RIS_CRIB299g_02.09.10e_Billing_Module_v1.1

Billing Module

The CRIS Billing Module allows hospitals to create and managePrivate Patient Billing and Insurance Cost Plans. This includes allbilling and invoicing requirements for the patient and the Insurance Provider.

TABLE OF CONTENTS

TABLE OF CONTENTS

PATIENT REGISTRATION AND INSURER DETAILS

HOW TO ADD AN INSURANCE PROVIDER

MAKING APPOINTMENTS AND ATTENDING PATIENTS

ATTENDING PATIENTS AND CREATING INVOICES

THE 'BILLING' SCREEN

ADDITIONAL BILLING FUNCTIONS

PAYMENT EXEMPTION

CO- PAYMENT COSTS

HOW TO ADD 'EXTRA COSTS'

BILLING MODULE SYSTEM TABLE CONFIGURATION

BILLING LICENCE

XR SETTINGS - SYSTEM > XR SETTINGS

ADDING INSURERS

CREATING COST BANDS

CREATING EXAM COSTS

EDITING AN EXISTING COSTS

CREATING EXTRA COSTS

PATIENT REGISTRATION AND INSURER DETAILS

This section of the Billing module is used to record information about the patient's registered Insurance Policies.

Once the initial patient details have been completed, all Insurance information can be entered(including any applicable exemptions) via the 'Patient Details' screen

More than one Insurance Policy can be created for each patient but only one policycan be the 'default' for the patient. The default Insurer will be displayed in the 'Billing' screen however you can select any other added Insurers in the 'Insurer to Bill' field. For further details please see the 'Additional Billing Functions' section of this document.

HOW TO ADD AN INSURANCE PROVIDER

  1. Load the patient that requires an insurance policyadding, and select the 'Insurers' tab viathe 'Patient Details' screen.

Please note: Insurer Details can only be added to existing Patients, and therefore it will be necessary to select [Save Patient] if attempting to add an insurance policy to a new patient.

.

  1. Select [Add], this will load an 'Insurer Details' box.
[Add] Insurer Details Utility
Billing Type / Select Patient's Registered Insurance Provider using [F4] prompt
Policy Number / Unique number provided to the hospital / patient
Policy Holder / Name of the Patient being registered. (Auto Completed)
  1. Press [F4] via the ‘Billing Type’field to display all the Insurance Providers and press [Enter] to select the relevant Insurer. This will auto-complete the 'Policy Holder' field with the patient's forename and surname.
  1. Complete the patients 'Policy Number' and click ‘Default’ if this is the patient's default Insurance Provider.

Click [Save] to save all details entered.

OVERVIEW OF INSURERS TAB / SCREEN (VIA PATIENT DETAILS)

Exemption Details
Number / Exemption reference number
Category / Request Category the Exemption is applicable to (which is typically Private)
Valid From / Exemption Start date
Valid To / Exemption End date

Please note: The Exemption Details can be completed at any time prior to or at the time of attendance. This is to enable the user to untick ‘Bill’ at the time of billing to defer or negate payment.

Policy Details
Billing Type / Code assigned to the patient’s registered insurance provider
Policy Number / Unique number provided to the hospital / patient
Policy Holder / Name of the patient being registered. (Auto Completed)
Insurer Code / Code assigned to the relevant insurer
Insurer Name / Insurer Name
Default / Use this field to retrospectively select or deselect the patients ‘Default’ policy.
[Add] function button / Allows user to add an Insurance provider / Policy details
[Edit] function button / Allows user to edit existing insurance provider
[Delete]function button / Allows Selected Insurance provider to be removed from patient record
[Add] Insurer Details Utility
Billing Type / Select Patient's Registered Insurance Provider using [F4] prompt
Policy Number / Unique number provided to the hospital / patient
Policy Holder / Name of the Patient being registered. (Auto Completed)

MAKING APPOINTMENTS AND ATTENDING PATIENTS

  1. Once a patient has been registered on CRIS and has an insurance policy assigned to their record you can proceed to create an appointment, or place their record on a waiting list.
  1. To do this follow the standard procedure of entering a [New Event] or changing an existing Request ensuring that at the minimum you have completed the Referral Source, Ref. Location, Referrer and Examination(s).

