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VersaForm User Guide

May 2008

VERSAFORM USER'S GUIDE


Copyright (c) 2008 VersaForm Systems Corporation This software product is copyrighted, and all rights are reserved by VersaForm Systems Corporation. Lawful users of this program are licensed only to read the program from its medium into memory of a computer, solely for the purpose of executing the program. Copying, duplicating, selling, or otherwise distributing this product is a violation of the law. This manual is copyrighted and all rights are reserved. This document may not, in whole or in part, be copied, photocopied, reproduced, translated, or reduced to any electronic medium or machine readable form without prior consent, in writing, from Applied Software Technology. Revised 05/08 Printed in U.S.A. VersaForm (TM) is a registered trademark of VersaForm Systems Corporation

CPT Copyright 2007 American Medical Association. All rights reserved.

VersaForm Systems Corporation


591 West Hamilton Ave., Suite 230 Campbell, CA 95008 Office: (800) 678-1111 or sales@versaform.com Fax: (408) 370-3393 Technical Support: (800) 999 6081 or support@versaform.com www.versaform.com

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Table of Contents ThisUserGuide.............................................................................................................................1 WelcometoVersaFormHelp...................................................................................................1


Help Yourself. .................................................................................................................. 2

Introduction....................................................................................................................................4
Concepts of Operation......................................................................................................... 4 Patient Data ..................................................................................................................... 4 Controlled Vocabularies ................................................................................................... 4 Frequent Lists and Practice-Wide Lists ........................................................................... 5 Users................................................................................................................................ 6 Providers .......................................................................................................................... 6 The VersaForm Tutorial ................................................................................................... 7 CPT4 Codes Overview .................................................................................................... 7 Controls ............................................................................................................................... 9 The Menu Bar .................................................................................................................. 9 Command Buttons ......................................................................................................... 11 Initial Data.......................................................................................................................... 12 First Login ...................................................................................................................... 12 Data that the System Needs .......................................................................................... 12 Security.............................................................................................................................. 14 Access Control Overview ............................................................................................... 14 Permission Categories ................................................................................................... 17 Effective Permissions..................................................................................................... 20 Report Security .............................................................................................................. 21 Denying Certain Users Access to Certain Reports ........................................................ 22 Preventing Some Users from Accessing the Ledger ..................................................... 26 Audit Trail ....................................................................................................................... 27 Passwords ..................................................................................................................... 27 Idle Workstation Shutdown ............................................................................................ 28

ThePatientChart........................................................................................................................29
Overview............................................................................................................................ 29 Organization of the Patient Chart................................................................................... 29 iii

The Problem-Oriented Chart.......................................................................................... 30 Opening a Patient Chart ................................................................................................ 30 Adding a New Chart ....................................................................................................... 31 Importing a Patient from VersaForm Practice Management .......................................... 31 Importing Patient Charts in Bulk .................................................................................... 32 Closing the Chart ........................................................................................................... 35 Removing a Patient Chart .............................................................................................. 35 Printing ........................................................................................................................... 35 Patient Chart Data: General .............................................................................................. 37 Adding a New Patient .................................................................................................... 37 Patient Registration........................................................................................................ 40 Patient Demographics.................................................................................................... 42 Patient Relationships ..................................................................................................... 46 Patient Billing Info .......................................................................................................... 48 Patient Insurance ........................................................................................................... 52 Patient Custom Data ...................................................................................................... 57 Patient Security .............................................................................................................. 60 Patient Pharmacies ........................................................................................................ 61 Patient Chart Data: Encounters ......................................................................................... 63 Adding an Encounter ..................................................................................................... 63 Edit/View Encounters ..................................................................................................... 64 Encounter Information.................................................................................................... 64 Associating a Problem with an Encounter ..................................................................... 65 Encounter Billing ............................................................................................................ 65 Exporting Billing Information .......................................................................................... 65 CPT Selection ................................................................................................................ 66 ICD9 Selection ............................................................................................................... 67 Printing an Encounter .................................................................................................... 67 Patient Chart Data: The Chart Index ................................................................................. 68 The Problem-Oriented Chart.......................................................................................... 68 Index by Encounter ........................................................................................................ 68 Index by Problem ........................................................................................................... 68

ClinicalEMR.................................................................................................................................69
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Problems ........................................................................................................................... 69 The Problems Tab of the Patient Chart ......................................................................... 69 Problems and ICD9 Codes ............................................................................................ 69 Adding a Problem .......................................................................................................... 69 Edit/View Problems ........................................................................................................ 70 Associated Problems ..................................................................................................... 71 Allergies ............................................................................................................................. 72 Adding an Allergy ........................................................................................................... 72 Edit/View Allergies ......................................................................................................... 72 Labs and Data ................................................................................................................... 74 Labs/Data....................................................................................................................... 74 Vitals .............................................................................................................................. 75 Adding a Lab .................................................................................................................. 75 Edit/View Labs ............................................................................................................... 76 Electronic lab: Creating Electronic Lab Orders .............................................................. 78 Electronic lab: Processing Electronic Lab Results ......................................................... 82 Electronic lab: Importing Lab Results Overview ............................................................ 89 Labs, Graphing Results ................................................................................................. 91 Flowsheets of Lab Results ............................................................................................. 92 Growth Charts ................................................................................................................ 92 Recalls, Labs and Studies Due ...................................................................................... 94 Medications ....................................................................................................................... 95 Medications and Prescriptions ....................................................................................... 95 Adding a Medication for a Patient .................................................................................. 96 Prescription Templates .................................................................................................. 97 Edit/View Medications .................................................................................................... 97 The Edit/View Medication Window................................................................................. 98 Medicine and Allergy Interaction Checking .................................................................... 99 Electronic Prescriptions ............................................................................................... 100 Histories........................................................................................................................... 104 The History Tab of the Patient Chart ........................................................................... 104 Adding or Changing a History Panel ............................................................................ 104 Printing History............................................................................................................. 105 v

Images ............................................................................................................................. 106 Images ......................................................................................................................... 106 Adding an Image .......................................................................................................... 106 Viewing an Image ........................................................................................................ 107 The Image Library ........................................................................................................ 107 Exporting an Image ...................................................................................................... 107 Printing an Image ......................................................................................................... 108 Patient Pictures ............................................................................................................ 108 Notes ............................................................................................................................... 109 Creating Notes Tutorials .............................................................................................. 109 Templates .................................................................................................................... 109 Templates and Topics.................................................................................................. 110 The Notes Tab ............................................................................................................. 110 Adding a Note .............................................................................................................. 111 Edit/View Notes............................................................................................................ 112 Adding Chart Data to a Note ........................................................................................ 112 Histories in Notes ......................................................................................................... 113 Printing Patient Notes .................................................................................................. 113 Searching Notes .......................................................................................................... 115 Dictating Notes............................................................................................................. 116 Template Example........................................................................................................... 116 Template Example 1 .................................................................................................... 116 Template Example 2 .................................................................................................... 116 Template Example 3 .................................................................................................... 117 Template Example 4 .................................................................................................... 117 Template Example 5 .................................................................................................... 118 E&M Documentation........................................................................................................ 119 The E&M Wizard .......................................................................................................... 119 HIPAA .............................................................................................................................. 123 HIPAA Documents ....................................................................................................... 123 Summary ......................................................................................................................... 125 The Summary Tab on the Patient Chart ...................................................................... 125

PracticeManagement............................................................................................................126
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Ledger Overview ............................................................................................................. 126 On the Ledger, you can: .............................................................................................. 126 Notes on the Patient Ledger ........................................................................................ 126 Collections ................................................................................................................... 127 To Print a Collection Letter for the Current Patient ...................................................... 128 To Print Collections Letters for all Patients that have Collections Information............. 129 Ledger Icons ................................................................................................................ 129 Authorizations .............................................................................................................. 130 To Keep Track of Authorization Activities .................................................................... 131 Ledger Notes ............................................................................................................... 133 The VersaForm Multi-Doc System ............................................................................... 134 Charges ........................................................................................................................... 135 Adding a Charge .......................................................................................................... 135 Edit or View a Charge .................................................................................................. 136 Charge and Insurance Information .............................................................................. 137 Charge ......................................................................................................................... 138 Problem/Facility Tab .................................................................................................... 140 Miscellaneous Tab ....................................................................................................... 142 Ambulance Tab ............................................................................................................ 145 Anesthesia Tab ............................................................................................................ 147 DME Tab ...................................................................................................................... 148 Measurements Tab ...................................................................................................... 150 Spinal Tab .................................................................................................................... 152 Drug Tab ...................................................................................................................... 153 EOB Adjustments (EOBA) Tab .................................................................................... 154 EOBA Codes by Code Number ................................................................................... 157 EOBA Codes by Reason ............................................................................................. 179 Properties of a Charge ................................................................................................. 202 Procedure Explosions .................................................................................................. 204 Payments and Adjustments ............................................................................................. 206 Adding a Payment........................................................................................................ 206 Entering Payments....................................................................................................... 207 Entering a Copay ......................................................................................................... 214 vii

Adjustments ................................................................................................................. 216 Reversing Charges, Payments and Credits ................................................................. 217 Multi-Patient Payments ................................................................................................ 218 Deposit Slip Report ...................................................................................................... 221 Balancing against the Deposit Slip .............................................................................. 222 Issue a Refund or Transfer .......................................................................................... 222 Correcting Mistakes ..................................................................................................... 224 Correcting for Insurance Takebacks ............................................................................ 227 Electronic Remittance Advice ...................................................................................... 230 Insurance ......................................................................................................................... 235 Viewing Charge Status ................................................................................................ 235 Claim and Charge Status ............................................................................................. 235 Claim Status Lifecycle.................................................................................................. 238 Secondary Insurance Overview ................................................................................... 240 Setting up Secondary Insurance Claims ...................................................................... 241 Problems with Secondary Insurance Claims ............................................................... 245 Proof of Filing ............................................................................................................... 249 Claim As....................................................................................................................... 251 Insurance: CLIA Numbers............................................................................................ 251 Insurance: Print Claims ................................................................................................ 254 Insurance: HCFA 1500 ................................................................................................ 267 Insurance: Electronic Claims ....................................................................................... 275 Insurance: Electronic Claim Acknowledgement and ERA ........................................... 303 Statements ...................................................................................................................... 306 Statements Overview ................................................................................................... 306 Printing Statements...................................................................................................... 311 Printing a Superbill ....................................................................................................... 313 Guarantors ................................................................................................................... 314 Searching for Patient Data .............................................................................................. 316 Advanced Search......................................................................................................... 316 Sort Parameters ........................................................................................................... 317

Reports.........................................................................................................................................318
Reports Overview ............................................................................................................ 318 viii

Practice Management Reports .................................................................................... 318 Clinical Reports Overview ............................................................................................ 318 Electronic Lab Orders Manifest Report - Clinical ......................................................... 320 Electronic Labs Received Report - Clinical .................................................................. 321 HL7 Lab Results Report - Clinical ................................................................................ 322 Patient History Report - Clinical ................................................................................... 323 Patient Summary Report - Clinical ............................................................................... 324 General Reports Overview .............................................................................................. 326 Appointment List Report - General .............................................................................. 328 Audit Report - General ................................................................................................. 329 CPT4 Codes Report - General..................................................................................... 330 Encounter List Report - General .................................................................................. 332 Facilities Listing Report - General ................................................................................ 332 ICD9 Codes Report - General...................................................................................... 333 Insurance Plan Listing Report - General ...................................................................... 334 Labs Due--Labels Report - General ............................................................................. 336 Labs, Studies and Other Data Due Report - General .................................................. 337 Patient Future Appointments Report - General............................................................ 339 Patient Listing Report - General................................................................................... 340 Provider Listing Report - General ................................................................................ 341 Referring Physicians Listing Report - General ............................................................. 342 Security - User List Report - General ........................................................................... 343 Practice Management Receivables Reports ................................................................... 344 Account Balances and Practice Total Due Report - PM Receivables .......................... 346 Aged Accounts Receivable Report - PM Receivables ................................................. 347 Aged Accounts Receivable as of a Date Report - PM Receivables............................. 348 Aged Accounts Receivable by Primary Insurance Plan Report - PM Receivables ...... 349 Aged Accounts Receivable by Primary Insurance Plan as of a Date Report - PM Receivables ................................................................................................................. 350 Aged Accounts Receivable by Primary Provider Report - PM Receivables ................ 352 Aged Accounts Receivable by Rendering Physician Report - PM Receivables .......... 353 Delinquent Accounts Receivable Report - PM Receivables ........................................ 354 Practice Management Reports ........................................................................................ 355 ix

ERA Reports ................................................................................................................ 360 Insurance Claims Reports............................................................................................ 360 Patient Reports ............................................................................................................ 361 Payments Reports ....................................................................................................... 363 Scheduler Reports ....................................................................................................... 364 Statements Printed Report........................................................................................... 364 Filtering Reports .............................................................................................................. 394 Sorting Reports................................................................................................................ 395 Installing a Custom Report .............................................................................................. 395 Installing a Custom Report on Other Machines ........................................................... 395

Setup.............................................................................................................................................397
Setup Overview ............................................................................................................... 397 Basic Setup .................................................................................................................. 397 Practice Management Setup........................................................................................ 398 Scheduler Setup .......................................................................................................... 399 EMR Setup................................................................................................................... 399 ID Lists............................................................................................................................. 400 General ............................................................................................................................ 400 The Preferences Tab ....................................................................................................... 400 Preferences Setup: Claim as Rendering...................................................................... 405 Preferences Setup: NPI Effective Dates ...................................................................... 405 The Users Tab ................................................................................................................. 408 Users Setup: User Setup ............................................................................................. 408 Users Setup: Adding a User to the List ........................................................................ 411 Users Setup: Changing a User on the List................................................................... 412 Users Setup: Changing User Passwords..................................................................... 413 Users Setup: Removing a User from the List............................................................... 414 The Providers Tab ........................................................................................................... 415 Providers Setup: Provider Setup.................................................................................. 415 Providers Setup: Adding a Provider to the List ............................................................ 421 Providers Setup: Changing a Provider on the List ....................................................... 422 The Facilities Tab ............................................................................................................ 423 Facilities Setup: Facilities Setup .................................................................................. 423 x

Facilities Setup: Adding a Facility to the List................................................................ 428 Facilities Setup: Removing a Facility from the List ...................................................... 430 Setting up Electronic Labs Overview ............................................................................... 431 Electronic Labs: Setting up Electronic Labs................................................................. 432 Electronic Labs: Setting up Electronic Lab Providers .................................................. 435 Electronic Labs: Setting up Electronic Lab Insurance.................................................. 438 Electronic Labs: Setting up Electronic Lab Panels ...................................................... 441 Electronic Labs: Electronic Lab Folders....................................................................... 446 ICD9s............................................................................................................................... 448 CPT4s.............................................................................................................................. 452 Clinical (EMR).................................................................................................................. 463 Allergies: The Allergies Tab............................................................................................. 463 Allergies: Allergies Setup ............................................................................................. 463 Allergies: Adding an Allergy to the List ........................................................................ 464 Allergies: Changing an Allergy on the List ................................................................... 464 Allergies: Removing an Allergy from the List ............................................................... 465 Medications ..................................................................................................................... 466 The Medications Tab in the Setup Window has these Functions ................................ 466 Medications: Medications Setup .................................................................................. 466 Medications: Adding a Medication to the List............................................................... 468 Medications: Changing a Medication on the List ......................................................... 469 Medications: Removing a Medication from the List ..................................................... 470 Medications: Importing Medications to the List ............................................................ 470 Labs/Data ........................................................................................................................ 476 The Labs/Data Tab ...................................................................................................... 476 Labs/Data: Lab Test or Data Item Setup ..................................................................... 476 Labs/Data: Adding a Lab Test or Data Item to the List ................................................ 478 Labs/Data: Removing a Lab Test or Data Item from the List ....................................... 479 Labs/Data: Lab Panel Editor ........................................................................................ 479 Labs/Data: Lab Tests Low Normal/ High Normal by Age ............................................ 481 Labs/Data: Lab Flowsheet Editor ................................................................................. 484 Labs/Data: Grouping Lab Tests in Flowsheets ............................................................ 485 Labs/Data: Importing Labs/Data Information ............................................................... 485 xi

Problems ......................................................................................................................... 487 The Problems Tab ....................................................................................................... 487 Problems: Problems Setup .......................................................................................... 487 Problems: Adding a Problem to the List....................................................................... 489 Problems: Changing a Problem on the List ................................................................. 490 Problems: Removing a Problem from the List ............................................................. 490 Problems: Importing Problems..................................................................................... 490 Notes, Templates ............................................................................................................ 492 Creating Templates...................................................................................................... 492 Notes, Templates: Creating Templates from the Notes Tab........................................ 492 Notes Templates: Editing Templates ........................................................................... 492 Notes Templates: Exporting Templates ....................................................................... 493 Notes, Templates: Importing Templates ...................................................................... 493 Notes, Templates: Creating a New Topic .................................................................... 494 Notes, Drop-downs .......................................................................................................... 495 Creating Drop-downs ................................................................................................... 495 Notes, Drop-downs: Editing Drop-downs ..................................................................... 495 Notes, Drop-downs: Entering Drop-down Choices ...................................................... 496 Notes, Drop-downs: Associated Text........................................................................... 496 Notes, Drop-downs: Creating Blank Fill-ins ................................................................. 496 Notes, Drop-downs: Blank Fill-ins ................................................................................ 497 Notes, Drop-downs: Editing Blank Fill-ins .................................................................... 497 Notes, Databases: Database Values ........................................................................... 498 Notes, Databases: List of Database Values for Notes ................................................. 499 Notes, Databases: Database Values That Can Be Filled In From Notes .................... 500 Notes, Databases: Miscellaneous Template Functions ............................................... 501 Notes, E&M Documentation: Documentation Tags ..................................................... 502 Practice Management...................................................................................................... 505 Insurance Setup Overview .............................................................................................. 505 Insurance Plans: The Insurance Tab ........................................................................... 505 Insurance Plans: Insurance Plan Setup ....................................................................... 506 Insurance Plans: Adding an Insurance Plan to the List ............................................... 518 Insurance Plans: Changing an Insurance Plan on the List .......................................... 519 xii

Insurance Plans: Removing an Insurance Plan from the List ...................................... 519 Insurance Plans: Importing Insurance Plans ............................................................... 520 Insurance Plans: Exporting Insurance Plans ............................................................... 522 How to Set Up for Electronic Claims ............................................................................... 524 Electronic Claims: The Claims Processors Tab ........................................................... 528 Electronic Claims: Claim Processor Setup .................................................................. 528 Electronic Claims: Adding a Claim Processor.............................................................. 533 Electronic Claims: Changing a Claim Processor ......................................................... 535 Electronic Claims: Removing a Claim Processor......................................................... 536 Electronic Claims: Creating Folders for Insurance Files .............................................. 536 Electronic Claims: Creating a HyperTerminal Connection Icon ................................... 538 Electronic Claims: Set up HyperTerminal to Store Downloaded Files ......................... 541 Electronic Claims: 835 Options Setup ......................................................................... 542 The Submitters Tab ......................................................................................................... 546 Submitters: Submitter Setup ........................................................................................ 546 Submitters: Adding a Submitter to the List................................................................... 551 Submitters: Changing a Submitter ............................................................................... 552 Submitters: Removing a Submitter .............................................................................. 553 The Referring Tab ........................................................................................................... 554 Referring Setup: Referring Provider Setup .................................................................. 554 Referring Setup: Adding a Referring Provider to the List ............................................. 558 Referring Setup: Changing a Referring Provider on the List........................................ 559 Referring Setup: Removing a Referring Provider from the List.................................... 560 Statement Options ........................................................................................................... 561 Statement Options Setup: The Statement Options Tab............................................... 562 Statement Options Setup: Statement Options Setup................................................... 562 Statement Options Setup: Adding a Statement Option................................................ 567 Statement Option Setup: Changing a Statement Option ............................................. 567 Statement Option Setup: Removing a Statement Option ............................................ 568 National Provider Identifier (NPI) ..................................................................................... 569 NPI Setup: Adding NPIs............................................................................................... 569 NPI Setup: NPIs and Claims ........................................................................................ 571 NPI Setup: NPIs and VersaForm ................................................................................. 572 xiii

NPI Setup: Notes on NPIs ........................................................................................... 576 The Scheduler Resources Tab ........................................................................................ 578 Schedule Setup: Schedule Resources Setup .............................................................. 578 Scheduler Setup: Adding a Scheduler Resource......................................................... 580 Scheduler Setup: Schedule Resource Events ............................................................. 581 Scheduler Setup: Adding Holidays .............................................................................. 585 Scheduler Setup: Changing a Scheduler Resource .................................................... 586 Scheduler Setup: Adding Visit Types........................................................................... 587 Scheduler Setup: Removing a Scheduler Resource.................................................... 589 Scheduler Setup: Appointment Reminders .................................................................. 590 Security Setup: Access Control Overview ....................................................................... 594 Security Setup: User Groups ....................................................................................... 597 Security Setup: Adding a User Group .......................................................................... 598 Security Setup: Removing a User Group ..................................................................... 599 Security Setup: Setting User Group Permissions ........................................................ 600 Security Setup: Patient Groups.................................................................................... 601 Security Setup: Adding a Patient Group ...................................................................... 602 Security Setup: Removing a Patient Group ................................................................. 603 Security Setup: Setting Patient Group Permissions..................................................... 605 Other Setup ..................................................................................................................... 607 Encounter Type Setup ................................................................................................. 607 Reports Setup .............................................................................................................. 607 Sig Line Setup.............................................................................................................. 609 System Parameters ..................................................................................................... 609 Set Up Backups ........................................................................................................... 610 Setting up Electronic Pharmacies ................................................................................ 614 WIA and VersaForm Image Utility................................................................................ 615

TheDesktop...............................................................................................................................621
The Scheduler ................................................................................................................. 621 Adding an Appointment................................................................................................ 622 The No Show Report ................................................................................................... 623 Scheduling Appointment Reminders............................................................................ 623 Letters.............................................................................................................................. 626 xiv

Letters .......................................................................................................................... 626 Predefined Letters and Forms ..................................................................................... 628 Selecting a Range of Names in a Patient Letter .......................................................... 629 Patient Recall Letters ................................................................................................... 631 Patient Form Kit ........................................................................................................... 632 Messages ........................................................................................................................ 635 Choosing which messages are to be displayed ........................................................... 635 The Message Timer ..................................................................................................... 636 Creating a Message ..................................................................................................... 636 Reading Messages ...................................................................................................... 637 The Physicians Dashboard ............................................................................................. 638 The Physicians Dashboard is Divided into Six Areas ................................................. 638

Backup..........................................................................................................................................640
Backup Overview............................................................................................................. 640 Backup Practices ......................................................................................................... 640 Moving the Location of your Backups .......................................................................... 641 Types of Failures ......................................................................................................... 641 Where Is My Data? ...................................................................................................... 642 When Your Backup is not Running .............................................................................. 642 Manual vs. Automatic Backup...................................................................................... 645 Legacy Installs ............................................................................................................. 645 How to Copy Backup Files to a CD or DVD ................................................................. 645

DatabaseTopics.......................................................................................................................650
Microsoft SQL Servers .................................................................................................... 650 SQL 2005 ..................................................................................................................... 650 SQL 2000 ..................................................................................................................... 650 How to Move VersaForm from One Server to Another.................................................... 651 Useful Views in the VersaForm Database ....................................................................... 652

Interfaces....................................................................................................................................654
Instant Medical History .................................................................................................... 654 Schedule Export .............................................................................................................. 654 Charge Capture ............................................................................................................... 657

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Importing Lab Results Overview...................................................................................... 659 Setup for Electronic Lab Results.................................................................................. 659 Processing Lab Results from an Electronic Lab .......................................................... 659 Deleting Electronic Labs for a Patient .......................................................................... 660 Mapping Lab Results to VersaForm Labs.................................................................... 660

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This User Guide


This User Guide is taken from the Help pages that are part of VersaForm. Everything in this volume can also be found in the Help.

