Reports: Billing Audit Tool

The Billing Audit Tool tab allows you to view and manage all evaluations, group sessions, and labs marked as billable, billed, or do not bill in your location or locations. You can also view and manage batches, view the ledger, and export items to CSV or Excel files. 

Note: If desired, you can work the billing items of a specific patient from that patient's chart. The processes are the same in both locations. 

Required Permissions: Users must have Super Admin, Records Admin, or Manage Users permissions to view and use the following areas. 

1. To begin, click Reports > Billing Audit Tool.

2. If you are in a master instance, you can view billable items by location or for the entire instance by either selecting a location from the header drop-down or choosing My Locations.
   

Billable

The Billable tab shows all billable items for your location or instance.

• Use the search fields to find the desired billable items.

  1. Customize Report Layout: Users can customize which columns appear in their view of the billable report and in which order. Click on the six dots and drag to rearrange or move the options into the other column. Be sure to click Save. If you wish to restore the default order, click Reset to Default. Top Level Columns appear across the top, while Expanded Columns are the elements that appear in the expanded view of an item. Hidden Columns are the elements that are hidden and now will not appear in either section. Once you have customized options, the button will appear blue so that it is clear at a glance that customizations have been made.

     By default names display as Last, First Middle. If you click this icon, the display will switch to First Middle Last. The selection made here will be followed both on this tab and on exported Excel and .CSV files. The numbers determine sort order. For example, if the primary sorting order is set as Name, and the second is set as DOS, all results will sort by patient name first, and then by DOS for each patient's results. The ascending and descending arrows indicate whether the columns will be sorted in ascending or descending order by default.

  2. Start Date: To return results by start date or date range, click on the field and either use the calendar to select a start date, or type in the desired start date using the MM/DD/YYYY format.
  3. End Date: To return results by end date or date range, click on the field and either use the calendar to select an end date, or type in the desired end date using the MM/DD/YYYY format.
  4. Patients: To return results by patient, enter the first three letters of their first name or last name and select them from the drop-down.
  5. Payer: To return results by payer, enter the first three letters and select the desired result from the drop-down.
  6. Billing Providers: To return results by billing provider, enter at least the first three letters of their name and select the desired result from the drop-down.
  7. Warning and Errors: Click on this field and choose Hide Warnings and Errors, Show Warnings, or Show Errors to filter results.
  8. Click Search.

Billable Items

Once you have chosen your parameters and clicked Search, you will see a charge row for each billable item (or bundled line item, depending on if you've configured any Payer Rules).

• The Billable tab has the following filters and columns.

  • The buttons below the search results can be used to perform the following actions:

    Expand All: Click on the Expand All button to expand the details sections of each item. Collapse All: Click Collapse All to close any/all details sections. Select All: Select all items ready for transmission. Select All Don't Bill: Will select all items marked as Do Not Bill. Select All Grouped: Select all grouped items. Deselect All: Deselects all selected items. Reset Filters: Resets filters to the default. Reset Sorting: Removes any sorting options selected. Excel: Export results in an Excel file. CSV: Export results in a CSV file.

  • You can show items in ascending or descending order by clicking on the arrows next to each column. The Filter fields under the column names allow you to type in any filter options you wish to apply.  
  • Clicking on the checkbox under Discharge Date once will show only items belonging to discharged patients. Clicking on it twice will show only items belonging to current patients. Clicking the checkbox a third time will re-set the filter.
  • Clicking on a patient's name will take you to their facesheet.
  • Click on the + to expand the item details.
• If information is not complete, or incorrect, you will encounter the following:
  • If an item has a flashing red notification, it indicates that there is missing information in the billing audit tool report. Hovering over it will tell you what information is missing. If there is any incomplete information, you will not be able to check off the Select Box.
  • If an item has a flashing yellow notification, it indicates that information is missing, but that transmission can still occur. 
• There are three types of checkboxes you can choose from: Select, Group, and Don't Bill.
  
