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Confidential Accounts - Non-EpicCare Sites (113.012)

Confidential Accounts - Non-EpicCare Sites (113.012) - Policies, Administrative, UWMF, UWMF-wide, Patient Business Services

113.012

PBS – 7: Confidential Accounts
4-1-06
1

University of Wisconsin Medical Foundation
Patient Business Services Policies & Procedures
CONFIDENTIAL ACCOUNTS, NON-EPICCARE SITES


__ __ New __X__ Revised

If Revised, Supersedes Policy Dated: 1-23-06

Effective Date: 4-1-06

Policy Number: PBS – 7
Approved By (Name): Connie Kinsella, Vice President, Patient Business Services


Purpose
To define the process for scheduling appointments and/or registering patients who request a
confidential account and collecting payment at the time of service for any services rendered
under a confidential account.


Policy
1. Patients may request that charges associated with a particular visit (or visits) be posted to a
confidential account.

2. Every attempt shall be made to collect payment, at check-out, from patients receiving
services under a confidential account. Patients who indicate they are unable to pay should
be directed to Patient Financial Services for consideration under the Community Care Policy.

3. Confidential accounts with outstanding balances will be statement producing accounts. PBS
staff will attempt to contact the patient by phone to obtain payment prior to production of the
first statement.


Procedure

SCENARIO 1 – Patient Requests Confidential Visit at Appointment Scheduling
1. Scheduling
a. Create a confidential account if none exists for that patient (see details at the end
of this policy/procedure).
b. Schedule the appointment. At the account selection window, be sure to select the
confidential account.
2. Check-In
a. Ensure the appointment is tied to the confidential account.
b. Generate the encounter form.
c. Inform the patient that s/he must return to the check-in/out desk following his/her
appointment to make payment. Failure to do this will result in him/her receiving
a call and/or statement for the services provided.

PBS – 7: Confidential Accounts
4-1-06
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3. Visit with Provider
a. Complete encounter form, marking all applicable CPT and DX codes. If any
ancillary services are provided, complete the ancillary encounter forms marking
all applicable CPT and DX codes.
b. Give patient a copy of the encounter form(s) and inform him/her to stop at the
Check-in/out desk. If any ancillary services are to be provided, it is preferred (but
not required) that the patient stop at the Check-in/out desk prior to receiving the
ancillary services.
c. Before day-end, the original encounter forms should be forwarded to or gathered
by the Check-in/out staff so that they can ensure that the charges have been
entered.
i. If the charges were entered: Either the original or the copy can be tossed.
Only one encounter form needs to be sent to PBS for scanning. The form
sent to be PBS should clearly indicate that the charges have already been
entered.
ii. If the charges were not entered: Make sure the encounter form clearly
indicates the services are to be posted to the confidential account and send
it to PBS, Attention Special Billing, for charge entry.
4. Check-Out
a. Note: If the provider requests a fee reduction, waiver, or consideration for
Community Care, follow the instructions at the end of this policy and procedure
instead of the steps listed below.
b. From the DAR or appointment desk, highlight patient and confidential
appointment, click on Check Out.
c. On the check out screen, click on Charges button. This will take you directly to
the Charge Entry screen.
d. From the Charge Entry screen, the appointment information will default in from
the appointment information entered in Cadence. At Account, make sure the
confidential account has populated the field. If not, click the ellipsis and select
the confidential account from the list of accounts which comes up. Confidential
accounts always starts with 3000.
e. Enter the CPT and DX codes provided. The fees will automatically populate.
i. Note: If the charge is for a laboratory test, at Referral svc, enter the
ordering MD.
ii. Note: If a warning pop-up box appears indicating there are charge errors
relating to coding, contact the provider to obtain the correct coding
information.
f. In the Fast Payment section, enter the payment code 1014 for patient payment, the
payment source (cash, check, credit card) and the amount. If the patient is paying
by check, enter the check number as the reference number (do not precede the
check number with “ck”; enter the number only). If the patient is paying by credit
card, enter the authorization number as the reference number.
g. At the Options section, choose receipt. The system will generate a receipt.
h. Click Accept at bottom of screen.

