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ChargeKeeper, part of our Enterprise offering, is an application that captures charges for billing more efficiently and accurately by providing all the patient information at the healthcare providers' fingertips.
Security
ChargeKeeper adopts the security features of PatientKeeper's Platform and mPI (new browser window opens on mPI security section). You only have access to this application if your institution's IT administrator grants appropriate permissions. Also, the administrator can set up "relationships" and "positions" for you, indicating what data you can access, including access to certain patients.
An audit trail is created for each new charge on the handheld. All charges are logged when submitted during synchronization, providing the time of synchronization and details on the charges. A log is created for each time you view a patient's list of charges and each time you open the detail of a charge posted to the billing system. Also, a log is created each time an administrator views a charge, and when a charge is deleted or posted to the billing system.
Interaction with Other PatientKeeper Applications
ChargeKeeper operates within PatientKeeper's Mobile Patient Index (mPI) provides the framework in which ChargeKeeper operates, so if you have access rights to the application, you can use the application in unison with your PatientKeeper applications. Also, AlertKeeper can be set up to send you an alert when a charge has not been entered on a patient.
Workflow
Selection of Patient: Select a patient from your personal list, which iss populated either automatically by certain parameters set up by the administrator, or by adding the patient manually from the master patient list.
Charge Entry: When you enter a charge into ChargeKeeper, it is either sent to an "Outbox" for ultimate submission to the billing system, or to a "Draft" state. Charges may be put in draft because the user is not sure what the ultimate charge will be, such as whether to be a subsequent hospital visit or a hospital discharge service. Draft charges can be sent to the Outbox when they are completed. All charges can be modified prior to synchronization.
Validity Checking: Prior to submission of the charge to the Outbox, ChargeKeeper processes the charge through several checks to ensure the charge is free of errors. There are checks to make sure each field has acceptable data, and that no required field has missing values. There are date validity checks to make sure the charge date is consistent with the patient's admission and discharge dates. Also, there are "Code Edits" (discussed below) which check specific fields in relation to specific charges. These checks can be set up by the IT administrators to be "fatal" or "non-fatal" errors. Fatal errors mean the charge will not be submitted until the error is corrected. Non-fatal errors can be submitted, but will be flagged as having a problem, and can be routed to a "Holding Bin" for processing if desired by the customer.
Holding Bin: Once the charges have passed validity checking, they are sent to the Outbox. Upon synchronization, the charges are submitted to PatientKeeper's Mobilizer server. The administrator may set up ChargeKeeper so that all charges have to be sent to the Holding Bin, or she may decide that only certain charges, such as ones with fatal errors, will be sent to the Holding Bin. This gives administrative personnel the opportunity to review the charges and "clean" them or validate them with the documentation prior to submission to the billing system. The administrator can edit, delete, check for validity and post the charges to the billing system.
Attaching a Note: The administrator may attach a note to the charge when a charge is edited or deleted. This note, along with the charge, goes back to you in your "Inbox" for review. Once you view the note, the charge can be marked as "Posted." However, edited charges can still be "Posted" as final, and then sent to the billing system prior to your review to avoid any delays in getting the charges submitted for payment.
Submission to the Billing System: If the administrator is satisfied with the charges submitted to the Holding Bin, then they are "Posted" as final and sent to the billing system. Alternatively, administrators that elect to have charges bypass the Holding Bin will have them go directly to the billing system from the handheld.
Viewing Previously Submitted Charges
You can view a certain number of charges for the patients on the patient list, as determined by the administrator, including the types of charges (all charges by all users or all charges for active encounters). This function allows you to view past patient charges, as well as what others have billed, to avoid duplicate billing. You can filter the charges by status, such as by those charges that have been Posted, or those that are in Draft form or in the Inbox.
Viewing Charge Details
Each charge has several fields associated with it., and each may be required to have a value order that the charge can be sent to the billing system. There is also header information, which includes date of service, billing provider, secondary provider, referring provider encounter or account, and place of service. The administrator can add up to five additional fields in the header.
The charge and diagnosis information is available for viewing too. Modifiers and a quantity are associated with each billable item. Also, up to five additional fields can be associated with each charge, such as a field for requiring a user to append or not append a GC modifier to a chare.
Capturing Charges
There are several methods that can be used to select a billable item. The user can select the code from:
A hierarchical list that he or she has created
Macros that contain a set of charges that are typically billed together
Searching the categorized list of billable items
You can create a customized hierarchical list on the handheld, or by using your PatientKeeper site. This allows you to add items that may not originally have been on your list, have the most common items on the primary hierarchy, or have a "most common" category, so that you can select items quickly. Macros also allow the user to add billable items quickly, such as surgical procedures that are always performed together. In addition, ChargeKeeper has a sophisticated search tool that allows the user to find an item based on categories and the items' definitions. A sub-string search is available to find any term entered by the user within the definitions of the individual items in the list. Finally, the user can enter a free-text item. This may occur if the user can't find a desired service using any of the methods above. The charge is sent to the Holding Bin for further processing.