Welcome to VersaForm Help


If you are just getting acquainted with VersaForm, there are several good places to start. If you have an Internet connection, watch the introductory video tutorials and demos. If you are interested in Practice Management, you will want to see: Practice Management Practice Management Setup

If you are interested in Clinical functions: First read the Introduction and The Patient Chart section. Then consult the particular topics you are interested in.

Help Yourself.
Use the table below to help you find the most common articles weve been asked about. The first column is the topic. The second column is what you would type in the Search Type in the word(s) to search for: field. The third column contains the articles you should read (or print). To print an article displayed in the right pane click on the Print button on the top tool bar.

To get rid of the highlights on the search words, click on Options in the top menu, and then choose Search Highlight Off. It is a toggle so you can turn it back on the same way. Note: you must be using version 3.139 or higher to see some of the articles noted below. You can download upgrades from http://www.versaform.com/index.php/support. Topic Keyword(s) Article(s) to Read Adding a Charge Charge Information for Billing Insurance Claim and Charge Status Edit or View a Charge Adding a New Patient Reversing Charges and Payments Facilities Setup How to Set Up for Electronic Claims Claim Processor Setup Electronic Claims Overview Printing Claims How to Print Paper Claims Insurance Setup Overview Insurance Plan Setup Adding a Payment Viewing Charge Status Claim and Charge Status

Adding a charge

charges

Adding a Patient Delete a line (charge or payment) Facilities How to make electronic claims

adding a patient reverse facilities set up electronic claims

How to print a paper claim

paper claims

Insurance Plan

insurance plan

Making an Insurance Payment

insurance payment

Topic Multi patient payments Navigating through the program

Keyword(s) insurance payment menu buttons

Article(s) to Read Multi-Patient Payments The Menu Bar Command Buttons Print to File Selecting Claims Printer at Creation Time Adding a Provider Provider Setup Providers Sending Claims with Hyper Terminal Statement Options Setup Printing Statements Statements Overview Submitter Setup Adding a User Users User Setup

Print to a File

print claims

Providers

providers

Sending Claims Statement Options Statements Submitter

hyper statement statement submitter

Users

users

Introduction
Concepts of Operation
Patient Data
All patient data is kept in the patient charts. This means that in order to enter information, you must open the patient's chart. If the patient does not yet have a chart, you must create one.

Data is Organized in two Main Ways within a Chart


By the kind of data it ismedications, labs, etc. Chronologically, by encounter

In addition, both encounters and the medical data within them can be associated with problems. This allows you to keep true problem-oriented medical records. All patient data (with the exception of registration information) is associated with an encounter. One opens an encounter, adds data, and closes it by "signing it". Most data(CPTs, ICDs, problems, medications, labs, etc.) use controlled vocabularies. Only data that is in the vocabulary can be entered. This prevents the use of many different terms for the same concept, which can make data impossible to retrieve accurately. However, you can enter new words into the controlled vocabularies.

Controlled Vocabularies
For each type of data in the database, the system maintains a vocabularya list of acceptable entries. Medications, problems, labs, allergies, ICD9 and CPT codes are all controlled vocabularies. This enhances accuracy in the use of medical terms and concepts and drug names. It also prevents the use of different terms for the same concept, such as "high blood pressure", "high BP", and "hypertension". Consistent use of terms enables the system to retrieve data accurately ("List all the patients with hypertension"). Proliferation of terms makes retrieval difficult and inaccurate. You can add to the vocabularies at any time, without using system setup. Each provider has a "Frequent List" of frequently-used problems, medications, etc.

Several vocabularies can be imported in bulk from the VersaForm Practice Management system (MD VersaForm). Other sources can be used if they follow the correct formats.

Frequent Lists and Practice-Wide Lists


Each of the controlled vocabularies in VersaForm forms a list that is presented to a user whenever a choice is to be made. These lists are called the Practice-Wide lists. Because they can be large, a Frequent List is also kept for each provider. You control the entries in your frequent list. Because these lists are typically much shorter, choices can be made quickly.

Here are Two Examples, Using the Problem Lists


Frequent Problems

Practice-Wide Problems

Search
Since the Practice-wide list may be large, there is a Search function. Simply enter a search word in the window, and press the Search button. The example below shows a search for problems with "pneu" in the description:

Users
Each User has a User ID and a password, which are used to identify and authenticate the user. Actions recorded in the audit report (see Printing) are identified by User ID. Each User is associated with a Provider on whose behalf he or she is normally acting. The User's name appears in the VersaForm title bar.

Providers
Any user can be a Provider. To add a Provider, you must first add him or her as a User.

We Refer to Providers in Several Contexts


Default Provider: Each user is associated with a Default Provider. (If the User is a Provider, then she or he is the Default Provider). The Default Provider is assigned in the Edit/View User Information window from the Users Tab in the Setup window. The operator may modify this value at any time.

Primary Physician: Each patient has a Primary Physician. The Primary Physician is chosen in the Registration, already be a Provider. Demographics Tab of the patient chart. A Primary Physician must

Referring Physician: Each patient may have a Referring Physician. The Referring Physician is chosen in the Registration, Demographics Tab from the list of physicians entered in the Referring Tab in the Setup window. Individual charges may also have a Referring Physician to be included on insurance claims.

The VersaForm Tutorial


A tutorial covering many functions of VersaForm EMR and VersaForm Chart Notes, with special emphasis on the process of creating progress notes, is available. In particular, you may use it to learn how to create and use templates to document your patient encounters. This tutorial does not cover Practice Management. The tutorial is available in two formsas a book and as an on-screen video. The book is distributed in electronic form along with the program; you probably already have it. It may be read and/or printed using the Adobe Acrobat reader, the latest version of which is available at www.adobe.com. If you received VersaForm on a CD, you already have the tutorial on that CD. Otherwise, the on-screen video is available from VersaForm. At this writing it is not available for download because it is too large (100 MB). To order it on CD-ROM, visit the VersaForm web site, www.versaform.com, or call VersaForm at 1-800-678-1111.

CPT4 Codes Overview


CPT4 codes are entered in Setup, with their fee schedules, charges, and insurance characteristics. Thus, when you enter a charge for a patient, all that information can be looked up so you don't have to key it in. 7

Each CPT4 code can have multiple charges according to different fee schedules. A CPT4 code can be the actual code, which is usually numeric, or it can be a mnemonica word or phrase. For example, 90050 is an actual, numeric code, and EKG is a mnemonic code. If you enter a mnemonic on the CPT4 setup form, you must also provide the actual code. You can then use the mnemonic when entering a patient charge. The system will automatically replace the mnemonic with the actual code. A CPT4 code can also be an Explosion, which lets one code expand into several codes when you enter it.

Controls
The Menu Bar
At the top of the VersaForm window is the Menu Bar and below it is the Tool Bar. Both can be used for navigating through VersaForm.

The Menu Bar


The Menu bar has the following items in it

File Has functions to create a new patient chart, open an existing chart, close a chart, import a patient picture, open the desktop, run reports, print charts, print the current datawindow, set up the printer and exit the system. A l t + F opens the File menu.

View

Removes or restores the Index from the currently active (selected) patient chart and lets you change what transactions show in the ledger and whether you see the current insurance status for each charge. A l t + V opens the View menu.

Utilities

Has functions for setup, import, export, statements, refunds or transfers and changing the program key. A l t + U opens the Utilities menu.

Insurance Print and send insurance claims from this menu, read EDI info, make multi patient payments and finding claims by number. A l t + I opens the Insurance menu.

Electronic Labs To import electronic lab results. 9

A l t + E opens the Electronic Labs menu.

Electronic Rx To get the status on electronic prescriptions. A l t + R opens the Electronic Rx menu.

Window Help Gets you to the Help Window. A l t + H opens the Help menu. Has functions to arrange the open charts, as well as a selection for each open chart. A l t + W opens the Window menu.

The Toolbar
The Toolbar has buttons that represent commands for opening and closing charts, setup, help and exiting the program.

Open Chart - Brings up the Select a Patient Chart window. Close Chart - Closes the current chart. Show Index - Toggles the display of the index of patient encounters when a chart is open. See Index by Encounter and Index by Problem for more information. Reports - Brings up the list of reports to choose among. See Reports Overview for more information. Desktop - Brings up the Desktop. Depending on your configuration, it may contain Messages/Reminders, Scheduler, Letters and Physician's Dashboard. Scheduler - Also brings up the Desktop but starts with the Scheduler rather than Messages/Reminders. Messages - Brings up the Desktop starting with the Messages/Reminders. Setup - Brings up all the Setup Tabs for entering basic information. Help - Brings up the VersaForm Help system. Exit - Leaves VersaForm. 10

Command Buttons
On each page of the chart there are several command buttons that can be used for navigating through VersaForm. To activate a button, click on it with the left mouse button. Alternatively, if a character in the button text is underlined, the button can be activated by holding down the Alt key and pressing that character on the keyboard. When there are command buttons for OK, Cancel, or Done, the Cancel button can also be activated by pressing the Esc key. The OK and Done buttons can be activated by pressing the Enter key. If a command button name is grayed out, its function has been disabled.

Double Clicking on an Item


If you double click on a data item in the chart (for instance, an encounter or a note) it will activate the Edit/View function for that item. It has the same effect as highlighting that item and then clicking the OK or Edit/View buttons.

Closing a Chart
To close the patient chart, click on the Close Chart button on the Toolbar.

Closing a Window
Close windows by clicking on the OK, Cancel, or Done buttons. Alternatively, click box with an X in it, in the upper right hand corner of the window. , the

11

Initial Data
First Login
All users of VersaForm must have a user name and password by which they are known to the system. In addition, there must be at least one user who is a provider. The initial provider information window lets you enter the needed information for the first provider, who will automatically be established as a user, too. After filling in the initial provider information, you will be able to use that user name and password to log in. On this screen you should also enter the practice information as you would like it to appear on letterheads, etc.

You must fill in:


Practice Name: 3 to 30 characters. Provider Name: 4 to 30 characters. Logon User Name: 2 to 15 characters.

Once you have completed entry of the data on this screen and click OK, you will see the password entry screen. Here you provide a password for the user just created. The password entry screen will show the requirements for a user password.

Data that the System Needs


To set up the system you will need to supply information in a number of categories. Most of the information can be entered as it is needed (if that is most convenient), but at least one User and one Provider, and the practice data must be entered initially. Users: All people who will access the computer. Each person must have a User Name and a Password. Providers: The names of licensed practitioners authorized to sign medical data. Practice Data: The name of the practice, its address, IRS Tax ID, and chief physician. Insurance Plans*: Insurance plan information for each plan that can be assigned to a patient. Lab Setup: Lab tests, lab panels (groups of tests), and lab flowsheets (groups of test results).

12

Problems*: The practice-wide problem list. Each provider can have a Frequent List (i.e., a "short list") of problems. Problems may be the same as ICD9 codes, or they may be either more specific or more general than ICD9 codes, as fits the needs of your practice. Medications: The practice-wide list of medications that you prescribe. Each provider can have a Frequent List. If you are using the NewCrop medication feature of VersaForm, the medications list will be loaded by a special setup program provided to you. Allergies: The practice-wide list of allergies that you encounter. If you are using the NewCrop medication feature of VersaForm, the allergies list will be loaded by a special setup program provided to you. If you want to interface with a billing system, you will also need: ICD9 Codes*: The list of ICD9 codes you use in billing. CPT Codes*: The list of CPT codes you use in billing. Patients*: A chart for each patient may be established either initially or as patients are seen. * These lists may be imported in bulk from the VersaForm Practice Management System (MD VersaForm).

13

Security
Access Control Overview
VersaForm provides four mechanisms for controlling security in your system:
Support for Users with Special Authorities Providing Two System Security Levels Controlling the Set of Users Who can Login to the System Controlling What Patient and Practice Information Users can See and Modify

Users with Special Authorities


There are two special attributes that can be granted to a User. User Authorities are granted in the Users Tab in the Setup window. You cannot grant a User Authority to another User unless you already have the authority being granted. The User Authorities are:

System Administrator
A System Administrator is allowed to view and change critical system settings such as setting the options for VersaForm backups. In addition, a System Administrator is granted all permissions (see the Controlling What Users can See and Modify section below) for viewing and changing all patient and practice data.

Security Administrator
A Security Administrator is allowed to view and change system settings relating to logins, passwords, and system security levels. Only a Security Administrator is allowed to change another User's password. A Security Administrator is not automatically granted all user permissions. The same User can be both a System Administrator and a Security Administrator. VersaForm requires that at least one User be a System Administrator and at least one User be a Security Administrator. The built-in User DBA satisfies this requirement as DBA is both a System and Security Administrator and these authorities cannot be removed from this User. You can (and should) change the password for the DBA User to limit the use of this User. The first User added when installing VersaForm is also both a System and Security Administrator but these authorities can be removed.

System Security Levels


The Security level is selected in the Access Control Tab in the Setup window. The two levels of System Security are: 14

Standard
When the system is set to Standard Security: 1. The password rules have no effect and passwords may be of any length, contain any characters, etc. 2. Passwords are not case-sensitive. 3. Reports are not restricted based on Administrator authorities. 4. A System Administrator can prevent users from using the Remember my user name and password for the login screen. 5. If a User login fails, the system will provide specific information about what caused the failure, such as bad User name or incorrect password. 6. Three login attempts are permitted using an incorrect password and then the system will exit but the User is not suspended and can try again by restarting VersaForm.

High
When the system is set to high security: 1. Only a Security Administrator can: Use the Access Control and Users Tabs in the Setup window. Set a User inactive. Grant Security Administrator authority to another User. Use the Audit and the Security User List reports. Change the password rules. Allow users to use the Remember my user name and password for the login screen.

2. The password rules become effective. 3. Passwords are case-sensitive. 4. You may be required to use a complex password. A complex password contains at least one upper case letter, one lower case letter, one number and one special character. 5. Consecutive attempts to login using the wrong password will cause a User to be suspended. The number of attempts is set by a Security Administrator. A suspended User can only be reset by the process of a Security Administrator assigning a new password to the User. 15

6. You may be prevented from reusing passwords. 7. The system will not provide information on the cause of login failures.

Controlling User Login


Every VersaForm User must have a password. Passwords are kept in the VersaForm database and are encrypted using an advanced hashing algorithm. Only the User who enters a password can know what the password is. If you forget your password, a System Administrator must reset your account by assigning you a new password. Using the Access Control Tab in the Setup window, a Security Administrator can set the password rules for your system including: 1. Permitting or disallowing use of the Remember my user name and password for the login screen. 2. Setting the System to the Standard or High Security Level. 3. Setting the minimum length of a password. 4. Forcing all users to change passwords on a periodic basis. 5. Making passwords case-sensitive. 6. Requiring you to use a complex password. A complex password contains at least one upper case letter, one lower case letter, one number and one special character. 7. Preventing Users from reusing passwords. 8. Setting the maximum number of login failures (caused by supplying an incorrect password) to allow before suspending a User. The Change Password window will show you the current requirements when you are entering a password. (See Changing User Passwords for more information.)

Controlling What Users can See and Modify


VersaForm controls access to patient and practice data using a system of permissions that are assigned to groups. User Groups can be established, and Users can belong to them. All Users belong to the AllUsers Group. Patient Groups can be established, and patients can belong to them. All patients belong to the All Patients Group. Permissions to access patient data are assigned to combinations of a User Group and a Patient Group. For instance, if User Smith belongs to User Group 1, and User Group 1 can view encounters for Patient Group 2, then Smith can view encounters for any patient in Patient Group 2. 16

Permissions to access non-patient data are assigned to User Groups. For instance, if User Jones belongs to User Group 1 and User Group 1 can change vocabularies, then Jones can change vocabularies. Permissions are assigned by category. In each category, the following permissions can be assigned: View: Select data for viewing on work station. Create: Create new data. Change: Change existing data. Delete: Delete data that has not been signed off. Sign: Certify data as clinically correct. Print: Pint reports, listings, or portions of patients' records.

Each of these permissions can be Yes, No, or Defer. When a permission is Defer, it does not determine the effective permission. This is usually because the permission will be determined by membership in some other User Group or Patient Group. Because users and patients can belongs to several groups the User's effective permission is a combination of the separate permissions. Users with System Administrator authority are automatically granted all permissions.

Permission Categories
There are separate Permissions for Viewing, Creating, Changing, Deleting, Signing and Printing. So you can allow someone to look at something that they can't change, print something that they can't delete, and so on. Saying No to View does not affect the other permissions. For example, Users who can't View the ledger can still use some of the buttons so they can still add charges and payments unless you also say No to Create as well.

Non-Patient Data
All_Rights: Covers all non-patient data categories. Users: User information or access permissions. Lab Setup: Lab or data tests, panels, and flowsheets. Vocabularies: Lists of problems, medications, etc. Admin: Other Setup Tabs, including ICD9 and CPT4 Codes. 17

Patient Data
All_Rights: Covers all patient data categories. Patient Demographics: Of the available. Encounter Data: Encounters. Patient Medications: Medications. Patient Problems: Problems. Patient Lab Results: Lab results. Patient Allergies: Allergies. Patient Notes: Notes and History. Patient Ledger: The Ledger. Patient Images: Images. Registration Tabs, only the Pharmacies Tab is

18

19

Effective Permissions
Rules for Determining Effective Permissions
Since users and patients may belong to several groups, they may have several applicable permissions for the same data. Hence rules are necessary to determine what the effective permissions are. Permissions can be Yes, No, or Defer. No prevails over Defer. Yes prevails over No and over Defer. Defer alone means Yes.

This means that when the system looks at all assigned permissions for a given category, its looking for a Yes. If it can find a Yes, the effective permission is Yes. Otherwise, if it finds a No, the effective permission is No. Finally, if there is nothing but Defer, the answer is Yes. The system starts out with all permissions set to Defer. Thus all users initially have access to all data.

How to Deny Some Users Access


1. Create a restricted User Group. (See Adding a User Group.) 2. Put the Users you want to deny access to in the group. 3. Set some permissions to No for that User Group. (See Setting User Group Permissions.) 4. Make sure that the Users don't belong to any other groups that might give them a Yes.

How to Deny Access to Some Patients for Some Users


1. Create a Patient Group. (See Adding a Patient Group.) 2. Put the Patients you want to deny access to in the group. 3. Set some permissions to No for some User Group and that Patient Group. (See Setting Patient Group Permissions.) 4. Make sure that the Users don't belong to any other User Groups and the Patients don't belong to any other Patient Groups that might give them a Yes for any of those Patients.

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What are This User's Permissions for This Patient?


If there are a number of User Groups it may be difficult to know what the result iscan this User access this Patient or not? To find out: 1. Open the Patient's chart. 2. In Registration, Security, click the View Permissions button.

What are This User's Permissions for Administration?


To find out: 1. Open the Setup window. 2. In the Preferences Tab, click the View Permissions button.

Report Security
Each report may have its own required access rights. That is, if you set the requirement for a report to Admin, then an operator must be a System Administrator in order to view that report. If the system security level is set to High, some reports are restricted so that only a Security Administrator can use the report. The Audit Report is an example of a report that is restricted in High Security mode.

To Set the Requirement for a Report


1. Log in as DBA, or some other user that is marked as a System Administrator. 2. Click on the Setup button.

3. Click on the Reports Tab. 4. Double click on the report or click once and click the Edit/View button.

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5. Choose the Access Rights you want. 6. Click the OK button.

Denying Certain Users Access to Certain Reports


A user can be denied access to a report by putting that user in a group that does not have access, for example, to viewing patient encounters, and then restricting access to that report.

The User must not Have System Administrator Authority


1. Log in as DBA, or some other user with System Administrator Authority. 2. In Setup Users, look for any user you want to restrict.

If there is a Y in the System Administrator column for that user, select the user, and click the Edit/View button.

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3. Uncheck System Administrator Click the Ok button.

4. Do the same for all users you want to restrict.

Set up a Restricted User Group


1. In Setup Access Control, click on the User Groups button. Click on the Add Group button.

2. Name it something like Clerk.

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Click the Ok button.

3. Use the <<Add button to add the users you want to restrict. 4. Click the Ok button.

Restrict Permissions for the Group


1. Click the User Group / Patient Group Permissions button. 2. Choose the User Group Clerk. 3. Make sure the Patient Group is All Patients. Set the Encounter Data | View permission to No.

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4. A red bar will appear just under View. 5. You may want to restrict other categories as well. 6. Click the Save Permissions button. 7. Click the Ok button.

Restrict Reports
1. In Setup Reports, select a report you want restricted, e.g. Electronic Labs Received, and click Edit/View. 2. Set the Access Rights to Patient Encounters. Click the OK button.

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3. Do the same for all reports you want to restrict. The Users in the Clerk User Group will not see the restricted reports in their list of reports. They also will not be able to access any other things, e.g. Lab Results, Allergies, etc., that you restricted.

Preventing Some Users from Accessing the Ledger


Suppose you want to prevent the people who do scheduling from accessing the ledger. How do you do it? 1. Set up a User Group for schedulers. Click on the Setup button in the top tool bar.

Click on the Access Control Tab. Click on the User Groups button. Create a User Group called Schedulers. See Adding a User Group for instructions. When you have the Schedulers group set up, use the <<Add button to assign users to it. Click the Ok button when you have added all the users.

