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/policies/administrative/uwmf/uwmf-wide/patient-business-services/113007.policy

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Policies,Administrative,UWMF,UWMF-wide,Patient Business Services

Charging (113.007)

Charging (113.007) - Policies, Administrative, UWMF, UWMF-wide, Patient Business Services

113.007

PBS – 5: Charging
Revsied: 8-18-05
1

University of Wisconsin Medical Foundation
Patient Business Services Policies & Procedures
CHARGING


__ __ New _ X__ Revised

If Revised, Supersedes Policy Dated: 2-1-05

Effective Date: 8-18-05

Policy Number: PBS - 5
Approved By (Name): Connie Kinsella, Vice President, Patient Business Services


Purpose
To account for all services provided and reductions from revenue, charges for all billable
encounters will be posted at the standard rate established in the UWMF fee schedule.
Adjustments, discounts, and write-offs shall be made using appropriate accounts receivable
(A/R) procedure codes and/or pricing contracts.

Charge entry accomplishes statistical tracking of productivity units, revenue recording and bills
to patients or insurance when appropriate. While not all posted charge transactions will result
in an actual claim to insurance or bill to patients, every service must have an associated
charge transaction entered.


Policy
1. UWMF follows CPT guidelines for charge submission and Medicare guidelines for
documentation. UWMF does not charge for certain services, including, but not limited to,
pre-op and post-op visits included in the global surgical charge, phone calls, e-mails, clinic
visits associated with direct admits, and patient no-shows (except for behavioral health
services). For questions about CPT guidelines, contact the PBS Manager of Coding and
Charge Capture or your Departmental Coding Coordinator.

2. All services will be charged at the standard rate established in the UWMF fee schedule. All
discounts, contractual adjustments, write-offs, or other adjustments to fees will be recorded
in Epic to ensure proper accounting and reporting.

3. Capitated services will be written off at the time of electronic remittance posting.

4. Other contractual discounts and/or write-offs will be recorded at the time of payment posting,
except as noted below.

5. Discounts associated with Company and Skilled Nursing Facility (SNF) accounts will be
taken following charge entry and prior to production of a monthly invoice.


PBS – 5: Charging
Revsied: 8-18-05
2
6. Discretionary discounts and/or write-offs requested by providers will be taken following
charge entry and prior to claim submission using the appropriate write-off transaction to
account for the reduction.

7. Discounts and/or write-offs associated with administrative errors, lack of documentation, and
patient relations issues will be taken following charge entry and prior to claim submission
using the appropriate write-off transaction to account for the reduction.

8. Requested discounts/write-offs for charity care will be evaluated by Patient Business
Services in accordance with the Community Care Policy. If approved, the adjustment for
charity care will occur following charge entry and prior to claims submission or statement
production, as the case may be.


Procedure
1. The payor/plan masterfiles will be appropriately set up to reflect contractual arrangements
with contracted payors. Payment received will be verified against the expected
reimbursement recorded in the Epic system. Adjustments will be made at the time of
payment posting using the appropriate contractual adjustment code.

2. Provider requested discounts should be recorded on the encounter form. A fee
waiver/reduction box is included on all encounter forms just below the header and above the
service codes. The appropriate reason code should be checked to ensure the proper
accounting of the discount or write-off.

3. Adjustments or write-offs associated with patient relations issues, lack of documentation, or
administrative issues/errors such as failure to obtain reimbursement credentials, failure to
capture an Advanced Beneficiary Notice (ABN), or failure to obtain a referral or prior
authorization may be made at various points in the revenue cycle depending upon when the
issue is brought to the attention of Patient Business Services. In all cases, the adjustment or
write-off will be made using the appropriate A/R procedure code.

4. If a provider or staff person identifies a patient who may qualify for UW Health’s
Community Care Program, s/he should direct the patient to Patient Business Services.
Appointments for such patients may be scheduled prior to a determination of his/her
eligibility for the Community Care Program being made.


Attachments
Fee Waiver Instructions


References
Company Account Policy
Skilled Nursing Facility Policy
Community Care Policy