PBS – 7: Confidential Accounts
4-1-06
3
SCENARIO 2 – Patient Requests Confidential Visit at Check-in
1. Check-In
a. Create a Confidential Account if one does not exist for the patient.
b. Check-in the patient.
i. At the Account selection screen reassign the appointment from the
personal/family account to the confidential account (make sure the
confidential account is checked and highlighted).
c. Generate the encounter form.
d. Inform the patient that s/he must return to the check-in/out desk following his/her
appointment to make payment. Failure to do this will result in the patient
receiving a call and/or statement for the services provided.
2. Visit with Provider
a. Same as in Scenario 1
3. Check-Out
a. Same as in Scenario 1


SCENARIO 3 – Patient Requests Confidential Visit (all services) After Check-in
1. Visit with Provider
a. From the exam room, call the front desk and have the patient speak with the
registrar (hub sites) or receptionist (non-hub sites). The registrar or receptionist
will create the confidential account if one does not exist for the patient.
i. If a co-pay was collected at check-in:
 REFUND the co-pay following the detailed instructions at the end
of this policy and procedure. If the co-pay was made by cash or
check, staff should save the refunded amount and reapply it (at
check-out), along with the additional patient payment for the
balance due, to the confidential account. (Note: the system
requires that you refund the co-pay before you cancel the
appointment.)
 CANCEL the original visit and reschedule a new visit tied to the
confidential account. A new encounter form must be generated
and the encounter form for the original visit should be destroyed.
ii. If a co-pay was not collected at check-in, the registrar or receptionist can
simply RE-CHECK-IN the visit so that the new account can be attached to
the encounter. A new encounter form does not need to be generated.
However, it would be helpful if the clinical staff crossed out the coverage
listed on the encounter form and noted somewhere on the form that the
services are to be billed as confidential.
b. Follow all other steps detailed in Scenario 1.
2. Check-Out
a. Same as in Scenario 1



PBS – 7: Confidential Accounts
4-1-06
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SCENARIO 4 – Patient Requests Some Confidential Services After Check-in
1. Visit with Provider
a. From the exam room, call the front desk and have the patient speak with the
registrar or receptionist. The registrar or receptionist will create the confidential
account if one does not exist for the patient.
b. The registrar/receptionist will schedule a second appointment for the patient
(walk-in) and attach that appointment to the confidential account. An encounter
form for the walk-in visit will be generated.
c. The provider must complete both encounter forms.
i. The services to be billed to insurance should be billed on the first
encounter form and should be processed as normal.
ii. The services to be treated as confidential should be recorded on the
Confidential encounter form and processed following the steps listed in
Scenario 1.
2. Check-Out
a. Same as in Scenario 1
b. If a co-pay was collected, it can remain on the personal/family account because it
will apply to the services being billed to insurance.


Attachments
Fees for Common Confidential Services


References
Confidential Account Brochure (order through PeopleSoft, item # PB5792-0803P)
Community Care Policy
On-Site Payment Policy

PBS – 7: Confidential Accounts
4-1-06
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ADDITIONAL DETAIL


CREATING A CONFIDENTIAL ACCOUNT:
1. Access the patient’s registration record (either directly through Prelude or through
Cadence, by clicking on the Reg icon)
2. At the Interactive face sheet, click on Guarantor Accounts in the left margin menu bar.
3. Select Add under the Accounts for Patient.
4. This will open the Account Information window.
5. Click on the ellipsis in the Account Type window
6. Select Confidential. Click Accept.
7. Click Search New.
8. If no account type is found, click Yes to create the account.
9. Complete the Guarantor information screen for the confidential account. Click Finish.
a. Note: Guarantor must be the patient. Any person 14 years or older (12 or older
for AODA) may have a confidential account (per state law).
b. Note: The patient’s address and phone number will default in to the confidential
account from patient information. If the patient wants the confidential account to
be sent to a different address or has a different phone number, turn off the
address link and manually enter the information specific to the confidential
account. If no phone or address information is added and there is a balance due on
the account, PBS staff will use the address and phone information from the
personal/family (P/F) account in order to collect on the account.
10. If you have questions regarding how to set up a confidential account or require assistance
in setting up such an account, please contact the central registration phone bank at 608-
287-2725.


