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Prepayment and Time of Services Payment - UWMF EpicCare Sites (113.022)

Prepayment and Time of Services Payment - UWMF EpicCare Sites (113.022) - Policies, Administrative, UWMF, UWMF-wide, Patient Business Services

113.022

PBS 12: Prepayments
Updated: 9-1-07
1

University of Wisconsin Medical Foundation
Patient Business Services Policies & Procedures
PREPAY & TIME OF SERVICE PAYMENTS
UWMF EpicCare Sites
(aka Self Payments)


_ __ New _X_ Revised

If Revised, Supersedes Policy Dated: 8-1-05

Effective Date: 9-1-07

Policy Number: PBS-12
Approved By (Name): Connie Kinsella, Vice President, Patient Business Services



Purpose
To define a process for collecting prepayment for services not generally covered by insurance for
which we require prepayment. Examples of such services are cardiovascular screening, laser eye
surgery, virtual colonoscopy, travel vaccinations, and certain infertility treatments. This policy
should not be applied to patients who are uninsured, unless they are receiving one of the
services noted above. Prepayment of cosmetic services, hearing aids, and non-covered bariatric
surgery is also required. Please refer the separate policies which have been developed relating to
those services.


Definitions
1. Prepayments – Payments collected in advance of scheduling the service or procedure.
Prepayments are required for high cost services (e.g., $1,500 or more) and are posted on a
special prepay account established for the patient.

2. Time of Service Payments – Payments for services that are not covered by insurance which
are collected either just before or just after the service has been rendered. These payments
are posted directly to the patient’s personal/family account.


Policy
PREPAYMENTS
1. Services costing $1,500 or more require prepayment in advance of the procedure/service
and must be coordinated through the Prepayment Specialist, 608-262-7354 (Monday –
Friday morning) and 608-287-2975 (Friday afternoons). Note: Hearing aids, non-
covered bariatric services, and cosmetic services are discussed in separate policies.
Please refer to those policies for more detail regarding those services.

2. A Prepayment Account Type will be established for all patients receiving high dollar,
non-covered procedures/services which require payment in advance of the
service/procedure.


PBS 12: Prepayments
Updated: 9-1-07
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3. The Prepayment Account Type should not be used for uninsured patients.

TIME OF SERVICE PAYMENTS
1. Payment for lower cost procedures/services where the price is known prior to the service
being rendered (e.g., implanon, Zostavax) should be collected at the time of check-in.

2. Payment for lower cost procedures/services where the price is not known prior to the
service being rendered (e.g., travel immunizations) should be collected at the time of
check-out.


Procedure
PREPAYMENTS
1. At the time the service requiring prepayment is identified:
a. The clinic site that will be performing the service that requires prepayment shall
inform the patient that prepayment is required. The clinic should inform the patient
that s/he will be contacted by the Prepayment Specialist. The clinic should e-mail the
Prepayment Specialist with the pertinent information so that s/he may follow-up with
the patient.
b. The Prepayment Specialist will send the patient a letter regarding the prepayment
process. This letter will include an estimate for the service and a Financial
Agreement for the patient to sign and return with the prepayment.
c. When the prepayment is received from the patient, the Prepayment Specialist will:
i.Create a Prepayment account for the patient on Epic.
ii.Post the prepayment to the patient’s Prepayment account. The payment will sit
undistributed on the account until the service is rendered and the encounter form
sent to PBS.
iii.Attach the appointment for the service (if there is one) to the Prepayment account.

2. At the time the service is rendered:
a. Services rendered in the clinic:
i.Check-in staff will verify that the appointment is tied to the Prepayment account
and generate an encounter form.
ii.The provider shall document the visit in EpicCare, designating the appropriate
DX and CPT codes associated with the service rendered and adding the modifier
of “PRE” to the CPT codes.
b. Services rendered in ASC or inpatient setting
i.Coding staff will prepare the appropriate encounter form and ensure that a dummy
modifier of “PRE” is listed for each CPT code to indicate to Charge Entry staff
that the service was rendered under a Prepayment account.

