Overview of Charge Master The charge master/ Edit charges screen is the primary screen for editing of charges. It displays the list of Encounters grouped by cases for the selected patient. For each encounter, the list of diagnosis codes, the procedure codes and their corresponding charges, Billed amount, Paid amount, current status, etc., are displayed and can be edited.
To view the Charge Master screen, select Charges from the main menu and then click on Edit Charges. The Charge Master window will be displayed, as shown in Image 1.
The Charge Master can be used in the following scenarios.
a. To edit the charges.
b. To add new CPT codes to an encounter.
c. To view all the activities related to an encounter(case level, encounter level, and line-level activities)
d. To add a new encounter.
e. To assign Claims to users.
Section 1-Search Parameter Section
1a. Enter either the first three characters of patient name or MR # in the Patient field. (This is a smart search field. To know more, click here.) To make changes in the patient demographic data, click on the Edit Button beside the Patient field.
1b. Case#, Claim#, DOS, ACCESSION# are other search filters. The OPEN CASE ONLY check box is used to display only the open cases of the patient.
Section 2- Encounters Section
This Section displays all the cases of the selected patient and the related encounters. Encounters are grouped according to the case.
Mouseover on the date of service listing will show the CPT code(s) present in the encounter (marked by an arrow in Image 1).
Section 3- Case, Patient, Guarantor, Insurance, and Diagnosis details section
3.a. Case tab (Image 3) displays the case details like case#, Case name, Case type, Start date, Last Claim Sent, Last Payment Applied, etc. Edit the selected case by clicking beside the case section. To view any activity on a case, click on icon. Click on to insert the case activity notes if required.
3.b. Patient tab (Image 4) displays the patient demographic information like patient name, MR#, DOB, Phone number, Address, email, etc.
3.c. The Guarantor tab (Image 5) displays details of the guarantor of the patient in the particular case selected. Relation to the patient, name, address, phone number, etc. are some of the fields in this tab.
3.d. Insurance tab (Image 6) displays the primary, secondary, and tertiary insurances, and the corresponding plans, balances, copay amounts, etc. of the selected case.
3.e. Diagnosis tab (Image 7) displays the ICD codes included in the selected case. To add new ICD codes to the case, click on and select the ‘Others’ tab in the Case screen and add the required codes in the fields D1, D2, and so on. Up to 12 diagnosis codes can be inserted in a case.
Section 4- The Encounter Tab
The encounter tab is as shown in Image 8.
4a. It is used to display/edit the information of encounters. Users can access the clinical note directly from the Charge Master screen. Icons similar to those present in the EHR screen depicts the status of the chart; see Image 8a.
4b. It can be used to add new encounters to the selected case-To add a new encounter to a case, click on the relevant case on the left pane. Add Date of Service Start, Time of Service, ICD-10 codes for the encounter. For all CPTs to be entered, repeat the following: In the Add New Line field (highlighted in Image 8), enter the required CPT code. Click onbutton; a new line gets created. Enter the rest of the fields such as Diagnosis and units and click button.
4c. Add new CPTs to an existing encounter- To add a CPT to an encounter, select the encounter from the left pane. In the Add New Line field (highlighted in Image 8), enter the required CPT code. Click on button; a new line gets created. Enter the rest of the fields such as Diagnosis and units and click button.
4d. This is the section where we can assign claims to users- A user icon is provided next to the Accession# field (see red arrow in Image 8). Click on the icon to open the ‘Follow-Up Action’ pop-up (see Image 8b) where the assignee user can be selected and any additional notes can be added. The assigned claim will fall into the user’s worklist in Collection Manager.
4e. Detail tab contains Main, Condition, Accident, Ambulance, Others, which include fields populated from the ‘Others’ tab of the case screen. Enter the Rendering Provider and update relevant fields as required. The ‘Others’ tab also has ‘Do not Send Statement’ checkbox to exclude the encounter from sending patient statements.
4f. Click on button. The encounter gets updated. If a new encounter is created, it will be displayed in the corresponding case in the Encounters section. Also, the encounter lines get created equal to the number of CPT codes entered.
Section 5- Encounter Lines
The section marked 5 in Image 2 displays the Encounter Lines corresponding to the CPT codes. Each line shows the CPT code, DOS Start and End date, diagnosis pointers, modifiers, units, Charge, Total amount, Amount paid, Adjustment amount, adjustment reason, balance, etc.(See Image 9). All the fields are editable except Total and Paid.
To know more about each column in the line, click here.
To know more on how to set the status of a line according to the billing workflow, click here.
After making the necessary changes, click on button. As in the charge entry screen, superbill forms such as HCFA 1500, CMS 1500 can be printed, and Claims Validation rule can be run while saving the encounter.
Section 6-Line Activity Log
1. All the updates and payments of each encounter line are logged in the Line Activity tab for later reference. This log also displays the Collection status, sub status, follow-up notes from the collection manager. Any change made to line sub status will also be recorded as an encounter activity.
2. Date & Time and Activity in the Line Activity screen will be color-coded as in Image 10. Furthermore, we can enter additional notes to the log through the Add Activity field.
3. When refunds are posted, the source and target payment numbers, and the amount gets captured in the line activity.
4. Any update on Resubmission Code and Original Ref# fields will also be recorded by the system as an encounter activity. Regarding Resubmission Code field, note that if the dropdown option selected in the Resubmission Code field is either “Replacement of Prior Claim” or “Void or Cancel of Prior Claim”, the Original Ref # entry is mandatory.
Note: To open Payer Remark and Line Activity as a full-screen pop-up window for better visibility, click on the icon ( indicated by an arrow in Image 10).
The Payer Remark tab (shown in Image 11) provides denial Information on the charges. Also, line Sub Status can be set from the Payer Remark. Click on the Line Sub Status drop-down to set the status. Any remarks on the sub status can be provided in the Remark field. For lines set to BILL_TO_PT status, any remarks to be included in the Patient Statement can be provided in the Remark To Pat. Stmt field.