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SYNAPSE MEDICAL BILLING USER MANUAL

1. a Sp ya ep Yer Page 38 of58 Synapse Medical Services User Manual 23 Ensure the correct date for the date of service is displayed HINT the grey highlighting around the DOS shows that only one DOS can be entered per invoice 24 Enter the item number in the correct field next to the date of service field at the bottom left of the screen 25 Add the AMA code to each item number e Click on item number f Select edit g Using the table below add the AMA code next to the item description h Select Ok 26 Table AMA codes Most commonly used codes 820 AJ051 110 AE115 116 AE125 132 AJ046 133 AJ047 880 AJ200 832 AJ095 830 AJ091 834 AJ101 326 AMO095 328 AM105 324 AM085 2801 AF010 2806 AFO20 11700 AV100 119 AE125 Bill at 75 Page 39 of58 Synapse Medical Services User Manual Patient 97171 1 Faux Margaret Balance 134 00 Doctor 557 Rasanayakam Dr Rajini DofB 21 08 2014 DOS Code Description 7 Edit New Billing Item Billing Item Subsequent Consulta SSE is Rule w Nun Fee 134 00 Benefit 0 00 M GSTApplicable GST 0 00 M NNAC M Multiple Procedure Override M Not Duplicate Service Notes Info COS cance pana 116 masc Dele eat aut cont D ttem 27 Add the AMA code to each item number billed 28 Select CONT 29 The Third Party Billing box now shows print and save functions HINT WHERE THERE IS MORE THAN ONE DOS IN THE
2. O Claims Pending Hold Claims Query 1 Task Type Allows you to change the range of tasks you are searching for For example Medical Billing tasks or Informed Financial Consent tasks 2 Status Filters Allows you to filter by the tasks 3 Assigned to Group Allows users to filter tasks assigned to a specific team in the company or a specific individaul 4 Client Filtering by a specific client can be very useful to find a specific task or to view the overall progress of all tasks for a client gt gt gt gt Page 3 of58 Synapse Medical Services User Manual 5 TASK LIST QUEUE NOTIFICATION PANEL This panel allows you to view information about the amount of tasks currently in queue for processing and outlines how many tasks are in each process filter and any current tasks that are assigned to you Dne JONES oynap andar USS ye Task List Clients Converting Task Manual Logout Filters New Enquiry Task New Arrear Task New Form New Task Current tasks in queue Total New In Progress istQC dandQC FinalQC Query Claim Pending Delay Hold Claims Synapse OT Team DP Team Assigned to you Task No 1228 175 260 49 121 128 3 472 7 3 836 292 100 95 6 SYNAPSE MEDICAL SERVICES TEAMS e DATA PROCESSING TEAM DP TEAM e The data processing team initiate the billing process in all tasks and conduct the first quality control check DP TEAM e OPERATIO
3. T Patient erification Screen Type Medicare Select Doctor Last Medicare OP O2 02 2005 Patient s eligibility cannot be determined Page 22 of58 Synapse Medical Services User Manual 8 IF PATIENT DOES NOT VERIFY Try the following methods 1 Check that you have entered ALL details CORRECTLY then try the following options a Change the Type selection to suit the claim Medicare Health fund Medicare and Health fund Veterans and retry verification b Ifthe patient is female change the Medicare reference number from 1 to 2 and try verifying the patient again c Change the last digit of the Medicare card the issue number up one number or down one number and try verifying the patient again 2 Ensure all combinations of steps above have been attempted 3 If none of the above options result in successful verification check with your manager 4 APPROVED STAFF ONLY contact the hospital if not a Synapse client for Medicare amp health fund details the health fund for health fund details or Medicare for Medicare numbers If no calls result in the correct details being obtained mark in Final QC in Tasklist to Synapse Billing Manager HINT Possible issues hindering PATIENT VERIFICATION a If the patient eligibility could not be determined the patient may have died the claim will need to be billed as a paper claim Discuss this possibility with a manager b Ifa verification message The patient is e
4. 4 s 6 7 Proofread edit and double check your work before passing the task on to the next stage 2 CHECK everything Synapse Medical Services triple check all of our medical billing claims as we know how hard it is to correct a small mistake that has slipped through the system One small mistake can lead to the rejection of an entire claim that could be worth thousands of dollars to our client Synapse incorporates a work flow that includes 4 quality control checking points However any mistakes that are undetected prior to the FINAL QC stage are marked as an error in our system The 4 CHECKS system Check your own billing As explained in the SLOWN DOWN steps 1 Quality Control QC Check 2 4 Quality Control QC Check oF Final Quality Control QC Check Page 11 of58 Synapse Medical Services User Manual IN PATIENT VS OUT PATIENT gt 4 e You re an INPATIENT starting when you re formally admitted to a H hospital The day before you re discharged is your last inpatient day e You re an OUTPATIENT if you are treated by a doctor and you have not been admitted to a hospital You can be treated at the emergency department of a hospital and still be an OUTPATIENT In Patient Claiming The billing process as outlined in the Synapse Medical Billing Manual requires you to select the tick box IN HOSPITAL for all IN PATIENT services C Default Ref Dr Ref Flags
5. Wor SERVICES PTY LTD SE SYNAPSE MEDICAL BILLING USER MANUAL Synapse Medical Services User Manual TASK LIST USER MANUAL Task List is a custom designed piece of software built by Synapse Medical Services to house Synapse workflows and processes 1 LOG IN TO TASK LIST Synapse IT department will issue you with a log in for Task List una Task List Log In Forgotten your password Username Password not working gjones Contact nervecentre msynapsemedical com_au Password seeeeeenee Log in 2 YOU ARE NOW LOOKING AT THE TASK LIST HOME SCREEN hapse Task List Clients Converting Task Manual Logout New Enquiry Task New Arrear Task New Form New Task Filters Current tasks in queue Total New In Progress 1st QC 2nd QC Final QC Query Claim Pending Delay Hold Claims Synapse OT Team DP Team Assigned to you Task No 1228 175 260 49 121 128 3 472 17 3 836 292 100 95 Date Filters Start Date End Date Task Type Filters Task Type Any status v Status Filters O Show All J New J In Progress D ist QC J 2nd QC J Final QC J Completed and Sent J Delayed J Claims Pending O Hold Claims J Query O Closed 3 Deleted Group User Filters Assigned To Group Any group v Assigned To User Any user v Client Filters Client Any user Go Q ID Task Type Client Name Task Description Status Group User Start Date Next Due C down ae BC Update 26782 IFC Ratnapala Mahilal 19 06 CABOOLT
6. BILL function in the patient screen The Billing box will appear Check details that appear in eclaims with the billing information provided by the doctor Select WORKERS for billing Type oo fF Synapse Medical Services Medicare C ACIR Imm 97171 1 Faux Margaret C 634 7 Oliver Rochester Dr Matthew C Private Referred by FeeList 2 7 o Date peia 7 I Default Ref Dr Ref Flags 7 Dofs ffi 2 08 2014 Online Claiming LSPN 000000 Payment 12 08 2014 Operator MON 1 Note as Resource 634 M Print Blank M NNAC l In Hospital OK Cancel Payment Only F PrePaymentDeposit 5 Enter Date of Service in D of S filed HINT No referring doctor of hospital details are needed for all workers compensation billing 6 Select OK only once all correct details are entered and checked 7 W Comp Billing box will appear WORKERS COMPENSATION BILLING BOX The W Comp box is the where the item numbers are entered for the claim NOTE Only one date of service D of S can be billed at a time per invoice Patient 97171 1 Faux Margaret Balance 134 00 Doctor 557 Rasanayakam Dr Rajini D of B 21 08 2014 DOS Code Description qo fey Ike de Fee GST TYPE ITEM NUMBER HERE 71 08 20 MBSC Dele Edit Quit Cont tem 1 Page 34 of58 Synapse Medical Services User Manual 8 Ensure the correct date for the date of service is displayed 9 Enter the item number in
