FACULTY PRACTICE PLAN LIFE OF A CHARGE PROCESS
Function:
Processing Bankruptcy Accounts
Function:
Payment/Charge Batch Preparation
Task(s):
Encounter Form Review for Completeness
Prepare Payment/Charge Batch Ticket
Compile Payment/Charge Batch
Submit Payment/Charge Batch to Practice Supervisor
or Designee
Measurement/Report:
Batch Proof
Missing Charge Report
Standard:
N/A
Policy and Procedure
Purpose:
To ensure proper and accurate processing of charge batches by the
physician practice.
Policy:
Controls will be in place in the physician office to ensure all charges and
time of service payments are processed accurately within the practice
management system.
Procedure:
1.
The appointed physician office staff member will ensure that the approved
encounter form is used when reporting the daily charges.
2.
The appointed physician office staff member will ensure that each encounter
form is marked accurately with the following information (using a blue or black
ball point pen or #2 pencil):
Office charges
a)
b)
c)
d)
e)
Patient name and account number
Date of Service
Indicate any payments received (copay/coinsurance/acct bal pmts)
Procedure code(s)
Procedure code modifier(s), includes indication of an ABN on file
EFFECTIVE DATE: ________________
REVISION DATE: __03/19/14 _______
AUTHORIZED: ________________
AUTHORIZED: Dir, Prac Mgmt
1
f)
Diagnosis code(s) - must be carried out to the furthest digit or diagnosis
description. For encounters with multiple procedures and diagnoses, the
diagnosis which justifies each service will be indicated.
g)
h)
i)
j)
k)
l)
m)
n)
Other data elements required (i.e. NDC, unit of measure, # of units, etc.)
Charge units
Case information, i.e. workers compensation
Performing Physician – ensure that the correct billing provider is indicated
Mid-Level Provider, if applicable
Referring physician, if applicable
Authorization number, if not attached to appointment
Physician signature of performing physician
Non-Office charges
a)
Facility Name
b)
Patient face sheet from facility to enable a full registration in our system
c)
Place of service (inpatient, outpatient, short-procedure unit, emergency
room, observation care)
d)
Date(s) of service
e)
Procedure code(s)
f)
Procedure code modifier(s)
g)
Diagnosis code(s) - must be carried out to the furthest digit or diagnosis
description. For encounters with multiple procedures and diagnoses, the
diagnosis which justifies each service will be indicated.
h)
Charge units
i)
Case information, hospital admit/discharge dates
j)
Performing Physician
k)
Mid-Level Provider, if applicable
l)
Referring physician, if applicable
m)
Authorization number, if applicable
3. The physician office coding/charge entry/clinical support staff member will adhere to
the guidelines in the following reference guide if information is missing:
MISSING
INFORMATION
REASON
ACTION
Date(s) of Service
not on encounter form
DO NOT SUBMIT
CHARGE TO CHARGE
ENTRY UNTIL OBTAINED:
Reference appointment
schedule
EFFECTIVE DATE: ________________
REVISION DATE: __03/19/14 _______
AUTHORIZED: ________________
AUTHORIZED: Dir, Prac Mgmt
2
ask physician to indicate
MISSING
INFORMATION
REASON
ACTION
retrieve date of service
from patient chart progress note
if hospital charge (IP, OP,
ER, SPU), use facility system to
access to obtain, or contact
Medical Records Department
for copy of patient inpatient
record
Procedure Code
physician did not record
DO NOT SUBMIT
CHARGE TO CHARGE
ENTRY UNTIL OBTAINED:
ask physician to indicate
Place of Service
not in system
Administrator to complete
Code Set Form (located at
www.rowan.edu/SOM/IST/physi
ciansys) and forward
to Billing Manager. Hold
encounter until request is
completed, then forward
to charge entry
physician/staff unsure
Provide coding
assistance - fax or send a
copy of the medical record
not in system
DO NOT SUBMIT
CHARGE TO CHARGE
ENTRY UNTIL OBTAINED:
Administrator to complete the
Location Form (located at
www.rowan.edu/SOM/IST/physi
ciansys) or Miscellaneous Form
(located at
www.rowan.edu/SOM/IST/physi
EFFECTIVE DATE: ________________
REVISION DATE: __03/19/14 _______
AUTHORIZED: ________________
AUTHORIZED: Dir, Prac Mgmt
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ciansys) as appropriate and
forward to Billing Manager- - the
physician office coding staff
member must obtain the full
name of the facility, type of
facility (i.e skilled/non-skilled
nursing facility)complete
MISSING
INFORMATION
REASON
ACTION
address and telephone number,
as well as Medicare, Blue Shield
and Medicaid facility
identification numbers.
