practice Choice
Charges will be transferred from Practice Choice to Medisoft in the following way:
• Clicking Send Charges on the patient Chart
All claims will be processed using Medisoft.
For further information on what data is transferred from Practice Choice to Medisoft, see “Billing
Data” on page 25.
Processing Charges in the Practice Management
Application
Charges will appear on the Unprocessed Charges screen.
It is possible for charges to be sent from e-MDs Practice Choice to Medisoft twice if you send the
charges and then add a new procedure to the encounter. Be sure to check your pending
transactions carefully for duplicates and delete the first sent charges. The second charges are
complete and have the new procedure.
Note: If you have ICD-9 codes that are mapped to multiple ICD-10 codes in e-MDs Practice
Choice: when you send charges that include multiple line items with the same ICD-9 code but
different ICD-10 codes, duplicate diagnosis codes could be sent to Medisoft or Lytec. Be sure to
check transactions in Medisoft or Lytec for duplicate information prior to processing charges.
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Processing Charges in the Practice Management Application
1. On the Activities menu, point to Unprocessed Transactions, and click Unprocessed EMR
Charges. The Unprocessed Charges screen appears.
Figure 2. Unprocessed Charges screen
2. Review the charges.
3. When you are ready, click the Post button to post the charges.
4. When you are ready, click the Save button to post the charges.
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Chapter 3 - Billing Transfer Only
When your VAR and e-MDs’s implementation specialist configured Practice Choice with Medisoft,
they processed an initial, one-time transfer of your patient records from Medisoft to Practice
Choice. In addition, they have configured Medisoft to transfer charges from Practice Choice to
Medisoft. These charges are transferred behind the scenes using the mobile application server
that installed with Medisoft.
Overview
Use the diagram below to see the workflow for the Demographics and Billing transfer. Details for
each procedure are provided in the remainder of the chapter.
Figure 3. End to End Workflow diagram
Creating Patient Records in Practice Choice
1. Click the Search button in the toolbar of Practice Choice. The Person Search screen appears.
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2. Click the Add New link. The New Person screen appears.
3. Complete the fields on the screen, making sure to enter complete information.
4. Click the Save button.
Whenever you create appointments for patients, use Practice Choice. Provide billers with a patient
listing of appointments so they can reconcile charges against appointments.
Charges will be transferred from Practice Choice to Medisoft in the following way:
• Clicking Send Charges on the patient Chart
All claims will be processed using Medisoft.
For further information on what data is transferred from Practice Choice to Medisoft, see “Billing
Data” on page 25.
Processing Charges in the Practice Management
Application.
Patients who have Existing Records in Medisoft
Charges will appear on the Unprocessed Charges screen.
It is possible for charges to be sent from e-MDs Practice Choice to Lytec twice if you send the
charges and then add a new procedure to the encounter. Be sure to check your pending
transactions carefully for duplicates and delete the first sent charges. The second charges are
complete and have the new procedure.
Note: If you have ICD-9 codes that are mapped to multiple ICD-10 codes in e-MDs Practice
Choice: when you send charges that include multiple line items with the same ICD-9 code but
different ICD-10 codes, duplicate diagnosis codes could be sent to Medisoft or Lytec. Be sure to
check transactions in Medisoft or Lytec for duplicate information prior to processing charges.
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New Patients in Practice Choice who do not have Records in
2. Review the charges.
3. When you are ready, click the Post button to post the charges.
New Patients in Practice Choice who do not have Records in Medisoft
Once the initial synchronization of patients is complete, the synchronization will be turned off by the
e-MDs Operations team. Follow these steps when processing charges that arrive in Medisoft from
Practice Choice.
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For New Patients
For New Patients
2. Review the charges. Since there is no patient, the charges will have the Chart ID MPCHOICE.
The Billing Note line will indicate if the encounter is a restricted encounter, and it will display
the patient’s last name, first name, and date of birth. You can use this information to create the
record in Medisoft.
3. Create a new patient record in Medisoft. For steps, see “Create Patient Records in Medisoft”
on page 10.
