• An Attending Physician is the one who is responsible for the overall care of a Patient in a hospital or clinical setting.
  

• The Attending Physician is required on Institutional Claims.

• Box 76 on the paper UB; Loop 2310A on the ANSI.
  

• The Billable field can be changed if the Charge is in an Open Period.
  

• A Claims Batch cannot be deleted if it has already been uploaded.
  

• If the Claims Batch has not been uploaded, it can be deleted by a User who had Admin permissions.
  

• A Denial often occurs with an adjudication of the Claim.

• Denials are received from the Payer on the EOB.

• Denials can be partial or full.

• A Rejection occurs before the Claim is adjudicated.

• Rejections are received from the Clearinghouse, or before they are entered into the Payer's system.

• The Payer will not have a record of the Claim.

Use the Payer ID DMERC for all DME Claims.

• The Claims are routed in the DME system based on the address on the Claim in the Subscriber Loop.
  

Yes:

• If the Primary Insurance is linked to a different Charge Fee Schedule where the Fee is different; and

• If the Insurance Profile is being changed on the Modify Encounter screen.

• You have the option to decline the Fee change.

• If this is being done in a Closed Period, a Reversal will be created with a new Encounter that has the same Encounter number as the original.

No:

• If the Insurance Profile is being changed in any area other than the Modify Encounter screen, the Charge Fee will not change.
  

• Go to the Procedure Code Library and enter the CPT® Code and select Search.

• Go to the Fee/RVU Management Library and Filter to see all Fee Schedules that have a specific CPT® code and the Fees.
  

• On the Fee/RVU Management screen: All 5 of the fields below must be selected.
  

• Select the Procedure Code.
  
• Select Type: Charge Fees
  
• Select a Billing Provider
  
• Select a Facility
  
• Select an Insurance
  

1. Incident-To Visit: The PA (NPP-Mid-Level Provider) sees a Patient for an Established Diagnosis follow-up visit.
   
2. Non Incident-To Visit: PA sees a New Patient or an Established Patient for a new problem.
   
3. The PA (NPP) must be credentialed under the GROUP NPI
   

1. Incident-To: The NPP (Mid-level) is the Rendering Provider; the Supervising Provider is the Billing Provider and the Supervising.
   
2. Non-Incident-To: The NPP (Mid-level) is the Rendering Provider AND the Billing Provider, the Physician is the Supervising Provider.
   

When a new Insurance or Self-Pay Profile is added, you may need to move some of the existing Encounters to the new Profile.

• This most often occurs when a claim is denied for not being covered, and a new Insurance Profile needs to be added and existing Encounters moved to the new Profile.

1. Make sure you are using the NDC 5-4-2 Rule shown at the beginning of this article.
   
2. Check the product to verify that you have entered the NDC number correctly.

• The NPI is only required when the POS = 11.

• For one Patient, look at the Encounter Dashboard Transactions to see if the Secondary has made a payment.

• For multiple Patients, run the Custom Encounter Report.

• This report can be run by a specific Payer or across all Secondary Insurances.

• Filter Policy-Insurance(2) - ID: Does not Equal > leave the field blank to pull all secondary payers.
  

Adding fees directly to the CPT code will update your Default Fee Schedule (Libraries > Charge Fee Schedules > Fee ID 0 (zero)).

• Updating the Fee on the Procedure Code in the Procedure Code Library will update the corresponding Fees on the Default Fee Schedule, 0.

• Updating the Fees on the Default Fee Schedule, 0, will update the corresponding Procedure Code(s) in the Procedure Code Library.

There are 2 ways to delete a line item from a Claim:

• Select the Trash can on the line item, and select Yes. Click Save on the Modify Charge screen.
• Select the Line item number, select the Delete Line checkbox, and Save [F2].
  
• Select Save [F2] on the Modify Charge screen.

1. NPP (Mid-Level) visits are typically reimbursed at a lower rate than the professional amount.
   
2. The advantage of billing Incident-To is that the visits are reimbursed at the full professional rate.
   
3. CMS Guidelines must be followed precisely. For more information, use this external link: Incident-To Billing Requirements-AAPC.)

1. This Validation Error means you are not currently attached to an Open Reference Batch.
   

• Another User might close a Reference Batch that you are using.

• In the upper right corner, select the Reference Batch link.

• Open and Attach to the Reference Batch.
  

2. If you forgot to attach to a Reference Batch, you can Open and Attach to an existing Reference Batch or create a new Reference Batch and attach to it.

3. If the Claim is already in another Reference Batch, it can be moved to the correct Reference Batch.
   

• The System Setting DETACHINC must be set to No for Incomplete Charges to attach to the Reference Batch.
  

System Settings for Timely Filing

A Timely Filing Default number of days can be set up in System Settings. This setting applies to all Insurances in the System. Individual Insurances can be set up with their own Timely Filing criteria. Use the Interactive Aging Report to see your claims that are nearing their Timely Filing Days.

Set up Timely Filing Criteria on the Insurance

Override the Timely Filing System Settings by adding the Timely Filing criteria to the Insurance in the Timely Filing Submission panel.

Set up Timely Filing Criteria on the Insurance Billing Group

• Go to the Insurance Billing Group Library (Libraries > Insurance Billing Group).

• Select or add a Billing Group.

• Use the checkbox to Update Linked Insurances to Use From Billing Group.

• Enter the Timely Filing criteria.

• Select Save [F2].

• Payments and Adjustments do not equal Charge.