  1. Select: Billable items with no errors can be selected.

  2. Group: Billable items for the same patient can be grouped to show up on the same claim. If you have added an item to the wrong group, and your instance has the Group Billable Items on Billing Report set to Show (under Settings > Billing Audit Tool > Location Settings), you can select the item and change group selected in the Group field. Changes will be included in the Billable Item History. 

     In order for two or more billable items to be grouped in the same claim, the following items must match. If there is a mismatch between the item being moved and the item(s) in the new group, the system will use the information from the group and drop the values from the source billable item. Patient Chart Location Insurance Authorization LOC Type - ie All Ancillary items or All Per Diem items LOC Type of Bill if claim format exists and it’s institutional LOC Value Code if claim format exists and it’s institutional LOC Occurrence Code if claim format exists and it’s institutional LOC Occurrence Span Code if claim format exists and it’s institutional Claim Format Billing Provider Konnector Place of Service

  3. Don't Bill: If you do not wish items to be billed, select them here. If you have not configured Do Not Bill options configured under Settings > Billing Audit Tool > Dictionaries > Do Not Bill, the items will be moved straight to the Do Not Bill tab. If options have been configured, you can add the correct one from the Do Not Bill Reason pop-up before the selected item or items are moved.
• Click on the edit pencil to edit the claim.
• If your instance uses konnectors, then the location will show a drop-down with the the available konnectors. If a default has been set, or if only one konnector exists, then that will be the default option. If no konnectors have been mapped, the drop-down will be empty.

Billed (Legacy)

The information and filters on the Billed tab function in the same manner as they do on the Billed tab, however, it only shows items that have already been billed.

1. From the Reports tab, click Billing Audit Tool > Billed and make sure that the toggle is set to Legacy Billed Report.
2. As the items in this tab are already billed, you cannot edit them from this screen.

• The Billed tab has the following filtering, column, and navigation options.
  1. You can show items in ascending or descending order by clicking on the arrows next to each column. The Filter fields under the column names allow you to type in any filter options you wish to apply.

  2. You can click on the patient's name to view their facesheet and on the status to view more information.

     

     Clicking on the status will take you to the Batches tab.

• If any errors are present, they will also appear in the Status column.
• If billed items were grouped, changes have been made to the original values (whether manually before billing occurred, if or if the payer rules Replace Code/Claim Format, Replace POS, Unit Billing, and/or Add Modifier were added), the Hx button will appear. 
  • Clicking on the Hx buton will open the Billable Item History window.
• If your instance uses konnectors, then the location will show a drop-down with the available konnectors. If a default has been set, or if only one konnector exists, then that will be the default option. If no konnectors have been mapped, the drop-down will be empty.

Billed Report (New)

From the Reports tab, click Billing Audit Tool > Billed and make sure that the toggle is set to New Billed Report.

• Use the start and end date fields to locate the desired billing reports.
  1. You can type in the dates or use the calendar by clicking on the icon.
  2. Click Search to locate the items billed between the chosen dates.
  3. Click Clear to clear any entered search parameters.  
• Use the Customize Layout element to determine which items will appear in the report, and the order in which they appear.

  4. Customize Layout: Users can customize which columns appear in their view of the billable report and in which order. Click on the six dots and drag to rearrange or move the options into another column. Be sure to click Save. If you wish to restore the default order, click Reset to Default. Top Level Columns appear across the top, while Expanded Columns are the elements that appear in the expanded view of an item. Hidden Columns are the elements that are hidden and will not appear in either section. Once you have customized options, the button will appear blue so that it is clear at a glance that customizations have been made.

     By default, names display as Last, First, Middle. If you click this icon, the display will switch to First, Middle, Last. The selection made here will be followed both on this tab and on exported Excel and CSV files. The numbers determine sort order. For example, if the primary sorting order is set as Name, and the second is set as DOS, all results will sort by patient name first, and then by DOS for each patient's results. The ascending and descending arrows indicate whether the columns will be sorted in ascending or descending order by default.

• Use the Export button to export billing reports.

