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BON SECOURS HEALTH SYSTEM, INC.
Topic: ConnectCare Reconciliation ofDepartment Charges /
Policy
No. E5301 / Date: December 1, 2009
Rev:
Area: Patient Financial Services
ConnectCare / Approved By: Joseph Ingold
Applies To: All Sites
Policy:
To ensure that all Hospital Inpatient and Outpatient ConnectCare department managers should validate and reconcile charges for their areas of responsibility. This process is to be done on a daily basis.
Purpose:
The purpose of this policy is to provide a standard and consistent system-wide guideline to validate that all charges for supplies, drugs and/or procedures administered have been appropriately charged to a patient account in the ConnectCare billing system: 1) completely, accurately, and timely, and 2) consistently across all departments. All chargeable procedures and/or supplies are to be captured and entered completely and accurately into the ConnectCare system on the date of service. In order to ensure that this will happen, all Hospital Inpatient and Outpatient ConnectCare department managers should validate and reconcile charges for their areas of responsibility on a daily basis.
Scope:
Ensuring the accuracy of charges for the services provided is a fundamental and critical responsibility of management of the revenue producing department. Charges are representative of resources utilized and future payment implications. Obtaining payment for services provided can only be accomplished if patient charges are fully and accurately captured and supported by documentation in the medical record.
Definitions:
Charge Reconciliation-- The procedure to validate that all services provided, including procedures, drugs and chargeable supplies, have been appropriately charged to the correct patient account.
Charge Review Work Queues (Also known as the “Daily Revenue and Usage Report”) – ConnectCare functionality that allows for charges to be edited prior to posting to Hospital Billing to ensure accuracy of charges.
ConnectCare—A comprehensive system designed to maximize revenues from all revenue producing departments. The ConnectCare system is designed to review all charge transactions and evaluate them for accuracy based on BSHSI specific edits.
ConnectCare Daily Revenue and Usage Report—This is a list of all charges that have successfully passed the ConnectCare Charge Workqueue edits. These lists are to be produced by each Hospital Inpatient and Outpatient ConnectCare department.
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Definitions Continued:
Source Charge Document-- The starting point documentation will be referred to as the “Source Charge Document” for a Hospital Inpatient and Outpatient ConnectCare department and could vary for each unique Hospital Inpatient and Outpatient ConnectCare department.
For Other Definitions See “2. Policies All Virginia, Section D Policies.”
Procedures:
1.0 This policy will serve to establish a standard, mandatory system-wide process to be utilized for daily
charge reconciliation for all Hospital Inpatient and Outpatient ConnectCare revenue-producing
departments.
1.1 All revenue-generating Hospital Inpatient and Outpatient ConnectCare departments
will be required to validate and reconcile their charges posted on a daily basis to ensure
they are adequately and appropriately billing patients for each day’s charge activity.
2.0 For the first 60 days following ConnectCare system implementation, all Hospital Inpatient and
Outpatient ConnectCare department managers will be required to submit documentation supporting
this daily charge reconciliation process to the facilities’ designated department.
2.1 This will be accomplished by completing and faxing the Verification of ConnectCare Daily
Charges form each day (See Appendix A to view this form.)
3.0 Following those first 60 days, all Hospital Inpatient and Outpatient ConnectCare departments will be expected to continue the daily charge reconciliation process and maintain the supporting documentation within their Hospital Inpatient and Outpatient ConnectCare department.
3.1 Evidence of the daily charge reconciliation must be maintained for one year. Audits may
occur at any time; documentation will be required as proof of compliance with this policy.
4.0 Charge reconciliation can have various starting points depending on the Hospital Inpatient and
Outpatient ConnectCare department.
4.1 For example, in a nursing unit the reconciliation may begin with a daily census report,
ensuring that all room and board charges are accurate for each patient on the census
report.
4.2 In an outpatient or ancillary department, the reconciliation may start with a daily patient
schedule or list of orders. The starting point documentation will be referred to as the “Source
Charge Document” for a Hospital Inpatient and Outpatient ConnectCare department and
could vary for each unique Hospital Inpatient and Outpatient ConnectCare department.
5.0 The starting point documentation will be referred to as the “Source Charge Document” for a
Hospital Inpatient and Outpatient ConnectCare department and could vary for each unique Hospital
Inpatient and Outpatient ConnectCare department.
