Background
Billing Setup in Profile EMR
Create a Claim
Method 1: Background Billing
Method 2: Quick Bill
Method 3: Scheduled Billing
WCB, ICBC, Third party Billing
Troubleshooting
Background
Profile EMR can generate and send service claims to MSP. All of our DTES clinicians are set up for semi-automatic creation of billing claims, but these incomplete claims need to have a diagnosis added which is most easily done using the Quick Bill function.
Shadow Billing, also called Encounter Billing is simply submitting billing where all the dollar amounts are set to $0.00, so no money changes hands. The Ministry of Health uses this to track data. There are a few claim items, like filling out disability forms, which are exceptions to this rule and will have dollar amounts which get paid to the individual clinics.
Billing Setup in Profile EMR
For clinicians to successfully bill in Profile EMR, they must have in their Profile EMR user account:
- MSP ID
- Payee ID linked to VCH Profile EMR Data Centre Number T7326
For Primary Care Providers who are also Panel Reporting, the POS account should have Facility ID.
See Clinic Setup for Encounter Reporting on how to get started, or call MSP Teleplan Billing Support: 604-456-6950. There are also setup instructions in Admin Forms:
Create a Claim
In order for a claim to be sent out of our EMR to MSP it must pass validation and then be forwarded (usually at few week intervals) together with all the other claims from that clinic to MSP electronically. The forwarding will be done by a front desk staff member. The validation is usually the responsibility of the physician/NP and front desk.
Location will default to B – Community Health Centre unless otherwise requested with EMRHelp@vch.ca.
Note: If an inward referral exists to the billing POS where the referral source has a valid MSP ID, the referral source will auto-populate in all billing claims regardless of billing code. This is to avoid rejections when referral source is required by some billing codes such as specialist consultations. Teleplan confirms that they ignore extra information such as referral source even if submitted with the billing claim, when the billing code does not require the referral source.
Front desk staff responsibility
- Must have a PHN
- Must have a billing code – this will automatically, by default, be set at a 0100 type visit and will not need to be changed by you regardless of the type of visit
Note: Exception For Billing Disability Forms (see below)
Physician/NP responsibility
- Must have at least one ICD-9 dx (see below)
Methods to Create Claims in the EMR
Method 1: Background Billing
Background billing: This is semi–automatic and is already turned on for all DTES clinicians who should be shadow billing. Each time a patient has been arrived for an appointment with you (even if it was a walk-in and not booked in advance) a claim is automatically generated in the background and waits for you to add a diagnosis to the claim (which is why it’s called semi-automatic).
Where to find that list of claims:
1. In Work Center click on Billing. (You may choose to do this at the end of the day or every few days)
You will see this list where it is easy to add a diagnosis to each claim:
2. Click to choose a claim or use the drop down arrow to select next one
a. You are automatically presented with a list of the patients’ diagnosis
b. Double click the Disease Code
c. It will be automatically added to Diagnosis 1 spot in the claim. Repeat Step 2 if a second disease code or Diagnosis needs to be added
IMPORTANT: Effective 1 Oct 2021, any claim submitted will require you to manually change the Location drop down from “A” (Practitioner’s Office – In Community) to “B” (Community Health Centre) before submission. For more information, click here.
Method 2: Quick Bill
Using Quick Bill: At the end of each encounter you can hit the Quick Bill button and the patient’s MSP claim will pop up with a diagnosis already filled in. The EMR assumes you want to use the diagnosis that titles your encounter. This works fine if you dragged up a problem from the patient’s problem list and it was properly created with an ICD-9 code in the background.
1. After finishing an encounter note, click on Quick Bill
2. Quick Bill window will open
a. Diagnosis 1 will automatically be filled in
b. Click OK
c. Or, hit Enter on your keyboard
Note: Most Clinicians use a combination of both methods – they will use quick bill throughout the day and then go to the billing section to see if there are any claims that they missed, and fix those ones there.
Method 3: Scheduled Billing
For management of ongoing maintenance of OAT (Opioid Agonist Therapy) for opioid use disorder, another method to create claims in Profile EMR is through Scheduled Billing.
This is an optional module where CSC, NPs, Physicians, and Psychiatrists can setup scheduled billing, where a billing claim is auto-created based on a claim frequency. This functionality will eliminate the manual process of creating a billing claim for each of their OAT clients on a regular basis. OAT providers can bill for an OAT client whether or not there is an existing appointment with the client.
Service code 39 (MANAGEMENT OF MAINTENANCE OPIOID AGONIST TREATMENT) is the only fee payable for any medically necessary service associated with the management of ongoing maintenance of OAT for opioid use disorder.
Once a week (the day before scheduled billing is setup), the billing clerk would review the Caseload Manager Tool for each Substance Use prescriber to reconcile against their scheduled billing list. The OAT Rx Due Date (see OAT Rx Due column) distinguishes the OUD vs non-OUD clients. The billing clerk will ensure that each client with OAT Rx Due Date also has scheduled billing. Also, clients who are no longer in the prescriber's care team should have their scheduled billing end-dated.
