The Challenges of Ancillary Billing

Galen has recently helped several Allscripts Enterprise clients work through a specific charge issue related to billing for ancillary visits originally scheduled under a generic provider. This is a common registration/scheduling practice, and we thought it would be good to share the issue we found and how to address it.

An example of this type of scheduling would be a setting where a patient sees a rotating nurse for an EP device check. Appointments might be scheduled for a generic provider named Pacemaker NP. This schedule is then worked by the NP on duty that day and billed by the attending physician.

From the standpoint of the EHR, there is an appointment scheduled for a non-billable provider, an order performed by a separate non-billable user, and then an encounter form billed by the attending physician. When an appointment for a non-billable provider is arrived, the EHR creates an encounter form but leaves the Billing Provider field blank. If this is not updated before charges start dropping to the encounter, problems arise.

If the ancillary staff places the order in the name of the attending provider, a separate encounter form is created for a Med Admin Encounter. This new encounter form is active under the name of the attending provider, but the original visit encounter form is still active with no billable provider. Two encounter forms for a single encounter.

Here’s an explanation of the flawed workflow and the solution we found.

Flawed Workflow:

  1. Patient is scheduled for a visit with a non-billable provider. For instance, “Clinic,Provider”.
  2. Ancillary staff monitors the Clinic,Provider schedule and clicks on current patient.
  3. Ancillary staff places a med admin order. Sets “Ordered By” to the name of the attending physician.
  4. This action creates a separate med admin encounter form for the ordering physician but also leaves the original encounter form linked to the non-billable provider appointment active.
  5. Confusion occurs as there are now two encounter forms for a single encounter. Potential for both double-billing and lost encounter forms.

Corrected Workflow:

Prerequisite: Ancillary staff personalizes the Daily Schedule so that double-clicking on appointment takes the user to the MD Charges screen. This only needs to be done once.

  1. Ancillary staff double-clicks on patient appointment from schedule. This takes the user to the Encounter Form.
  2. Ancillary staff changes the Billing Provider from non-billable provider to the attending physician.
  3. Staff navigates to the clinical desktop and places a med admin order.
  4. Staff selects the attending physician as the ‘Ordered By’ provider in the order details.
  5. Now the charges are dropped to the recently updated appointment encounter form.
  6. Appointment encounter form is submitted to biller for review.

The basic idea here is that the encounter form needs to be updated before the order is placed. Automatically navigating certain users from the daily schedule to the encounter form is a good way to remind and encourage them to follow this workflow. This issue can occur anytime appointments are scheduled for non-billable providers. It applies most commonly with med admin appointments but can also come into play with other ancillary workflows depending on how they are designed. Without this correction, you can end up with piles of incorrect encounter forms that will need to be sorted out.

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