Your system has been updated with a new ‘patient check out’ program

· Office Medicine version 8 automatically bills anything that can be telecommunicated. In other words, as soon as the patient checks out, his claim goes right into the telecommunications file. This can be toggled off with BILL=N.

· The prior authorization prompt in patient checkout now has a different prompt. This will occur if you haven’t set the toggle ASKPAN=Y and the patient has P.A. in option1 or option2 (or the patient’s primary carrier has an ‘A’ in the HCFA_FLAGS) field. This new prompt will display both the option1 & option2 fields & ask you to choose 1 of them (as the prior authorization number). After you choose one, it will remove the ‘P.A.’ if it is there and it will remove everything after the first space. Thus if option1 says: P.A. 1234 PAY NOW When they choose it, the checkout screen will display 1234.

· You can now put an ‘A’ in the HCFA_FLAGS field for a particular insurance carrier if you want a prior authorization prompt for all claims assigned to that insurance at time of checkout.

· A new toggle is available to suppress the warning that appears if you use a date of service over 180 days old:

CKSD=N

Action: Supresses the warning that appears if the date of service is over 180 days old.

Otherwise: The warning will appear if applicable.

You can change how this program works through the use of toggles. The are set from the management functions menu, choice #4 (configure system controls):

PATIENT CHECKOUT TOGGLES:

These are set under the code of PTEX. These toggles affect patient checkout (also known as procedure entry) and no other program.

ADV_DAY=N

Action: This will prevent the default ‘to date’ from being incremented no matter what the procedure code is. In other words, to ‘to date’ and the ‘from date’ will be the same.

Otherwise: The default ‘to date’ will be the date of service plus the quantity (if the quantity is 3, the default ‘to date’ will be 3 days after the line item date of service).

Notes: This toggle is NOT the opposite of ADV_DAY=Y.

The ‘dates of’ prompt must be set to Y for that procedure code and the toggle

‘TODATE=YES’ must be set. Otherwise, this toggle does nothing.

ADV_DAY=Y

Action: The default date of service (a.k.a. the ‘from date’) is incremented 1 day if the procedure code entered is the same as the procedure code on the previous line item.

Otherwise: The default date of service is the date from the previous line item.

Notes: This toggle is NOT the opposite of ADV_DAY=N.

The ‘dates of’ prompt must be set to Y for that procedure code. Otherwise, this toggle

does nothing.

Some examples of what the dates will default to (with the ‘dates of’ prompt turned on & the ‘TODATE=YES’ toggle set):

No ADV_DAY toggles:				Only ADV_DAY=N
Proc	Qty	Dos	‘to date’	Proc	Qty	Dos	‘to date’
ABC	4	101698	101998	ABC	4	101698	101698
ABC	10	101998	102898	ABC	10	101698	101698

^defaults to previous ‘to date’. ^defaults to previous ‘to date’.

If there was no ‘TODATE=YES’ toggle, If there was no ‘TODATE=YES’ toggle,

it would have defaulted to the previous dos. it would have defaulted to the previous dos.

Only ADV_DAY=Y				Both toggles
Proc	Qty	Dos	‘to date’	Proc	Qty	Dos	‘to date’
ABC	4	101698	101998	ABC	4	101698	101698
ABC	10	102098	102998	ABC	10	101798	101798

APPLYCREDIT=Y

Action: If the patient has a credit balance and the patient pays no money on this claim, this toggle causes the autoapply screen to come up to apply the credits.

Otherwise: It doesn’t.

APPT=N

Action: Prevents the “Appt/Recall” prompt from appearing.

Otherwise: The prompt appears.

ASKPAN=Y

Action: Will prompt you to choose prior authorization from the ones you have entered in the inbound referral log (REFLOG2).

Otherwise: It doesn’t.

This is not NEW!, but acts differently now:

The prior authorization prompt in patient checkout now has a different prompt. This will occur if

the you haven’t set the toggle ASKPAN=Y and the patient has P.A. in option1 or option2 (or the

patient’s primary carrier has an ‘A’ in the HCFA_FLAGS) field. This new prompt will display both the option1 & option2 fields & ask you to choose 1 of them (as the prior authorization number). After you choose one, it will remove the ‘P.A.’ if it is there and it will remove everything after the first space. Thus if option1 says: P.A. 1234 PAY NOW When you choose it, the checkout screen will display 1234.

