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1. 72 Payme S reves ncatrnnadnctedetians 71 PEDT HO oea ener eee 80 WTITG OTS siaiuts occt ieee 78 79 Client Accounts cccccceeeeeees 91 a E EEE AE EE 50 Creating INVOICES ceeeeees 98 INV OCI oeei biases 6 96 sales representative 89 CPT Enee Pane IS anona 35 CEPT TUIC oori a R 5 20 Create Client Invoices 97 Edit AC COUR ads sesctihe Sad iepeniouieec ee 97 Ed Clans eeaeee 6 Edit INVOICE aineena 97 electronic DIN S ecsnacianicssessim FONDA raaa O i 57 INIGG1C al Ces ichsncead ioeseecenee 50 118 Electronic Billing 00 116 Electronic Claims cc 00ccceee DCU Ds ae EEE R 116 USE raa 117 HCF he 00 eoe 6 SE er E 49 50 ICD 29 COGS uisisaiaruertinicdemecse 60 apportioning to procedures 75 MSANGE aee eed nceee elie 46 adding POlICVi2 aacesyuite ta ceceas 73 HD VOC CG ia tat naa etait sara eteats AUC TAINO ictus AE ES 105 denera No eare 97 1 8 01 ee ere Maer 108 PAVINCMUS satsereeovteneeaniceree 103 PNN 5 eenei 99 reassigning patient claims 107 rebundling or repricing 106 TV OIE Saa a tenes WIC WI Ope r A 100 Laboratory Options 05 11 aT D E E E EEE 12 MediCal billing ee 124 Medical DUNS 3222552 2scteadesaccue hese client s provider ID 53 doctor s provider ID 55 Medicare DUD nerne doctor s UPIN erensia 55 CIE CIONIC airan AE 6 ent
2. 40 To define a new non lab procedure select the New procedure button SchuyLab displays the Add Procedure box E Add Procedure Lode Description VENT VENT PUNCTURE Charge Bill Code POS Note Code 5 00 Basas lo List fo discounts allowed Add Handling charge schedule Charge Expect Bill Code POS Add anew Schedule X Cancel In the Code entry field type the code you wish to assign to that specific procedure In the Description entry field type in the name of the procedure as you wish it to appear on the bill or invoice In the Charge field type your base price for the procedure Finally in the Bill Code entry field type the procedure code CPT code or your in house equivalent To implement differential pricing for the procedure select the Add a new Schedule button SchuyLab displays the Add Schedule box 1 Add Schedule Eg schedule Charge Expected CLIENT l 0 00 0 00 Bill Code POS Note Code mm a X Cancel Wvo From the Schedule pull down list field select one of the previously defined schedules In the Charge field type the price that you wish that procedure to be billed at for that particular schedule This specific price will override the general 41 percentage that you may have set under Schedule NOTE Entering a negative number in the Charge field will cause the Billing Module to not charge for this procedure on this schedule It won t even show up on the in
3. To add procedure codes and prices to panels From the Define Billing screen select Panels SchuyLab displays the Panel to Procedure Translation box E Panel to Procedure Translation Description Procedure ACUTE AP ACUTE HEP PANEL 80074 ANEMIA ANEMIA PANEL ARTH ARTHRITIS PANEL 80072 BASICMET BASIC METABOLIC s00d46 LBC 65025 LOAGULAT ION COMP METABOLIC 80055 COMP THYROID PAL CYTOLOGY MANUAL DIFF w Code C Name The Panel to Procedure lists all the panels currently defined on your SchuyLab system including their procedure codes if any You can tell at a glance which panels can be billed Some of the procedure codes have an asterisk in front these mark the panels that follow the CPT Rule and thus can be billed to Medicare and similar agencies More on that in a minute 32 To define or update the prices and codes on a panel select that panel from the list SchuyLab displays the Add Update Procedure box It looks remarkably like the one for tests doesn t it E Update Procedure Lode Description CBC CEC Charge Bill Code POS o Note Code 0 00 gfo List No discounts allowed eal Add Handling charge schedule Charge Expect Bill Code POS Add anew Schedule X Cancel Delete W OK As with the individual tests enter the charge procedure code amp c in the appropriate fields Because this is a panel you have a bit of leeway with the Bill Code field If this is not a
4. In the Amount field enter the amount of the payment that was received In the Check field enter the check number You can annotate this entry using the Note and Note Codes fields The Batch field is a reference number that allows you to print a report on how much money was received on a given day We recommend you leave the Batch field blank When that happens SchuyLab will automatically fill it with a Batch ID number based on today s date The Invoice field allows you to associate the payment with the invoice the payment applies to When done select OK If the payment is for less than the full amount of the claim SchuyLab displays a box showing you the amount remaining on this claim and asking you if you wish to write it off Amount remaining 34 70 Amountto write off 39 FU X ow P The full remaining amount is displayed in the Amount to Write Off field by default To change this click on the field then type in the amount you wish to write off and then select Yes If you don t want to write off any amount at this time you can either enter 0 00 or select No If the Amount to Write Off is less than the Amount Remaining or if you selected No SchuyLab displays a box asking if you want to bill the amount remaining to the next payor on that patient s Bill Type in this case the patient Bill remaining 27 70 to INSURE 78 Select Yes SchuyLab returns to the Edit Claim screen showing the pa
5. Pririt f Features Fe Tools Print Monthly Sales repart Each of these reports 1s accessed by its appropriate icon 86 Monthly Sales The Monthly Sales function prints a sales report for a given date range for any given client or for all clients To access the function select the Monthly Sales icon SchuyLab displays the Sales Report box E Sales Report Report Date Range GUELE Client Mame setup A Cancel ew OK In the Report Date Range fields enter the beginning and ending dates for the report In the Client Name field type the name of the client you want on the report if you leave this field blank the report will be for all your clients You can change which queue it will print to with the queue pull down menu or change the default report settings using the Setup button When all the fields are ready select OK SchuyLab prints the Monthly Sales report Each client s section of the report will look something like this CLAIMS CHARGES PAYMENTS ADJUSTMENTS WRITE OFFS Client 1 INSURE 13 19 355 00 19 180 00 0 00 MEDICARE 45 64 1212 95 65 635 00 0 00 MEDICAID 12 17 288 00 16 301 78 0 00 TOTAL 70 1855 95 1116 78 0 00 At the end of the report will be a summary for all the clients in the report Bear in mind that the dollar amounts charges payments write offs amp c are those entered during the Report Date Range They do not necessarily apply to the same claims Thus in the abo
6. Rebill 124 previously billed claims box This tells SchuyLab to look for claims whose status is Billed instead of Ready You can put in a bill date and time for a previous transmission at this point to specify a specific set of claims to rebill 7 Select Export SchuyLab writes all of the MediCal claims within that range to the diskette Setting up your modem software for Medicaid Before you can send files over the phone lines you ll need to set up your modem software with such trifling details as Medicaid s phone number baud rate amp c The exact commands necessary to set up your modem software will of course depend on which software your lab has purchased There are many different modem software packages commercially available HyperTerminal is a program that comes with all recent Windows installations and we will be using the Windows XP Pro version of it for our example Setup for other programs will require similar information but may use different commands DISCLAIMER HyperTerminal is not a product of Schuyler House Schuyler House does not program maintain train or support HyperTerminal Please refer to your HyperTerminal or Windows documentation for any questions regarding these products We have included these instructions here as examples and for your convenience only For HyperTerminal 1 Go to the computer station with the modem If you aren t sure which computer that is check the back of the co
7. See the section on Transactions below for printable billing notes that apply to a single line item This option lets you jump to another claim number you want to view without having to go one by one through the claims in sequence Accesses the previous claim matching the search criteria if any Next Accesses the next claim matching the search criteria if any Charge Payment Write Off These functions will be discussed in the section on Transactions below Price Select this button to reprice the line items on this claim If there have been any changes in prices e g altering the fee schedule changing the patient s Bill Type whatever they ll be recalculated and a new value displayed in the Total field If a new bundling has been set up on this claim after it was generated SchuyLab will also rebundle the tests The claim status must be Open or Ready for the Price button to work Results Selecting this button allows you to view the results of the lab tests actually run on the patient Use this button to insure that all of the tests performed are being billed as procedures E SchuyLab View Results C Je Fo Patient Test G olla ID 00000565 Or Test P Doctor 16 73 433 Fatient sample Doctors Inc 10 27 7004 DOB 2 05 1950 54 Other ID fi B Accn 04 010635 10 01 2004 9 55 Fa Cancel Fil Done ccession Value Units Normal Range W Motes ae SL 10 3 uL 8L 10 6 uL g Devi
8. Now enter the complete number range for the claims you wish to print in the Claim Number Range fields and select a Payor Uncheck Test Billing Now that it is aligned and you are printing actual forms If you are re generating HCF 1500 forms for claims which are already set to status Billed click the check mark on the Rebill previously billed box Select Generate SchuyLab prints out all the status Ready claims of the selected bill type Payor between that pair of numbers inclusive If you select the Rebill previously billed option all of the Billed status claims of the selected bill type are printed Printing Non HCFA Claims While most claims printing for US labs can be handled with the HCFA 1500 form if you need to fill out other claims forms whether for specific insurers or for processing by non US insurers SchuyLab can handle that as well In the Setup chapter you ve seen how to create reports to print paper claims and how to link them to the insurance they will be used with Here we will show you how to generate those claims once they have been setup If you setup a report or reports of type Claim in the reports section and associated insurance companies with that report you can print claims for those companies 114 Select F7 Features Select Billing Select Paper Claims This takes you to the Print Paper Claims window E Print Paper Claims To produce claims on paper sel
9. PATIENT PATIENT Select one of the entries in the scroll box or select New to create a new entry 14 SchuyLab displays the Add Update Schedule box E Add Schedule Lode Description M CPT Rules hoo 3 E Do Not Combine Frocedure Description Charge Expect Bill Code POS Add new Procedures Discounts x Cancel y OF In the Code field enter the name up to eight characters of the schedule you wish to create In the Description field type in a longer non abbreviated description of the schedule for instance the client for whom it s intended If this schedule represents a flat percentage of your base standard fees enter that percentage in the Pct field For instance if you enter 80 in the Pct field the schedule will charge at 80 of your base price It s not just for discounts If you enter 120 the schedule will charge at 120 of your base price If you intend for this fee schedule to follow the CPT pricing rules for use with Medicare Medicaid and other carriers check the CPT Rules box at the upper right If this box is left unchecked claims on this fee schedule will bill as ordered Often two different tests will have the same procedure code Such tests will normally be combined into a single line of the claim If you don t want this to be done for claims on this fee schedule check the Do Not Combine box at the upper right For instance Chlamydia DNA Probe
10. The body of the report will contain the following Accession Number The specimen number that this claim is for In this case we are using the YYMMDDn format You may be using the same or a different format Patient s Name Lists the patient s name We have blacked out the names here and any other proprietary information Svc Date The service date is the date the work was done or at least entered into SchuyLab 144 Proc Billed Modifier Primary Code Adjustments Deduct Co Pay Paid Remarks Procedure or CPT code s for the test s run How much you billed for There are five basic modifiers to explain what is or is not being paid CO Contractual obligation PR Patient Responsibility PI Payor Instigated Reduction CR correction OA Other Adjustment The modifier is followed by a code that explains why the modifier was used There are too many codes to list here You can get a list of the codes from Medicare Medical How much you are NOT being paid This is the patients deductible amount This is the patient s co pay amount How much you did get paid NOT FOUND This means that SchuyLab couldn t locate the claim or the procedure code and service date weren t matched WRONG this claim may have been re posted d claim is already there It may have already been posted or entered manually 145 The last thing to look at is the summary section T BCBS
11. not the Medicare Medicaid or Insurance ID fields When all the requirements are set select OK When the fields in the Add Bill Type box are complete select OK again Defining Codes and Prices for Procedures Pricing Rules When a claim is brought over from the lab side of SchuyLab to the billing side any test or panel without a procedure code will be ignored But that leaves the procedures that are brought over how are they billed As individual tests As panels If the claim includes say a Sodium test is it billed as a separate Sodium test or as part of an Electrolytes panel or as part of a Comprehensive Metabolic panel Or all of the above As mentioned earlier in the section on Panels exactly how a procedure is billed 19 depends on three things how it s defined how it was ordered and the kind of schedule to which it s being charged Most bill types will use a standard schedule in those cases if you order an Electrolytes panel the Billing Module charges for an Electrolytes panel if you only order a Sodium test it charges for a Sodium test amp c But if the schedule is intended for Medicare and agencies that follow Medicare s protocols such as Medicaid SchuyLab starts to build panels for you If you were to order Sodium Potassium Chloride and CO2 as separate tests for such a schedule the Billing Module would automatically combine the four tests into an Electrolytes panel and ch
12. p8284289 031720 EDIT STATUS ERROR SUMMARY REPORTS 101304 ANSI 997 report 101304 p8284287 026024 EDIT STATUS O O Oo a a AN E a N e M ee ee ee ee ee eet S Se S Select an item number N ext page or P rev page H The one you are looking for will be listed as an 835 file and normally you will be looking for the most recent one If you do not find it on the initial list you will need to go through the available emails by using the N and P commands until you find it When you find it type in the corresponding number for that email in this case it s 4 ERROR SUMMARY REPORTS 101904 ANSI 997 report 101904 p8284293 038235 EDIT STATUS ANSI 839 report 101604 ERROR SUMMARY REPORTS 101504 ANSI 99 report 1015904 p8284289 031720 EDIT STATUS ERROR SUMMARY REPORTS 101304 ANSI 99 report 101304 p8284287 026024 EDIT STATUS BO Oo a A OE a NO e M eee ee ee ee S tee S te rt mn Select an item number N ext page or P rev page 4 Transmission Protocol Menu X modem Y modem 2 modem Kermit Exit Enter Selection H 134 You will now be given a choice of download protocols Schuyler House recommends using number 3 Zmodem When you type the 3 in and then hit enter when prompted you should begin downloading the file to your default directory You should write down the filename that appears at this time so you can type it in when processing the remittance The file will be named MA
13. Alabama Remittance 40510163 8710704 84443 S44 C4 45 Claim Totals 54 45 40804125 e 8 04 04 87088 scien PR 27 16 50 Claim Totals 16 50 Ed i d m T b HAHA 260 Claims 20735 15 13420 10 4135 90 497 24 6401 51 coe e ge ye ye bali we teh UENEN iPosting Statistics Test only no actual posting Litt a ar Notes Adjust Paymerts 1365 855 7373 05 4195 95 0 00 0 00 0 00 Unable to post 797 14 4800 20 2205 96 Totals 2162 55 12173 25 6401 51 LE ttt tt 1 111 ee Tt in i A i anit in ini se A i ir aril in mil i inl Bassas Sass as aiai tls U ee res As you can see with this remittance we are being paid for 260 claims we had billed for 20 738 15 The billing had adjustments for a total of 13 420 010 which we write off or bill the patient there is 418 90 that is the patient deductibles 487 24 that is the patient co pay and the total that Medicare is paying for which is 6401 91 Now let s post Select F7 Features Select Billing Select Electronic Remittance Select the remit icon for your lab Put in your path and queue or leave the queue path to the default printer and select OK Do not mark the box for test posting 146 There you ve posted But now let s check it If you look at the last page of your posting you will see that it not longer says Test only no actual posting Other than this the report is what you vie
14. Billing Module menu screen select Open Claims SchuyLab displays the Print Open Claims box E Print Open Claims Sequence and by S Claim Patient Claim Number Range GUELE pf PRINTER Client Name Leave blank tor ALL Setup Lance S X Cancel A o Enter the first and last claim numbers 1 e specimen numbers of the range to be included in the report and select the print queue to use You can also click on Setup to assign the default print queue and font for all of your reports You can also choose how you want your claims to be grouped together In the Sequence drop down box you can choose to group claims by Client or by Bill Type or leave blank to not group claims in any special manner You can also choose to order your claims by Claim or by Patient name by clicking the appropriate selection When you are done select OK SchuyLab prints the report 83 Claim Aging The Claim Aging icon will print the claims for a given client separated by aging category 30 days aged 60 days 90 days or 120 days Note that a claim must be at least 30 days old before it will appear on this report The client s name the patient s bill type CASH MEDICARE amp c and the aging category can all be specified To print the Claim Aging report From the Billing Module menu screen select Claim Aging SchuyLab displays the Print Claim Aging box E Print Claim Aging LIueue Sequence BILLING Bi
15. HCFA 1500 Edit Account add fees Use Patient forms payments discounts Claims to or amp c as necessary generate patient invoice Use Electronic Create Client Invoices Billing Once Billing is done e Leave SchuyLab and run the Billdata program to generate the billing statistics e Back in SchuyLab print the Monthly Sales and other reports as desired Chapter 1 2Billing Setup Introduction Before any bills can be generated the schedules prices codes and bundling rules need to be defined This is done through the Billing Setup screen in the Billing Module The Billing setup procedure 1s as follows Set Laboratory Options Define Schedules Set Bill Types Define codes and prices for procedures Define panels and rules Set up Insurance Clients and Doctors If you intend to use them set up Electronic Billing and ICD 9 codes Sh ae eee 10 S amp S To access the Billing Setup functions From the Billing Module menu screen select Setup SchuyLab displays the Define Billing menu screen E SchuyLab Define Billing j Patient Ale Accession ok Devices ls Worksheet Insurance Define Testto Procedure link Setting the Laboratory Options Laboratory Options This icon is used to set your lab s name and address so that it can be printed on forms transmitted with claims and so forth ae Procedures Clients aR ERICSTOK MSTR 15 27 dag 1 11 2
16. Mail Menu Send Remove Search for Text Page down Page up Download mail to PC Quit il Box for 000025080 SUBMITTER unread 54 total 1465219 ave Date Time Size Subje Sender 0ct19 04 22 23 21574 ERROR SUMMARY ee Editor File 0ct19704 320 ANSI 99 report Editor 0ct19704 l 403 p8284293 R EDIT Editor Fi 0ct16704 230080 ANSI 835 rep Editor File Oct15 64 l 20502 ERROR SUMMARY REPORTS Editor Fil 0ct15704 320 ANSI 99 report Editor Fi 0ct15704 403 p8284289 031720 EDIT Editor Fi 0ct13704 19162 ERROR SUMMARY UEIS Editor Fi 0ct13704 320 ANSI 99 report Editor Fi 0ct13704 403 p8284287 she EDIT Editor Fi 0ct13704 l 400 ANSI 99 repor Editor Fi 0ct12704 403 p8284286 903062 EDIT Editor Fi a b C d e f g h i J k l Enter Selection H 133 At this menu you will type in 6 to Download Mail to your PC You will then get a numbered list of possible mails to download Oct15 04 15 53 403 p8284289 031720 EDIT Editor File Oct13 04 21 55 19162 ERROR SUMMARY REPORTS Editor File 1 0ct13 04 21 11 320 ANSI 997 report Editor File 0ct13 04 16 25 403 p8284287 et EDIT Editor File 0ct13704 61 21 400 ANSI 99 repor Editor File Octl12 04 16 59 403 p8284286 323262 EDIT Editor File Enter Selection 6 File list ERROR SUMMARY REPORTS 101904 ANSI 99 report 101904 p8284293 038235 EDIT STATUS ANSI 835 report 101604 ERROR SUMMARY REPORTS 101504 ANSI 99 report 101504
17. Panelis Sequence Delete Cancel JRK Once the panels are correctly defined we can add the prices and procedure codes to them for billing purposes As with tests any panel that does not have a procedure code CPT code HCPCS code or your in house equivalent will be ignored by the Billing Module In some cases that may be exactly what you want For example you may want to define a special panel for a doctor to make it easier to order tests a CBC UA TSH Hepatitis screen and Rubella But you may want to bill the doctor for each individual component of the panel the CBC UA TSH amp c instead of for the special panel If the panel is given no procedure code SchuyLab s Billing Module will ignore it however it will bill for all the components of the panel if they have procedure codes As with tests there are two ways that prices and codes can be added to the panels 31 One way is through SchuyLab s Panel Definition function via F8 Tools Set Up Test amp Panel Definition and thence to Panel Definition The procedure is described quite completely in the full SchuyLab User s Manual and need not be repeated here However the prices and codes for the panels can also be defined through Billing Setup This allows you to keep the billing department s tasks separate from the lab tech s tasks You can even through Billing Setup update the codes and prices that were entered through Test Definition
18. Rep Transactions icon SchuyLab displays the Sales Rep Audit Report E Sales Rep Audit Report Report Date Range LIUeue Po ftutina y oalesrep Leave blank far ALL 1 Summary Only Report setup A Cancel wf OK In the Report Date Range fields enter the beginning and ending dates for the report In the Client Name field type the name of the client you want on the report if you leave this field blank the report will be for all your clients If you click off the Summary Only Report checkbox you will only print the summary information If needed you can change the print queue using the Queue pulldown menu When all the fields are ready select OK SchuyLab prints the Sales Audit by Sales Rep report It will separate out by sales representative all the charges payments adjustments and write offs for each claim line by line with totals at the bottom of the page Each sales rep s numbers are on a separate page so you can hand one rep his report without him seeing any other sales rep s take Then at the bottom of the report it will print the summary by bill type for all sales reps Client Accounts The Client Accounts function prints a report of the current status of each of your invoiced clients This only applies to Client Invoicing and not to any other type of claim it won t for instance list the HCFA 1500 claims from a given client For that you should use the Claim Aging report To access the fu
19. a set of procedures tests and or panels that have been done on a single patient specimen The claim is assigned a claim number we currently define it to be the specimen ID number for that specimen The tests ordered on that specimen may each have prices set for them this can be done on the lab side of the system at the same time as the tests ranges and values are defined or it can be done through the Billing Module Setup screen Either way if a procedure code has been assigned to a test it becomes a billing procedure If no procedure code has been assigned to a test the Billing Module ignores it such tests are transparent and do not appear on the claim Panels are likewise defined as procedures and prices set for them This can be done on the lab side by the same function where the panels constituent tests are defined or it can be done through the Billing Module Setup screen As with tests if no procedure code is assigned to a panel the Billing Module ignores it as a panel however the individual items in the panel if they have procedure codes are sent to the billing side to be included in the claim If the panel is assigned a procedure code then in normal use when the panel is ordered it s included in the claim The panel can also be set to be a CPT panel which means that it obeys the bundling rules followed by Medicare for that panel in that case the panel is included in the claim if all the t
20. and GC DNA Probe share the same code 87797 If both are ordered on a patient the claim will normally read DNA Probe x2 If you don t want that done if you want both probes separately listed on the claim make sure the Do Not Combine check box is checked Special prices for individual procedures may be added to this schedule directly by using the Add new Procedures button but that must wait until we ve defined all the procedures We ll come back to it trust me 15 If you click on the Discounts Button you can set volume discounts into your schedule Clicking on it brings up the following box E Volume Discounts Volume Discount 2s E Add Discount Volume i Discount si 7 joo X Cancel Here we can set a volume and a discount to automatically apply when an invoiced amount exceeds this figure You can setup multiple discount levels of course which will show up on the Volume Discounts page like so E Volume Discounts Volume Discount gt 1000 _00 J000 00 5000 00 10000 00 X Cancel Press OK when you are finished entering in discounts and return to the Add Schedule screen When all the fields on the Add Schedule screen are complete select OK SchuyLab returns to the Billing Schedules box Select New to define the next fee schedule 16 NOTE If you plan to bill to Medicare or to an agency that bills in a Medicare fashion following the CPT panel defini
