Correct Mistakes (oops)
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2007/10/15 21:24:28
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- Table of Contents
- 1. Introduction
- 2. Starting oops
- 3. Charge History Screen
- 4. Insurance Status Screen
- 5. Electronic Claim Responses
- 6. Visit Status Screens
- 7. oops in Action
1. Introduction
No matter how skilled your staff is at entering information into Partner, everyone makes mistakes. You need a tool designed to help you correct misposted charges and payments. The oops program is that tool. In addition to deleting charges and payments so they can be reposted, oops can change the insurance company, responsible party, diagnoses, or visit information of any posted charge. You can also resubmit claims and perform many other useful tasks. All of these tools are available in oops while viewing a convenient charge history that helps you better understand an account's charges.
 | The sections below will explain all of the features and tools available in oops. For some real-world examples of using oops to solve common billing problems, skip to the oops in Action section below. |
2. Starting oops
The oops program is a powerful and useful tool, so it is made available from many different screens in Partner. You can also run oops as a stand-alone program from your Partner Windows or a command prompt.
Programs That Link to oops
From the Charge Posting (chuck) program, press [F4 -- Correct Mistakes] after posting a charge.
From the Post Insurance Payments (pip) program, press [F3 -- oops].
From the first page of checkin, press [F8 -- Billing FKey Set] and then press [F2 -- Correct Mistakes].
If you are not already working with an account, oops will ask you to select one:
Remember that you can also find accounts by patient, insurance ID#, or any of several other criteria. For more information, see the Tools for Finding Patients and Accounts manual.
| Run oops For One Patient |
|---|---|
Do you need to run oops for a single patient, instead of seeing all of the patients linked to an account? Run oops -k and find the patient you need. PCC can add this option to your Partner windows if you need it frequently. |
3. Charge History Screen
The main screen in oops shows a history of account transactions. The most recent transactions appear at the top. Charges are grouped by date of service. Claim submission history, billing messages, and payments all appear beneath the charges to which they are linked. Every item has a line number for quick selection.
Press Page Up or Page Down to scroll through the history. You can also use the up and down arrow keys to scroll ten lines or the right and left arrow keys to scroll up or down line-by-line.
3.1. Understanding Charges
As shown in the example above, charges are grouped by date of service. Each charge shows the patient name, procedure name, diagnosis code, provider initial, amount charged, and amount due. Since all items in oops have a number line at the left, you can easily select specific charges with which to work.
Status Indicators: You may see several letters or an asterisk (*) between the date of the charge and the patient's name. These indicate basic insurance status information about the charge:
- A
The letter A indicates that the charge is flagged as an accident. Accident information will appear on the insurance claim. Press [F5 -- Visit Status], enter the number of the charge, and then press Page Down to review or change the accident information.
- P
The letter P indicates that some portion of the charge is currently pending an insurance company. Once the charge has been fully paid off or no longer pends an insurance company, the P will disappear.
- C
The letter C indicates that the charge has a copay charge linked to it. The C appears whether the copay has been paid off yet or not. Copays are not procedures, they generally occur as part of the amount due for an office visit or physical procedure.
- *
An asterisk (*) indicates that the charge currently pends a Medicaid policy.
3.2. Understanding Payments and Adjustments
Payments and adjustments appear in oops with information similar to charges: a description, a date, a provider, and an amount. All linked payments will appear underneath the charges towards which they are applied.
If a single payment is applied to more than one charge, it will be indicated using item numbers:
The numbers listed with the payment indicate which charges the payment pays off. The 6/15/05 payment shown above at number 1 is applied to both the physical copay charge on 5/24/05 as well as the OV Problem Focus copay charge on 4/26/05.
| Unlinked Payments |
|---|---|
If a payment is not applied to any charge, it is called an "open-item" payment or unlinked. Open-item payments appear after charge entries and do not have dates in front of them. Linked payments appear underneath the charges they pay off and have posting dates in front of them. Partner calculates both open-item and linked payments towards an account's final balance, but it will be difficult for you to discover to which charges open-item money is applied. You should use [F7 -- Relink Payment], described below, to link any open payments. You should also link every payment when it is first posted in pam. |
3.3. Reading Billing Messages and Other Items
In addition to charge and payment information, oops displays billing messages and other important data. For example, you will see entries indicating when a claim was sent, when an electronic clearinghouse received a claim, and when a personal bill was generated.