  5. You can export the billing report to CSV or Excel file. Exporting all fields will export both the information shown in the columns and in the expanded view. Exporting top columns only will only export the information in the top columns.

     

     • Top Column
     • Expanded Columns

• In addition to the sorting, viewing, and export options above, you have the following options on this tab. 

  

  1. Click on the + icon to expand all items.
  2. Click on the carrots to expand or collapse individual items.
  3. Click on the name link to open the patient's chart in a new tab.
  4. Click on the status to open the batch in a new tab.
  5. Click on the history icon to view edits made to the item.

Batches

The Batches tab allows you to see the history of the data transmitted to your billing system.

1. From the Reports tab click Billing Audit Tool > Batches.

• The Batches tab has the following filter and search options.

  1. You can use the filters to refine which results you see.

     

     1. Batch Created Start Date: Select Batch Created Start Date by clicking on the field and using the calendar or by typing in the start date with the MM/DD/YYYY format.
     2. Batch Created End Date: If needed, select Batch Created End Date by clicking on the field and using the calendar or by typing in the end date with the MM/DD/YYYY format.
     3. Patients: Type the first three letters of a patient's first or last name and select them from the drop-down.
     4. Payer: Type the first three letters of the payer's name and select the correct option from the drop-down.
     5. Billing Providers: Type the first three letters of the billing provider's name and select the correct option from the drop-down.
     6. Status: Filter results by status (Completed, Error, Pending)
     7. Claim ID/Treatment ID: Enter a claim or treatment ID to search for a specific item.
     8. Batch ID: Enter a batch ID to search for a specific item.
     9. Created By: Search for batches created by a specific user by typing the first three letters of the user's first or last name and select them from the drop-down.

  2. Once you have selected your desired filters, click Search.

     

     1. The Batches section will display all batches that meet the chosen search criteria.
     2. The Billed Items section will show all items included in all the displayed batches. You can click on the patient's name to navigate to their chart and on the status to open the batch to which the item belongs.
  3. To view the details of a batch, click View.
  4. The item details will open in a new tab.
     1. You can expand or collapse all items, reset filters, export information to Excel or CSV files, and download HL7 data without returning to the main batches page.
  5. Billable items in each batch will appear at the bottom of the details.
     • If the batch file was sent via HL7 to RCM (Avea) or CMD (or if it was sent using the HL7 Billing Type), review it by searching for the ID in the Batch ID field.

     • Then click Download HL7. Afterwards, locate the Downloads section of your computer to extract the files and view the data. This data can be viewed using Notepad or any similar txt viewer.

       

       • Note: If an batch has an error, the Download HL7 button will disappear until the error is resolved or removed.
  6. You can click on the red x anywhere it appears to delete the batch.
  7. Additionally, if there are multiple items with errors, you can click the Remove Errors button to remove them all from the batch.

Do Not Bill

The Do Not Bill tab shows all items that have been marked as Do Not Bill.

1. From the Reports tab, click Billing Audit Tool > Do Not Bill.

• The Do Not Bill tab has the following filter options.

  1. Use the filters to search for specific items.

     

     1. Start Date: Select a start date by clicking on the field and using the calendar or by typing in the start date with the MM/DD/YYYY format.
     2. End Date: Select an end date, if needed, by clicking on the field and using the calendar or by typing in the end date with the MM/DD/YYYY format.
     3. Patients: Type the first three letters of a patient's first or last name in and select them from the drop-down.
     4. Payer: Type the first three letters of the payer's name and select the correct option from the drop-down.
     5. Billing Providers: Type the first three letters of the billing provider's name and select the correct option from the drop-down.
     6. Do Not Bill Reason: Click on the drop-down and select the desired reason. The search will return only the items with the matching Do Not Bill reason. These reasons can be configured under Settings > Billing Audit Tool > Dictionaries.
  2. Once you have selected your desired filters, click Search.
• Once you search the tab, the results will appear in the following format.