Diagnosis: The administrator can set a maximum number of diagnoses that can be associated with a charge, with 12 being the upper limit. Diagnoses are selected from the DxKeeper problem list and copied into the charge, allowing the user to instantly access a diagnosis for which to bill. If the desired diagnosis is not present, the user may find a proper diagnosis by using the DxKeeper application. Because DxKeeper is integrated seamlessly with ChargeKeeper, accessing the problem list or finding a diagnosis feels like it is being done within ChargeKeeper itself. Once diagnoses are selected for the charge, the user can re-order them by moving it up and down the list.
A user may find a diagnosis or problem in one of three ways:
The user selects a problem from her hierarchical list
The user selects a standard problem that is in the "dictionary"
The user enters non-standardized free-text as the description of the problem
You determine the categories that ChargeKeeper contains a hierarchical list. This makes it easy to find your most common diagnoses. The diagnoses in the list can be free-text problems or standard problems. Add individual diagnoses as an initial "category", or have a "most common" initial category, further enhancing the ability to efficiently select a problem.
The problem dictionary can contain several types of code sets, such as ICD-9, SNOMED, and DSM IV. Select one of the code sets on which to search for a code. Also, you may search the dictionary by traversing the hierarchical structure of the dictionary or by using a "sub-string search."
When searching by traversing the ICD-9 hierarchical structure of the dictionary, it's possible to select a major category and then drill down to the most specific code possible. The product will search for any code with a problem description that contains the term you enter, either as a whole word or as a portion of a whole word. All of the problems with that term will be returned to the user, allowing you to select one.
For the ICD-9 codes, there can be multiple definitions for the same diagnosis, making it easy for you to find the correct code. For example, one can enter "aspiration pneumonia" and get the correct code, although it may actually labeled as "food and vomiting pneumonitis" in the ICD book. By default, all created problems are public and can be viewed by anyone with the authorization to view the patient's information. However, anyone has the ability to mark a problem as a "private," thus restricting the viewing of the problem to only that user.
Finally, the diagnosis can be a free-text problem. Charges with free-text problems will be sent to the Holding Bin, so administrative personnel can search for a standard problem to associate with the charge.
Guidelines: Each CPT code is associated with a guideline that clarifies its definition and use. The guidelines can be accessed after a billable item has been selected. For the evaluation and management (E/M) or visit codes, ChargeKeeper uses the current HCFA guidelines, allowing you to comply with current billing and documentation rules set by the federal government. In addition, the guidelines for the rest of the CPT codes are the definitions for the codes themselves, as contained in the AMA CPT-4 Manual. Furthermore, administrators can add to, or change any of these guidelines to better suit their needs. These changes are sent to all of the handheld devices upon synchronization.
Modifiers: The administrator can set a maximum number of modifiers for each billable item. You can create categories for different types of modifiers, such as surgical or E/M modifiers. This allows you to better find diagnoses that would be appropriate for certain billing situations. In addition, the administrator can select up to 10 yes/no questions posed to you upon selection of the billable item. The modifier is attached to the charge automatically, if the answer leads to this outcome.
Provider Fields: As described above, there are four provider fields set for ChargeKeeper: billing provider, secondary provider, referring provider and ordering provider. These charges may be sent to the Holding Bin prior to their release for billing. The list is dynamically created so that the most recent (up to 10) providers show up first. You can add a provider's name manually if it is not on the list, and it will be flagged and sent to the Holding Bin for resolution.
Note that each charge can have more than one billable item associated with it. The billable items are the individual items that are charged for reimbursement, such as a CPT code. ChargeKeeper supports the use of a custom billing item, which an administrator would translate into standard coding nomenclature within the institution's own billing system. You have the ability to add a new charge using a "quick charge" feature, or copying an existing charge, saving time in the process.
Besides the selection of a charge code and a diagnosis code, there are other fields that can be filled in, such as modifiers, quantity (or unit of service) and place of service. The administrator can select which fields are required to have a value in order for the charge to be posted to the billing system.
Date-Based Business Rules
ChargeKeeper has several date-based business rules to ensure the charges are submitted properly. For example, youcan't enter a charge for a service rendered on a date prior to the current date. Or, you can't submit a charge for a service rendered "x" days after the patient is discharged from the hospital. The administrator will have the ability to set the day limit on some of these rules.
Code Edits
As mentioned above, one type of validity checking is the code edits, which are only performed on billable items that have CPT codes. This category has several types of edits, such as age, gender, CPT code to CPT code, and a required "referring MD" field for a consult code. The administrator chooses which types of edits to activate or inactivate (and can add more functionality if desired). The edits go to the handheld, so you can address the error while it is fresh in your mind. The edits can generate "fatal" and "non-fatal errors," as determined by the administrator. Fatal errors mean the charge may not be submitted until the errors are corrected. Non-fatal errors may be submitted, but are flagged as having errors so they may be routed to the Holding Bin.
Editing Charges
Charges can be edited or removed up until the time they are sent to the Holding Bin or Mobilizer server via synchronization. This means any charges in "Draft" or "Outbox" status can be revised prior to submission. In the screen where one would edit or add a charge, there is a remove tab. After you acknowledge a confirmation notice, the charge will be removed.
Reporting
ChargeKeeper contains a complete set of reports for your institution, segregated by administration, department and individual user, with access granted by the administrator. The administrative reports have overall summaries for the entire institution as well as detailed reports by department. The department reports track summary and detailed data for each user in the department. Each user can only view his or her own reports, with data from his or her own patients.
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