Entering Charges in the Charting Workspace

Summary

When working with the Charting Templates, it is possible to manually add medical activities for billing on the RESULTS tab and the PROCEDURES tab as well as the Charges button on the Menu Bar. Should you do this? You may be surprised to find that we recommend that it not be part of your normal procedures. However, what works in any clinic is very dependent on the work flows in that clinic, so it might make sense for you.

The reason we recommend against it is two-fold. The first reason is simply that it is cumbersome for medical personnel to take the time to add individual activities. The second reason is that the Charting Templates provide a much better way of getting most charges on visits.

Part of setting up Charting Templates is creating Wizards. Wizards can be designed specially for individual actions taken in dealing with specific complaints. One feature of Wizards on certain Template Elements is that you can associate medical activities for billing with the Wizard. When you select a Wizard to document a procedure, test, or order, Net Health Employee Health and Occupational Medicine will automatically add that charge to the visit. For example, you can have it be that when a provider orders an x-ray, the medical activity is immediately added to the visit. If you do an effective job of setting up your Wizards, most medical activities should get added without your doing so manually. This is not to say exceptions will never occur. They will, and that is why we provide the ability to add charges manually. Whether it makes sense for medical staff to enter the charges in the EMR, or for front desk staff to enter by another route is a matter of the procedures that best fit your clinic.

Adding Charges with Wizards

The Template Elements which can add charges with wizards are Test Results, Procedures, and all the elements on the ORDERS tab except Work Restrictions. You can also add charges to Immunizations and Clinical Practices Guidelines.

Here are some examples of how to use Auto-Charge:

  • If you offer an Instant Urine Drug Screen test, a Test Results Wizard for that drug screen could walk you through documenting the results, then automatically add the charge to the visit.

  • If you have charges that are bundled together, create a Medical Activity Template that combines all the individual charges into a single medical activity (CPT code) which can be associated with the relevant Wizard and added to the visit.

  • It is also possible to enter charges not when the Wizard executes, but based on choices made on the Wizard. This involves wizard steps of the two multiple choice types: Pick One & Pick All That Apply. Both of these types of steps allow you to enter a list of options from which the user can choose. For Wizards on the appropriate tabs, an Auto-Charge activity can be indicated for each multiple choice option. This has many uses. For example, you could have a Medication Orders Wizard for meds dispensed in house. When run, the provider would select the appropriate med, and a charge for that specific med would be added to the visit. Another example is laceration repair. On each laceration repair Wizard, include a multiple choice step which allows the user to select the length of the laceration based on the standard lengths covered by different CPT codes (0-2.5cm, 2.6-5.0 cm, etc). Link the appropriate auto-charge medical activity to each length. When the Wizard is executed, the correct charge will be added to the visit.

  • You can even combine entering a charge for the Wizard and one from a multiple choice option. For instance, on the laceration repair Wizard just described, you could also have a Suture Kit charge on the Wizard itself. When the Wizard executes, one charge will be added to the visit based on the length of the laceration. Regardless of the length selected, a second charge will be added for the Suture Kit.

  • If you need to review old medical records, set up a Wizard to indicate in the Charting Note that you have done that and have Net Health Employee Health and Occupational Medicine add the charge.

Medications

On Medications Orders Wizards when the Dispensed By field is set to Dispense In-House or Provider Administered, you can have the medication billed to the patient directly instead of the insurance carrier. When Auto-Charge is selected, a check box labeled Charge Patient Directly is enabled for that purpose.

Net Health Employee Health and Occupational Medicine Fee Ticket

Auto-Charge is great for many activities like x-rays, laceration repair, etc. For on-demand items like gauze which might or might not be needed during a particular procedure, and which can be required in quantity, auto-charging via Wizards can be tedious. You might want to try a combination approach. Use auto-charge where it make sense, then have a Net Health Employee Health and Occupational Medicine fee ticket designed specifically for the on-demand activities. Complete exceptions can still be added manually.

Marking Charges Complete

Medical activities added by a wizard are created with a status of Pending. Before Net Health Employee Health and Occupational Medicine will actually bill for a charge, the Status must be changed to Complete. This can be done from an EMR Charting Template, manually for each charge, or for all charges by clicking the Complete All button. What is the best way? Probably neither one of these methods. We recommend that the health care providers not be the ones to mark activities complete, but instead, leave that to the front desk as part of the process of confirming that all activities have been entered and in fact completed. The full process of completing charges in Net Health Employee Health and Occupational Medicine is discussed in the topic on How to Enter Charges.

Paper Fee Tickets

Can all this eliminate the need for paper fee tickets? One less piece of paper is always good news, and this might let you dispense with the fee ticket. Again, it will depend on the clinic procedures you develop. There are several reasons for using a paper fee ticket:

  • It might be easier to check activities off on paper, then enter them later, than it is to enter them directly during the visit.

  • The paper fee ticket can serve as a double-check that all charges got entered.

  • It might be the best way to record any atypical charges that are not added automatically via a Wizard so that a billing or front desk person can enter them manually.