7. Does the IN or OUT Patient selection match the billing IMPORTANT THINGS TO REMEMBER Doctors are busy and are usually in a hurry they often make errors on their billing data Doctors also don t know much about Medical Billing That s what they hire us for It is our job as their billing service provider to pick up on these errors and ensure that our clients are billing correctly IF SOMETHING DOESN T LOOK RIGHT LET YOUR SUPERVISOR KNOW BEFORE YOU BEGIN TO BILL THE CLAIMS Page 10 of58 Synapse Medical Services User Manual Take it SLOW It s not a race Rushing and trying to complete work quickly often leads to simple mistakes being made and attention to detail forgotten Taking it Slow leads to increased productivity and less little mistakes that can take a long time to fix Medical billing is very COMPLEX and requires precise ATTENTION TO DETAIL Follow these steps every time you bill to minimise mistakes 1 Always have a printed copy of the doctors billing sheet in front of you Always check no changes have been made to the billing sheet these notes will be written in the billing task Follow the Synapse Medical Services Billing Manual Instructions completely Never guess Enter item numbers CAREFULLY and SLOWLY Check every specific number entered on your screen matches the billing sheet Pay attention to detail and remember specific requirements of certain item numbers 3
8. T 04 32 04 PM l f Facsimile 02 9632 0096 i Email info acsshealth com es E Claims Specialist ver 1 91 05 reeset Online Claiming Re 2011105 Maintenance Build date 23 09 2011 MBS Fees 01 07 2011 Patient Search Batch Handler Comms Centre _ a aha i Register Now MBS item Codes j Click here to register ACSS Service Notifications _ amp Newsletters via Email Referrals Daysheet In Hospital Claims Backup Utility e Now Available Scheduler Click for more info 7 TParty Master File Report Centre Medicare web site www medicareaustralia gowau Medicare Australia 1800 700199 DYA web site waw dva ae noso Napse Medical Services 4pos m Page 13 of58 Synapse Medical Services User Manual 2 BEFORE YOU BEGIN TO PROCESS A CLAIM L Review the claiming information that the doctor has provided to Synapse 2 Ensure the doctors Dr number Dr No is in eclaims before starting to process the claim a Select Batch Handler b Scroll down the Batch Handler pop up box until you find the doctor c Find the correct Dr no for the location provider number being claimed if there is more than one listing for the doctor in the batch handler d Note the doctors number on the right hand side of the box 4D 00893 E Claims Specialist Patient 21 08 2014 Thu 09 53 46 AM GE gi E 4 Select Doctor or Batch Ed Repo
9. for all INPATIENTS Page 51 of58 Synapse Medical Services User Manual 9 Ensure the tick box is NOT selected for In Hospital for all OUTPATIENTS 10 Select Hospital if required 11 Select referring doctor and referral date in Referred by field if required outlined in steps 14 15 12 Select OK only once all correct details are entered and checked 13 Private Billing box will appear PRIVATE BILLING BOX The Private Billing box is the where the item numbers are entered for the claim ate Billing Patient 97171 1 Faux Margaret Balance Doctor 634 Oliver Rocheste Or Matthew D of B 12082014 DOS Code Description 12 06 2014 110 Initial Consultation 300 00 o 00 a 12 08 2014 116 Subsequent Consultation 134 00 TYPE ITEM NUMBER IN HERE omn TD MBSC Dele Edit Quit Ca ti 14 Check the correct date for the date of service is displayed Bottom right corner 15 Enter the KNOWN GAP KG billing amount a Enter the letters KG into the item number field b The pop up box will appear c Set the fee as the gap amount that you need to charge the patient If you are unsure of this amount check with your supervisor d Select ok Continue to follow the below steps 16 After the KG Item has been entered continue to enter all of the item numbers used during the service as per the doctors billing instructions Page 52 of58 Synapse Medical Services User Manual 17 Once all item numbers h
10. BATCH select save and repeat the billing process again from steps 1 14 again until all dates of service have been billed amp saved 30 On the final claim select PRINT amp SAVE instead of save Then Continue Patient 97171 1 Faux Margaret Balance Doctor 794 Macdonald TVPH Dr Martin DofB 22 04 2015 DOS Code Description tT Gat eR Fee GST 22 04 2015 116 Subsequent Con AE125 W 1 2 W 134 00 Total 134 00 Balance Today 134 00 pr Page 40 of58 Synapse Medical Services User Manual 31 The current Third Party claims box will appear 32 Select the current claim number or create a new claim Patient Screen Patient Details Patient 97171 1 Title Ms External ID 000096476 Last Name Faux First Margaret Mi Address 4s Lyndoch Road RespAcct 97171 City Gawler State SA PiCade 5118 FileMRN CC Num 5004 1 9264 1 Inj Date Injury Details Injury Claim Number VANumber CD Current claim numbers will Health Fund Ne appear here Click to select Fund Name BUF Membership 8487 Member AliasName Alias Surname Referring No Re 0 x if 0 x if Notes 23 041 963 Extra Notes Total Family PatVerif BookedAppt SMS OEC clinical ooo Reports 33 Enter the new claim details a Enter claim number exactly as provided b Select either EMPLOYER or INSURANCE SOLICITOR c Optional If known add contact personals f
11. Dots 12 05 2015 Online Claiming spn 000000 Pament 12 05 2079 Operator GAB 1 Note Resource 803 PrePayment Deposit IMPORTANT INFORMATION This step is the most critical step in the billing process THIS BOX MUST NOT BE TICKED FOR OUTPATIENT CLAIMS Before TICKING the IN HOSPITAL BOX for ANY CLAIM Take a moment to double check the doctors billing sheet to ensure they have selected INPATIENT or OUTPATIENT service Check the doctors billing type If the billing type and service type do not match inform your team leader to confirm that you can continue to bill the claim in the correct way EXAMPLE If the doctor has selected NO GAP as his billing type and OUT PATIENT as the service type then he has made an error and his billing should actually be IN PATIENT billing Page 12 of58 Synapse Medical Services User Manual MEDICAL BILLING MANUAL HOW TO BILL BASIC CLAIMS Synapse Medical Services utalises eclaims software to conduct all medical billing process 1 LOGIN TO ECLAIMS 1 Click on the eclaims icon on your desktop to open program 2 Use a valid user name and password and enter in the login box see below passwort 3 The eclaims home screen will open D 00893 E Claims Specialist zil Patient Advanced Computer Software Supplies 04 10 2011 Tue Sales amp Marketing 1300 788 005 Technical Support 02 9632 0026
12. OK Cancel 3 For all types of billing a Select correct Type b Check correct Fee List appears Page 25 of58 Synapse Medical Services User Manual Number Fund pe O Veterans and Medicare bulk bill Electronic 1 Medicare schedule fee Simona Balan business hours Paper 2 Workers comp AMA rates Paper 3 Workcover VIC TAC Eclipse Scheme _ 6 NB Eclipse Scheme _ 8 AHSANSWE Eclipse Scheme _ 9 BUPANSWO Eclipse agent GMHBA and all funds 20 above schedule fee 22 AHSAWA Eclipse Scheme _ 23 ABR Eclipse ag 25 Balan AH Simona Balan after hours 120 schedule fee Paper to hospital ANA 45 Unit Mark Porter 80 of AMA rates Warwick Clark at Manly Hospital Complex claim c Select correct Bill To option d Enter Date of Service in D of S filed e Select In hospital for all INPATIENTS HINT Ensure the tick box is NOT selected for In Hospital for all OUTPATIENTS f Select Hospital if hospital required by a Selecting the green ball button b Start typing the location of the treatment hospital or clinic name c Select correct location hospital or clinic Page 26 of58 Synapse Medical Services User Manual i 1 Party Master File IY Only Active Files Name lt Search Hospital Name Allamanda Surgicentre Alwyn Rehabditahon Hospital Ashford Community Hospital Ballarat Base Bathurst Base Hospital Bayside Day Procedure Clinic Be
13. Select In hospital for all INPATIENTS Page 42 of58 Synapse Medical Services User Manual 9 Ensure the tick box is NOT selected for In Hospital for all OUTPATIENTS 10 Select Hospital if required 11 Select referring doctor and referral date in Referred by field if required 12 Select OK only once all correct details are entered and checked 13 Private Billing box will appear PRIVATE BILLING BOX The Private Billing box is the where the item numbers are entered for the claim ate Billing Patient 97171 1 Faux Margaret Balance Doctor B34 Oliver Rochester Or Matthew D of B 1208 2014 DOS Code Description J a 12 08 2014 110 Initial Consultation 300 00 0 00 a 12 08 2014 116 Subsequent Consultation 134 00 TYPE ITEM NUMBER IN HERE MBSC Dele C eat D Quit Cont tem 3 Re 14 Check the correct date for the date of service is displayed Bottom right corner 15 Enter the item number in the correct field next to the date of service field at the bottom left of the screen HINT When billing claims privately to the patient there is usually a set amount desired by the doctor outlined in the doctors billing information Use the following steps to EDIT the Item numbers amount to show to instructed charges If the doctor has not mentioned any amount to charge inform your supervisor Page 43 of58 Synapse Medical Services User Manual 16 Click on the item number you which to ed
