Avatar PM 2022 Update 34

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Product Requirements / Recommendations

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Product Update Form Description

The following changes are made: 1) The authorization distribution logic is modified to assign units from the parent service's authorization record to split service when there are no other authorizations available. 2) The new column 'JOIN_TO_PARENT_TX' is added to the SQL table 'SYSTEM.billing_tx_history'. 3) The service entry and edit logic are modified to suppress progress notes ToDos for split services. 4) The 'Edit Service Information' form is updated to support split service functionality. 5) The 'Spreadsheet Edit Service Information' form is modified to suppress the split services.

Included Updates

None

Required Updates

None

Details

NEW2 CHANGED0 FIXED0

New (2)

AV-76222 Details \| User Acceptance Tests Electronic billing - Split services workflow The 837 billing logic is updated to allow all split service(s) in the bill. The 837 billing logic is updated to allow the service to split into two services if the units remaining in an authorization does not cover the total service units. Both split services need to be associated with the Progress Note for billing and reporting purposes. Value Added: The split service(s) functionality is enhanced to link all the split service(s) to the Progress Note through a table column 'JOIN_TO_PARENT_TX' in the 'SYSTEM.billing_tx_history' SQL table.	Topics • 837 Institutional • 837 Professional • Managed Care Authorizations • NX

AV-80783 Details \| User Acceptance Tests Edit Service Information - Editing split services Resolves an issue to ensure that all the split services are included in the bill after updating through 'Edit service Information' form. Value Added: Electronic billing logic is enhanced to allow all the split service(s) in the bill after editing service information.	Topics • Edit Service Information • Managed Care Authorizations • NX

Acceptance Tests

AV-76222 Summary | Details

Electronic billing - Split services workflow

Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:

Admission (Outpatient)
App Dashboard
Client Ledger
CPT Code Definition (PM)
Crystal Report Viewer
Diagnosis
Dynamic Form - Admission - Client
Dynamic Form - Progress Notes
Dynamic form- Social Security Number
Electronic Billing
Financial Eligibility
Guarantors/Payors
Managed Care Authorizations
Progress Notes (Group and Individual)
Registry Settings (PM)
Service Codes
Set System Defaults (CWS)
SQL Query/Reporting Tool
Client Charge Input
Admission
Dynamic Form - Edit Service Fee Definition

Scenario 1: 837 Professional - Running the bill for the split services - Service created through progress note form

Specific Setup:

Guarantor/Payors:
An existing guarantor is selected to edit or a new guarantor is identified. Note the guarantor code/name.
Authorization Information Section:
Select 'Check For Available Units' in the 'Verify Services and Appointments Against Available Authorizations' field.
Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Client Charge Input' field.
Select 'No Warning or Error If Authorization Is Missing' in the 'Verification Level For Authorizations For Appointment Scheduling' field.
Select 'Report As Error And Include On Bill' in the 'Verification Level For Authorizations For 837 Electronic Billing' field.
Set the 'Split Service If The Authorization Does Not Cover Units' to "Yes".
Admission (Outpatient):
A new client is admitted in an outpatient program. Note the client id/name, admission program,
Financial Eligibility:
The guarantor identified above is assigned to the client.
Diagnosis:
A new diagnosis record is created for the client.
Service Codes:
A new service code is added as below. Note the service code/value.
Type Of Fee= User Defined
Minutes per Unit = desired value
Service Fee/Cross Reference Maintenance:
Service fee definition is created for the above service code.
Managed Care Authorizations:
Create a 'Managed Care Authorization' record for the client/guarantor/service code identified above.
The 'Maximum Units' field is set to desired value such that some units do not cover by the authorization on file for the client.
Enter desired value to all the required fields.
Progress Note form:
Please note : the split service functionality is not supported by Ambulatory Progress Note. It will be available in the next update.
A new service is rendered through desired progress note form.
The 'Service Duration' is set to the value that makes number of units needs to be used for the service becomes more than the 'Maximum Units' setup in the 'Managed Care Authorization' section to create a split service.
Client Ledger:
The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.
Close Charges:
All the charges are closed.
An interim billing batch is created to include the client, service and guarantor.

