Client Ledger - Re-billed claims
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Admission
- Client Ledger
- Create Interim Billing Batch File
- Crystal Report Viewer
- Diagnosis
- Dynamic Form Address Validation
- Electronic Billing
- Financial Eligibility
- Individual Cash Posting (PM)
- Posting/Adjustment Codes Definition
- Admission (Outpatient)
- Client Charge Input
- Electronic Re-Billing Service Assignment
Scenario 1: Client Ledger - Validating 'Claim' crystal report for payment/adjustments /transfers posted to client account
Specific Setup:
- Posting/Adjustment Codes Definition:
- Identify an existing payment, adjustment and/or transfer codes. Note the codes/values for further testing.
- Admission:
- A new client is admitted in the inpatient program. Note the client's id/name, admission program, admission date.
- Guarantor/Payors:
- An existing guarantor is identified to assign to the client.
- Financial Eligibility:
- The existing guarantor is assigned to the client. Note the Guarantor code/value.
- Service Codes:
- An existing room and board service code is identified to render services to the client. Note the service code.
- Client Charge Input:
- 5-6 days of the room and board services are rendered to the client.
- Close Charges:
- The charges rendered to the client are closed.
Steps
- Open the 'Electronic Billing' form.
- Run an 837 Institutional bill for the client.
- Verify the bill compiles successfully.
- Claim the services.
- Verify the bill compiles successfully.
- Open the 'Client Ledger' form.
- Process the report using 'Claim' ledger type and validate that the claim based report displays all the claim specific information.
- Open the ‘Individual Cash Posting’ form.
- Select the ‘Client’.
- Select desired value in the ‘Post By’ field.
- Click [Select Item(s) To Post Against].
- A grid opens containing a row for all services.
- Select a desired row.
- Click [OK] when all desired rows have been selected.
- Note the ‘Information’ message and the current balance for the guarantor.
- Click [OK].
- Enter desired value in ‘Posting Date’.
- Enter desired value in ‘Date of Receipt’.
- Validate that the ‘Guarantor’ defaulted to the guarantor in the current balance message.
- Enter desired value in ‘Dollar Amount To Be Posted’. Amount entered can be the full amount due or a partial amount due.
- Enter desired value in ‘Posting Code’.
- If desired, enter a value in ‘Check #’.
- Enter desired value in ‘Action For Remaining Balance If Applicable’.
- Click [Update Temporary File].
- If desired, continue to add payment/adjustments/transfers using the steps above for all other services.
- Click [Submit] when all payment/adjustments/transfers have been completed.
- Open ‘Client Ledger’ for the client’.
- Process the report using ‘Simple' ledger type and validate that the payment/adjustments/transfers posted correctly.
- Process the report using ‘Claim' ledger type and validate that the payment/adjustments/transfers posted correctly specific to claim.
- Close the form.
Scenario 2: Client Ledger - Validating Simple/ Crystal/ Claim types of the ledger for Re-bill claims
Specific Setup:
- Admission:
- A new client is admitted, or an existing client is identified. Note the client's id/name, admission program, admission date.
- Guarantor/Payors:
- An existing guarantor is identified to assign to the client.
- Financial Eligibility:
- The existing guarantor is assigned to the client. Note the Guarantor code/value.
- Service Codes:
- An existing service code is identified to render services to the client. Note the service code.
- Client Charge Input:
- A service is rendered to the client.
- Client Ledger:
- The service distributed to the guarantor assigned to the client in the financial eligibility.
- Close Charges:
- The service rendered to the client is closed.
- Create Interim Billing Batch File:
- An interim file is created which covers client, guarantor and service distributed to the guarantor. Note the batch file number/name.
- Electronic Billing:
- An 837 bill is created and claimed for the service. Note the claim number.
- Electronic Re-Billing Assignment:
- The claim created above is re-billed.
- Electronic Billing:
- An 837 bill is created and claimed for the re-bill service created in above step.
Steps
- Open the 'Client Ledger' form.
- Enter desired client in the 'Client ID' field.
- Select 'Claim' from the 'Claim/Episode/All Episodes' field.
- Select desired claim # created in the setup section.
- Click [Process].
- The crystal report launched successfully.
- Verify the report displays correct re-bill information.
- Close the report.
- Select 'Crystal' from the 'Claim/Episode/All Episodes' field.
- Select desired claim # created in the setup section.
- Click [Process].
- The crystal report launched successfully.
- Verify the report displays correct re-bill information.
- Close the report.
- Select 'Simple' from the 'Claim/Episode/All Episodes' field.
- Select desired claim # created in the setup section.
- Click [Process].
- The crystal report launched successfully.
- Verify the report displays correct re-bill information.
- Close the report.
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Topics
• Client Ledger
• NX
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