ASNCAR=Y

Action: It will always ask what insurance to assign the claim to (even if there is only one there and even if it’s NONE).

Otherwise: It will only ask if there is more than one valid (not expired) insurance for that patient.

AUTOAPPLY=YES

AUTOAPPLY=ALWAYS

Action: Activates autoapply capability for payments entered in patient check-out. After entering a payment, you will see a screen showing how the payment will be applied to the oldest date(s) of service. You then has the option of whether or not to apply it in that way. (If not applied, payment will be applied to the current claim).

Always:Performs an autoapply even though a payment was not entered. – This is useful for fixing credits.

Otherwise: The payment is just applied to the current claim.

Note: The toggles to set the behavior of Autoapply are set under ‘POSTCL’.

BILL=N NEW!

Action: Prevents the claims from being billed as they are entered.

Otherwise: The checkout program automatically adds claims to the telecommunications file so they will be billed right away (if they can be telecommunicated).

CKSD=N NEW!

Action: Supresses the warning that appears if the date of service is over 180 days old.

Otherwise: The warning will appear if applicable.

COMPLETE

Action: Causes the words “Transaction Complete” to appear on the screen after claim is posted to the financial files. It then waits for the operator to press <return>.

Otherwise: That doesn’t happen.

CONSULTREFERAL=Y

(Yes this is how it’s spelled)

Action: If the operator enters a procedure with the word “CONSULT” in the internal name, and there has been no referral code entered for that claim, the screen will prompt for a referral code.

Otherwise: It doesn’t do that.

COPY=YES

Action: Automatically print two copies of the receipt.

Otherwise: It just prints it one.

COUNTDOWN=Y COUNTDOWN=MRN

Action: Both toggles enable the authorized “visit” countdown – the kind that uses REFLOG2. The COUNTDOWN=MRN number will cause it to work across all jobs based on the medical record number.

Otherwise: It doesn’t count down.

Note: This is based on the procedure code (or procedure group code) and the ending date of service only – assigned doctor and referring doctor don’t matter.

DEFVER=Y

Action: Causes the default answer for the ‘Verify’ prompt to be the same as the last time you answered this prompt.

Otherwise: There is no default.

DISCT=N

Action: Deactivates ‘discount’ prompt.

Otherwise: The discount prompt appears as normal. If the operator enters a discount, it will be applied to all patient amounts on the claim.

DR=YES

Action: Activates first doctor prompt. Has no affect on second doctor prompt.

Otherwise: It doesn’t ask the (first) doctor, it just defaults to the one from patient information.

DR2=Y

Action: Activates second doctor prompt. This allows two physicians to be associated with this claim. However, all billing is still done under the first doctor. Reports can be run on either the first or second doctor. UB92 forms can be set to report the second doctor.

Otherwise: There is no prompt and there’s no second doctor associated with the claim.

See also: PTEXDRS entry at the end of this section.

DX=DEF

Action: When prompting for a diagnosis code, it only allows the use of codes that are defined in the diagnosis dictionary.

Otherwise: Diagnosis codes don’t have to be in the dictionary.

DX=PC

Action: This causes the diagnosis from the procedure code dictionary to be the default diagnosis

Otherwise: Depends on the DX=PT toggle.

DX=PT

Action: This causes the diagnosis from the patient’s information screen to be the default diagnosis if there are no other diagnosis to default to and the diagnosis prompt is off. (Note: If the diagnosis prompt is on, it can default to the patient diagnosis even if this toggle isn’t set).

Otherwise: With the diagnosis prompt off, it can only default to the diagnosis from the previous line item or, failing that, the diagnosis associated with that procedure.

Note: Overrides DX=PC.

EDITAMT=ALL

Action: Allows you to edit the expected dollar amounts on the previous line item by pressing the right arrow key at the enter code prompt.

Otherwise: You can only edit amounts for procedures set up with the ‘$’ flag.

EDITAMT=N

Action: Prevents the operator from editing any dollar amounts on the previous line item. (This overrides EDITAMT=ALL and EDITBILLED=Y)

Otherwise: Operator can only edit amounts for procedures set up with the ‘$’ flag.

EDITBILLED=Y

Action: If a flag or toggle is set that allows the editing of expected dollar amount (on the previous line item by pressing the right arrow key and the enter code prompt), the toggle allows the operator to edit the billed amount in addition to the expected amounts.

Otherwise: The operator can only edit expected amounts, depending on the other toggles.