14. State sA PiCode 5118 senm BL Not obtained B C Accident Indicator IFC Issue C Compensation Indicator Admission C Financial Interest Indicator W Authorise to submit Claim 24 Select IFC ISSUED In Writing from the drop menu 25 Select OK 26 Continue with part 2 of the Known Gap claim Verbal W B Page 50 of58 Synapse Medical Services User Manual KNOWN GAP BILLING PART 2 INVOICE TO THE PATIENT 1 Select the BILL function button in the patient screen 2 The Billing box will appear 3 Check details that appear in eclaims with the billing information provided by the doctor Al Billing D O Medicare O ACIR lt Imm Veterans 97 171 1 Faux Margaret O Workers O Third Party 83 Fauz SVPH AProf Steven iii Referred by _ icici Ref Dr Ref Flags Online Claiming L5PN Refabilita Note conse TER Priit Blank NKAC oe 4 Select Private for billing Type 5 Select Feelist as number 1 Unless otherwise advised HINT Billing as Fee 1 allows you to edit and change the amount billed for each item number Only bill using another Fee number if your supervisor has advised you to do so in order to compete a different type of private billing to the patient 6 Select Bill To field as Patient 7 Enter Date of Service in D of S field 8 Select In hospital
15. Subsequent Con AE125 W 1 2 W 134 00 Total Balance Today 4q sae Eat cancei 18 The current W C claims claims box will appear 19 Select the current claim number or create a new claim Patient Details Patient 97171 1 Title Ms External ID 000096476 Last Name Faux First Margaret Mi Address ag Lyndoch Road RespAcct 97171 City Gawler State SA PiCode 5118 FileMRN it Num 5004 18264 1 Inj Date Injury Details Injury Claim Number vanumber ii Current claim numbers will Health Fund Ne appear here Click to select Fund Name BUF Membership 8487 Member aj Alias Name f Alias Surname Referring No Re 0 7 if 0 x if Notes 23 041 963 Extra Notes Total Family PatVerif BookedAppt SMS OEC ctinical ooo Reports Page 36 of58 Synapse Medical Services User Manual 20 Enter the new claim details a Enter claim number exactly as provided b Select either EMPLOYER or INSURANCE SOLICITOR c Optional Add Contact personal s First amp Last name T Injury Details LD If Claim Number Number CE d Insurance Solicito i Solicitor CGWAND C DISNEY Piggad Contact Oo 21 Once claim number amp insurer details are correct Select OK 22 The claim will now PRINT from your printer Page 37 of58 Synapse Medical Services User Manual 5 THIRD PARTY COMPENSATION C
16. Subsequent Consultation 134 00 TYPE ITEM NUMBER IN HERE rane T D masc Dele Edit Quit Co tem 2 14 Check the correct date for the date of service is displayed Bottom right corner 15 Enter the item number in the correct field next to the date of service field at the bottom left of the screen 16 Select ENTER HINT Do not continue if the Fee amount shows as zero S0 Refer to your manager 17 Continue to enter the item numbers and select ENTER after each item number Patient Claims Information 18 Once all item numbers have been entered revise and check all of your item numbers and entry in Patient FAUX Margaret Fully Paid siTe Claimant AaLi E i Ee DOB 2304 1 G3 the Private Billing box before continuing T Sumame Faux Medicare 5004 182641 E 19 Select Cont to continue First Name Margaret ae Address 48 Landoch Road 20 Patient Claims Information box appears City Gawier State SA P Code 5118 Acc Name 21 Select OK do not need to enter or check ES anything in this box p Accident indicator IF Issue Compensation Indicator Admission date if Financial interest Indicator Discharge date ig IY Authorise to submit Claim IME Log Ady D Page 29 of58 Synapse Medical Services User Manual 2 MEDICARE CLAIMS 1 Select the BILL function in the patient screen 2 The Billing box will appear 3 Check the details
17. the Billing box Further details are required for all types of billing Up to fourteen items can be routinely claimed on one invoice Page 24 of58 Synapse Medical Services User Manual eat net prev conf pir rreat pele Laver sae aut Patient Details Patient 3922 1 Title Ms External ID 000054649 Last Name Faux First Margaret hli Address 4g Lvndoch Road RespAcct g9g27 City Gawler State Sa Pritode 5118 Filesbi FM Mum 5004 18264 9 Exp 0413 kef Indigenous io VA Number vA Card Mot Set E Mail Tenor Home Phone coz Dr 176 ea un i i Netofkin BillTo Other Work Phone 02 9377 2480 Fee 4 Fund Name Medibank Private Mobile Num Sex F Membership 030001877 UPI o DOBiAge 23041963 Arch D Member Entitle Mo Exp i Alias Mame noodles Deceased iy Statem fe Alee SUr Recall Emp Info Referring Ho Referring Details Ref Date Period RefTo First Consult 4102 094294 3L Abel Siman 0s0arz01 3 176 03 D2011 Motes Extra Motes 2 The Billing box will open i sd Synapse Medical Services E Medicare C ACIR lt Imm Veterans Workers C Third Party Fehabilita Private FeeList MF Default RefDr Ref Flags Online Claiming LsP 000000 ofS 21 2 08 2014 Payment 12 08 2014 Operator MON 1 2 Resource 634 Mote Print Blank ent Only PrePaymentDeposit
18. the edit process Apply the new prices to the item numbers a Click on the item number you which to edit b Select Edit s Edit New Billing Item 110 Initial Consultation Qty Rule w v NumPat 42 Benefit 0 00 TAp GST 0 00 Restrictive Override Referral Flag Onna v C Multiple Procedure Override C Not Duplicate Serice Notes mo a ox Deres c Enter the new FEE AMOUNT in the Fee field see circled selection in figure above d Select Ok e Continue to enter the item numbers and edit the fee amounts until all item numbers have been entered correctly f Once all item numbers have been entered revise and check all of your item numbers and entry in the Private Billing box before continuing 3 Known gap The Multiple Service Rule is applied to both the Health Fund amp the Patient billing portion of the surgical procedure 1 Part 1 Claim to the Health Fund This method of billing will automatically apply to multiple service rule 2 Part 2 Claim to the Patient The MSR will need to be applied directly to the patient billing as shown above Please refer to your printed invoice of the Health Fund claim Part 1 for the revised surgical prices for each item number Page 58 of58
19. 215 Ret f1 Indigenous Not Stated z Comms Centre VA Number i WAcardNotSet z EMail WiComp amp TParty TE Home Phone koz Dr 557 ealth Fun j i MBS item Codes Newtotkin BillTo Other Work Phone 02 2293 2480 Fee 2 Referrals Fund Name z Mobile Num Sex F Daysheet Membership UPI f 0 DOBiAge 12 08 1959 Arch 7 Backup Utility Member z Entitle No Exp Scheduler Alias Name Deceased if Statem 7 Word Processing Alias Surname I Recall I Emp Info Party Master File Referring No Referring Details Ref Date Period RefTo First Consult Report Centre ms 608 0467823 Shakespere William 23 04 2013 12 0 z if Exit Notes 2304 1 963 5004 18264 9Margaret84879089 i i Operator MON 1 Total Family PatVerif BopkedAppt SMS OEC ctinical o oo Reports Page 20 of58 Synapse Medical Services User Manual 5 6 7 Patient Verification Screen will appear Select Submit Wait for eclaims to verify the patient details gt Patient erification Screen Possible outcomes of patient verification a Patient will verify for BOTH MEDICARE and FUND you will see a message Type Medicare amp Healt Balan Cvagga Base Dr Sirr Last Health Fund GPW Or0S2014 The Patientis Eligible to Claim Medicare service Health Fund Response Patientis Eligible Cancel b Patient verifies for one OR other but not both Type Medicare
20. 300 00 12 08 2014 ll Subsequent Consultation 134 00 TYPE ITEM NUMBER IN HERE rane T D masc Dele Edit Quit Cen D tem 2 14 Check the correct date for the date of service is displayed Bottom right corner 15 Enter the item number in the correct field next to the date of service field at the bottom left of the screen 16 Select ENTER HINT Do not continue if the Fee amount shows as zero 0 Refer to your manager 17 Continue to enter the item numbers and select ENTER after each item number 18 Add the custom note to the invoice to show the patient has been informed of a known gap amount Use the instructions below to enter this note a Once all item numbers have been entered click on the SECOND item number to highlight HINT If you put the note in the FIRST item number it will not show on the invoice b Click the edit button at the bottom of the screen c Inthe NOTES field enter the following sentence Patient charged a Known Gap KG of S enter amount d Click Ok to continue Page 48 of58 Synapse Medical Services User Manual Patient 97171 1 Faux Margaret Balance Doctor 794 Macdonald TVPH Or Martin DofB 28 04 2015 Code E Edit New Billing Item Ede Billing Item 30 04 2015 116 Sub 110 initial Consultation ay P Rule w v NumPat TH Fee 150 90 Benefit 0 00 C GST Applicable GST 000 Restrictive Override Referral Flag O nnac v Multiple Pro