2. Set permissions for the schedulers. Click on the User Group /Patient Group Permissions button. 26

Choose the Schedulers User Group, and the All Patients Patient Group. Scroll down to Patient Ledger, and set the View permission to No.

VersaForm will search for any User Group the User belongs to that has permission to view the Ledger before displaying it. If All Users (to which everyone belongs) has not had its permissions to the Patient Ledger changed from the default of Defer, and this User belongs only to Schedulers, then the permission will be No, and the Ledger will not be shown.

Audit Trail
The VersaForm Audit Trail keeps a record of each important action. This enables entries in the system to be traced to the user who made the entry. The audit trail may be printed as a standard report. If the system security level is set to High, only a Security Administrator can run the Audit Report.

Passwords
Each user must have a password. The requirements for the format of the password, how often a user must change passwords and the rules for re-use of previous passwords are set on the Access Control Tab of the Setup window by a Security Administrator. For a full list of possible password options that can be set, see Access Control.

27

Idle Workstation Shutdown


As a security measure, VersaForm has the ability to automatically shut down a workstation after it has been idle for a specified time interval. The time interval is specified in the CPR.INI file by the item Idle Time Before Shutdown. It is specified in seconds. Thus each workstation may have its own time interval. If the time interval is set to 0 (zero), there is no shutdown. Prior to release 3.138 the default location for the CPR.INI file was C:\Program Files\VersaForm 3.0, from 3.138 on the default location for the CPR.INI file is C:\VersaForm 3.0. Be very careful when editing the CPR.INI file.

28

The Patient Chart


Overview
Organization of the Patient Chart
The Patient Chart (see illustration below) has two parts: the Index on the left and the Tabs on the right.

The Index organizes the data by Problems and by Encounters; in the Setup window you can choose whether or not it is shown automatically. The toggles the Index off and on. The Tabs organize the patient's medical information. When the chart is first opened one of the Tabs is shown (you can choose which one). You may switch to any of the other Tabs by clicking on its Tab. Typically the Tabs have provisions for adding, removing and changing their data. (The exception.) Summary Tab is an Show Index button on the Toolbar

The Tabs are

Summary Encounters

Problems Medications

29

Allergies Labs/Data Notes Images

HIPAA History Ledger Registration

The Registration Tab has Seven Sub Tabs


Demographics Relationships Billing Info Insurance Custom Data Security Pharmacies

The Problem-Oriented Chart


The VersaForm Computer-based Patient Record provides for a fully problem-oriented medical record. Because the system keeps associations between problems and other data, it can, at any time, present the medical data in a problem oriented format. When a new problem is recorded in a patient's chart, it is automatically associated with the current encounter. Other encounters, and other data (i.e., Labs, Medications, Procedures, Allergies and Notes) may be explicitly associated with one or more problems.

Opening a Patient Chart


To Open an Existing Chart
1. Click the Open Chart button on the Toolbar. 2. Select the patient from the list. You can select the patient by double clicking on the patient's name with the left mouse button. Alternatively, click once with the left mouse button and then click on the OK button. You can use the Advanced Search button to search by any of the columns shown as well as by the claim number that is returned with an EOB. If you want to list all patients, uncheck the Active Only check box. You can set a patient to active or inactive on the Demographics Tab of the patient chart. 30

To Create and Add a New Chart


1. Click the New Patient button on the right side of the Select Patient Chart window. 2. Proceed with completing the new patient registration information. If you don't see the patient you want, use the Search or the Advanced Search buttons.

To Search
1. Enter the last name of the patient or one or more characters of it in the Find window. 2. Select a patient by double clicking on the patient's name with the left mouse button. Alternatively, click once with the left mouse button and then click on the OK button. If the patient is highlighted you can just press E n t e r .

Adding a New Chart


To Add a New Patient Chart, either
1. From the File menu select New Patient. --Or-Click the Open Chart button on the Toolbar, and then click the New Patient button. The Registration Information For A New Patient window will be displayed. 2. Enter the patient's name and any other items you want to at this time. 3. When you are done, press the Ok button. Additional information may be added or changed at any time. When a chart is created, it is automatically assigned a unique identifier (the Patient ID) to which all other data in the chart is referenced. Thus even the patient's name can be changed without losing track of the information in the chart. An External Chart # can be entered if your office currently uses them to reference the paper chart. The chart will be displayed; it is ready to use. When you are done, close the chart.

Importing a Patient from VersaForm Practice Management


If you have the VersaForm Practice Management system, you may import patients directly from it. 1. Click the Open Chart button on the Toolbar, and then click the Import from VF Practice Mgt. button.

31

2. Enter the last name of the patient or one or more characters of it in the Search window. Then click the Search button. 3. Choose the patient on the basis of name, sex, and birthdate.

Importing Patient Charts in Bulk


Patient charts may be created by importing demographics data from the VersaForm Practice Management system (MD VersaForm) or other systems. VersaForm Practice Management creates a text file which VersaForm then reads; any other text file of the same format can be read similarly.

To Import
Click the Utilities menu.

Select Import form DOS VFPM, Import one at a time, or Import all patients from file. Select the file containing the data to be imported. If you have chosen to import one at a time, you will see a window containing the names of the patients on that file. Select the patients to be imported.

If the data is exported from VersaForm Practice Management, it is placed in a file named "patients.txt", in the subdirectory "tocpr" under the VersaForm folder. If VersaForm is installed under "C:\Program Files\VersaForm 3.0", then the input file will be "C:\Program Files\VersaForm 3.0\TOCPR\patients.txt". Field Name equivalent in VersaForm Practice Management Lname Fname MI Acct#

Field

Size Field Name

Last Name First Name Middle Initial Account #

18 10 1 16

Last Name First Middle Billing ID

32

Field

Size Field Name

Field Name equivalent in VersaForm Practice Management Ad1 Ad2

Address Line 1 Address Line 2 Sex Not imported City State Zip code Home Phone Phone 2 Work Phone Guarantor ID Not imported Soc. Sec # Date of Birth Referring Phys Primary Insurance Plan

23 15 2 2 14 2 10 12 30 30 10 17 14 10 10 10

Street

Sex

Sex MD_ID

City

City St Zip

Phone

Ph

Dear SSN Date of Birth Ref Physician Plan Name (Primary Insurer) Plan Name (Secondary Insurer) Holder Name (Primary Insurer) SSN DOB Ref_by Ins1

Secondary Insurance Plan

10

Ins2

Prim Ins. Holder Last Name

18

H1_Lname

33

Field

Size Field Name

Field Name equivalent in VersaForm Practice Management H1_Fname H1_MI

Prim Ins. Holder First Name 10 Prim Ins Holder Middle Init Prim Insurance Holder ID 1 15

Holder Name

Holder ID (Primary Ins) Group Number (Primary) Relationship to Insured (Primary) Holder Name (Secondary) Holder First Name (Sec) Holder Middle Init Holder ID (Secondary) Group Number (Secondary) Relationship to Insured (Secondary)

H1_ID

Prim Ins Holder Group # Relationship of patient to primary Insurance Holder Sec. Ins Holder Last Name

19

H1_Grp#

H1_Reln

18

H2_Lname

Sec. Ins Holder First Name Sec. Ins Holder Middle Init Sec Ins Holder ID

10 1 15

H2_Fname H2_MI H2_ID

Sec Ins Holder Group #

19

H2_Grp#

Patients relationship to Sec 2 Ins Holder

H2_Reln

Sample
"ZABRISKIE","WILMA","F","WILM0003","123 MIDDLE ROAD","ADDRESS 2","F", "MW","SAN JOSE","CA",94232,"415 676-9807","415 676-9806", "415 676-9804", "BBR001", "WILMA","999-99-9999","01/02/1962","","BLUE CROSS","SAGAMORE","ZABRISKIE", "WILMA","F",88888888888,77777777777,"SE","ZABRISKIE","ZORRA","Q",55555555555,4 444444444444,"SP" 34

Closing the Chart


To close a chart, close the window that contains it. With the mouse, click the Close Chart button on the Toolbar or click the upper right corner of the window. From the keyboard, press C t r l + F 4 . icon in the

Removing a Patient Chart


If the patient has medical data already entered in the chart that has been signed, the chart cannot be removed. If this is a new, unused chart, you can use it by just filling in the information of the next new patient.

To Remove a Chart
1. Open the chart. 2. Select the 3. Select the Registration Tab. Security Tab.

4. Click on the Remove Chart button.

Printing
To Print the Current Patient's Entire Chart
From the File menu, click on Print Chart. To print data specific to a Tab, such as Encounters, appropriate Tab and click the Print button on that Tab. Labs/Data or Notes, select the

To print data for another patient, you must open that patient's chart.

To Print a Report
1. Click on the Reports button on the Toolbar. The Select Report window will open. 2. Click on the report you want to print. 3. Click on the Print button. The report will be printed on the default printer for your computer.

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Utility Printing
In many windows that display data, it is possible to get a quick printout of the data in that window. Utility printing is different from reports because the data is not formatted for a report; it is just a printout of the available data on display. Right-click on an unused portion of the window, near, but not within, a data field. If you do , try right-clicking in another location. The not get the little Save / Print menu menu may show up some distance below and to the right of where you clicked. Choose Print from the resulting menu.

36

Patient Chart Data: General


Adding a New Patient
How to Open
Click on the Open Chart button on the top Toolbar. Click on the New Patient button.

What You Will See

What Goes in Each Field


Field Name Last Name First Middle* Sex Information to Enter Patient's Last Name Patient's First Name Patient's Middle Name or Initial Patient's Sex (M for Male and F for Female and ? for Unknown) Sample Sickley Very Always M

37

Field Name Date of Birth SSN* Genetic Group*

Information to Enter Patient's Date of Birth (can type it in or use dropdown calendar) Patient's Social Security Number Patient's Genetic Group (for outgoing Labs) (note drop-down list) Whether the Patient is Hispanic (for outgoing Labs) (note drop-down list) Patient's Primary Physician in your Practice (Note drop-down list. The physician must be a Provider.)

Sample 04/02/1942 555-66-7777 Asian

Hispanic?* Primary Physician Reg Date Referring Physician* Date of Death* Title* Suffix* Dear* Active Chart External Patient #* External Chart #* Occupation*

N Marcus W Welby M.D.

Date the Registration Form was Filled in (will auto fill 08-23-2006 with today's date) The Doctor who Referred this Patient to your Office (If any. Must be listed in the Setup/Referring dialog.) Date the Patient Died Patient's Title (note drop down list - Mr. Mrs., Ms., Miss) Additional Title for Patient (Sr., Jr., III, etc.) How to Address the Patient Whether the Chart Should Show in the Select a Patient Chart List A Number that Identifies this Patient Could be a Hospital Chart Number or Nursing Home Chart Number Patient's Occupation DOT44 Mr. Sr. Mr. Sickley John J Johnson

VAS44 Clerk

38

Field Name External Billing ID* Memo*

Information to Enter Imported from MD VersaForm Acct# Field (for your chart #, shows in Select a Patient) Free Form Information of Interest Patient's Street Address (note there are two lines available) City Where Patient Lives The Initials for the State Where the Patient Lives (note drop-down list) The Patient's Zip Code Patient's Home Phone Number Phone Extension (if any) Patient's Fax Number (if any) Patient's E-Mail Address (if any) Patient's Pager Number (if any) Patient's Cell Phone Number (if any)

Sample VERT0077 Blind, lead in. 42 43rd Street Apt 465 New York NY

Street

City State (not labeled) Zip (not labeled) Phone* Extension* Fax* E-Mail* Pager* Cell*

01232 232 343 5555 44 232 343 6666 sickly@msn.net 232 343 7777 232 343 4444

* This field may be blank.

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The Completed Dialog

Other Actions
Click on the Ok button to save this new patient's registration. You will be taken to the Registration Tab for this chart. You can then fill out the Insurance, Custom Data, Security and Relationships, Billing, Pharmacy Tabs with the patient's information.

Patient Registration
To Edit Patient Registration Data
Click on the Registration Tab. Click the Tab on which you want to enter or change data. Click on the OK button when you are done. Click the Cancel button to undo any changes.

The Registration Tab has Seven Tabs


Demographics Relationships Billing Info 40 Insurance Custom Data Security

Pharmacies

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Patient Demographics
The Demographics Tab under the Registration Tab of the Patient Chart contains data about the Patient and identifies the Primary and Referring physicians. This is an important Tab and there are many fields that must be filled in.

How to Open
Open a Chart Click on the Registration Tab. Demographics Tab.

If necessary, click on the

What You Will See

What Goes in Each Field


Field Name Last Name First Information to Enter Patient's last name. Patient's first name. Sample Roe James

42

Field Name Middle* Sex

Information to Enter Patient's middle name or initial. Patient's sex - M for Male and F for Female and ? for Unknown. Patient's date of birth - can type it in or use drop-down calendar. Patient's social security number. Patient's Genetic Group (for outgoing Labs) use dropdown list Whether the Patient is Hispanic (for outgoing Labs) use drop-down list Freeform for where born. Patient's primary physician in your practice. Use dropdown list. The physician must be listed in the Setup, Provider Tab. Date the registration form was filled in - will auto fill with today's date. The doctor who referred this patient to your office - if any. Must be listed in the Date the patient died. Patient's title - use drop-down list - Mr. Mrs., Ms., Miss. Additional title for patient - like Sr., Jr., III, etc. How to address the patient. Whether the chart should show in the Select a Patient Chart window. Setup, Referring Tab.

Sample

Date of Birth SSN* Genetic Group*

12/23/1945 555-66-7777 White/Caucasian

Hispanic* Birthplace Primary Physician

? Denver, CO

Ozzie Mehan

Reg Date Referring Physician* Date of Death* Title* Suffix* Dear* Active Chart

03/21/2008

Mr. Sr. Mr. Roe

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Field Name External Patient #* External Chart #* Occupation* External Billing ID* Memo* Address

Information to Enter A number that identifies this patient. Could be a hospital chart number or nursing home chart number. Patient's Occupation. Imported from MD VersaForm Acct# field - for your chart number. A large area for free form input.

Sample DOT44

VAS44 Clerk VERT0077

Street

Patient's street address - note there are two lines available. City where patient lives. The initials for the state where the patient lives - can use drop-down list. The patient's zip code. Patient's home phone number. Phone extension - if any. Patient's fax number - if any. Patient's e-mail address - if any. Patient's pager number - if any. Patient's cell phone number - if any.

42 43rd Street Apt 465 New York NY

City St (not labeled) Zip (not labeled) Phone* Extension* Fax* E-Mail* Pager* Cell*

01232 232 343 5555

232 343 6666 roe@msn.net

* This field can be blank.

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The Completed Tab

VersaForm saves all previous names for each patient. In addition to the Home Address, VersaForm also keeps Work, Emergency, Mother and Father addresses. Select the one you wish to enter or view by using the radio buttons in the lower right corner. Each of these addresses can be copied from a patient's Home Address. VersaForm saves all previous addresses.

Other Actions
Click the OK button to save and close. Click the Cancel button to close without saving. Click the Copy Address button to copy the Home Address from some patient to the address that is currently displayed. Click the Remove Address button to remove the address that is currently displayed. Click the Prior Names button to see a list of prior names, if any. Click the Prior Addresses button to see a list of current and prior addresses, if any.

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Click the Bal button, on the right, under the title bar to see a window with the patient balance, insurance balance, credits and total due. Click anywhere in the window to remove it.

Future Appointments
A list of future appointments can be seen on the right side, Under the Help button.

Patient Relationships
The Relationships Tab of the patient's chart contains information on the Patient's employment, family and emergency contact. Most of the information on this Tab is of use to the office, but usually not necessary for billing insurance.

How to Open
Open a Chart. Click on the Click on Registration Tab.

Relationships Tab.

What You Will See

What Goes in Each Field


Field Name Employer Employee ID Information to Enter Name of patient's employer. Any ID assigned by the employer. Sample Very Expensive Clothing 8787

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Field Name Work Status Retire Date Marital Status Mother's Name Father's Name Name of Spouse Spouse SSN Spouse Occupation Spouse Wk Phone Spouse Cell Phone Emergency Contact Emergency Phone Student

Information to Enter Drop Down list available. Drop down calendar available. Drop Down List Available. Name of patient's mother. Name of patient's father. Name of patient's spouse. Social Security Number of spouse. Occupation of patient's spouse. Work phone number for the spouse. Cell phone number for the spouse. Who to contact in case of an emergency. What number to call in case of an emergency. Student status for the patient.

Sample Full time

Married Sally Sickley Samuel Sickley Sara Sickley 555-77-4587 RN 202 878 6547 202 787 5476 Sam Sickley, Jr.

202 254 8888 Non student

All of these fields may be blank.

The Completed Dialog

Other Actions
Click the OK button to save and close. 47

Click the Cancel button to close without saving.

Patient Billing Info


The Billing Info Tab under the Patient's billing information. Registration Tab of the Patient Chart contains the

This is an important Tab and there are several fields that must be filled in correctly in order to receive insurance payments.

How to Open
Open a Chart. Click on the Click on the Registration Tab. Billing Info Tab.

What You Will See

What Goes in Each Field


Field Name Information to Enter Sample

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Field Name

Information to Enter

Sample

Overrides for Insurance Plan Information The fee schedule to be used for this patient. If blank, the fee schedule for the appropriate insurance plan or, failing that, the default fee schedule will be used. Controls statements. The No automatic statements option means just that. The Delay option will show $0.00 in the payable now column when insurance is pending. The Delay option may be overridden by Statement Options. Did the patient assign benefits? blank or A, B, C, etc.

Fee Schedule

Hold Statement

Use Default

Benefits Assigned

checked

Patient Responsibility

The patient's degree of responsibilityNone, Copay, or Full. If None, the Patient Bal will always be $0 and no Copay statements will be sent. If Full, the Insurance Bal will always be $0; however, the insurance will be billed. 12 means 12% per year. Usually blank

Interest Rate

Release of Medical Information Provider has signed statement Auth for HCFA-1500 blocks 12 & 13 on file

Release On File

Patient's release of medical information.

Patient Signature Source

Whether you have signatures and for which blocks.

Bill To--Use Guarantor or Different Address, but not both. Used when there is a guarantor who is set up with his own chart and ledger. This cuts down on the number of statements sent when the guarantor is paying for 2 or more patients.

Guarantor

Usually blank

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Field Name

Information to Enter Used when there is a guarantor who is not set up with his own chart and ledger. This is done when someone other than the patient is paying. When checked, the fields for the address become visible.

Sample

Bill to Different Address

Unchecked

Additional Insurance Information Other Responsible Party Only if there is a responsible party other than the insurance subscriber to be reported on insurance claims.

Credit Card Info This information is for your records only, VersaForm does not use it for billing. Card Effective Card Termination Number Type Suffix Note The date that the card became effective. The date that the card is no longer valid. 12/10 5411 2222 3333 4444 MC 567

The card's number. Visa, MasterCard, Discover, etc. The 3 extra digits on the back of the card. For any other information you want.

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The Completed Tab

Billing Addresses
If the Patient is the person you want to send statements to, you don't need to do anything with the other addresses on this Tab. If the Patient is one of a group of patients whose statements are to be combined and sent to a Guarantor, choose the Guarantor's chart. Guarantors must have a ledger of their own. If the Patient has asked you to send statements to another person, e.g. an elderly patient's daughter, check the Bill to Different Address checkbox and fill in the information. If you check Bill to Different Address, you can click on the Edit button that appears and the Billing Address ... window will open for you to fill in.

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If you check Other Responsible Party, you can click on the Edit button that appears and the Billing Address ... window will open for you to fill in.

Patient Insurance
The Insurance Tab under the Registration Tab of the Patient Chart contains information on the Patient's current and past insurance plans.

How to Open
Open a Chart. Click on the Registration Tab.

Click on the Insurance Tab.

What You Will See

How to Add an Insurance Plan


To add an insurance plan, click on the Add button. The Insurance Plan for ... window, below, will appear.

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How to Change an Insurance Plan


To change an insurance plan click on the Edit/View button. The Insurance Plan for ... window will appear.

What Goes in Each Field


Field Name Information to Enter The position of the plan in the claims sequence - 1 for primary, 2 for secondary, etc. The largest number is 4. If this plan is not in the usual sequence (as may be the case with auto insurance or workers comp), delete the number. See Plans Without Numbers, below. Choose the insurance plan from the drop-down list. The subscriber's ID number for this plan. Checkbox. The patient's ID number for this plan. Only used if the patient is not the subscriber and has an added ID. 987654321 Sample

Number

Plan Subscriber ID Is a Person Patient ID

Wonder Insurance 123456789

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Field Name

Information to Enter The relationship of the patient TO the subscriber. If the patient is the son of the policy holder, this would be Child. If you do not choose Self for this value, more fields will become visible for information about the Subscriber.

Sample

Relationship

Child

Medicare Secondary Type

Type of Medicare secondary insurance. "Required when Medicare the destination payer is Medicare and Medicare is not the Secondary primary payer". Usually it is Other Liability Ins is Black Lung Primary. The effective dates of this plan. If both dates are blank, the plan is assumed to be always in force. If the start date is blank, the plan is assumed to be effective at any time before the end date. If the end date is blank, then the plan is assumed to be effective at any time after the start date. The patient's assigned group number. The patient's assigned group name.

Start Date/End Date

1/1/05

Group # Group Name

123456 Whatever

Overrides for Insurance Plan Information Accept Assignment Overrides the normal value in the Insurance Plan Setup. Overrides the normal value in the Insurance Plan Setup. Put 0 or the actual amount here to keep the patient balance zero until the insurance pays. Overrides the normal value in the Insurance Plan Setup. Overrides the normal value in the Insurance Plan Setup. NEVER choose Yes for a primary insurance. Normally blank.

CoPay

% Crossover Destination

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Additional Fields When the Patient is not the Subscriber

What Goes in Each Field


Field Name Information to Enter Required

Subscriber Information Last or Co. Name First The Subscriber's last name or, if it is a company, the company name. The Subscriber's first name. Yes If not a company. If not a company. If not a company. If not a company. Generally not. Generally not.

Middle

The Subscriber's middle name.

Sex

Female, Male or Unknown.

DOB SSN Employer

The Subscriber's date of birth. The Subscriber's Social Security Number. The Subscriber's employer.

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Field Name

Information to Enter

Required

Subscriber Address Street E-Mail City St (not labeled) Zip (not labeled) Country Phone Extension Fax Pager Mobile Contact Dear Department Note The Subscriber's street address - note there are two lines available. Subscriber's e-mail address - if any. Subscriber's city. The initials for the Subscriber's state - note the dropdown. The Subscriber's zip code. The Subscriber's country. Only use a 2 letter code. Subscriber's phone number. Phone extension - if any. Subscriber's fax number - if any. Subscriber's pager number - if any. Subscriber's cell phone number - if any. The person to talk to if it is a company. What should appear in the salutation on a form letter. Any necessary department heading for this subscriber. Any special note or information. Yes Generally not. Yes Yes

Yes Only if not US. Generally not. Generally not. Generally not. Generally not. Generally not. Generally not. Generally not. Generally not. Generally not.

