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Prepayment and Time of Services Payment - UWMF Non-EpicCare Sites (aka Self Payments) (113.023)

Prepayment and Time of Services Payment - UWMF Non-EpicCare Sites (aka Self Payments) (113.023) - Policies, Administrative, UWMF, UWMF-wide, Patient Business Services

113.023

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

University of Wisconsin Medical Foundation
Patient Business Services Policies & Procedures
PREPAY & TIME OF SERVICE PAYMENTS
UWMF Non-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 complete the encounter form, designating the appropriate CPT
and DX codes associated with the service rendered.
iii.The encounter form will be given to coding staff to be processed per the coding
guidelines for that department (i.e., will or will not be coded). Coding staff will
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.
Staff will then forward the encounter form to Charge Entry.
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.


PBS 12: Prepayments
Updated: 9-1-07
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3. Charge entry:
a. Staff will enter the charge and ensure that the charges are tied to the Prepayment
account. The presence of the “PRE” modifier will route the charge to a special work
queue so that the Special Billing department can distribute the payment.

4. Special Billing Team:
a. 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.


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, 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. Click on Check Out at the appointment desk screen.


2. On the next screen that comes up, select the Charges icon.



PBS 12: Prepayments
Updated: 9-1-07
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3. This will take you to the charge entry screen. At this screen, click in the “DBI” (do not
bill insurance) button next to the coverage field. This will wipe out the coverage for this
visit and treat it as self-pay.



4. Follow the screen, entering charges and posting the payment (under the fast payment
section). Be sure to list the source of the payment (cash, check, or credit card). If the
patient pays by check, the check number should be listed in the reference number field
(the number alone, it should not be preceded with “ch”.)

5. After the charge has been entered and the payment posted, send the encounter
form, via Inter-D mail, to Scanning at PBS, Excelsior Drive (mail code 115). Please
note the charge has already been entered. Liz will ensure that the encounter form is
scanned into the document imaging system.


NOTE: IF SOME SERVICES ARE COVERED AND SHOULD BE BILLED TO
INSURANCE,
 Skip step 5 above. Instead, next to the charge that was entered, write in red or other
noticeable color, “charge already entered” (you may want to have red stamps made to
speed this process). This will direct PBS charge entry staff to skip this charge and
enter only the remaining, covered charges.
 Include the encounter form with all others to be sent to PBS for charge entry.


PBS 12: Prepayments
Updated: 9-1-07
8



Attachments
Insemination Services
Implanon


References
Hearing Services Policy
On Site Payment Policy
Bariatric Surgery Policies
Transformations/Cosmetic Services Policy