Steps

Open the 'Electronic Billing' form.
Select the '837 Professional' from the 'Billing Form'.
Select desired value in the 'Type Of Bill'.
Select the guarantor identified in the setup section.
Select the 'Interim Batch' in the 'Select All Clients Or Interim Batch' field.
Select the interim billing batch in 'Interim Batch Number'.
Populate all the required fields.
Compile the bill for the client, services and guarantor identified in the interim billing batch.
Verify the bill compiles successfully.
Select 'Run Report'.
Select 'Print' from the 'Print Or Delete Report' field.
Select the file compiled successfully in the previous step.
Verify that both the split services are included in the bill.

Scenario 2: 837 Professional - Running the bill for the split services because of not having authorization through 'Client Charge Input' form

Specific Setup:

Guarantor/Payors:
An existing guarantor is selected to edit or a new guarantor is identified. Note the guarantor code/name.
Authorization Information Section:
Select 'Check For Available Units' in the 'Verify Services and Appointments Against Available Authorizations' field.
Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Client Charge Input' field.
Select 'No Warning or Error If Authorization Is Missing' in the 'Verification Level For Authorizations For Appointment Scheduling' field.
Select 'Report As Error And Include On Bill' in the 'Verification Level For Authorizations For 837 Electronic Billing' field.
Set the 'Split Service If The Authorization Does Not Cover Units' to "Yes".
Admission (Outpatient):
A new client is admitted in an outpatient program. Note the client id/name, admission program,
Financial Eligibility:
The guarantor identified above is assigned to the client.
Diagnosis:
A new diagnosis record is created for the client.
Service Codes:
A new service code is added as below. Note the service code/value.
Type Of Fee= User Defined
Minutes per Unit = desired value
Service Fee/Cross Reference Maintenance:
Service fee definition is created for the above service code.
Managed Care Authorizations:
Create a 'Managed Care Authorization' record for the client/guarantor/service code identified above.
The 'Maximum Units' field is set to desired value such that some units do not cover by the authorization on file for the client.
Enter desired value to all the required fields.
Client Charge Input
A new service is rendered through desired progress note form.
The 'Service Duration' is set to the value that makes number of units needs to be used for the service becomes more than the 'Maximum Units' setup in the 'Managed Care Authorization' section to create a split service.
Client Ledger:
The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.
Close Charges:
All the charges are closed.
An interim billing batch is created to include the client, service and guarantor.

Steps

Open the 'Electronic Billing' form.
Select the '837 Professional' from the 'Billing Form'.
Select desired value in the 'Type Of Bill'.
Select the guarantor identified in the setup section.
Select the 'Interim Batch' in the 'Select All Clients Or Interim Batch' field.
Select the interim billing batch in 'Interim Batch Number'.
Populate all the required fields.
Compile the bill for the client, services and guarantor identified in the interim billing batch.
Verify the bill compiles successfully.
Select 'Run Report'.
Select 'Print' from the 'Print Or Delete Report' field.
Select the file compiled successfully in the previous step.
Verify that both the split services are included in the bill.

Scenario 3: 837 Institutional - Split services - Services created through 'Client Charge Input' form

Specific Setup:

Guarantor/Payors:
An existing guarantor is selected to edit or a new guarantor is identified. Note the guarantor code/name.
Authorization Information Section:
Select 'Check For Available Units' in the 'Verify Services and Appointments Against Available Authorizations' field.
Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Client Charge Input' field.
Select 'No Warning or Error If Authorization Is Missing' in the 'Verification Level For Authorizations For Appointment Scheduling' field.
Select 'Report As Error And Include On Bill' in the 'Verification Level For Authorizations For 837 Electronic Billing' field.
Set the 'Split Service If The Authorization Does Not Cover Units' to "Yes".
Admission:
A new client is admitted in an inpatient program. Note the client id/name, admission program,
Financial Eligibility:
The guarantor identified above is assigned to the client.
Diagnosis:
A new diagnosis record is created for the client.
Service Codes:
A new service code is added as below. Note the service code/value.
Type Of Fee= User Defined
Minutes per Unit = desired value
Service Fee/Cross Reference Maintenance:
Service fee definition is created for the above service code.
Managed Care Authorizations:
Create a 'Managed Care Authorization' record for the client/guarantor/service code identified above.
The 'Maximum Units' field is set to desired value such that some units do not cover by the authorization on file for the client.
Enter desired value to all the required fields.
Client Charge Input
A new service is rendered through desired progress note form.
The 'Service Duration' is set to the value that makes number of units needs to be used for the service becomes more than the 'Maximum Units' setup in the 'Managed Care Authorization' section to create a split service.
Client Ledger:
The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.
Close Charges:
All the charges are closed.
An interim billing batch is created to include the client, service and guarantor.