21. 71 1 Faux Margaret Workers Third Party Doctor O O O O O IE 634 liver Rochester Dr Matthew A Referred by 10832 24288672A Farah Claude Scheme Date Period Tuesday I Default Ref Dr RefFlags gt 12 08 2014 a Payment 1208 2014 Online Claiming L5PN 00000O Operator MON 1 Mote Alamanda Private Hospital D Resource 634 l Print Blank M NNAC Payment Only PrePayment Deposit i DK Cancel Select Private for billing Type Check correct FeeList appears see fee list table above Check correct Bill To field appears and if not change see fee list table above Enter Date of Service in D of S filed Select In hospital for all INPATIENTS 9 pP N m n eS Ensure the tick box is NOT selected for In Hospital for all OUTPATIENTS 10 Select Hospital if required shown on page 26 27 11 Select referring doctor and referral date in Referred by field if shown on page 19 20 12 Select OK only once all correct details are entered and checked 13 Pri Billing ill Page 28 of58 Synapse Medical Services User Manual PRIVATE BILLING BOX The Private Billing box is the where the item numbers are entered for the claim ate Billing Patient 97171 1 Faux Margaret Balance Doctor B34 Oliver Rochester Or Matthew D of B 1 208 201 4 boas Code Description i 12 06 2014 110 Initial Consultation 300 00 12 08 2014 116
22. EAM OT TEAM OT TEAM CLAIMS SYNAPSE TEAM FINAL QC NEW IN PROGRESS COMPLETED amp SENT QUERY QUERY TASKLIST STATUS CLAIMS PENDING HOLD HOLD CLOSED IN PROGRESS Picture 1 Billing 1 First quality Second Final quality Conversion processing check against quality check check against Dataentry 2 Queries day sheet against day day sheet awaiting Complete sheet Data chasing Synapse errors Data chasing from clients Confirmation Billing Completing 3 Awaiting remaining billing Dr s patients Assigning registration batches Completing task Closing task TASK ACTION 6 PLEASE NOTE BEING AHEAD OF SCHEDULE IS GREAT Page 9 of 58 Synapse Medical Services User Manual THINGS TO KNOW BEFORE YOU BILL Medical billing is the process of submitting and following up on claims in order to receive payment for services rendered by a healthcare provider Synapse Medical Services takes pride in our knowledge and understanding of the complex operation of Australia s health care system To ensure we are always billing correctly we follow 3 key instructions when completing any medical billing work 1 Think before you bill Think ahead take time to focus on what you are billing and be clear about what type of billing you are using before you start to bill Does it look right Do the item numbers match the doctor chosen billing type
23. If the invoice message has appeared at the bottom of the page you will now need to edit this message to add a custom note to your Known Gap private claim follow instructions below Page 53 of58 Synapse Medical Services User Manual a Click on the Edit Msg button at the bottom on the screen The message box will now turn white and allow you to type new text in the box Fanon RAEE Payment options 1 Direct deposit Name SG Faux BSB 082 052 Account no 65205 8902 Use this reference Synapse PLEASE EMAIL OR SMS TO ADVISE US OF YOUR PAYMENT AFTER WHICH YOUR RECEIPT WILL BE ISSUED b Click above all other text in the message box c In capital letters enter the sentence PLEASE PAY THE HIGHLIGHTED KNOWN GAP AMOUNT ONLY steven Faux Edit Msg GAP AMOUNT ONLY Cheque payment details Payee A Prof Steven Faux Address PO BOX 330 Randwick NSW 2031 EFT payment details Name 5G Faux BSE 082 052 ACC 65205 8902 d Read through your added message to ensure there are no spelling mistakes e Click SAVE the message box will now turn grey again 34 Once all pf the above steps have been completed revise and check all of your work and entry in to the Private Billing box before continuing 35 Select Cont to continue Page 54 of58 Synapse Medical Services User Manual HINT Patient claims need to be sent manually to the recipient 36 Click
24. LAIMS 16 Select the BILL function in the patient screen 17 The Billing box will appear 18 Check details that appear in eclaims with the billing information provided by the doctor 19 Select THIRD PARTY for billing Type Synapse Medical Services C Medicare C ACIR Imm O Veterans 97171 1 Faux Margaret eT Ces OEE 634 7 Oliver Rochester Dr Matthew C Private peust 7 foo Sf i Date Period I Default Ref Dr Ref Flags Dots fi208 2014 Online Claiming LSPN Payment 12 08 2014 Operator MON1 Ne e Resource 634 x I Print Blank Tl NNAC lr In Hospital OK Cancel M Payment Only F PrePaymentDeposit il 20 Enter Date of Service in D of S filed HINT No referring doctor of hospital details are needed for all third party billing EXCEPTION All TAC claims need to have referring doctor amp referral date Add these details as a custom message to the invoice 21 Select OK only once all correct details are entered and checked 22 Third Party Billing box will appear THIRD PARTY BILLING BOX The Third Party box is the where the item numbers are entered for the claim HINT Only one date of service D of S can be billed at a time per invoice T Party Billing Patient 97171 1 Faux Margaret Balance Doctor 794 Macdonald TVPH Dr Martin DofB 27 04 2015 DOS Code Description TALR Fee GST 27 04 2015 10 Initial Consultation a 2 W 310 00 0 00
25. Last Name FirstName MI Address City Birth PatNo a Press F to Create New Patent Page 15 of58 Synapse Medical Services User Manual Click Create New Patient New Patient screen appears See below image Enter the patient first amp last name e fe a Enter the patients Medicare and or veterans affairs DVA details a Enter Medicare number b Enter Medicare expiry date if it is provided If it is not provided use a default of 12 12 YYYY where YYYY this year c Enter Medicare reference number if it is provided If it is not use a default of 1 male 2 female 3 or higher number child d Enter veterans affairs number If the Veterans number is not provided enter the number as NX123456 a Enter patients DOB 6 Select Create 7 ADYOOSS3 E Claims Specialist Pi E3 Patient Advanced Computer Software Supplies 0501 2012 Thu Sales amp Marketing 1300 788 005 Technical Support 02 9632 0026 F 96 03 32 Pa En Facsanile 02 9632 0096 a Emal intoeacsshesath com r i a O ne 05 C pranama rar C Number Exp Date Referencef vA Number Acard Not Set Entitle No Birth Date 13 10 1987 Home Phone fa 3 Survey Mobile Phone C Seme p our Medicare m ath Copyright 1992 2012 All Rights Reserved Medicare web site Medicare Australia 1800 700 199 ee eee Synapse Medic
26. NS TEAM OT TEAM e The operations team initiate all complex claiming and conduct the second quality control check of all billing batches They also follow up OUP all arrears and operate the Synapse Saver Program e SYNAPSE TEAM SYDNEY amp MELBOURNE e The Synapse team conduct all final quality checks and answer any queries from the other teams and consult directly with the clients SYNAPSE Doctors Page 4 of58 Synapse Medical Services User Manual TASK LIST WORKFLOW AND PROCEDURES FILTERS 1 NEW Billing drops into Task List via the Synapps smartphone app and the website creating a NEW TASK and is assigned a TASK Number Patients Claim counts are automatically defined by Synapps generated tasks Steps for NEW tasks DP Team complete picture conversion of the task and save task OT Team manually upload faxed billing OT Team manually count and detail the amount of patients claims for website and faxed billing OT Team assign the task to the APPORPRIATE TEAM Teams defined by Synapse per doctor 2 IN PROGRESS Only ONE person needs to handle In Progress billing this person is referred to as Biller One Biller one needs to Mark the task as in progress Using the Synapse Medical Service Billing instructions manual amp the doctors billing sheet Complete the billing of all patients in the order that they appear on the page If you are not sure how to bill a p