Plans without Numbers


If you have set up an insurance plan with no Number (it is not primary, secondary, etc.), then claims will not be automatically created for that plan. A charge that is to be billed to this plan (for example, eyeglasses on a Vision plan) will still get billed to the primary insurance (assuming that the primary is set up to automatically bill). You must remember to cancel billing for the primary insurance, and bill the charge to this unnumbered plan. A good way to 56

remember to do this is to set a Reminder on the CPT code for codes that should be billed this way. See CPT4 Setup.

Removing an Insurance Plan


If an insurance plan has been used it can not be removed; however, it can be made inactive.

Replacing an Insurance Plan


To Replace the Primary Insurance Edit the old primary insurance. Fill in an End Date that is at least one day before the Start Date you will put into the new insurance. Click OK. Click Add. Type a 1 in the Number field. Enter the appropriate information for the new insurance plan. Enter a Start Date that is at least one day after the End Date in the old insurance. Click OK.

To Replace Secondary Insurances Follow the steps above for primary insurance but put a 2 , 3 or 4 in the Number field.

Patient Custom Data


The Custom Data Tab under the Registration Tab of the Patient Chart allows you to add patient data fields that are not part of the standard VersaForm patient demographics, and subsequently add values to these fields. See Patient Recall Letters for one use for Custom Data.

How to Open
Open a Chart. Click on the Click on the Registration Tab. Custom Data Tab.

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What You Will See

How to Add Data


1. Click in an empty right-hand field. 2. Type in the freeform data you want. 3. Click the Ok button to save the data.

How to Edit Data


1. Click in the right-hand field you want to modify. 2. If you want to replace what is there, just start typing. Otherwise edit the data. 3. Click the Ok button to save the changes.

How to Add a Custom Data Field


Suppose, for example, you wanted to add a Recall Date and Recall Reason to each patient record. Click the Modify button and, in the History Panel window, click the Add button. Type the name of the desired field in the entry box that appears on the screen. In our example you would type r e c a l l d a t e . Click the Add button again and type r e c a l l r e a s o n .

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Click the OK button and you will return to the Custom Data Tab with the new field displayed along with an entry box to enter the data for the current patient.

Note that this adds the custom data field for all patients.

Other Actions
Click the Move Up button to move the highlighted field up. Click the Move Down button to move the highlighted field down Click the Remove button to remove the highlighted field. Click the Cancel button to undo any changes.

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Patient Security
Related Topics
The Security Tab under the Registration Tab of the Patient Chart allows you to change the Patient's Group Memberships, view your effective permissions for this Patient and possibly remove the chart.

How to Open
Open a Chart. Click on the Click on the Registration Tab. Security Tab.

What You Will See

Patient Group Membership


By default the Patient is automatically a member of the All Patients Patient Group as well as a member of the Provider that they have been assigned to (i.e. "Patients of Dr. Small"). You can not remove the Patient from these two groups. The Select All button checks the checkboxes for all of the Patient Groups listed. The Select None button unchecks the checkboxes for all of the Patient Groups listed.

You can also select and unselect patient groups in the list by clicking on the checkbox next to the group name.

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Viewing Permissions
The View Permissions button brings up the Effective permissions for ... window for this Patient.

Removing a Chart
The Remove Chart button removes the patient's chart. If the chart contains signed data, you can make the chart inactive by unchecking Active Chart on the window. Demographics Tab and it will not show up in the Select a Patient Chart

Patient Pharmacies
The Pharmacies Tab under the Registration Tab of the Patient Chart contains a list of the patient's pharmacies. VersaForm makes use of the information in this Tab if you have the optional Electronic Prescriptions. If you have the optional Electronic Prescriptions, you will be able to search for and add new pharmacies from this Tab. If you don't have the option, you will need to first enter the Pharmacy in the Setup Facilities Tab.

How to Open
Open a Chart Click on the Click on the Registration Tab. Pharmacies Tab.

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What You Will See

If the Active Only checkbox is checked, any pharmacies that have been marked not Active in the Facilities Tab will not show in the list.

How to Add a Pharmacy


1. Click on the Add button. The Pharmacies not already used by this patient window will appear.

2. Either choose a pharmacy from the list of existing pharmacies or, if you have Electronic Prescriptions, search for a pharmacy.

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How to Delete a Pharmacy from this Patient


1. Click the Delete button. 2. Click the Yes button.

Patient Chart Data: Encounters


Related Topics
All patient data (except registration information) is associated with an encounter. An encounter is considered to be any interaction with or on the patient's behalf that adds or modifies medical data in the chart. Encounters provide the framework for billing information. You can add new encounters and remove them. You can change encounter information at will, until you sign the encounter. At that time it is considered closed. There can be several unsigned encounters in a chart at any time. Any one of them may be designated as the Open encounter. The open encounter is the one with which new data (for instance, new medications) are automatically associated. This association is shown in the index on the left side of the chart. (if one is present) next to an encounter you can see a list of all data By clicking the elements associated with that encounter.

When you open a chart, if there is an unsigned encounter with today's date, it is opened automatically. If it is older, you are asked whether to use it or start a new encounter. When you enter data, (for instance, when you begin a note) if there is no open encounter, one will be created automatically. Depending on your setup options, you can fill in the chief complaint, etc. then.

Adding an Encounter
To Add an Encounter
Click on the Add button in the Encounters Tab in the patient's chart. The Encounter Information window will be displayed; enter this data now. You may also enter Encounter Billing information now, or you can enter it later. 63

When you finish entering the encounter information this encounter will become the current open encounter. If there was a previous open encounter, it will remain unsigned.

Edit/View Encounters
To Edit an Encounter
1. Click on the Encounters Tab in the patient's chart. 2. Select the encounter you want to edit by clicking it in the list. 3. Click on the Edit/View button. The Encounter for window will open. The window has two tabs, Encounter Information and Encounter Billing. 4. Choose a Tab, and make changes to the items you want. 5. Click on the Ok button to accept the changes. If the encounter has been signed then you cannot change the data. This will be indicated by the words "(Read Only)" in the window title bar.

Encounter Information
Encounter Information Contains
Started: When the encounter was opened. Chief Complaint / Description: Any description may be typed in here. Provider: This is a drop down list of provider names within the practice. Encounter Type: This is the class of encounter for CPT coding purposes. (Certain types of encounter, for instance "Office or outpatient--established patient", have a range of CPT codes from which you must choose. The E&M Wizard uses this information to help in choosing a code. Facility: The facility where the encounter occurred. When Signed: The date the encounter was signed. Signed By: The name of the provider who signed the encounter. Associated Problems: You can choose from the list of Problems those that are associated with this encounter.

Show Active Problems or Show All Problems.

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Associating a Problem with an Encounter


To Associate a Problem with an Encounter
1. Edit the encounter. 2. Click the Encounters Tab, if necessary.

3. Choose the problems to be associated with the encounter. Once a problem has been associated with an encounter or other piece of data, it will appear in the Index. If the Index is in "By Problem" mode, the encounter will appear under each of the problems that are associated with it.

Encounter Billing
To Enter Billing Information for an Encounter
1. Click on the encounter in the button. 2. Click the Encounter Billing Tab. 3. Click on the Add button, choose the first CPT for the encounter and click on the OK button. 4. Click the drop-down arrow in the Associated ICDs column. You will see a list of all the ICD codes relating to the patient's active problems, and any ICD codes you have already chosen for this encounter. 5. Click on the ICD9 Code(s) that you want to associate with this CPT. If you want more than one from the list, hold down the C t r l key and click on each ICD code in the order that you want them listed. The order in which you select the ICD codes is important, since reimbursement may depend on it. 6. Add any other CPTs with their associated ICD codes. Now you can click on Print Superbill, E/M Wizard or just click on the Ok button. The billing information may now be exported for use by another accounting system. Encounters Tab and then click on the Edit/View

Exporting Billing Information


If you are using VersaForm Practice Management, there is no need to export billing information. VersaForm already has the needed information. 65

VersaForm writes billing information for each encounter for export to other practice management programs. It is written in HL7 format, and can be read by any practice management program, primarily for generating insurance claims and patient statements. The HL7 segments used are MSH, EVN, PID, FT1 and DG1.

Writing the Billing Information


If the billing system is NOT VersaForm Practice Management, billing information is exported using the Utilities menu. There are two options: 1. Export Billing Info. This writes all the unbilled encounters (for all providers) to the billing information file. 2. Re-Export Billing Info. The user chooses the encounters to be re-billed by highlighting them in a list of all encounters since a chosen date. Exporting billing information should be done from a single workstation. Otherwise there is a risk that billing information from different workstations will get put in different files. Billing information is written to a file whose name is chosen by the operator. The default name is in the Billing File parameter of the CPR.INI file. If the billing file exists, VersaForm appends the billing summary for each transaction to the existing file. Otherwise it automatically creates a new file. The file should be deleted by the practice management program after the information is read.

CPT Selection
CPT codes may be selected from either the practice-wide list or from a provider's frequent list.

To Search for a Particular CPT Code


1. Enter a word or a few letters in the Find box. 2. Click on the Search button. To specify search criteria in more detail, use the Advanced Search feature. To add a code to the practice-wide list, use the Add to List button. If you are in the Frequent ICDs list, it will be added there, too. To add a code to a frequent list, highlight the code on the practice-wide list, then click the Add Frequent button.

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ICD9 Selection
ICD9 codes may be selected from either the practice-wide list or from a provider's frequent list. If the list is long, entries may begin with a plus sign (+), which indicates that the entry is a heading; there are more codes "beneath" it. Double-click on the plus sign to expand the list.

To Search for a Particular ICD9 Code


1. Enter a word or a few letters in the Find box. 2. Click on the Search button. To specify search criteria in more detail, use the Advanced Search feature. To add a code to the practice-wide list, use the Add to List button. If you are in the Frequent list, it will be added there, too. To add a code to a frequent list, highlight the code on the practice-wide list, then click the Add Frequent button.

Printing an Encounter
To Print an Encounter
On the Encounters Tab of the chart 1. Select the encounter. 2. Click the Print button.

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Patient Chart Data: The Chart Index


The Problem-Oriented Chart
The VersaForm Computer-based Patient Record provides for a fully problem-oriented medical record. Because the system keeps associations between problems and other data, it can, at any time, present the medical data in a problem oriented format. When a new problem is recorded in a patient's chart, it is automatically associated with the current encounter. Other encounters, and other data (i.e., Labs, Medications, Procedures, Allergies and Notes) may be explicitly associated with one or more problems.

Index by Encounter
The Chart Index is a representation of the patient chart organized chronologically by encounter. To view the encounter related data: 1. Click on the Show Index button at the top of the screen.

2. Click on the By Encounter radio button at the top of that chart. A folder will appear for every encounter along with its date and description. 3. Double click on any of the unopened folders to see the patient data that was added during that encounter. 4. To see the data, right-click on the item you want to examine.

Index by Problem
To view data on a problem oriented basis: Click on the Show Index button at the top of the screen.

Click on the By Problem radio button at the top of the patient's chart. A list of the patient's problems will appear. Click on any of the problems to see the encounters and other data that were associated with that problem.

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ClinicalEMR
Problems
The Problems Tab of the Patient Chart
This Tab displays the patient's active and inactive problems. The associated ICD9 code and the problems' dates are also shown. A problem can be deactivated by clicking the Resolve button. This will automatically assign the current date to the Resolved On date.

To deactivate a problem with a date other than today:


1. Edit the active problem. 2. Enter the desired date in Resolved On. 3. Uncheck the Unresolved box. If the encounter in which it was entered has not been signed, a problem may be removed by clicking the Remove button.

Problems and ICD9 Codes


VersaForm has separate vocabularies for problems and for ICD9 codes. This is because many physicians feel that the ICD9 codes (which are designed for billing rather than clinical use) do not accurately describe patients' problems. To make billing easier, each problem in the problem list can be associated with an ICD9 code. The physician needs only to record the problems. When the system creates billing information for an encounter, it automatically looks up the associated ICD9 code for each of the patient's problems.

Adding a Problem
Before you can add a problem to a chart, the problem must be in the practice-wide problem list, or on your frequent list. This allows the problem vocabulary to be controlled. If you haven't set up your problem lists, see: 1. Overview of the practice-wide and frequent lists. 2. Adding problems to the problem list.

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To Add a Problem to a Chart


1. Click on the Add button on the open. Problems Tab. The Select A Problem window will

2. Select a problem from the Frequent Problems or Practice Wide Problems Tabs. If the problem is not in the Practice Wide Problems Tab, add it to the vocabulary by clicking the Add to List button. Adding a problem to a frequent list automatically adds it to the practice-wide list as well. The Problem for ... window will open with the default settings. Make any needed changes and click the OK button.

To Reactivate an Inactive Problem


1. On the Problems Tab, select the problem 2. Click on the Activate button. This adds a new active problem that has the same name and properties as the previous problem, but with a new date.

Edit/View Problems
To Edit a Problem
1. Select the problem you want to edit by clicking on that line. 2. Click on the Problems Tab in the chart.

3. Click on the Edit/View button in that Tab. If the problem has been signed then you will only be able to view the data. This will be indicated by the words "(Read Only)" in the banner following the patient name.

In This Window you can Edit


Problem Name: The text can be changed if desired to be more specific. Date Reported: This value defaults to the current date. Resolved On: The date the problem is deactivated. Checkboxes Chronic: Checked if the problem is chronic. Acute: Checked if the problem is acute. Unresolved: Checked if the problem is active. 70

Note: A place to write a note.

Associated Problems
Encounters and other data can be associated with problems. Data associated with a problem is displayed under that problem in the problem-oriented Index. When a problem is added, the encounter that is open at the time becomes automatically associated with that problem. Other data, such as medications, can also be associated with a problem, but this doesn't happen automatically. To associate data with a problem, first select the appropriate Tab, then the particular data itemfor instance, a particular medication. Edit the item. Then select the problem to be associated from the Associated Problems pane that appears at the bottom of the window. Data from encounters that have been signed can no longer be associated.

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Allergies
Adding an Allergy
To Add an Allergy
1. Click on the Add-Check Interactions or Add-Skip Check button on the Allergies Tab on the patient's chart. The Select An Allergy for ... window will open. 2. Select a reactant. Selecting a reactant for an allergy is similar to selecting a medication for a prescription with the exception that you can choose from Group, Ingredient, Medication and Non-Standard Allergies. 3. Click the OK button and the Allergy for ... window will open.

4. Check the boxes that correspond to the patient's Symptoms/Reactions and then click the Ok button.

Edit/View Allergies
To Edit an Allergy
1. Click on the Allergies Tab in the patent's chart. 72

2. Select the allergy you want to edit by clicking on that line. 3. Click on the Edit/View button. 4. The Allergy for ... window will open. 5. Make changes to the items you want. 6. Click on the Ok button to accept the changes when you are done. If the data has been signed then you may not change it. This will be indicated by the words "(Read Only)" in the banner following the patient name.

The Edit/View Allergies Window has the Following Data


Reactant: Name selected from the practice wide list of allergies. Started: Date allergy first reported. Defaults to the current date. Stopped: Date allergy was deactivated. Symptoms / Reactions (check one or more of the following) Skin Rashes Shock Asthma Nausea Anemia Other Symptoms

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Labs and Data


Labs/Data
If you are using Electronic Labs, see Setting up Electronic Labs. Labs and other data may be grouped as panels or ordered individually. A panel is simply a group of lab tests or other data items. After results have been entered, they may be displayed on a flowsheet and, in turn, the flowsheet may be graphed. Any group of data items may be set up as a panel and recorded, whether they are measured by a laboratory or not. For instance, during a pregnancy it is usual to record, at intervals, such items as fundal height, fetal heart tones, presentation, etc. These items can usefully be organized as a data panel, and then can be viewed as a flowsheet which shows the progress of the pregnancy.

The Labs/Data Tab has the Following Functions


Add Panel: Adds an order for a lab or data panel to the patient's chart. Remove: Removes all the results for a panel (if there is no data). Edit/View: Allows the user to edit and/or view lab results for a single panel. Detailed List: Use this button display a list of panels and tests for the patient. The list may be sorted by panel, test, facility, order date, due date, reviewed or specimen id. There is also a Filter button in the detailed list which allows you to only select labs for the criteria specified. You may filter on panels, tests, facilities, only completed, order date, due date, reviewed date, specimen id, only final results, only abnormal flags, only electronic labs, only sent to electronic labs and/or only received from electronic labs. The Reset Filter button on the filter screen clears all the filter criteria. The Apply Filter will show a detailed list of only labs which satisfy all the criteria specified. If the list is filtered, the heading will indicate the filter specified. Flowsheet: Displays a predefined set of lab results or other data items in a flowsheet format. Flowsheets can be printed or graphed. Growth Charts: The user can chart Weight for age, Stature for age, Weight for stature, or Body mass index for age for patients between 2 and 20 years old, or Weight for age, Length for age, Weight for length, or Head Circumference for age for infants. Add Vitals: Adds a lab panel for vitals. Print: Offers printing of a lab order, results of the lab/test, or a history. Recall: Brings up the recall letter for the patient. 74

Show Vitals: This radio button allows inclusion/exclusion of the special Vitals panel to the list.

Vitals
Vitals are treated as a special type of lab panel, thus they can be displayed on flowsheets and graphs just as any other lab panel. A vitals flowsheet is built into the system. On the Labs/Data Tab, use the Show Vitals radio button to list (or not to list) vitals along with the other lab panels. A special window at the top of the chart makes entry of vitals easy, and keeps them in view.

To enter vitals, click the New button on the Vitals window and enter the values.

Adding a Lab
To Add a New Lab
1. Click on the Add Panel button on the Labs/Data Tab of the patient's chart. A list of lab panels or individual tests will be displayed.

2. Select a line in the list of lab panels. The Data Panel for ... window will display.

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3. Select any of the patient's problems that are related to this lab panel. When you print a lab order, these ICD-9s will be included. 4. If this is an order for a lab panel, click the Ok button (WITHOUT entering any data). The ordered lab will appear in the patient's list of pending labs. 5. If the lab test or panel has been completed and you will not be receiving electronic lab data, enter the results. 6. You can print the standard Panel Instructions or Panel Prompt. 7. You can also create Patient Instructions, Patient Comments and Test Comments. 8. Click the Ok button.

Edit/View Labs
To Edit Lab Results
1. Click on the Labs/Data Tab in the patient's chart. 2. Select the panel you want to edit by clicking on that line. 3. Click on the Edit/View button. 76

The Data Panel for ... window will open. It has three sections; the first describes the panel, the second the individual tests and the third the Associated Problems. 4. Enter test results in the Data Value column of the Lab Tests section. You may enter the Low Norm and High Norm values also. 5. Click on the Ok button when you are done. If the lab has been signed you may not change the data. This will be indicated by the data values having grayed out backgrounds.

The Data Panel Section Contains the Following Values


Facility: The name of the lab to send the test to or that sent the results. Send Lab Electronically: Whether the lab requisition is being sent electronically. Lab Billing Option: Whether the lab should bill the patient, the patient's insurance or the Practice. Specimen ID Sample Date: The date the sample was taken. Sample Volume: The size of the sample. Units: The units of the volume, e.g., grams. Source Fasting: Whether the patient was fasting when the sample was taken. Relevant Info: Any other relevant information for the lab. Lab Accession Number: Will be filled in by the lab that sent the results. Ordered On: The date the lab was ordered. Lab Due: The date the lab is due. Reviewed: The date that the lab was reviewed. Complete: If checked, the lab is complete.

The Test Section Contains the Following Values


Test Name Data Value: The resultant value. Flags: 'H' if the value is high, 'L' if it is low. 77

Low Norm: Low Normal value. High Norm: High Normal value. Units: The units of the Data Value, e.g., mg/dl. Test State: Currently just 'F' for final. Results Comments: Comments from the lab.

The Associated Problems Section Contains the Following Values


Problem Name: Filled in from the ICD9 Started Stopped Show Active or Show All Only Show Tests With Data: Click this to remove tests that don't have associated data. Problems Tab.

Electronic lab: Creating Electronic Lab Orders


As an optional feature, VersaForm can both send lab orders TO and receive lab results FROM an electronic lab (called round-trip labs). Before creating lab orders, you must complete the steps shown for round-trip labs in Setting up Electronic Labs. Lab orders are placed in the \LabOrders subfolder of the Lab Folder you specified when setting up the electronic lab facility. The transmission of lab data to the lab happens outside of VersaForm. The process of transmission belongs to the individual lab and they will normally set up the programs and procedures necessary to automatically take lab orders from your system and deposit lab results on your system. VersaForm technical support is happy to assist the lab in setting up this process but the primary responsibility for this procedure rests with the lab.

Creating a Lab Order


Lab orders are created when you assign a lab to a patient. Open a patient chart and click on the Labs/Data Tab. Click the Add Panel button. If the system parameter Allow Lab Without Encounter = No and there is not an open encounter, you will be asked to create an encounter. If there are any problems associated with the encounter used for this lab order and they have ICD9 codes associated with them, then these ICD9s will be included in the information 78

sent to the electronic lab. You must specify the problems in the encounter before you create the lab order. Many insurance companies require you to specify the ICD9 codes appropriate to the lab being requested. If you want vitals to be included in the lab order, you must add vitals (for today) to this patient before you create the lab orders. Next you will see a list of all lab panels. Select the lab panel desired. In order to send an electronic lab order, the panel you select must have a mapping set up between this VersaForm panel and the panel information for the facility you select to receive the lab order. (See Setting up Electronic Lab Panels for more information.) The system parameter Lab Panel Show Prompt on Add is used to decide if the prompt for panels should pop up at this time. If there is no prompt defined for this panel, then the system parameter is ignored and nothing pops up. If the panel prompt does pop up it may be printed at this time. Press the Done button when finished viewing the prompt. Your screen at this point will look like:

Follow These Steps to Create the Lab Order


1. Select the correct electronic lab from the Facility drop-down list. 2. Check the box labeled Send Lab Electronically . If you selected a facility that is not an electronic lab, you will get an error when you check this box. 3. Choose the billing option using the Lab Billing Option drop-down list, either Insurance, Patient or Practice. If you do not choose an option, the default specified in the system parameter Labs Billing Default will be used to determine the billing option.