In the example above, the charge was sent by ECS to Proxymed (a claim clearinghouse) and then to USHC on 4/26/05. A USHC insurance payment and adjustment were posted in pip on 5/24/05, and a personal bill (for the unpaid copay amount) was printed on 6/15/05. Note that the USHC check number is also shown.
| E - Toggle Billing History |
|---|---|
With all the different steps a claim passes through, your oops screen can get very cluttered. Press E to hide billing history notes. The oops listing will collapse and show you only charge and payment information. Press E again to reveal the billing information. To increase the number of visible lines in oops, you could also learn about making your Partner window bigger by reading Larger Partner Windows. |
3.4. Functions from the Charge History Screen
From this screen, you can perform (or begin) the following actions:
- [F1 -- Jump to Item] or J
Press F1 and enter an item number or a date. You will be taken to that item/date in the history.
- [F2 -- Print TOS HCFA] or T
Press F2 and enter charge item numbers to print a HCFA form immediately. Seperate item numbers with a space.
- [F3 -- Batch HCFA] or H
Press F3 and enter charge item numbers to prepare charges that you will generate a claim for using the ecs or hcfa program. Batching adds a "tag" that you can later turn into a claim, either paper or electronic.
- [F4 -- Insurance Status] or I
Press F4 and enter charge item numbers to view the Insurance Status screen. On the Insurance Status screen, you can change the responsible party of a charge or modify the copay amount. Whenever you change insurance status, you should batch the updated charges for resubmission or print a new claim. Read the Insurance Status Screen section below for more information.
Press F4 and enter a claim response item number to view portions of the related electronic claim report. Read the Electronic Claim Responses section below for more information.
- [F5 -- Visit Status] or V
Press F5 and enter charge item numbers to view the Visit Status screens. On the Visit Status screens, you can view and change diagnosis and other HCFA specific information related to a charge, such as billing provider, referring provider, authorization numbers, accident dates, etc. Read the Visit Status Screens section below for more information.
- [F6 -- Unlink Payment]
Press F6 and enter the item number of a linked payment to unlink it. You might want to do this when cleaning up an account balance problem.
- [F7 -- Relink Payment]
Press F7 and enter an item number of an unlinked payment that you wish to link up to a particular charge. You will be asked to select unpaid charges to which the payment should be linked. You can then designate how much of the payment should be applied to each of the charges you selected.
For an example of relinking a payment, read the "Problem: The Wrong Procedure Was Posted, Payment Needs Relinking" tutorial below.
- [F8 -- Delete Item(s)] or D
Press F8 and enter item numbers to delete items from the account history. You will be asked to confirm your choices before they are deleted. Once deleted, items can not be retrieved. Partner keeps a log of which user deleted an item and how that action affected the account's balance. You can review this log by running the daysheet or dsscan programs. Contact PCC for more assistance.
| Entering Item Numbers |
|---|---|
When entering items numbers for the operations above, such as batching a claim or changing insurance status, you can either type in each of the numbers separated by spaces or commas, like "1 2 3 4 5 6" or "1,2,3,4,5,6", or you can use a range, such as "1-6". You can also combine these methods: "1,3-5". |
4. Insurance Status Screen
Press [F4 -- Insurance Status] or I and enter charge item numbers to view the Insurance Status Screen. This screen allows you to quickly review or change the pending and copay information on charges.
