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KPG Newsletter - Credit Balances & The Law
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October 2016
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Kathy Puziak PMP CMPE
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Credit Balances: No, you can't keep it; even if it's Unclaimed!
by Kathy Puziak CMPE PMP
kathy.puziak@kpgrcm.com
What is unclaimed property? How do escheat laws apply to my medical practice? If you collect payments from any source, whether it be a patient or a payer, that results in a credit balance, then you have the potential for unclaimed property. If you cannot move the credit balance to an open balance on the patient account or return the credit balance to the payer, then you have an obligation to return the money somewhere! That "somewhere" is usually the state, depending on how individual state laws are written.
State laws vary, but most states regulate unclaimed property from the healthcare industry on insurance and patient credit balances. When the money becomes "abandoned", you are obligated to turn the money over to the state. We have all seen the newspaper issues where unclaimed property lists are published. These lists include property reported by medical practices.
The time interval before property is considered abandoned is called the dormancy period. This varies from state to state. Once this period passes, the money must be turned over to the state. Unclaimed property first goes to the state of the patient's last known address. If the patient's address is unknown, the right to the money goes to the state where your practice is located.
Ultimately it is your responsibility to know the unclaimed property laws (sometimes referred to as escheat laws) for your state. We will discuss credit resolution management, as well as the new requirements from CMS on resolving credits in a timely manner, in our next newsletter.
References:
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Notes in Group Management
Part 2 in a Series on Notes
by Ellen Jakovich,
Director of Training, KPG RCM
Account Notes - Short/Long Questions - Patient Notes - Patient Data Sets
If your staff wastes endless hours searching for information that should be at their fingertips, then you may need to look at reorganizing the notes in your system.
Let's take a look at where note fields are available and where they can be imported/exported to. Hopefully, this look will provide new insight into how you pull and store information. As we proceed, you may find new ways to organize workflow. Building a catalog or process for where your staff should store specific information, will allow for speedier data entry; a defined location for the data; and increased ease in retrieving the data at a later date.
Account Notes:
Account notes have a Comments tab in GPP. If you've been a system user for a while, you may remember that using Account notes is also accessible in WFE and GPP within registrations, inquiry, charges and payments. The Account notes field allows up to 5 lines with a maximum of 50 characters per line. The challenge is that account notes can be typed over, deleted and/or edited, making them non-HIPAA compliant. Additionally, they can't track date, time or users who enter information, another HIPAA compliance issue. Account notes remain a valuable tool, and can still be used today for notes that do not contain data that is a part of the patient formal record, such as: "Pt may need help with wheelchair access".
The five available account notepad lines can be formatted on claims, statements, demand statements, and special forms.
Short/Long Questions:
Patient Short/Long questions also has a tab in Comments that gives you the ability to edit the answers as updates are documented. Questions are defined by the practice and set up in General Parameters. Short question responses may contain up to 10 characters and long questions can have up to 20 characters. Since these are free text fields, we often see information that is not accurate for reporting due to lack of consistency in the characters or definition for the field usage. A great way to use these fields is to pull information from interfaces like the hospital MRN or Account IDs from another system. These fields should be reviewed every year to ensure they remain vital and active or identify the need for update or deletion.
Patient Notes:
Patient Notes are the original comment lines available since the inception of Group Management. They consist of 9 pages and 144 blank lines for all documentation. The biggest issue with these notes was that over time, many practices ran out of lines and had to delete material to accommodate new information.
Once HIPAA laws came into effect in April 2002, it was no longer compliant to erase any information to gain additional space. Group Management was redesigned and Coded notes were added to meet HIPAA requirements by stamping each note with time, date and user. The Patient Notes tab is found in Comments and is accessible in both Charge and Payment mini menu, Task Management and in PM.
With that said, no practice wants to lose any of their Patient Notes especially if heavily utilized. You have the ability to update the security on the notes screen to make them "View Only". This precludes new notes from being added and the original notes are grayed out.
GE also created a Special Program to transfer Patient Notes into Coded Notes. Having them
all stored in coded notes will save your users time, reducing the need to search multiple locations.
Special Program: MOVENOTES - allows the client to move or copy Patient Notes to a single Coded Note for each account. Specific criteria used by the program is entered into an ini file which allow the user to specify what Coded Note it should be posted to. Additional information can also be posted to the note such as, provider codes or if it should be a sticky note.
Moving note
s is one of the ways CGM's Special Programs can help your practice update your information with minimal user time invested.
Patient Data Sets:
There are 7 different types of fields available in Patient Data Sets. They are date,
 amount, number, info, data, yes/no and free text fields. A handy way to think of Patient Data Sets is to remember that anything stored in this area can be attached and printed on claims, special forms and custom reports. Each prompt can be customized to ask a question or prompt a date or dollar amount. A great example of one use for Patient Data Set is for the seasonal address for snowbirds!
For more on Notes, check the Resource Library at KPGRCM.com
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Expanding Task Management to
Manage Adjustments
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by Stephen Stoyko,
Director of Business Intelligence, KPG RCM
stephen.stoyko@kpgrcm.com
T
ask Management brings many opportunities to your practice to automate processes. Without a doubt, the biggest areas of work effort are in the management of denials and insurance follow-up. By applying effective design to Task Management, you can streamline the claims process and shorten revenue cycle time, resulting in faster payment and less rework.
Sounds like a miracle! It's all in the practical setup and monitoring of non-contractual adjustments. Get down to the root cause of denials and you are on your way to a healthy practice. Using specific Status Codes and Action Codes that work in tandem to create an audit process that works with your write-off process, develops ownership and reduces denials as trends are identified and corrective actions applied. A checks and balances system is introduced that ensures non-contractual adjustments are approved by leadership, thus providing accountability and audit trails to answer the inevitable question of "WHY WAS THIS WRITTEN OFF?" Adjustments are made only after approval; charges are adjusted to specific non-contractual adjustment codes; and, even more importantly, the adjustments are managed thru a special program. This reduces the manual processing time, inefficiencies and potential errors associated with a manual write-off process.
An additional benefit of using Task Management to manage your write-off process is expanded reporting. Write-Offs by Category, Write-Offs Requested per User, and Write-Offs Rejected per User, are just a few examples of the metrics available.
Contact KPG Revenue Cycle Management at info@kpgrcm.com or 303-478-3828 for information on how to implement this process in your organization.
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