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4. Anything you enter into the Sample Volume, Units, Source, Fasting, or Relevant Info areas of the dialog will be included in the electronic lab order. 5. Information entered by pressing the Patient Instructions or Patient Comments buttons will not be sent to the lab. 6. The Sample Date and Ordered On date will default to today but you may change these dates if desired. There is no default for the Lab Due date but it may be specified in this dialog. 7. The Reviewed button should be clicked and the Complete checkbox should be checked only after the lab results have been received and the Provider has reviewed them and determined that the lab is complete. They should not be checked when creating a lab order because the lab results are not known at that time. 8. There are three ways to specify Specimen ID: Enter a Specimen ID in the dialog Press the Unique Specimen button. A unique ID will be inserted in the dialog for you. Press the Same Specimen button. You will be presented with a list of all of the specimen IDs previously used for this patient. When you select an item from this list, the dialog will be filled with the same information for specimen ID, sample date, sample volume, units, source, fasting and relevant information. This will ensure that the information sent to the electronic lab for the same specimen is the same on all lab orders for that specimen.

9. The dialog will show a list of lab tests for the panel in the lower section of the dialog. Do not enter data in this area if you are expecting electronic lab results for this lab order. The test list is an indication of the tests expected from the electronic lab when the lab results are processed. If you are not expecting an electronic response, these values may be entered manually. Once you receive electronic lab results for a lab order you may not modify the information in the lab test section of the dialog. 10. Click the Ok button. A lab order file will be created in the \LabOrders subfolder of the Lab Folder you specified during facilities setup. 11. For electronic lab orders, the system parameter Electlab Autoprint Requisition is used to determine if the requisition for this lab is automatically printed at this point. You can also print the requisition by editing the entry and clicking the Requisition Report button, then right click on the report and choose the Print option. 12. The Electronic Lab Manifest report displays information for all lab orders for a specific electronic lab which were created within the dates specified. It is listed under

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"Clinical" reports. This report is required by some electronic labs and can be printed and sent to the lab with the lab samples when the samples are picked up.

Other Actions
Click on the Panel Instructions button to see general instructions, if any, for this panel. Click on the Panel Prompt button to see the general prompt, if any, for this panel. Click on the Patient Instructions button to enter or view specific instructions for this patient for this panel.

Click on the Patient Comments button to enter or view specific comments for this patient for this panel.

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Select a test from the list of tests for this patient for this panel and click on the Test Comments button to enter or view specific comments for this test for this patient for this panel.

Electronic lab: Processing Electronic Lab Results


As an optional feature, VersaForm can process lab results received from a lab (called oneway or inbound labs) or both send lab orders TO and receive lab results FROM an electronic lab (called round-trip labs). The setup and use of electronic labs depend on which of these features you have installed on your system. Before processing lab results, you must complete the steps shown in the section Setting up Electronic Labs. Lab results should be placed in the Lab folder you specified during setup. The receipt of lab data into the main lab folder happens outside of VersaForm. The process of transmission belongs to the individual lab and they will normally set up the programs and procedures necessary to automatically take lab orders from your system and deposit lab results on your system. VersaForm technical support is happy to assist the lab in setting up this process but the primary responsibility for this procedure rests with the lab.

Reading and Processing Lab Results


To begin the process, click on the Electronic Labs menu item (at the top of the screen) and choose the Import ElectLab Results item from the drop-down list.

Click the Begin button. 82

If you have more than one active electronic lab facility you will see the Search Result window.

Click on the lab whose results you want to read and click the OK button. If there are no files in the folder, you will get an error message. If a single lab result exists, processing will begin. If more than one lab result exists, you will see:

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If you click the Process All Files button, all labs will be processed. Clicking the Process One File button will show a window that allows you to select the file to be processed:

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Highlight the file you want and click the Open button. Lab processing will begin. If the lab results cannot be matched to a VersaForm patient, you will be asked to select the patient. The selection window looks like:

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The selection dialog shows the closest patient matches that could be found. You can select a patient from the list or click the New Patient button to add a patient. Obviously, care must be taken to ensure that the lab data is assigned to the correct patient. If the exact Panel name does not already exist in VersaForm, you will be prompted:

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You will need to decide which action to take. As each lab result is processed, it is moved to either the \LabResultsProcessed subfolder if no errors were encountered, or to the \LabResultsErrors subfolder if errors were encountered during processing. This should prevent you from attempting to process the same lab results file more than once. If you chose to process one file, when VersaForm has finished processing it, you can click the Begin button again to process another file or the rest of the files.

Which Patients Received Lab Data?


VersaForm provides you with a report so you can see which patients received lab data. Click on the Reports button on the Toolbar, expand Clinical and choose the Electronic Labs Received report. You can specify the date range that interests you and each patient will be listed along with the name of the lab panel they received. The report looks like this:

Matching Lab Results to VersaForm Lab Orders


When VersaForm receives a lab results file, it may be the result of a VersaForm lab order request (round-trip lab) or it may be a one-way lab result. If it is from a round-trip lab order, 87

VersaForm assigns an identifier to the order that should be returned in the result so matching the result to the request is a fairly straightforward matter. Matching results to requests for one-way results is another matter. The lab order may not exist, the patient name may be spelled differently, and the names of the lab panel and tests associated with the panel may not match. VersaForm takes great care (sometimes with your assistance) to match the lab data with the correct patient. In addition VersaForm tries to find an outstanding lab order by checking to see if the patient has an outstanding order for this result. To match an existing order: 1. The patient name must be correct. 2. The panel name must be the same. 3. If the lab order is assigned to a lab, it must be assigned to the lab providing the result. 4. The lab order must be marked Valid. 5. There must not be any data already entered for the result. 6. The lab order must not be marked complete. 7. The lab order date must be within 30 days of receipt of the result. 8. The results must not have been used previously. If the lab result matches multiple orders, you will be asked which one should be used. If the result cannot be matched to an existing order, VersaForm will add a lab order for the patient and match the results to the newly created order. Results that contain tests other than those currently defined in your system will cause the additional tests to be added to the existing panels.

Panel Names and Round-Trip Labs


Because results matching is done with a lab order identifier, round-trip labs do not require that the VersaForm panel name match the lab panel name. The panels are matched internally by VersaForm. There still are some restrictions on the use of panel names including: 1. VersaForm panel names must be unique. 2. Only one VersaForm panel may be mapped to an electronic lab panel. Unfortunately, some labs use panel names for more than one battery of tests. If you need to use an electronic lab panel which does not have a unique electronic lab panel name (e.g., Opiates with lab panel id 123 and Opiates with lab panel id 456) you must create two different VersaForm panels. In this case, you could create VersaForm panel "Opiates-123" and a different VersaForm panel "Opiates-456". You could then use the VersaForm 88

Electronic Lab Panel screen to map VersaForm "Opiates-123" to electronic lab panel id 123 with lab panel name Opiates and map VersaForm "Opiates-456" to electronic lab panel id 456 with lab panel name Opiates.

Electronic lab: Importing Lab Results Overview


The Lab Results feature allows you to receive lab results data generated by a lab for your patients. Lab results are read using the Electronic Labs, Import ElectLab Results option in the menu bar. When a result is read, an optional feature sends a notification message to a selected User that a lab result has arrived. This would normally be the patients Primary Physician but you can choose a different user to receive the message. In addition, you can elect to have a high-priority message sent if the lab results show an abnormal result. The message options for lab results are set using the Preferences Tab in the Setup window. VersaForm currently supports receiving lab results from Bio-Reference, LabCorp, Quest Diagnostics, Enzo Clinical Labs, and TCL. Only final results for lab data are supported. The data to be imported must use the HL7 (Health Level Seven) format for medical data interchange. While the HL7 specification sets the standard for the format and content of the data to be received, different labs have used different interpretations of the standard and, consequently, VersaForm supports several different data format/content combinations. (See Format of HL7 Lab Results Data and Format of HL7 Lab Order Data for technical specifications.)

Setup for Electronic Lab Results


Before reading Lab Results, you must establish a facility that contains the customer ID assigned to you by the lab. To do this, go to Setup, Facilities and add a facility for each of the labs you are using. Under the section Electronic Lab Data Information, choose the appropriate lab from the pull-down list and enter your customer ID (sometimes called the submitter ID) in the Customer ID (Submitter ID) field. See Setting up Electronic Labs for more on how to set up electronic labs. You should also choose the options for sending messages when labs are received. To set the message options, go to Setup Preferences and choose the message options that you prefer in the When an electronic lab is received: section.

Processing Lab Results from an Electronic Lab


Electronic lab results files (sent from the lab) must be put in the electronic lab folder specified by your practice in order to be processed by VersaForm. If you have more than one electronic lab facility, you will be prompted to specify the facility. If there is only one file in the lab's folder, VersaForm will process it. If there are multiple files in the folder, VersaForm will ask if you want to process ALL of them or select a single file. If you specify a single file, then VersaForm will process the file you select. If you specify process ALL, it will loop thru all the files in the folder and process them one at a time. At the end of the loop it 89

will indicate how many files were processed successfully and how many files had errors. In either case, processed files are moved to the appropriate subfolder \LabResultsProcessed or \LabResultsErrors. (See Processing Electronic Lab Results for more information.)

Deleting Electronic Labs for a Patient


Open a patient chart and go to the Labs/Data Tab. Select the lab you want to delete and press the Remove button. If the lab results were received electronically, you will get a message that says "These lab results were received from the lab electronically. Do you want to remove it from the list?" If you say yes, the lab will not be deleted, but it will be marked invalid but it will no longer show in the list. See Mapping Lab Results to VersaForm Labs below.

Mapping Lab Results to VersaForm Labs


When VersaForm processes an electronic lab result file it moves the file to the proper subfolder (depending on whether it was processed successfully or with errors). The date and time the file was processed is pre-pended to the file name to ensure that the file name is unique. When VersaForm processes an electronic lab results file, it may be the result of a VersaForm lab order request (round-trip lab) in which case there should already be a lab in the VersaForm data base for it, or it may be a one-way lab which means there may or may not already be a lab in the VersaForm data base for it. If it is a round-trip lab, then OBR.3.1 should be the VersaForm lab id for that lab. VersaForm makes sure the VersaForm lab is for the same patient, same panel, same electronic lab facility (or facility is null), lab is not complete, lab is not used for other lab results, lab order date is within 30 days, there is no data for this lab and lab is valid. If so, VersaForm will update that lab. If a lab with this lab id exists but it has been marked invalid (because someone deleted it) then you have the option of using the invalid lab or creating a new lab. If you use the invalid lab, it will be marked valid if the lab result is successfully processed. If OBR.3.1 was not a VersaForm lab id that satisfied the criteria described above then VersaForm checks to see if there are any VersaForm labs that satisfy the criteria. If there is only one, then VersaForm updates it. If there is more than one, you will be asked if one of them should be used or if a new lab should be inserted. If there are no labs that satisfy the criteria above, VersaForm inserts a new lab. The reports Electronic Labs Received and HL7 Lab Results may be used to see lab results. Note: As of March 2008, only final lab results are accepted by VersaForm. Intermediate results will not be processed.

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Labs, Graphing Results


Selecting Tests to Graph
To graph tests: 1. Display the flowsheet that has the tests you want to graph. 2. To include a particular test, check the box in the Graph column associated with that test name. 3. Click on the Graph button. Up to three tests can be graphed at the same time.

Graphing a Test and Its Normals


Normals for one of the tests may be included on a graph. To do so: 1. Make sure the column titled Norms in the left section of the flowsheet window is visible. 2. Check the box in the Norms column associated with that test name. 3. Click on the Graph button.

Changing the Values to be Graphed


If you want to see different tests graphed. 1. Make sure the flowsheet and graph windows are both visible. 2. Select the new tests to graph in the flowsheet window. 3. Click on the Refresh button in the graph window.

Changing the Number of Columns Displayed


1. You can change the value in Start in the graph window to see other columns graphed. 2. You can change the value in Columns in the graph window to change the number of columns graphed. 3. Click on the Refresh button in the graph window whenever necessary.

Changing the Graph Style


Graph Type: You may choose either a line or bar graph. X-Axis: Either the date or time the sample was taken or the column number on the flowsheet may be shown on the X axis. Note: The graph displays only one dependent value 91

for each X-axis value. Thus if you choose date for the X-axis, only one value is displayed for each day, even if you have several. In this case, choose time or columns for the X-axis.

Flowsheets of Lab Results


To Display, Graph or Print Lab Results
1. Click the Flowsheet button on the Labs/Data tab of the patients chart. You will see the Select Flowsheet window with a list of flowsheets. Each displays a particular set of lab data. 2. Select the flowsheet desired and click the OK button. A window with a flowsheet of lab results will display for this patient.

The Window has the Following Functions


Graph: Displays lab results and normals as a graph. Print: Prints the flowsheet in portrait mode (8.5x 11). Print Landscape: prints the flowsheet in landscape mode (11x8.5) Up to 99 columns of test results can be viewed. You may scroll and resize the flowsheet window by dragging the lower right corner of the window.

Growth Charts
Growth charts consist of a series of percentile curves that illustrate the distribution of selected body measurements in U.S. children. The patient's own measurements (as recorded in the Vitals panel or in a Head Circumference data item) are plotted against this data.

To View the Growth Chart for a Patient


1. On the Labs/Data Tab, click the Growth Charts button. 2. Choose the desired chart for children or Infants:

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The growth charts consist of 16 charts (8 for boys and 8 for girls). The individual growth charts have the grids aligned to English units (lb, in).

The Individual Charts Include the Following


Infants, Birth to 36 Months
1. Weight-for-age 2. Length-for-age 3. Weight-for-length 4. Head circumference-for-age

Children and Adolescents, 2 to 20 Years


5. Weight-for-age 6. Stature-for-age 7. Body mass index-for-age

Preschoolers, 2 to 5 Years
8. Weight-for-stature

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Data for the growth charts is taken from the CDC Growth Charts at http://www.cdc.gov/growthcharts/.

Recalls, Labs and Studies Due


It is often necessary to establish a due date for a lab, study, test or treatment, and to track whether the event has in fact occurred. For instance, a patient may be advised to have a particular test each year. To track these events, simply enter them as tests in the Labs/Data Tab. For instance, if your practice tracks mammograms, set up mammogram as a Lab/Data test. Then, when a patient is advised to have a mammogram, order that item for the expected date (perhaps a year in advance). When the mammogram occurs, record the result. If the mammogram has not occurred when the due date approaches, it will be noted on the Labs/Data Due report and the practice can take the appropriate action. The Labs/Data Due report should be run on a scheduled basis.

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Medications
Medications and Prescriptions
The Medications Tab has the Following Functions
Add-Check Interactions: Adds a new medication to the patient's list of active medications and checks for interactions. Add-Skip Check: Adds a new medication to the patient's list of active medications. Remove: Removes a medication that has not been signed. Edit/View: Allows the User to edit and/or view an active medication or view an expired one. Refill: Records a refill order of an active medication. Once a medication expires, a new prescription must be issued. Discontinue: Records the fact that a medication has been discontinued. Print Rx: Prints a prescription. The printer should contain the correct size paper. The heading printed will contain the address of the practice, unless a separate address has been entered for the prescribing provider (see below). Print Preview Rx: Previews a prescription before printing.

The following buttons work only with electronic prescriptions:


Send Electronically Refresh e-Status Invalidate Rx Monograph Handout

To make prescribing easy, information about a medication has three sources:


The medications vocabulary (the Frequent list or the Practice-Wide list) has the name and characteristics of the medication. The sig list contains default dispensing information. Optionally, you can have a template that supplies a particular sig and dispensing information. 95

Whose Name Goes on the Prescription?


If a Provider is entered in the By field of the medication edit window, he or she is assumed to be the prescribing provider, and the prescription is printed with his or her information. If the By field is not filled in, the Provider who is connected with the encounter in which the medication is added is assumed to be the prescribing provider. This is usually the patient's Primary Provider.

Adding a Medication for a Patient


To Add a New Medication and Check Interactions
1. Click on the Add-Check Interactions button on the patient's chart. The Choose a Medication window will open. 2. Select a medication from the list of frequently prescribed medications, or from the practice-wide list. You can add a medication to the list, too. 3. If the drug has any interactions with previous medications or if the name of the medication matches any allergies you have entered, you will see a message. Warning: Medication-allergy checking only works if the names match exactly. 4. If you want to use the drug, click on the Use this drug button; if you don't, click on the Do not use this drug button. 5. If you clicked the Use this drug button, the Edit/View Medication window will open, permitting you to edit the Medication and Dispensing data. Medications Tab on the

To Add a New Medication without Checking Interactions


1. Click on the Add-Skip Check button on the The Choose a Medication window will open. 2. Select a medication from the list of frequently prescribed medications, or from the practice-wide list. 3. Click the OK button. The Edit/View Medication window will open, permitting you to edit the Medication and Dispensing data. If you have a previously created prescription template for the medication, choose the one you want, and click the OK button. Otherwise: 1. Select a Sig, or enter a new one. 96 Medications Tab on the patient's chart.

2. Fill in Note to Pharmacist and External Rx by, if necessary. 3. Fill in Quantity, Refills and Stop Date. 4. Check the Allow Substitutes, if applicable. 5. If you plan to use this prescription frequently, create a prescription template by clicking on the Create Template button. 6. You can Print RX & Save or Submit Electronic Rx, if appropriate. 7. If necessary, click the OK button when you are done.

Prescription Templates
Prescription templates enable you to prescribe quickly, with minimum effort. If you have defined a template for a medication, then when you choose that medication, the template will automatically be used. If you have several templates, then the one with the lowest quantity will be used as default.

You Can Create a Template from any Prescription


1. Choose the medication. 2. Enter a Sig, Quantity, Refills and Allow Substitutes. 3. Click the Create Template button.

Edit/View Medications
To Edit a Medication
1. Click on the Medications Tab on the patient's chart. 2. Select the medication you want to edit. 3. Click on the Edit/View button. The Edit/View Medications window will open. 4. Change the items you want. 5. Click on the Ok button when you are done to accept the changes. If you are using the NewCrop medication and allergy interaction checking feature of VersaForm, you cannot modify medication information that is supplied by NewCrop.

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The Edit/View Medication Window


The Following are in the Edit/View Medication Window
Prescription Template Note: If available, defaults to the template with the lowest medication quantity

Medication Data
Medication: (read only) SIG: Autofilled if a template is selected. Prescribed: Autofilled with today's date and time, or you can fill in a date. By: Which Provider. Note to Pharmacist: For electronic prescriptions. Reason Discontinued: Why the medication was discontinued. External Rx by: If not by this practice, who prescribed it?

Dispensing Data
Quantity: Autofilled if a template is selected, or fill in a number. Refills: Defaults to None, or fill in a number. Start Date: Autofilled with today's date and time, or you can fill in a date. Stop Date: You can fill in a date. Allow Substitutes: Autofilled if a template is selected, or check it or not.

Electronic Prescription
Pharmacy Transmit Method Submitted Last Status Check Transaction ID Status

Associated Problems
This area shows a list of Problem Names, their associated ICD9s, Started date and Stopped date. You have the option of seeing only the active problems or all problems. 98

The Edit/View Medications Window has the Following Functions


Ok: Closes the window and accepts the changes made. Cancel: Closes the window and rejects the changes made. Don't Use Template: Clears the prescription template information. Create Template: Creates a template for future prescriptions using the values entered here. Remove Template: Deletes the template in use. Print RX & Save: Prints the prescription, saves any changes and closes. Print Preview RX: Shows what the prescription would look like. Submit Electronic Rx: Send the prescription electronically.

Medicine and Allergy Interaction Checking


As an optional feature, VersaForm can check and display potentially harmful interactions between medications and between medications and allergies. This interaction checking is done dynamically, over the Internet, whenever you add a medication or allergy to a patient's record. Because this is the case, you must have a high-speed Internet connection available to each VersaForm station using this feature. VersaForm uses the services of NewCrop LLC to perform the interaction check. When you add this feature to your system, you will be given instructions on downloading and running a special setup program that will add the NewCrop medicines and allergies to your system. Over 30,000 medications and over 11,000 allergies will be available for you to choose from.

VersaForm Setup
After running the NewCrop setup program, you must enter two values in the VersaForm Setup screen before using this feature. On the Setup Medications Tab, click the NewCrop Setup button. Enter the values given to you for the fields Account ID and Site ID.

VersaForm Medications Conversion


Because drug and allergy interaction checking can be done only on medications that are in NewCrop format, you may want to convert existing VersaForm medications to NewCrop form. On the same setup screen you used to enter the Account ID and Site ID, you will see two data conversion buttons, Convert All Drugs to NewCrop Form and Convert In-use Drugs to NewCrop Form. You should, at a minimum, convert in-use medications (those that have been assigned to a patient) to NewCrop Form. The system will display a list of NewCrop medications that are potentially equivalent to the VersaForm medication and you will be asked to select the equivalent NewCrop medication. Obviously, care must be taken during this process to ensure that the correct NewCrop medication is selected. 99

Dynamic Checking
Each time you add a NewCrop medication to a patient record, VersaForm will: Check the NewCrop system to ensure you are using the latest drug information. The medication might, for example, have been replaced or removed from use. If the drug is not current, you will receive a message, the drug data will be updated in the VersaForm database, and you will be asked to select a different drug. Check the medication for interactions with all other NewCrop drugs assigned to the patient. Check the medication for interactions with all NewCrop allergies assigned to the patient

Each time you add a NewCrop allergy to a patient record, VersaForm will check the allergy for interactions with all other NewCrop drugs assigned to the patient.

Non-Standard Medications and Allergies


To facilitate special drug and allergy needs, such as a physician who compounds custom medications, you are allowed to keep medications and allergies in the system that are not in NewCrop format. These are called Non-Standard drugs and allergies by VersaForm. Please keep in mind that interaction checking cannot be performed on Non-Standard drugs or allergies.

Electronic Prescriptions
As an optional feature, VersaForm can electronically send your prescriptions to a pharmacy. This transmission is done dynamically, over the Internet, whenever you select a prescription to be sent electronically. Because this is the case, you must have a high-speed Internet connection available to each VersaForm station that will be sending prescriptions. VersaForm uses the services of NewCrop LLC to send the prescription. In some cases, NewCrop processes the prescription (prescriptions that are sent via FAX) or NewCrop may use the SureScripts Electronic Prescribing Network to directly send the prescription to the receiving pharmacy. Whether the prescription is sent directly or by FAX depends on several things, including the receiving capabilities of the pharmacy. When you add this feature to your system, you will be given instructions on downloading and running a special setup program that will add the NewCrop medicines and allergies to your system. Over 30,000 medications and over 11,000 allergies will be available for you to choose from. In addition, you will be able to select from over 30,000 pharmacies in the United States who accept either FAX or direct prescriptions.