IF PROVIDER REQUESTS A FEE REDUCTION:
1. From the DAR or appointment desk, highlight patient, click on Check Out.
2. On the check out screen, click on $ Other Payment button. This will take you directly to
payment screen.
3. Click on “other payment”.
a. In the “paid” field, enter the amount paid.
b. Pass by the “payment code field (it should automatically populate with “patient
payment”).
c. Click the ellipsis in the “post method” field and select #6, “For Later
Distribution”.
d. In the source field, select the appropriate payment method (e.g., cash, credit card,
check).
e. In the reference field:
i. Type the check number if the patient paid by check.
ii. Type the authorization number if the patient paid by credit card.
iii. If the patient paid by cash, this field should be left blank.
f. Clinic accept. A box will pop up indicating the printer the receipt will be printed
at.

PBS – 7: Confidential Accounts
4-1-06
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4. Send the encounter form to Special Billing at PBS-Excelsior in an interdepartmental
envelope marked “Confidential”. Please attach a copy of the receipt to the encounter
form. Special Billing will post the charge (overriding the fee as requested by the
provider) and distribute the payment to the charge.



IF PROVIDER REQUESTS A FEE WAIVER:
1. Send the encounter form to Special Billing at PBS-Excelsior in an interdepartmental
envelope marked “Confidential”. Special Billing will post the charges and write-off them
off.



IF PROVIDER REQUESTS CONSIDERATION FOR COMMUNITY CARE:
1. Send the encounter form to Special Billing at PBS-Excelsior in an interdepartmental
envelope marked “Confidential”. Special Billing will post the charges and direct the
account to Patient Financial Services for evaluation.
2. Note: the patient will be contacted by PBS and asked to provide detailed financial
information in order to assess whether s/he qualifies for community care.



REFUNDING A COPAY

NOTE: The copay must be refunded prior to the cancellation of the appointment. If the
appointment is canceled prior to the co-pay refund you will need to contact Charge Corrections
in the Central Business Office to request that the copay be voided (608-829-5624).


PBS – 7: Confidential Accounts
4-1-06
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To refund a co-payment to an appointment that you have checked in, you will need to “Check
In” the appointment again (see below). NOTE: For clinics that do sign-in, you will need to
“Sign In” the appointment again.



At this point you click on the “Copay Rfd” button.


PBS – 7: Confidential Accounts
4-1-06
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Enter the dollar amount that you wish to refund. In the “Reason” field below, click on the ellipse
and choose patient canceled. Once you have completed the appropriate fields, click the “Accept”
button. Do not use the “Comment” field.






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4-1-06
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You will get a window asking for the printer name (this is your printer number) in order to
provide a refund receipt. This receipt will be kept to track the refund with your end of day user
batch report.


After entering your printer number click the “Accept” button. The “Type” and “Number of
Copies” will default the appropriate data.


PBS – 7: Confidential Accounts
4-1-06
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When the co-payment process has been completed in Epic, ask for the patient’s original receipt.
If for some reason the patient does not have the original receipt, you can still proceed with the
refund. Please keep the refund receipt and include it with your end of day user batch report.
Click the “Accept.”



PBS – 7: Confidential Accounts
4-1-06
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The “Print Encounter Form” window will appear. Please click on “Cancel” because you do not
want an encounter form to print.



The “Print Visit Label” window will appear. Please click on “Cancel” because you do not want
a label to print.


PBS – 7: Confidential Accounts
4-1-06
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You will return to the “Appointment Desk.” Click the “Close” button to exit.