3. Special Billing Team:
a. When the charge files from EpicCare to Resolute, the presence of the “PRE” modifier
will cause the charge to route to a special work queue so that the Special Billing
department can distribute the payment.
b. Special Billing staff will work the Prepay Work Queue on a daily basis, distributing
the payments received to the charges to ensure that the patient is not billed.


PBS 12: Prepayments
Updated: 9-1-07
3

TIME OF SERVICE PAYMENTS COLLECTED AT SIGN-IN OR CHECK-IN

1. Select Sign-in or Check-in (based on the processes defined at your site)



PBS 12: Prepayments
Updated: 9-1-07
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2. Select Other Payment


3. Complete the fields noted with the stop sign. For Post mtd, enter 6 (for later
distribution/prepayment). Source is cash, check, or credit card. When finished, click
accept. This will take you back to the sign-in or check-in screen.




PBS 12: Prepayments
Updated: 9-1-07
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4. Complete the Sign-in and/or Check-in processes as normal, except, when you get to the
co-pay screen, click to the “Do Not Bill Insurance” box (this should be done even if the
patient does not have insurance).


5. When the provider renders the service and documents that service in EpicCare,
he/she must add a modifier of PRE to the services that were paid at the time of
sign/check-in. This will ensure that when the charge is posted to Epic, it will be routed
to Special Billing so the payment can be matched to charge.



PBS 12: Prepayments
Updated: 9-1-07
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TIME OF SERVICE PAYMENTS – COLLECTED AT CHECK-OUT

1. At Sign-In or Check-In, complete the processes as normal, except, when you get to the
co-pay screen, click to the “Do Not Bill Insurance” box (this should be done even if the
patient does not have insurance).


2. When Provider renders the service, he/she must document the services received in
EpicCare and close the encounter before the patient leaves. This is necessary so that
the check-out person can identify the charges, collect the correct amount, and post the
payment to the charges.


PBS 12: Prepayments
Updated: 9-1-07
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3. At Check Out, at the appointment desk screen, select “check-out.”


4. Then Select Other Payment



PBS 12: Prepayments
Updated: 9-1-07
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5. Complete the fields noted with the stop sign. For Post mtd, enter 1 (outstanding charges).
All outstanding patient balances will display in the box. If “do not bill insurance” was
correctly selected at check-in and the provider closed the encounter in EpicCare after
seeing the patient, the charges for the visit to be collected should show.

Click in the box next to the visit. A check mark will display (not shown in screen shot
below). This tells the system that is the charge the payment should be applied to.

Note the Self-Due balance. Collect this amount (recording the dollar amount in the paid
box). Record the source (cash, check, credit card). If paying by check, the check number
should be recorded in the Ref # field. If paying by credit card, record the authorization
number in this field. Leave the Ref # field blank if paying by cash.

Click accept when done.



NOTE:
IF SOME SERVICES RENDERED WILL BE PAID AT CHECK-OUT AND SOME ARE
TO BE BILLED TO INSURANCE THE VISIT MUST BE SPLIT. TO DO THIS, A
SECOND, WALK-IN APPOINTMENT MUST BE CREATED AND THE PROVIDER MUST
DOCUMENT IN TWO ENCOUNTERS. ONE ENCOUNTER SHOULD BE PROCESSED AS
NOTED ABOVE, THE OTHER CAN BE PROCESSED AS USUAL. FOR MORE
INFORMATION, REFER TO THE SPLIT VISIT POLICY.





PBS 12: Prepayments
Updated: 9-1-07
9
Attachments
Insemination Services
Implanon


References
Hearing Services Policy
On Site Payment Policy
Bariatric Surgery Policies
Transformations/Cosmetic Services Policy
Split Visits, EpicCare Sites