  1. The results displayed will match your selected filters.

     

     1. Buttons: The Select All/Deselect All buttons will allow you to select and deselect all results. The Expand All/Collapse All buttons display and hide the detail views of each item, Reset Filter removes the selected filters, and Excel and CSV export results to Excel or CSV files.
     2. Use the Filter fields to type in a patient name, date of service, location name, insurance name, level of care type, code, unit, claim format, billing provider name, claim ID/treatment ID, or reason.
     3. Click on the edit button to open the Do Not Bill Reason window.
     4. Clicking on the + icon will expand the item.
     5. Click on the checkbox to select an item. You can click on the patient's name to be taken to their facesheet.
     6. Click on the text in the Status field to view the batch.
  2. Click the Remove Do Not Bill button at the bottom of the page to remove selected items.
  3. If your instance uses konnectors, then the location will show a drop-down with the the available konnectors. If a default has been set, or if only one konnector exists, then that will be the default option. If no konnectors have been mapped, the drop-down will be empty.

Removing Do Not Bill Items

If an item in the Do Not Bill tab has been added by mistake, for troubleshooting purposes, private pay situations, or any other reason, it can be easily returned to the Billable tab.

• Follow these steps to remove a billable item.
  1. From the Do Not Bill tab, use the search options to locate the desired item or items.
  2. Click on the checkboxes by the desired item (or items) and click Remove Do Not Bill.
  3. You will see the green notice that the selected items have been marked as billable.
  4. You will then be able to return to the Billable tab, locate the item, and interact with it as a normal billable item.

Ledger

The Ledger tab allows you to view all transactions for your location or locations. 

1. From the Reports tab click Billing Audit Tool > Ledger.

• The Ledger tab has the following search and filter options.
  1. The filter fields at the top of the page can be used to narrow down results.
     1. Current Census: Click on this field and choose one of the following from the drop-down.
        • Current Census: Shows ledger items for patients currently in the census. Because data is pulled from the current census, you cannot edit the From Date and To Date fields. This option is the default.
        • Census: Select Census and then add from and to dates to view ledger items for patients who were on the census during that timeframe.
        • Admission Date: Shows ledger items for patients who were admitted during the selected date range.
        • Discharge Date: Shows ledger items for patients who were discharged during the selected date range.
        • Transaction Date/Time: Shows ledger items for transactions that occurred during the selected date range.
        • Posted Date/Time: Shows ledger items for items that were posted during the selected date range.
     2. From Date: Click on the field and choose the desired date/time.
     3. To Date: Click on the field and choose the desired date/time.
     4. Aging: Click on the field and choose the age range of the ledger items you wish to view.
     5. Click on the Search button to view the results.
     6. You can remove any filters by clicking on the Clear All Filters text.
  2. Click on the + button beside Advanced Search to access more filters.
  3. Click on the - button beside Advanced Search to collapse it, click on the Search button to search using the entered filters, and click on the Clear All Filters text to remove all filters.
     1. Patient: Type in the first three letters of the patient's first name or last name, then select the correct patient from the drop-down.
     2. Type: Select the desired payment type from the drop-down.
     3. Account: Select the desired account type from the drop-down.
     4. Payment Type: Select the desired payment type from the drop-down.
     5. Posted By: Select a staff member from the drop-down to view all all ledger items posted by that user.
     6. >: Use the drop-down options in this field in conjunction with the Outstanding Balance field to view all items.
     7. Outstanding Balance: Enter the outstanding balance amount you wish to filter by. Use in conjunction with the > drop-down.
• Once results have been generated, they can be exported.
  1. Below the filter options are the Export to XLS and Export to CSV buttons which allow you to export the ledger to an XLS or CSV file. Additionally, you can click on the + icons next to Charges and Payments to view more detailed breakdowns.
  2. Clicking the - icons will collapse the details again.

• Ledger items appear as follows.

  

  1. Click on the up and down arrows in each column to sort that column by ascending or descending order.
  2. Click on the name of the patient to navigate to their chart.
  3. Click on the + to expand the item's details.
  4. CSV: Export results in a CSV file.