27. Print amp Save to print the claim for mailing unless otherwise advised by a supervisor Patient 97171 1 Faux Margaret Balance 0 00 Doctor 557 Rasanayakam Dr Rajini D of B 21 08 2014 Code Description 187 0872014 116 Subsequent Consultation Total Balance Today 37 The Patient Claims Information box will now appear Patient Claims Information Patient FAUX Margaret Fully Paid Claimant EMA EEEN E DOB 23041963 Surname Faug Medicare 5004 18264 1 a First Name Margaret Phone K 3 Address as Lyndoch Road City Gawler State 5A PiCode 5118 Acc Name Acc Num BSB Accident indicator IFC Issue compensation Indicator Admission date if et Discharge date Ii IMC Log Ady 38 IMPORTANT REMOVE the tick authorising the claim to be submitted As circled above 39 Click OK to complete the patient claim process 40 Collect printed invoices from your printing device Page 55 of58 Synapse Medical Services User Manual 6 REVIEWING THE COMPLETED INVOICE FOR ACCURACY RE PRINTING A CLAIM After completely a batch of billing you MUST always open a copy of the invoice you have billed and check over it again for any mistakes that may have been missed previously Eo Der tea ase aaa sve a icare has expired Copy Duplicate Invoice E aiD 000096476 Mi spAcct 97171 IRN Patient E Last Name ae Bill R
28. URE Patient nam In Progress Synapse Asif Haideri 19 05 2015 21 05 2015 26781 IFC Ratnapala Mahilal 22 05 CABOOLTURE Patient nam In Progress Synapse Asif Haideri 19 05 2015 21 05 2015 26778 BILLING B Wei James St John Of God Bendigo New DP Team 19 05 2015 19 05 2015 111min 0 26777 BILLING B Warrier Anita North Shore Private New DP Team 19 05 2015 19 05 2015 111 min 0 26776 BILLING B Thoo William North Shore Pnvate Hospital New DP Team 19 05 2015 19 05 2015 111min 0 Page 2 of58 Synapse Medical Services User Manual 3 SYNAPSE PROCESSES CONDUCTED IN TASK LIST Synapse uses the Task List software to create workflows for the following services we provide 1 Medical Billing 2 Informed Financial Consent Service 3 Medical Transcription Synapse also uses the Task List software for the following processes Daily Receipting Daily Rejections Enquires Following up leads 1 2 3 Registrations New Client Sign Up 4 5 Reporting 4 FILTERING TASK TYPES IN TASK LIST The Task List software has a filter located at the top of every page Date Filters Start Date Task Type Filters Task Type Any status Status Filters O Show All J New _J Closed J Deleted Group User Filters Assigned To Group Any group Client Filters Client Any user Go End Date In Progress 5 1st QC 2 2nd QC gt Final QC Completed and Sent Delayed v Assigned To User Any user
29. al Services P 22 Customer ki ADY00893 7 Patient Screen box will appear See image below Patient data entered already will auto populate into the new patient box 8 Enter remaining patient demographic information into the fields provided a Enter title Correct Gender must be selected see Doctors billing sheet for patients gender Page 16 of58 Synapse Medical Services User Manual b Enter address If patients location details are not available use the city state and postcode of the hospital where the services were provided as per the billing sheet of the doctor c Enter Medicare expiry date if it is provided If itis not provided use a default of 12 12 YYYY where YYYY this year Patient Details lt Patient 971712 C Title MR External ID 000125564 Last Name CLOONEY First GEORGE mi Address 8 Lyndoch Road RespAcct 97171 PMS Num 5004 18264 1 Exp 1274 Ref 2 Indigenous Not Stated x VAN umber OoOo VA Card Not Set lv E Mail De ae Home Phone Healin Fund Mextot km Work Phone uP o DOB Age arch Alias Name os Deceased Statem Alias Surname OOOO O C Recall C Emp Info Referring No Referring Details Ref Date Period Reflo First Consult 9 Enter the correct Doctor number Dr see PAGE 2 for instructions 10 Enter the correct Fee Number a Usethe Eclaims Fund Numbers List table below to determine the fe
30. amp Healt Healthcare Or Kevin Last Health Fund OP fi The Patient is Eligible to Claim Medicare service Health Fund Response Check Fund and Membership Card details Cancel Page 21 of58 Synapse Medical Services User Manual c Patient DOES NOT verify at all If patient details cannot be determined See instructions below under if patient does not verify qi Patient Yerification Screen Select Doctor Type Medicare amp Healtt Last Health Fund OPV if Patient s eligibility cannot be determined Health Fund Response Fund patient validation not Undertaken as the Medicare validation was unsuccessful d Patient is MATCHED with differences and could not verify If the below message is shown during patient verification CLICK SUBMIT again Medicare will update patient details where all other details match fed T Patient Yerification Screen Type Medicare amp Healt Healthcare Dr Kevin Last Health Fund OP fy The individual has been matched using the submitted data however differences were identified Please check the information returned and update your records Patient Medicare Reference Number has been Updated Submit Cancel e Patient s eligibility cannot be determined Ifthe doctor is BULK BILLING claims and this message appears during verification DO NOT BILL THE CLAIM and begin process for obtaining correct Medicare numbers
31. atient or need more information complete the other patients and move the task to 15 QC Check your billing to ensure there are no errors Using a day sheet Mark the task as 1 QC or to another process if 1 QC is not applicable Page 5 of58 Synapse Medical Services User Manual 3 QUERY Tasks are marked In Query if the task cannot be processed as a major piece of the information is incorrect and is needed to bill the majority of the claims in the task See STEPS below 4 HOLD Tasks are marked On Hold if the task is unable to be processed as the doctor is not yet registered with the MAJOR health funds Claims may also be placed on hold if there is an outstanding billing complication that is disrupting all of the doctors billing See STEPS below 5 STEPS FOR MARKING A TASK AS IN QUERY OR ON HOLD Biller One After realising during IN PROGRESS that you cannot bill the claims in this task notify your supervisor of the issue with the batch Supervisor Will determine if the task does require more information or whether the doctor is still pending registration and will give Biller One permission to mark the task as IN QUERY or ON HOLD Biller One Mark the task as IN QUERY or ON HOLD Supervisor Email Billing Manager Synapse of the issue and task number Query Tasks or inform the registration team to send notification once the major funds have been reg
32. ave been entered you will need to adjust the amounts of all item numbers except the KG item to show the exact fee s charged to the health fund follow the steps below 18 Click on the item number you which to edit 19 Select Edit 20 The Edit New Billing Item box will appear Patient 97171 1 Faux Margaret Balance Doctor 794 Macdonald TVPH Dr Martin DofB 29 04 2015 Edit New Billing Item m Billing Item 30 04 2015 116 Sub 110 Initial Consultation T Rule w v NumPat Benefit 0 00 C GST Applicable GST 0 00 Restrictive Override Referral Flag CONNac x Multiple Procedure Override Not Duplicate Service Notes Info Item 30 04 2015 110 28 Using the bill invoice that you printed at the end of Part 1 Bill to the Health Fund Enter the specific amounts that the health fund has paid for each individual item number 29 Enter the new FEE AMOUNT in the Fee field see circled selection in figure above 30 Select Ok 31 Continue to enter the item numbers and edit the fee amounts until all item numbers have been entered correctly 32 Once all item number have been entered check that the automatic invoice message has appeared at the bottom of the page HINT Invoice messages will appear automatically the message outlines payment details for the doctor If no invoice message appears please inform your supervisor 33
33. cedure Override lot D Pv Se ee Dele eat J aut cont D tem Ta ee 19 Revise and check all of your item numbers and entry in the Private Billing box before continuing 20 Select Cont to continue 21 Select PRINT amp SAVE the claim will be transmitted electronically however you will need the invoice to know the amounts the health fund has been billed during billing of Part 2 the patient claim Patient 97171 1 Faux Margaret Balance 0 Doctor 557 Rasanayakam Or Rajini Dof B 21 08 2014 A F JOS code Jescriptior 187 0872014 116 Subsequent Consultation Total Balance Today Page 49 of58 Synapse Medical Services User Manual 22 Patient Claims Information box appears Patient Claims Information Patient FAUX Margaret Fully Paid Claimant e cop aoaaa Surname Faux Medicare 5004 18264 1 1 First Name Margaret Phone K a Address as Lyndoch Road City Gawler State 5A Picode 5118 Act Name Acc Num Accident Indicator D Compensation Indicator MEE Financial interest Indicator Discharge date fi IY Authorise to submit Claim IME Log Ady OK 23 Click the drop down box to select the IFC Issue method el Patient Claims Information Patient FAUX Margaret Fully Paid Claimant Faux Margaret DOB 01 01 1950 Sumame Medicare 5004182641 4 First Name Phone 13 Address 48 Lyndoch Road city