21. and RA Factor just as defined in the CPT manual You must have these four items at least in your Arthritis panel or else it may not be billed to Medicare as a panel although the components could be billed Conversely while you can have more than those four minimum items in your Arthritis panel you d be foolish to do so Many labs offer an Arthritis Profile that includes a CBC Calcium Urinalysis and other items If you define your Arthritis panel that way you re just giving the additional components to Medicare 30 gratis because they won t pay for them as part of Arthritis 2 Is the panel constructed from smaller panels whenever possible SchuyLab s Billing Module assumes that larger panels when possible should use smaller panels as their components not the individual tests For instance the Basic Metabolic panel CPT 80048 consists of eight chemistry tests BUN Creatinine Calcium Glucose Sodium Potassium Chloride and CO2 The last four are also the Electrolytes panel CPT 80051 In SchuyLab then we should define the Basic Metabolic panel as the Electrolytes panel plus three tests not as seven tests See the illustration below as an example E Update Panel BASICMET BAST CMET BASIC METABOLIC Full Description Tests Procedure GLUCOSE GLUCOSE 80048 BUN Amount CREATININE 34 00 34 00 CALC TUM FLECTROLYTES w LPT Facility LAB Hefer Billing Add Testis Add
22. be Start gt All Programs gt Accessories gt Communications gt HyperTerminal You can use the HyperTerminal folder to see your selection of possible connections Select the Icon you setup in the previous section 3 Select OK and then Select Dial to call up the BBS 120 4 Once you ve connected to the Medicare BBS system you ll see a screen that looks like this Authorized users only please Submitter ID 5 Type in your nine digit submitter number and Enter 6 You ll be prompted for your password Type in your password and Enter 7 The Medicare BBS will now show you the Main Menu CABBS MAIN MENU Electronic Mail Menu News Publications Menu Claims Submission Menu Inquiry Claims CABBS User Reference File Library E Eligibility it 1 2 3 4 2 6 E Enter Selection Type 3 and Enter ER 121 8 You will get the Claims Submission Menu Claims Submissions Henu 1 2 3 A 3 E Enter Selection Set up CABBS to Receive Claims Quick Receive using Defaults Set Receive mode to Test Set Receive mode to Production View transmission log Exit Type 1 and Enter 9 You re given a list of protocol options Transmission Protocol Henu 1 K modem 2 Y modem 3 Z modem Kermit 9 Blast E Exit Enter Selection Type 3 and hit enter 122 10 The Medicare BBS will give you the following choices Transmission Di
23. button 7 Your computer modem should already be set up for your laboratory but it might need some final entries The most common will be if your phone system requires you to dial 9 for an outside line If that s the case select the Dialing Properties button In the field labeled To access an outside line first dial type 9 Select OK to return to the Connect box 8 Select Dial If everything has been set up right HyperTerminal should begin dialing the Medicare BBS phone line Select Cancel before it can complete it 9 From the menu bar select File gt Exit The Medicare BBS phone number is now set up in HyperTerminal First Transmission to the Medicare BBS Before using Electronic Claims with Medicare you will need to enroll in your region s Medicare BBS system They should give you a submitter ID and password or the equivalent for their system Once your Medicare BBS account is ready to be used you should transmit a small set of claims just to be sure that everything is set up correctly 1 Have ready a diskette with a file of valid Medicare claims between ten and twenty of them Be sure you know the file s name as defined in SchuyLab s Export ANSI Claims to Medicare box Refer to the above section To Prepare the Medicare File 2 Go to the terminal with the modem Log out of SchuyLab and into your modem software HyperTerminal From Windows XP go to the Start Menu The path should
24. for entering the code denoting Place Of Service When SchuyLab prints a bill on the HCFA 1500 form it automatically uses the POS code that means done in house Only those procedures done elsewhere say in the patient s home require the POS field to be filled This is moot for your lab tests but may be useful when defining procedures that aren t tests phlebotomies for instance The Note icon and the Result Code field allow you to annotate this procedure for your own records They don t print out on invoices The Note icon is a free text format the Result Code is a pre recorded comment Result Codes are defined as part of your system setup see the User s Manual Section VI for a full description The check box labeled No discounts allowed will prevent this procedure from being reduced in price Many fee schedules for instance are simply defined to be a percentage of the base price If this box is checked it cannot be charged as a percentage but always at the full base price Sendout tests for instance may need to have this box checked The check box labeled Add Handling charge is not functional at this time When you ve entered the billing code price and all other options select OK SchuyLab returns to the Test to Procedure Translation box Select the next test you wish to edit When done select Done SchuyLab returns to the Define Billing menu screen Schedules and procedures Eventua
25. for the insurance you want to modify 140 E Update Electronic Remittance Lode Description Format MCREASCA So Lal Medicare ANSI Telephone Password Setup Delete XR Cancel ok At this point you can put in the telephone number you use to call up the BBS or the password you use to log into it but these are only for your own reference SchuyLab doesn t do anything with these values except keep them for you It would be a bad idea to click on Delete here as that would remove the interface from your system and require Schuyler House to reinstall it for you to use it again Instead let us click on Setup to bring up the Remittance configuration window E Configure ANSI Remittance for MCRE4SCA Transmission id Favors Organization 31146 NHIC SOUTHERN CALIFORNIA Import Pathname C S695 MED T CARE X Cancel Ta Ok When you have successfully submitted a claim for electronic billing you have already given them all the information about who your lab is so the only configuration option you need here is to tell SchuyLab where to find your remittance files normally So just enter in the pathname as shown and then repeat this process for any other Remittance accounts you may have The pathname will automatically be put in by SchuyLab when you process your remittance and you will only need to enter in the filename And this should be all the setup you need to start processing remittances Processing t
26. if you wish In the Code field enter the CPT code for the procedure being added In the Amount field enter the charge for the procedure in this above example 42 00 In the Description field enter a brief description of the new charge 1 e PSA If you re entering multiple procedures on this single line type the number in the Qty field In the Diagnosis fields enter the numbers 1 through 8 of the ICD 9 codes that apply to this charge If all the claim s ICD 9 codes apply leave these fields blank they ll be filled in automatically The Authorization field is optional if a prior authorization number is required for a specific charge you can put it in here When done select OK SchuyLab returns you to Edit Claims with the new line appearing as a Chg Billed When a claim is billed electronically or on paper SchuyLab creates a Bld entry on the claim noting that this has occurred Billed transaction records can be altered manually To take a concrete example to our previous claim for Mr Drinkwater we ve added a charge for PSA We then print the claim on a HCFA 1500 form When we 76 return to the Edit Claim screen we see both those actions listed a Chg for the PSA and a Bld for the bill sent to Medicare and the Status of the claim has been automatically set to Billed E SchuyLab Edit Claim Drinkwater Mortemer K ERIC ID 000000000s Or Smith Robert ie ae Northwest M
27. patients to bill where you can check them on or off Clicking on Setup brings up the Setup Patient Invoicing window E Setup Patient Invoicing E Days before rebilling Faid accounts may be billed immediately for new services Do not print Zero Balance invoices Detault Motes E Current Mote E 30 Days Past Due jee bU Days Past Oue mA 40 Days Past Due M Cancel m 120 Days Past Due y Ok Placing a number in the days before rebilling box will set the minimum amount of time between a patient getting billed and being eligible to be billed again So if you send out patient invoices every Friday but set the days before rebilling to 14 then even though you are creating invoices once a week an individual patient will still have 2 weeks to pay you before they are invoiced again If you check off Paid accounts may be billed immediately for new services you allow exactly that If that is not checked off SchuyLab will wait the number of days specified in the number of days before rebilling box before sending out a new invoice If you check off do not print zero balance invoices invoices won t be printed if their balance is 111 zero What a surprise The notes area allows you to customize the notes that will be printed with the invoices for past due and current accounts These will only apply to patient invoices there are a separate set of notes for client invoices Accessible from the Create Client Invo
28. print the Batch Payments report From the Billing Module menu screen select Batch Payments SchuyLab displays the Print Batch box E Print Batch Queue BILLING Batch ID X Cancel ef OK Enter the Batch ID number for the day you wish to report By default the Batch ID number is set by SchuyLab It takes the form of a six digit number the year then the month then the day For example to see the Batch Payments report for June 27 1998 enter 980627 as the Batch ID number When a Batch ID number has been entered choose a print queue from the pull down menu and select OK SchuyLab prints the Batch Payments report a Billing Analysis The functions in Billing Analysis are more useful from a managerial viewpoint They re similar in nature which is why they ve been grouped onto their own screen The six functions Monthly Sales 12 Month Revenue Sales by Rep Client Accounts Transaction Audit and Sales Rep Transactions track the actual revenue flow according to date client and sales representative 85 To access the Billing Analysis screen From the Billing main menu screen select Billing Analysis SchuyLab displays the Billing Analysis screen E SchuyLab Billing Analysis Fe MST LAB 15 40 65 AE FES Cancel Accession _ pa Q ap r Monthhy 12 Month Transaction cales Rep Sales Revenue Audit Transactions Dewices Client Patient Worksheet Accounts Accounts Sls
29. rebill 81 3 Move the pointer to the place on the line right after the date as illustrated below E SchuyLab Edit Claim Drinkwater Moremer K MESTR LE Northwest Medical group 101 9142006 DOB 5 03 1952 54 Other ID 5591 434604 Fa Cancel Claim Bill Type Payor Status Ww Paper Employment 309005 MEDICARE INSURE1 READY m Accident Diagnosis ICO 9 Hormebound 333 33 111 1 444 44 904 9 Charged Paid Adjusted Balance 904 9 250 600 111 List 139 70 100 00 12 00 27 70 Date Typ Code Description TTA E 3 16 Chq 85024 CEC 70 1235 Charge d4 16fchg 80061 LIPID STUDIES 00 _ 3 16 thg 80053 COMP METABOLIC 00 Payment Us Fb 3 16 Chg 64155 PSA 00 9 14 Bld MEDICARE HCF1500 paper 70 Write Off 9 14 Fmt MEDICARE Payment 00 9 14 W0 MEDICARE Wri teott 00 Necessity Price Patient Accession Claim Results 44 Prev gt gt ext 4 Click the mouse button and an asterisk appears at the indicated position This means that the selected line item has been paid and will not be rebilled 5 Repeat the above steps for all the line items that are not to be rebilled 6 Now you can rebill the claim either electronically or on paper You can set the claim status from Billed back to Ready or you can go straight to the HCF1500 icon and use the Rebill Previously Billed check box Either way when you rebill only those items without an asterisk will be rebilled Pr
30. sends files that your grab from their mail menu with names in the form of MAIL where represents a number from their mail system While this may be useful for them it isn t much help to you if you want to go back later and find out what 835 file you are dealing with Other insurance providers will even send their files to you under the same name every time which will overwrite any previous file that you have sitting in that folder In any case it is rare that they will send it with exactly the name that you want which is why we recommend changing your file names immediately after you receive a file How do you do this There are many ways once again but we will try to provide a simple one First we need to go to the folder where the file was downloaded Often when we train remittance Schuyler House will put a shortcut on your desktop to take you right to the folder you want but even if this isn t a case the process is simple 1 Go to the machine that will be downloading your 835 files 2 Click on the Start button in the lower right hand corner of your screen 3 From the provided menu choose My Computer 4 On the window that pops up in the area labeled hard drives double click on the C drive 5 Double click on the folder named 835 The 835 folder will be displayed 6 Find the name of the provider you just got the 835 file from and double click on their folder You should now see a listing of all the files in that fol
31. that particular panel If you intend to implement differential pricing for these panels select the Add a new Schedule button SchuyLab displays the Add Schedule box 1 Add Schedule Eg schedule Charge Expected MEDICARE 2 0 00 Bill Code POS Note Code m a X Cancel ox From the pull down list box labeled Schedule select one of the schedules defined in the system In the Charge field type the price that you wish that procedure to be billed at for that particular schedule This specific price will override the default 38 flat percentage that you set when defining the schedule NOTE It is very important that you prevent these multi channel chemistry panels from being charged to Medicare To do this select the Medicare schedule In the Charge field instead of entering a price enter negative two 2 as shown in the illustration above This tells SchuyLab that this panel is NA Not Applicable It won t charge Medicare for this procedure it won t show up on the invoice 1t won t even be built for this claim Medicare claims will now ignore this panel and will be charged for the individual components instead When done select OK SchuyLab returns to the Add Update Procedure box Notice that the Medicare schedule now says NA as it should E Add Procedure Lode Description 80007 7 tests Charge Bill Code POS Note Code 0 00 gfo Ls No discounts allowed Add Handli
32. the account level of processing 5 Edit Invoice The title here is a misnomer This is intended as a view only screen do all of your processing of client accounts on either the account level or the claim level Nonetheless to view an invoice select this icon and input the invoice number CE _ Print Invoices Use this icon to reprint a range of invoices It s also used to define the printer queue on which invoices are printed Generating Invoices As with any other Billing function the first step is to bring the claims from the lab side to the billing side of SchuyLab This is done using the Bill Accessions icon as described in Section III of the Billing Manual Once that s done you can edit any claims that need your attention via Edit Claims or since PHYSICN bill types are usually defined to automatically set claims to Ready you can generate your invoices immediately 97 Note that once a claim is put on an invoice its status changes from Ready to Closed This guarantees it won t show up on the next invoice for that Client To Generate and Print an Invoice 1 Select the Create Client Invoices icon SchuyLab displays the Select Clients to Bill box listing all the Clients currently defined in your system E Select Clients to Bill Bill thru Statement Date 1 31 2005 M Skip Inactive Clients Due Date TSM Clinic Baltimore ac WHO Office of Dr Feelgood Labor Family Practice
33. the payors from the list to update its information These accounts are added to this list when you purchase Electronic Claims processing or Electronic Remittance modules from us Note that these are categorized as Claim or Remit 56 depending on which features have been installed and licensed If you click on a claim SchuyLab displays the Update Electronic Claims box E Update Electronic Claims Description Format So Lal Medicare d010 ANSI Telephone Password 213 593 5943 Setup Delete x Cancel Ta OF In the Code field type the code name up to eight characters for the site to which you re transmitting When setup is done you ll have an icon that looks like a little terminal with the code name underneath Type a more complete description of the site in the Description field In the Telephone field type in the phone number of the site to which you re transmitting If they require you to have a password before you can transmit billing data type your password in the Password field SchuyLab does not transmit these They are for your records and can be omitted if you wish The Format field displays the electronic format in which the billing data must be written ANSI is the standard for both Medicare and Medicaid now The format must still be configured for your lab Select the Setup button SchuyLab displays the Configure format for code name box E Configure ANSI for MEDICARE Interchange
34. to generate in the United States is the HCFA 1500 Printing HCFA 1500 Forms Any claim in the SchuyLab Billing Module can be printed on a HCFA 1500 form regardless of its default method of printing or transmission E Generate HCF1500 Claims To generate HCF1500 Paper claims select payors to bill and press Enter Fayors Claim Number Range Insure Medicaid 7 Medicare Test Billing Rebill previously billed BTU Lance LS z Xc iv Gk To print a HCFA 1500 form 1 2 3 4 5 Load your HCFA 1500 forms into the billing printer That is to say a printer set on the billing queue If you re not sure whether a printer is set to the billing queue sign onto the station controlling that printer go to F8 Tools and select Printer Setup It will give the current queue for that station s printer if it s not Billing set it to Billing and select OK Select the HCF 1500 icon SchuyLab displays the Generate HCF1500 Claims box Set a single number in the Claim Number Range entry fields i e 1001 1001 Point and click on one of the entries in the Payors list box Check the box labeled Test Billing and select the Generate button SchuyLab will print out that one HCF 1500 form without setting that claim to Billed Now go over to the printer and check your paper for alignment 113 6 7 8 Continue this process until the HCF 1500 forms are properly aligned
35. to make sure that the Connect Using drop down menu is set to your modem if your modem is in a computer that came with your SchuyLab system it is probably a MultiTech modem Otherwise if you don t know which device is your modem on the dropdown menu contact your IT person or whoever provided your computer to get that information When this is done click OK to continue Connect To ae SoCal Medicare Enter details for the phone number that you want to dial Country region United States 1 v Area code 213 Phone number 593 5943 Connect using MultiTech System s MTSB34ZPx P C o Cra You will now be at the Connection window At this point if your modem location settings are properly setup you can just click OK to dial your connection immediately When HyperTerminal asks you if you want to save this connection click yes 130 Connect st SoCal Medicare Phone number 1 213 593 5943 Your location My Location v Dialing Properties Calling card None Direct Dial If you have problems connecting at this point it may be that your settings are not setup properly In that case you should click on Dialing Properties and then on Edit to adjust your local settings to conform to your phone system If you need to dial 9 before getti
36. top panel of the Drinkwater Mortemer K ERIC ID QOOO000005 Or Smith Robert Northwest Medical group 101 DOB 5 03 1952 54 Other lD 5591434604 Claim Bill Type MSTA LAB 17 37 65 393 1472006 Fa Cancel Fld Done Payor Status Paper Employment 409005 MEDICARE MEDICARE l READY pa Accident Dlagnosis ICD 9 Homebound 333 33 111 1 ddd 904 9 Charged Paid Adjusted Balance List 97 70 0 00 o oo 97 70 Date Typ Code 3 16 Chg 85024 32 16 chg 80061 2 16 Chg 80053 Description CEC 11 70 Charge LIPID STUDIES 54 00 COMP METABOLIC a2 00 FEayment Write Ott Necessity Price Patient Accession Claim Results 44 Prev gt gt Nex There are a number of fields scroll boxes check boxes and buttons to help you edit this claim as needed In order they are Claim the field Bill Type This field shows the Claim number being displayed this is synonymous with the accession specimen ID number The Claim number cannot be changed through this field Displays the Bill Type assigned to this patient when entered in the SchuyLab system There must always be an entry in the Bill Type field or else the claim can t be billed If there s no Bill Type it can be added through the Demographics button as described below 67 68 Payor Status Employment Accident Homebound Displays the current payor Medicar
37. we can give you a sneak preview so to speak and describe a bit of how they work 80 Before a claim can be billed for its first time its status must be Ready Both the Electronic Billing and HCF1500 icons will ignore the claims whose status isn t Ready Once a claim has been billed by either method SchuyLab changes its status from Ready to Billed At that point if you want to rebill it you must do one of two things Change the status from Billed back to Ready through Edit Claims OR Check the Rebill Previously Billed box through the HCF1500 shown below or Electronic Billing icons When this box is checked these icons look for Billed claims instead of Ready claims E Generate HCF1500 Claims To generate HCFIS00 Paper daims select payors to bill and press Enter Favors Claim Number Range Insure Medicaid a Medicare Test Billing W Rebill previously billed Setup XK cance ok To Rebill Part of a Claim You may need to rebill only one or two line items on a particular claim say if Medicare disallowed that test based on the ICD 9 code and the doctor has since provided you with a new ICD 9 code to cover it In that case you can freeze some of the lines of the claim so that they aren t available for rebilling The other lines can then be edited as necessary and rebilled To do this 1 Select Edit Claims and go to that claim 2 Choose the first line item you don t want to appear on the
38. will write off some or all of an individual charge You will note on the side bar that the option to write off is grayed out from the edit claims screen when we have remittance results 149 What we do is double click on the charge we want to write off and click on the write off button on the edit charge screen SchuyLab Edit Claim CS F2 lt Add Writeoff Date Code Patient 614 2007 P9604 7 Description Fld Done Uri teoff a Cancel ploy 509 Reference Mote Codes X Cance Accident gk Dlagno E wm 10 o List y OK omebound evices sue dusted Balance Os ff 1 na 25 27 0 00 0 00 25 27 ccession Claim Lode Description 60185 DILANTIN 80185 80185 ANSIMFFL PR 31 36415 VENIPUNCT GOOo1 l Charge a e po 36415 9 ANSIMRFL PR 31 i Print P9604 TRAVEL P9604 Payment ksheet P9604 ANSIMEFL PR 31 MEDICARE MCRE_FL Electron _erte of MEDICARE MCRE_FL Electron Necessity Price Patient Accession Claim Results 44Prev gt gt Nex Features Fe Toals Now there are lots of choices that can be made at this point in time Here we have changed the code from Medicare to P9604 to better reflect that it is a writeoff for that charge specifically we have made sure that the amount matches the amount in our note field and a Note Code has been put in Potentially we might want to put the PR 31 reason code in either the Reference or the Descripti
39. write to the C drive hard drive which is faster but requires the billing person who wishes to have backups of their old submissions to copy them to new file names Also note that some payors will require that the file have a specific name so you should check with them before setting this up Whichever method you choose you should keep track of where you are saving the file as you will want to know this when it comes time to submit your claim Click Ok to return to the Update Electronic Claims box and OK again to return to the Update Electronic Payors box The process for setting up a remittance is much the same as for a claim You click on the remit account on the Update Electronic Payors box And you get the Update Electronic Remittance box Update Electronic Remittance Lode Description Format MCREASCA So Lal Medicare ANSI Telephone Password setup Delete X Cancel MOK 58 You have all the same categories as the Update Electronic Claims box but there is a difference if you click on the Setup button You get the Configure format Remittance for Code box E Configure ANSI Remittance for MCRE4SCA Transmission id Favors Organization 31146 NHIC SOUTHERN CALIFORNIA Import Pathname C S695 MED T CARE X Cancel Ta Ok The only changeable field is the Import Pathname field This is where you can tell SchuyLab where to look for 835 files when processing Remittances This will normall
40. 005 Fa Cancel Fl Done Hult Channel Schedules Ba Electronic Laboratory Billing Options From the Define Billing screen select Laboratory Options 11 SchuyLab displays the Laboratory Billing Options box Laboratory Billing Options Laboratory Name Tax ID Schuyler House Clinical Lab 12 3456789 Address CLIA ID ki Titus Street 1203456789 Medicare ID City St_ Zip 0500926703 Panorama City CA 91402 Medicaid ID Telephone Printed Form Electronic Bill Tests and Panels Bill Patients wia Vrhen Ordered C Claims C When all Complete Accounts O P 800 706 0266 HCF 1500 NA l Blue Cross Shield EE MFI Billing Address XM Cancel In the Laboratory Name field enter your name as you wish it to appear on billing reports and electronic transmissions Under Address City St and Zip enter your lab s mailing address again as it should appear on reports and transmissions Your telephone number should be entered in the Telephone field In the Printed Form pull down field select the paper form your lab will use by default Right now your only defined form is the HCFA 1500 form so select that form from the list In the Electronic pull down field select the type of electronic billing your lab will use by default If no electronic billing formats have been defined yet the field will say N A Not Applicable Leave it that way for now In the Tax ID entry field en