The Insurance Status screen shows the date, patient name, procedure, diagnosis, provider initial, amount charged, and amount due for each charge you selected. Underneath each charge, you can see the responsible insurance plan and the copay amount. You can change either of these fields, or you can use the function keys to quickly change the responsible party for all of the charges listed.
Press Tab to enter the field you wish to change. In the Insurance field, use an asterisk (*) to see a list of plans on the account and then jump to a list of all plans on your system (if needed).
 | Changing the status of a charge does not update any claim you have already submitted or is already waiting to be submitted. If you need to submit an updated claim with the new information, you must rebatch or print the claim using [F3 -- Batch HCFA] or [F2 -- Print TOS HCFA] on the main screen in oops. |
Functions on the Insurance Status Screen
- [F1 -- Save Changes]
Save all changes made on this screen and return to the main oops screen.
- [F5 -- Make All Insurance]
Turn on the Pending status for all charges shown. If more than one insurance policy is active on the account for the charges' dates of service, a pop-up window will ask you to select which insurance to make responsible for all of the items. You can select from active or inactive policies, or you can select from all of your system's insurance plans.
- [F6 -- Make All Personal]
Turn off the Pending status for all charges shown. Any outstanding amount will become a personal charge.
5. Electronic Claim Responses
When Partner receives an electronic claim response from the insurance payor or the claim clearinghouse, a one-line message is added to oops. Here are two examples:
If the claims were sent through either the Medavant or Proxymed claim clearinghouses, you can review a more detailed response report from within the oops program. Press [F4 -- Insurance Status] and then select any billing response item that begins with "Payor Response" or that indicates a rejection or acceptance.
EXAMPLE 1: In the example below, you can see that the electronic claim clearinghouse (Proxymed) sent several messages to Partner regarding William Amis's visit on 01/06/06.
To read the full electronic report, press [F4 -- Insurance Status] and then select any entry beginning with "Payor Response" or "PROXYMED Accepted Claim":
Partner will open the relevant ECS report and display portions related to this patient that are on that report:
In the above example, the claim was accepted.
EXAMPLE 2: You can also review information about a rejected charge. In the next example, Female Baby Garg's immunization administration charge was rejected by the MVP insurance company:
To find out why the claim was rejected, press [F7 -- Insurance Status], enter the number next to the rejection, and press Enter:
Partner will display the segment of the report related to the patient, and you can read all the information that the insurance company (or claim processor) returned:
Using this feature, you can read your ECS reports (from Medavant or Proxymed) from within the oops program. You can also read ECS reports in your e-mail or through the ecsreports program. Read the ecsreports manual for more information.
6. Visit Status Screens
Use the Visit Status Screens to change diagnoses, billing provider, and other important visit information that appears on an insurance claim. To reach the Visit Status screens, press [F5 -- Visit Status] or V, and enter the numbers next to the charges you wish to modify.
The first Visit Status screen looks like this:
Each of the charges you selected are shown with the date, patient name, procedure name, provider, amount of charge, and amount due. Underneath each charge is a list of all diagnoses currently linked to it, as well as the provider that will appear on the insurance claim. Note that you can assign up to four diagnoses per procedure.
Press the Tab key to enter any field and make changes. Use the asterisk (*) to view a list of possible entries. Press Page Down to view more pages of Visit Information. The last page holds visit specific details that are included on a claim:
Press the Tab key to reach the field you wish to change. Press [F1 -- Save Changes] to save your changes or press [Page Up] to return to the diagnoses and billing provider information.
Information on the Visit Status screens will be transmitted with the insurance claim. For example, the "Prior Authorization Number" generally appears in Box 23 of a HCFA 1500 form.
| Rebatch After Making Changes |
|---|---|
After making changes on any Visit Status screen, you must rebatch the charges in question, even if you have not yet sent the associated insurance claim. Save your visit status changes, and then press [F3 -- Batch HCFA] on the main oops screen. |
Functions on the Visit Status Screens:
- [F1 -- Save Changes]
Save all changes made on this screen and return to the main oops screen.