34. e been completed 11 CLOSED Tasks move into the Closed status after they have passed through Completed and Sent and have been marked off CLOSED on the website This process allows the client to view the progress of their batch of billing 12 DELAYED Tasks in the Delayed status are tasks that are unable to be processed for a specific reason at the time of billing The reason may occur as a result of a technical issue or an issue with a client s provider numbers that is inhibiting their registration with Medicare the funds or something else These issues will be dealt with by the Sydney office by liaising with the client Once the issue has been dealt with the task will be assigned to NEW and will continue through the task statuses Page 8 of58 Synapse Medical Services User Manual SYNAPSE 5 DAY BILLING TURN AROUND TIME 5 DAY TURNAROUND Synapse has a 5 business day turn around time TAT s for all medical billing tasks submitted by our clients HINT Determining the 5 business day TAT s f a batch of billing arrives before the 5pm cut off on any day FOR EXAMPLE Monday they will be processed by the following Monday If a batch arrives at 5 01pm or thereafter the claims will be processed by Tuesday the following week 5 DAY TURN AROUND DAILY WORKFLOW DIAN DAY 2 DINEE DYE i OT TEAM STANDARD DP TEAM DP TEAM DP TEAM OT TEAM SYNAPSE TEAM CLAIMS COMPLEX OT TEAM DP TEAM OT T
35. e number b Locate the patients health fund take caution to select the correct STATE c Write the number beside the fund s name in the FEE NUMBER box in the patient screen Page 17 of58 Synapse Medical Services User Manual Eclaims Health fund billing Fee numbers list a E 0 Veterans and Medicare bulk bill Electronic 1 Medicare schedule fee Simona Balan business hours Paper 2 Workerscomp AMArates Paper Workcover VIC TAC 6 NB Eclipse Scheme 7 GMHBA and all funds 20 above schedule fee Latrobe and all funds 25 above schedule fee Balan AH Simona Balan after hours 120 schedule fee Paper to hospital AMA 45 Unit Mark Porter 80 of AMA rates Warwick Clark at Manly Hospital Complex claim HINT Find the AHSA amp BUPA State Fee Numbers listed on the table below NSW Doctors AHSA fee 8 amp BUPA fee 9 VIC Doctors AHSA fee 15 amp BUPA fee 12 ACT Doctors AHSA fee TBA and BUPA fee TBA QLD Doctors AHSA fee 17 amp BUPA fee 7 Page 18 of58 Synapse Medical Services User Manual 11 Enter the correct Health fund Name 12 Enter membership number 13 If Veterans Enter Veterans number HINT Billing Veterans Patients If patient verifies with Veterans Bill in the following way a Veterans Gold Card only Bill using Veterans Gold Card b Veterans Gold Card amp Health fund details Bill using Veterans Gold Card c Veterans White Card only Bill using veterans
36. ef T DateotSer Dr No Dr Name City eT 63 Faux SVPH APro Medicare 83 Faux SVPH A Pro K E Dr e3 Num 5004 VA Number Fee 4 Screen Sex F Arch i z ua emme no T Exp i Alias Name Deceased Oi Statem v Alias Surname C Recall Emp Info Referring No Referring Details lt Ref Date Period RefTo First Consult 23099187 Aarons Karin 13104 2015 12 792 140412015 Notes 23 04 1963Gawler Sch Alert Extra Notes Total Family Click on the COPY button at the top of the patient screen All invoices billed to the patient will appear in the Copy Duplicate Invoice Box The invoices are displayed with the most recently billed invoice at the top of the list Select the way you would like to view the invoice Screen or Printer Click Ok ae P A N mP Your invoice will now appear either on the screen or in your printer HINT If the invoice reads as a LODGEMENT ADVICE then and error has been made and you will need to delete this invoice and re bill the claim Unless a supervisor has instructed you to lodge this patient s claim Page 56 of58 Synapse Medical Services User Manual MEDICAL BILLING MANUAL COMPLEX CLAIMING 1 SURGICAL CLAIMING APPLING THE MUTIPLE SERVICE RULE The multiple service rule MSR refers to mult
37. ical Services User Manual HINT Referring Doctor Helpful Information a Noreferring doctor needed for anaesthetics claims b If not able to identify the correct referral details then check to see if the patient had had a previous referring doctor You may use an EXISTING REFERRAL IF THE REFERRAL DOCTOR IS LOCATED IN A SIMILAR LOCATION TO THE PLACE WHERE THE PATIENT RECEIVED TREATMENT c If not able to enter correct referral details contact the Synapse billing manager 15 Enter referral date a Enter the correct referral date details as per the claiming details provided by the doctor b If NO DATE is given use the default 1 day prior to the Date of Service DOS 5 VERIFYING PATIENTS DETAILS Verifying a patient is MANDATORY before commencing the rest of the billing task Verifying a patient is a critical and an essential quality step in the billing process Verifying patient details confirms that the patient is eligible for Medicare or health fund claims 1 Ensure the correct patient has been selected OR 2 All details have been entered for a new patient 3 Verify patient by pressing Pat Verify Patient decid oe it Next Prev Copy Bill Treat Dele Label Save Quit 03 11 51 PM Patient Details JCT Last Name Patient First fima mil Reports O A Address ag Lyndoch Rd RespAcct 9922 x City Evanston State SA PiCode 5118 File MRN Jeee E Batch Handler Num Jo Exp E 1
38. iple procedures performed at the same session by the same provider The multiple service rule only applies to claims for the surgical provider or surgical assistant the MSR does not apply to Anaesthetists The Rule e 100 of the allowed amount is claimable by the provider for the highest paying item number e 50 of the allowed amount is claimable for the second highest paying item number e 25 of the allowed amount is claimable for any existing surgical procedure item numbers HINT Medicare procedure items usually begin with the number 3 or 4 IMPORTANT PLEASE USE PREVIOUS INSTRUCTIONS ON HOW TO BILL EACH SPECIFIC BILLING TYPE BELLOW APPLY THE MSR TO THE ITEM NUMBERS DURING THE BILLING PROCESS Applying to multiple service rule to billing types 1 No gap Medicare and Veterans Claiming The MSR will be applied automatically after all item numbers have been entered and you have clicked continue 2 Workers Compensation Third Party Patient Claiming The MSR will need to be applied during the billing process 1 Enter all of the item numbers claimed into the patient screen billing box 2 Look at the prices assigned to each surgical item and apply the formula e 100 for the highest paying surgical item e 50 for the second highest paying surgical item e 25 for all respective surgical items 3 Calculate the new amounts for each item on a piece of scrap paper Page 57 of58 Synapse Medical Services User Manual 4 Using
39. irst amp last name TR li Claim CClaim Number gt m C Coo CGWAND C DISNEY Piggad CGWAND C DISNEY Piggad es foe Contact Contact OK 34 Once claim number amp insurer details are correct Select OK 35 The claim will now PRINT from your printer Page 41 of58 Synapse Medical Services User Manual PRIVATE BILLING TO THE PATIENT 4 1 Select the BILL function button in the patient screen 2 The Billing box will appear 3 Check details that appear in eclaims with the billing information provided by the doctor A Billing EN Symapse Medical Senices Medicare O ACIR Imm gt Fatient O Veterans 97171 1 Faux Margaret 83 Faux SVPH A Pro Steven Sl Referred by 556 C598979A Test Test Date 04 03 2015 Paid C Default Ref Dr Ref Flags ae Payment Online Claiming SPN Note Print Blank C NNAC In Hospital _ Payment Only PrePayment Deposit 4 Select Private for billing Type 5 Select Feelist as number 1 Unless otherwise advised HINT Billing as Fee 1 allows you to edit and change the amount billed for each item number Only bill using another Fee number if your supervisor has advised you to do so in order to compete a different type of private billing to the patient 6 Select Bill To field as Patient 7 Enter Date of Service in D of S filed 8
