English French Notes Complete/Exclude Billing Rate: Type of Charge. Charge Set: Charges for a specific Billing Rate, broken down by type of event to be billed/charged. Charge Item: The individual items for a Set and their charge amounts. Billing Region: The region or divisions the charges apply to. Rate Schedule: Definition of charges billable to specific payers. Link between Charge Sets and Rate Types. Once the Rate Type is set for a bill, the Rate Schedule will be used to find all charges to add to the bill. Special Groups: Special requirements that are applied when charges are calculated for a bill: Revenue Code links to care provided Provider discounts IBCR BILLING REGION Regions/localities covered by the same charges Institution: No Billing Regions defined IBCR CHARGE ITEM Default Revenue Code: items billable to Charge Set on or before on or after The Billing Rate of this Set has no Billable Item defined, therefore no Charge Items may be defined for it. (The charges may be calculated amounts.) No Charge Items defined for this Set. has no charges for this set. No Charge Item chosen for display: - Non-bedsection type Items must be specifically chosen for display. - Use the CI action and select an item to display. This set has no charges in this date range. has no charges for this set in this date range. Select a billable to display for Charge Set IBCR SPECIAL GROUPS Group Type: No Special Groups IBCR REVENUE CODE LINK Revenue Codes linked to * revenue code used on a bill for applied to bills for: No Revenue Code links for this CPT. IBCR PROVIDER DISCOUNT Provider Discounts for Provider Type: No Person Class Assigned No Provider Discounts for this Group IBCR BILLING RATE No Billing Rates defined IBCR RATE SCHEDULE Link types of payers and charges ~ charges not auto added to bills (if base $=100, adjusted $= No Rate Schedules defined IBCR RATE TYPE This is a Standard file with entries released nationally. Rate Type: Bill Name: Abbreviation: Third Party?: Inactive: AR Category: Who's Respns: RI Statement?: NSC Statement?: No Rate Types defined ****** Charge Item Report ****** This report will list all charges that are effective within a date range. First sort by Select a single item to display or press return for all items. Charges effective beginning on Charges effective ending on CHARGE SET: Charge Item Effective Inactive Effective Inactive Charge Item Charge Set Charge Rv Cd Charge Rv Cd Charge Item Report Charges for Charges by Set for Enter 'Y' for a list of all Providers in a discount group. Enter 'N' for a list of discount groups. Print report by Provider Sort Report By IB Provider Discount List BILLING PROVIDER DISCOUNT LIST PROVIDER TYPE VA Code Subspecialty BILLING PROVIDER DISCOUNT LIST FOR PROVIDERS SPECIAL GROUP: PERSON CLASS: Charge Master Reports: Report requires 120 columns. BILL SERVICE CHARGES ADJUSTED Caution: This report may be extremely long for some Charge Sets. Some Charge Sets, such as CMAC or AWP, may have many thousands of Charge Items. THIRD PARTY BILL? REIMB INS? This report is for reference only, the rates and charges in this report are no longer used. They have been replace by the rates in the Charge Master. Already being edited by another user WANT TO RETURN BILL TO A/R AT THIS TIME YES - To set the status to Returned Select BEDSECTION: Select CPT: Select NDC #: Select DRG: Select MISCELLANEOUS Item: TORTIOUSLY LIABLE Charge Type: Billing Event: Default Rev Cd: Billing Rate: Default Bed: Region: All Charge Items will use Rev Code if one is not specified for the Item. A Default Rev Code is not specified, one will be required for each Item. All items billable to the Billing Rate must be Billing Rate charges are calculated, there are no Charge Items. Set: Date of Death: NO ALIAS ON FILE Pt Short SC Care: (Enter '7' to list disabilites) Rate Type : Form Type: Responsible: Payer Sequence: Bill Payer : MRA NEEDED FROM MEDICARE Transmit: No- Forced to print local MRA not active EDI not active Rate typ transmit off Ins. co transmit off Failed RULE # Inst. Name : UNKNOWN INSTITUTION Insurance : NO REIMBURSABLE INSURANCE INFORMATION ON FILE [Add Insurance Information by entering '1' at the prompt below] Whose **Patient has additional insurance - use ?INS to see the entire list ORGAN DONOR Facility ID #s: Secondary: Tertiary : Mailing Address : Electronic ID: NO MAILING ADDRESS HAS BEEN SPECIFIED! Send Bill to PAYER listed above. 