Please note: You will need to ensure that the ‘Request Category’ for the Event matches the (Request) ‘Category’ specified via the Patients Insurance Policy otherwise billing functionality will not work. This is typically ‘P’rivate.

  1. In the 'Billing' Tab enter the 'Insurance Code' and 'Card Reference' details if known at this point.This information can also be entered retrospectively at the time of attendance via the 'Billing' screen.

'Billing' Tab / Screen via Event Details
Insurer / Enter the Insurer the patient is registered with in 'Patient Details' screen
Insurance code / Provided by insurance company to authorise payment of treatment. If the final code isn’t available use a ‘Pre Auth’ code
Billing Excess / Displays the patient excess for the selected Insurer as entered in the Insurer's Exam Cost Policy
Card Reference / Used to hold a swipe of the patient's credit card for non insured patients
  1. Having done this select [Add to Diary] or [Waiting List] as appropriate.

To REVIEW BILLING DETAILS for a patient's Appointment or Waiting List entry, reload the Patient andrelevant Appointment/ Waiting List event and select the [Billing] function button to display the 'Billing' screen.

ATTENDING PATIENTS AND CREATING INVOICES

Once a patient has arrived in the department, the next stage is to attend the event.

  1. Load the patient and select the relevant Appointment or Waiting List entry and proceed to Point 3.
  1. Alternatively, for patients without an Appointment or Waiting List event select [New Event] and follow the standard procedure of entering a [New Event] or changing an existing Request ensuring that at the minimum you have completed the Referral Source, Ref. Location, Referrer and Examination(s).
  1. Click [Attend] to move to the 'Attend Event' screen and [Attend] which will save the attendance and load you into the 'Billing' screen.

To REVIEW OR PRINT ANY BILLING INFORMATION at any point after a patient has been attended, you shouldreload the attendance and select the [Billing] function button to display the 'Billing' screen. In the 'Billing' screen you can 'Create Invoice' to create a new invoice if any changes have been made or Print Insurer/ Patient Invoices and Receipts from here.

THE 'BILLING' SCREEN

In the 'Billing' screen users can complete the final part of billing to issue the patient and Insurer with an Invoice and receipt. It is also possible to defer or negate payment at this stage if a valid exemption status is in place.

  1. The ‘Insurer to Bill’ fields should have defaulted from the patient details at the time of attendance. However if this is not already completed, or you wish to amend this field as the patient has more than one Insurance Policy you can do this by pressing [F4] and selecting from a list of options.
  1. Having confirmed that the ‘Insurer to Bill’ field is as required – you should press [Create Invoice]to populate the‘Invoice Number' and 'Invoiced date' (which will default to the current date) via the ‘Policy’ fields.The majority of the remaining ‘Policy’ fields will also be automatically populated, although some may also need to be completed as follows:

Policy Fields
Invoice Number / Auto populatedwhen [Create Invoice] is selected – Read only
Invoiced Date / Auto populated with the current date upon clicking [Create Invoice] – Read only
Billing Type / Auto populatedwith the patients Insurer Code –Read only
Policy Number / Auto populated with patients Policy Number for the Insurer selected- Read only
Policy Holder / Auto populatedwith Policy Holder name – Read only
Insurance Authorisation / Provided by insurance company to authorise payment of treatment. If the final code isn’t available use a ‘Pre Auth’ code
Card Reference / Used to hold a swipe of the patient's credit card for non insured patients
Billing Excess / Auto populates with billing excess but can be amended or removed as applicable
  1. You should also enter 'Payment Status' or press [F4] for a list of available options,followed by'Payment Date' asapplicablevia the fields at the bottom of the screenbefore proceeding to begin printing any associated paperwork.

