7. Patient Check-Out
7.1. Introduction: The Checkout Process
Partner's checkout program, also called "chuck," can post charges and check out a patient in seconds. At the end of a patient visit, a medical office must record and bill the services performed by the provider. While this happens, the office may collect and record a payment, schedule a return visit, and sometimes collect other information from the patient or family. In checkout, you can quickly perform all of these tasks while giving care and attention to the customer.
Your Experience May Differ: The checkout program is very customizable. Your practice can rearrange the order of the screens and customize the procedures and diagnoses that appear for different visit reasons. Your office's configuration will be different from the examples shown below.
What's New? Partner Version 9.2007 introduces a new payments screen, a better workflow, the ability to post payments received during checkin, and redesigned screens throughout the checkout program.
7.2. Quickstart: Post Charges
This section will walk you through a basic checkout procedure.
Run Post Charges (checkout)
You can run the checkout program from your Partner windows.
You can also type checkout or chuck at a command prompt.
Select a Patient
Just as the checkin program provides a list of today's appointments, the checkout program displays a list of patients waiting to be checked out:
Use the arrow keys to select a patient and then press [F1 -- Post Charges].
If you do not see the patient you need, press [F2 -- Find Patient] to post charges for any patient on your system, whether they have an appointment scheduled or not. To learn more about the appointment selection screen, read Appointment Lists.
Review Insurance Notes and Copay
As soon as you select or find a patient, checkout will tell you the patient's insurance information, expected copay, and any copay note your practice added for the family:
Press Enter to continue.
Check Demographic Information
Next, review and update patient and family information on the Demographics screen.
Press [F1 -- Next Step] or Page Down to continue.
Check Insurance Information
Next, verify and update patient policies on the Policies screen. Confirming the patient's primary insurance before posting new charges is very important.
To learn more about the Policies screen, read Managing Insurance Policies.
Press [F1 -- Next Step] or Page Down to continue.
Post Procedures and Diagnoses
Next, enter procedures and diagnoses from the visit. You can enter or change the date, provider, location, and visit reason if necessary. The most common procedures and diagnoses for the scheduled visit reason appear for you to select:
Press Tab or Enter to move among the fields. You can use an asterisk (*) to search in any field. Mark each diagnosis with an X. Mark each procedure with the letter of the diagnosis to which it should be linked.
If your practice uses an EHR or EMR, the screen may be filled out for you. Review the entries for accuracy before continuing.
Optional: Perform Other Special Visit Functions. If you need to change the copay, enter a discount, enter hospital dates, or enter special claim information, there are function keys on the Post Charges screen for each of those tasks.
When you are finished entering diagnoses and procedures, press [F1 -- Next Step] or Page Down.
Post Today's Payment
Enter payment information on the Payments screen. You can apply a payment collected during checkin or add new payments.
The Payments screen displays how much is due for today's visit and how much is due from a previous balance. If a payment was collected during checkin, you should review and confirm the amount and make sure it is applied correctly.
Press [F3 -- New TOS Payment] to add a new payment and then enter payment type, check number, and amount.
Review Visit and Post
If you need to review previous steps in checkout, press Page Up or Page Down to move among the screens of the program.
When you are finished entering and reviewing all visit information, press [F1 -- Post and Print] from the Payments screen to save the new charges and payments to the account.
The checkout program will warn you if you made any obvious mistakes, such as entering an invalid diagnosis code or forgetting to enter a payment type. checkout may also ask you whether or not you wish to print a receipt.
Conclude the Visit
After posting the charges, you will see a "Wrap Up" screen describing the visit. The Wrap Up screen allows you to print an extra receipt, correct any mistakes, print patient form letters, or perform other functions:
When you are ready to check out another patient, press [F1 -- Next Visit]. Or, press F12 to quit checkout.
7.3. The Four Steps of Charge Posting
The sections below describe each screen in the checkout process and detail all functions and tools.
As mentioned above, the order of the four steps in checkout can be customized, so you may see the screens differently at your practice. No matter what order the screens are in, you can always press Page Up or Page Down to cycle through each page.