40. istered 6 1 QC 1 QUALITY CONTROL CHECK Only ONE person needs to handle billing in 1 QC this person is referred to as Biller Two Biller two needs to i ENAN mar N Printa day sheet and cross check all of the patient demographic data ir entry with the doctors billing sheet d fa Open the patient screen and verify the patient Bi y Using the day sheet and billing information check that all patients have mab been billed correctly Once all details have been cross checked assign the task to 2 QC Page 6 of 58 Synapse Medical Services User Manual 7 2 4 QC 2 QUALITY CONTROL CHECK Only ONE person needs to complete the 2 Quality Control check this person is referred as Biller Three Biller three needs to Print a day sheet and cross check all of the patient demographic data entry with the doctors billing sheet Open the patient screen and verify the patient Ensure the patients title is labelled correctly eg Mr Mrs Miss Etc Using the day sheet and billing information check that all patients have been billed correctly double checking the billing type and fund fee Make NECESSARY calls to complete any billing for patients that were unable to be billed in the previous stages Once all details have been cross checked assign the task to Final QC 8 FINAL QC FINAL QUALITY CONTROL CHECK Only ONE person needs to complete the final checking of the batch this
41. it 17 Select Edit Patient 97171 1 Faux Margaret Balance Doctor 794 Macdonald TVPH Dr Martin DofB 28 04 2015 Edit New Billing Item 30 04 2015 116 Sub 110 Initial Consultation Qty a Rue w fv NumPat TH Benefit 0 00 C GST Applicable GST 0 00 Restrictive Override Referral Flag CINNac v C Multiple Procedure Override Not Duplicate Service Notes i Info L Cox Pearce i 18 Enter the new FEE AMOUNT in the Fee field see circled selection in figure above 19 Select Ok 20 Continue to enter the item numbers and edit the fee amounts until all item numbers have been entered correctly 21 Once all item numbers have been entered revise and check all of your item numbers and entry in the Private Billing box before continuing 22 Select Cont to continue HINT Patient claims need to be sent manually to the recipient 23 Click Print amp Save to print the claim for mailing unless otherwise advised by a supervisor Cancel Page 44 of58 Synapse Medical Services User Manual 24 The Patient Claims Information box will now appear Patient Claims Information Patient FAUX Margaret T Fully Paid Claimant EEE oop 2041983 Surname Faux Medicare 5004 18264 1 1 First Name Margaret Phone R a Address Jag Lyndoch Road City Gawler State SA PiCode 5118 Acc Name Acc Num BSB Accident i
42. leka Preate Hospital Bellbrd Prate Hospital Benchgo Health Care Group Brisbane Pirate Hospetal HOS HOS HOS HOS HOS HOS HOS HOS HOS HOS Brisbane Waters Prrrate Hospital HOS Southport Strathfield Ashford Ballarat Bathurst Frankston M onnngton Blackburn Bendigo Bnsbane Wow Wioy Cancel g Select referring doctor in Referred by field if required h Select referral date Referred by field if required i Select OK only once all correct details are entered and checked 1 Where possible when a batch includes claims for items on different dates of service bill in one invoice 2 To process for claims with more than 14 items a Contact the fund b Request guidance on how to lodge the claim c Suggest splitting over two invoices and gain a reference number and or a contact person to follow the claim through to its completion d Fax the claim directly to the contact person include the reference number when provided with one e Follow the progress of the claim regularly f Enter notes in eclaims after each contact with the fund Page 27 of58 Synapse Medical Services User Manual 1 NO GAP BILLING 1 Select the BILL function button in the patient screen 2 The Billing box will appear 3 Check details that appear in eclaims with the billing information provided by the doctor f Billing NLA rites C Medicare C ACIR Imm gt E A veterans 971
43. ligible to claim Veterans Service Veteran Entitlement Code Pensioner Concession Card appears this means that the patient is not a full Veteran and cannot be billed as a Veteran Bill using the patients Medicare and Health Fund details for a No Gap claim instead Page 23 of58 Synapse Medical Services User Manual 9 BILLING THE MEDICAL CLAIM Once all patient demographic details are correctly entered or found during a search in eclaims and have verified the billing process may begin using the following steps The claim details can be entered using the claiming information provided by the doctor 10 TYPES OF BILLING There are six routine types of billing completed at Synapse 1 No gap No Gap claims are only INPATIENT claims Never outpatient claims 2 Medicare bulk billing Either inpatient or outpatient 3 Veterans affairs Either inpatient or outpatient 4 Workers Compensation Either inpatient or outpatient 5 Third Party Either inpatient or outpatient 6 Patient Claims Either inpatient or outpatient 7 Known gap Known Gap claims are only INPATIENT claims Never outpatient claims 11 PROCESS FOR BILLING A CLAIM 1 Select the BILL function button in the patient screen The Billing box will appear Each type of billing requires different input into the Billing box when it appears The patient details and the doctor details that have been entered so far in the billing process will appear in
44. n 14 Select ENTER HINT Do not continue if the Fee amount shows as zero SO Refer to your manager Medicare Billing Patient 97171 1 Faux Margaret Balance Doctor 557 Rasanayakam Dr Rajini D of B 21 08 2014 DOS Code Description TLR Fee Benefit TYPE ITEM NUMBER IN HERE mpsc Dele Eat Quit tem 1 15 Continue to enter the item numbers and select ENTER after each item number 16 Once all item numbers have been entered revise and check all of your item numbers and entry in the Medicare Billing box before continuing r 17 Select Cont to continue 18 The printing Medicare Billing screen will appear 19 Click Save Total Balance Today Page 31 of58 Synapse Medical Services User Manual 3 VETERANS CLAIMS 1 Select the BILL function in the patient screen 2 The Billing box will appear 3 Check the details on the screen in eclaims with the billing information provided by the doctor 4 Select Veterans for billing Type Bilina CR _SitelD Patient C Third Party Ce o chabilita 10832 f 2428672AFarah Claude e RefFiags 2of8 12082014 li flee nooo Payment 12 08 2014 Q ee Operator MON 4 Note Alamanda Private Hospital 3 Resource 634 M Print Blank T ANAC M In Hospital OK Canca Payment Only PrePaymentBeposit 5 Enter Date of Service in D of S field 6 Tick the In hospital box fo
45. ndicator IFC Issue Compensation Indicator Admission date ii Fig Discharge date ii 25 IMPORTANT REMOVE the tick authorising the claim to be submitted As circled above 26 Click OK to complete the patient claim process 27 Collect printed invoices from your printing device Page 45 of58 Synapse Medical Services User Manual 5 KNOWN GAP BILLING Known gap agreement means an agreement where the medical practitioner agrees to accept a payment by the insurer in part satisfaction of the amount owed and the patient has provided informed financial consent so that the gap or out of pocket expense to be paid by the insured person is known in advance Known gap claiming is billed using two of the above explained billing methods 1 PART 1 NO GAP BILLING Claim is sent to the Health fund with added note to explain how much the patient has been charged as a known gap 2 PART 2 PRIVATGE PATIENT CLAIM The claim is billed to the patient This claim is the remaining amount GAP after the health fund amp Medicare have paid their contributions The billing is sent to the patient with notification of the item numbers claimed and amount charged to their health fund Page 46 of58 Synapse Medical Services User Manual KNOWN GAP BILLING PART 1 INVOICE THE HEALTH FUND Instructions match NO GAP billing instructions given on page 15 1 Select the BILL function button in the patien