41. 35 Setting up download folders The exact process for creating new folders on your hard drive will vary slightly depending on what operating system you are using but will be fairly analogous for most systems that SchuyLab will run on The majority of our current customers use Windows XP Professional so we will use that OS for our example In XP you can accomplish this task in many ways here is one of them 1 Go to the machine that will be downloading your 835 files 2 Click on the Start button in the lower right hand corner of your screen 3 From the provided menu choose My Computer 4 On the window that pops up in the area labeled hard drives double click on the C drive 5 On the side bar on the left side of the window under File and Folder Tasks choose Make a New Folder this will pop up a new folder in the folder listings to the right with New Folder highlighted in blue 6 Type in 835 and press the Enter Key 7 Double Click on this new folder to bring it up 8 Depending on your needs you may want to have process remittances from Medicare Medicaid and or various Insurance Clearinghouses For each one you wish to add follow step 5 above and then step 6 replacing 835 with the name of the processor ie Medicare For the moment let us assume that you have made one folder in step 8 and named it Medicare We have now created the folder where our 835 files will get downloaded Next we want to adjust HyperTerminal
42. Bill Type Account Smi th Rober t PHYSICN l ooooo00005 Client Nor thuest Medical group Insurance Employer Medicare Medicaid Diagnosis ICD 9 359480455 5591434606 904 J 250 600 411 List Notes added to this screen will print out on the patient report not the claim Do not enter printable billing notes on this screen The most important things in Patient Demographics as far as billing 1s concerned are probably the Name and Address Other ID Medicare and Medicaid numbers the Diagnosis ICD 9 Codes the Bill Type the Doctor and Client names and the Insurance Most of those are self explanatory and in any case are discussed more thoroughly in the SchuyLab User s Manual Insurance requires a bit more explanation so follow along 72 Insurance The Insurance button on the Patient Demographics screen lets you enter policy information on the patient Selecting that button causes SchuyLab to display the Add Insurance Policy 1 screen E Add Insurance Policy 1 Relationship Insured ID SELF l Insurance Compans rs i ee a ia Group Policy Number Other EmployerSchool Po Cancel Insurance Flan or Program _ Cancel OO O Most labs will only have to use four possible Relationships Self the default Spouse Child and Other If the Relationship field is set to Self SchuyLab automatically defaults to the name and address on the Patient Demographics screen If any other choice in th
43. Billing no status change box This tells SchuyLab to not change the claims status from Ready to Billed as they re exported 6 SchuyLab will normally look only for Medicare claims whose status is set to Ready If you wish to retransmit previously billed claims check the Rebill previously billed claims box This tells SchuyLab to look for claims whose status 1s Billed instead of Ready You can put in a bill date and time for a 118 previous transmission at this point to specify a specific set of claims to rebill 7 Select Export SchuyLab writes all of the Medicare claims within that range to the diskette Setting up your modem software for Medicare Before you can send files over the phone lines you ll need to set up your modem software with such trifling details as Medicare s phone number baud rate amp c The exact commands necessary to set up your modem software will of course depend on which software your lab has purchased There are many different modem software packages commercially available HyperTerminal is a program that comes with all recent Windows installations and we will be using the Windows XP Pro version of it for our example Setup for other programs will require similar information but may use different commands DISCLAIMER HyperTerminal is not a product of Schuyler House Schuyler House does not program maintain train or support HyperTerminal Please refer to your HyperTerminal or Windows
44. Bud s Medical Center Mandate Clinic Sample Medical Grop Client n setup Cancel Bill All 2 Inthe Bill thru entry field type the end date of the time period covered by the invoices This is usually the end of a month but can be any other time period you Select 3 To generate invoices for all your clients select the Bill All button Otherwise 4 To generate invoices for only certain of your clients select them from the list They ll be highlighted in dark grey and the Bill All button will now say Bill Selected Push it 5 SchuyLab will begin printing the invoices To Reprint an Invoice 98 1 Select Print Invoices SchuyLab displays the Print Invoices box E Print Invoices Queue BILLING Invoice Range First Last 0 0 Setup Ronei F_OK 2 Inthe Invoice Range fields enter the range of invoices to be printed e g 316 318 If you only want to print a single invoice enter its number as both the start and end of the range e g 316 316 3 Use the Queue dropdown box to select which print queue to send the invoices to 4 To find out which printing options are defined for invoices select the Setup button SchuyLab displays the Configure Invoices box E Configure Invoices Llueue Font default default l Print aging atthe end Alphabetic by patent name Combine claims into a single term X Cancel Choose the appropriate Queue and Font from their
45. F10 Done Accession Claim Bill Type Payor Status Paper Employment De 50307586 MEDICARE MEDICARE READY je Accident Dlagnosis ICD 9 Homebound evices 345 41 Charged Faid Adjusted Balance Oe List 25 27 0 00 0 00 25 27 Typ Code Description 00185 DILANTIN 80165 keheet 60185 ANSIMRFL PR 31 els 36415 VENIPUNCT GOOO1 _ Charge Ye rb 36415 ANSIMRFL PR 31 i Pant P9604 TRAVEL P9604 _Payment P3604 ANSIMRFL PR 31 z MEDICARE MCRE_FL Electron _ White Off z MEDICARE MCRE_FL Electron Necessity Features Price si Patient ACCESSION Claim Results Prev gt gt Next Revievwiaccept results from online devices Toals You will generally want to do one of two things with the remittance notes The first would be to rebill the charge to another payor This is done as normal by setting the status to Ready freezing those charges that you don t want to rebill and making sure the payor drop down is set to the one you wish to bill and then billing The second thing you might want to do is to write off that charge Not every charge that is denied is worth the effort of re billing it or has a quick fix You may find that write offs are a little different now that you are doing electronic remittance This is because with remittance we match the adjustments with the individual charges and instead of writing off some or all of an entire claim you
46. Fayor s Organization Submitter id Receiver id MHIC SOUTHERN CALIFORNIA Submitter ID 31146 Mame of Contact Group Eric Submitter id Receiver id Contact Phone Version 818 555 1112 401 0 Export Pathname Transaction e eE A T A MEDICARE a X cancel o The Payor s Organization field and Receiver ID fields are already entered for you as you can see Depending on which organization you are sending to some or all of the 3 different Receiver IDs will be listed When you purchase the ability to submit claims electronically to an organization these are part of the installation 57 In the Submitter ID field type in the ID number assigned to your lab by the payor You will normally have one Submitter ID for each Receiver ID In the Name of Contact field type in the name of your lab s contact person in other words when the payor needs to discuss a bill from your lab who takes the call And the phone number to call them at is the Contact Phone on the next line You must also specify the Export Pathname this will be the drive directory and filename of the billing file that SchuyLab creates The sample given has a file called MEDICARE being created in the A drive which is normally the floppy disk drive Since it will use the same filename in the same place each time many labs like to write their billing files to floppies so they can change it each time and can keep a copy of their old claim files Others prefer to
47. IL where is a unique number assigned by the Medicare BBS Receiving MAIL 594 Storing as C Documents and Settings eric stokien Files 1 Last event Recenving Retries l Status Receiving File PERRRREOOE EBK of 225K 4 Elapsed 00 00 18 Remaining 00 00 42 Throughput 3ra cps When the download is finished you can exit the program and disconnect Setting up Remittance Now our section on retrieving the 835 files works fine for what it is a description of processes for one carrier California Medicare But even so we can see a couple of problems with it The first problem is that it is sending the files to a folder with a rather long pathname that has nothing to do with billing or 835 files or the like The second is that the filename that we are getting Mail 594 doesn t tell us much about this remittance or even that it is a remittance file and as it happens this is the same format that California Medicare uses if you download 997 files or anything else from their server Now the issue of the pathname is an important one for organizational purposes and if the pathname is too long it can make it difficult to actually process the 835 file Schuylerhouse therefore suggests that for best practices you create a special directory for storing your remittance files and that you setup HyperTerminal or whatever your communications program is so that it will download files directly to that folder 1
48. In the entry field labeled Code enter the code up to eight characters long for the bill type you wish to create MEDICAL MEDICARE PHYSICN CASH amp c For certain bill types notably MediCal you can enter your lab s ID number in the Id entry field It doesn t show up anywhere this is just for your records In the entry field labeled Name enter a more complete description of this billing type for your own records The Fee Schedule field is optional Leaving this field unchanged will assign the new bill type to your system s standard base price schedule If you wish to assign a specific pricing schedule to this bill type select that schedule from the pull down list The Fee Schedule field determines how all patients of this bill type will be charged with exceptions If the payor on a claim is Client or Insurance and the Fee Schedule field on the bill type is left blank then the prices charged to the claim are determined by the schedules assigned to the client record or insurance group The five check boxes labeled Payors for this Billtype determine the payors for claims of this Bill Type Select the payors appropriate for these claims More than one payor may be selected for instance when you bill to Medicare and receive a partial payment you may want to bill the remainder to the patient s insurance In that case select both Medicare and Insurance as payors for the Medicare Bill Type When bi
49. PFOCCQUIES scsiei cedencuerstaicdeads 3 39 DrOCE UUTE Sareen oat ead differential pricing 23 38 41 new PLOCeUIES cceccee eee 40 TCD OLS arnar naeo atenceueseenceadess 82 Sales DY R Pirprensisresn ini aan 7 Sales Rep Transactione 91 SCHEdUlES einen ea 13 adding procedures 25 attaching to Bill Type 18 attaching to client 52 M SUTA OE a NE 48 SUS AEE E AAE A AT 20 VIEW rESUl Sararen 71 Transaction Audit 00000000annn 90 ANS ACTIONS sess tass cee ee 75 Watina per Od sisipin 6 WIE OT Seii adding to account 104
50. R AMA EMPLOYER PLAN Medicaid state unknown Import Print New Carrer m From here you can print a list of all your current insurance carriers by selecting Print But we assume you want to create an entry for a new carrier Select one of the entries in the scroll box to update that insurance carrier OR Select New Carrier to create a new entry 47 SchuyLab displays the Add Update Insurance Carrier box E Add Insurance Carrier ID FIM GRP Other ID eee Hame Fee Schedule standard Address Printed Form HCF1500 Electronic E City ot Zip NWA a Contract In Care of heey os Plan Mare Modifier Flace Service Telephone Write Off Line 24k 0 00 wi Type Service Ron Enter the insurance company s pertinent information in this box Most of the fields are self explanatory For billing purposes the most important fields are ID SchuyLab will automatically assign an ID number to each new insurance company You can override this if you wish NOTE however that since Medicare and MediCal are treated as insurance for billing purposes they need to have specific ID numbers More on that below PIN Enter your lab s identification number with this insurance carrier On the HCFA 1500 form this will be printed in space 33 right under your lab s name Fee Pull down the scroll list and select the schedule to be Schedule assigned to this insurance carri
51. SIC METABOLIC BLOOD CULTURE BUN CALE TU Add new Procedures Discounts x Cancel OK 11 Select OK SchuyLab returns to the Billing Schedules list box 12 Repeat the process for the next schedule When all the schedules have their prices defined select OK SchuyLab returns to the Define Billing menu screen 2 Defining Panels and Rules a Panels Some confusion arises as a result of the use of the word panel by both the lab and the billing department When the lab says panel they mean a set of tests grouped together for convenience in ordering When the billing department says panel they mean a set of procedures which must be billed together Very often the two meanings are the same after all when you order all the tests that make up a Urinalysis panel you expect to bill for a Urinalysis panel However there are two situations in which the lab s meaning of panel doesn t match the billing department s meaning of panel When you ve defined a panel for a customer to make it easier for him to order tests but will charge him by each constituent in the panel say you ve made BUR COMP to be a comprehensive panel for Dr Burton but intend to bill him separately for the CBC Comp Metabolic amp c that went into the panel or When you re billing Medicare or an agency following Medicare pricing rules such as Medicaid and have to charge for a panel as defi
52. Table of Contents 10verview 3 W Hats SchuyLap BUNE heeren cal oaita E OEN 3 Biter He Bline Module asmane a eit 4 Bine TYDES cas A E O AE 6 Recommended Heck MSi erriniaieni i E 9 Chapter 1 2Billing Setup 10 INTO UG Oe a a cha da aati ies sa emaeaiaa 10 Setting the Laboratory Options cccceseeessceeeeeccceeeeeeeeeeaeeeeeeeeeeeeeas 11 Detimine BUM Schedule anneer a E 13 Setn BU TYPES oianean a a E eocesesenies 17 Defining Codes and Prices for Procedures cccccecccccesseseeeeeeeeeeeeaees 19 Schedules and Droced rES naiseni a a nue 23 Defining Panels and Riles ricini E IE 28 Setting up Custom Paper Claims ccccccccscssseseeeceseeeeceeeaeeeeeeas 44 Setting up Insurance Clients and Doctors cccssssseeeeeeeneeeeeens 46 Setting up Electronic Billing and Remittance eeeeeeeeeeeeeeeees 56 Seina Up TCDD COCs a cseccusptecasenairceseeies er anata aes eee 59 Chapter 2 3Claims 62 CPCI CLANS inise e eA T R T 62 Editia Clans aaa aE O TO 63 TP TanSACiOns cian excision a a ee eee 75 Reb illite atti San E A 80 Printing REDONS easar r E Samos sents oaso E 82 Troubleshooting Cains aseensa ern n a a E A RS 94 Chapter 3 4Client Billing 96 Overview of Chen BUNIO orein fa a ieaivesneaiierateeainaeeaede 96 Generatine VOICE Sania h tends E E N 97 Account WIAIMLCTI ATIC E essien 101 Chapter 4 5Patient Invoicing 108 Glim Based Tivol M nesiem a E a 108 Account Based VOLCI npn a EN 110 Chapter 5 6Paper Billing 113 P
53. The invoice also displays any past due amounts from previous invoices and any new payments made to that Client s account Each invoice has a unique invoice number automatically assigned to it by SchuyLab An account is the record kept for each Client showing all the financial activity invoices billed payments received adjustments made The account number for a Client is the same as his client ID number but must be preceded by a number sign Payments and adjustments made to an account are entered through the Edit Account icon not through the Edit Invoice icon Bill types are the key to Client Invoicing When defining bill types you have a choice of payors to be billed through that bill type Medicare Medicaid Insurance Patient and Client Review Section II Billing Setup for more information Any bill type with Client chosen as a payor is available for Client Invoicing For bill types with multiple payors you must wait until the payor has rolled over to Client before using Client Invoicing some bill types have only Client as a payor and are intended solely for Client Invoicing these are often given names like PHYSICN or DOCTOR Obviously in order to be billed to a Client a patient s claim must specify the Client s name either as part of the patient entry process on the lab side of the system or through the Patient Demographics function of the Edit Claims icon on the billing
54. UTE HP ANEMIA ARTH BASICMET LBC LOAD COMP MET COMP THY CYTO DIFF ACUTE HEP PANEL ANEMIA PANEL ARTHRITIS PANEL BASIC METABOLIC LBC LOAGULAT TON COMP METABOLIC COMP THYROID PAL CYTOLOGY MANWAL DIFF sotby Code Name Frint 29 Select the panel you wish to examine SchuyLab displays the Update Panel Panel Name box showing the individual components of the panel and the billing code and price if any E Update Panel ARTH Code Mame ART ARTHRITIS PANEL Full Description Tests Procedure URIC_ACD URIC ACID 80072 TOTAL PROTEIN paren PHOSPHORUS wo CALCIUM a ALK PHOSPHATASE W CPT ALBUMIN Facility GLOBULIN A G RATIO RA SED RATE __ Been ANTI NUCLEAR AG T Billing Add Testis Add Panelis Sequence Delete Cancel JRK Unless you the biller are authorized to make changes in the lab side of the SchuyLab system you should leave the panels components alone On the other hand as the lab s biller you ll need to have some say in how the panels are defined particularly if the panels are to be billed to Medicare or a Medicare style agency like Medicaid There are two important points of each panel s definition that concern Billing r 1 If the panel is to be billed to Medicare is the panel defined as Medicare defines it In the above example we have an Arthritis panel CPT 80072 with four components Uric Acid Sedimentation Rate Antibody Screen
55. VITIS IMPACTED CERUMEN OTITIS MEDIA LABYRINTAITIS 01 PRESBRYCUSSTA Add Code Fririt Finished 60 You can click on a code to edit the description print the list by clicking the Print button or click on the Add Code button to add a code to the list The Add ICD 9 Code box will pop up E Add ICD 9 Code Lode Description A Cancel y OK In the Code field you type in the code number for the new ICD 9 code In the Description field you type in a brief description of the diagnosis When complete select OK SchuyLab returns to the Update ICD 9 Code Range Category box Select Add Code to insert another code Click Finished to exit this Category and return to the Update ICD 9 Codes box When you have entered in all the ICD 9 codes in all the categories that you desire select Finished SchuyLab returns to the Define Billing menu screen 6l Chapter 2 3Claims Creating Claims To begin billing on a set of claims they have to be brought from the lab side of the SchuyLab system to the billing side 1 e the Billing Module This is done using the Bill Accessions icon he To import claims to the Billing Module From the Billing Module menu screen select Bill Accessions SchuyLab displays the Generate Claims box E Generate Claims Eg Thru Date 10 72572004 Accession Number Range A Cancel oe OK In the Thru Date field enter the cutoff date for the claims you want
56. aims made payments received and write offs entered in that time 12 Month Revenue Lists all the revenue received per Client per bill type over the last 12 months Which 12 months 1s user selected A Sales by Rep Lists all of the revenue received from all the Clients assigned to each sales representative in a user selected interval of time There are also tools you will use often enough that you can find them in the main Billing Section Including Claim Aging Lists all claims per bill type per Client per aging category 30 60 90 120 days All of the above mentioned parameters are user Selected kc Open Claims Lists all of the claims within a user defined range which are still Open e g they have never been set to Ready or Billed Batch Payments Lists the total of a given day s payments entered into the system for accounts receiving purposes There are also a number of reports that are not strictly speaking financial reports yet are useful to the Billing department These are the Patient Demographics Client Demographics and Billing Demographics reports accessed through F6 Printing For more information on these reports consult the SchuyLab User Manual Recommended Checklist The Billing Process e Bill Accessions e Print the Open Claims report e Edit Claims set to Ready as necessary For claims For client invoicing For patient processing invoicing Print
57. ansaction is applied to that invoice in particular not to the account in general 12 Select OK SchuyLab returns to the Edit Account screen with the new charge displayed and the Total adjusted Altering an Invoice On occasion you may need to alter or adjust the contents of an invoice Circumstances which can cause this to occur include e You find out that several of the patients on an invoice don t actually belong to that Client but to a different one or to Medicare or some other bill type e The Client calls back and points out that you charged the standard price for a special panel for which you had contracted a special price You now need to reprice and reprint that invoice In such cases you want to revise either the contents of an invoice or the manner in which it s billed We ve made it deliberately difficult to alter your invoices if we made it too easy your Accounts Receivable department would get upset at you And us But it is possible Here are the rules to remember e You can make changes to the most recently generated invoice of any Client All previous invoices are immutable they can t be changed If you want to alter an invoice other than the most recent 105 you have to delete the most recent one Then the prior invoice becomes the most recent invoice on record at least and you can begin altering it e Invoices that have already been sent to the Client must be treated differently
58. arge for that panel even though it wasn t explicitly ordered Moreover if the schedule is intended for Medicare then SchuyLab has to guarantee that a test isn t double billed If you were foolish enough to order an Electrolytes panel and a Basic Metabolic panel which includes all the tests of the Electrolytes panel SchuyLab will bill only for the Basic Metabolic panel If you were to order an Electrolytes panel and a Comprehensive Metabolic panel which includes some of the tests of the Electrolytes panel you d be less foolish but still SchuyLab would bill for the Comp Metabolic panel plus the one test from Electrolytes CO2 that isn t part of Comp Metabolic It won t let you double bill for the tests the two panels have in common And how does it know which panel to bill and which to dissect SchuyLab will bill for the larger of the two panels How then does SchuyLab know which course to take SchuyLab looks for two things the CPT Rules check box on the Schedule definition and the CPT check box that s part of the Panel definition either through the Panel Definition icon itself or through the Panels icon in Billing Setup Any patient who obeys a CPT rule as determined by the fee schedule which is dictated by his bill type will follow Medicare s fee structures Any patient who obeys a standard pricing rule again as determined by the fee schedule attached to his bill type will be bi
59. at scroll box is selected you have the option of entering pertinent information into any of the fields Note that if you choose Spouse the last name will automatically be set to the Patient s last name and the Gender will automatically be set to the opposite of the Patient Hey anything to make your life easier There are also additional relationships labeled Child1 Child2 etc Unless the insurance requires that children be numbered which is currently only in Cura ao you should just use Child instead 73 Complete the fields for the patient s primary insurance If the patient has only a single insurance coverage select OK If there s a second insurance policy select Other SchuyLab displays the Add Insurance Policy 2 box Add Insurance Policy 1 E Add Insurance Policy 2 Relationship Insured IL SPOUSE Insurance Company Insured s Last Name First Hame Patient Address City St Zip E Telephone Birth Date Gender UWE Group Policy Number EmployerSchool _ Cancel Cancel OF Insurance Flan or Program This is a duplicate of the Add Insurance 1 box Simply complete the information for the patient s secondary insurance in the same way you did for the primary insurance Then select OK SchuyLab returns to the Patient Demographics screen When you re done entering or altering data through the Patient Demographics screen select F10 Done to save the changes and leav
60. been properly prepared and contains all the information necessary for a successful posting SchuyLab permits each claim to be individually checked When the claim has been checked by the biller its status is set from Open to Ready The Ready claims are available to the system for billing on paper or export to other systems for electronic billing Billing Types SchuyLab currently has four types of billing available Billing on the HCFA 1500 Medicaid MediCal Medicare amp Private Insurance claims can be printed on the HCFA 1500 form Billing electronically Claims are transmitted to a diskette file A commercially available modem program is then used to transmit the file to the insurance provider a Patient Billing When an individual patient is to be billed SchuyLab can generate an invoice for that patient s lab work J Client Billing When an invoice is created for a Client all the patient claims that belong on that invoice are set to Closed and an invoice number and date are appended to each individual patient claim From that point on those patient claims are dealt with on the invoice Client invoices accumulate from all eligible claims in the system which have been set to Ready a Billing Analysis You have many tools to analyze your billing statistics in the Billing Analysis section Including mn y Monthly Sales Tracks the activity on a given Client account in a user defined period of time cl