Quitting checkout: You can press F12 to quit checkout at any time. No charges will be saved or billed. The other way to quit checkout is to save and post your charge by pressing [F1 -- Post & Print] from the Payments Screen.
7.3.1. Demographics
The Demographics screen contains basic information about the patient. You can press Enter or Tab to reach a field and make changes. Your changes will be saved when you continue to the next step by pressing Page Down or [F1 -- Next Step].
The function keys match those found in the Patient Checkin (checkin) program. Use them to perform patient and account tasks. For more information, read Patient Checkin.
7.3.2. Policies
The Policies page contains insurance information for the patient. You can add a new policy before posting charges. For information about insurance policies in Partner, read Insurance Policies.
7.3.3. Post Charges
After you select an appointment and complete the other checkout steps, you will see the Post Charges screen. On the Post Charges screen, you can edit the appointment's date, provider, place of service, diagnoses, procedures, and the number of units performed. Partner will fill out some or all of that information for you, either from information in the appointment record or from your practice's EHR. Function keys on the Post Charges screen open special screens for adding additional visit information or scheduling a new appointment.
7.3.3.1. Post Charges Screen Basics
If the appointment was scheduled in Partner, checkout will automatically fill out most of the fields. For example, in the above image, Partner knows that Pebbles Flintstone is seeing Dr. Casey on November first for a Sick Call visit in the main office location.
If the patient has no appointment, or if the basic visit information has changed, you must fill out the Physician, Visit Date, Visit Reason, and Place of Service ("POS") fields in order to post a charge. You can use abbreviations or the asterisk (*) to find entries quickly.
Supervising Physician: You can enter a supervising or "Billing" physician in addition to the primary physician for a visit. If a visit was scheduled with a nurse or an unaccredited physician, the "Billing" physician could replace or accompany the provider of service on the insurance claim. Contact PCC for assistance configuring these options, which can be set differently for each insurance company.
7.3.3.2. Finding Diagnoses and Procedures
Computer screens can not fit all of the hundreds of different diagnoses and procedures a provider may perform. The Post Charges screen in checkout displays a customized list based on the visit reason or other information. Your practice probably has their own custom Post Charges screen for sick procedures and a different one for each physical or "well child" visit. Read the Custom Charge Screens section below to see examples.
If the provider performs a diagnosis or procedure that is not on the screen, you can use abbreviations and asterisks to search for the item in any available blank field.
You can also enter diagnoses or procedure codes and Partner will look up the names for you.
Other Procedure and Diagnosis Features
Change Visit Reason On-the-Fly: You can enter a new visit reason to switch to a more useful list of diagnoses and procedures. If a physical visit turns into a sick visit, for example, you can change the text in the Visit Reason field and the lists of diagnoses and procedures will change to reflect the new visit.
HIPAA Compliant Diagnoses Code Checking: If you enter a diagnoses code that is not HIPAA compliant for the date of service, the code will turn red on your screen and you will receive a warning message when posting it. With Partner's diagnosis code validation, your office will not waste time and resources resubmitting claims due to expired diagnosis codes.
EMR/EHR Integration: If your office uses an Electronic Health Record that has been fully integrated with Partner, you will not have to fill out procedures and diagnoses on this screen. The EMR will send the data to the screen, and you can review it for errors and continue to the Payments step.
Post a Missed Visit: You can use checkout to post a Missed Appointment procedure with or without a fee. Partner can then automatically mark the appointment as missed in your schedule. For assistance configuring a Missed Appointment procedure, contact PCC Support.
7.3.3.3. Linking Procedures to Specific Diagnoses
You should specify which diagnoses apply to each procedure. Enter the letter of each diagnoses into the boxes next to the procedures they warranted. For example, the letter "h" is used to indicate why the Urinalysis procedure was performed:
You can link up to four different diagnoses to each procedure. A high-level sick visit, like a 99214, may need two or more diagnoses attached to it:
 | Skip The Diagnoses |
|---|---|
You can save time while posting by simply marking procedures with the letter next to the diagnoses. In other words, you do not have to manually "X" off each diagnosis, just use the associated letter on a procedure and Partner will know what diagnosis you intend. |
Fixing Diagnoses After Posting: Once a procedure is posted and saved, it is part of a patient's financial and medical record. Diagnoses are more flexible. You can change which diagnoses appear on a claim and how they link to each procedure from the Visit Status screen in the Correct Mistakes (oops) program. After making such changes, you should rebatch the claim.
