English French Notes Complete/Exclude IBRREL-1 This patient does not have any charges 'on hold.' The following IB Actions associated with this bill for this patient are ON HOLD: (REF #) to release (or '^' to exit): Enter: the name of a patient with charges 'on hold,' or '??' -- to see all patients with charges 'on hold,' or The following patients have charges 'on hold:' Print Admission Sheet for Current Adm. ( Answer 'YES' if you want to print an admission sheet for the current admission, or 'NO' if you wish to select another admission date. IB - Print single admission sheet Select Visit: PRINT ADMISSION SHEET Answer YES if you wish to print an admission sheet which could be place on the top of the inpatient chart. Answer NO if you do not want to print one. ADMISSION SHEET No admission Found Adm. Date: Adm. Type: Pt ID: YES - MORE...... Ins. Co Subsc. ID: Final Procedures Done Service Connected Conditions: Treated MORE.... NO SC DISABILITIES LISTED I attest that these are the diagnoses and procedures for which the Patient was treated during this episode of care. MD: __________________________________ Date: __________________ Bill Preparation Report for a Single Visit IB - Bill Preparation Report Bill Preparation Report Visit Information Visit Type: No Visit Selected Visit Date: No Outpatient Encounter Found Special Cond: Fill Date: Refill Date: Days Supply: Visit Billable: NO- Second Opinion: REQUIRED-NOT OBTAINED Auto Bill Date: Special Consent: ROI NOT DETERMINED Special Billing: Insurance Information Pre-Cert Phone: Coord Ben: Billing Phone: Filing Time Fr: Claims Phone: Policy Comment: Billing Information Initial Bill: Bill Status: Total Charges: $ Amount Paid: $ Additional Comment: Estimated Recv (Pri): $ Estimated Recv (Sec): $ Estimated Recv (ter): $ Means Test Charges: $ Eligibility Information Primary Eligibility: Means Test Status: Service Connected Percent: Patient Not Service Connected Group Plan Comments: Insurance Review Information Type Review: Opt Treatment: Appeal Type: Case Status: No Days Pending: Final Outcome: Authorized From: ENTIRE VISIT Authorized To: Authorized Diag: Denied From: Denied To: Denial Reasons: Case Pending: No Coverage: Review Date: Insurance Co.: Person Contacted: Contact Method: Call Ref. Number: Last Edited By: Patient Contacted: Hospital Review Information Severity of Ill: Intensity of Svc: Criteria Met: Non-Acute Reason: Day of Review: Dschg Screen Met: Acute Care Dschg: Discharge Screen: D/C Screen Met: Special Unit SI: Special Unit IS: Review Type: Diagnosis Information Nothing on File Procedure Information Provider Information Associated Interim DRG Information Estimate ALOS: Days Remaining: Total Cost: $ Delivery Date: Return Status: Denied Days Report Answer YES if you only want to print a summary or answer NO if you want a detailed listing plus the summary. IB - Denied Days Report No Denials Found in Date Range. MCCR/UR DENIED DAYS Report for Denials Dated Dates of Days Approved Care Attending Denied Denial Reason Appealed on Appeal MCCR/UR DENIED DAYS Summary Report for Reviews Dated Days won Maximum Denials Billing Rate Print Report By [P]atient [A]ttending [S]ervice: This report may be prepared by either Patient, Attending, or Service. Print List of Visits Requiring Review LIST OF VISITS FROM REQUIRING REVIEWS Include [H]ospital Reviews [I]nsurance Reviews [B]oth: This report will list visits that are currently indicate that reviews are required. Indicate if you want visits that require Hospital Reviews, Insurance Reviews or Both The default is Both. List Admissions Only Answer Yes if you only want admissions listed, answer No if you want all visit types (outpatient, prescription, etc) listed Unbilled Care from Claims Tracking IB - Unbilled Care from Claims Tracking Not Done Yet MCCR/UR ACTIVITY REPORT Report Pending Reviews Report Print [H]ospital Reviews [I]Insurance Reviews [B]oth: Select if you would like to print pending Hospital Reviews, Insurance Reviews or both. The default is both. This will print first the hospital reviews, then the insurance reviews. IB - Pending Reviews Report Building your work list... No Pending Reviews found. Pending Reviews Report for Division For Period Review