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VersaForm NewCrop Setup


After running the NewCrop setup program, you must enter two values in the VersaForm Setup screen before using this feature. On the Setup Medications Tab, click the NewCrop Setup button. Enter the values given to you for the fields Account ID and Site ID.

Requirements for Using Electronic Prescriptions


Before you can send an electronic prescription, the following items must be done: 1. The NewCrop Setup (shown above) must be completed. Because electronic prescriptions can be sent only for medications that are in the NewCrop format, you may want to convert existing VersaForm medications to NewCrop format. On the same setup screen you used to enter the Account ID and Site ID, you will see two data conversion buttons, Convert All Drugs to NewCrop Form and Convert In-use Drugs to NewCrop Form. You should, at a minimum, convert in-use medications (those that have been assigned to a patient) to NewCrop Form. The system will display a list of NewCrop medications that are potentially equivalent to the VersaForm medication and you will be asked to select the equivalent NewCrop medication. Obviously, great care must be taken during this process to ensure that the correct NewCrop medication is selected. 2. Providers who write prescriptions must be registered. Providers are registered (and charged) based on a provider/facility pair. That is, if a provider writes prescriptions for two different locations (such as a main office and a nursing home) the provider must be registered twice. In VersaForm, you must first be a User before you can be a Provider so you may need to add a second user/provider before you can register a second time. To register a provider:

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The Provider must have an assigned Facility. Providers not specifically assigned to a facility are associated with the Primary Facility. Go to Setup Providers, highlight the provider and click on the Edit/View button. Then use the Facility pull down list to select the correct facility.

Be sure the provider has both a current valid DEA Number and Medical Lic. No. with the associated State. Then click on the OK button. Click the Register button on the Provider Setup Tab. If this is the first provider registered, you will be asked to accept the NewCrop Electronic Prescription License Agreement. The next screen shows the registration status. It usually takes two working days for a registration to be completed. You can check the registration status at any time by using the Check Status button on this dialog.

3. Select pharmacies. Pharmacies you use are added as VersaForm Facilities. There are three ways you can add a pharmacy to the system: Use the Pharmacy Search button of the Setup Facilities dialog. Adding pharmacies using this method adds the pharmacy to the VersaForm list of pharmacies but does not assign a pharmacy to a patient.

Open a patient chart, click the Registration Tab and then click the Pharmacies Tab and the Add button. You can assign a pharmacy from the list of VersaForm pharmacies or you can find a new pharmacy by using the Search For Pharmacies button. If you use the Search For Pharmacies button to select a pharmacy, the pharmacy selected will be added to VersaForm and assigned to this patient. After you have assigned a medication to a patient, the Send Electronically button will ask you to select a pharmacy from the pharmacies assigned to the patient. You may also use the Search For Pharmacies button on this dialog to add a different pharmacy.

To Successfully Send an Electronic Prescription


Electronic prescriptions are sent using the Send Electronically button shown in the Medications Tab in a patient chart. Keep these items in mind when you send electronic prescriptions: 1. The prescriber must be a registered Provider. 2. You must be using a drug in NewCrop format. 3. You can not send NewCrop DEA classcode 4 or 5 drugs. However, you can fax prescriptions for scheduled drugs. 4. The patient record must contain complete information, such as first and last name, DOB, home address and home phone number. If the patient record does not contain complete information, the prescription cannot be sent. 102

Checking on Prescription Status


The status of an electronic prescription is shown in the bottom pane of the Medications Tab in a patient chart. You can update the status at any time by selecting a prescription and pressing the Refresh e-Status button. You can check the status for electronic prescriptions, regardless of the patient, by clicking on the Electronic Rx menu item (near the top of the VersaForm screen) and select the Rx Status item from the list.

You can refresh any item from the list shown. To print the list, right click on an empty spot in the display area and select Print. It is important to remember that VersaForm can only tell if a prescription has been successfully sent or not. VersaForm has no way to know if or when the pharmacy filled the prescription or if the patient has received the medication.

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Histories
The History Tab of the Patient Chart
The History Tab displays the patient's Past Medical History, Family Medical History, and Social and Behavioral History. Additional history panels are present in specialized systems, for instance, the Ob/Gyn version contains Ob History and Gyn History. You can add additional history panels if you wish. (See Adding or Changing a History Panel.) The History Tab can display up to 6 panes at once. If there are more than 6 history panels, the panes will scroll. To add information to a history pane click the New or Edit button next to the window.

Histories in Notes
Any history panel can be displayed or edited while writing a notethe template functions View_History and View_Choose_History can pop up any history pane. If desired, the viewed history can be pasted into the note.

Data Fields in History Panels


The Value field is a "free text" fieldyou can type any information there. The Abnormal field is a check box to flag an item. Checking the Abnormal field will cause the Item and Value fields to be displayed in red letters.

Adding or Changing a History Panel


Each type of history is really a data panel. Any data panel that has the word "history" or "Hx" in its name is deemed to be a history panel, and will be shown in a pane on the Tab. History

To Add a History Panel


Let's add a panel called "Immunization History".
1. Click Setup on the Toolbar

2. Click the Labs/Data Tab of the Setup window. First add any new data items for each of the items that will be in the history panel that are not already on the list; for instance, "smallpox" and "polio". 3. Click on the Add button. The Datum/Test Setup window will open.

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4. Enter the Item Name and other information as needed. Now create a new data panel (i.e., a lab panel) called "Immunization History". 5. Click on the Panels button. The Lab Panel Editor window will open. 6. Click the Add Panel button in the lower left corner of the window. 7. Enter the new panel name (e.g., I m m u n i z a t i o n H i s t o r y ) and click Ok. (Be sure to include "history" or "hx" in the name.) Then add or remove tests. 8. Select any tests you want to add from the Data Item or Test list on the right side. Click the <<Add button. - Or Select any tests you want to remove from the Items in this Panel list on the left side. Click the Delete>> button. 9. Use the Move Up and Move Down buttons to change the order of the tests in the panel, if desired. 10. Click Ok to save the panel. Next time you open a patient's chart and click on the History Panel. History Tab, you will see the new

Printing History
To Print the Patient History Report
1. Click the Reports button on the toolbar. 2. Click on the + to the left of Clinical to open the clinical reports. 3. Double click on Patient History, and then click the Print button.

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Images
Images
Images from scanners, files and other sources can be added to a patient's chart. On Windows XP, VersaForm uses WIA (Windows Image Acquisition) to scan images, and the Windows Picture and Fax Viewer to view them. WIA requires Windows XP SP1 or higher. The file wiaaut.dll should be in your System32 directory (usually located at C:\Windows\System32) It must be registered. To register it, from a Command Prompt in the System32 directory type the following command: RegSvr32 WIAAut.dll WIA supports only the PNG, BMP, JPG, GIF and TIFF image formats. On Windows 2000, VersaForm uses Microsoft Imaging for Windows. (Imaging for Windows can be installed on Windows XP too, but normally it is not present.) Images can be annotated, saved, printed and exported. An image library can be designated to contain anatomical images, such as may be used to illustrate findings or procedures.

Adding an Image
You can add images in any of the common PC formats. You can also add PDF files in the image window. To display PDFs, you must have the Adobe Acrobat Reader installed. Note: On Windows 2000, VersaForm uses the Windows Imaging facility, except when reading a TIFF. This is because Windows Imaging cannot display a multi-page TIFF. On Windows XP and other systems after 2000, Microsoft has replace Windows Imaging by WIA (Windows Image Acquisition). On these systems, VersaForm uses WIA for scanning, and it uses whatever program has been designated on your computer to display images.

To Add an Image
1. Click the Add Image button on the Images Tab of the chart.

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2. Choose whether to scan the image or to read the image from a file. Whether using WIA or reading from a file, you can choose to display the image or to save it immediately, without displaying it. 3. When scanning with WIA and displaying the image, you can add more images, making a multi-page document. 4. After viewing the image, you can enter a Description. 5. Click the Save button to save the image, or the Discard button to discard it.

Viewing an Image
1. In the Images Tab of the patient's chart, highlight the image you want to see. 2. Click the Edit/View button.

The Image Library


The Image Library allows you to use a particular folder to contain anatomical diagrams or other images to illustrate findings or procedures. VersaForm will remember which folder you used last, making it easy to find images to add to your charts. Aside from remembering the folder, the Library button functions just as the Add button.

Exporting an Image
You can export only to a .TIFF or .BMP file. If you export to a BMP file, annotations will be merged into the image (burnt-in). If the annotated image is black and white, you may export it in color or in black and white. Warning: Exporting an annotated black and white image in color to a BMP file makes the exported file much larger. If you export to a TIFF file, annotations will be held separately within the TIFF file, and can still be manipulated by an image program with TIFF annotation capability (e.g., Imaging for Windows). 1. From the Images Tab of the patient's ledger, Edit/View the Image. 2. Click the Export button. 3. Enter a file name.

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Printing an Image
Edit/View the Image Click the Print button. The image will be printed to the current default printer, bit-for-bit (that is, neither expanded nor compressed).

Patient Pictures
Both current and previous patient pictures (that is, the ones displayed on the chart) are displayed on the Images Tab. To import a patient picture to be shown on the chart, use the File menu on the main menu bar. Importing a new patient picture does not remove the old one; it remains on the Images Tab. The image only shows if the Show Index button is pushed.

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Notes
There are several ways to enter progress notes, histories and similar information. Notes can be typed by the physician or other staff member, or by a transcriptionist. Templates are the best way to enter notes, often faster than dictating. You can use drop-down lists, blank fill-ins, and information from the patient chart to quickly add information to notes. Dictation, using a transcription program.

Creating Notes Tutorials


These are video tutorials that are stored on the web. You will need Internet access to run them.

How to Use Templates to Write Notes


Entering a Note Using a Template Filling in the Note Automatic Filling Using Defaults Modifying a Drop-Down Changing a Template Printing on Your Letterhead

Templates
You can create templates from any paragraphs that you use often. Or templates may be letters, outlines or forms to fill in. You can use drop-downs, blank fill-ins, and database values when you need variable information in a template. You can also have templates within templates. Variables are recognized by being enclosed in brackets like "<<abdominal findings>>". You can organize templates into topics, just as your disk files are organized into folders. In order to create a note from a template, you must process the template.

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Templates and Topics

In this Ob-Gyn example, a number of HPI templates (organized by complaintmenopause, post-meno bleeding, etc.) are organized within a topic called "condition cc complete", which in turn is within a topic called "HPI COMPLETE".

The Notes Tab


The Notes Tab in the Patient's Chart has these Functions
Add: Adds a new note to the chart. Remove: Removes the highlighted Note. Edit/View: Opens the Note for viewing or editing. Search: Search all of a chart's Notes for any word, phrase or text fragment Print: Prints the highlighted Note to the default printer. Print Preview: Prints the highlighted Note to your choice of available printers. Print Letter: Prints the highlighted Note in your choice of special letters. Help: Brings up the context sensitive VersaForm Help.

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Adding a Note
To Add a Note
2. Click on the Notes Tab of the chart. 3. Click on the Add button to the right of the chart. The system will check for an open Encounter and start a new one if necessary. See Encounters for more on this. The Note for ... window will open.

4. Enter the note using any combination of the following methods: Type text into the note as you would in any standard word processor. To use an existing template, double-click or drag and drop it from the template list on the left. Insert templates, drop-downs, blank fill-ins, and/or database values. To do this, left click in the note where you want to position the insert. Then right-click at the insert point, and choose what to insert from the pop-up menu. Enter the note through dictation. (See Dictating Notes for details.)

5. If using a template, click the Start Process button to make choices from your dropdowns and fill-ins. 6. If desired, click the Use Defaults button to assign default values to any drop-downs and fill-ins you skipped.

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7. If there are any remaining unprocessed items, Click the Remove All button to remove them. 8. If desired, click on Spell Check to use VersaForms powerful medical spelling checker. 9. If a template or drop-down has not already done so, enter a Description for the note. If you choose not to enter a description, the first words of the note will be used. 10. Enter a Date for the note if it is not to be dated today. Enter the author's name in Reviewed By if it is not the provider for the current encounter. 11. Click Save Note to save the Note.

Edit/View Notes
To Edit a Note
1. Click on the Edit/View button on the The Note for ... window will open. 2. Edit the note. 3. Click Save Note or Cancel. Notes Tab of the patient's chart.

Adding Chart Data to a Note

If you want to record a problem, medication, allergy, or lab for the patient while entering the note, you may do so by clicking the appropriate button. The data is selected and recorded in the usual way, as if you had used the respective chart Tabs. After entering one of these, the data (for instance, the name of the medication you chose) will be placed in the note automatically. If you are using the NewCrop medication feature of VersaForm, drug/drug and drug/allergy interaction checking will be performed when the medication is added to the patient record. The The The Problem button brings up the Select A Problem window. Med button brings up the Choose a Medication window. Allergy button brings up the Select An Allergy for ... window. 112

The The

Data button brings up the Select A Lab/Data Panel window. Billing button brings up the Charge for ... window.

The E&M Wizard button brings up the Evaluation and Management Documentation window. The Msg button brings up the Reminder/Message window.

Histories in Notes
History panels display the patient's Past Medical History, Family History and Social and Behavioral History. Additional history panels are present in specialized systems, for instance, the Ob/Gyn version contains Ob History and Gyn History. History panels cannot be modified in the Chart Notes programonly in VersaForm EMR. Any history panel can be displayed or edited while writing a notethe template functions View_History and View_Choose_History can pop up any history window. If desired, the viewed history can be pasted into the note.

Data Fields in History Panels


The Value field is a "free text" fieldyou can type any information there. The Abnormal field is a one-character field to flag an item. Entering a value in the Abnormal field will cause the field to be displayed with red letters.

Printing Patient Notes


The Print Letter buttons in the Notes Tab and Note for ... window allow you to print notes to a letter so you can design the letterhead you want rather than use the standard form you get from the Print button. When you click the Print Letter button, you will see the Select Letter window.

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Any Letter that has a name starting with "Note" will show in this list. We have included two example Letters that you can modify to suit your practice. We suggest that you do a Save As, rather than a Save so you always have the original Letters available for creating more Letters. The Note Patient Form Kit looks like this:

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You can remove fields, add fields, change fonts, and generally design the form to look as you want. When the Letter is printed, the text of the Note will replace <<insert note>>. These Letters are only meant to be printed through the Print Letters buttons.

Searching Notes
You can search all of a chart's notes for any word, phrase or text fragment. Click on the Search button on the Notes Tab on the patient's chart.

The Search Notes for ... window will open. Enter text you are searching for, and click the Search button. If any notes are found, you can view them by clicking the Go To button.

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Dictating Notes
Notes can be dictated directly into the computer. In order to dictate notes, you must have installed a dictation program. Several dictation programs can work with VersaForm. The dictation program transcribes your dictation and lets you make corrections. Then you can copy the text and paste it into your note.

Template Example
Template Example 1

This short template is for a new pregnancy. It consists of one sentence, followed by 3 dropdown lists: risk level, pregnancy confirmation and social history. Let's see what happens when the first drop-down, <<risk level>>, is processed.

Template Example 2
The list of choices for risk level appears, offering the user four possibilities. The preview window appears above the listit shows where the choice will go. The user has chosen "low ". When the user clicks Ok

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Template Example 3
At this point the choice of low risk has replaced the drop-down name (risk level).

Template Example 4
This drop-down list records how the pregnancy was confirmed. In this case, two items were chosen. (Note the Modify List buttonyou can modify the list at any time.) Let's see the result:

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Template Example 5
The choices from the two drop-downs have been placed into the note.

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E&M Documentation
VersaForm helps you assess the compliance of your documentation with the guidelines jointly produced in 1997 by the AMA and HCFA. The guidelines may be found on the HCFA web site; the present URL is http://www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp. The guidelines tell how to evaluate the level of Evaluation and Management services. The level of service is dependent on several components: history, examination and medical decision making. The guidelines specify which elements should be documented to qualify for each level. VersaForm provides a method of scoring your documentation automatically. Thus the system can tell you which level of documentation (and presumably of service) has been reached. This is done in the following way: As you create a note, the templates and drop-downs you use can automatically record a documentation tag for the element concerned. For instance, the drop-down that records the result of percussion of the patient's chest in the Respiratory portion of the Multi-System Exam would record the documentation tag "Exam Respiratory percussion of chest". Documentation tags can also be inserted manually. As the documentation tags are recorded, they are evaluated against the guidelines, and the scores in each of the three main categories (history, examination, and medical decision making) are displayed on the E&M Scoreboard.

On the screen, there is also a button

for the E&M Wizard. The Wizard can:

Let you specify the encounter type (Hospital, Office, etc.) Show full details on the scoring, including what is needed for the next level. Recommend the code. Transfer the CPT4 code to your billing information for the encounter.

The E&M Wizard


The E&M Wizard reports the documentation score for an encounter. It shows the scores for History (chief complaint, ROS, HPI and PFSH), Examination, and Medical Decision Making. The Wizard has 3 panels: 119

You must first choose an encounter type (for instance, Office or Outpatient, Established Patient). This is necessary because the E&M requirements are different for different Encounter types. Click the Select Encounter Type button and choose an encounter type from the list. Usually, you have already chosen one when you opened the encounter.

Hint: You can set up a default encounter type in the Preferences Tab in the Setup window. The second panel tells you what code the documentation qualifies for.

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To see the score in detail, choose the Show Scoring Details button.

To see the documentation tags that comprise the reported score, click the Show Inputs to Scoring Process button.

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On the third panel, choose the CPT code you will submit, and click the Finish button.

Don't forget to enter the linked ICD codes on the Encounter Billing Tab.

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HIPAA
HIPAA Documents
VersaForm is capable of storing HIPAA related documents for each patient. In the patient chart, there is a Tab titled HIPAA which has a list of folders for each of the various HIPAA categories. For further information on these HIPAA categories, please see the section "Partial Summary of Requirements in the HIPAA Privacy Act"

Documents can be pulled into VersaForm by clicking the Add Note or Add Image buttons. Add Note invokes the Edit Note window, where the user can type in text as well as select HIPAA templates from the left.

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Add Image allows you to add an image via a scanner, or a file on disk, and then invokes the Image Edit window. After the user has finished editing their note or image, they can click the Save Note or Save button, and the note or image will be saved under the HIPAA folder which was selected in the HIPAA Tab of the patient's chart.

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Summary
The Summary Tab on the Patient Chart
The Summary Tab Displays the Following Information
Demographics: Including name, home phone, primary provider and referring physician. Current Medications: Medications that have not expired. Unresolved Problems: Unresolved problems, indicating date of onset. Labs/Data: Labs that have been ordered but not completed. Active Allergies: Active allergies. Past Medical History: A data panel (usually a history panel) is displayed. The panel is given by the Summary Data Panel item in the Setup window, System Parameters Tab. Thus you can choose the panel to be displayed.

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Practice Management
Ledger Overview
Patient billing and insurance functions are on the Ledger Tab of the patient chart.

On the Ledger, you can:


Add charges View or change charge information (except for the grayed out fields: Code, Charge, Qty and Total Charge) Add information needed for insurance Add payments, and apply those payments to charges Add adjustments (Use the View menu to show or hide adjustments) Reverse charges and payments View the insurance status of a charge View the payments applied to a charge Print claims, statements, and superbills Track collections and authorizations Keep Notes

Notes on the Patient Ledger


If the Patient Bal is $0.00 when you know that the patient has a balance, either: There are claims pending with either the primary or later insurance companies. Patient Responsibility is None under the Registration | Billing Info Tab. If Patient Responsibility is None, VersaForm will never bill the patient; if it is Full, VersaForm will always bill the patient. Be sure to click the OK button on the after making any changes. Billing Info Tab

If the Insurance Bal is $0.00 when it should not be make sure that:

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In the Registration, Billing Info Tab the Benefits Assigned checkbox is checked and the Patient Signature Source includes ...blocks 12 & 13 on file; In the Registration, Insurance Tab edit the insurance plan and make sure that Accept Assignment is Assigned and the Co Pay is filled in with the copay or $0; You can also go to Setup, Insurance Plans and make sure that the default Accept Assignment is set to Assigned for the insurance plan in question. If charges are showing up as ".00" instead of "0.00", that indicates that Accept Assignment is Capitated Health Plan in the Registration, Insurance Tab.

If the patient balance does not show up on a statement, the unapplied credits exceed the outstanding balance. If you see "Filtered" in red at the bottom left of the screen, then you may not be seeing all of the entries in the ledger. To see all entries, go to the View menu in the top menu bar, then down to Ledger, and check anything that is unchecked. If you need to reverse a charge, do not reverse any payments made to that charge.

Collections
The Collections screen tracks your collection activity and makes it easy to determine the status of each account. It enables you to record the notes of each conversation you have with your debtor, and displays that information on the screen each time you call. That way you always know what's been promised, how each collection effort has progressed, and how to proceed. It also keeps track of when the next action is required. Letters can be automatically produced that inform your debtors that the collection process is under way, or that their account has been sent to an outside agency. The Collections module also produces reports that can tell you which callbacks are due, and others that can track your overall collection activity.

To Keep Records of Collection Activity


1. Click the More... button on the patient's ledger. 2. Click Collections.

3. On the Collections window, fill in any data that will help you track the account. 127

4. Click Add Entry to record each interaction you have with the debtor. You can also edit or view Collections by clicking on the Coll button at the top of the Ledger. The Coll button will be available, not grayed out, after closing the chart and reopening it.

To Print a Collection Letter for the Current Patient


1. Click the More... button on the patient's ledger. 2. Click Collections.

3. On the Collections screen, make sure Send Batch Letter 4. Choose a Letter Type. 5. Click Print Letter.

has a check.

A collection letter will automatically be printed for that patient if the balance is over 120 days. 128

To Print Collections Letters for all Patients that have Collections Information
These letters will only print if the balance is over 120 days. 1. For each patient that needs a letter printed, click the More... button on the ledger. 2. Click Collections.

3. On the Collections screen, check the box Send Batch Letter 4. Set Letter Type to Collection Letter. 5. Click the OK button. 6. Click on the Desktop button at the top of the screen.

7. Click on the Letters Tab. 8. Double click on Collection Letter. 9. Click on the Data Tab at the bottom left of the Letters and Labels window. 10. Click the Retrieve button. 11. Click on the Letter Tab. 12. Click on the Show Merged button. 13. Click the Print All button.

Ledger Icons
These are the icons that you may see under Ins1 and Ins2 in the Ledger: Bill (to be billed, either electronically or on paper): Cancelled: Crossover:

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Denied: Paid: Sent Advisory: Sent Electronic: Sent on Paper:

Authorizations
The Authorizations window tracks authorizations and allows you to keep a record of how many of the authorized treatments have been performed.