6.0 Each Hospital Inpatient and Outpatient ConnectCare department will be able to produce a
ConnectCare Daily Revenue and Usage Report which lists all charges that have successfully
passed the ConnectCare Charge Workqueue edits.
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Procedures Continued:
7.0 This Daily Revenue and Usage Report should be validated and reconciled with the Hospital Inpatient and Outpatient ConnectCare department’s “Source Charge Document” to validate that all charges were accurately and appropriately processed.
7.1 Any charge transactions on the “Source Charge Document” that are not reflected on the
Daily Revenue and Usage Report should be researched by the Hospital Inpatient and
Outpatient department to determine the cause for omission.
8.0 If the procedure or item had been entered into the ConnectCare system but failed to be reflected
on the Daily Revenue and Usage Report, then most likely the charge transaction failed an edit
within the ConnectCare system and is captured in a temporary file also known as a Charge Review
Workqueue.
8.1 If the charge transaction from the “Source Charge Document” is missing because the
procedure or item was not entered into the ConnectCare billing system, and then it should
be entered into the ConnectCare system immediately.
9.0 The ConnectCare system is designed to review all charge transactions and evaluate them for
accuracy based on BSHSI specific edits. BSHSI has established a standardized set of edits within
the ConnectCare system which is used to edit all patient charges presented in the system.
9.1 A charge must pass all the edits before it can post to a patient account.
9.2 Charges failing one or more of these edits are routed back to the originating Hospital Inpatient and Outpatient ConnectCare department via the Charge Review Workqueue for follow-up. This workqueue displays a list of temporary charges awaiting corrective actions.
9.3 Each charge in the workqueue must be reviewed and corrected if applicable before it can post as a permanent charge transaction. Charges can be selected from the workqueue to be reviewed and corrected.
9.4 Corrected charges can then be resubmitted for another round of edit checks.
9.5 To correct a charge in a Work queue please refer to the ConnectCare workqueue procedure and training materials.
10.0 From an operational perspective, the various Hospital Inpatient and Outpatient ConnectCare
departments can be very different from each other; and therefore, may require a variation in the
reconciliation process to fit their unique operational needs.
10.1 While it is difficult to prescribe a “one size fits all” set of validation and reconciliation
procedures, the procedures set forth below may serve as a foundation to assist each
Hospital Inpatient or Outpatient ConnectCare department with charge reconciliation.
11.0 Daily Charge Validation and Reconciliation Responsibilities Should Include:
11.1 Reconcile the “Source Charge Document” and the Daily Revenue and Usage Report
to ensure all chargeable services and supplies are captured accurately and
appropriately.
11.2 Verify that all patients have the appropriate charges on their correct account
(accomplished using census reports and other “Source Charge Documents”).
11.3 Verify charges are posted to the correct Hospital Inpatient or Outpatient ConnectCare
department.
11.4 Resolve Charge Review Workqueue entries.
12.0 Clinical department management may delegate this task to a knowledgeable co-worker, but
each department manager will be required to retain oversight over the process and will ultimately
be responsible for ensuring the completeness and accuracy of charges. E5301
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Prepared by/Title:
/Russel Reiter, Director of Revenue Cycle Services, ConnectCare
Signature/Date:
/SIGNED 12-11-09
Reviewed by/Title:
/Nick Dawson, Director of Revenue Cycle Systems, PFS
Signature/Date:
/SIGNED 01-04-10
Approved by/Title:
/Joseph L. Ingold, VP-Integration, HSO
Signature/Date:
/SIGNED 12-15-09
Related Policies & Procedures; Notes; Controls:
Charging Focus and Philosophy:This policy supports the Mission and philosophy of the Sisters of Bon Secours and the core values of
Justice and Stewardship by providing instruction and accountability for assuring appropriate charging
for our patients.
Revision Date: Review Date:
(Use if Revised.) (Use if Reviewed
No Changes.)
Filename: RR E5301
Date: December 1, 2009
APPENDIX A
Verification of ConnectCare Daily Charges
Name of Department ______
Revenue Center/ConnectCare Department # ______
Date of service being verified ______
Revenue & Usage Report $ ______Daily Benchmark $______
1) Is the total quantity of items correct? YES NO If no, please explain:
2) Is the price of each item correct? YES NO
If no, please explain:
3) Are the total charges correct? YES NO
If no, please explain:
4) Corrected charge review work queues? YES NO
If no, please explain:
Person completing verification ______Ext ______
Date verified ______
Please submit the completed form to designated facility representative by fax or by e-mail each day.
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