837 Professional bill - Re-Bill Claims - Discharge Date Segment
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Admission
- Client Charge Input
- Client Ledger
- Create Interim Billing Batch File
- Diagnosis
- Discharge
- Electronic Billing
- Electronic Re-Billing Service Assignment
- Financial Eligibility
- Performing Provider Association - Error
- Registry Settings (PM)
Scenario 1: Validating re-bill claim claimed via 'Electronic Billing' in the 'SYSTEM.billing_rebill_tx_assign' SQL table.
Specific Setup:
- Registry Setting:
- The 'Specify Loops/Segments To Suppress/Include' is set 1.
- Guarantor/Program Billing Defaults:
- The 'Discharge Date (2300-DTP-096)' is selected in the 'Select Segments To Suppress' field.
- Guarantors/Payors:
- An existing guarantor is identified to be used. Note the guarantor's code/name.
- Service codes:
- An existing service code is identified to be used where the 'Does This Service Have a professional Component' is set to 'Yes'. Note the service code/description.
- Service Fee/ Cross Reference Maintenance:
- A fee definition is created for the service code identified in the ' Service Codes' form.
- Admission:
- An existing inpatient client is identified, or a new client is admitted. Note client id, admission program, admission date.
- Financial Eligibility:
- A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
- Client Charge Input:
- A service is rendered to the client on the admission date. Note service date, service code.
- Client Ledger:
- A service distributed correctly to the assigned guarantor.
- Diagnosis:
- A diagnosis record is created for the client.
- Close Charges:
- The charges distributed to the guarantor are closed.
- Create Interim Billing Batch File:
- An interim billing batch is created for the client that includes an identified client and services. Note the batch number/name.
- Discharge:
- Client is discharged after 30 days from the admission date. Note the discharge date.
- Electronic Billing:
- The bill is created, and the services are claimed. Note the claim number.
- Electronic Re-billing Service Assignment:
- The claim is flagged for the re-bill.
Steps
- Open the 'Electronic Billing' form.
- Create an 837-Institutional/professional claim for the services assigned for the re-billing.
- Verify the bill compiles successfully.
- Close the form.
- Open the 'Crystal Reports' or any other SQL reporting tool.
- Query the SYSTEM.billing_rebill_tx_assign table.
- Verify the SYSTEM.billing_rebill_tx_assign table does not contain the flagged claim.
- Close the crystal report.
Scenario 2: Cal-PM - 837 Professional Bill - Validating 2300-DTP segment for the date of discharge - Re-bill services
Specific Setup:
- Registry Setting:
- The 'Specify Loops/Segments To Suppress/Include' is set 1.
- Guarantor/Program Billing Defaults:
- The 'Discharge Date (2300-DTP-096)' is selected in the 'Select Segments To Suppress' field.
- Guarantors/Payors:
- An existing guarantor is identified to be used. Note the guarantor's code/name.
- Service codes:
- An existing service code is identified to be used where the 'Does This Service Havs a professional Component' is set to 'Yes'. Note the service code/description.
- Service Fee/ Cross Reference Maintenance:
- A fee definition is created for the service code identified in the ' Service Codes' form.
- Admission:
- An existing inpatient client is identified, or a new client is admitted. Note client id, admission program, admission date.
- Financial Eligibility:
- A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
- Client Charge Input:
- A service is rendered to the client on the admission date. Note service date, service code.
- Client Ledger:
- A service distributed correctly to the assigned guarantor.
- Diagnosis:
- A diagnosis record is created for the client.
- Close Charges:
- The charges distributed to the guarantor are closed.
- Create Interim Billing Batch File:
- An interim billing batch is created for the client that includes an identified client and services. Note the batch number/name.
- Discharge:
- Client is discharged after 30 days from the admission date. Note the discharge date.
Steps
- Open the 'Electronic Billing' form.
- Create an 837-Professional claim for the services.
- Verify the bill compiles successfully.
- Dump the 837 professional file.
- Verify the dump file does not contain DTP*096 segment to the bill to include the date of discharge. Note the claim number.
- Close the form.
- Open the 'Electronic Re-Billing Service Assignment' form.
- Mark the claim from the recent 837 compile to re-bill.
- Close the form.
- Open the 'Electronic Billing' form.
- Compile an 837-Professional bill for the services assigned for the re-billing.
- Verify the bill compiles successfully.
- Dump the 837 professional file.
- Verify the dump file does not contain DTP*096 segment to the bill to include the date of discharge.
- Close the form.
- Open the 'Guarantor/Program Billing Defaults' form.
- The 'Discharge Date (2300-DTP-096)' option is not selected in the 'Select Segments To Suppress' field.
- Submit the form.
- Open the 'Electronic Billing' form.
- Compile an 837-Professional bill for the services assigned for the re-billing.
- Verify the bill compiles successfully.
- Verify the dump file contains DTP*096 segment to the bill to include the date of discharge.
- Close the form.
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Topics
• 837 Institutional
• Electronic Re-billing Service Assignment
• Re-Bill
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