Quick Start: Maternity Neighborhood Billing
The Billing tool is intended to assist with in-house billing and to create super-bill documents for use by an external biller or billing service. Maternity Neighborhood support can assist with understanding the functionality and workflows for the tool, but cannot provide billing services such as appeals or direct communication with insurance companies.
First steps: An account owner or practice manager login must be used to establish a fee schedule and to adjust settings so that users have access to the billing functions they will be using. The tool is prepopulated with a procedure code list consisting of the most common codes used in maternity care. Users also have the option to add codes to the fee schedule.
Create a fee schedule for your practice:
- Navigate to Settings in the Practice-level menu (top left-hand corner).
Clicking on the Billing tab will show the Fees schedule, divided into headings.
2. To add fee amounts to codes, click Edit/Add in the right-hand corner.
3. If you click on Edit/Add there is also the option of adding a custom procedure, service or supply. Be sure to save all the fees entered for pre-populated codes before adding a custom code.
Assign user settings for Billing
- User settings are also accessed on the practice level menu. Under Settings, go to Users.
- By default, all Care Providers have access to the coding module for individual encounters and all of the billing tool functionality in individual charts. Care Providers can also be designated as Practice Managers. A Practice Manager is someone who assists in managing practice operations, maintaining billing fees, and handling deletion requests.
- Other User types can also be assigned billing permission by accessing Settings under the practice level menu. Other users may also be designated as a Biller and/or Bookkeeper, or a Practice Manager. The user permissions define a Biller as someone who can enter billing data for encounters and can manage claims. A Bookkeeper is someone who can manage the payment ledger in individual charts, adding payments, charges, or adjustments. A Practice Manager is someone who assists in managing practice operations , maintaining billing fees and deletion request
Coding an Encounter
Once a practice fee schedule is set up and clinical encounter(s) have been posted, the option to code individual encounters with procedure and diagnostic codes becomes available. The coding workflow is flexible and allows users to add multiple codes per encounter. "Unbillable" encounter types as well as encounters marked as phone call or text locations cannot be coded for billing.
- Click on the $ in the right-hand corner of the encounter to code an encounter for billing.
- A box for coding will appear, with the progress note for that encounter appearing in the top of the box. Click on "+ Add procedure, service or supply".
- Search for the procedure, service or supply code from the practice fees schedule by entering at least three digits or the code number or start typing in the name of the procedure type. For each procedure, the mandatory fields are Units (default is 1), Diagnoses Code in ICD-10 (at least 1 entered), Place of Service (auto-populated from location if entered on the encounter note), and Provider. The date will populate automatically and there is a Notes section for additional billing information if needed. A note about diagnoses codes: these are in ICD-10 format and will populate from the Problems or Allergies list if there are codes entered in either of those sections. Otherwise, choose "Search for a diagnosis code". You can search for diagnosis codes either by by text or numeric search. The search feature begins once you have typed in 3 characters. The IMO terminology services designed to get the best match by typing in search terms. For example, if you need the diagnosis code for prolonged labor, you can type in long labor, stalled labor or any other descriptive term and retrieve the appropriated code for billing.
- Enter multiple procedure codes by clicking on the '+Add procedure, service or supply' again for each procedure.
- When you click on the Billing tab in the client chart you will see a list of all coded encounters under "Services". If the encounter is for the newborn, the name of the baby will be listed under Patient.
The Client Billing tab
The client billing section contains four tabs: Insurance, Services, Claims, and Payments. Each tab is detailed below.
- Insurance: This section contains a file storage area for insurance cards and uploaded files relating to billing. The client insurance information is auto-populated here from the financial information section of the Forms. When all mandatory fields have been entered for primary or secondary insurance, the workflow for verification of insurance electronically or by phone can be done here. Clients can view this tab but they cannot edit it. User Tip: The client insurance information will auto-populate from the intake form but not until the user clicks “Add Insurance” on the client billing page. The information is then verified for accuracy for benefits or claim generation required.
- Verification: Electronic insurance verification is done through the Eligible clearinghouse and there is no extra cost other than the billing tool subscription amount to do electronic verification of benefits. Unlimited insurance verification is included.
- Services: All coded encounters are listed here in Unbilled and Billed sections. "Generate Claim(s)" allows the Unbilled services to move to the Billed section and also populates the Claims tab. At a minimum, the Primary Insurance information must be entered and confirmed to generate a claim. Once assigned to a claim, the procedures cannot be included in another claim unless the first one is deleted. Clients are not able to view this part of their chart.
- Claims: Billed services separated into claims are listed here and their status can be tracked manually (Unsent, Sent, Paid, Denied). Individual claims can also be edited and printed in a superbill format or downloaded in x12 format for submission to an insurance clearinghouse. Electronic claim submission is not currently available. This section is not visible to clients when they login to view their chart.
- Payments: The expanded payment ledger contains all charges and payments entered by users, as well as adjustments of the balance owed. A new charge increases the balance owed, while a payment (by the client or of an insurance claim) as well as an adjustment decreases the balance owed. Notes can be added at the bottom and can be made private or shared with the client. This section will record payment history from all episodes of care on a client chart and is visible but not editable to the client when they login.
Printing a Superbill
Once you organize your procedures and generate a claim, you will see it populate on the Claims tab, where you can double-click and print it.
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