61. by Medicaid are included on this list If any are missing select the Add Tests button select the procedures to be included then select Done In like manner if there are too many procedures that is if there are any procedures that aren t on Medicaid s list of multi channel chemistry tests select them from the list SchuyLab will ask if you want to remove that procedure from the list Say Yes These are the tests that may be included in a multi channel automated chemistry panel Albumin Alk Bilirubin direct Bilirubin total Phosphatase BUN Calcium Carbon Dioxide Chloride Cholesterol Creatinine Glucose LDH Phosphorus Potassium SGPT ALT SGOT AST Sodium Total Protein Uric Acid Your Medicaid or insurance provider may include additional tests as well 37 On the right side of the Multi Channel Tests box is a list of the possible chemistry panels with procedure codes Each of these needs to be assigned a price To do this select a procedure from the list SchuyLab displays the Add Update Procedure box E Add Procedure Lode Description 80007 7 tests Charge Bill Code POS Note Code owo p mjo is Mo discounts allowed Add Handling charge schedule Charge Expect Bill Code POS Add anew Schedule X Cancel ew OK The Code and Description fields should already have entries You can overwrite the Description field if you d prefer to call it something else In the Charge field enter the price for
62. ces a Worksheet MCHC ROW FLATELETS MEUTROPHILS Dd 2 LYMPHOCYTES d 2 3 ft MONOCYTES B3 EOSINOPHILS H FESULT VERIFIED BY MANUAL SMEAR SCAN ures BASOPHILS 0 8 ee WHEN THE FATIENT S AGE IS WOT PROVIDED THE HEMOGRAM REFERENCE la RANGES PERTAIN TO ADULT POPULATION ONLY IN THE EVALUATION UF Tool THE WEC DIFFERENTIAL THE ABSOLUTE COUNTS SHOULD ALSO BE TAKEN adis Select E10 Done to leave this screen and return to the Edit Claim screen 71 Patient Selecting this button displays the Patient Demographics screen This is the same screen that s accessed through the Patient Processing screen on the lab side of SchuyLab Any changes or additions made to this screen from Billing will be visible and accessible to the lab Likewise changes made to this screen through the lab side will be reflected here E SchuyLab Patient Demographics j Fatient Ale Accession ok Devices ls Worksheet le Features r Tools ERIC Drinkwater Moremer K MoTR LE ID 000000000 Dr Robert Smith 17 01 G5 Northwest Medical group 101 9142006 DOB 5 03 195254 Other lD 5591434604 Accn 100000040 11 18 1997 20 06 Patient ID Fatient Type Last Name First Name Drinkwater Mor temer K Gender Race Location Address Us E 101 1234 E Elm Street Birth Date Age ia 503 195 54 at Zip Other ID BES a ca 91355 5591434604 5 Telephone 297 3845 Doctor
63. d select Done To implement differential pricing as part of a complete schedule 1 From the Define Billing menu screen select Schedules SchuyLab displays the Billing Schedules box 24 2 Select the schedule to which you wish to add prices SchuyLab displays the Update Schedule box E Add Schedule Lode Description M CPT Rules HERITAGE Her i tage Insurance Ho mi Do Not Combine Frocedure Description Charge Expect Bill Code POS Add new Procedures Discounts x Cancel OK 3 Select the button marked Add new Procedures SchuyLab displays the Add Billing Procedures box listing all the billing procedures currently defined in the SchuyLab system Remember a test or panel will not become a billing procedure until it has a procedure code assigned to it E Add Billing Procedures Description ABO ABO ABSCREEN ANTIBODY SCREEN ACUTE HP ACUTE HEP PANEL ALE ALBUMIN ALKPHOS ALK PHOSPHATASE ArtyLASE ANTI NUCLEAR AB ARTHRITIS PANEL BASICMET BASIC METABOLIC BLOOD BLOOD CULTURE Mm Cancel Ta OK 25 4 Highlight the procedures to be added to the schedule Select only those procedures that will have specific prices assigned to them overriding the Percentage field defined for this schedule Any procedures not selected will be assigned that schedule s defined percentage of the base price When you ve selected all the procedures you want select OK SchuyLab returns to the Update Schedule box
64. d from Billing Setup The Description field shows the test name as it prints on the patients reports and invoices If you change the Description field it will affect only how the test s name is printed on your invoices NOTE Two procedures can be given the same description on your bill For instance both a GC probe and a Chlamydia probe separate tests with different prices may be given the description DNA probe for your invoice In the Charge entry field type in the price of that individual test This will be the default or base price to be used when no other price is specified on a schedule In the Bill Code entry field type the procedure code CPT code HCPCS code or your in house equivalent you wish to assign to that specific test NOTE Two tests can be given the same Bill Code procedure code There are a number of tests that may be separate and distinct when ordered and run in the lab but that are essentially the same procedure and are charged to the same Bill Code For instance your lab may have defined tests for Vancomycin Peak values and Vancomycin Trough values the high and low levels of that drug in the patient s blood But they ll each be billed using the same CPT code 80202 if they re both done on a patient the invoice will simply say 80202 x2 You 22 can also change their billing Descriptions as described above so they both bill simply as Vancomycin The POS field is
65. d so forth We recommend this Or you can print your patient claims To test the Patient Claims feature 1 From the Billing Module main menu select Patient Claims SchuyLab displays the Bill Patient Claims box 2 Select the Test Billing option that is put a check mark on that box 3 In the Claim Number Range field enter a single claim number twice The claim should have PATIENT as the payor and its status should be Ready 4 Select Bill SchuyLab prints the designated invoice to let you check for paper type and alignment The status of the test claim does not change from Ready and the invoice does not appear on the claim To bill patient claims Once you ve tested your printer you re ready to print patient invoices 1 From the Billing Module main menu select Patient Claims SchuyLab displays the Bill Patient Claims box 109 2 3 In the Claim Number Range field enter the range of claim numbers i e specimen numbers to be printed Select Bill SchuyLab creates patient claim invoices for all Ready claims whose payor is Patient within that range of numbers SchuyLab prints the invoices on the queue defined in Setup It then sets the status of each claim to Billed and creates a line item of the date billed on each claim To rebill patient claims Let S say you ve printed out your patient invoices and now you need to print them again Maybe somebody spilled creatinine reagent all
66. dent from the laboratory setup that special pricing or billing protocols can be inserted painlessly without interfering with the lab tests themselves It helps to think of the overall SchuyLab system as containing two sides rather like the two hemispheres of a brain There s the lab side where the patient and specimen information is entered where tests are ordered where results are printed And there s the billing side where the orders are compiled where costs are summed where bills are printed The two sides talk to one another minimally the lab side tells the billing side the patient s demographics and the tests ordered while the billing side can update the lab side s patient records Not much more is sent or needed In particular while tests ordered individually are automatically sent from the lab side to the billing side panels can be recognized by the Billing Module in one of two ways The panels can be considered indivisible units for billing purposes 1f say a Thyroid panel were ordered on the lab side then the billing side would register and charge for a Thyroid panel and the individual tests of the panel would be ignored by the Billing Module Or the panels can be considered simply a convenient way to order a number of other procedures in that case were a Thyroid panel ordered on the lab side the billing side would register and charge for a T3 Upta
67. der Now we need to find the file that you just downloaded If you follow this process every time that you download a file this will be easy because it will be the only one that does not follow your filename format If you forget to do this or try and grab multiple files at the same time this may be more difficult and you may need to have either carefully noted the file name of every 835 file you downloaded or go to the menu bar and choose View and then Details so that you can see the modified date and time for every file in your directory so you can find the latest file Before we go any further let s talk about file names At their root each filename consists of two elements a name and an extension In some cases this extension can be blank but usually it names a file type and helps Windows decide how to deal with that file In folder options you can choose several ways to sort files in a folder but by default they are sorted in alphanumeric order 137 What is alphanumeric order Well it is similar to alphabetic order but if you have a numeric digit in place of a letter 1t will sort the number ahead of the letter and it will also sort the digits in order from 0 9 What does it mean practically Well it means that even though 2005 is a bigger number than 21 2005 will actually be sorted ahead of 21 This also means that if you use a date in your filename and want it sorted in order by date you want to display it in the order of yea
68. diCal enter X005 as the ID This number is for whatever ID number the insurance company has given you to personally identify your laboratory GRP These fields are used for different purposes for Other ID various billing setups particularly with electronic billing Schuyler House will inform you if values need to go in these fields when your billing gets setup Fee Pull down the scroll list and select the appropriate Schedule fee schedule Fee Schedules are defined in the Schedules area of Billing Setup as described earlier in this chapter For Medicare or Medicaid you must choose a CPT Rule schedule Printed This will be the HCFA 1500 form by default Most Form paper billing in the USA can use this form For some carriers you may want to use a different form that has been defined for Paper Billing See Setting up Custom Paper Claims Electronic If you don t plan to do any electronic billing set this to N A Not Applicable If you plan to do electronic billing you ll need to set up your electronic billing formats See the section on Electronic Billing setup below Once you ve done that come back to this screen and select the appropriate electronic format here Modifier If you want all CPT codes to be followed by a two character suffix for this carrier enter it here A Clients The Clients icon in Billing Setup is identical in use to the Update Group icon found in the Medical Reco
69. documentation for any questions regarding these products We have included these instructions here as examples and for your convenience only For HyperTerminal 1 Go to the computer station with the modem If you aren t sure which computer that is check the back of the computer there should be a telephone line plugged into the modem 2 Log out of SchuyLab 3 Select HyperTerminal To access it through the Start Menu the path would be Start gt All Programs gt Accessories gt Communications gt HyperTerminal To establish a new connection click on the icon rather than the HyperTerminal folder 4 When you first bring up HyperTerminal it asks you to create a new connection Enter a name and choose an icon for the connection In the Name field type Medicare BBS or whatever label you wish for the new connection From the row of icons select the icon you d want to click on to call Medicare Select OK ER 119 5 HyperTerminal next asks Enter details for the phone number that you want to dial Complete the fields as shown here in this example we re using the Medicare BBS for Southern California Country Code United States of America Area Code 213 Phone number 741 7522 Connect using whatever modem is installed in your computer When done select OK 6 HyperTerminal now displays the Connect box If you need to make last minute changes to the phone number amp c select the Modify
70. done on this specimen If all the tests of the Arthritis Panel weren t done say they cancelled the Uric Acid then SchuyLab couldn t build an Arthritis Panel for billing In that case it would bill for the tests that were done as separate line items If all the tests on the Arthritis Panel were done is the Arthritis Panel itself set up for billing If the Arthritis Panel doesn t have a procedure code the Billing Module will ignore it and bill its component tests as separate line items Additionally if the claim 1s a Medicare style claim the Arthritis Panel has to have its CPT check box checked Both of these can be verified through Billing Setup then Panels Select the Arthritis Panel and make sure it s got its procedure code and that its CPT box is checked Then go back to Edit Claims and hit the Price button If that still doesn t work there s one more thing to try I know it sounds crazy but are you sure you only have one Arthritis Panel I ve seen labs that went through several lab managers each of whom defined new panels to suit their own personal tastes It may be that the Arthritis Panel you ve set up for Billing isn t the same as the Arthritis Panel the lab staff has been ordering If you can go to F8 Tools Setup Test amp Panel Definition and finally Panel Definition See how many Arthritis Panels are defined in your system Then go to Screen Definition to see which one s able to be orde
71. e 30 00 jasoas 0 List fo discounts allowed iw LPT Add Handling charge schedule Charge Expect Bill Code POS MEDICARE 11 86 MEDICAL 3 25 Add anew Schedule X Cancel Delete W OK 34 The final step in the billing setup for this panel involves the check box labeled CPT For panels being billed to Medicare or to an agency that bills in a Medicare fashion e g Medicaid you ll almost certainly want to check this box The CPT check box determines whether the panel can be billed to Medicare and how it does so If the panel is to be If the panel is to be billed to a Medicare billed to anyone else like agency If the CPT box is The panel will be The panel is billed as not checked ignored The ordered The individual components of the components of the panel will not be panel will be billed separately billed separately I e if the panel contains other panels as components the smaller panels won t be billed If the CPT box is The panel will be As above The panel checked billed if all the is billed the same components of the way whether the panel are ordered by CPT box is any means The checked or not components of the panel will not be separately billed To make this work particularly if you ve checked the CPT box I remind you again that the definition of the panel is all important If the panel is to be billed to Medicare it mus
72. e Medicaid Insurance Client or Patient for this claim Displays the current status of this claim Each claim starts with a status of Open When you ve examined the claim and made any necessary changes to the charges or demographics set the claim to Ready This will make this claim available to the various billing mechanisms The claim must be set to Ready before it can be billed The claim cannot be set to Ready until all the requirements of that particular Bill Type e g Medicare number birth date amp c have been met Checking this box makes the claim unavailable for electronic billing it can only be printed If your SchuyLab isn t set up for electronic billing it doesn t matter whether you check this box But if you are set up for electronic billing then if the Paper box is checked the claim can only be printed if left unchecked the claim can only be sent electronically These three check boxes are for use when printing on the HCFA 1500 form Checking the appropriate box causes the equivalent area on the form to be marked Diagnosis ICD 9 These eight entry fields show the diagnosis code s for this claim If ICD 9 codes were entered as part of Patient Demographics they will be displayed here To change one of those codes select that code and then type in the code you want If you want to enter ICD 9 codes that are specific to this claim select a blank entry field and either type in the code
73. e the screen SchuyLab returns to the Edit Claim screen NOTE In some cases you may have to re generate a claim for the changes in Patient Demographics to take effect Simply use the Bill Accession icon and bring that single claim across from the lab side again 74 Editing Individual Procedures The Edit Claim screen displays the procedures for a given claim in its central window Date Type of Transaction Code and Description are listed in columns Along with the prices of course And if there s more than one of any given procedure SchuyLab will also display the quantity Each of these procedures can be individually edited To edit a procedure of the claim simply point the mouse on that line of the claim and click it SchuyLab displays the Edit Charge box E Edit Charge Description beat Pre ros Reference Expected Mote Codes Delete 0 00 A o o ts X Cancel Yo Authorization The Date Code Amount Description and Qty quantity fields are carried over from the claim itself You can if you wish edit these fields by simply selecting that field then typing what you want it to say Most of the other fields are self explanatory but let me expound on the Diagnosis fields The four Diagnosis fields are for apportioning the claim s ICD 9 codes If all the codes on the claim apply to all the procedures on the claim simply leave these fields blank But if some ICD 9 codes only apply to so
74. ebundle and or reprice an invoice other than the most recent 1 Select Edit Account 2 Enter the account number Be sure to precede the account number with the number sign Select OK 3 Point and click on the bottommost invoice 4 Select Delete SchuyLab asks Are you sure Say Yes 5 Continue repeating points 3 and 4 until you have deleted the oldest invoice to be repriced 106 6 7 8 9 Select F10 Done Now you have deleted the incorrect invoices and are ready to begin regenerating them Select Bill SchuyLab displays a date entry box Enter the end date of the oldest invoice to be repriced SchuyLab regenerates that invoice It will reprint automatically Throw the printout away Point and click on the invoice you have just regenerated and select the Price button SchuyLab now reprices that invoice Select Print Continue until you have regenerated and repriced all of the invoices To reassign patient claims to another client or bill type 1 2 Select Edit Account Enter the account number Be sure to precede the account number with the number sign Select OK SchuyLab displays all of the invoices for that account Select the invoice containing the patients whose client or bill type is to be changed Ask yourself this question Am I about to alter an invoice which has already been sent to a client e Ifthe answer is Yes note down all the claims on t
75. ectthe form wou desire and select OF Paper Claim Format e o Claim Mumber Range Test Billing no status change Rebill previously billed claims Xm Cancel T Ok Any claims that you have setup will appear in the Paper Claim Format drop down menu CHDP appears by default but any others will need to be setup as described in the Billing Setup section Choose the paper claims format that you wish to bill from the pull down menu enter in a starting and an ending claim number in the claim number range and check off any options you choose to use SchuyLab will print your claim forms to the Billing Queue The Test Billing option will print the claims without actually updating your claims in SchuyNet This is useful for verifying that your claim matches up with your form when you print it out without having to regenerate claims for each test The Rebill previously billed claims option determines whether the printout will include claims in the given range that have already been billed in some capacity or it will only include claims that have never been billed before This is useful in regenerating claim forms that you have accidentally lost shredded dropped in hydrochloric acid etc 115 Chapter 6 7Electronic Claims SchuyLab has electronic claims billing utilities available for separate purchase with the billing module Contact your SchuyLab Rep for pricing You can buy as many as your laboratory needs and purchase add
76. ed To access an outside line first dial type 9 Select OK to return to the Connect box 8 Select Dial If everything has been set up right HyperTerminal should begin dialing the Medicare BBS phone line Select Cancel before it can complete it 9 From the menu bar select File gt Exit The Medicare BBS phone number is now set up in HyperTerminal 10 For California residents In addition to the MediCal production line described above there s a MediCal test line to allow you to send a test case to MediCal for them to check Repeat steps 3 9 above substituting MediCal Test for the name of the entry and using the phone number 1 916 638 8127 First Transmission to the Medicaid BBS Once your Medicaid BBS account is ready to be used you should transmit a small set of claims just to be sure that everything is set up correctly As before the examples used here are for California s MediCal system Remember there are two phone lines for MediCal one for test transmissions like this one and one for all transmissions thereafter the so called production line You will normally need to get some information ahead of time from your Medicaid agency In the case of MediCal you will need to get a submitter ID and a password 1 Have ready a diskette with a file of valid MediCal claims between ten and twenty of them Refer to the above section To Prepare the MediCal File 2 Go to the t
77. edical group 101 9 147006 DOB 503 7195254 Other ID 5591434604 Fa Cancel Fld Done Claim Bill Type Payor Status Ww Paper Employment 409005 MEDICARE MEDICARE BILLED ms Accident Diagnosis CD 9 Homebound 333 33 111 1 ddd 904 9 Charged Paid Adjusted Balance List 139 70 0 00 0 00 139 70 Date Typ Code Description 3 16 chg 85024 CEC Charge 3 16 chg 80061 LR WE STUDIES 3 16 chg 80053 COMP METABOLIC Payment 3 16 Chg 64155 PSA 3 14 Bld MEDICARE HOF 1500 paper Write Off Necessity Price Patient Accession Claim Results 44 Prev gt gt Nex Payment A payment on a claim may entered by selecting the Payment button SchuyLab displays the Add Payment box Add Payment Date Lode Amount Check 314 7006 MEDICARE 100 00 0 Description Mote Codes Payment a 0 0 List X Cancel Batch Invoice Entry Date By 0 wo The Date field is for the date the payment was received It shows today s date by default but you can override it by clicking on that field and typing in the correct date The Code field displays the payor from whom the payment was received the 71 Description field displays Payment by default Both of these fields can be overridden by the user if desired The Entry Date field and By field on the other hand are not changeable they show today s date and the operator s ID respectively
78. en selected or left blank for Al click on the First Claim field and enter the number of the first claim you wish to examine and then select OK SchuyLab displays that claim if it matches the selected status and bill type otherwise it displays the next matching claim NOTE To display the first example in the system that matches the selected status and bill type without knowing its specific claim number simply select OK without entering a number in the First Claim field Use the Next button to progress along the chain of similar claims 65 You can also bring up the claims for a specific patient by clicking on the By Patient button This brings up the Select Patient form E Select Patient Enter the Patient s Name Last First anna Cr the IO Date of Birth Patient s Chen X Cancel Ta QUUU06G65 Patient Testi From this form you can search for a patient s claims by name patient ID date of birth or client You also can click on the results for the most recent patient accesses listed at the bottom of the window In the example above Test G Patient This can be up to 5 different patients that SchuyLab has recently brought up When you click OK you will bring up the first of any claims that match your criteria 66 SchuyLab displays the claim information on the Edit Claim screen The patient s information for this claim e g screen E SchuyLab Edit Claim patient name is displayed in the
79. ep entered Transaction Audit On occasion you may need to track down exactly when a payment was entered into SchuyLab or which claims were billed on the week of 1 April For those occasions the Transaction Audit prints out an audit trail of exactly what when and who for every billing transaction in a given period To access this function select the Transaction Audit icon SchuyLab displays the Sales Audit Report box E Sales Audit Report Report Date Range LIUeue Po tuna Client Mame Setup X Cancel OK In the Report Date Range fields enter the beginning and ending dates for the report In the Client Name field type the name of the client you want on the report if you leave this field blank the report will be for all your clients You can select a print queue using the print queue pulldown menu When all the fields are ready select OK SchuyLab prints the Sales Audit by Bill 90 Type report It will simply list each transaction entered into SchuyLab during the selected interval every charge payment write off or line edit Each transaction will also include the date time SchuyLab operator ID client ID bill type and claim accession number Then at the bottom of the report it will print the summary by bill type as found in the Monthly Sales report a Sales Rep Transactions It is often helpful to separate a transaction audit by sales representative rather than client For this select the Sales
80. er The base fee schedule is the default 48 Name Address City St Zip In Care of Plan Name Write Off SchuyLab will print these at the top of the HCFA 1500 form NOTE that if you have many insurance carriers with the same name use the Name field to distinguish them in some way e g Blue Cross of Oxnard Blue Cross of Visalia Blue Cross of Altadena don t just use Blue Cross for all of them Enter the name of the contact person at the insurance company who will deal with claims from your lab Enter the name of the insurance plan that covers your patients through this carrier Enter the dollar amount if any you will automatically write off from all claims paid by this carrier For setting up Medicare and MediCal insurance carriers there are some special requirements to note E Update Insurance Carrier Other ID IL FI GRE 040 0500936097 0500930097 ame Fee Schedule Medicare MEDICARE Address City Printed Form z BOs 27 652 HCF 1500 Electronic Sto Zip WA CHICO cA 959272852 0 In Care of Plan Marne Telephone WA x Modifier __ Place Service write Ott Line 24k TO i000 mj o Type Service Delete XM Cancel 49 For Medicare and the various states Medicaid programs the SchuyLab ID number must start with the letter X For Medicare enter X040 as the ID For Me
