Understanding Alerts/Hold Bills

Transcription

1 Understanding Alerts/Hold Bills Overview Introduction Alerts, also known as Hold Bills, are typically identified and worked three to five days prior to a visit. This module discusses how to work alerts. Objectives Upon completion of this lesson, you should: Understand Alerts/Hold Bills. Know what Alerts/Hold Bills you will see. Know who uses Alerts/Hold Bills. Be able to determine if an Alert/Hold Bill is on a visit. Understand what happens if an Alert/Hold Bill is not worked. Prerequisites Prior to beginning this lesson, you should have completed the following classes: Met the prerequisites specified for current module 1

2 What is an Alert/Hold Bill? An Alert/Hold Bill can be triggered at any point in the Patient Financial Services (PFS) process up to eight days after the visit is closed (discharged). Many Alerts/Hold Bills are triggered at the time of scheduling and will stay with the visit until they are cleared. An Alert/Hold Bill is a flag on an AVM visit that indicates some type of action may need to be taken to optimize payment. Alerts/Hold Bills are a critical tool provided through AVM to streamline the pre-arrival process and increase communications between pre-arrival and point of service. Note: In some places, the system will refer to Alert/Hold Bills as flags. 2

3 What Alerts/Hold Bills Will You See? System Generated Alerts: Alerts/Hold Bills are automatically assigned by the system. Examples of Alerts/Hold Bills the School of Medicine is using are as follows: 1. G-Plan assigned to visit 2. Primary insurance eligibility response other than active 3. Secondary insurance eligibility response other than active 4. No plan assigned to the visit 5. No verification date 6. Special billing 7. Plan assigned is not special billing and different than the registration FSC 8. Assigned plan is the same as a terminated registration FSC User Generated Alerts: Alerts/Hold Bills can also be assigned by other users to communicate throughout the Patient Financial Services (PFS) process. Examples of Alerts/Hold Bills the School of Medicine is using are as follows: 1. Notes A (Note from Scheduling staff to Pre-Arrival staff) 2. Notes B (Note for billing staff and other) 3. Notes C (Note from Pre-Arrival staff to Point-of-Service staff) Note: Interface departments will use Alerts/Hold Bills for missing registration information in addition to the Alerts/Hold Bills identified above. 3

4 Why aren t there Alerts/Hold Bills for missing registration information for non-interface departments? Alerts/Hold Bills can be set for each required registration field. The School of Medicine is committed to obtaining complete and accurate registration information from patients. Instead of using Alerts/Hold Bills for missing registration information, emphasis is placed on obtaining the information from the patient using the Patient Registration Form. The Patient Registration Form includes the patient s demographic and insurance information and is given to the patient to review and update at each appointment. Changes are immediately entered into IDX. 4

5 Who Uses Alerts/Hold Bills? Alerts/Hold Bills are checked: During the pre-arrival process to optimize financial payment using the Financial Risk/Pre-arrival Report, Alerts Manager or Appointment Manager. By point of service plan assignors who may be responsible, based on departmental procedures, for checking open Alerts/Hold Bills the day of the appointment, including instructions to point of service staff. By front desk staff, who do not assign plans, to check for a Notes C and other Alerts/Hold Bills. By interface department staff. 5

6 Identifying an Alert/Hold Bill on the Visit? Pre-arrival staff will first identify the visit has an Alert/Hold Bill through the Prearrival Identification of Financial Risk Report (identified in the system as: All/Pre- Arrival Report), Alerts Manager, or Appointment Manager, during pre-arrival work. If there is a flag that an Alert/Hold Bill is on the visit, the user goes to the visit to view the Alert/Hold Bill on the Alerts/HBView screen. Pre-Arrival staff check: The Alerts Manager List to verify if the visit has an Alert/Hold Bill. For practice sites not using Alerts Manager, the scheduling report/arrival list should have a flag that an Alert/Hold Bill is on the visit. Point of service staff check: The Appointment Manager List to check if the visit has an Alert/Hold Bill For practice sites not using Appointment Manager, the scheduling report/arrival list should have a flag that an Alert/Hold Bill is on the visit. In all of the above situations, go into the system to review the Alert/Hold Bill on the Alerts/HBView Screen. The Alerts/HBView Screen is part of the AVM visit information. 6

