Department of Veterans Affairs

Department of Veterans Affairs Integrated Billing (IB) User Manual

Version 2.0 July 2013 Original Release March 1994 Office of Information and Technology (OIT) Product Development

Revision History

Initiated on 12/29/04

Date 3/26/2013

Description (Patch # if applic.) Project Manager

? Updated cover page.

Kimberly Nix

? Added blank pages and noted pages left intentionally blank: pp. iv, 6, 8, 10, 12, 52, 78, 132, 138, 218, 292, and 308.

? Removed extra blank pages.

? Corrected heading styles and updated Table of Contents.

? Added "Sample Screens" label to p. 187 and "Sample Output" label to p. 200.

? Rearranged options in the IRM System Manager's Integrated Billing Menu section to better reflect actual menu layout in Table of Contents. Options were moved up to pp. 298-307.

Changes highlighted in Green.

Technical Writer Kayte Vo

ii

IB V. 2.0 User Manual

March 1994

Revised July 2013

Date 3/26/2013

3/26/2013 8/17/11 10/16/07 5/27/05 12/29/04 12/29/04

Description (Patch # if applic.) Project Manager

Updated for patch IB*2.0*458:

Kimberly Nix

? Added new ROI Consent option to Claims Tracking Editor screen on pp. 17, 21, and 22

? Added new ROI Special Consent screen to pp. 20 and 22

? Reformatted bulleted lists and added note about additional review types on pp.18, 115, and 120;

? Updated Days Denied Report description and sample output on pp. 142-143;

? Added new ROI Expired Consent Report to p. 217;

? Added new RC Change Facility Type option to Charge Master IRM Menu on p. 317.

Changes highlighted in Green.

Updated for patch IB*2.0*474. Changed last sentence under "Rate Schedule Adjustment Enter/Edit" option on p.317.

April Scott

Updated for patch IB*2.0*449.

Technical writer review-- formatting and convert to Section 508 compliant PDF.

Chris Minardi

Updated for patch IB*2*303

Re-paged for clarity.

Updated to comply with SOP 192352 Displaying Sensitive Data.

Pdf file checked for accessibility to readers with disabilities.

Technical Writer Kayte Vo

Bob Sutton Ed Zeigler (Oakland); Susan Strack (Oakland), technical writer review Tim Dawson Mary Ellen Gray Mary Ellen Gray Mary Ellen Gray

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Table of Contents

(This page included for two-sided copying.)

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Revised July 2013

Preface

This is the user manual for the Integrated Billing (IB) software package.

This manual is designed to provide guidance to a broad range of users within VA medical facilities in daily usage of the Integrated Billing software.

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Table of Contents

Revision History ............................................................................................................................. ii Preface............................................................................................................................................. v Introduction..................................................................................................................................... 1 Orientation ...................................................................................................................................... 7 Package Management ..................................................................................................................... 9 Package Operation ........................................................................................................................ 11

Billing Clerk's Menu............................................................................................................... 13 Claims Tracking Menu for Billing........................................................................................ 13 Claims Tracking Edit .................................................................................................... 13 Print CT Summary for Billing ...................................................................................... 23 Assign Reason Not Billable .......................................................................................... 27 Third Party Joint Inquiry............................................................................................... 27 Enter/Edit Billing Information...................................................................................... 46 Automated Means Test Billing Menu................................................................................... 49 Cancel/Edit/Add Patient Charges ................................................................................. 49 Patient Billing Clock Maintenance ............................................................................... 50 Estimate Category C Charges for an Admission .......................................................... 50 On Hold Menu ...................................................................................................................... 53 On Hold Charges Released to AR ................................................................................ 53 Count/Dollar Amount of Charges On Hold .................................................................. 53 Days on Hold Report .................................................................................................... 53 Held Charges Report..................................................................................................... 54 History of Held Charges ............................................................................................... 54 Release Charges 'On Hold'............................................................................................ 55 List Charges Awaiting New Copay Rate ...................................................................... 55 Send Converted Charges to A/R ................................................................................... 56 Release Charges 'Pending Review' ............................................................................... 57 List Current/Past Held Charges by Pt ........................................................................... 57 Release Charges Awaiting New Copay Rate................................................................ 58 Patient Billing Clock Inquiry ........................................................................................ 58 Category C Billing Activity List................................................................................... 59 Single Patient Category C Billing Profile..................................................................... 60 Disposition Special Inpatient Billing Cases.................................................................. 60 List Special Inpatient Billing Cases .............................................................................. 61 CHAMPUS Billing Menu..................................................................................................... 63 Delete Reject Entry ....................................................................................................... 63 Reject Report ................................................................................................................ 63 Resubmit a Claim.......................................................................................................... 63 Reverse a Claim ............................................................................................................ 64 Transmission Report ..................................................................................................... 64 Patient Billing Reports Menu................................................................................................ 65 Catastrophically Disabled Copay Report...................................................................... 65 Patient Currently Cont. Hospitalized since 1986.......................................................... 65 Print IB Actions by Date............................................................................................... 66