81. ering Medicare ID 50 patient s Medicare ID 72 SE HI a EE E ENT 17 Monthly Sales ccccceccseeees 7 multi channel panels 36 Open Claim Sanhi 7 ONE S E A 5 28 defining components 35 Pane leror ene CPET aenn e aa 35 Paper DINE eunice 113 DOS UNO in aaa nctatentendenelad 113 vs electronic billing 68 Patient Claims 0 6 108 DIDO yess tance aN 109 PODINIMG saraca 110 LOS UM Oss sents eee acswariene iets 109 PAVING armani adding to account 102 adding to claim 0608 TI DAY OF a tGoaeticeaeeenieeenae 113 PAY Ol E E E ean aaa displayed in Edit Claims 68 DAV OLS ere E 18 Pricing Rules iscsscisoccesheissa tates 5 19 SCHECUICS nrinn 20 SCNECUICS active recu neces stn totes 15 Print I VOICES sia ceacsetadassedacadstnvest 97 DN 10 o ee ete E ne eee en eee batch payments report 85 claim aging report 6 84 HCFA 1500 formas 113 insurance companies 47 monthly sales repott 87 open claims repott 83 patient INVOICES 8 108 sales sorted by rep 06 89 SCHECUICS araeir seur drun i 42 yearly TEVENUC 2st Haier 88 procedure COdeS 008 20 31 adding codes to tests 21 multi channel panels 36 new charges on claims 76
82. erminal with the modem Log out of SchuyLab and into your modem software From Windows select Start gt Programs gt Accessories gt HyperTerminal 126 3 Call the MediCal Test Transmission phone number Select the MediCal Test icon Select Dial 4 The MediCal BBS will show you the sign in screen 5 At the prompt type CMCSUB and then your submitter ID and press Enter So if your submitter ID was RJ45 you d type in CMCSUBRJ45 and then press Enter 6 The screen then prompts you for a password Type in the password you received from MediCal and press Enter 7 Once you ve logged in successfully the MediCal BBS will show you any current messages and ask you to press Enter to continue 8 The MediCal BBS will next bring up the Main Menu Screen Type F to bring up the file menu 9 Type U to upload files 10 You are now given a choice of protocols to upload under Type Z for Zmodem Hit Enter 11 Use your modem software to begin transmission HyperTerminal From the menu bar select Transfer gt Send File HyperTerminal will ask for the name of the file Type A MCALTELE and Enter The modem software will keep track of your progress in sending the file 50 75 amp c When it s done you ll return to the MediCal BBS screen 12 At the end of the transmission the computer will emit a series of beeps to let you know it s done MediCal then displays the number o
83. ests in the panel are ordered no matter how Nobody ever said medical billing would be easy The manner in which panels are included in the claim is called the rule This too is done through the Billing Module There are basically two rules e The CPT rule for use with Medicare and related payors which bills panels only if defined as CPT panels e The default rule 1 e not the CPT rule where panels are billed exactly as they re ordered In general the CPT rule gives precedence to larger panels over smaller ones If two panels have tests in common SchuyLab will bill for the larger panel and the remainder of the smaller panel s tests as separate items on the claim As a concrete example The Comprehensive Metabolic panel and the Electrolytes panel have three tests in common Sodium Potassium and Chloride If both panels are ordered and we re following the CPT rule SchuyLab won t let you double bill those three tests Instead the CPT rule will try to include those tests in one panel only It will choose the largest panel that it can build from the tests that were done So in this case we d end up billing for a Comprehensive Metabolic panel plus a CO2 test the only test in Electrolytes that isn t in Comprehensive as a separate item That is if all the tests defining a Comprehensive Metabolic panel are present in the claim If one of those tests were missing then we d bill for an Electroly
84. et setup the connection you should follow the steps in Setting Up Your Medicare BBS Connection HyperTerminal should automatically dial and connect to the Medicare BBS at this point In many cases your screen may be blank with just a blinking curser line If this happens hitting the Enter key will bring up the login Type in your submitter ID and then when prompted type in your password You will then get the following menu Criminal law prohibits unauthorized use violators will be pr osecuted User validated COM MENT produced by SANS SOUCI COMPANY c 1995 Reproduction of this product is not allowe E CABBS MAIN MENU Electronic Mail Menu News Publications Menu Claims Submission Menu Inquiry Claims CABBS User Reference File Library Inquiry Eligibility xit m on On F a hor M ee ee ee ee ee Sa H m m M s A D i O m 132 You will then type 1 to go to the Electronic Mail Menu That menu looks like this 5 CABBS User Reference File Library 6 Inquiry Eligibility E Exit Enter Selection H1 CABBS MAIN MENU Electronic Mail Menu News Publications Menu Claims Submission Menu Inquiry Claims CABBS User Reference File Library nary Eligibility xit 1 2 3 4 9 6 E See eee eel ee ee eet el Enter Selection 1 CABBS ELECTRONIC MAIL MENU 1 Display Send Receive Mail E Exit Enter Selection H Type 1 again to go to the Display Send Receive
85. f Service Patient Name Charges Payments Writeoff Adjustments and Balance 93 Troubleshooting Claims There will be occasions rare we hope but it happens to us all when you will have problems with some of your claims Medical Billing is a complex topic and we can t cover all possibilities here but some problems crop up more frequently than others and there are remedies you can try All of these examples assume that the problem is with the claim itself before we even get to forms and invoices There are no procedures on my claim Presumably you ve gone to Edit Claims and while the patient s name and demographics were in the panel at the top of the screen and the claim number aka the accession number was displayed there were no procedures to be seen The most probable cause is that the procedure codes CPT codes and such haven t been entered yet Go to Billing Setup select Tests or Panels or Procedures as appropriate and enter the procedure codes and prices Then go back to Billing and use Bill Accessions to bring the claim across a second time I ordered an Arthritis Panel on a specimen but the claim doesn t show an Arthritis Panel it shows individual tests Two errors might have caused this First were all the tests on the Arthritis Panel actually done If you re not sure go to Edit Claims and select the Results button SchuyLab will display all the test results that were
86. f files sent shows any transmission errors and gives the dollar amount for that transmission Write down that information and keep it until you ve received your reimbursement 13 Hit Enter The MediCal BBS returns to the File Transfer Protocol Selection Menu Type Q and Enter to leave the BBS 14 Leave the modem software program and return to SchuyLab Subsequent Transmissions to the Medicaid BBS As soon as your test transmission is validated you ll be able to send as many claims as you want to the MediCal BBS There s a different phone number to use that s why we set up two different entries in your modem software but the steps are exactly the same as they were for the first transmission Except that the files being larger will take longer to transmit over the phone lines You may want to time your calls for early in the day to avoid busy signals ER 127 Follow the instructions given above To recap them 1 Generate claims on SchuyLab and export them to a diskette 2 Log into your modem software and connect to the MediCal BBS 3 Type cmc Enter cmcMode and Enter 4 From the File Transfer Protocol Selection Menu select ZMODEM 5 Enter your submitter number and password 6 Begin transmission of the file 7 When done leave the modem software and return to SchuyLab If you have any questions regarding the MediCal TelePoint system including the status of any of your claims
87. for Medicare Select F7 Features Select Billing Select Setup SchuyLab displays the Define Billing Menu Screen Select Multi Channel SchuyLab displays the Multi Channel Tests box E Multi Channel Tests HoE SOD TUM POTASS TUM CHLOR IDE LO GLUCOSE BUM CREATININE CALCIUM ALBUMIN This is the special program that generates the multi channel chemistry procedures i e those with procedure codes between 80002 and 80019 or GO058 G0060 that can be billed to Medicaid MediCal and similar agencies The Multi Channel Tests box will look at a claim and find the chemistry procedures that aren t part of another panel it won t for instance look at a Cholesterol procedure on a claim if it s already being billed as part of a Lipids panel It then counts the number of chemistry procedures and generates a claim for an automated multi channel 36 chemistry panel of that many tests If it finds seven it bills for a Chem 7 with a procedure code of 80007 if it finds twelve it bills for a Chem 12 80012 and so on On the left side of the Multi Channel Tests box is a list of the procedures to be incorporated in a multi channel chemistry panel Note that the list 1s of chemistry procedures tests that have procedure codes assigned to them If the individual tests don t have procedure codes they can t be included in this list Check the list to ensure that all the elements of a general chemistry panel as defined
88. g This may depend on what information you choose to include in your write off and the policies of your billing department We hope that the clarity of being able to see which charges are written off and which ones have not been will make up for the inconvenience of putting in three write offs instead of one to write off the entire claim While you do have the option of doing a write off for the full amount of the claim in one entry we suggest that you do not do so as this will make things more difficult if you need to check what you did on this claim later Troubleshooting Remittance Issues Most issues with electronic billing you will encounter will happen with the actual submission of your electronic claims as that is where the complicated processes occur but there are still a few situations where you may get unexpected results in remittance processing 151 Issue When trying to process the remittance SchuyLab tells you that it is unable to find the file Solution This could be for several reasons First the file may not be going into the directory where you think it is going Check that the path that you are putting in to process the remittance is in the correct folder and with the correct filename It is possible if you did not specify an extension when you renamed the file that Windows has kept a previous extension on the file and you will need to type that extension in For example the file that you get from the insurance is
89. guarantee that last month s payments are reflected in this month s invoice for instance To enter a payment 1 Select Edit Account SchuyLab displays the Select Account box Account Client Patient R conce FO _ 2 Inthe Account entry field type a number sign and then the number of the account you wish to see The account number is the same as the Client ID number Thus if you wanted to see the account for Client ID 2 you d type 2 Without the number sign SchuyLab looks for a patient account and tries to find a matching Patient ID number If you don t have the Client ID number handy you can click on the Client button and type in the Client name to find the account The Patient button is there for patient account management see the Patient Invoicing chapter for more details 102 3 Select OK SchuyLab displays the Edit Account screen listing the account Client information in the nameplate at the top of the screen and listing the current activity E SchuyLab Edit account Account 204 sample Doctors Inc Account Last Billed Credit ERTCSTOK MST 14 30 4353 206 2005 Fa Cancel Total 24 fo 22 00 E Current 30 Days bO Days 40 Days 120 Days P2200 ff Date Tyo Code 2 03 Ive Client Description Invoice 1 Add Charge Payment rite Off Demographics Account Bill dd Prev gt gt Next In the above example we only
90. have a single invoice Generally an account will display several invoices You can look at any specific invoice by selecting it from the list SchuyLab displays the Edit Invoice screen And from there you can select a specific claim from the list and get the Edit Claim screen 4 Select the Payment button SchuyLab displays the Add Payment box E Add Payment Date Code Amount Check 3 15 2006 7 0 00 0 Description Mote Codes Payment Jo jo us Batch Invoice Entry Date Bye _ Delete X Cancel o vax 5 In the Amount field enter the dollar amount of the payment In the Check field enter the check number for future reference 103 6 7 8 In the Invoice field enter the number of the invoice for which this payment applies This makes sure that this transaction is applied to that invoice in particular not to the account in general Select OK SchuyLab returns to the Edit Account screen with the payment entered and the Total adjusted When finished select F10 Done SchuyLab returns to the Billing module main menu screen To make an adjustment 1 2 3 4 5 6 7 104 Select Edit Account SchuyLab displays the Select Account box Enter the account number Be sure to precede the account number with the number sign Select OK To enter a write off the most common form of adjustment select the Write off button SchuyLab di
91. he Remittance Claim You are now sending your claims into Medicare Medicaid and or any of the insurance companies electronically and they have sent you your payment information back to you also electronically Now what Is there an easy way to check what claim was paid and how much was paid Yes there 1s 141 Select F7 Features Select Billing SB gt B a a 2 You will see two electronic icons select Electronic Remittance Any remittance interfaces that are installed will be displayed here E schuyLab Electronic Remittance Patient Ale Accession a Devices Ells Worksheet Bs Print tle Features Electronic Remittance ANSIBCAL TORIFF IN MSTA 13 15 513 6 20 2004 FS Cancel Fld Done Select the remit icon for your payor which in this instance is ANSIBCAL E ANSIBCAL remittance j xj To process remittances specifythe path Queue ews to your downloaded file then click OF PRINTER select Path Test Posting ino actual update Printexceptions only X Cancel y Queue Select Path Test Posting Print exceptions only You can chose to print this report recommended to any of your printers or just to the screen to review it Which file are you opening and where is it With this box checked the report will be generated but not posted Print only those claims with notes 143 Under Select Path type in the path name for
92. he invoice which are going to be changed Write down the dollar amount for each claim Add the dollar amounts together and enter that number as an adjustment on the account Remember to enter the invoice number in the Reference field Now go into the individual claims and reassign their clients or bill types Set them to Ready They will now rebill automatically e Ifthe answer is No 1 e you caught the problem before the invoice got out of your hands then you don t have to post an adjustment Delete the invoice in question reassign the patients and then regenerate the invoice 107 Chapter 4 5Patient Invoicing Some laboratories will bill the patient directly instead of through their insurance companies or clinics In those cases SchuyLab provides patient invoicing There are two types of patient invoicing claim based or account based This can be designated in Laboratory Options see the Setup chapter Claim Based Invoicing Claim based patient invoicing is the default setting In this setting you will invoice a patient separately for each claim billed to that patient a To print patient invoices From the Billing Module main menu select Patient Claims SchuyLab displays the Bill Patient Claims box E Bill Patient Claims To bill Patient claims e specify a claim number range and press Enter Claim Number Range GUELE Test Billing no status change Rebill previously billed claim
93. ices process of course A note on the patient account itself will override these default notes if you need to send a patient a specific message With account based patient invoicing the Edit Account and Edit InVoice buttons on the billing menu do double duty Edit InVoice will bring up whatever invoice matches the number you put in which can be either a client or a patient invoice Edit Account will continue to bring up client accounts when you put in the client s account number preceded by the character However if you put in a number with no it will look up patient account numbers instead So type in 56 to get client account 56 and type in 56 to get patient account 56 Account Client Patient R corce WOK _ You can also look up a patient account by clicking on the Patient button This gives you the following screen E Select Patient Enter the Patient s Name Last First Cr the ID Date of Birth po po Patient s Chen X Cancel Ta UOUUU06G65 Patent Test G You can look up the patient by name ID date of birth or patient s client here If you have recently looked at a patient s information they will also be listed below the OK and Cancel buttons and you can just click on their name to go to that account 112 Chapter 5 6Paper Billing While Electronic Billing is becoming more and more common there is still a need for paper claim forms The most common claim form you will want
94. instead of tracking outstanding Client Invoices it tracks outstanding Patient Invoices Patient Accounts also starts its options with Any Balance as including every patient in the database with no outstanding invoice would do nobody any good except for your lab s printer paper supplier i Claim Recap Claim Recap will print you a report on any specified range of claims regardless of their current status E Print Claims Recap SEQUENCE and by amp Caimg C Patient Client Mame Leave blank tor ALL Claim Number Range Liueue Frinton separate_paqes Setup A Cancel ew OK Enter the first and last claim numbers 1 e specimen numbers of the range to be included in the report and select the print queue to use You can also click on Setup to assign the default print queue and font for all of your reports You can also choose how you want your claims to be grouped together In the Sequence drop down box you can choose to group claims by Client or by Bill Type or leave blank to not group claims in any special manner You can also choose to order your claims by Claim or by Patient name by clicking the appropriate selection Finally you can click the checkbox next to Print on separate pages if you want a page break between every group that you specified in Sequence This has no effect if you leave Sequence blank When you are done select OK SchuyLab prints the report which will have columns for Claim Billtype Date o
95. inting Reports SchuyLab s Billing Module has several report functions for tracking such things as unmailed claims past due claims or claims for a given client Three of these are accessed directly through the main Billing Module menu screen Open Claims Claim Aging and Batch Payments The others are accessed through the Billing Analysis icon There are also some reports that while not billing reports as such are often of interest to the billing department of your lab These are the Patient Demographics Client Demographics and Billing Demographics reports accessed through the F6 Print menu screen The setup and use of these features are described more fully in 82 the SchuyLab User s Manual Open Claims The Open Claims icon will print a list of all claims within a specified range that are still Open that is that have never been set to Ready or Billed This 1s particularly useful for claims which are automatically be set to Ready when they meet defined criteria for instance that the patient s date of birth and Medicare number are on file Printing the Open Claims report would tell you which claims haven t yet met those criteria and why It s very useful to print the Open Claims report immediately after having brought the claims to the Billing side via Bill Accessions That way you ll have a list of the claims that will need to be amended through Edit Claims To print the Open Claims report From the
96. intne HCFA TS00 FOIS meieni a neous E E A 113 Printing Non HC PA CIAS seansini aea a aa aa a 114 Chapter 6 7Electronic Claims Using Elcctronio Clais ipni a MEICALEC cccecceccscosceccsccscecceccscscescscescaccscescescscscscscscucucs IVA IC AU Nose ucceeared T AT E soausetee Chapter 7 Electronic Remittance Setting Up The Medicare BBS Connection ces Retrieving S35 FICS eeen a a bean aaaerae es PEIN G Up REMAN Eierne es sdersevtasden E Processing the Remittance Claim cccc cc cceeeeesseeeeeeeeeeeeeees THe REDOT rure A E Notes and Write Ofo erson naa i aacipatenclinias Troubleshooting Remittance ISSueS ccccccceeceeeeeeeeeees Index 1O0verview What is SchuyLab Billing The SchuyLab Billing Module is an optional feature of the SchuyLab system It won t make you into a billing professional overnight there s no substitute for education and experience But in the hands of a medical biller the Billing Module is a powerful tool What makes the Billing Module special It permits the user to bill the procedures ordered for the patients without having to enter the patients names and tests a second time The information entered on the patient during the course of laboratory analysis automatically becomes part of the billing record name patient ID doctor s name and of course the tests and procedures performed Yet at the same time the Billing Module is sufficiently indepen
97. iscussion on Panels Either way the procedure will not be billed 1t won t even show up on the invoice 7 optional If the procedure code for this procedure on this schedule differs from the default type the procedure code to be used in the Bill Code field Medicare may have different codes for some tests for instance In the POS field if the procedure is done elsewhere than in your lab type the appropriate two digit code in the POS field The Expected field is not functional at this time 8 When all the fields are correct select OK SchuyLab returns to the Update Schedule box Go to the next procedure and repeat the above steps 9 A procedure that was mistakenly added to the schedule can be deleted by selecting it thus bringing up the Update Schedule s Procedure box and selecting Delete SchuyLab removes that procedure from the schedule 10 When all the procedures on the schedule have prices entered for them select OK SchuyLab returns to the Update Schedule box listing all the procedures and their prices In the example below some of the panels are listed as NA Not Applicable and would never be billed to patients on this schedule Remember this is done by entering 2 as the price E Add Schedule Lode Description M CPT Rules HERITAGE Her i tage Insurance Ho E Do Not Combine Frocedure Description Charge Expect Bill Code POS AMYLASE ANTI NUCLEAR AB ARTHRITIS PANEL BASICMET BA
98. itional interfaces as your needs grow Currently there are electronic billing interfaces designed for Medicare Medicaid and several insurance clearinghouses Each of these utilities takes the claims for its payor that have been set to Ready status and creates an electronic file of them The files can then be transmitted in the ANSI 4010 protocol Any commercially available modem software can be used to transmit the files we find that HyperTerminal works fine and is included with standard Microsoft Windows installations The exact procedures will vary from state to state and which clearinghouses you use Update Windows Vista no longer includes HyperTerminal by default if you need to use a Vista machine to dial into your insurance carrier s site you will need to purchase separate software to do so We use Southern California Medicare and Medicaid in our examples but while the method SchuyLab uses to generate the electronic file will generally be the same you will want to check with your local provider and Schuyler House on the best means of transmission Setting up Electronic Claims Before we begin we would like to remind you that Electronic Claims needs some setup before it will work We will just review the main points here Go back to Section 2 Billing Setup in this manual for complete details From the Define Billing menu screen here s where you should look Go to Electronic Billing In the Update Electronic Pay
99. ke a T4 and a TSH the panel qua panel would be ignored by the Billing Module You can do some of your panels one way and some panels the other way the choice is wholly configurable by the user The SchuyLab Billing Module will ignore any test or panel which is not a procedure that is does not have a procedure code most labs use CPT codes for this but there are other coding systems On the other hand the Billing Module allows you to define procedures that are neither tests nor panels venipuncture for instance and charge for them on your invoices Finally the tests and panels are entered into the invoice according to predetermined rules Bill this panel first then this other one then Everything follows a protocol as determined by the user Thus the Billing Module provides a flexible billing environment to work alongside SchuyLab s laboratory system Entering the Billing Module Select F7 Features Select Billing SchuyLab displays the Billing Module screen E SchuyLab Billing DER ERIC MSTR LAB 16 58 65 215 2006 Bill Print Invoices ACCeSsions Create Client Worksheet Invoices us Fe Print a Electronic Claims a Electronic E Edit Accourt a Billing Remittance Analysis Payments gle Features Electronic Remittance Posting Let s do a quick run through of how the Billing Module is organized SchuyLab bases its billing on a claim
100. laim and that you are creating a form for Duckworth Insurance E Create New Report Name Description DUCKWOR Duckworth Insurance Type Claim l Setup Print X cone OK After you click OK here you will be taken to the Configure Claim Form Screen Here is where you can setup the format to fit your form but the actual process for doing so is beyond the scope of this document Section 7 of the SchuyLab User Manual Reports and Printing should give you the information you need to modify the report to fit your claim form So what do you do after you ve created and formatted your new claim form You need to tell SchuyLab which claims you want to use it on You do this in the Insurance setup which you can find in the next section Setting up Insurance Clients and Doctors Insurance The Insurance icon is used to record information on the insurance carriers who will receive bills from you Note that SchuyLab treats Medicare and Medicaid MediCal as insurance carriers so they need to be defined here To enter information on insurance carriers From the Define Billing screen select Insurance 46 SchuyLab displays the Update Insurance Carriers scroll box listing all the currently defined insurance carriers E Update Insurance Carriers w O0 C Name Blue Cross of California Metropolitan Lite Insurance Company Carrier 10 Company 11 BF eh LIFE PACIFICARE OREGON MEDICARE NATIONWIDE HEALTH INSU