Type Due Date Assigned to Scheduled Admissions Report IB - scheduled Admissions Report No Scheduled Admission found in date range TOTAL = NO - Scheduled Admissions with Insurance Adm. Date Billable ....task stop* ed at user request MCCR/UR Summary Report Print Report By [A]dmissions [D]ischarges: This summary report may be prepared by either Admissions or Discharges. If you choose by discharge the report will contain information on all claims tracking information for the discharges that fall in the date Range. That is, all reviews for discharges found in the date range will be included in the report. If you choose by Admissions all reviews found in the date range will be included but the reviews may be for cases not related to the admissions. If you want to know the total reviews done during a date range sort by admissions. If you want to know the total reviews done on the discharges for a date range sort by Discharges IB - MCCR/UR Summary Report with Insurance: Total Billable Requiring Reviews: Reviewed-Multi Carrier: Total Reviews Done: Number of Days Approved: Amount Collectible Approved for Billing: Number of Days Denied: Amount Denied for Billing: Total Cases Appealed: Number of Initial Appeals: Number of Subsequent Appeals: Penalty Report: Number of cases Dollars No Pre Admission Certification: Untimely Pre Admission Certification: VA a Non-Provider: Reason Not Billable Report: Reason Count Days Denied by Specialty: Specialty No. Days Dollars Days Approved by Specialty: Specialty No. Days Dollars ....task stopped at user request. Claims Tracking Inquiry IB - Inquire to Claims Tracking None on file. Claim Tracking Inquiry Unscheduled Admissions Report IB - Unscheduled Admissions Report No Unscheduled Admission found in date range. Unscheduled Admissions with Insurance UR Activity Report IB - UR Activity Report Sort By [R]eviewer [S]pecialty [P]atient: When printing the list of patients reviewed, how should this report be sorted. It can be sorted by Reviewer or by Specialty or by Patient. If sorted by Reviewer it will be sorted within reviewer by type of review. The default is Patient. HOSPITAL REVIEW SPECIALTY SUMMARY REPORT For Hospital Reviews Dated Days Not Met Criteria Not Met Crit. Met Crit. INSURANCE REVIEW SPECIALTY SUMMARY REPORT For Insurance Reviews Dated Approved ibtour0,ibtrn)=ibtrn (case list) Total Admissions: Total Admissions to NHCU: Total Admissions to Domiciliary: Total Admissions Requiring Reviews: Number of Scheduled Adm. Reviewed: Total Admissions with Insurance: Total Billable Admissions: Cases with Pre-Cert and Follow-up: Cases with Pre-Cert no Follow-up: Number of Closed Cases: Number of Billable Closed Cases: Number of Unbillable Closed Cases: Number of New Cases Still Open: Number of Previous Cases: Number of Previous Cases Closed and Billable: Number of Previous Cases Closed, not Billable: Number of Previous Cases still Open: Number of Outpatient Cases Reviewed: UR ACTIVITY SUMMARY REPORT Total Cases Reviewed: Number of New Case Still Open: Total Random Sample Cases: Total Special Condition Cases: COPD: TURP: Total Locally Added Cases: Total Cases Meeting Criteria on Adm.: Total Cases Not Meeting Crit. on Adm.: Total Days Reviewed: Total Days Meeting Criteria: Total Days Not Meeting Criteria: No Insurance Reviews Found in Date Range. UR Insurance Review Activity Report Last Reviewer No Hospital Reviews Found in Date Range. UR Hospital Review Activity Report Days Met Days Not Met Criteria Assigned Reviewer Reviewer: Type Review: Visit Report IB - Visit Report Select Insurance Review or Contact Date IB CLAIMS SUPERVISOR Must first delete appeals associated with Denials Service Connected Percent: Clin Print Insurance Review Worksheet IB - Print Review Worksheet INSURANCE REVIEW WORKSHEET Pt ID: DC Date: ________ LOS: _____ Attending MD: Primary MD: Complaint/Hist: |Insurance Contact: |Date |Comments (#day approved, next review date, etc.) Reviewer: _____________________________________ Date: ____________________ Expanded Insurance Reviews for: Action Information Type Contact: Opt Treatment: Treatment Auth: Contact Information Contact Date: #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### ####################