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Quick Billing Rule Definition - PM

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Create a quick billing rule.

Quick billing is a process that combines several billing steps into one:

  • Create Interim Billing Batch

  • Close Charges

► Bill types to generate:

  • 837 Professional Bills (Including Error Report)

  • 837 Institutional Bills (Including Error Report)

  • 837 Dental Bills (Including Error Report)

  • Paper Bills

  • UB04 bills

  • Self Pay Bills

  • Site-specific bill formats

In addition to creating a quick billing rule, a collection of quick billing rules can be grouped into one (Quick Billing Group Definition section). Quick billing rules are compiled in the Quick Billing form.

  1. Go to: Avatar PM >  System Maintenance  > Billing Setup Maintenance > Quick Billing Rule Definition
  2. In the Add New Or Edit Existing Rule Definition field, select Add New to add a quick billing rule, or select Edit to edit an existing quick billing rule.
  3. If adding a rule, in the Rule Description field, enter the quick billing rule title.
  4. If editing a rule, in the Rule field, select the quick billing rule.
  5. In the Active field, select Yes to make the quick billing rule active; select No to deactivate the quick billing rule.
  6. Click Print Quick Billing Rule Definitions to generate a report that displays details for all quick billing rules.
  7. In the Financial Class field, select the financial class(es).
    Guarantors display in the Guarantor field that are associated with the financial class.
  8. In the Guarantor field, select the guarantor(s).
  9. In the Treatment Setting field, select the treatment setting(s).
    Programs display in the Program field that are associated with the treatment setting.
  10. In the Program field, select the treatment program(s).
  11. In the Billing Form field, select the type of billing form.
  12. In the HCFA-1500/837-P Billing Options field, select the following services to include in the 837-P quick billing file:
    • Select Service Consolidation to include consolidated services (set up in the Service Code Consolidation form).
    • Select Diagnosis Entry to include services that contain a medical diagnosis.
  13. In the UB-04/837-I Billing Options field, select Diagnosis Entry to include services that contain a medical diagnosis in the 837-I quick billing file.
  14. In the File Description field, enter the file name. This name will be used at the beginning of a bill and error report toderive the description of any 837 Institutional, Professional, or Dental files generated as a result of the related quick billing rule. Dynamic keywords embedded in the file description will be calculated at compilation. 
    This descriptions supports the use of the following dynamic key words, when entered in brackets, as shown:
    - Adds the day that the rule is executed to the description.
    - Adds the month that the rule is executed to the description.
  15.  - Adds the four-digit year that the rule is executed to the description.
  16. - Adds the two-digit year that the rule is executed to the description.
  17. <ct#> - Adds a counter number to the file description. (Include the starting number for the counter within the brackets in place of the "#". Example: )
    This number will be incremented by one each time the rule is executed per day. If the value is changed at any point, the counter will be reset and the next time the rule is executed it will start with that integer.
    Warning: Using dynamic file description keywords without including the keyword could result in overwriting existing files.
  18. In the Number of days from 'Date of Service' field:
    • Determine which services will be assigned an 837 delay reason code during the quick billing process.
    • Enter the number of days from when a service is rendered, to when that service is claimed, where that service will require a delay reason code.
  19. In the Delay Reason Code field, select the code.
  20. In the UB04 - Service Detail Summary Forms field, select how service details in the UB04 billing file will be summarized when the bill is generated:
    • Select No Summary to bypass summarizing.
    • Select Revenue Code to summarize services by revenue code.
    • Select Revenue Code And Charge to summarize services by revenue code and service charge amount.
  21. In the Include inpatient and outpatient programs in the same file? field, select whether or not to combine the programs. If No, the system will output separate files.
    Note: This functionality is currently only supported for the 837 Professional file.
  22. In the Send Generated Bill To field:
    • Select File to generate the billing file in a directory (File Location field).
    • Select Printer to print the bill directly (Printer To Send The Bill To field)
      Note: Settings on the printer may need to be modified in order for the bill to align properly.
      The format for entering a printer network address is \\PrinterServerName\PrinterName. An example of this would be "\\it-ny-ad02\Prt-Heckscher."
  23. In the Printer To Send The Bill To field, enter the printer's network address.
  24. In the File Location field, enter the directory where the billing file will be generated.
    Note: The user who runs the quick bill process must have access to the file location.
  25. In the Client Exclusion Criteria, select the criteria for excluding clients from the quick billing batch.
    • Exclude Clients With Missing Admission Diagnosis means clients without a diagnosis marked as Admission entered in the Diagnosis form will not be included.
    • Exclude Discharged Clients With Missing Discharge Diagnosis means clients without a diagnosis marked as Discharge in the Diagnosis form will not be included.
    • Exclude Clients With Missing Subscriber Policy # means clients without a Subscriber Policy # entered in the Guarantor Selection section of Financial Eligibility or Cross Episode Financial Eligibility forms will not be included.
    • Exclude Active Clients means only clients with episodes that do not have a Date Of Discharge will be considered active.
    • Exclude Active Clients Based On Through Date Of Batch means clients with episodes that do not have a Date Of Discharge will be considered active but clients with episodes that have a Date Of Discharge after the Through Date of the batch will be considered active also.
    • Exclude Services Past Client Discharge Date means that services will not be included in batch generation if the date of service is after the date of discharge for the service's episode.
  26. In the Exclude Clients with Balances Less Than field, enter the minimum balance for clients in the quick billing batch.
  27. In the Include Zero Balanced Services field, select Yes to include zero balance services in the bill.
  28. In the Create Interim Billing Batch field, select Yes to create an interim billing batch number when the file is compiled.
  29. Click Submit when finished. Billing batches are defined in the Create Interim Billing Batch File form.
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