101. lect Option 1 Setup CABBS to Receive Claims 5 Select ZMODEM 6 Select Production Mode if you are sending actual claims ER 123 6 Begin transmission of the file 7 When done leave the modem software and return to SchuyLab Medicaid Medicaid billing will vary from state to state The following instructions for California Medicaid MediCal are typical To prepare the MediCal file 1 From the Electronic Claims menu screen select the MediCal icon SchuyLab displays the Export ANSI claims to MEDICAL box E Export ANSI claims to MEDICAL X To export claims in ANSI el format Insert a blank disk and press Enter select Path A SMCA Claim Mumber Range Test Billing no status change Rebill previously billed claims po Cancel Export 2 Puta formatted diskette in your A drive 3 The Select Path field displays the default pathname you defined as part of Electronic Billing setup For MediCal the file must be named MCALTELE 4 In the Claim Number Range fields enter the first and last claim numbers you wish to transmit 5 If this is a test transmission to MediCal to see if it works check the Test Billing no status change box This tells SchuyLab to not change the claims status from Ready to Billed as they re exported 6 SchuyLab will normally look only for Medicaid claims whose status is set to Ready If you wish to retransmit previously billed claims check the
102. list box E Edit Claims search By Status Blar S Search E Bia First Claim By patient Cancel OF If no status is selected SchuyLab defaults to All and displays claims from all statuses Otherwise select from one of the following Closed Claims whose balances have reached zero 0 00 Open Claims which are available for billing but have yet to be examined and set to Ready Ready Claims which are available for printing electronic transmission or invoicing Billed Claims which are awaiting payment or have been partially paid and are awaiting future transactions These claims have a balance greater than zero 64 Similarly in the Search by Bill Type section select the bill type of the claims you wish to examine See Billing Setup for how to establish these billing types If no bill type is selected SchuyLab defaults to All and will display claims from all billing categories Edit Claims Eg search By status Bia S search By Bill Type Bla f INSUFE _ NOTE To review the claims that have been entered into SchuyLab without a bill type select Open in the Search by Status field and the blank space at the top of the list in the Search by Bill Type field This will allow you to review all of the claims that have been entered with blank as their bill type Presumably you ll want to do something about this Once the status and bill type have be
103. list boxes If you want a claim aging summary current 30 days past due 60 days amp c to print at the bottom of your invoices select the Print Ageing at the End check box Select OK 5 Select OK SchuyLab prints the invoices 99 To View NOT Edit an Invoice There may be times when you want to look at an invoice without printing it other than the initial invoice generation which automatically prints the invoice This is done through the Edit Invoice icon The name is misleading You should not try to edit any invoice through this function But it s useful for viewing purposes 1 Select Edit Invoice SchuyLab displays the Select Invoice box Invoice Cancel OF 2 Inthe Invoice field enter the number of the invoice you wish to view 3 Select OK SchuyLab displays the Edit Invoice screen E SchuyLab Edit invoice ERTCSTOK MST 14 26 433 206 2005 FY Cancel 10 Done Invoice 1 Date Tyo Code Description 4010057 Invoice oRint Delete Price 44 Prev gt d Next 4 This function is currently intended ONLY to view invoices Attempts to actually edit invoices through this function will result in major problems for the Billing Module LOOK but DON T TOUCH 100 5 The items listed are as they appear on the invoice itself the previous balance 6 7 if any followed by the individual claims To look at an individual claim select it from the list In thi
104. lled the procedures exactly as they were ordered Tests Before the Billing Module can be used to its full potential the different procedures that is the tests and panels must have prices and procedure codes assigned to them Recall that a test or panel becomes a procedure for billing purposes when it s given a procedure code Any test or panel without a procedure code will be ignored by the Billing Module Sometimes you may decide you want Billing to ignore a test for instance you don t really want to bill for each individual Urine Cast result you want to bill for a Urinalysis panel which includes a Urine Casts test which happens to include the individual Urine Cast results But the grand majority of tests and panels should all have codes assigned to them The prices and codes for the individual tests may be defined when the tests 20 themselves are defined This is done through SchuyLab s Test Definition function via F8 Tools Set Up Test amp Panel Definition and thence to Test Definition The procedure is described quite completely in the full SchuyLab User s Manual and need not be repeated here However the prices and codes for the tests can also be defined through Billing Setup This allows you to keep the billing department s tasks separate from the lab tech s tasks You can even through Billing Setup update the codes and prices that were entered through Test Definition To enter or change p
105. lling a claim SchuyLab will roll down the list of selected payors in order If you have bought the optional Medical Necessity module you can turn checking on and off for a particular pay type with the Medical Necessity check box 18 The Required button allows you to set conditions for accepting a given claim as Ready to be billed Select Required to display the Bill Type Requirements box E Requirements IO Format l Insurance Diagnosis CO9 Date of Birth Medicare ID Gender Medicaid ID Address Manual Review Doctor s IPIN Doctor s Provider X Cancel Ta Select the items you want to be in place before a claim can be ready for billing do we have the patient s date of birth their gender the name of their insurance carrier amp c If Manual Review is selected then every claim must be reviewed in the Edit Claims icon of the Billing Module before it can be set to Ready i e ready to be billed If Manual Review is not selected then the claim is automatically set to Ready when it s brought over to the Billing Module so long as the other requirements address gender have been met The ID Format list field checks whatever number is in the Other ID field in Patient Demographics and makes sure it s in a specific format MediCal Medicare or non blank 1 e some ID number required Choose the one appropriate for the bill type Remember SchuyLab checks the format of the Other ID field
106. lltype Client select Billtype Summary Only al select claim aqe All 0 Current 30 7 60 40 120 selectfor Client Blank for ALL setup A Cancel w OK In the Select Billtype pull down menu you can select a single bill type CASH MEDICAL or MEDICARE for example or leave it on all to print out all bill types In the Select claim age section you can choose all to print all aging categories or select from any combination of Current 30 60 90 or 120 days to display in your aging report In the Select for Client field type in the name of the appropriate client If you wish to print a report for all clients leave the field blank You can select the sequence the data will appear from the Sequence pull down menu If you click off the Summary only the report will display only the summary information As before you can change which queue it will print to with the queue pull down menu or change the default using the Setup button When all the fields are ready select OK SchuyLab prints the Claim Aging report 84 Batch Payments The Batch Payments icon will print a report of the total payments that had been entered into the individual claims a simple form of accounts receivable Each payment is assigned a Batch ID number through the Batch field in the Edit Payments box Though you can invent your own system SchuyLab will assign a Batch ID number by default and we recommend that users do this To
107. lly you ll have to set up fee schedules for your clientele with a price for each procedure Most labs define their prices in one of two ways they may have a separate list of tests and prices for each client Prices for Dr Smith Lipid Panel 15 00 Thyroid Panel 50 00 amp c Or they may have a list of tests with all the clients prices Lipid Panel Dr Smith 15 00 Dr Jones 13 25 Dr Khan 16 50 amp c If your prices are defined the first way you may want to enter the prices via the Schedules icon which we ll discuss in a minute But most labs define their prices the second way which makes it easier to enter the prices along with the billing codes To implement differential pricing for an individual procedure 1 From the Define Billing menu screen select Tests SchuyLab displays the Test to Procedure Translation box 2 Select the test you wish to edit SchuyLab displays the Update Procedure box 23 3 Select the Add a new Schedule button SchuyLab displays the Add Schedule box 1 Add Schedule Eg schedule Charge Expected CLIENT 0 00 0 00 Bill Code POS Note Code PP Elo wet X Cancel ox 4 From the pull down list box labeled Schedule select one of the schedules defined in the system In the Charge field type the price that you wish that procedure to be billed at for that particular schedule This specific price will override the default flat percentage that y
108. me procedures use these fields to specify which codes apply to which procedures For instance if the claim s first ICD 9 code applies to this procedure type 1 in the first Diagnosis field Ifthe claim s second and fourth ICD 9 codes apply type 2 and 4 in two of the Diagnosis fields You can enter any combination of 1 through 8 in these four fields as appropriate These numbers print out in space 24e of the HCFA 1500 form When done select OK SchuyLab returns to the Edit Claim screen with the changes to the procedure reflected in the Total Transactions The Edit Claim screen has four types of transactions which can appear as line items on a claim Chg Charge Bld Billed Pmt Payment and W O Write Off Each of these transactions either creates or modifies a line item on a claim Chg Pmt 75 and W O are entered by the user through Edit Claims Bld is inserted on the claim by SchuyLab after a bill is printed or transferred electronically All procedures on a claim are displayed as Chg To add a new charge to the claim select the Charge button SchuyLab displays the Add Charge box E Add Charge Date Code Amount lt Fa 34 16 1995 84153 42 D0 eee Description to o Diagnosis POS Writeott rr TP Reference Expected Mote Codes betes oo uy jo jo List Authorization X cancel The Date field will show today s date by default this can be overridden
109. mputer there should be a telephone line plugged into the modem 2 Log out of SchuyLab 3 Select HyperTerminal To access it through the Start Menu the path would be Start gt All Programs gt Accessories gt Communications gt HyperTerminal To establish a new connection click on the icon rather than the HyperTerminal folder 4 When you first bring up HyperTerminal it asks you to create a new connection Enter a name and choose an icon for the connection In the Name field type Medicaid BBS or whatever label you wish for the new connection From the row of icons select the icon you d want to click on to call Medicaid Select OK ER 125 5 HyperTerminal next asks Enter details for the phone number that you want to dial Complete the fields as shown here in this example we re using the MediCal BBS for California Country Code United States of America Area Code 916 Phone number 638 9838 Connect using whatever modem is installed in your computer When done select OK 6 HyperTerminal now displays the Connect box If you need to make last minute changes to the phone number amp c select the Modify button 7 Your computer modem should already be set up for your laboratory but it might need some final entries The most common will be if your phone system requires you to dial 9 for an outside line If that s the case select the Dialing Properties button In the field label
110. n you should now have an option under File and Folder Tasks to rename the file Click on Rename this File 3 Name the file in the format of your choosing We suggest the yyyy mm dd txt format discussed above 4 Press the Enter key and you are ready to start processing the file Setting up Remittance in SchuyLab When we have the folders chosen for our remittance downloads there is one other thing that we may want to do to make our lives easier We can tell SchuyLab where we expect to find the files 138 Select F7 Features Select Billing E SchuyLab Billing ERIC CS Fe MSTA LAE 16 58 65 zje ACcession Go ap Fa Bill Print Open Claims ACCESSIONS lrvoices Devices Ez HAH H m Create Client Electronic Edit worksheet Invoices Claims Account Ge amp a Print Create Patient Electronic Billing Invoices Remittance Analysis Payments if Features setup Jr Tools Electronic Remittance Posting 139 Select Setup E SchuyLab Define Billing Patient Jle Accession e ag be ae Electronic EEE Worksheet Billing Options ela Frint Ge Features Jr Tools Define Testto Procedure link Select Electronic Billing You will see all of your billing interfaces and your remittance interfaces E Update Electronic Payors Claim MEDICAL ANSI MED T CAL Claim MEDICARE ANSI Sa Cal Medicare d0i0 kemit MCREdASCA ANS 5o Cal Medicare Choose the remittance interface
111. named 835 dat you go to name it 20070815 but don t give any extension Windows keeps the existing extension then and the file would actually be named 20070815 dat The best way to avoid this is to always rename your files with a specific extension like the txt extension we use above Another possibility is that the file you have downloaded is not actually an 835 file If you have downloaded a 997 file or some other remittance format instead then SchuyLab will be unable to process it Check with the insurance company that you are setup to do 835 remittances and that you are looking in the right place to retrieve them Issue SchuyLab processes the 835 file but every line in the report has Not Found on it But you can find the claims in Edit Claims Solution Usually this happens when you go from submitting your claims in paper format to doing electronic submission and remittance in one fell swoop SchuyLab will only process remittances for claims that have been submitted electronically If you receive a remittance with claims from a paper submission SchuyLab won t process it Wait until you start getting results from your electronic submissions before using Electronic Remittance Issue When I process the 835 files all my claim amounts are going negative Solution Once again this is most likely a transition issue Often your billing department will be used to processing as soon as a check comes in and if you have payments and
112. nction select the Client Accounts icon SchuyLab displays the Client Accounts box 91 E Client Accounts Print activity on eee client accounts PR INTER l Activity level fall Accounts setup X Cancel Wyo Here you can specify current Queue and Activity level or go to Setup to specify default queue and font In the Activity level box you have a few different choices All Accounts This level will print listings for all accounts whether they have any activity or not Any Balance This level will print listings for all accounts that have a non zero balance Past Due 30 Past Due 60 Past These levels will print listings for all Due 90 accounts with balances in the specified range 1 e 30 days or older 60 days or older or 90 days or older Note that these settings determine which clients appear and which don t not what information is printed on those clients In all cases SchuyLab prints the Client Account Status report which looks something like this Current 30 Days 60 Days 90 Days 120 Balance Last Days Payment Client 1 10 00 25 00 0 00 0 00 0 00 35 00 3 1 98 Client 2 0 00 17 00 212 56 0 00 0 00 229 56 12 31 97 TOTALS 10 00 42 00 212 56 0 00 0 00 264 56 Because the client accounts are cumulative like your monthly credit card statement the totals do add up and can be reconciled 92 Patient Accounts Patients Accounts functions almost exactly the same as Client Accounts except
113. ned by Medicare regardless of how the tests within that panel were ordered and without duplicating the tests in other panels For instance if you ve ordered a Comprehensive Metabolic panel CPT code 80054 and a Hepatic panel CPT 80058 you may not be able to charge for the Hepatic panel there are tests found in both panels and you aren t allowed to double bill for those tests You would instead charge for a Comp Metabolic panel plus SGPT and Direct Bilirubin the remaining tests in the Hepatic panel Or as another example if you ve ordered Uric Acid Sedimentation Rate RA Factor and an Antibody Screen on a patient by Medicare s rules you must charge those tests as an Arthritis panel CPT 80072 even if your lab doesn t explicitly offer an Arthritis panel to its customers No Billing is not for the faint of heart Fortunately SchuyLab is able to deal with both situations It all hinges on the definitions of the panels and that s done outside Billing Setup The only panels currently defined in Billing Setup are the general chemistry panels 80002 80019 still used by some Medicaid providers and insurance companies We ll discuss these in order To define panels for billing purposes Select F8 Tools Select Set Up Select Test amp Panel Definition Select Panel Definition SchuyLab displays the Define Panels box listing all the panels currently defined in 28 your system E Define Panels AC
114. ng an outside line or need a special code to dial long distance you would set those properties up there You are now ready to connect and download your 835 file ER 131 Retrieving 835 Files Quick Reference Summary 1 Bring up HyperTerminal or other terminal program 2 Ifmenu screen does not come up hit enter key 3 Login using your submitter ID and password 4 When the menu screen comes up type to go to the Electronic Mail Menu 5 Type 1 on the Electronic Mail Menu to go to Display Send Receive Mail 6 Type 6 to Download mail to PC and choose the files you wish to download by typing in the corresponding number 7 When you are prompted about transmission protocol choose one Zmodem is generally a good choice if your terminal supports it 8 Press Enter to start downloading files they will be saved as MAIL H 9 When you are finished downloading quit out of the program 10 SchuyLab displays the Billing Module screen To start out with you will use HyperTerminal to access the Medicare BBS Go to the Start Menu by clicking on the Start button in the lower left of the screen when the menu pops up choose All Programs then Accessories then Communications If you see two choices that say HyperTerminal one should be a folder icon the other one will be the program icon If you have already setup the Medicare BBS as a choice you should click on the HyperTerminal Menu and then choose the Medicare BBS icon If you have not y
115. ng charge schedule Charge Expect Bill Code POS MEDICARE NA Add anew Schedule X Cancel Select Add a new Schedule again and proceed as above When all the schedules have prices select OK SchuyLab returns to the Multi Channel Tests box Select the next multi channel chemistry panel and repeat the above steps When all the chemistry panels have prices select OK SchuyLab returns to the Define Billing menu screen ae Procedures Once the tests from the lab side of SchuyLab are assigned their CPT codes and prices they are considered procedures within the Billing Module s use of the term 39 However there are other procedures not directly related to the lab for which you may want to charge venipuncture phlebotomy handling fees amp c This is done through the Procedures icon To define new procedures for billing From the Define Billing screen select Procedures SchuyLab displays the Billing Procedures box E Billing Procedures Description 80002 2 tests 80004 3 tests 80007 7 tests sotby Code Mame New procedure OF The Procedures box will already contain the multi channel chemistry panels defined through the Multi Channel icon Selecting one of these procedures from the list will bring up the Update Procedure box as seen in the discussion on the Tests icon with all the fields filled The buttons near the bottom permit you to sort the procedures either by CPT code or by name
116. odule altogether but don t worry it ll only take a moment 53 To update your list of doctors Select F8 Tools Select Doctor Records Select Update Doctor SchuyLab displays the Select Doctor box allowing you to search for a doctor by name E Select Doctor Enter the Doctor s name Last First x Cancel T Type in the name part of the name or ID number of the doctor you wish to update and select OK If there are multiple matches you will have the option to select a doctor from a list If there is only one match that doctor s information will be brought up If there are no matches you will have the option of entering in a new doctor E Which Doctor 0271 sap Mama 0223 see Fliu 0272 sevious Namco X Cancel NewDocor_ 54 SchuyLab displays the Add Update Doctor Record box E i Doctor Record Title Frovider A O ai IP Last Mame First Hame MAL License Sabourin Thomas E Medical Group LUPIN Address SSAM NFI Zip Telephone Queue Restricted OK l Extra Copy supervising Physician Delete RX _Cancel The ID field will automatically be filled by SchuyLab but if you prefer another number for this doctor you can enter it here Complete the remainder of the fields as shown For billing purposes the most important fields are Provider Enter the doctor s MediCal provider number in this field On the HCFA 1500 form this will print in
117. on field as well You will want to go with whatever information best fits the needs of your lab 150 Once we choose OK and the Write Off is entered we can see that our balance has been updated and an asterisk has been put next to our charge so that if we rebill at this point our written off amount will not be sent again E SchuyLab Edit Claim CS F2 Drinkwater VArEMEN sae LAR ID QOOO000005 Or Smith Robert 19 99 65 Patient Northwest Medical group 101 9142006 DOB 5 03 1952 54 Other ID 5591434604 jle E4 Cancel Fld Done Accession Claim Bill Type Payor Status Paper Employment De 50307566 MEDICARE MEDICARE READY Accident Diagnosis ICD 9 Homebound evices 345 1 Charged Paid Adjusted Balance a List 25 27 0 00 3 75 21 52 Date Typ Code Description 3 07 Chg 60165 DILANTIN 80185 4 20 Nte 80185 ANSIMEFL PR 31 36415 VENTPUNCT GOO01 36415 ANSIMRFL PR 31 P9604 TRAVEL P9604 P3604 Wei teat t P9604 ANSIMRFL PR 31 l n MEDICARE MCRE_FL Electron 7 6 14 Bld MEDICARE MCRE_FL Electron Necessity es Toals ksheet Price Patient Accession Claim Results 44 Prev gt gt Next We have a choice at this point to either delete out the Note code or not We might want to keep the note code since it contains the remittance processing information and doesn t affect the bottom line or we can delete it out if will just be redundant and confusin
118. or if you don t know the code for a particular diagnosis select the List button SchuyLab displays the Select ICD 9 Codes window listing the already entered codes with their corresponding diagnoses and allowing you to search for codes E Select ICD9 Codes Description HYPERLIPIDEMIA ISCHEMIC HEART DISEASE FATIGUE search by code or phrase Select allwords C anyword C phrase search x Cancel vw In the Search by code or phrase field type in all or part of the ICD9 Code or Description Click on the Search button Any matches to the search will appear in the space below Select the desired codes from the list and then click on select 69 When you are finished adding codes click on the Ok button to save your changes SchuyLab returns to the Edit Claims screen with the selected codes entered in the Diagnosis fields You can have up to four ICD 9 codes per claim 70 Charged Paid Adjusted Balance Claim the button Prev These fields are calculated automatically by SchuyLab and are recalculated automatically when items are added or removed Charged is the total of all charges on the claim Paid is the total of all payments made Adjusted 1s the total of all adjustments such as Write offs The Balance is how much is still owed after Payments and Adjustments Put notes or comments on the claim The comments placed here should apply to the claim as a whole rather than to a single line item
119. oratory Billing Address box E Laboratory Billing Address Billing Mame Schuyler House Clinical Lab Address m Huntington Lane Unit F Caty ot Zip Valencia CA 91355 Telephone 800 706 0266 X Cancel Ta In the Billing Name field type your lab s name In the Address City St and Zip fields enter the address as it should appear on your invoices where to send the money The Telephone field is optional When done select OK SchuyLab returns to the Laboratory Billing Options box When all the fields are complete select OK Defining Billing Schedule 2 Schedules The Schedules icon defines the different billing schedules These allow you to assign different sets of prices for different clients bill types amp c The SchuyLab Billing Module uses schedules as a common factor we associate a particular schedule with a specific client patient bill type e g Medicare and insurance carrier You can have as many fee schedules as you have bill types clients and insurance carriers In general though you ll want to simplify your life by using as few schedules as you need 13 To define the billing schedules From the Define Billing menu screen select Schedules SchuyLab displays the Billing Schedules box listing all the schedules currently defined in the system E Billing Schedules Description CLIENT Client fee sched INSURANCE insurance fee sched MEDICAL MediCal MEDICARE Medicare
120. ors box are Medicare and your state s Medicaid listed Select each one in turn Is the correct format ANSI or NSF in place Are the Payor s Organization Submitter ID Receiver ID Name of Contact and Export Pathname all correctly entered Go to Insurance In the Update Insurance Carriers box are Medicare and your state s Medicaid listed They ll be at the very bottom of the list and their ID numbers will begin with the letter X Select each one in turn In the Electronic field is the appropriate Electronic Payor entered If it says N A Electronic Billing won t work Go to Laboratory Options In the Laboratory Billing Options box is one of your Electronic Payors entered It doesn t matter which one but one of them has to be there if it says N A Electronic Billing won t work 116 In addition before you can begin Electronic Billing Medicare and Medicaid require you to have accounts with their BBS systems these come with submitter ID numbers and passwords which are over and above your provider ID or CLIA numbers Using Electronic Claims Okay now that we ve reviewed our setup we re ready to begin using Electronic Claims Remember Electronic Claims works in much the same way as the HCFA 1500 forms In both cases the claims have to be set to the correct payor and their status set to Ready before they can be billed The only real difference between Electronic Claims and HCFA 1500 forms i