Diagnosis Code(s)
not known
ask physician to indicate
physician did not record
DO NOT SUBMIT
CHARGE TO CHARGE
ENTRY UNTIL OBTAINED:
ask physician to indicate
not in system
Administrator to complete
Code Set Form (found at
http://www.rowan.edu/som/ist/p
hysiciansys.html) and forward
to Billing Manager
Modifier
physician/staff unsure
Provide coding
assistance - fax or send a
copy of the medical record
and/or any other
supporting documentation
not in system
DO NOT SUBMIT
CHARGE TO CHARGE
ENTRY UNTIL OBTAINED:
Administrator to complete
Code Set Form (found at
http://www.rowan.edu/som/ist/p
hysiciansys.html) and forward
to Billing Manager
physician/staff unsure
EFFECTIVE DATE: ________________
REVISION DATE: __03/19/14 _______
Provide coding
assistance - fax or send a
AUTHORIZED: ________________
AUTHORIZED: Dir, Prac Mgmt
4
copy of the medical record
and/or any other
supporting documentation
MISSING
INFORMATION
REASON
ACTION
Referring Physician
not in system
DO NOT SUBMIT
CHARGE TO CHARGE
ENTRY UNTIL OBTAINED:
Submit request via call tracking
system to request Referring
physician by emailing
somCBhelp@rowan.edu.
Administrator should
complete Provider Referring
Form (located at
www.rowan.edu/SOM/IST/physi
ciansys) and submit to Billing
Manager and Managed Care the physician office staff
must obtain the referring
physician full name, suffix,
specialty, name, address,
telephone number and UPIN
number
Admit/Discharge Date
not known
if office charge, contact patient
or ask physician to indicate.
If hospital charge (IP, OP, ER,
SPU), contact medical records
and request copy of
Consultation Record.
physician/staff unsure
ENTER CHARGE INTO
BILLING SYSTEM (claim edits
will prevent the charge from
being sent):
Access the facility system to
obtain, or contact the hospital
EFFECTIVE DATE: ________________
REVISION DATE: __03/19/14 _______
AUTHORIZED: ________________
AUTHORIZED: Dir, Prac Mgmt
5
admissions department and
request
Insurance info
not in system
Commercial FSC SHOULD
HAVE BEEN ENTERED BY
SCHOOL OR REGISTRATION
AS THE INSURANCE
COMPANY/CATEGORY/PLAN
TEMPORARILY. Copy of the
Insurance card should
Accompany encounter form.
MISSING
INFORMATION
REASON
ACTION
Administrator should complete
Insurance Form (located at
www.rowan.edu/SOM/IST/physi
ciansys) and forward to Billing
Manager-a copy of the
insurance card(s), front and
back,must accompany the
request
Physician Signature
patient does not
know
Charges will not be held
due to missing
insurance information.
Any patient who is
treated and does not
bring proof of insurance
will be considered selfpay until insurance
information is received.
missing
DO NOT SUBMIT
CHARGE TO CHARGE
ENTRY UNTIL OBTAINED:
Ask physician to sign
4. The physician office staff member will complete a PAYMENT or CHARGE BATCH
TICKET with the appropriate daily charge and payment information. The physician
office staff member will assign the batch date as follows:
Batch Type BA Mnemonic
EFFECTIVE DATE: ________________
REVISION DATE: __03/19/14 _______
User Initials
Bank Deposit Date
AUTHORIZED: ________________
AUTHORIZED: Dir, Prac Mgmt
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(Ex: FD/CE) (Ex: SOFS)
(Ex: FD/PMT)
(Ex: CE/MISC)
(Ex: LXL)
(Ex: 08072013)
Batch Type Key: FD/CE = Front Desk/Charge Entry; FD/PMT = Front Desk/Payments;
CE/MISC – Charge Entry/Miscellaneous (IP Hosp/SNF/NH/etc.)