7.3.3.4. Number of Procedure Units
The Units field indicates how many of each procedure will be billed. If you increase the number of units, you will see the corresponding charge for that procedure automatically increase in the Charge column.
In the above example, three "repeat" nebulizer breathing treatments were performed. When the unit number was changed from 1 to 3, the New Charge increased. Both the number of units and the final price will appear on the insurance claim.
7.3.3.5. F2 - Copay & Discount
After you enter diagnoses and procedures, press [F2 -- Copay & Discount] from the Post Charges screen to open the Copay & Discount screen.
On this screen, you can:
Enter a new expected copay amount for each procedure or erase the current expected copay. This may be necessary for insurance policies that have unusual copay rules.
Assign a different Primary Payor to a charge. You can change the responsible party for a procedure to a different insurance policy. Leave the Primary Payor blank in order to charge the patient's guarantor instead of an insurance plan.
Enter a time-of-service discount for each procedure and change the discount type. Your office may mark down the cost of procedures for Professional Courtesy or other reason. You can enter a discount amount or a percentage.
If you enter a discount on this screen, it will appear on the Payments screen.
When you are finished changing copays or other items on this screen, press [F1 -- Save] to return to the Post Charges screen and finish posting the visit.
Automate The Copay: Many unusual copay rules can be automated. If an insurance plan requires a different copay depending on the OV or physical procedure, Partner can adjust the copay automatically. Contact PCC Software Support to learn more.
7.3.3.6. F4 - Hospital Details
After you enter diagnoses and procedures, press [F4 -- Hospital Details] to enter service dates for a procedure, hospital administration dates, or to change the provider or price for a specific procedure.
The Hospital Details screen shows the selected procedures along with fields for a provider initial, service dates, units, and the new charge. At the bottom, you can enter Admit and Discharge dates for the visit.
The "Prov" field on the left side of the screen will override the visit's provider for the specific procedure.
The contents of the Service Dates fields will appear on the insurance claim. Changing the service dates may automatically increase the Units field.
The hospital Admit and Discharge fields will appear on the insurance claim.
When you are finished changing procedure dates or other items on this screen, press [F1 -- Save] to return to the Post Charges screen and finish posting the visit.
7.3.3.7. F5 - Claim Info
Press [F5 -- Claim Info] from the Post Charges screen to open the Claim Information screen.
The fields on this screen contain additional information that may be required for insurance claim submission. If the visit needs a prior authorization number or accident information, for example, it can be entered on this screen.
Your office may choose to enter or update claim information later, after a visit has been posted. All of the fields on this screen are also available on the Visit Status screen in the Correct Mistakes (oops) program.
The function keys on this screen jump to specific fields, speeding up data entry. If your office regularly needs to jump to a specific field, you can select that field and press [F8 -- Set Jump Point]. The checkout program will remember the field location and jump directly to it on subsequent visits to the Claim Information screen.
7.3.4. Payments
The fourth and final step of the checkout program is the Payments screen. The Payments screen displays the previous personal balance and the new personal charges. You can review any personal payments received before checkout, add a new payment, and confirm the New Personal Balance.
7.3.4.1. Today's Visit and Previous Balance
The top of the screen displays the personal amount due for "Today's Visit." If the patient has insurance coverage, this will typically include only the copay. If the patient's guarantor has an outstanding personal charge or credit, it will appear under the "Previous Balance" header.
7.3.4.2. Today's Payments
The "Apply Today's Payments" section displays all of the visit's personal payments, discounts, and adjustments. If a payment was collected during checkin or a discount was entered on the Copays & Discount screen, it will appear on this list.
