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Functions and from the Main Invoice Screen and Detail Invoice Screen data Entry Fields
Menu Path: FILES/Invoice -- select A-Add
Most invoice data entry fields are the same from state to state except special fields for Medicare and Medicaid. In addition to the information on these pages, refer to the Medicare and Medicaid specifics for your state.
Special invoices for Contracts (HMO, Nursing Home, Hospice, etc.)
Special codes/fields that vary from state to state
QUICK REFERENCE TO DATA ENTRY FIELDS FOR NEW INVOICES
Service Date Due Date Bal(ance Due) Patient Code Name (Patient) Doctor Code Name (Doctor) Stat(us) Code Ordered Related To Emp(loyment) Service Type Accident Service Level Round Trip Transported From Transported to Signed Medicare Base Rate Modifier Medicare Information Code (State dependent-secondary modifier) ICD Code Pri(mary) Diag(nosis) Sec(ondary Diag(nosis) Pri(mary) Pay Code Sec(ondary) Pay Code
Screen 2 - Main Invoice Screen
Letter A key was pressed (A-Add record), and at the bottom, a prompt line is displayed with a blank invoice number for key entry -- for the example above, FM7 and 947530 were entered into the two fields. Then a (mostly) blank detail invoice screen is displayed with the invoice number that was entered and the service date defaulted to yesterday's date. Either press the <ENTER> key to accept the service date or type over the default date. The computer will calculate a due date which will be the first of a subsequent month, and you can either accept or type over -- NOTE -- payment status, etc. plus this due date will affect the severity of statement messages, as described in the section POST PAYMENTS. Bal(ance Due) will show total balance for all invoices this patient, once the patient code is entered. Next, make up a patient code from the patient's name, for example BLACKJIM for Jim Blackstone -- 5 characters of the last name plus 3 characters of the first name. This is not etched in stone, but we have found that this scheme results in insignificant duplication for different people with similar names.Once the patient has been either entered or retrieved (already on file), the patient name is retrieved from the patient data base.
Screen 3 - Detail Invoice Screen
After entering a patient code, one of 2 things will happen:
if the patient is on file and has an existing invoice on file, the one with latest date of service will have that invoice data imported into screen 3 above, and you can change the date of service, and other data specific to THIS trip. Charges, payments, memos, are not imported, and the status is set of A-Active. This is useful for frequent flyers, plus patients you previously transported to the hospital, and this is the return trip. If the trip to the hospital was CVA, then modify the diagnosis description by adding: Discharged after treatment for...............
if the patient is not on file, the program branches to the patient screen, shows a window of nearest matches to the patient code you have entered, for either selecting one displayed or selecting A-Add (patient), as described in PATIENT section.
After a patient has been selected/new one entered, the top part of your screen will look like this
Screen 4 - Detail Invoice Screen After patient selection
Doctor Code--(See the DOCTOR Database). The next field to enter is either the attending physician of the referring physician. Once the doctor has either been entered, the doctor name is retrieved and displayed. Often times, an ambulance service transporting a patient to a hospital and/or some facility does not know the physician, and thus, often we will use something like ER Doctor-County Hospital, and more of your screen is filled in as follows:
Screen 5 - Detail Invoice Screen Data Entry
Continuing the data entry -- On a new invoice, the default Stat(us) is A-Active, but later may change. When your cursor is at this field, a prompt line will be displayed at the bottom of your screen as follows:
Screen 6 - Detail Invoice Screen Prompt Line-Invoice Status
The Code field is free form, and on a new invoice is usually left blank -- this field is discussed more in the field descriptions section of the INVOICE screen in another section.
Ordered -- Who called the ambulance - Family, Bystander, via 911, etc.
Related To Emp(loyment)-- Workman's Comp?
Service Type--screen below is displayed on your prompt line when the cursor is at this field
Screen 7 - Detail Invoice Screen Prompt Line-Service Type
E-Emergency--This is the only selection that is classified as an emergency transport; all others are non-emergence. Thus, not select T-Transfer for hospital to hospital transports, when the patient is in a health threatening situation (EKG, IV, etc. enroute)--use Emergency for these type transports. O-Outpatient--These are for local trips (nursing home to Physician Office-Clinic, and to hospital) where the patient is not discharged first facility, admitted second facility. T-Transfer--this is non-emergency facility to facility transport, discharged first facility, admitted second facility.
Accident -- Two types (Auto) and (2) non-auto your prompt line is shown below
Screen 8 - Detail Invoice Screen Prompt Line-Accident (enter Y, N, or A)
Service Level -- A-ALS, B-BLS. Some states may argue the point as to what is ALS and BLS, but the ALS/BLS is not what you do, it is ambulance and crew. Prior to 1995, some services were allowed to charge all ALS if trucks and crews qualified PLUS there was a local ordinance mandating all ALS. On January 1, 1995 HCFA addressed this problem and instituted four ALS codes-two emergency and two non-emergency, away from the single ALS code (A0220) which was the highest reimbursed.HCFA initiated two non emergency ALS codes intended to reduce Medicare reimbursements, but it backfired, and reimbursements went up. On the Federal Register about October 1997 HCFA listed proposed legislation (for comment) to fix their previous fix, and defining about 50 ICD codes (diagnoses) for ambulance services with those where ALS is allowed, and those that can only be BLS--these are listed on our Sample Run Sheet. There has been some controversy about these codes. For example, HCFA proposes a hand injury to be ALS, but unconscious can only be BLS - does not take a Ph.D. physician to see the absurdity in this. To summarize ALS versus BLS, different states could interpret this however they wish-good luck.
