Cases

Karen J. Kuhn

Revenue Cycle Management Consultant

Using, building, managing, attaching and maintaining cases to streamline billing.

Objectives of this Session

• Assess when cases should be used• Learn how to build cases• Maintaining Cases• Closing Cases• Setting up patient accounts with

multiple cases• Case building within your workflow• When cases go wrong…

Assess the Need for Cases• Multiples Lines of Business

– Medical– Dental– Mental Health– Any other Specialty Care– Workers Compensation– Third Party Liability (TPL) such as auto

accidents– Inbound authorizations– Visit Limitations– Outcomes of OB Care for UDS reporting

Multiple Primary Insurances

• Any time your medical insurance differs from the insurance for another service

• Leave the Medical Insurances active on the Patient Registration

• Specialty insurances are inactive on the Patient registration

• Handle the other insurances within the appropriate case

Registration Examples

• In the Patient registration only payors for Medical services are active

• Dental is not active on registration, but is in the case.

Specialty insurances are Inactive in the Patient

Registration

Who Builds the Case?

1. Registration

2. Scheduling

3. Front Desk

4. Billing

Once a case is built it should be attached at scheduling to all appropriate visits.

Case Building – Naming Conventions

• Naming convention is important• Make a policy for name creation based on

your CHC• Suggested Info to Include

Line of Business Insurance Carrier Date of Injury or Delivery Injured Body PartExamples: Dental DentaQuest, OB Aetna EDD 4/2015, Dental SFS B, WC SIF 4/24/15 R arm, MVA Geico 1/1/15 Neck

Building a Case

• From within Registration: Edit, Case Management…

• Click New

• Name the Case

• Activate the correct carrier(s) in Insurance tab

• Make sure Allocation Set and Financial Class are set correctly on the Visit Info tab within the case

• Say OK • This is the basic case set up

Case Information overrides patient registration

information

Attach the Case – Patient Registration

Attach the Case - Scheduling

Attaching Cases to the Visit

From the Billing Component, once the visit is double clicked…

Managing Cases from the Visit

• From within a visit you can perform all case management functions

• Go into the Visit, Charges tab

• Double click the case field and you are back to Select Case criteria

Adding Case Management Button to the Billing Toolbar

Viewing Cases from the Billing Spreadsheet

Different Functions within a Case

• Workers’ Comp – once you check WC box, your menus change

• From:

• To:

Worker’s Compensation Registration

Configure the Employer Attach to Registration

Workers’ Comp Tab

• By capturing the Employer Info, the Ins Carrier Info populates:

Case Information Overrides Registration Information

Authorization/Referral Numbers

• Authorization numbers needed on claims can be stored in the case

• Insurance Carrier tab, click on insurance, click on Edit, complete pop up box, OK

Visit Limit Types

Adding Procedure Code Limits

Patients with Multiple Cases

• Naming conventions make it easy to choose the right case

Specialty Insurances are Inactive in Registration

Perinatal Data

• Within the OB Delivery case, click Perinatal button

• The following screen shows the capture of Perinatal data for UDS from within the case

UDS Required Fields

Managing OB/Perinatal Cases

• Use the Visualutions Button on the Main Menu to access the Perinatal Cases. In the case field, type OB and search to modify your OB cases.

Case Information Overrides Registration Information

Closing Cases

• From within the case, check the Closed box

• I closed a case, I still need it. Show Closed Cases

• Then uncheck the Closed box, it’s open again

Modify v. Close & Rebuild

• Modify a case that has not been attached to a ticket

• Modify a case when it was set up wrong to begin with and all tickets attached need to change to the modification

• Close a case when the insurance for that patient, that line of business, changes – example: from Delta Dental (close) to DentaQuest (new case)

• Close a case that is no longer needed

What happens when the case is wrong?

• If the ticket won’t approve correctly, the case is wrong

• If the case is wrong, the ticket is wrong because…

• When you delete a case from a visit, the insurances from the patient account populate that visit

• Cases on the visit overrule the registration screen of the patient

Case Management Summary

Why Use Cases?Tracking multiple primary insurances

Authorizations/Referrals, Visit Limits

Reporting i.e. UDS OB/Perinatal

How To Build Cases Verify coverage needed for the case.

Create the Case using a standard naming convention.

Attach the case to the appointment or visit.

Managing Cases A d d C ase M an agemen t B u tt o n t o B i l l i n g C o mp o n en t fo r easy access.

But if I can leave you with only two thoughts:

• Case Information Overrides Registration Information

• Specialty Insurances are Inactive in Registration

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