If the patient or family has not yet paid, the list will be empty:
Press [F3 -- New TOS Payment] to add a new blank line and enter type, check number, and amount.
Pay Old Balance: Note that you can allocate any amount of your payment to today's visit, to the previous balance, or leave your payment unapplied and unlinked. If you post additional money against an old balance, the new payment will be linked directly to the old charges.
7.3.4.3. Applying Old Credits to Today's Charges
If the account has a credit, the credit will appear beside the "Previous Personal Balance" label and will appear as a "Credit on Account" payment in the Apply Today's Payments section.
When you press [F1 -- Post and Print], Partner will automatically apply the old credit to today's charges, as shown above. A payment received in the past will be linked to today's charges.
If you do not wish to apply the old credit to today's charges, press the End key to erase the "Apply to Today's Visit" field. The full amount of the credit will shift to the "Unapplied" collumn. You can then enter a new payment by pressing [F3 -- New TOS Payment] or allow the charge to remain unpaid.
Partner Totals Credits and Charges: Although you can leave credit amounts in the unapplied collumn, Partner will include any credits in its calculation of an account's final personal balance (on reports, for example).
7.4. Custom Charge Screens
The Post Charges screen is customizable. Computer screens are too small to hold the hundreds of different procedures and diagnoses that you may perform, so checkout brings up a list based on the visit reason. For example, if a patient was scheduled for a sick visit, Otitis Media and other common sick diagnoses will appear.
Here is a sample "Baby Well" charge screen from a PCC practice:
This screen has plenty of blank spaces for strange diagnoses and procedures that occur during a visit, but also includes the standard physical visit codes and the immunizations and immunization administration fees. Some offices design a different Well Child screen for every age physical.
Automatic By Age: Partner can place the correct physical procedure for the child's age on the charge screen automatically. Partner users should not need to hunt for the correct age-specific physical procedure code.
Here is a practice's custom "Asthma Recheck" charge screen:
Custom Length, More Screen Space: The examples above show room for 16 diagnoses and 16 procedures. If you make your Partner window larger, checkout can show up to 23 of each. You can learn about making your window larger by reading the Larger Partner Windows article or by contacting PCC Support.
7.5. The Wrap-Up Screen
When you press [F1 -- Post and Print] from the Payments screen, checkout saves the information you have entered, may print a receipt or ask if you want one printed, and shows you a wrap-up screen. Once you see the Wrap Up screen, the visit has been posted and saved.
The wrap-up screen displays several simple-English messages: the new personal and insurance balances, and insurance and claim submission information.
You can perform a number of useful functions on the Wrap-Up screen.
Function Keys from the Wrap-Up Screen
- [F1 -- Next Patient]
Press F1 to return to the appointment list and pick a new patient.
- [F2 -- Correct Mistakes]
Press F2 to run oops, the Correct Mistakes program. In oops you can delete charges and payments, change the responsible party for charges, change diagnosis information for procedures, and perform many other functions. Read Correct Mistakes (oops) to learn more.
- [F3 -- Reprint TOS Bill]
Press F3 to generate an additional receipt. Some practices do not print receipts by default, in which case press F3 to print the first receipt.
Last Chance. The receipt is a formal record of the transaction and the payment. Once the Wrap-Up screen has been cleared, there is no way to regenerate a receipt. You can instead generate an account history for a single day (tater), a Collection report, or a personal bill.
- [F4 -- Print TOS HCFA]
Press F4 to print a HCFA form for the charges you just posted. Your practice may generate a HCFA for patients who have an insurance plan with which you do not participate.
- [F5 -- Post Reg Payments]
Press F5 to run pam, the Post Regular Payments program. Read the pam manual to learn more.
- [F6 -- Patient Forms]
Press F6 to jump to the patient form-letter page. To learn more about generating patient form letters, read Working With Patients and Accounts.
- [F7 -- Account Forms]
Press [F7] to jump to the account form-letter page.
- [F8 -- Pediatric Advisor]
Press [F8] to run the Pediatric Advisor program. Pediatric Advisor is a library of handouts on various medical issues. Your office may not have the Pediatric Advisor program installed.