4. In Unprocessed Charges, update the charge line with the new Chart ID.
5. Click the Post button.
Create Patient Records in Medisoft
To create patient records:
1. On the Lists menu, select Patients/Guarantors and Cases. The Patient List screen appears.
2. Click the New Patient button. The Patient (New) screen appears.
3. Enter data for the patient. Make sure you enter the same data for this record as exists in the
record in Practice Choice, especially the following data: First Name, Last Name, Date of Birth,
and Social Security Number.
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After you add the patient in Medisoft, add the Chart ID as the MRN in the Practice Choice Chart
View - Patient Demographics page.
4. Click the Save Button.
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Chapter 4 - Billing Considerations
Considerations
• There is no claims processing in Practice Choice. No Claims are created in Practice Choice
when the Billing Sync is enabled, even using the Scheduler. Checking in will not create shell
claims. Therefore, you cannot use Claims as an auditing tool for Billing Sent/Unsent.
• There is no flow of Billing from Medisoft to Practice Choice. If the biller makes a change, and a
sync of the data records is desired, the biller needs to update the Billing data in Practice
Choice manually as well.
• Resending charges from Practice Choice creates multiple entries in Unprocessed Charges.
Clinicians are not restricted from resending charges (even if they are already posted in
Medisoft).
• The patient’s Social Security Number and Chart ID are editable. Take care not to edit these
fields.
Failure to Transfer Claims
If there is a network error during the transfer of claims to Medisoft, the following will take place:
• The Charges column on the encounter will display Failed.
Figure 6. Encounter screen with failed charge highlighted
• If you are still in the encounter, you will receive a warning message that the charges did not
send.
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Auditing Billings
Chapter 4 - Billing Considerations
• The rendering provider in Practice Choice will receive a message in their Inbox.
If there is a network error, try clicking Send Charges again to see if they transfer. Once the charges
are successfully sent, remove the message in the provider’s Inbox.
If you continue to have problems with transferring charges, contact your Value-Added Reseller or
e-MDs Support.
Auditing Billings
Administrators or billing services can perform an audit using the Encounter Search screen after
they’ve identified the missing billing information in Medisoft.
To display the Encounter Search screen:
1. In Practice Choice, click the Admin button.
2. Click the Clinical button to display the Clinical worklist.
3. Click Encounter Search. The Encounter Search screen appears and the Charges column
shows the status of the encounter.
Figure 7. Encounter Search screen with Charges column highlighted
Tip: The patient should have an encounter status of Failed if there is missing billing information.
You should NOT click the Send Charges link on any encounter that is not in a Failed status without
verifying that the billing information is not already entered into the Medisoft for that encounter.
Reviewing Charge Details
When charges appear on the Unprocessed Charges screen, you should review the details. Make
sure the Case number is correct and updates any details associated with it.
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Appendix A - Making Fields Required
This chapter shows you the steps for setting up Medisoft to require fields during patient entry.
You can create a patient template and use patient Quick Entry to ensure that you enter all of the
information in the practice management system that are required by Practice Choice for a patient.
Creating a Patient Template
1. On the Lists menu, click Patient Entry Template. The Patient Entry Template List screen
appears.
2. Click New. The Patient Entry Template (new) screen appears.
Figure 8. Patient Entry Template (new) screen
3. Enter a Code and Description.
4. Click Add Fields. The Add Fields list screen appears.
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5. Scroll through the list and select the Selected check boxes for the following fields: Last Name,
First Name, Address 1, City, State, Zip, Home Phone, Birth Date, and Inactive.
Figure 9. Add Fields List screen
6. Click the OK button. The Patient Entry Template (new) screen appears with the grid populated
with the fields you selected.
Figure 10. Patient Entry Template (new) screen populated
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7. Select the Required and Display check boxes for each field that you added.
Figure 11. Patient Entry Template (new) screen with check boxes selected
8. Click the Save button.
9. Click the Close button on the Patient Entry Template List screen.
10. When you add a new patient, on the Lists menu, click Patients/Guarantors and Cases. The
Patient List screen appears.
Figure 12. Patient List screen
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11. Click Quick Entry. The Patient Quick Entry screen appears. All of the fields that you marked
as required display here and Medisoft will not allow you to save the record until they are
completed.
Figure 13. Patient Quick Entry screen.
12. Complete the fields.
13. Click the Save button. The new patient record will be created and all of the fields required for
correct transmission to Practice Choice will be completed.