121. ou set when defining the schedule NOTE On some schedules you may not want to charge for a procedure There are two ways of doing this If you simply enter a zero 0 in the Charge the procedure will appear on the invoice with a charge of 0 00 If you don t want it to appear on the invoice at all enter a negative one 1 or a negative two 2 in the Charge field This will cause the test to be either NC No Charge if you enter the 1 or NA Not Applicable if you enter 2 The distinction doesn t mean anything for a test but it does for a panel more on that under the discussion on Panels Either way the procedure will not be billed it won t even show up on the invoice 5 optional In the Bill Code field type the procedure code to be used on this schedule for this procedure Medicaid may have different codes for some tests for instance In the POS field type the code for this procedure if it s done elsewhere than in your lab The Expected field is not functional at this time 6 When all the fields are correct select OK SchuyLab returns to the Update Procedure box 7 Select Add a new Schedule to add another schedule to the procedure Repeat the above steps 8 When all the desired schedules have been added to this test select OK SchuyLab returns to the Test to Procedure Translation box Select the next procedure you wish to edit and proceed as above 9 When all the procedures have schedules attache
122. over them To do this 1 2 3 4 From the Billing Module main menu select Patient Claims SchuyLab displays the Bill Patient Claims box Select the Rebill Previously Billed Claims option that is put a check mark on that box In the Claim Number Range field enter the range of claim numbers i e specimen numbers to be printed Select Bill SchuyLab prints the invoices on the queue defined in Setup for all Billed claims whose payor is Patient and adds another line item to each claim with the date billed Account Based Invoicing The second way to do patient invoicing in SchuyLab is to use account based patient invoicing Using this type of patient billing patients are treated like clients with account numbers and multiple unpaid claims combined on one invoice When you are setup to do account based patient invoicing and enter billing you get a different icon than you do with claims based patient invoicing Patient Claims is replaced with Create Patient Invoices 2 To create patient invoices 110 From the Billing Module main menu select Create Patient Invoices This is where you will generate patient invoices for your accounts You get the following screen E Bill Patient Accounts There are 22 patient claims ready to bill LIT Bill thru statement Date 2 1672005 Due Date Setup Cancel 7 ok If you click on List at this point you will be taken to a listing of all the possible
123. panel to be billed to Medicare but only to a private physician probably on a monthly invoice then the procedure code needn t be a CPT code You can use an in house code instead Remember even to private payors a panel cannot be billed unless it has some procedure code But if this were a panel you devised for this one client then you can invent your own procedure code for it 33 To charge different prices on the various fee schedules select the Add a new Schedule button SchuyLab displays the Add Schedule box Select the appropriate schedule from the Schedule pull down field and enter the appropriate charge for that schedule in the Charge field NOTE If this panel is not applicable to one of the schedules say Basic Metabolic to a Medicaid schedule or a client s private panel to a Medicare schedule in the Charge field type 2 SchuyLab will ignore that panel for billing purposes and will bill for the components of the panel instead 1 Add Schedule Eg schedule Charge Expected CLIENT l 0 00 0 00 Bill Code POS Note Code PP Blo us X Cancel Wo When done select OK and then repeat for the other schedules When you re done return to the Add Update Procedure box You should have a screen that looks something like the one below with the procedure code and base price displayed along with the schedules E Update Procedure Lode Description CBC CEC Charge Bill Code POS Note Cod
124. percentage of the standard price of zero and naturally all the claims based on that schedule had prices of 0 00 I ordered a Basic Metabolic panel on a Medicare patient But the claim shows a Basic Metabolic panel and an Electrolytes panel I didn t order Lytes What gives What gives is that the Basic Metabolic panel wasn t defined correctly on the lab side of SchuyLab Remember whenever possible a large panel should be built from smaller panels otherwise SchuyLab Billing will build both panels In this particular case the Basic Metabolic panel has seven tests Glucose BUN Creatinine Sodium Potassium Chloride and CO2 The Electrolytes panel has four tests Sodium Potassium Chloride and CO2 matching four of the tests on the Basic Metabolic panel So Basic Metabolic needs to be defined not as seven tests but as Electrolytes plus three tests To fix this go to F8 Tools Setup Test amp Panel Definition and finally Panel Definition Select the Basic Metabolic panel and change its definition to Glucose BUN Creatinine and the Electrolytes panel Select OK go back to Billing and Edit Claims look up the claim in question and hit the Price button Chapter 3 4Client Billing Overview of Client Billing Client Billing creates an invoice for any of the Clients in your database The invoice lists the patients names and specimen numbers the procedures and prices for each patient and the total amount due
125. port and compare them eal B US 14 S7088 16 50 CO A2 2 50 14 00 Claim Totals 16 50 2 50 i4_00 40805018 As you can see you charged the insurance company 16 50 for this test Under the contract they have with you they paid 14 50 and SchuyLab automatically wrote off the remaining 2 50 Notes and Write Offs The above example was a CO adjustment Most of these are price adjustments that you knew were going to happen to begin with They are normally not rebilled so SchuyLab writes them as an adjustment and if it zeroes out the account the account is closed However some adjustments you will get back from your insurance company will be of a different sort You may be missing certain patient demographics or have a typo in your ICD 9 code or other correctable issues Or it may be a test that Medicare won t pay for but the patient has secondary insurance to cover it In these cases you may or may not want to rebill certain items SchuyLab handles these by adding them to your claim as note codes rather than adjustments Note 148 codes will show the amount and the reason code the insurance company gives for the adjustment but will not be added into the bottom line This document has note codes for each charge E SchuyLab Edit Claim CS E Drinkwater Helretitel 4 LAE ID OOOOO00005 Dr Smith Robert 65 Patient Northwest Medical group 101 9714 2006 DOB 5 03 1952 54 Other ID 55971434604 B ES Cancel
126. r month day rather than the month day year we are more used to seeing in the USA So what should you name your files For simplicity we suggest a format such as yyyy mm dd txt for example 2007 08 06 txt for an 835 file dated to August 6 2007 The date so that it can be displayed in order by date and txt so that you get rid of any strange extensions like the 594 in MAIL 594 and to make it easier if you need to check on something in the file later What date should you use for the file Well since sometimes remittance files will contain payments or rejections from multiple claim files using the claim date could be problematic so you will probably want to use one of two values The post date for the file on the server or the date that you download the file from the server The advantage of the latter is that it is easy to check on using View gt Details the disadvantage is that if you download multiple files on the same date you will have to name them 2007 08 06a and 2007 08 06b and if they are from multiple weeks they may seem artificially close together The advantage of the former is that you don t have the disadvantages from using the download date but you have to look on the processor s site to find the information you need to name your files So back to our renaming process 1 Once you have located the file that needs to be renamed click once on it to highlight it 2 On the toolbar on the left hand side of the scree
127. rds screen accessed through F8 Tools Client groups are assumed to be financial entities as opposed to doctors which are medical in nature we distinguish between Dr Shipley who ordered the CBC and Wm Shipley M D Inc a California corporation If you have not yet defined your list of clients you should do so as part of Billing Setup To add or update your list of client groups From the Define Billing menu screen select Clients SchuyLab displays the Update Clients box listing the currently defined client groups in alphabetical order E Update Clients Enter the Client s name 0224 Baltimore Zao 004G Bud s Medical Center 0017 Client 0169 Dr Brown s Medical Offices 0222 Family Practice 0188 kinko s Kitten Kare 0218 LABCOR 0091 Mandate Clinic 0134 Office of Dr Feelgood 0220 Sample Medical Group Add Client Ta Type in the name or ID number of the client group you wish to update and select OK OR Type in the first letter s of the client group you wish to update and select Find then choose from the list OR Type in the name of the new client group you wish to create and select OK OR Select Add Client without typing anything 51 SchuyLab displays the Add Update Client Record box E Update Client Record ID Fee Schedule Account sales Telephone iit E i _ GUELE a Lopy to Fax or __ fu a_i Client Name Telephone 2 Nor thwest Medical grop Address ma W Acti
128. red I set up one fee schedule for my doctors another for Medicare When I look at the claim the wrong prices are displayed for the procedures First make sure that the patient s demographics are correctly entered To do this from the Edit Claim screen select the Demographics button Is the patient s Client correct Remember the Client field determines who gets billed not the Doctor field Is the patient s Bill Type correct If not change them here and then select F10 Done exit the Edit Claim screen and use Bill Accessions to bring the claim across again If the patient s demographics are accurate then go to Billing Setup Make sure the fee schedules you ve defined are attached to the appropriate Bill Types Insurance carriers and Clients For instance the Medicare fee schedule should be attached to the MEDICARE bill type through the Bill Types icon The schedule for Client Billing should be attached to the client record through the Clients icon Insurance schedules should be attached to carriers via the Insurance icon And so on If the schedules are correctly attached we have one more place to look In Billing Setup select the Schedules icon Make sure each schedule is correctly defined In particular make sure that the Medicare style fee schedules have the CPT Rules box checked Also make sure that the Pct field has an entry other than zero I know one user who had entered a Pct which 1s the
129. rocedure codes and prices for individual tests From the Define Billing screen select Tests SchuyLab displays the Test to Procedure Translation box E Test to Procedure Translation Description Procedure A FETO PROTEIN ABO 66900 zy ANTIBODY SCREEN 86650 A G RATIO Cale ALBUMIN 62040 ALE PHOSPHATASE 84075 AMIKACIN AMOKTECILLIN AMPICILLIN APTYLASE w Code Mame The Test to Procedure Translation box lists all the tests currently defined in the SchuyLab system regardless of whether they have prices or codes assigned yet The buttons on the bottom of the box allow you to organize the list either by Code the eight character code that SchuyLab uses internally or by Name the complete test name that s actually printed on the patient report In either case the ordering will be alphabetical Select the button that arranges the list most conveniently for you 21 To add or change the procedure code for a test select that test from the list SchuyLab displays the Add Update Procedure box E Update Procedure Lode Description ALKPHOS ALK PHOSPHATASE Charge Bill Code POS Note Code 12 00 s4075 Ho List Mo discounts allowed Add Handling charge schedule Charge Expect Bill Code POS MEDICARE 7 20 7 20 Add a new Schedule X Cancel Delete W o SchuyLab shows the code and name of the test in the Code and Description fields The Code is unique to each test and cannot be change
130. s Solution Was there a check for those claims There is probably nothing wrong here Some companies will put out remittances of the non paid claims before doing the full or partially paid claims Your payments will likely be in the next 835 file If you get several 835 files in a row without any payments showing up you should contact the insurance company that is processing the claims as sometimes they may not be rejecting the 837 files you send them but there is an issue that doesn t come out until the individual transactions are processed 153 12 Month Revenue 0006 7 ACCOUNUS sc sanandesinciedsareetecvonaas 101 ACIUSTIMCNIS aasman 104 Batch Payments 00006 7 85 Bi lleACCESSIONS ixsvesciginiiedes essed 6 BULT DCS resero 17 displayed in Edit Claims 67 SEUD airis nescence ecu 96 108 Billing Analysis cccccccceee 85 Billing SCO Dis aeacinedibasieieciarsbhow 10 BT TD VD CS aenean 17 billing address 0008 13 electronic billing 6 56 Medicare TDs sitegiedceim ection IZ 8 21 oe eee ee 28 required information 19 SC MCCUE S aosan 13 23 ES EE EE E S 21 CHISE nee ee Soe eee adding to account 105 adding to claims 066 76 Claim Aging ccccccceeeeees 7 84 CIAIINSiajidsceeicichactelnetinaciaassieeiae 4 62 1211 Care eee mere ner meaner ee arent ener 76 SUING eenia 63 75 patient demographics
131. s Doctor Records Update Client and select a client or create a new client entry you d see the Update Client Record box E i Client Record Fee schedule Account Sales Telephone of f Tl GUELE Copies Copy to Faw ee ESON EO Client Mame Telephone 2 Northwest Medical group Address Active 1 lndividual Provider City St Zip E m_a Tax IDF Responsible Physician P s MP Do not bill this client Print Mew Patent Reports Tela Special Panels COAG COAGULATION Ser A Cancel LIFID LIPID STUDIES Add wf OK The field labeled Sales is where the sales representative for that client is entered It might be the rep s initials or a number but it should be some unique identifier for that sales rep 89 Once that s done the Sales by Rep function can be used To access the function from the Billing Analysis menu screen select the Monthly Sales icon SchuyLab displays the Sales Report by Rep box E Sales Report by Rep Report Date Range GUELE setup X Cancel OK In the Report Date Range fields enter the beginning and ending dates for the report and select a print queue When all is ready select OK SchuyLab prints the Sales by Sales Rep Report The headings and layout are the same as the Monthly Sales Report above but all the clients for each sales representative are collected together under the rep s name There s even a section for clients with no sales r
132. s Setup Cancel Bill From here the Patient Invoicing functions are accessed Bill types are the key to Patient Invoicing When defining bill types you have a choice of payors to be billed through that bill type Medicare Medicaid Insurance Patient and Client Review Section I Billing Setup for more information Any bill type with Patient chosen as a payor is available for Patient Invoicing For bill types with multiple payors you must wait until the payor has rolled over to Patient before using Patient Invoicing some bill types have only Patient as a payor and are intended solely for Patient Invoicing these are often given names like PATIENT or CASH 108 The first step is Setup to insure that the patient claims print to the desired printer queue To do this select Setup SchuyLab displays the Configure Patient Claims box E Bill Patient Claims E Configure Patient Claims Eg CIUEUE Font REPORT Draft W Print aging atthe end Combine charges into a single tem A Cancel ef From the Queue list field select the printer queue you wish to use for patient invoices From the Font list field select the font you wish to use this should probably match the font used in the other reports in your system When complete select OK The Patient Claims is now ready for use At this point you have two choices You can print a test case to make sure your printer is properly aligned an
133. s example we ve selected claim 4010057 SchuyLab displays the Edit Claim screen E SchuyLab Edit Claim Name No ERTCSTOK MSTR ID DOU008bb Or Doctor Test E 14 27 499 Sample Doctors Ine 2 08 2005 DOB 12 29 1944 60 Other ID FS Cancel 10 Done Claim Bill Type Payor Status Paper Employment 4010057 CLIENT CLIENT l CLOSED gy Accident Diagnosis ICO 9 Hormebound Charged Paid Adjusted Balance Date Typ Code Description 9 03 chg 80061 LIFID STUDIES Charge 9 03 chg GOO01 BLOOD DRAW 3 03 chg 80076 HEPATIC PANEL A Payment 2 09 Inv CLIENT Client Invoice Write Ott Price Patient Accession Claim Results 44 Prev gt gt Nex Note that the invoice is a line entry on the claim the Balance is now zero 0 00 and the Status is now Closed Once your review is complete select F9 Cancel to return to the Edit Invoice screen Showing the full invoice To print the invoice select Print To leave the Edit Invoice screen select F9 Cancel SchuyLab returns to the Billing Module main menu screen Account Maintenance ie Once you ve sent out your invoices you probably expect payment Or you may need to make other adjustments in a Client s account Payments charges and write offs can be entered through the Edit Account icon Please note that in some cases you may want to edit the Client s account before 101 generating the invoices to
134. s where the information is sent to the printer or to a diskette a To use Electronic Claims From the Billing menu screen select Electronic Claims SchuyLab displays the Electronic Claims screen E SchuyLab Electronic Claims DiR ERTCSTOK 11 44 4353 1 05 2005 Fa Cancel 10 Done 8 MEDICARE MEDICAL In this example there are two icons visible one for Medicare one for MediCal California s version of Medicaid ER 117 Medicare Most labs electronic transmissions will be for Medicare claims The Medicare age group is the most rapidly growing section of the population after all To prepare the Medicare file 1 From the Electronic Claims menu screen select the Medicare icon SchuyLab displays the Export ANSI claims to MEDICARE box E Export ANSI claims to MEDICARE X To export claims in ANSI Ea format insert a blank disk and press Enter select Path A MED CAR Claim Number Range Test Gilling no status change Rebill previously billed claims 2 Puta formatted diskette in your A drive 3 The Select Path field displays the default pathname you defined as part of Electronic Billing setup If you wish to override this and type in another path select this field then type it in 4 In the Claim Number Range fields enter the first and last claim numbers you wish to transmit 5 If this is a test transmission to Medicare to see if it works check the Test
135. side When claims are written to an invoice a transaction entry Invoice and the invoice number is automatically made on each claim the claim is zero balanced and the status of that claim is set to Closed Thereafter the balance due is handled as part of the invoice rather than as individual claims There are four icons in the Billing module specifically designed for use in Client Billing and invoices Create Client Invoices Edit Account Edit Invoice and Print Invoices 96 Create Client Invoices Select this icon to generate your client invoices usually monthly but they could be at any other regular interval Once this function generates the invoices they will automatically be printed You can generate invoices for all your clients at once or choose which clients to invoice at this time a Edit Account Use this icon to manage your invoices deleting or repricing enter payments or make adjustments To view the contents of a particular invoice point and click at the invoice entry in the list box and SchuyLab displays that invoice Once you ve done that and are looking at a particular invoice you may view a claim on that invoice in the same manner Point and click on the line item representing that claim and SchuyLab displays the individual claim information To back out from the claim level and go back to the invoice select F9 Cancel SchuyLab returns you to the invoice Do likewise to return again to
136. space 1 7a Enter the doctor s medical license ID in this field Enter the doctor s UPIN Universal Personal Identification Number in this field On the HCFA 1500 form for Medicare claims this will print in space 17a Enter the doctor s Social Security number in this field On the HCFA 1500 form for insurance claims this will print in space 1 7a 55 The National Provider Identifier is a new number that will be used by both Medicare and Medicaid to uniquely identify healthcare providers rather than using separate Medicare and Medicaid numbers They are currently usable and starting in May of 2007 they will be required for all Medicare transactions When all the fields are complete select OK Setting up Electronic Billing and Remittance Electronic Billing SchuyLab is able to write billing data patients names tests performed charges amp c to a file which can then be transmitted to Medicare Medicaid or an Insurance Clearinghouse SchuyLab prepares the data and writes it in a format designed for the receiver To set up SchuyLab for electronic transmission From the Define Billing menu screen select Electronic Billing SchuyLab displays the Update Electronic Payors box listing the electronic payors currently defined in the system E Update Electronic Payors Claim MEDICAL ANSI MED T CAL Claim MEDICARE ANSI Sa Cal Medicare dOio kemit MCREASCA ANS 5o Ca Medicare Select one of
137. splays the Add Writeoff box E Add Writeoff Description Wei teat Ft Reference Mote Codes majo fo us eo In the Amount field enter the dollar amount of the adjustment optional If you wish to call the adjustment something other than Writeoff select the Description field and enter the name here You might want to call it Discount or Rebate for instance You can also annotate the adjustment using the Note and Result Codes features In the Reference field enter the number of the invoice for which this adjustment applies This makes sure that this transaction is applied to that invoice in particular not to the account in general Select OK SchuyLab returns to the Edit Account screen with the new Writeoff listed and the Total adjusted 8 To enter a new charge select the Add Charge button SchuyLab displays the Add Charge box t Add Charge Eg Amount 0 00 Description Diagnosis POS Reference Expected Mote Codes po 0 0 A o o ts X Cancel Authorization C vok 9 Inthe Amount field enter the dollar amount of the new charge lity o OO go g Doe X Cancel 10 In the Description field enter a brief description of the new charge You can also annotate the new charge using the Note and Result Codes features 11 In the Reference field enter the number of the invoice for which this charge applies This makes sure that this tr
138. sposition Menu 1 Production 2 Test Model Office E Exit Enter Selection You will want to start out with test transactions so we will choose 2 and hit enter 11 Medicare is now ready to receive your file Use your modem software to begin transmission HyperTerminal From the menu bar select Transfer gt Send File HyperTerminal will ask for the name of the file Type A MEDICARE or whatever the name you exported from SchuyLab and Enter The modem software will keep track of your progress in sending the file 50 75 amp c When it s done you ll return to the Medicare BBS screen 12 Disconnect and Exit from the Program HyperTerminal From the menu bar select Call gt Disconnect Then choose File gt Exit to close the window Subsequent Transmissions to the Medicare BBS As soon as your test transmission is validated you ll be able to send as many claims as you want to the Medicare BBS The steps are exactly the same as they were for the first transmission except that the files being larger will take longer to transmit over the phone lines You may want to time your calls for early in the day to avoid busy signals Follow the instructions given above To recap them 1 Generate claims on SchuyLab and export them to a diskette 2 Log into your modem software and connect to the Medicare BBS 3 From the Main Option Menu select option 3 Claims Submission Menu 4 Se
139. t be defined as Medicare and the CPT codes define it at a minimum You could of course add more tests to this minimum but then you d be giving away money And if the panel can be defined in terms of a smaller panel you should do so For instance your large Thyroid panel CPT 80092 should have as its components your small Thyroid panel CPT 80091 plus TSH Do not define it as T3 T4 and TSH or you ll end up double billing Medicare every time you order it It s not always possible because some panels definitions don t completely overlap but it must be done when possible 29 E General Multi Channel Chemistry Panels Obsolete The only exception to the above setup would be for the General Chemistry panels the ones done automatically by most modern chemistry analyzers They re sometimes called multi channel chemistry panels because all the tests are coming from the analyzer at more or less the same time These multi test chemistry panels are defined not by which tests they include but by how many tests they include Until 1998 Medicare recognized these multi channel chemistry panels as of this writing Medicare no longer pays for them SchuyLab has special programs to accommodate chemistry panels for any agency that still recognizes them while still using the disease oriented chemistry panels for Medicare This is done through the Multi Channels icon To set up the multi channel chemistry panels
