Home Forums Discussions General Discussion Billing for In Patient Hospital Encounters

can anyone please share the best practice related to in-patient billing? we want the invoices to be kept within amazing charts but there is no corresponding health record as that is kept in a hospital system (we may scan in H&P / discharges summaries with import feature).

We could create a superbill without a corresponding record but the program has a warning about doing this. any suggestions on how to best record/bill these in-patient services within Amazing Charts?

Currently, it appears that we need a separate superbill created for each day that a patient is in the hospital. This seems to be the only way to get the CMS1500 to come out right. Of course, there are difficulties with this method such as entering ICD-9 diagnostic codes multiple times and not being able to type into the field. This ends up being a very slow method to enter invoices so we are really hoping for other suggestions.

Eric:

I do not use the billing features of Amazing Charts, so I am not qualified to answer questions about getting CMS 1500s to come out right.

However, I did have some thoughts on ways to record a hospital visit in Amazing Charts. My thoughts were focused on recording the entire stay in one encounter, to correlate with a bill that I had created:

First, I would create a "dummy" encounter, which I would assign a chief complaint of "HOSPITAL STAY, DATE #/#/2008". I would then set the date of the encounter to the initial date of the hospitalization.

I would then either add a templated phrase in the HPI such as "Patient was hospitalized at General Hospital during the dates above." Or if I wanted to go all-out, I would forward the chart to the appropriate physician, so he/she could update the Past Medical History with the latest developments, and possibly even add a brief synopsis of the hospitalization. This would be helpful for the next person who saw the patient.

Next, I would enter in the corresponding ICD-9 codes associated with the hospitalization, to support the billing, and to simultaneously populate the Patient Summary. You might want to add a templated phrase under "Plan", making clear that the patient was not seen in the clinic that day, or recording any further data you might need to support your billing.

Finally, I would attach the scanned H&P and Discharge Summary, and I think that would be a very nice little record of a hospital stay.

ADDENDUM(S): By the time I typed this note, you had posted the second time. Another option you might consider is the "Addendum" feature, which can also generate an invoice.

The downside is that this would create a lot of little "Addendums" containing minimal data, cluttering up the "Past Encounters" view, but the physician can screen them out, if you can't figure out any other way to do it.

After evaluating our options, we decided to not enter the superbill directly and go with something similar to what Brian suggests above. The only twist is that we create patient encounter for each day that the patient is in the hospital. Entering them separately makes the billing submission and traceability much easier (makes the CMS1500s and invoices appear correctly).

The physician collects the face sheet at the hospital for billing purposes. She will also secure the discharge summary once it is available.

These paper copies are then provided to the medical assistant. Under "Chief Complaint", the medical assistant enters "HOSPTALIZATION, mm/dd/yyyy"

We created a template under assessment that states "Patient was seen at West Shore Medical Center. Hospital maintains medical record and this encounter exists for billing purposes."

The medical assistant then forwards the chart to the physician for entry of ICD9 codes and creation of the invoice. She changes "CHART" to "HOSPITAL" in the subject line to better differentiate the messages. Once the first encounter is signed, subsequent encounters can then be created by the physician from the initial or "prior encounter". This brings along the ICD9 codes and makes following days very easy to invoice.

Sounds great, Eric.

I am delighted to have been of the slightest assistance!

Keep us posted of how things work out, and any refinements you come up with.