Billing- Additional Fields
Payment Status / Allows you to record the method of payment received
BIBill InsurerIPInsurer has paidNBNot yet billed
NPNot yet paidPCPaid by cashPCCPaid by credit card
PCKPaid by cheque
Payment Date / Enter the date or press [F4] to use the calendar
  1. Having confirmed all required ‘Billing’ fields you can proceed to begin printing any required paperwork as follows, or simply [Finish] the attendance.

'Billing' Function buttons
[Finish] / Saves all information entered and clears the screen
[Create Invoice] / Populates 'Invoice Number' and 'Invoice Date' in the 'Policy' details
[Print Insurer Invoice] / Click to copy of the print Insurer Invoice
[Print Insurer Receipt] / Click to copy of the print Insurer Receipt
[Print Patient Invoice] / Click to copy of the print Patient Invoice
[Print Patient Receipt] / Click to copy of the print Patient Receipt
[Get All Defaults] / Loads the patient's default Insurer policy, costs will be updated in the event of any amendments
[Get Default Policy] / Loads the patient's default Insurer policy, costs will be updated in the event of any previous amendments.
[Get Policy Costs] / Should it be necessary to amend any Policy Costs via the System Tables (Tables Setup> Exam Costs) prior to completing an attendance, this function will update all costs in the 'Billing' screen based on new values.
  1. To complete the Billing process press the [Finish] function button in order to save all entered information and clear the screen.

Please note: If you see the following error message at any point whilst working in the'Billing' screen, it indicates that the 'Request Category' assigned via the 'Event Details' screen is incorrect and will need to be amended accordingly (typically to P for Private).

ADDITIONAL BILLING FUNCTIONS

PAYMENT EXEMPTION

It is possible to defer or negate payment at the time of Billing by unticking ‘Bill’ adjacent to the examination costs displayed in the centre of the screen. However, this is only possible if the patient already has ‘Exemption Details’ completed via the ‘Patient Details’ > ‘Insurers’ screen. If this is not already in place you can enter these details and [Save Patient] via ‘Patient Details’ before returning to the ‘Billing’ screen.

You can also type a brief comment for future reference via the ‘Bill Exemption’ and ‘Comment’ fields before clicking [Finish] to save the event.

CO- PAYMENT COSTS

'Co Payment Costs'should be used in the scenario where the insurance company is only paying a proportion of the cost of the examination, and therefore a part payment is also being made by the patient.

To do this highlight the relevant exam, right click and choose ‘Add Co-Payment Costs’ via the resulting menu and enter the appropriate co-payment cost to be deducted from the total cost of examination.

Thefollowing examples showsaPatient Invoice with a co-payment of £50.00 added to patient excess (£20 in this example) and the total cost to the patient is £70.00 as show in the example letter below. This is followed by the Insurer Invoice which only details the remaining balance of the original £200.00 examination.

HOW TO ADD 'EXTRA COSTS'

It is also possible to add additional costs to an event / attendance without the need to amendthe overall 'Exam Costs' tables for an Insurance Policy - For example:Administrative Costs – i.e. Late Payment, or Patient DNA's. These additional costs will then be printed on any associated Billing Paperwork.

  1. To do this highlight the relevant exam, right click and choose ‘Add Extra Costsvia the resulting menu which will display a submenu of options and associated costs. Select the relevant additional cost to add it to the invoice for the examination, and repeat for any additional costs if applicable.
Additional Cost Types
Add Extra Costs
Categories / MCMiscellaneous
PCPayment Cancelled
PDAPatient DNA
PIInvalid Payment
PLPayment Late
RCRequest Cancelled

Please also refer to the ‘Creating Extra Costs’ section of this document for full details on configuring these costs for use via the Billing Module.

BILLING MODULE SYSTEM TABLE CONFIGURATION

In order to make use of the Billing Module it will first be necessary to configure the relevant system management tables, and to continue to maintain some of these tables on an on going basis as additional Insurers and updates to associated costs are required.

BILLING LICENCE

Following receipt of your purchase order, a Billing Licence will be created by HSS to activate the Billing Module. This Billing Licence is saved in the Licence table;do not delete this from the TABLES > SYSTEM TABLES > LICENSES as the Billing Module will be deactivated.