EDIT_EXISTING_CLAIM=Y

Action: This toggle allows for the editing of an existing claim by first removing the charges from the ledger and then pulling the claim back into charge entry. The claim can then be changed, including the revision of CPT codes, diagnosis or Physician. The claim must be verified again normally in order to be saved. This function is restricted to claims for the current working date.

EDIT_EXISTING_CLAIM=ALL

Action: If a flag or toggle is set that allows the editing of an existing claim , this toggle allows for the editing of the existing claim by first removing the charges from the ledger by removing the charges from the ledger pulling the claim back into charge entry. The claim can then be changed, including the revision of CPT codes, diagnosis or Physician. The claim must be verified again normally. This function is NOT restricted to claims for the current working date, but is restricted to the OPEN period.

EMR_INTERFACE=N

Action: This toggle stops charges and diagnosis codes generated in the EMR from being automaticvally loaded into the charge module.

EXPLAIN=NO

Action: Prevents the ‘Explain:’ prompt from appearing.

Otherwise: The prompt appears.

FAC=YES

Action: Requires entry of a facility code on the claim.

Otherwise: Facility code not required.

GENERIC=YES

Action: Program will prompt for a password if the procedure entered is only found under the generic job (blank job). The password is canned in as “SECURE-”.

Otherwise: It doesn’t ask.

LEARN=Y

Action: Causes the program to ‘learn’ the billed amounts by taking the amounts entered in the check-out screen and writing them back to the procedure code dictionary. There are no prompts or anything to indicate that this is active.

Otherwise: It leaves the procedure dictionary unchanged.

NEXTAPPT=RECALL NEW!

Action: The next appointment (as printed on the receipt) will be pulled from the recall database, not the appointment scheduler.

Otherwise: It’s pulled from the appointments scheduler.

Note: Also affects ‘reprint previous receipt’

NOTE=YES

Action: Allows the entry of ledger notes. After verifying claim, it will prompt: LEDGER NOTE? Y/N: (This happens after the other prompts of appointment, recall, and receipt).

Otherwise: You can’t enter ledger notes in patient checkout.

OVERBILL=N

Action: Lowers the total expected amount, if necessary. If the total expected amount is greater than the billed amount, it sets the total expected amount equal to the billed amount.

Otherwise: It leaves the total expected amount as is.

OVEREXP=N NEW!

Action: This prevents the billed amount from being increased to the total expected amount.

Otherwise: Increases the billed amount, if necessary. If the billed amount is less than the total expected, it will sets the billed amount equal to the total expected amount.

Note: This is not the opposite of the OVEREXP=Y toggle.

OVEREXP=Y

Action: When editing the dollar amounts on the screen, allows the “billed amount” to be more than the total expected. If the total expected amount is greater than the billed amount, it sets the billed amount equal to the total expected amount.

Otherwise: It leave the billed amount as is.

Note: This is not the opposite of the OVEREXP=N toggle.

PL=Y

Action: Causes the PL prompt to appear after the diagnosis prompt (if this is the first time this diagnosis appeared on the claim and it is not the default diagnosis). The “PL?” prompt means “add to the problem list?”

Otherwise: There’s no PL prompt.

PROCDX=N

Action: When prompting for a diagnosis code, it won’t show the diagnosis associated with this procedure.

Otherwise: It will show them.

PT=NULL

Action: Clears out the previous patient number when starting patient checkout.

Otherwise: The ‘patient number’ prompt defaults to the last patient number used.

PTFAC=NO

Action: There’s no default facility code.

Otherwise: The facility code defaults to the one from patient information.

RCEDIT=Y NEW!

Action: If you answer ‘R’ to the recall prompt, you will get the recall editing screen and you can key in the recall code/date/time/dr where you want.

Otherwise: If the you answer ‘R’ to the recall prompt, you will be prompted for a date, time, and procedure code.

REC=BILLED

Action: If the patient’s receipt is showing the insurance amounts, the billed amount will appear in that column instead of the expected amount.

Otherwise: If the receipt is showing the insurance amounts, it will show the expected amounts.

RECEIPT=HALF

Action: The receipt will only use a half page of paper

Otherwise: It prints a full page as usual.

Note: Some information that’s on the full page receipt is not on this receipt due to space constraints. Also, if there’s more than 10 line items, the it will run onto the next half page.

RECEIPT=NOAUTO NEW!