7 What happens if an Alert/Hold Bill is not worked? Some Alerts/Hold Bills that are not worked may delay the billing process. Example: Not working an Alert/Hold Bill that shows the visit plan (not special billing) is the same as a terminated Registration FSC, and may result in sending the claim to the wrong insurance company. Example: A referral is required for a patient s visit and not obtained at the time of the patient s appointment. This will create a delay in the billing process. Other Alerts/Hold Bills are an indication that there is potential financial risk. Example: A patient is scheduled to see a provider in Cardiology; however this patient has a large outstanding balance. The alert indicates that there is a potential financial risk. 7

8 What is the Alerts/HB View Screen? The Alerts/HBView screen displays all the alerts on a visit. Example: Alerts/HBView Screen 8

9 Column Heading Description Category the alert falls under Example: POS, Eligibility, Referral, Special Billing, etc. Alert Categories Example POS (Point of Service) Notes to the front desk from the pre-arrival staff Insurance cards needs to be scanned Co-payment field is blank FIN (Financial) Patient has a self-pay balance REF (Referral) Referral is needed SB (Special Billing) Visits that have been marked as Special Billing and need to be reviewed Workers Compensation PRE (Pre-Arrival) Visit Plan/Registration FSC mismatch No plan assigned to the visit GPLN (G-Plan) Visit has a G-Plan ELIG (Eligibility) Primary insurance has not been verified REG (Registration) Missing patient address Management Currently not used Column Heading Description Description of the alert / holdbill / flag User who generated the alert If the alert is system generated this field will read SYSTEM Date alert was generated Date the alert was deleted/expired by the user Action code the system recommends to work this alert Example: Alerts/HB View Screen Buttons The first feature of the Alerts/HB View screen is the button. 9

10 Navigation Button Description The button provides access to the screen(s) indicated by the action code listed for the selected alert. Example: Alerts/HB View Screen Navigation Button Description The button refreshes the screen. 10

11 The button provides the following additional features: Action Currently not used. Description Allows you to manually expire an alert that needs no further action. Note: Some alerts need to be manually expired to remove them from the visit. Some Alerts/Hold Bills are cleared by the system when the Alert/Hold Bill has been satisfied. Example: Alerts/HB View Screen 11

12 Action Description Allows you to view the definition of an alert/holdbill and how to clear it from the visit. Example: View Hold Bill/Claim Flag System Definition Screen 12

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14 The field provides you with the ability to perform a multitude of actions by entering the appropriate action code. Action codes were discussed previously in Understand Key AVM Screens. Example: Alerts/HB View Screen 14

15 Viewing Flag Definitions View Flag System Definition is your resource to verify the purpose of an Alert/Hold Bill and how to satisfy the alert. Steps used to view a flag definition: 1. From the Alert/HB View Screen select the appropriate alert, click and select from the drop down list. Example: Alert/HB View Screen 15

16 2. The View Hold Bill/Claim Flag System Definition Screen displays. Example: View Hold Bill/Claim Flag System Definition Screen 16

17 The AVM Alerts (Holdbills) Database is an additional resource available to learn the purpose of an Alert/Hold Bill and how to satisfy the alert. Steps used to access the Alerts Manager Database: 1. Select the Homebase workplace. 2. Select on the Vertical Toolbar (VTB). 3. Select from the navigation bar. 17

18 4. Select from the drop down menu. 5. Select from the list of database resources. 6. Select. 7. The AVM System Generated/POS Alerts Grid displays. Example: AVM Alerts Manager Database 18

19 Lesson Summary In this lesson, you learned: What Alerts/Hold Bills are. What Alerts/Hold Bills you will see. Who uses Alerts/Hold Bills. How to determine if an Alert/Hold Bill is on a visit. What happens if an Alert/Hold Bill is not worked. 19