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.