- [Page Down]
Go down one page. There will be additional pages to display all of the procedures and diagnoses you selected. The final page of the Visit Information screens holds important HCFA information, such as prior authorization numbers, disability dates, accident information, and more.
- [Page Up]
Go up one page.
- [F12]
Return to the main oops screen without saving any changes made to visit status.
| Post It In chuck |
|---|---|
All of the items on the Visit Status Screens can be entered when the charge is first posted in the chuck program. |
7. oops in Action
As you can tell from the sections above, oops is a powerful program that can make a wide range of changes to an account's charges. Below are three examples of common problems that practice billing staffs face and how oops could be used to solve them. You can follow the steps below using a fake account to learn more about how oops works.
7.1. Problem: Charges Were Posted Before Insurance Information Was Updated
A charge was posted before the new insurance card information was entered into the system. The account has a new copay amount with a new carrier. You will need to update the insurance information on the account, repend the procedures to the new insurance company, and then resubmit the claim. Follow the procedure below.
Confirm that the account has been updated with the correct insurance information. The insurance screen for an account can be found in fame, checkin, or by running policy.
Run oops for the account.
Press [F4 -- Insurance Status]
Enter the item numbers of those procedures that were posted to the wrong insurance company.
On the Insurance Status screen, press [F5 -- Make All Insurance].
Pick the new insurance company from the list and press Enter.
If necessary, press Tab and change the listed copay amount.
Press [F1 -- Save Changes].
Back on the main oops screen, press [F4 -- Batch HCFA]. Do this for either a paper or electronic claim, as F4 prepares a claim for either HCFA printing or electronic submission. Read Generate Claims for more information.
Enter the item numbers of the procedures that need to be resubmitted and press Enter.
7.2. Problem: Missing Diagnosis and Hospital Information
A charge was posted with the wrong diagnoses and without the needed hospital dates. The insurance company has rejected the claim, so you will need to fix the diagnoses, add the hospital admission and discharge dates, and then print out the corrected claim.
Run oops for the account.
Press [F5 -- Visit Status]
Enter the item numbers of those procedures that appeared on the rejected claim.
On the Visit Status screen, change the diagnoses for the relevant procedures.
Press Page Down to view the second page of the Visit Status screen.
Add the admission and discharge dates in the hospital visit fields. If necessary, enter a resubmission authorization number as well.
Press [F1 -- Save Changes].
Back on the main oops screen, press [F2 -- Print TOS HCFA] and enter the item numbers of the charges needing to be resubmitted. Alternatively, you could press [F3 -- Batch HCFA] and print the claim later from the hcfa program.
7.3. Problem: The Wrong Procedure Was Posted, Payment Needs Relinking
Several procedures were posted, along with a check for two copays. Later, you discovered that the Office Visit procedure was incorrectly coded. You need to post the correct procedure in chuck, relink the payment to the correct procedures, and then delete the charge with the incorrect code.
Run chuck and post the correct procedure. Be sure and put in the correct date of service. Do not repost the payment.
Run oops for the account. You can do this from the wrap-up screen of chuck by pressing [F4 -- Correct Mistakes].
Press [F7 -- Relink Payment] and enter the item number next to the actual payment (probably labeled "Personal Check" with a date).
Partner will show you a list of all charges on the account that still have balances. Enter numbers, either as a range or separated by commas or spaces, indicating to which of the charges the payment should be linked.
Next, you will see a payment screen, similar to pip or pam, which allows you to designate how much of the payment should be allocated towards each charge. Enter how much of the total payment should be applied to each charge.
If you wish to review details about account history or patient information, press [F2 -- View Account] or [F3 -- View Patient].
When you are happy with how the money is distributed, press [F1 -- Save Payments] to confirm. You will be returned to the main oops screen where you can review your work.
If you are satisfied that the new procedure has the correct code and date and that the payment is linked to the correct charges, press [F8 -- Delete Item(s)], enter the item number of the incorrect code, and press Enter.