To Enter an Authorization
1. Click the More... button on the patient's 2. Click Authorizations. Ledger.

3. To add an authorization, click the Add button. 4. Fill in any data that will help you track the authorization.

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To Keep Track of Authorization Activities


There are two basic ways to keep track of authorization activities. 1. When you are entering the charge, go to the Miscellaneous Tab. 2. Under the Administrative section you will find Prior Auth. Num. . 3. Click on the down triangle and you will see the Authorizations window.

4. Highlight the authorization you want to use and click the Choose button.

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5. Click on the Choose this authorization and count one usage button and you will be returned to the Miscellaneous Tab with the Prior Auth. Num. filled in. 6. Finish with the charge and click the OK button. 7. If you click on the Auth button at the top of the Ledger you will see:

8. Click on the Edit button and you will see:

9. If you want to fill in Service and/or have a Qty Used of more than 1, in step 5 above, click on the Edit this authorization button and then continue with step 6. --Or--

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10. Click on the Auth button at the top of the Ledger. The Auth button will be available, not grayed out, after closing the chart and reopening it. 11. You will see the Authorizations window.

12. Double click on the authorization you want to track.

13. Enter the Date, Service, Qty Used and any notes. 14. After you click OK and Done, you can come back into the Authorizations window and you will see the number that is Remaining.

Ledger Notes
To Add Notes to a Patient's Ledger
1. Click the More... button on the patient's ledger.

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2. Click Ledger Notes.

3. Click Add Entry to record each note.

You can also edit or view Ledger Notes by clicking on the Notes at the top of the Ledger.

button

The Notes button will be available, not grayed out, after closing the chart and reopening it.

The VersaForm Multi-Doc System


The VersaForm Multi-Doc System is very similar to the standard system; the main difference is that, instead of having only one database, the Multi-Doc system has one database for each practice that is being administered. Of course, there are several other differences: When you log in, you choose the practice database in which you want to work. (VersaForm remembers the last practice you logged into.)

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In Setup, there is an additional Tab for Multi-Doc, in which you can add and remove practices (except that you cannot remove either the first practice or the practice you are currently logged in to). You should be logged in as DBA or as a user with System Administrator authority to do this. Removing a practice deletes the data! If you submit claims electronically, you may receive acknowledgements electronically, too. These are formatted according to a specification called ANSI 997we just call them 997s. When receiving a 997 Acknowledgment, VersaForm will let you know if the Acknowledgement is for another practice (you may not know beforehand which practice it is for). The VersaForm Program ID and Program Key are different, to authorize the additional databases.

Charges
Adding a Charge
There are Four Ways to Add a New Charge
1. Quick methodin the patient's chart, click on the on the the Add Charge button. Ledger Tab, then click

A new line will appear on the ledger, where you can choose a CPT code, ICD9 codes, charge amount, etc. Only basic information--date, CPT, modifiers, rendering physician, ICD9s, and amount can be entered. If you need to add more information, use the Edit/View button after clicking the OK button. 135

Not all the ICD9s will be shown initially. You can choose Frequent ICDs or Practice Wide ICDs to see more. To add several ICD9s, hold down the C t r l key while clicking the ones you want. If you want to use the Problem/Facility and Misc Tabs' information from a previous charge, click on the Use Previous button that appears on the right hand side of the ledger.

VersaForm looks for the previous charge; based on date created, but only if it was entered within the last 30 days. 2. Click on the Add Charge Full button on the Ledger Tab. A tabbed window will open, in which you can enter all of the information that might be required for an insurance claim. Click on the triangle at the right of the ICDs field to get a window for entering or changing multiple ICD9s. 3. From the Encounters Tab on the Chart. This is designed to give clinical staff a Ledger.

quick way to enter charges without opening the

Click on the Add button to get the Opening New Encounter for window. Click on the Encounter Billing Tab. Click on the Add button to get a list from which to choose CPT Codes. You can then add modifiers, Descriptions, ICDs and Charges.

4. Charges can be entered directly from the Notes Tab or through Templates. This feature is available only in systems that have clinical functions.

Edit or View a Charge


On the Ledger Tab of the Patient Chart
Select the line, and click the Edit/View button. --OR-Double-click the line containing the charge

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Charge and Insurance Information


On an electronic claim, there is so much information that might be required that a single window can't hold it all. Thus the Charge and Insurance Info window has ten Tabs. In particular, if you are billing for in-hospital work, you will need to add information in the Problem/Facility Tab.

The Ten Tabs are:


Charge: has the basic information about the charge and diagnoses. Problem/Facility: includes lab information, hospital information, hospital admit and discharge dates and problem history. Miscellaneous: Disability, hearing/vision information, prior authorization number, and administrative data. Ambulance: Information needed for ambulance claims. Anesthesia: Information needed for some anesthesia claims (simpler claims can be entered on the Problems Tab). DME: Durable Medical Equipment billing information. Measurements: For reporting clinical measurements such as Concentration, Hemoglobin, Hematocrit, Epoetin Starting Dosage, Creatin, and Oxygen. Spinal: For reporting spinal manipulation information. Drugs: For reporting use of certain drugs. (Only for electronic claims.) EOB Adjustments: For reporting to a secondary payer the adjustments to a charge that a previous payer has taken on their EOB. Note: These are NOT the same as your adjustments on the ledger. For instance, the payer considers a deductible or a copay to be an adjustment, since it changes what he pays you. But you will not make it an adjustment on your ledger, because you may collect the money from the patient. Insurance EOB adjustments can be included on an electronic claim to a secondary payer. They are not used when the secondary payer(s) get their claims on paper. Use any of these Tabs as necessary to record information for an insurance claim. All the items thereon are derived from the ANSI 837 Implementation Guide, and their usage is described there. The Guide can be obtained from Washington Publishing Co. It can be downloaded from http://www.wpc-edi.com/hipaa/HIPAA_40.asp. See also CMS at http://www.cms.hhs.gov/home/regsguidance.asp.

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Information that Applies to More than One Charge


If the same additional insurance information (from the Problem/Facility and/or Miscellaneous Tabs) applies to more than one charge, do not enter that information for each charge. Instead, enter the information for the first charge then, for each additional charge, click the Use Previous Info button. Doing this may allow the charges to appear on a single claim. VersaForm looks for the previous charge information, based on the date entered, only within the last 30 days.

Charge
The Charge Tab contains the basic information for billing.

The Fields are:


Date of Svc: The first (or only) service date. Defaults to today's date. End Svc Date: The last service date of a series. Code: CPT code. M1, M2, M3, M4: Procedure modifiers.

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Charge: Charge per unit. Cannot be changed after clicking on the OK button. Qty: Number of units. Cannot be changed after clicking on the OK button. Units: International Unit (dosage), Minutes or Unit. Total Charge: Calculated charge per unit times number of units. Cannot be changed after clicking on the OK button. Copay Amt: The copay amount. If this is 0.00 or blank, the charge will show as a patient balance, not an insurance balance. Deductible: The deductible amount. ICDs: ICD9 code or codes. OTAF Amt: The Obligated To Accept as payment in Full amount. Assignment: Assigned, Clinical Lab Services Only, Not Assigned or Patient Refuses to Assign. Allowed Amt: The allowed amount. Description: The procedure description. Place Of Svc: A drop-down list of places of service. Will be translated to a code for box 24B. Type of Svc: A drop-down list of types of services. Not used on the HCFA 1500 (08/05) nor in ANSI claims. Provider: The Rendering Provider. Claim As: The Rendering Provider for Incident-to billing. Referring: A drop-down list of your Referring Physicians. Second: A drop-down list of your Referring Physicians. Referral Date: Date of the referral. Acct Code: An internal use only accounting code. Charge No.: Automatically filled in if the charge was entered in an encounter. Encounter: Automatically filled in if the charge was entered in an encounter. Note: This is just for your information; it does not show on claims.

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Problem/Facility Tab
The Problem/Facility Tab is used to bill for hospital visits and when other problem-related information is needed. In general, it will complicate electronic insurance claims if you fill in more than is required. In particular, if this is a hospital visit, you must fill in the Service Facility and, if it is inpatient, Hospital Admit and Hospital Discharge dates. Anything else should only be filled in if it is required by some special circumstance.

The Fields
Facility / Providers
Lab Work: Check for Yes. May affect either Box 20 or Box 23 on the HCFA 1500 (08/05). Purchased Svc or Lab Wk Provider: Choose the lab from your list of facilities. Only fill this in if you are also going to fill in Amt. Will fill in Box 32 on the HCFA 1500 (08/05). 140

Amt: Amount you paid for the purchased service. Goes in Box 20 on the HCFA 1500 (08/05). Referring Lab: Choose the lab from your list of active facilities. Service Facility: Choose the facility from your list of active facilities. This will go into Box 32 on the HCFA 1500 (08/05). Room: In the service facility. Dept: In the service facility. Hospital Admit: From date for Box 18 on the HCFA 1500 (08/05). Required for inpatient hospital. Hospital Discharge: To date for Box 18 on the HCFA 1500 (08/05). Supervising Provider: A drop-down list of your Providers. Supervising Provider (referring): A drop-down list of your Referring Physicians. Hospice Employed Provider?: Check for Yes. Ordering Provider: A drop-down list of your Referring Physicians. Coordination of Benefits: Check for Yes. Emergency Related: Check for Yes in Box 24C on the HCFA 1500 (08/05). Family Planning: Check for Yes.

Problem History
Date Condition Originated: This date is put in Box 14 on the HCFA 1500 (08/05). Date First Consulted: Date. Had similar symptom: Check to fill in Box 15 on the HCFA 1500 (08/05). Similar Symptom Date: The date for Box 15 on the HCFA 1500 (08/05). Date Last Seen: Date. Last Seen For: A narrative Box. Assumed care: Date. Relinquished care: Date. Last Xray: Date. Acute Manifestation: Date. 141

Creatine test date: Date. Hemo test date: Date.

Type of Problem
Illness_Accident_Pregnancy?: Accident, Illness or Pregnancy. If this is Accident, then Box 10C on the HCFA 1500 (08/05) is "Yes" LMP: Date of last menstrual period. Related Causes 1, R2, R3: Auto_Accident State: State in which the auto accident occurred. Auto Acc Country Code: The country where the auto accident occurred if it was not in the US. Accident Date: This date refers to an auto accident. If it is filled in, then Box 10B on the HCFA 1500 (08/05) is "Yes" and this date is put in Box 14 on the HCFA 1500 (08/05). Employment Related?: If this is checked, then Box 10A on the HCFA 1500 (08/05) is "Yes". Employer Coverage?: Check for Yes. Weight: In pounds. Pregnant?: Check for Yes. Estimated DOB: When the baby is due. Order Date (svcs or supplies): Date.

Miscellaneous Tab
The Miscellaneous Tab is used to bill for disability information, hearing and vision, administrative information and EPSDT for Medicaid.

142

The Fields
Disability Information Last Worked: Date. Return to Work: Date. Homebound?: Checkbox. 143

Begin Disability: Date. End Disability: Date. Hearing and Vision Prescription Date: Date. Vision Category: Contact lenses, Spectacle frames or Spectacle lenses. Vision Conditions 1, 2, 3, 4, 5: 20 Degree or .5 Diopter Change, Breakage or Damage, Loss or Theft, Medical Reason or Patient Preference. Administrative Mammography Cert #: Mammography Certification number. APG Number: Ambulatory Patient Group. FDA Exemption #: FDA Exemption number. Claim Reason: Adjustment of Prior Claim, Original, Replacement of Prior Claim or Void/Cancel of Prior Claim for Medicaid Box 22. Original Reference No.: Number assigned by Medicaid to identify a claim for Box 22. Delay Reason: Authorization Delays, Delay in Certifying Provider, Delay in Custom-made Appliances, Delay in Eligibility Determination, Delay in Prior Approval, Delay in Supplying Billing Forms, Litigation, Original Denied--not Billing Limit, Other, Proof of Eligibility Unavailable or Third Party Processing Delay. Participation Agreement for Non-Par Provider: Check to put a P in loop 2300 CLM16. Special Program: Disability, EPSDT or CHAP, Induced Abortion - Danger to Life, Induced Abortion - Rape or Incest, Physically Handicapped Children, Second Opinion or Surgery or Special Federal Funding. Authorization exception: Client as Temporary Medicaid, County Request for Second Opinion, Emergency Care, Immediate/Urgent Care, Request for Override Pending or Special Handling. Claim Note and Code: Additional Information, Block 19 (paper claim, or Loop 2300 NTE in an electronic claim), Certification Narrative, Diagnosis Description, Goals Plans etc., Payment or Third Party Organization. Line Note and Code: Additional Information, Goals Plans etc., Payment or Third Party Organization Notes. Goes in Loop 2400 NTE. Report Type: Admission Summary, Certification, Dental Models, Diagnostic Report, Discharge Summary, Explanation of Benefits (COB or MSP) or Models. 144

Report Transmission: Code defining timing, transmission method or format by which reports are to be sent. Attachment Control No.: Code identifying a party or other code. Univ. Prod. Num.: Product Number or Vendor Product Number. UPN Qualifier: Product Number or Vendor Product Number Qualifier. Prior Auth. Num.: Prior authorization number. You can choose from the drop-down list. Goes in Block 23. Approved Amt.: Approved amount. Date Product Shipped: Date. Immunization Batch No.: The manufacturers lot number for vaccine used in immunizations. Postage Amt.: Cost of postage used to provide service or to process associated paper work. Sales Tax Amt.: Amount of sales tax attributable to the referenced Service. Copay Exempt: Checkbox. File Information: To be used in the case of an unexpected data requirement by a state regulatory authority. EPSDT Medicaid services from EPSDT screening referral?: Checkbox. Referral Given?: Checkbox. Condition 1, 2, 3: New Services Requested, Not Used, Patient Refused Referral or Under Treatment.

Ambulance Tab
The Ambulance Tab is used to bill for an ambulance.

145

The Fields are


Weight: Pounds. Transport Code: Initial, Return, Transfer or Round Trip. Distance: Miles. Reason Code: Nearest/Residential, Benefit physician, Near family, Specialist care or Rehab facility. Round trip reason: A narrative. Stretcher Reason: A narrative. Condition Code 1, 2, 3, 4, 5: Emergency, admitted to a hospital, bed confined before or after, had to be restrained, moved by stretcher, unconscious or in shock, medically necessary, to nearest facility or visible hemorrhaging. Service Location If the service facility location is in an area where there are no street addresses, enter a description of where the service was rendered (e.g., crossroad of State Road 34 and 45" or Exit near Mile marker265 on Interstate 80".)

146

Name: Facility name. Addr: Of the facility. City: Of the facility. St: Of the facility. Zip: Of the facility.

Anesthesia Tab
When entering an anesthesia charge, you can enter modifiers, time, and/or units on the screen shown below.

To use this window, there are two Setup items that must have been completed:
The CPT code must be set up with the Type of service set to Anesthesia. To do this, click on Setup and then CPT4 Codes, and enter or edit the code. Then set the Type of service. Once the Type of service is set to Anesthesia, the window above will appear whenever the CPT code is used.

147

The insurance plan's characteristics for handling anesthesia must be set up. This is found in Setup, Insurance Plans. Select the plan and then click the Anesthesia Units button and you will see the setup screen below:

DME Tab
The DME/Oxygen Information Tab is used to bill for Durable Medical Equipment and/or Oxygen.

148

The Fields are:


Length of medical necessity (days): Number of days. Rental Price: In dollars. Rental Unit: Daily, Monthly or weekly. Purchase price: In dollars. Attachment Transmission: Certification or Documentation required. Certificate Type: Initial, Renewal or Revised. 149

Duration (months): Number of months needed. Begin Therapy Date Revision Date Condition Code: DME or Oxygen. Condition Applies: Check box. Condition 1, 2, 3, 4 and 5: Ambulation limitations, Certification on file, Oxygen delivery equipment, Patient was discharged or Replacement item. Last Certification Date Oxy Certification Type: Initial, Renewal or Revised Oxy Treatment Period (months): Number of months needed. Oxy Arterial Blood Gas: Oxy Arterial Blood Gas Date Oxygen Saturation: Oxy Saturation Test Date Test Condition: At rest on room air, exercising or sleeping. Oxygen Flow Rate: Required if patients arterial PO2 is greater than 55 mmHg and less than 60 mmHg, or oxygen saturation is greater than 88%. Dependent edema suggesting congestive heart failure: Check box. P Pulmonale on Electrocardiogram (EKG): Check box. Erythrocythemia with a hematocrit greater than 56 percent: Check box.

Measurements Tab
The Measurements Tab is used to specify physical measurements or counts, including dimensions, tolerances, variances, and weights.

150

Click the Add button to add a measurement:

The Fields are:


Ref Id Code: Original Starting Dosage or Test Results. Qualifier: Creatin, Epoetin Starting Dosage, Gas Test Rate, Height, Hematocrit or Hemoglobin. Value: The value. Date: Date of the measurement.

After adding a measurement, you will see a list of measurements.

151

Spinal Tab

The Fields are:


Treatment No. Within Series: The number of this treatment in the series. Treatment Series Total Count: The number of treatments in the series. Subluxation Level: Cervical 1 through 7, Coccyx, Ilium, Lumbar 1 through 5, Occiput, Sacrum, or Thoracic 1 through 12. Subluxation Level End: The same list as above. Treatment Period: The time period involved in the treatment series. Units: Days, Months, Weeks or Years. Monthly Treatment Count: The number of treatments rendered in the month of service. Patient Condition: Acute Condition, Acute Manifestation of a Chronic Condition, Chronic Condition, Non-acute, Non-Life Threatening, Routine or Symptomatic. Complication Indicator: Checkbox. Description: A free-form description to clarify the related data elements and their content. Xrays Available: Checkbox.

152

Drug Tab
The Drug Tab is used to bill for Drug Services. The information from this Tab goes into Loop 2410; it is not used in paper claims.

Click the Add Button to Add a Drug

The Fields are:


NDC Drug Id: National Drug Code. Description: Description of the drug. Unit Price: Unit price. Quantity: Quantity prescribed. Unit Of Measure: Gram, International Unit, Milliliter or Unit. Prescription Number: The prescription number.

153

After adding a drug, you will see a list of prescribed drugs.

EOB Adjustments (EOBA) Tab


The EOB Adj Tab is used when you send an electronic claim to a non-primary insurance and you have to hand enter the EOB information. If you have ERA, Electronic Remittance Advice, these values will be entered into the database for you but will not show up in this window.

To Add an Adjustment Click the Add Button

154

What You Will See

Pick the Insurance Plan from the drop-down list:

Enter the Adjudication Date or use the drop-down calendar. Pick the Group Code from the drop-down list:

Pick the Reason Code from the drop-down list. The full list is available, sorted by Code number here, and sorted by Description here.

155

Enter the Adjustment amount. Enter the Quantity (at least 1).

The Completed Dialog

Click the OK button. Repeat for each adjustment made to the charge. The sum of the adjustments you enter plus the payment received must equal the original charge. When all the adjustments have been entered, click on the OK button.

156

The Completed Tab

EOBA Codes by Code Number


# Reason 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount The procedure code is inconsistent with 4 the modifier used or a required modifier is missing. 5 The procedure code / bill type is inconsistent with the place of service. The procedure / revenue code is inconsistent with the patient's age. The procedure / revenue code is inconsistent with the patient's gender. The procedure code is inconsistent with the provider type / specialty (taxonomy). The diagnosis is inconsistent with the patient's age. Notes Start Date 1/1/1995 1/1/1995 1/1/1995 Stop Date

1/1/1995

1/1/1995

1/1/1995

1/1/1995

1/1/1995

1/1/1995

157

10

The diagnosis is inconsistent with the patient's gender. The diagnosis is inconsistent with the procedure. The diagnosis is inconsistent with the provider type. The date of death precedes the date of service. The date of birth follows the date of service.

1/1/1995

11

1/1/1995

12

1/1/1995

13

1/1/1995

14

1/1/1995

Payment adjusted because the submitted authorization number is missing, invalid, 15 or does not apply to the billed services or provider. Claim / service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be 16 comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Payment adjusted because requested information was not provided or was insufficient / incomplete. At least one 17 Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) 18 Duplicate claim / service. Claim denied because this is a work19 related injury / illness and thus the liability of the Worker's Compensation Carrier. 20 Claim denied because this injury / illness is covered by the liability carrier.

1/1/1995

1/1/1995

1/1/1995

1/1/1995

1/1/1995

1/1/1995

158

21

Claim denied because this injury / illness is the liability of the no-fault carrier.

1/1/1995

Payment adjusted because this care may 22 be covered by another payer per coordination of benefits. Payment adjusted due to the impact of 23 prior payer(s) adjudication including payments and / or adjustments Payment for charges adjusted. Charges 24 are covered under a capitation agreement / managed care plan. 25 Payment denied. Your Stop loss deductible has not been met.

1/1/1995

1/1/1995

1/1/1995

1/1/1995 1/1/1995 1/1/1995 Redundant to codes 26&27.

26 Expenses incurred prior to coverage. 27 Expenses incurred after coverage terminated. Coverage not in effect at the time the service was provided.

28

1/1/1995 1/1/1995

10/16/2003

29 The time limit for filing has expired. Payment adjusted because the patient 30 has not met the required eligibility, spend down, waiting, or residency requirements. 31 Claim denied as patient cannot be identified as our insured. Our records indicate that this dependent is not an eligible dependent as defined. Claim denied. Insured has no dependent coverage. Claim denied. Insured has no coverage for newborns.

1/1/1995

2/1/2006

1/1/1995

32

1/1/1995

33

1/1/1995

34

1/1/1995

159

35

Lifetime benefit maximum has been reached. Balance does not exceed co-payment amount.

1/1/1995

36

1/1/1995 1/1/1995

10/16/2003 10/16/2003

37 Balance does not exceed deductible. Services not provided or authorized by 38 designated (network / primary care) providers. 39 Services denied at the time authorization / pre-certification was requested. Charges do not meet qualifications for emergent / urgent care. Discount agreed to in Preferred Provider contract.

1/1/1995

1/1/1995

40

1/1/1995

41

1/1/1995

10/16/2003

Charges exceed our fee schedule or 42 maximum allowable amount. (Use CARC 45) 43 Gramm-Rudman reduction. 44 Prompt-pay discount. Charges exceed your contracted / legislated fee arrangement. This change to be effective 6/1/07: Charge exceeds 45 fee schedule / maximum allowable or contracted / legislated fee arrangement. (Use Group Codes PR or CO depending upon liability). 46 This (these) service(s) is (are) not covered. This (these) diagnosis(es) is (are) not covered, missing, or are invalid. Use code 96.