Steps

Open the 'Electronic Billing' form.
Select the '837 Institutional' from the 'Billing Form'.
Select desired value in the 'Type Of Bill'.
Select the guarantor identified in the setup section.
Select the 'Interim Batch' in the 'Select All Clients Or Interim Batch' field.
Select the interim billing batch in 'Interim Batch Number'.
Populate all the required fields.
Compile the bill for the client, services and guarantor identified in the interim billing batch.
Verify the bill compiles successfully.
Select 'Run Report'.
Select 'Print' from the 'Print Or Delete Report' field.
Select the file compiled successfully in the previous step.
Verify that both the split services are included in the bill.

Topics

• 837 Institutional • 837 Professional • Managed Care Authorizations • NX

AV-80783 Summary | Details

Edit Service Information - Editing split services

Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:

Admission (Outpatient)
App Dashboard
Client Charge Input
Client Ledger
CPT Code Definition (PM)
Crystal Report Viewer
Diagnosis
Dynamic Form - Admission - Client
Electronic Billing
Financial Eligibility
Guarantors/Payors
Managed Care Authorizations
Registry Settings (PM)
Service Codes
Admission
Spreadsheet Edit Service Information

Scenario 1: Edit Service Information - Split Services - Editing Parent Service

Specific Setup:

Guarantor/Payors:
An existing guarantor is selected to edit or a new guarantor is identified. Note the guarantor code/name.
Authorization Information Section:
Select 'Check For Available Units' in the 'Verify Services and Appointments Against Available Authorizations' field.
Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Client Charge Input' field.
Select 'No Warning or Error If Authorization Is Missing' in the 'Verification Level For Authorizations For Appointment Scheduling' field.
Select 'Report As Error And Include On Bill' in the 'Verification Level For Authorizations For 837 Electronic Billing' field.
Set the 'Split Service If The Authorization Does Not Cover Units' to "Yes".
Admission (Outpatient):
A new client is admitted in an outpatient program. Note the client id/name, admission program,
Financial Eligibility:
The guarantor identified above is assigned to the client.
Diagnosis:
A new diagnosis record is created for the client.
Service Codes:
A new service code is added as below. Note the service code/value.
Type Of Fee= User Defined
Minutes per Unit = desired value
Service Fee/Cross Reference Maintenance:
Service fee definition is created for the above service code.
Managed Care Authorizations:
Create a 'Managed Care Authorization' record for the client/guarantor/service code identified above.
The 'Maximum Units' field is set to desired value such that some units do not cover by the authorization on file for the client.
Enter desired value to all the required fields.
Client Charge Input
A new service is rendered through desired progress note form.
The 'Service Duration' is set to the value that makes number of units needs to be used for the service becomes more than the 'Maximum Units' setup in the 'Managed Care Authorization' section to create a split service.
Client Ledger:
The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.

Steps

Open 'Edit service Information' form.
Select desired client and episode.
Click [Select Service(s) To Edit].
Confirm the split service is displayed with the word "Split" near to it.
Select the parent service to edit.
Verify the message: "There are one or more services selected that are split services. These services must be edited together."
Please note user need to edit the split service first and then parent service.
Select the split service to edit.
Verify the service launched successfully to edit.
Verify the split service edited successfully.
Click [Submit].
Close the charges.
Open the 'Electronic Billing' form.
Select the '837 Professional' from the 'Billing Form'.
Select desired value in the 'Type Of Bill'.
Select the guarantor identified in the setup section.
Select the 'Interim Batch' in the 'Select All Clients Or Interim Batch' field.
Select the interim billing batch in 'Interim Batch Number'.
Populate all the required fields.
Compile the bill for the client, services and guarantor identified in the interim billing batch.
Verify the bill compiles successfully.
Select 'Run Report'.
Select 'Print' from the 'Print Or Delete Report' field.
Select the file compiled successfully in the previous step.
Verify that both the split services are included in the bill.