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Table of Contents

Employer Report ........................................................................................................... 67 Episode of Care Bill List............................................................................................... 68 Estimate Category C Charges for an Admission .......................................................... 68 Outpatient/Registration Events Report ......................................................................... 70 Held Charges Report..................................................................................................... 72 Patient Billing Inquiry................................................................................................... 73 List all Bills for a Patient .............................................................................................. 76 Category C Billing Activity List................................................................................... 77 Third Party Output Menu...................................................................................................... 79 Veterans w/Insurance and Discharges .......................................................................... 79 Veteran Patient Insurance Information ......................................................................... 80 Veterans w/Insurance and Inpatient Admissions.......................................................... 81 Veterans w/Insurance and Opt. Visits........................................................................... 82 Patient Review Document............................................................................................. 83 Inpatients w/Unknown or Expired Insurance ............................................................... 85 Outpatients w/Unknown or Expired Insurance............................................................. 88 Single Patient Category C Billing Profile..................................................................... 90 Third Party Billing Menu...................................................................................................... 91 Print Bill Addendum Sheet ........................................................................................... 91 Authorize Bill Generation............................................................................................. 92 Enter/Edit Billing Information...................................................................................... 93 Cancel Bill .................................................................................................................... 94 Copy and Cancel ........................................................................................................... 95 Delete Auto Biller Results ............................................................................................ 96 Print Bill........................................................................................................................ 96 Patient Billing Inquiry................................................................................................... 97 Print Auto Biller Results ............................................................................................... 99 Print Authorized Bills ................................................................................................. 100 Return Bill Menu ................................................................................................................ 101 Edit Returned Bill ....................................................................................................... 101 Returned Bill List........................................................................................................ 101 Return Bill to A/R ....................................................................................................... 103 UB-82 Test Pattern Print............................................................................................. 103 UB-92 Test Pattern Print............................................................................................. 105 HCFA-1500 Test Pattern Print.................................................................................... 107 Outpatient Visit Date Inquiry...................................................................................... 108 Claims Tracking Master Menu............................................................................................ 109 Pending Reviews......................................................................................................... 111 Single Patient Admission Sheet .................................................................................. 117 Insurance Review Edit ................................................................................................ 117 Appeal/Denial Edit...................................................................................................... 126 Inquire to Claims Tracking ......................................................................................... 130 Supervisors Menu (Claims Tracking) ................................................................................. 133 Manually Add Opt. Encounters to Claims Tracking .................................................. 133 Claims Tracking Parameter Edit ................................................................................. 134 Manually Add Rx Refills to Claims Tracking ............................................................ 137

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Table of Contents

Reports Menu (Claims Tracking) ....................................................................................... 139 UR Activity Report ..................................................................................................... 139 Days Denied Report .................................................................................................... 142 Inquire to Claims Tracking ......................................................................................... 143 MCCR/UR Summary Report ...................................................................................... 145 List Visits Requiring Reviews .................................................................................... 146 Review Worksheet Print ............................................................................................. 147 Scheduled Admissions w/Insurance ........................................................................... 148 Single Patient Admission Sheet .................................................................................. 149 Pending Work Report ................................................................................................. 150 Unscheduled Admissions w/Insurance ....................................................................... 150 Hospital Reviews ........................................................................................................ 151 Third Party Joint Inquiry............................................................................................. 156

Patient Insurance Menu ....................................................................................................... 173 Patient Insurance Info View/Edit................................................................................ 173 View Patient Insurance ............................................................................................... 179 Insurance Company Entry/Edit................................................................................... 183 View Insurance Company........................................................................................... 187 Process Insurance Buffer ............................................................................................ 190 List Inactive Ins. Co. Covering Patients ..................................................................... 194 List Plans by Insurance Company............................................................................... 195 List New not Verified Policies.................................................................................... 196

Billing Supervisor Menu ...................................................................................................... 197 Insurance Buffer Activity ........................................................................................... 198

Management Reports (Billing) Menu ................................................................................. 199 Statistical Report (IB) ................................................................................................. 199 Most Commonly used Outpatient CPT Codes............................................................ 202 Insurance Buffer Employee ........................................................................................ 203 Clerk Productivity....................................................................................................... 205 Rank Insurance Carriers By Amount Billed ............................................................... 206 Billing Rates List ........................................................................................................ 208 Revenue Code Totals by Rate Type............................................................................ 211 Bill Status Report ........................................................................................................ 212 Rate Type Billing Totals Report ................................................................................. 214 Insurance Payment Trend Report................................................................................ 215 Unbilled BASC for Insured Patient Appointments..................................................... 217 ROI Expired Consent .................................................................................................. 217

Medication Copayment Income Exemption Menu ............................................................. 219 Print Charges Canceled Due to Income Exemption ................................................... 219 Edit Copay Exemption Letter ..................................................................................... 221 Inquire to Medication Copay Income Exemptions ..................................................... 223 Manually Change Copay Exemption (Hardships) ...................................................... 225 Letters to Exempt Patients .......................................................................................... 226 List Income Thresholds............................................................................................... 228 Print Patient Exemptions or summary ........................................................................ 229 Reprint Single Income Test Reminder Letter ............................................................. 230

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