XR SETTINGS - SYSTEM > XR SETTINGS

In addition to HSS activating the required module license, the following XR setting will also need to be turned on as follows via TABLES > SYSTEM TABLES > XR SETTINGS.

Section / Item / Description
RECEPT / BillingModuleAvailable / Select Yesto enable access to the Billing Module and associated configuration tables.

ADDING INSURERS

To enable to system to issue an invoice with the correct details, insurance providers must be enteredvia TABLES > OTHER TABLES > COSTS > INSURERS.You will need to configure this table before any other Billing Configuration table as the majority of tables have interdependency on the Insurers table.

Field Name / Required Information
Code / Unique code to identify Insurance provider
Name / Name of Insurance provider
Address 1-5 / Contact Street address, used for sending bills
Post Code 1- 2 / Part 1 & 2 of the registered post code
Email / Main Email address for the Insurance provider
Telephone / Main Contact number for the Insurance provider
Fax / Fax number for Insurance provider
End Date / Used to deactivate Insurance provider from appearing on the system

CREATING COST BANDS

Cost bands can be created to allow you to specify a fixed cost which can then be applied to individual examination, all examinations for a modality or all examinations.To do this you should go to TABLES > OTHER TABLES > COSTS > COST BANDS.

CREATING A COST BAND

  1. In the ‘COSTBANDS’ table click [New]
  1. In 'Exam Cost Code' press [F4] and select the Insurer code you would like to add the additional costs to.
  1. Assign a one digit number or letter in 'Band' – i.e. M = MRI Procedures
  1. Enter the cost you want to apply to the procedure – i.e. £100.00 and click [Save].

APPLYING A COST BAND

HSS would recommend that you to attach a fixed cost at the time of the initial set up of all examination costs, which can then be incremented and applied to however many exams have the associated Cost Band. The advantage of this being that the Exam Costs table only allows you to increment ALL examinations not a subset of examinations.

  1. To apply the CostBand you should go tothe 'ExamCosts' table, and select the 'Request Category' and 'Exam Cost Policy' you want to apply the cost band that you have created.
  1. Highlight the first relevant exam code and assign the ‘Cost Band’ at the bottom of the screen.
  1. Amend as many examinations as applicable and click [Save] to save all changes made.
  1. Clicking [Refresh Table] will show all changes made.

Please note: You can only assign Cost Bands one by one per examination, and therefore HSS would recommend creating Cost Bands prior to setting up Exam Costs so that you can set-up all associated costs at the time of initial set-up. Once the cost band is allocated to an examination you can then amend the cost associated with the band which will retrospectively update all examinations to which it is assigned.

CREATING EXAM COSTS

The 'EXAM COSTS' table contains every examination code that can be performed ateach site and its associated costs per Insurance Provider. It is important therefore essential that each insurance provider has the appropriate cost file configured via TABLES > OTHER TABLES > COSTS > EXAM COSTS.

  1. To create a new cost file, click the [New] button at the right hand side of the screen, this will load the following 'Create Exam Cost Policy' box.
  1. In this example, the Insurance Provider AXA had been assigned the 'Request Category' of 'P- Private Patient', press [F4] and select the relevant Insurance Provider. You should therefore complete the fields as follows and upon clicking [Create] you will be presented with a status bar informing you the cost file is being created.

Field Name / Required Information
Cost Code / Unique code to identify cost file being created - AXA
Cost Description / Description of the exam costs – i.e. AXA 2010 Cost File
Cost Year / Year the cost file was created
Cost Site / Site cost file will be used
Request Category / Request Category the Policy is applicable for, press [F4] and select
Cost Insurer / Used to link a cost file with the appropriate insurer, press [F4] and select. Insurer must have been created via the 'Insurer' table
Policy Excess / Required excess for the Policy as applicable
  1. Once the 'Create Exam Cost Policy' status box states that the policy is ‘Done’, you should click [Close] and then select the appropriate 'Request Category' and 'Examination Cost Policy' at the top of the screen to display the populated examination cost policy as below.