Round Trip--if Y(es), a field will be displayed for the return vehicle, plus when charges are posted, the return HCPCS codes will be posted with the base rate modifiers reverse (Residence to hospital modifiers--going RH, return HR). Round trips are to and return the same day. You may choose to code round trips as two trips. However, beginning January 1, 1999, Medicare nursing home patients in Part A stay may require coding it as one claim.
Transported Form/To--A database can be user-defined with local transport locations and facilities such that a 1-3 character input at an address data input field will pull in City, State, Zip, Area Code in order to reduce data entry. However, this coed is not necessary, and the locations can be manually entered. The advantage of using the database and codes is that base rate modifiers are automatically assigned (see FROMTO). In the screen above, the code BHB was entered and Baptist Hos........... was retrieved. If you cannot remember a code, a Ctrl-PageDown (Hold the Ctrl and tap the PageDown key) will get you to the FROM/TO file for viewing, searching, selection, adding a new one.
Signed -- Did the patient sign the run sheet: Yes or No. This message will not show here if programmed in the Company Screen parameters. For a sample of the statements you may choose to have the patient sign, see the statement (taken from what some hospitals require) on our Sample Run Sheet.
Medicare Base Rate Modifiers -- immediately above, it was stated that base rate modifiers are automatically assigned for transport locations in the FROM/TO database--here, NH have been assigned and will be attached to the HCPCS (A0330NH) for claims submission. For a more detailed description of Base Rate Modifiers, go to the FROMTO section.
Medicare Information Code--This will be specific to each state and is a secondary HCPCS modifier. Different states may or may not have secondary modifiers, and will call them some other than Medicare Information Code. When you put your billing state in company screen 1, your screens are configured to suit that specific state. Here, you are seeing the configuration for Alabama. Click HERE to see special secondary modifiers specific to your state, as well as Medicare and Medicaid differences. When you come to this data entry field in the invoice screen, pressing Function key F1 will display your choices.
Primary and Secondary Diagnoses
Philosophy for coding diagnoses, using the search engines, etc. are discussed in detail in the DIAGNOSIS section. To summarize here, the diagnosis data base has one record per diagnosis, with multiple fields per record, as shown below.
Screen 9 - Diagnosis screen-Sample display
Here, the user has defined a short code they can remember SOB (Shortness of Breath). When the cursor is at the beginning of either diagnosis field in the invoice data entry screen, entering less than eight characters is a signal to the computer that this is not a diagnosis, but a user-defined code, and the description and ICD code are extracted from the diagnosis database. For more details, examples, and special cases, go to the DIAGNOSIS section.
Primary and Secondary Pay Codes
The system uses 9 payor categories as follows:
1-Medicare 2-Medicaid 3-Auto Insurance 4-Workman's Comp 5-Primary Insurance 6-Secondary Insurance 7-Private Pay(monthly) 8-Discounts 9-Writeoffs (Several Categories)
Click on one of the categories above for a detailed description
There is a priority chain of payers. Payment filing and responsibilities trickle down from the Primary payer, once the primary payment has resolved. Private Pay is the last (and defaulted) when there is some type Medicare. Insurance, etc. coverage. Payment from secondaries are not considered due until the primary payers have either paid or rejected. Three examples of Medicare patients follow:
Medicare Patient With No Secondary Coverage -- The patient will not receive statements saying you owe until Medicare has either paid or rejected. In other words, after the primary has been resolved, payment trickles down to the next payer, and in this case it would be private pay (the patient).
Medicare Patient With secondary MEDIGAP insurance -- When the Medicare claim is filed, the secondary (crossover) MEDIGAP insurance is also filed to Medicare and along with the Medicare claim. Medicare files the secondary for you, and no more filing is required. The patient will not receive statements saying you owe unless there is a balance after Medicare and MEDIGAP pay/reject.
Medicare Patient With non-MEDIGAP secondary insurance. When the Medicare claim is filed, the secondary will not be filed. After receiving payment/rejection, the secondary insurance is filed (HCFA1500 form) with a copy of the Medicare EOB (Explanation of Benefits). Similar to above, the patient payment responsibility will be after resolution of the secondary payer if there is still a balance due.
(Hospices, Nursing Homes, Hospitals, etc.)
Click here for a sample contract for SNFs under PPS/Consolidated Billing Part A Stay
If a Patient record is on file with status T
(Contract) for a Nursing Home, e.g. then when an invoice is entered for this contract
patient (Nursing Home), the contract invoice data entry screen will be displayed as shown
Screen 10 - CONTRACT Invoice
Invoice data entry for a contract patient generally does not have to go through the rigors of medical necessity justification, and hence requires less data entry. Most likely, the contractor (Jims Nursing Home) called the ambulance.