Create a new scheduled claim.
- Control Centre > Financial > Scheduled Billings
1. Click on Create a new Scheduled Claim
2. Select a client through displayed Client for Scheduled Claim screen
3. Selecting client will open the Financial tab.
4. Enter the details:
- Clinician: enter clinicians’ name
- Service: enter 39
- Diagnosis: enter OUD
5. Click on Schedule tab. In this tab, specify the recurrence of the scheduled billing by entering the information about the scheduled claim:
a. Scheduled Task: select Weekly
b. Start After: Enter 0600 in the time field
c. End Before: Change year to next year (2024) and enter 2300 in the time field
d. Check Tue
e. Click OK
6. Click Yes on the Profile screen asking: The schedule is set into the past. Should missing claims be created?
7. The Scheduled Billing will appear on the Scheduled Billings list:
Select proper filter view to see the list of clients for your POS on the Scheduled Billings screen:
All clients whose current week date is part of Date To will show on the list;
By clinking on Click button under History column the list of previously saved Scheduled Billings show up on the Edit Scheduled Claim screen:
After scheduling the claims, they need to be processed (sent to MSP) and to be found on the Billing screen .
Edit a Scheduled Billing
1.highlight the record on the Scheduled Billings list
2.click on the Open the selected line icon or double click on the highlighted record
3.Edit Scheduled Claim screen shows up, click on Schedule tab
4.Make changes in the schedule; click on OK
Delete a Scheduled Billing
1.highlight the record on the Scheduled Billings list
2.Click on Delete the selected line icon
3. Profile screen shows up asking if you really want to delete the selected billing. Click on Yes or No as appropriate.
WCB, ICBC, Third party Billing
WCB Billing
The easiest way to create the WCB claim is by using the WCB F8/F11 Form. Depending on the workflow of the clinic, the form can be either filled out by the physician entirely or partially by the admin staff (General tab) and then finished by clinician.
The form collects information related to accidents and reports it to WCB through Teleplan. Once the form is completed and saved, it will automatically generate a claim with all the relevant data from the form. The claim can be processed in the Control Centre Billing view.
Follow the steps below to complete the form.
1. Open the WCB F8/F11 Form.
2. Enter the information into the tabs and click Save or OK.
3. The system will automatically lead you to the Approval Edit screen. Review the information and click OK.
4. The form will be saved in the client encounter with the status Incomplete.
*Note*: The provider can click the link in the Notifications window in a client Medical Record to access and complete the WCB F8/11form.
5. Once all required information is obtained and entered, then click on Process Claim Now and OK to proceed.
6. The system will identify if any mandatory fields are not completed. Enter that information and click OK.
7. The form will be saved and the status will change to Claimed. A WCB claim will be generated with all relevant information populated from the form, to be processed in the Control Centre Billing view.
Other WorkSafe BC forms available in EMR
- WorkSafeBC - Physician's Report F8/F11 form
- Work Safe BC - NP Report 8NP/11NP form
However, by using these two forms the WCB claims will be created by using either Method 1 or Method 2, and should be updated with the following details:
1. Enter the service code if it's known or select the service code through the Select Service Code search and click on OK:
a. Select Text contains
b. enter a key word
c. Check Only Active
d. Click on Search
2. Select Workers Compensation Board of BC from the dropdown list in the Payer field.
3. Enter Diagnosis
4. Enter Nature
5. Body Part
6. Approval by clicking on Create a New Approval.
The system will automatically lead you to the Approval Edit screen. Review and click OK.
*Note*: please be aware that the claim's service code Fee (First report of Injury (Form 8) and Progress report (Form 11) depends on time when the claim was received
ICBC Billing
The claim can be created using either Method 1 or Method 2, depending on the workflow of the POS.
Open the claim in the Control Centre Billing view and update Payer and the Service Code by following the steps below:
1. Select Insurance Corporate of BC from the dropdown list in the Payer field
2. Enter the service code if it's known or select the service code through the Select Service Code search and click on OK:
a. Select Text contains
b. enter a key word
c. Check Only Active
d. Click on Search
Third Party Billing
If the payer is a patient or other organization rather than (MSP, WCB, or ICBC), the invoices must be created to charge the patient or the organization. If you can't find the payer, please ask your admin staff to review the payer list and update as necessary (see Manage Payers List for Third Party Billing or Private Invoicing).
Troubleshooting
The diagnosis in the problem list was created incorrectly
- When an ICD-9 diagnosis is not attached to it in the background, the claim will not be generated.
- Go to the patient's medical record (or in a new encounter) delete the incorrectly linked diagnoses and problem and create a new one.
Claim is failing because of other reasons (example no PHN)
- The admin staff will follow up with it.
Claims for filling out disability forms and WCB forms
- Forms will still go through MSP system although those claims will not have a 0.00 dollar figure and can still be paid to the clinic if that is the usual workflow