The staff will open a “payment batch” at the beginning of each day. A payment batch
should be closed at the end of each day.
The staff will open a “charge batch” at the time of entering charges. A charge batch can
be left open overnight to ensure all/most of the encounters are included, but MUST
close out by NLT noon the following day, or end of the month close date.
For inpatient or miscellaneous dates of service (straggler batches) that do not have a
deposit, the physician office staff member will use the date of when the batch was
created in lieu of the Bank Deposit Date.
5. A copy of the daily deposit slip will be attached to the charge batch.
6. The physician office coding staff member will assemble the charge batch in the
following order (from bottom to top) to be submitted for Charge Entry:




Completed encounter forms - originals only
Copy of the Batch Proof
Calculator tape or spreadsheet showing HASH calculation
Completed original CHARGE BATCH TICKET
7. The physician office coding staff member will assemble the payment batch in the
following order (from bottom to top) to be submitted to the Practice Supervisor.




Envelope with cash/checks/MO and/or copy of credit card tape/report
Completed Payment Journal
Copy of the Batch Proof
Completed original PAYMENT BATCH TICKET
8. The payment/charge batch packages and the completed daily schedule will be sent
to the Practice Supervisor or their Designee (A Designee must be a person other
than the person who collected the monies) for review and reconciliation prior to
EFFECTIVE DATE: ________________
REVISION DATE: __03/19/14 _______
AUTHORIZED: ________________
AUTHORIZED: Dir, Prac Mgmt
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further distribution for securing payments and assigning to charge entry. The
Supervisor or designee will run (TBD) the End of Day Reconciliation Report and
reconcile all total payments for that day prior to safekeeping or deposit process
beginning. This will include a reconciliation of the payment amounts to the receipt
book. The receipt book must be signed and dated by a department designee, other
than the individual who performed the physical count and reconciliation to the
receipt book and verified by the supervisor. All receipts must be stored in a locked
safe, lockbox, or locked cabinet at the end of each day.
9. Once the payment batch is reconciled, the staff will follow the Rowan University
Cash Policy and Procedure. In particular ensure to secure cash and deposits
immediately upon receipt in a locked cash register, point of sale terminal, safe, cash
box or deposit bag. All cash and checks should be secured in a safe or lockbox that
has limited access. Access to safe combinations or lockbox keys should be limited
to appropriate personnel. Safe combinations should be changed in accordance with
the Safe Changing Policy (Attached to and included in the Rowan University Cash
Policy and Procedure).
10. Once the payment batch is reconciled, the staff will follow CBO “Depositing
Payments” policy and process for deposits and ROA payments.
EFFECTIVE DATE: ________________
REVISION DATE: __03/19/14 _______
AUTHORIZED: ________________
AUTHORIZED: Dir, Prac Mgmt
8
Charge Batch Ticket
Div:
B/A:
#Pts Sched:
#Pts Seen:
#Pts Canx:
#Pts No Show:
Provider:
#Encs Attached:
#Pts R/S:
Charges:
Date Prepared:
Date(s) of Service:
Batch #:
Hash Total:
Comments:
Prepared by:
EFFECTIVE DATE: ________________
REVISION DATE: __03/19/14 _______
AUTHORIZED: ________________
AUTHORIZED: Dir, Prac Mgmt
9
To Be Completed by Charge Entry Personnel ONLY
Date Received:
Date Charges Posted:
Hash Totals Verified:
Completed By:
Payment Batch Ticket
Div:
B/A:
Provider:
Date Prepared:
Date(s) of Service:
Batch #:
Payments:
Dollar Amount:
(Dept./Practice)
Cash:
EFFECTIVE DATE: ________________
REVISION DATE: __03/19/14 _______
/
(ROA)
/
AUTHORIZED: ________________
AUTHORIZED: Dir, Prac Mgmt
10
Check/MO:
/
Credit Cards:
/
N/A
TOTAL:
Comments:
Prepared by:
To Be Completed by Practice Supervisor ONLY
Date Received:
Date Payments Posted:
Reconciled By:
EFFECTIVE DATE: ________________
REVISION DATE: __03/19/14 _______
AUTHORIZED: ________________
AUTHORIZED: Dir, Prac Mgmt
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