Scenario 2: Edit Service Information - Episode Update for a split service - Admission Date Validation

Specific Setup:

Registry setting:
Set the 'Avatar PM->Services->Ancillary/Ambulatory Services->Edit Service Information->->Edit Service Episode Number' to "Y". Please note: This will add the 'Episode Number (Edit)' field to the form.
Admission (Outpatient):
A new client is admitted in two episodes. Note the client id/name, admission programs, Admission dates.
Financial Eligibility:
The guarantor identified above is assigned to the client.
Diagnosis:
A new diagnosis record is created for the client.
Service Codes:
A new service code is added as below. Note the service code/value.
Type Of Fee= User Defined
Minutes per Unit = desired value
Service Fee/Cross Reference Maintenance:
Service fee definition is created for the above service code.
Managed Care Authorizations:
Create a 'Managed Care Authorization' record for the client/guarantor/service code identified above.
The 'Maximum Units' field is set to desired value such that some units do not cover by the authorization on file for the client.
Enter desired value to all the required fields.
Client Charge Input
A new service is rendered through desired progress note form.
The 'Service Duration' is set to the value that makes number of units needs to be used for the service becomes more than the 'Maximum Units' setup in the 'Managed Care Authorization' section to create a split service.
Client Ledger:
The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.

Steps

Open 'Edit service Information' form.
Select desired client and episode.
Click [Select Service(s) To Edit].
Confirm the split service is displayed with the word "Split" near to it.
Select the split service to edit.
Verify the service launched successfully to edit.
Select the 2nd episode number in the 'Episode Number (Edit)' field.
Verify the episode cannot be changed as the date of service is before the admission date of the second episode.

Scenario 3: Spreadsheet Edit Service Information - Editing split services

Specific Setup:

Guarantor/Payors:
An existing guarantor is selected to edit or a new guarantor is identified. Note the guarantor code/name.
Authorization Information Section:
Select 'Check For Available Units' in the 'Verify Services and Appointments Against Available Authorizations' field.
Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Client Charge Input' field.
Select 'No Warning or Error If Authorization Is Missing' in the 'Verification Level For Authorizations For Appointment Scheduling' field.
Select 'Report As Error And Include On Bill' in the 'Verification Level For Authorizations For 837 Electronic Billing' field.
Set the 'Split Service If The Authorization Does Not Cover Units' to "Yes".
Admission (Outpatient):
A new client is admitted in an outpatient program. Note the client id/name, admission program,
Financial Eligibility:
The guarantor identified above is assigned to the client.
Diagnosis:
A new diagnosis record is created for the client.
Service Codes:
A new service code is added as below. Note the service code/value.
Type Of Fee= User Defined
Minutes per Unit = desired value
Service Fee/Cross Reference Maintenance:
Service fee definition is created for the above service code.
Managed Care Authorizations:
Create a 'Managed Care Authorization' record for the client/guarantor/service code identified above.
The 'Maximum Units' field is set to desired value such that some units do not cover by the authorization on file for the client.
Enter desired value to all the required fields.
Client Charge Input
A new service is rendered through desired progress note form.
The 'Service Duration' is set to the value that makes number of units needs to be used for the service becomes more than the 'Maximum Units' setup in the 'Managed Care Authorization' section to create a split service.
Client Ledger:
The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.

Steps

Open 'Spreadsheet Edit Service Information' form for editing the services.
The grid loads the parent and split service for editing.
Verify the warning displays: "There are one or more split services selected. These services must be edited by using the 'Edit Service Information' form.".
Verify the grid does not load the parent/split services for editing.

Topics

• Edit Service Information • Managed Care Authorizations • NX