'MAIL TO' PERSON/PLACE UNSPECIFIED STREET ADDRESS UNSPECIFIED CITY UNSPECIFIED STATE UNSPECIFIED ZIP UNSPECIFIED Ins WILL NOT REIMBURSE Policy #: Grp #: Rel to Insd: Grp Nm: Insd Sex: Insured: (Patient has Medicare) UNSPECIFIED CODE No PTF record for this ADMISSION PTF record status: OPEN Accident Hour: Source : Status : Other Diag.: ***There are more diagnoses associated with this bill.*** ICD-9-CM CPT-4 Pro. Code : CPT Code : ICD Code : HCFA Code : Occ. Code : Cond. Code : Value Code : SNF Care : UNSPECIFIED [NOT REQUIRED] SNF Care SUB-ACUTE Sub-Acute Unknown NO DX CODES ENTERED FOR THIS DATE NO PRO CODES ENTERED FOR THIS DATE DIAGNOSIS SCREEN * No DIAGNOSIS CODES in PTF record for this episode of care. date of service Move: to see more codes or '^' to QUIT: Enter to view more movement dates and diagnosis or '^' to stop the display. OPERATION/PROCEDURE OPERATION/PROCEDURE SCREEN Non-O/R Procedure Date: * No PROCEDURE CODES in PTF record for this episode of care. ICD PROCEDURE CODE ( PROCEDURE DATE ( DIAGNOSIS CODE ( You may only choose codes found in PTF record! Select ICD DIAGNOSIS Enter a diagnosis for this bill. Duplicates are not allowed. Only codes active on Only diagnosis codes active on , no duplicates for a bill, and bill must not be authorized or cancelled. The Diagnosis code is inactive for the date of service ( This diagnosis was removed as a procedure diagnosis. ----------------- Existing Diagnoses for Bill ----------------- Enter the number preceding the Diagnosis you want added to the bill. Multiple entries may be added separated by commas or ranges separated by a dash. The diagnosis will be added to the bill with a print order corresponding to its position in this list. SELECT NEW DIAGNOSES TO ADD THE BILL YOU HAVE SELECTED TO BE ADDED TO THE BILL IS THIS CORRECT ============================= DIAGNOSIS SCREEN ============================== SELECT DIAGNOSIS FROM THE PTF RECORD TO INCLUDE ON THE BILL Enter the alphanumeric preceding the diagnosis you want added to the bill. To enter more than one separate them by a comma or within a movement use a range separated by a dash. * indicates the diagnosis is already on the bill. The print order for each diagnosis will be determined by the order in this list. TO BE ADDED TO THE BILL Move No DX Codes Entered For *** No DRG for Charges *** Not In Bill Range Discharge: NOT DISCHARGED =============================== Diagnosis Screen =============================== Enter Yes to delete all Diagnosis currently defined for a bill, including any CPT Associated Diagnosis. DELETE ALL DIAGNOSIS ON BILL, INCLUDING CPT ASSOCIATED DIAGNOSIS Event Date : OP Visits : Opt. Code : ***There are more procedures associated with this bill.*** *** There are more Pros. Items associated with this bill.*** *** There are more Rx. Refills associated with this bill.*** This rx fill does not exist in Pharmacy for this patient! The prescription number for the fill. Select RX FILL ADD/EDIT RX FILL Select RX FILL DATE ----------------- Existing Prescriptions on Bill ----------------- (Rx Procedure Rev Code This prosthetic item does not exist in this patients prosthetics record. Enter the date the item was delivered to the patient Select ITEM DELIVERY DATE Select PROSTHETIC ITEM ----------------- Existing Prosthetic Items for Bill ----------------- PROSTHETICS SCREEN PRESCRIPTIONS IN DATE RANGE Enter the number preceding the RX Fills you want added to the bill. SELECT NEW RX FILLS TO ADD THE BILL If an Rx fill has been assigned to another bill it will be displayed in the last column. [ORG=Original Fill, NR=Not Released, RTS=Returned to Stock, OTC=Over-the-Counter, INV=Investigational, SUP=Supply Item] Bill Type : Loc. of Care: Covered Days: Bill Classif: Non-Cov Days: Timeframe: Charge Type : Form Type : Co-Insur Days: Provider # : Assignment: NOT COMPLETED STATUS UNKNOWN Pow of Atty : LOS : Too many Revenue Codes to display, enter '5' to list Non-Cov: Rate Sched : (re-calculate charges) Prior Payments: Prior Claims: Bill From : Bill To: Rev. Code NO OFFSET RECORDED OFFSET DESCRIPTION UNSPECIFIED BILL TOTAL Disch Stat: OP Visits : Bill Remark : #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### ####################