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Appendix B - Data Transferred Between
Applications
Patient Data
McKesson Practice Interface Center will transfer patient demographic information to Practice
Choice and transfer billing data from Practice Choice to Medisoft.
The synchronization process will transfer demographic data for active patient records. This is true
for new patients and for changes to existing patient records. The table indicates fields that are
required in Medisoft and those that are sent for new patients as opposed to patients whose records
are being updated. An asterisk next to the name in the Field column denotes fields that are
required to qualify for “meaningful use.”
Field
Required
Locked
New Patient
Update Patient
Last Name
x
x
x
x
First Name
x
x
x
x
Practice Choice Default
Middle Name
x
Suffix
x
x
AKA Last Name
x
x
Automatically filled by Practice
Choice from the Last Name
AKA First Name
x
x
Choice from the Last Name
SSN
x
x
x
x
x
x
Race*
x
x
Ethnicity*
x
x
Birth Date
x
Gender*
x
x
Contact
Preference
x
Choice to Phone Call
Address 1
x
x
x
x
Address 2
x
x
x
x
City
x
x
x
x
State
x
x
x
x
Zip
x
x
x
x
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Patient Data
Field
Appendix B - Data Transferred Between Applications
Required
Locked
x
x
See the
Practice
Choice
Default
Column
x
x
x
Cell Phone
x
x
x
Work Phone
x
x
x
Work Extension
x
x
x
Fax
x
Email*
x
x
x
Country*
Home Phone
This person is a
patient check box
x
New Patient
Update Patient
Choice based on the State
and Zip Code (US and
Canada only)
x
At least one of the following
phone numbers is required:
Home, Cell, Work. If multiple
number are provided, the
Home number is marked as
Primary.
Auto-selected by Practice
Choice. It is not editable.
Auto-selected by Practice
Choice. It is editable.
HIPAA Privacy
Requested check
box*
Status*
Practice Choice Default
x
Updated when it is changed in
Medisoft or Lytec and a user
confirms the change in e-MDs
Practice Choice.
MRN
x
Preferred Internal
Provider
x
If the provider in the message
matches the provider in
Practice Choice, then it will
map correctly. If the provider
in the message does NOT
match the provider in Practice
Choice, the auto-mapping
logic will map that patient to
the appropriate provider
This information will be validated during transmission. If a field is blank or contains invalid data,
such as a zip code that is too long, the system will generate an error and write it in the Validation
Log. The record will not be transferred.
NOTE: guarantor records are NOT transferred to Practice Choice.
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Billing Data
Billing Data
The table below describes the data that is transferred from Practice to the practice management
application.
Field
Required?
Notes
Date of Service
x
This is the date of the service.
Diagnosis Code(s)
at least 1
You can transfer up to 12 codes.
When the charges are transferred, the claim will be
updated. If the chart is updated with another diagnosis
code or a code is removed, the updated information will
be transferred as a second charge line to the practice
management application.
Procedure Code(s)
at least 1
When the charges are transferred, the claim will be
updated. If the chart is updated with another code or a
code is removed, the updated information will be
transferred as a second charge line to the practice
management application.
Rendering Provider
x
No other providers are transferred.
Chart Number
x
This is the Chart ID for the patient. If the system is set
up to transfer charges only, with no patient
synchronization, this ID will appear as MPCHOICE for
patients who do not yet have records in Medisoft.
Unit
Modifiers
Payer specific information, facilities, and other billing data, such as NDC numbers, are handled by
the billing staff using Medisoft. This data is not transmitted from Practice Choice to Medisoft.
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Billing Data
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Index
Index
A
T
auditing
billings 14
transfer claims
failure 13
transferring
charges 5, 8
B
billing
considerations 13
billings
auditing 14
C
charges
transferring 5
claims transfer
failure 13
creating
appointments 4, 8
patient records 3, 7
patient records in Medisoft 10
I
information required by Practice Choice 19
O
overview 1, 3, 7, 13
P
patient templates in Medisoft 15
Practice Choice EMR configuration overview 1, 3, 7,
13
prerequisites 1
processing
charges 8
providers
Practice Choice 1, 3
practice management system 1, 3
R
recommendations 1, 3
creating patients 4
required data 1, 3
required fields
creating 18
required information 1, 3, 19
February 2015
23

Demographic and Billing Interface Guide for Medisoft

Transcription

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