140. t requirements In particular our reports system which allows you to have tremendous control over your report s layouts can also be used to print claims customized to your needs So how would you setup one of these claim reports First you need to create a new report type 44 Select F8 Tools Select Set Up Select RePort Setup Select Reports SchuyLab displays the Report List Box E SchuyLab Report Setup F2 E Report List Patient Single Accession Specimen Report vA leat Ammon 41 CARDIAC ACCeSsion CHOP Chinese Sample Headings Location client Cytology Devices Demographic gls Worksheet Glee Print G ie Features SE Fs Tools From here click on New Report to bring up the Create New Report box E Create New Report Name Description Type 1 col accession Setup Print X cone __ From here there are two ways you can go depending on what kind of form you need 45 to fill out If you are writing one form for one claim you should choose the type Claim from the Type dropdown list This will make the claim information available for this report If the form covers is a cumulative report covering multiple claims then you should choose Invoice as the type In either case you should of course give it a descriptive name and description in the name and description boxes so you don t confuse it with one of your other reports For the moment assume that you ve chosen C
141. tandard Pricing which is your base fee schedule This isn t an explicitly defined schedule that is you never have to enter Standard or Base Price as the name of a schedule Rather this fee schedule is compiled by SchuyLab from the base prices defined for all the procedures Although the Billing Schedules function will not display this schedule on the screen it will print out for you The Standard Pricing schedule is followed by the schedules you ve defined for your system 4 To print all the fee schedules select the Print All button 43 5 To print one or some of the fee schedules select them from the list SchuyLab highlights in grey the schedules you select In the process the Print All button changes to become the Print Selected button E Print Fee Schedules E Print Fee Queue schedules BILLING I Only list custom prices Lode Description LLIENT Client fee sched INSURNLE insurance tee sched MEDICARE Medicare PATIENT PATIENT Setup Cancel Print Selected When you ve chosen all the fee schedules you wish to print select Print Selected SchuyLab prints the fee schedules Setting up Custom Paper Claims For the majority of our customers their paper claims will use HCFA 1500 forms and no special setup will be required Some of our customers however and particularly those who are not in the United States may need to print out insurance claims with differen
142. ter your Federal Tax Number Your CLIA ID Medicaid MediCal ID and Medicare ID numbers should be entered in the appropriate fields These numbers will be printed on your HCFA 1500 forms the Tax ID field in space 25 on the form the CLIA ID field in space 23 and utilized in Electronic Billing as appropriate If your lab has an NPI number you can enter it in the appropriate box If you don t and you bill Medicare or Medicaid you really need to get one check the CMS website for more info SchuyLab will start utilizing it for both HCFA and Electronic Billing shortly The Bill Tests and Panels buttons on the bottom left determine when the bills are to be generated when the tests are ordered or when all tests are complete Next to the Bill Tests and Panels buttons you have buttons to determine whether 12 you wish to Bill Patients via Claims or Accounts If you leave this set at Claims when you directly invoice Patients it is for a specific claim Changing this to Accounts will put all outstanding bills for a patient on one invoice Changing this setting will have a number of effects on the billing section and if you change this setting you should exit completely out of billing before doing anything else with billing If your billing address differs from your lab s address that is if you receive mail in a different place than you actually perform the tests select the Billing Address button SchuyLab displays the Lab
143. tes panel plus the extra tests that would have gone into the Comprehensive NOTE While the CPT rule does normally give precedence to larger panels over smaller panels an exception 1s made if you re still billing for the General Chemistry panels 80002 80019 Medicare doesn t pay for those panels any more but as of this writing some states Medicaid programs insist on using them In those cases SchuyLab will try to build all the CPT panels it can from the tests that were done if any chemistry tests are left over they re bundled into the appropriate General Chemistry panel Since statistics are accumulated by SchuyLab on a daily basis and may be printed in any increment of time the user selects a month end closing is not necessary desirable or possible Bill Accessions Claims are imported from Lab to Billing by specimen number range The Bill Accessions icon begins the billing process By selecting this icon you can enter the range of specimen numbers you wish to be imported from the lab side to the Billing Module Take into consideration your typical turn around time for a final report if you bill as run rather than bill as ordered you ll want to wait until most of your specimens are complete before billing them We recommend 48 hours as a reasonable waiting period Edit Claims Claims are individually edited individual line items can be manipulated In order to assure that each claim has
144. than those that are still in house SchuyLab has no way of enforcing this of course we can t tell whether you ve stuck a stamp on an envelope but it s the standard accounting practice and you should make it part of your Billing Department SOP If an invoice is still in house you can revise and regenerate it with relative impunity if you ve sent it out to a Client you need to post changes as adjustments on the Account rather than just alter the invoice Such adjustments would then appear on the next invoice Think of your monthly credit card bill If you spot an error they don t send you a new bill the adjustment shows up on next month s bill right To rebundle and or reprice the most recent invoice 1 Leave all the claims set to their current status Closed 2 Select Setup Billing Create whatever changes to the prices panels rules schedules etc that need to be reflected in the new invoice 3 Select the Client icon Apply the new Schedule to your Client if necessary 4 Select F10 Done to return to the main Billing menu screen then select Edit Account 5 Enter the account number Be sure to precede the account number with the number sign Select OK 6 Point and click on the most recent invoice 7 Select the Price button SchuyLab asks if you wish to reprice the invoice Say Yes SchuyLab reprices that invoice 8 Select Print to print the newly priced invoice To r
145. the file in this case we will be using Colbert 2 and then select OK If you downloaded the EOB to a floppy disk your path will something like A name of file After selecting OK SchuyLab does the rest for you but you will need to check the claims line item by line item checking the payments and any remarks The Report Let s look at the report that is opened There are three parts to the report the header the payments and a summary E BCBS Alabama Remittance BCBS Alabama Remittance Created 8 14 7004 11 21 Test Posting BLUE CROSS BLUE SHIELO OF ALABAMA Processing Date 8 15 2004 450 RIVERCHASE FEHY EAST Check EFT O024134217 BIRMINGHAM AL 35244 Check amount 6401 91 Svc Date Proc Billed Adjustments Deduct Co Pay Paid 40802072 inane minnadll 602704 84560 16 50 CO Az iz 30 Claim Totals 16 50 12 30 40802032 eae ian 8 02 04 80074 00 CO A2 136 00 Claim Totals 165 00 136 O00 40730014 Teog S297 22 00 CO A2 is 30 Claim Totals 22 00 15 30 40805095 PoE femme 5705704 SO076 27 50 CO A2 20 00 5705704 50074 165 00 CO Az 136 00 Claim Totals 1932 50 O0 40809132 Filadiippe amaa 5709704 564320 z4 75 C AZ i 00 60 Not Found 5709 704 56038 35 50 C AZ i 60 Not Found Claim Totals B3 25 z0 im C ooe The header part is simple the name and address of the insurance carrier the process date of this claim the check number that has been issued to your lab and the check amount
146. tions you must have at least one schedule with the CPT Rules check box marked Even if your prices to Medicare are the same as your base prices the schedule has to be there so that the CPT rules can be activated When all the schedules have been defined select OK SchuyLab returns to the Define Billing screen Setting Bill Types a Bill Type The Bill Type icon defines the types of bills that will be used in the system Each bill type has payors defined for it as well as the method of billing by claim by invoice or straight to the patient as well as a list of the information the billing department 1 e you would need for a complete claim To define the Bill Types From the Define Billing screen select Bill Type SchuyLab displays the Update Bill Types scroll box listing all the currently defined bill types E Update Bill Types CLIENT CLIENT INSURE Insurance MEDICAL Medical MEDICARE Medicare MEDIMEDI Medicare Medical NOLAARGE Mo Charge PATIENT Patient PHYSICH Bill Client Bill Doctor detail t A Cancel Mew Type Ta Ok Select one of the entries in the scroll box or select New Type to create a new entry 17 SchuyLab displays the Add Update Bill Type box E Add Bill Type Eas Code Ep Fee Schedule Sf Standardy Mame Medical Necessity Payors for this Billtype Medicare Write OH Medicaid 0 oo Insurance Patent Required Client B Rce oe
147. to consider It will default to today s date In the Specimen Number Range enter the first and last specimen numbers you want brought over to the lab side of SchuyLab If your lab doesn t use date based specimen numbers you might find it hard to remember the specimens for a certain time period Print out an Order Log for the appropriate dates and then use the first and last specimens on the Log Leaving the Specimen Number Range fields blank will cause all the specimens up to the cutoff date to be brought over When all is ready select OK SchuyLab generates claims from the date or specimen number range that you entered and makes those claims available to the Billing Module 62 Editing Claims Once the claims have been brought over to the Billing Module they can be individually edited if you choose You may for instance need to prepare them for billing or to enter EOB s or you might simply want to scan through the Open claims for those with incomplete information This is done through the Edit Claims icon To edit claims that have been generated From the Billing Module menu screen select Edit Claims SchuyLab displays the Edit Claims box E Edit Claims search By Status Bia S search By Bill Type Bia First Claim By patient Cancel 63 In the Search by Status section select the status of the claims you wish to examine This is done by pulling down the status
148. to download files to the correct directory when we grab them Following our example from the previous section we have a HyperTerminal selection labeled SoCal Medicare 1 Following the instructions in Retrieving 835 files immediately following the numbered list bring up your HyperTerminal Connection for Medicare You will be given a choice to Dial or Cancel 2 You can choose either for this purpose but for now we will choose Cancel SO we aren t tying up lines This will bring up an empty terminal window with a toolbar and menu bar 3 On the menu bar choose Transfer and then choose Receive File This will bring up the Receive File window 4 Where it says place received file in the following folder there will be a folder pathname listed highlight this pathname and then press the delete key on your keyboard 5 Type in the path of the folder where you want the files to go in our example this is c 835 Medicare 6 Click the close button Your receive directory has now been changed You can exit HyperTerminal at this point by clicking the red X in the upper right hand corner of this window 136 7 If you have HyperTerminal connections for any other place that you have electronic remittance for follow this same process for them typing in the appropriate path in step 5 So now we move on to the next issue uninformative file names Changing the names of your downloaded files As we noted California Medicare
149. transmissions call their CMC Technical Support at 916 636 1100 The most common problem is a freezing of the line that s simply the BBS being overloaded and there s nothing to do but log out wait a few minutes and try again 128 Chapter 7 Electronic Remittance Setting Up The Medicare BBS Connection This document is to show you how to setup a typical HyperTerminal connection to the Medicare s BBS system In this document we make the assumption that you have Windows XP Pro on your computer and many of the examples we will be using involve Southern California Medicare Other regions will normally have similar but not exactly the same setup Start by bringing up HyperTerminal You do this by going to the Start Menu then choose All Programs then Accessories then Communications and choose HyperTerminal At this point HyperTerminal opens and gives you the New Connection dialog First type in your state s Medicare i e SoCal Medicare and then choose an icon or just click OK to use the default icon Connection Description Sy Hew Connection Enter a name and choose an icon for the connection Name lor ER 129 HyperTerminal will then ask you to enter the area code and number you will use to dial At the time of writing the possible numbers for Southern California are 213 593 5943 or 530 879 1774 You will also want
150. ve ingdiigdual Provider City oto Zip Tam IDF i a Responsible Physician d MFI Do not bill this client Print New Patent Reports Delete Special Panels COAG COAGULATION Seq A Cancel LIPID LIPIO STUDIES Add The ID field will automatically be filled by SchuyLab but if you prefer another number for this client you can enter it here Complete the remainder of the fields as shown For billing purposes the most important fields are Fee Pull down the scroll list and select the schedule to Schedule be assigned to this client The default will be your base schedule Enter the initials or other identifying symbol of the sales representative for this client Sales to this client will thereafter be credited to this sales rep in your Sales by Rep reports Active Check this box if the client is still active and should still appear in reports and as an accession possibility Ifthe Client is no longer with your lab but you still need to keep legacy information you should uncheck this box rather than deleting the client 52 Individual Checked if the client is a single individual unchecked if the client is a group or organization Provider Enter the client s Medicaid or MediCal provider number in this field Tax ID Enter the client s tax ID number in this field NPI The National Provider Identifier is a new number that will be used by both Medicare and Medicaid to uniquely identif
151. ve example the Medicaid payments for the month of May don t equal the Medicaid charges for the same month because the payments apply to charges from previous months instead They were the payments entered in May not payments for the charges in May 87 0 00 0 00 0 00 0 00 12 Month Revenue The 12 Month Revenue function prints a sales report for a full year for any given client or for all clients To access the function select the 12 Month Revenue icon SchuyLab displays the 12 Month Receipts Report box E 12 Month Receipts Report Report Date Range GUELE Client Mame setup A Cancel ew OK Under the heading Report Date Range two fields are shown Type in the start and end date that you want the report to cover In the Client Name field type the name of the client you want on the report leave this field blank if you want a report on all your clients You can change which queue it will print to with the queue pull down menu or change the default report settings using the Setup button When all the fields are ready select OK SchuyLab prints the 12 Month Revenue report for the twelve month period ending with the specified date 88 a Sales by Rep The Sales by Rep function prints a sales report for a given date range for any given sales representative or for all sales representatives Sales representatives are initially entered as part of the definition of each client If you were to select F8 Tool
152. voice If you want it to appear on the invoice but don t want to charge for it or rather charge 0 00 for it enter zero 0 in the Charge field When complete select OK When all the schedules are added to the procedure select OK again 2 Printing your fee schedule Once you ve defined the prices for all the procedures setting different prices for each schedule it s a good idea to print out the fee schedules as a permanent hard copy Some people find it easier to review hard copy than numbers on a computer screen De gustibus non est disputandem If you want to print out your fee schedules 1 From the Billing Setup screen select Schedules SchuyLab displays the Billing Schedules scroll box listing all the schedules currently defined in the system E Billing Schedules Description CLIENT Client fee sched HERITAGE Heritage Insurance INSURANCE insurance fee sched MEDICAL MediCal MEDICARE Medicare PATIENT PATIENT 42 2 Select the Print button at the bottom of the Billing Schedules box SchuyLab displays a very similar box the Print Fee Schedules box E Print Fee Schedules fog Frint Fee LIUEUE Z Schedules BILLING Only list custom prices Lode Description Standard Standard Pricing CLIENT Client fee sched HERITAGE Heritage Insurance INSURNLE insurance fee sched MEDICAL Medical MEDICARE Medicare PATIENT PATIENT setup Cancel Frint All 3 The first item on the list is S
153. wed previously E BCBS Alabama Remittance b gt Posting statistics cy er TE a cl al Nin Flag Sg ly Ply le ye yl igap BCBS Alabama Remittance 8 14 2004 11 21 Page 25 Sug Date Proc Bil led Adjustments Deduct Co Payw Paid Notes Adjust Payments Posted this run 1365 85 73732 05 4195 95 Already posted 0 00 0 00 o 00 Unable to post 7937 14 4500 20 2205 96 Totals 2Lb2c89 12173 25 B401 231 els ls ls lg MSW ecb ees shay hs heap hesr bebe aa heey bas hae aay ae has hae SESE ninini T KERER Select F10 Done to go to the billing screen Select Edit Claims Enter your first claim number E Edit Claims Ex Search By Status eja 7 Search By Bill Type S A a FirstClaim 40805018 By patient Select OK 147 Here is your claim SchuyLab Edit Claim arnan e ID 001551 Dr Patient E Accession Claim Bill Type Payor Status e 40805018 INSURE INSURE1 CLOSED M Paper RAAE g F4 i x mT Accident DOB 6 24 1969 35 Other ID Diagnosis ICD 9 Total F Homebnund Devices 599 7 0 00 Date Typ Code Description 8705 Chg 87088 URINE CULTURE 16 50 Workehoat 9715 Pmt 87088 ANSIBCAL Remitta 14 00 9 15 Adj 87088 ANSIBCAL CO A2 2 50 E Necessity Features Price Pics DE Fo Demographics Claim Prev Next Results Now find this claim on the re
154. with all the chosen procedures listed E Add Schedule Lode Description M CPT Rules HERITAGE Her i tage Insurance wi A Do Not Combine Frocedure Description Charge Expect Bill Code POS Any AMYLASE ANA ANTI NUCLEAR AB ARTH ARTHRITIS PANEL BASICMET BASIC METABOLIC BLOOD CULTURE BUN CALCIUM Add new Procedures Discounts x Cancel OK 5 Once the procedures are part of the schedule select each one in turn to bring up the Update Schedule s Procedure box E Update Schedule s Procedure Eg aE Description Charge Expected Bill Code A 0 00 0 00 a Delete X cance Wvo 6 The Code and Description fields will already be filled since this is already a defined billing procedure In the Charge field type the price that you wish that procedure to be billed at for that particular schedule This specific price will override the default flat percentage that you set when defining the schedule NOTE On some schedules you may not want to charge for a procedure There are two ways of doing this If you simply enter a zero 0 in the Charge the procedure will appear on the invoice with a charge of 0 00 If you don t want it to appear on the invoice at all enter a negative one 1 or a negative two 2 in the Charge field This will cause the test to be either NC No Charge or NA 26 Not Applicable The distinction doesn t mean anything for a test but it does for a panel more on that under the d
155. write offs manually entered in and they combine with the same payments and adjustments from Remittance processing this will register as multiple payments Since it is this very manual entering in of payment information that Remittance is designed to free you from what you want to do is not enter them in manually in the first place If you do have double entries though the only thing you can do is go in and delete the extraneous lines in your claims Another thing to note here is that if you have full claim payments or write offs on your claim they won t always play well with the charge by charge adjustments that you get from remittance and you may need to remove the full claim items before you can write off specific charges Issue The claim gives me nothing but zeroes and there is no data in the remittance report Solution There is most likely something wrong with the 835 file that you are trying 152 to process Perhaps you got cut off in the downloading process and only have part of a file In certain cases the insurance company may be sending an improperly formatted file As of the present time 835 files from California Medicaid MediCal have extraneous line breaks in them that prevent them from being properly processed without some additional steps You should contact tech support and be prepared to get them a copy of the 835 file to analyze Issue Hey I processed this 835 file and there are no payments just adjustment
156. y be on your C drive rather than your A drive as 835 files can be rather large See the Electronic Remittance chapter for more information When you are finished you can click Ok to return to the Update Electronic Remittance box and OK again to return to the Update Electronic Payors box When you have updated all of your Electronic Payors you can return to the Billing Setup menu by clicking Done Setting up ICD 9 Codes ICD 9 Codes Many claims require a diagnosis code before they can be considered ready for billing This is done through the use of ICD 9 codes Once defined they can be entered as part of the patient demographics up to four ICD 9 codes per patient They can also be added directly to a specific claim again up to four ICD 9 codes per claim 59 To define ICD 9 codes for your system From the Define Billing menu screen select ICD 9 Codes SchuyLab displays the Update ICD 9 Codes box listing in numerical order the code categories E Update ICD9 Codes Infections amp Parasites Neoplasms Endocrine Nutritional Metabolic Blood amp Blood Forming Organs Mental Disorders Nervous System Circulatory System Respiratory System Digestive System Genitourinary System v Import Bim Select one of the categories from the list to see which codes are on your system SchuyLab displays the Update ICD 9 Code Range Category box E Update ICD9 320 389 Nervous System MIGRAINE NEUROPATHY CONJUNCTI
157. y default it can be overridden if you wish The Code field shows the current payor in this case PATIENT 79 The Description field displays the term Writeoff For a given claim you may wish to use another term such as Discount In that case simply select the Description field and type in the term you wish to use The Reference field Note and Note Codes field are optional and are used to annotate this transaction The Amount field shows the remaining balance for this claim If you wish to write off the full amount simply select OK If you wish to write off a smaller amount than the remaining balance click on the Amount field and type in the amount you wish to write off and then select OK When the Total reaches zero 0 00 the Status of the claim is automatically set to Closed Rebilling Claims Sometimes after a claim has been billed and sent to the payor you may need to rebill it send it again The payor may have disallowed the claim on the first sending pending more information the correct ICD 9 codes for instance It may also happen that having received payment from your first payor you wish to bill only part of the claim to the second payor Both of these can be done through SchuyLab Rebilling a Claim The two methods of billing individual claims are Electronic Billing and Paper Billing 1 e HCFA 1500 forms These are discussed more fully in their own sections of this Billing Manual But
158. y healthcare providers rather than using separate Medicare and Medicaid numbers They are currently usable and starting in May of 2007 they will be required for all Medicare transactions Responsible This field is optional and is used when all Physician accessions from a client will normally use the same doctor record such as when the client is an independently practicing physician The doctor should be part of the Doctors records and you can pull them up by name or by number Do not bill This should be pretty self explanatory If this is this client checked off this client will not be included in client billing Print New Checked if the client s patients should be included Patient in New Patient reports For those labs that make Reports use of New Patient reports functions The Special Panels area is used for entering in client specific panels associated with client being viewed It is used in the test ordering screens if you choose to define a button as having multiple meanings depending on what client an accession is for and is not currently used for billing When all the fields are complete select OK SchuyLab returns to the Define Billing menu screen Ye Doctors Many payors require more than just the client s information on the claim they require the ordering doctor s information as well For instance space 17a of the HCFA 1500 form This has to be setup outside the Billing M
159. yment and write off that have been entered with the Payor field automatically advanced to the next payor in this example from MEDICARE to INSURE1 and the Status changed to Ready E SchuyLab Edit Claim ERIC Drinkwater Moremer K MESTR LE ID 000000000s Or Smith Robert 19 35 65 Northwest Medical group 101 9 147006 DOB 5 03 1952 54 Other ID 5591434604 FS Cancel Fill Done Claim Bill Type Payor Status Ww Paper Employment 309005 MEDICARE INSURE1 l READY p Een 5 omeboun Dlagnasis ICD 9 333 33 111 1 444 44 904 9 Charged Paid Adjusted Balance 904 9 250 600 111 List 139 70 100 00 12 00 27 70 Date Typ Code Description 85024 CEC 70 1235 Charge 80061 LIPID STUDIES 00 80053 COMP METABOLIC 00 Eayment 84153 PSA 00 MEDICARE HCF 1500 paper 70 Write Off MEDICARE Payment 00 MEDICARE Writeott 00 Necessity Features l Price S Fs er Patient Accession Claim Results 44 Prev gt gt ext Tools The claim is now ready to be billed to the next payor and the process repeated Write Off In addition to the above method of entering a Write Off you can manually add a Write Off line to the claim To do this select Write Off SchuyLab displays the Add Writeoff box E Add Writeoff Date Lode Amount 214 2006 PATIENT 27 70 Description Wri teof f X Cancel Reference Mote Codes Pe ao fo List The Date field shows today s date b

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