46. on the screen in eclaims with the billing information provided by the doctor 4 Select Medicare for billing Type HINT Fee list will appear as O A Bilina a eee 2 Synapse Medical Services C lays gt Co A veterans 97171 1 Faux Margaret C Workers Third Party C Rehabilita 557 Rasanayakam Dr Rajini Private foo Date f Default Ref Dr Ref Flags gt DofS 1908 2014 Online Claiming LSPN Payment 21 08 2014 Operator MON 1 Note DT m Resource 557 Print Blank M NNAC I In Hospital OK Cancel I Payment Only F PrePayment Deposit I Enter Date of Service in D of S field Tick the In hospital box for all INPATIENTS Ensure the tick box is NOT selected for In Hospital for all OUTPATIENTS Select Hospital if required refer to section 2 F for instructions oe E S Select referring doctor and referral date in Referred by field if required refer to section 14 15 for instructions 10 Select OK only once all correct details are entered and checked 11 Medicare box will appear Page 30 of58 Synapse Medical Services User Manual MEDICARE BILLING BOX The Medicare Billing box is the where the item numbers are entered for the claim 12 Check the correct date for the date of service is displayed Bottom right corner 13 Enter the item number in the correct field next to the DOS field at the bottom left of the scree
47. person is referred as Biller Four and will be the fourth pair of eyes to view the batch Biller four needs to Print a day sheet and use the doctors billing information sheet to cross check all of the patients billed and ensure that they have been billed correctly Make necessary calls or email to complete any outstanding billing for patients that were unable to be billed in the previous stages Assign all billed patients in the Batch Handler If there are un billed patients ASSIGN ALL OF THE BILLED PATIENTS and then move the task to Claims Pending Post any Paper Claims after all billing has been checked over If all patients have been successfully billed and assigned posted move the complete task to Completed and Sent Page 7 of58 Synapse Medical Services User Manual 9 COMPLETED AND SENT Once a task has been moved to Completed and Sent every patient in the task has been billed and processed and assigned or sent via paper billing methods Tasks can only enter Completed and Sent after a senior staff member has moved the batch from Final Qc Tasks cannot be altered after they have been moved into Completed and Sent 10 CLAIMS PENDING Tasks become Claims Pending tasks after they have passed through Final Qc and are unable to be moved to Completed and Sent Tasks are marked to Claims Pending by BILLER FOUR only after all steps of Final Qc hav
48. r all INPATIENTS 7 Ensure the tick box is NOT selected for In Hospital for all OUTPATIENTS 8 Select Hospital if required 9 Select referring doctor and referral date in Referred by field if required 10 Select OK only once all correct details are entered and checked 11 DVA Billing box will appear Page 32 of58 Synapse Medical Services User Manual DVA BILLING BOX The DVA Billing box is the where the item numbers are entered for the claim HINT Only one date of service D of S can be billed at a time per invoice 4 Billing Patient 9171 1 Faux Margaret Halance 134 00 Doctor 557 Rasanavakam Or Rajini D of B 20a DOS Code Description Fee Benefit TYPE ITEM NUMBER HERE 108 204 MBSC Dele Edit C out Cont tem Lt 12 Ensure the correct date for the date of service is displayed 13 Enter the item number in the correct field next to the date of service field at the bottom left of the screen 14 Select ENTER HINT Do not continue if the Fee amount shows as zero 0 Refer to your manager 15 Continue to enter the item numbers for the date of service and select ENTER after each item number 16 Once all item numbers have been entered revise and check all of your item numbers and entries in the DVA Billing box before continuing 17 Select Cont to continue Page 33 of58 Synapse Medical Services User Manual WORKERS COMPENSATION CLAIMS Select the
49. rts Maintenance IV OnlyActive Resources Patient Search 5 Comms Centre WiComp amp T Party MBS Item Codes Conroy Canberra Dr Paula Referrals E Conroy Hurstville Dr Paula Daysheet Backup Utility Batch Number Scheduler d OK Cancel Word Processing 3 SEARCHING FOR A PATIENT 1 Click on Patient Search Button on the left side of the screen 2 Search for the patient using a method bellow a Enter patient s last name first name or last name initial eg Smith M For previously created patients b Enter patient number c Enter patients date of birth DOB in the following format DD MM YYYY eg 01 01 1988 a MedSpeech Page 14 of58 Synapse Medical Services User Manual Patient lookup box will appear See Image Below 3 4 Select the correct patient 5 Cross check the DOB amp Address suburb city field 6 Click OK loctMame Firsthame mal Tiir unui Pato Press FS to Create Mew Patient Tap Create Hew Patient uit ONLY PROCEED TO BILLING PROCESS STEP 4 where all details given on the screen matches the patient s details given by the Doctor IF THE PATIENT DOES NOT APPEAR DURING PATIENT SEARCH CONTINUE TO STEP 4 4 CREATING A NEW PATIENT Only create a new patient if the search for a patient shows the patient is not in the eclaims T Patient Lookup h system Show Deceased and Deleted Patients
50. t screen 2 The Billing box will appear 3 Check details that appear in eclaims with the billing information provided by the doctor ste C Medicare C ACIR lmme C veterans C Workers 97171 1 Faux Margaret G34 Oliver Rochester Dr Matthew Date 12 08 2014 Period T l Default Ref Dr Ref Flags x Online Claiming L5PN 000000 Payment 12 08 2014 Operator MON 1 X Resource A34 Print Blank MO NNA Mote Alamanda Private Hospital l Payment Only PrePaymentDeposit OK Cancel Select Private for billing Type Check correct FeeList appears Check correct Bill To field appears and if not change it to correct fee Enter Date of Service in D of S filed Select In hospital for all INPATIENTS 9 o N gr pi p Ensure the tick box is NOT selected for In Hospital for all OUTPATIENTS 10 Select Hospital if required 11 Select referring doctor and referral date in Referred by field if required 12 Select OK only once all correct details are entered and checked 13 Private Billing box will appear Page 47 of58 Synapse Medical Services User Manual PRIVATE BILLING BOX The Private Billing box is the where the item numbers are entered for the claim ate Billing Patient 97171 1 Faux Margaret Balance Doctor 634 Oliver Rochesten Or Matthew D of B 1 208 201 4 DOs Code Description 12 06 2014 110 Initial Consultation
51. the correct field next to the date of service field at the bottom left of the screen 10 Add the AMA code to each item number a Click on item number b Select edit c Using the table below add the AMA code next to the item description d Select Ok 11 Table AMA codes Most commonly used codes for additional codes use the AMA fee schedule Comp Billing 820 AJO51 110 AE115 Patient Balance Doctor DofB 21 08 2014 116 AE125 132 AJ046 133 AJ047 880 AJ200 832 AJO95 830 AJO91 834 AJ101 326 AMO095 328 AM105 324 AM085 2801 AFO010 Fule w MurmPFat Fee 134 00 Benefit 0 00 GST Applicable GST 0 00 M NNAC Multiple Procedure Override Wot Duplicate Service Motes Info 2806 AF020 11700 AV100 119 AE125 Bill at 75 moma 116 masc pete eat D out com tem 2 12 Add the AMA code to each item number billed 13 Select CONT 14 The W Comp Billing box now shows print and save functions HINT WHERE THERE IS MORE THAN ONE DOS IN THE BATCH select save and repeat the billing process again from steps 1 14 again until all dates of service have been billed amp saved Page 35 of58 Synapse Medical Services User Manual 15 On the final claim select PRINT amp SAVE instead of save Patient 97171 1 Faux Margaret Balance Doctor 794 Macdonald TVPH Dr Martin DofB 22 04 2015 DOS Code Description 1 Qik eR Fee GST 22 04 2015 116
52. white card d Veterans White Card amp Health Fund details Bill to patients Health Fund 14 Enter the referring doctor details Patient T 31 03 2015 Tue 10 57 08 AM Patient Details N Tite Reports LastName CLOONEY First GEORGE F 5 Address 48 Lyndoch Road City Gawler Maintenance State P Code 511 Patient Search J i Num 5004 18264 1 Exp 12 14 1214 Ref a Indigenous Not Stated WiComp amp TiParty PORE Home Phone 13 Dr MBS Item Codes jii Work Phone Fee 4 Referrals Fund Name Medibank Private Mobile Num f Sex Daysheet Membership 1234567 UPI a DOB Age 01 01 1960 Arch Backup Utility Member EntileNo e Exp QE AiasName Deceased Statem Word Processing Alias Surname C Recall M Emp Info TiParty Master File Referring No Referring Details Ref Date Period Reffo First Consult Report Centre i a o i o v PS a Yew ketera i i C Sch Alert Extra Notes Operator GAB 1 Total Family a Look up referring doctor in the eclaims Referral List and select correct doctor Search using Last name Provider no or location City b If referring doctor is not in the list Select NEW and create a new referring doctor Note referral date rules Specialist referral lasts 3 months GP referral lasts 12 months Page 19 of58 Synapse Med

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