Action: Prevents the word ‘AUTOAPPLIED’ from printing on the receipt.

Otherwise: The receipt will show the word ‘AUTOAPPLIED’ if the patient payment was autoapplied.

RECEIPT=PLAIN96

Action: Prints a patient statement as a receipt. The statement will just show activity from the current date (and the total patient-side balance owed).

Otherwise: It uses the standard receipt.

RECEIPT=PT

Action: Receipt will only show patient amounts.

Otherwise: Receipt will show patient and insurance amounts unless you answer “P” to the ‘invoice’ prompt.

RECEIPT=1PAGE

Action: If there are multiple claim pages for one date of service, it will only print the last one.

Otherwise: It prints all claim pages.

RECEIPTAGE=Y NEW!

Action: Will print the 30/60/90 aging of the patient (family) balance near the bottom of the receipt.

Otherwise: The aging doesn’t print.

Note this will not print if the RECEIPT=HALF toggle is set.

RECEIPTDX=N

Action: The diagnosis won’t show on the receipt. (This overrides RECEIPTDX=CODE).

Otherwise: It does.

RECEIPTDX=CODE

Action: The code for the diagnosis will show on the receipt instead of the description.

Otherwise: It has the description.

RECEIPTINSCO=Y

Action: The receipt will show the name of the insurance carrier that the claim is assigned to.

Otherwise: It shows a description of the coverage code.

RECEIPTINSTOT=Y

Action: If the patient’s receipt is showing the insurance amounts, it will also show the total of those amounts.

Otherwise: The insurance total doesn’t show.

RECEIPTQTY=DICT NEW!

Action: Will print the quantity from the procedure code dictionary on the receipt unless they entered something other than ‘1’ at the quantity prompt.

Otherwise: The quantity printed is always what was entered in patient checkout.

REFCHECK=Y NEW!

Action: Will check to see if patient has any open referrals (for any code) before he is checked out. If there are no referrals, or if there is only one left, a warning is issued. It will only do this for patients with “P.A” in their options fields OR if the carrier the claim is assigned to has an “A” in the HCFA_FLAGS field.

Otherwise: This doesn’t happen.

This works with the inbound referral program called REFLOG2. If you are using this toggle, you’ll also want set COUNTDOWN=Y

REFDEFAULT=C NEW!

Action: Clears the referral code off of the claim, but leaves it on the screen. This only has an effect if the you press down arrow at the doctor prompt.

Otherwise: Referral prompt functions as normal.

REFDEFAULT=N NEW!

Action: There is no default referral code.

Otherwise: The default referral code comes from the patient’s demographics screen.

RESIDENT=Y

Action: If there is a “9” in the “ranking” field (field 30) of provider information for this provider, it will not allow that doctor as the primary doctor on that claim. It will say: Primary Provider cannot be a resident.

Otherwise: Any active doctor can be a primary doctor on a claim.

CHECK_ENC=Y NEW!

Action: If a route slip wasn’t generated for this patient (for this dos), a warning will appear to that effect.

Otherwise: No warning appears.

TEXT=Y

Action: It will prompt for the entry of narrative text for undefined procedure codes.

Otherwise: Undefined procedure codes are not allowed.

Note: To get the narrative text prompt for other procedures, put a double asterisk (**) somewhere in the internal description of the procedure code. It will also prompt if “99” occurs only in the 4^th & 5^th positions of the in-house billing code (no toggle required).

TODATE=YES

Action: Activate prompt for “to date” for all procedures.

Otherwise: There is no prompt.

UBOPTS=Y

Action: Allows U for Ub92 options screen at the action line.

Otherwise: The U command is not available.

VCODE=Y

Action: Ready? If it is a procedure billable to the insurance and the revenue center begins with “L” and option 2 (in the coverage) is set to “2” and the diagnosis code starts with a “V” it will bill the entire amount to the insurance regardless of what the coverage matrix says.

Otherwise: Those procedures are subject to the coverage matrix like everything else.

PTEXDRS

If you have the toggle DR2=Y set, you can use the following toggle to change the description displayed by the two “doctor” prompts.

In FMCONTROL, under the code PTEXDRS:

In field one, enter the prompt to use instead of Dr.#1

In field two, enter the prompt to use instead of Dr.#2

Example: If you enter “Attending” in field one, patient checkout will prompt: Attending Dr: instead of: Dr.#1:

If DR2=Y is not set, this code has no effect.