1/1/1995

6/1/2007

1/1/1995 1/1/1995

7/1/2006

1/1/1995

1/1/1995

10/16/2003

47

1/1/1995

2/1/2006

160

48

This (these) procedure(s) is (are) not covered.

Use code 96.

1/1/1995

10/16/2003

These are non-covered services because this is a routine exam or screening 49 procedure done in conjunction with a routine exam. These are non-covered services because 50 this is not deemed a 'medical necessity' by the payer. 51 These are non-covered services because this is a pre-existing condition

1/1/1995

1/1/1995

1/1/1995

The referring / prescribing / rendering 52 provider is not eligible to refer / prescribe / order / perform the service billed. Services by an immediate relative or a 53 member of the same household are not covered. 54 Multiple physicians / assistants are not covered in this case.

1/1/1995

2/1/2006

1/1/1995

1/1/1995

Claim / service denied because procedure / treatment is deemed 55 experimental / investigational by the payer. Claim / service denied because procedure / treatment has not been 56 deemed 'proven to be effective' by the payer. Payment denied / reduced because the payer deems the information submitted 57 does not support this level of service, this many services, this length of service, this dosage, or this day's supply.

1/1/1995

1/1/1995

Split into codes 150, 151, 152, 1/1/1995 153 and 154.

6/30/2007

161

Payment adjusted because treatment was deemed by the payer to have been 58 rendered in an inappropriate or invalid place of service. Charges are adjusted based on multiple or concurrent procedure rules. (For 59 example multiple surgery or diagnostic imaging, concurrent anesthesia.) Charges for outpatient services with this 60 proximity to inpatient services are not covered. 61 Charges adjusted as penalty for failure to obtain second surgical opinion.

1/1/1995

1/1/1995

1/1/1995

1/1/1995

Payment denied / reduced for absence 62 of, or exceeded, pre-certification / authorization. 63 Correction to a prior claim. 64 Denial reversed per Medical Review. 65 Procedure code was incorrect. This payment reflects the correct code.

1/1/1995

4/1/2007

1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 Use code 23. 1/1/1995

10/16/2003 10/16/2003 10/16/2003

66 Blood Deductible. 67 Lifetime reserve days. (Handled in QTY, QTY01=LA)

10/16/2003 10/16/2003

68 DRG weight. (Handled in CLP12) 69 Day outlier amount. 70 Cost outlier - Adjustment to compensate for additional costs.

71 Primary Payer amount.

6/30/2000

162

72

Coinsurance day. (Handled in QTY, QTY01=CD)

1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995

10/16/2003 10/16/2003

73 Administrative days. 74 Indirect Medical Education Adjustment. 75 Direct Medical Education Adjustment. 76 Disproportionate Share Adjustment. 77 Covered days. (Handled in QTY, QTY01=CA) Non-Covered days / Room charge adjustment.

10/16/2003

78

1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 Only use when the payment of interest is the responsibility of the patient. Duplicative of code 45. 10/16/2003 10/16/2003 10/16/2003 10/16/2003 10/16/2003 10/16/2003

79 Cost Report days. (Handled in MIA15) 80 Outlier days. (Handled in QTY, QTY01=OU)

81 Discharges. 82 PIP days. 83 Total visits. 84 Capital Adjustment. (Handled in MIA)

Interest amount. This change effective 85 1/1/2008: Patient Interest Adjustment (Use Only Group code PR)

1/1/1995

86 Statutory Adjustment. 87 Transfer amount.

1/1/1995 1/1/1995

10/16/2003

163

Adjustment amount represents collection 88 against receivable created in prior overpayment. 89 Professional fees removed from charges. 90 Ingredient cost adjustment. 91 Dispensing fee adjustment. 92 Claim Paid in full. As of 004010, CAS at the claim level is optional.

1/1/1995

6/30/2007

1/1/1995 1/1/1995 1/1/1995 1/1/1995 10/16/2003

93 No Claim level Adjustments.

1/1/1995

10/16/2003

94 Processed in Excess of charges. 95 Benefits adjusted. Plan procedures not followed.

1/1/1995 1/1/1995

Non-covered charge(s). At least one Remark Code must be provided (may be 96 comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Payment adjusted because the benefit for this service is included in the payment 97 / allowance for another service / procedure that has already been adjudicated 98 The hospital must file the Medicare claim for this inpatient non-physician service. Medicare Secondary Payer Adjustment Amount. Payment made to patient / insured / responsible party.

1/1/1995

1/1/1995

1/1/1995

10/16/2003

99

1/1/1995

10/16/2003

100

1/1/1995

164

Predetermination: anticipated payment 101 upon completion of services or claim adjudication. 102 Major Medical Adjustment. 103 Provider promotional discount (e.g., Senior citizen discount).

1/1/1995

1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995

104 Managed care withholding. 105 Tax withholding. 106 Patient payment option / election not in effect.

Claim / service adjusted because the 107 related or qualifying claim / service was not identified on this claim. 108 Payment adjusted because rent / purchase guidelines were not met.

1/1/1995

1/1/1995

Claim not covered by this payer / 109 contractor. You must send the claim to the correct payer / contractor. 110 Billing date predates service date. 111 Not covered unless the provider accepts assignment.

1/1/1995

1/1/1995 1/1/1995

Payment adjusted as not furnished 112 directly to the patient and / or not documented. Payment denied because service / 113 procedure was provided outside the United States or as a result of war. 114 Procedure / product not approved by the Food and Drug Administration. Use Codes 157, 158 or 159.

1/1/1995

1/1/1995

6/30/2007

1/1/1995

165

Payment adjusted as procedure postponed or canceled. This change 115 effective 1/1/2008: Payment adjusted as procedure postponed, canceled, or delayed. Payment denied. The advance 116 indemnification notice signed by the patient did not comply with requirements. Payment adjusted because transportation is only covered to the 117 closest facility that can provide the necessary care. 118 Charges reduced for ESRD network support. Benefit maximum for this time period or occurrence has been reached. Patient is covered by a managed care plan. Use code 24.

1/1/1995

1/1/1995

1/1/1995

1/1/1995

119

1/1/1995

120

1/1/1995 1/1/1995 1/1/1995

6/30/2007

121 Indemnification adjustment. 122 Psychiatric reduction.

6/30/2007

123 Payer refund due to overpayment.

Refer to implementation guide for 1/1/1995 proper handling of reversals. Refer to implementation guide for 1/1/1995 proper handling of reversals.

6/30/2007

124 Payer refund amount - not our patient.

6/30/2007

166

Payment adjusted due to a submission / billing error(s). At least one Remark Code 125 must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) 126 Deductible -- Major Medical 127 Coinsurance -- Major Medical 128 Newborn's services are covered in the mother's Allowance. Payment denied - Prior processing information appears incorrect.

1/1/1995

2/28/1997 2/28/1997 2/28/1997

129

2/28/1997 2/28/1997 2/28/1997 2/28/1997

130 Claim submission fee. 131 Claim specific negotiated discount. 132 Prearranged demonstration project adjustment. The disposition of this claim / service is pending further review.

133

2/28/1997 10/31/1998 10/31/1998

134 Technical fees removed from charges. 135 Claim denied. Interim bills cannot be processed.

Claim adjusted based on failure to follow 136 prior payers coverage rules. (Use Group Code OA). Payment / Reduction for Regulatory 137 Surcharges, Assessments, Allowances or Health Related Taxes. Claim / service denied. Appeal 138 procedures not followed or time limits not met.

10/31/1998

2/28/1999

6/30/1999

167

Contracted funding agreement 139 Subscriber is employed by the provider of services. 140 Patient / Insured health identification number and name do not match.

6/30/1999

6/30/1999

Claim adjustment because the claim 141 spans eligible and ineligible periods of coverage. 142 Claim adjusted by the monthly Medicaid patient liability amount.

6/30/1999

6/30/2000 2/28/2001 6/30/2001 6/30/2002

143 Portion of payment deferred. 144 Incentive adjustment, e.g. preferred product / service.

145 Premium payment withholding Payment denied because the diagnosis 146 was invalid for the date(s) of service reported. 147 Provider contracted / negotiated rate expired or not on file.

6/30/2002

6/30/2002

Claim / service rejected at this time because information from another 148 provider was not provided or was insufficient / incomplete. Lifetime benefit maximum has been 149 reached for this service / benefit category. Payment adjusted because the payer 150 deems the information submitted does not support this level of service.

6/30/2002

10/31/2002

10/31/2002

168

Payment adjusted because the payer 151 deems the information submitted does not support this many services. Payment adjusted because the payer 152 deems the information submitted does not support this length of service. Payment adjusted because the payer 153 deems the information submitted does not support this dosage. Payment adjusted because the payer 154 deems the information submitted does not support this day's supply. 155 This claim is denied because the patient refused the service / procedure.

10/31/2002

10/31/2002

10/31/2002

10/31/2002

6/30/2003 9/30/2003

156 Flexible spending account payments Payment denied / reduced because 157 service / procedure was provided as a result of an act of war. Payment denied / reduced because the 158 service / procedure was provided outside of the United States. Payment denied / reduced because the 159 service / procedure was provided as a result of terrorism. Payment denied / reduced because injury 160 / illness was the result of an activity that is a benefit exclusion. 161 Provider performance bonus State-mandated Requirement for Property and Casualty, see Claim 162 Payment Remarks Code for specific explanation.

9/30/2003

9/30/2003

9/30/2003

9/30/2003

2/29/2004

2/29/2004

169

Claim / Service adjusted because the 163 attachment referenced on the claim was not received. Claim / Service adjusted because the 164 attachment referenced on the claim was not received in a timely fashion. 165 Payment denied /reduced for absence of, or exceeded referral

6/30/2004

6/30/2004

10/31/2004

These services were submitted after this 166 payers responsibility for processing claims under this plan ended. 167 This (these) diagnosis(es) is (are) not covered.

2/28/2005

6/30/2005

Payment denied as Service(s) have been considered under the patient's medical 168 plan. Benefits are not available under this dental plan 169 Payment adjusted because an alternate benefit has been provided Payment is denied when performed / billed by this type of provider.

6/30/2005

6/30/2005

170

6/30/2005

Payment is denied when performed / 171 billed by this type of provider in this type of facility. 172 Payment is adjusted when performed / billed by a provider of this specialty Payment adjusted because this service was not prescribed by a physician Payment denied because this service was not prescribed prior to delivery

6/30/2005

6/30/2005

173

6/30/2005

174

6/30/2005

170

175

Payment denied because the prescription is incomplete Payment denied because the prescription is not current

6/30/2005

176

6/30/2005

Payment denied because the patient has 177 not met the required eligibility requirements Payment adjusted because the patient 178 has not met the spend down requirements. Payment adjusted because the patient 179 has not met the required waiting requirements Payment adjusted because the patient 180 has not met the required residency requirements Payment adjusted because this 181 procedure code was invalid on the date of service Payment adjusted because the 182 procedure modifier was invalid on the date of service 183 The referring provider is not eligible to refer the service billed.

6/30/2005

6/30/2005

6/30/2005

6/30/2005

6/30/2005

6/30/2005

6/30/2005

The prescribing / ordering provider is not 184 eligible to prescribe / order the service billed. 185 The rendering provider is not eligible to perform the service billed. Payment adjusted since the level of care changed

6/30/2005

6/30/2005

186

6/30/2005

171

187 Health Savings account payments This product / procedure is only covered 188 when used according to FDA recommendations. Not otherwise classified or "unlisted" procedure code (CPt / HCPCS) was 189 billed when there is a specific procedure code for this procedure / service Payment is included in the allowance for 190 a Skilled Nursing Facility (SNF) qualified stay. Claim denied because this is not a work related injury / illness and thus not the 191 liability of the workers compensation carrier. 192 Non standard adjustment code from paper remittance advice.

6/30/2005

6/30/2005

6/30/2005

10/31/2005

10/31/2005

10/31/2005

Original payment decision is being 193 maintained. This claim was processed properly the first time. Payment adjusted when anesthesia is performed by the operating physician, the 194 assistant surgeon or the attending physician Payment denied / reduced due to a 195 refund issued to an erroneous priority payer for this claim / service 196 Claim / service denied based on prior payer's coverage determination. Use code 136.

2/28/2006

2/28/2006

2/28/2006

6/30/2006

2/1/2007

172

Payment adjusted for absence of precertification / authorization. This 197 change effective 1/1/2008: Payment adjusted for absence of precertification / authorization / notification. 198 Payment Adjusted for exceeding precertification / authorization. Revenue code and Procedure code do not match. Expenses incurred during lapse in coverage

10/31/2006

10/31/2006

199

10/31/2006

200

10/31/2006

Workers Compensation case settled. Patient is responsible for amount of this 201 claim / service through WC Medicare set aside arrangement or other agreement. (Use group code PR). Payment adjusted due to non-covered 202 personal comfort or convenience services. 203 Payment adjusted for discontinued or reduced service.

10/31/2006

2/28/2007

2/28/2007

This service / equipment / drug is not 204 covered under the patients current benefit plan 205 Pharmacy discount card processing fee 206 NPI denial missing 207 NPI denial - Invalid format 208 NPI denial - not matched

2/28/2007

7/9/2007 7/9/2007 7/9/2007 7/9/2007 5/23/2008

173

Per regulatory or other agreement. The provider cannot collect this amount from 209 the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected. (Use Group code OA) Payment adjusted because pre210 certification / authorization not received in a timely fashion 211 National Drug Codes (NDC) not eligible for rebate, are not covered.

7/9/2007

7/9/2007

7/9/2007 1/1/1995

A0 Patient refund amount. Claim / Service denied. At least one Remark Code must be provided (may be A1 comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Use Code 45 with Group Code CO or use another appropriate specific adjustment code. The Stop date of 1/1/2008 may change.

1/1/1995

A2 Contractual adjustment.

1/1/1995

1/1/2008

A3 Medicare Secondary Payer liability met. A4 Medicare Claim PPS Capital Day Outlier Amount. Medicare Claim PPS Capital Cost Outlier Amount. Prior hospitalization or 30 day transfer requirement not met.

1/1/1995 1/1/1995

10/16/2003

A5

1/1/1995

A6

1/1/1995

174

A7 Presumptive Payment Adjustment A8 Claim denied, ungroupable DRG B1 Non-covered visits. B2 Covered visits. B3 Covered charges. B4 Late filing penalty. Payment adjusted because coverage / B5 program guidelines were not met or were exceeded. This payment is adjusted when performed / billed by this type of provider, B6 by this type of provider in this type of facility, or by a provider of this specialty. This provider was not certified / eligible to B7 be paid for this procedure / service on this date of service. Claim / service not covered / reduced B8 because alternative services were available, and should have been utilized. B9 Services not covered because the patient is enrolled in a Hospice.

1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 10/16/2003 10/16/2003

1/1/1995

1/1/1995

2/1/2006

1/1/1995

1/1/1995

1/1/1995

Allowed amount has been reduced because a component of the basic B10 procedure / test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure / test. The claim / service has been transferred to the proper payer / processor for B11 processing. Claim / service not covered by this payer / processor.

1/1/1995

1/1/1995

175

B12

Services not documented in patients' medical records.

1/1/1995

Previously paid. Payment for this claim / B13 service may have been provided in a previous payment. Payment denied because only one visit B14 or consultation per physician per day is covered. Payment adjusted because this service / procedure requires that a qualifying service / procedure be received and B15 covered. The qualifying other service / procedure has not been received / adjudicated. B16 Payment adjusted because 'New Patient' qualifications were not met.

1/1/1995

1/1/1995

1/1/1995

1/1/1995

Payment adjusted because this service was not prescribed by a physician, not B17 prescribed prior to delivery, the prescription is incomplete, or the prescription is not current. Payment adjusted because this B18 procedure code and modifier were invalid on the date of service B19 Claim / service adjusted because of the finding of a Review Organization.

1/1/1995

2/1/2006

1/1/1995

1/1/1995

10/16/2003

Payment adjusted because procedure / B20 service was partially or fully furnished by another provider. The charges were reduced because the B21 service / care was partially furnished by another physician.

1/1/1995

1/1/1995

10/16/2003

176

B22

This payment is adjusted based on the diagnosis.

1/1/1995

Payment denied because this provider B23 has failed an aspect of a proficiency testing program. Use code 16 and remark codes if necessary. Use code 16 and remark codes if necessary. Use code 16 and remark codes if necessary. Use code 16 and remark codes if necessary. Use code 16 and remark codes if necessary. Use code 16 and remark codes if necessary. Use code 16 and remark codes if necessary.

1/1/1995

D1

Claim / service denied. Level of subluxation is missing or inadequate.

1/1/1995

10/16/2003

D2

Claim lacks the name, strength, or dosage of the drug furnished.

1/1/1995

10/16/2003

Claim / service denied because information to indicate if the patient owns D3 the equipment that requires the part or supply was missing. Claim / service does not indicate the D4 period of time for which this will be needed.

1/1/1995

10/16/2003

1/1/1995

10/16/2003

D5

Claim / service denied. Claim lacks individual lab codes included in the test.

1/1/1995

10/16/2003

Claim / service denied. Claim did not D6 include patient's medical record for the service.

1/1/1995

10/16/2003

D7

Claim / service denied. Claim lacks date of patient's most recent physician visit.

1/1/1995

10/16/2003

177

Claim / service denied. Claim lacks D8 indicator that 'x-ray is available for review.' Claim / service denied. Claim lacks invoice or statement certifying the actual D9 cost of the lens, less discounts or the type of intraocular lens used. Claim / service denied. Completed D10 physician financial relationship form not on file. D11 Claim lacks completed pacemaker registration form.

Use code 16 and remark codes if necessary. Use code 16 and remark codes if necessary.

1/1/1995

10/16/2003

1/1/1995

10/16/2003

Use code 17.

1/1/1995

10/16/2003

Use code 17.

1/1/1995

10/16/2003

Claim / service denied. Claim does not identify who performed the purchased D12 diagnostic test or the amount you were charged for the test. Claim / service denied. Performed by a facility / supplier in which the ordering / D13 referring physician has a financial interest. D14 Claim lacks indication that plan of treatment is on file. Claim lacks indication that service was supervised or evaluated by a physician.

Use code 17.

1/1/1995

10/16/2003

Use code 17.

1/1/1995

10/16/2003

Use code 17.

1/1/1995

10/16/2003

D15

Use code 17. Use code 16 with appropriate claim payment remark code [N4].

1/1/1995

10/16/2003

D16

Claim lacks prior payer payment information.

1/1/1995

6/30/2007

178

D17

Claim / Service has invalid non-covered days.

Use code 16 with appropriate claim payment remark code. Use code 16 with appropriate claim payment remark code. Use code 16 with appropriate claim payment remark code. Use code 16 with appropriate claim payment remark code.

1/1/1995

6/30/2007

D18

Claim / Service has missing diagnosis information.

1/1/1995

6/30/2007

Claim / Service lacks Physician / D19 Operative or other supporting documentation

1/1/1995

6/30/2007

D20

Claim / Service missing service / product information.

1/1/1995

6/30/2007

D21

This (these) diagnosis(es) is (are) missing or are invalid Workers Compensation State Fee Schedule Adjustment

1/1/1995

6/30/2007

W1

2/29/2000

Taken from Claim Adjustment Reason Codes: Last Update 7/9/2007, http://www.wpcedi.com/custom_html/claimadjustment.htm.

EOBA Codes by Reason


# Reason Adjustment amount represents collection 88 against receivable created in prior overpayment. 73 Administrative days. Notes Start Date Stop Date

1/1/1995

6/30/2007

1/1/1995

10/16/2003

179

Allowed amount has been reduced because a component of the basic B10 procedure / test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure / test. 36 Balance does not exceed co-payment amount.

1/1/1995

1/1/1995 1/1/1995 1/1/1995

10/16/2003 10/16/2003

37 Balance does not exceed deductible. 119 Benefit maximum for this time period or occurrence has been reached. Benefits adjusted. Plan procedures not followed.

95

1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 10/16/2003

110 Billing date predates service date. 66 Blood Deductible. 84 Capital Adjustment. (Handled in MIA) 61 Charges adjusted as penalty for failure to obtain second surgical opinion.

Charges are adjusted based on multiple or concurrent procedure rules. (For 59 example multiple surgery or diagnostic imaging; concurrent anesthesia.) 40 Charges do not meet qualifications for emergent / urgent care.

1/1/1995

1/1/1995

Charges exceed our fee schedule or 42 maximum allowable amount. (Use CARC 45)

1/1/1995

6/1/2007

180

Charges exceed your contracted / legislated fee arrangement. This change to be effective 6/1/07: Charge exceeds 45 fee schedule / maximum allowable or contracted / legislated fee arrangement. (Use Group Codes PR or CO depending upon liability). Charges for outpatient services with this 60 proximity to inpatient services are not covered. 118 Charges reduced for ESRD network support.

1/1/1995

1/1/1995

1/1/1995

Claim adjusted based on failure to follow 136 prior payers coverage rules. (Use Group Code OA). 142 Claim adjusted by the monthly Medicaid patient liability amount.

10/31/1998

6/30/2000

Claim adjustment because the claim 141 spans eligible and ineligible periods of coverage. 31 Claim denied as patient cannot be identified as our insured. Claim denied because this injury / illness is covered by the liability carrier. Claim denied because this injury / illness is the liability of the no-fault carrier.

6/30/1999

1/1/1995

20

1/1/1995

21

1/1/1995

Claim denied because this is a work19 related injury / illness and thus the liability of the Worker's Compensation Carrier. Claim denied because this is not a work related injury / illness and thus not the 191 liability of the workers compensation carrier.

1/1/1995

10/31/2005

181

34

Claim denied. Insured has no coverage for newborns. Claim denied. Insured has no dependent coverage. Claim denied. Interim bills cannot be processed.

1/1/1995

33

1/1/1995

135

10/31/1998 1/1/1995 Use code 17. 1/1/1995 10/16/2003

A8 Claim denied; ungroupable DRG D11 Claim lacks completed pacemaker registration form. Claim lacks indication that plan of treatment is on file. Claim lacks indication that service was supervised or evaluated by a physician.

D14

Use code 17.

1/1/1995

10/16/2003

D15

Use code 17. Use code 16 with appropriate claim payment remark code [N4]. Use code 16 and remark codes if necessary.

1/1/1995

10/16/2003

D16

Claim lacks prior payer payment information.

1/1/1995

6/30/2007

D2

Claim lacks the name; strength; or dosage of the drug furnished.

1/1/1995

10/16/2003

Claim not covered by this payer / 109 contractor. You must send the claim to the correct payer / contractor. 92 Claim Paid in full. 131 Claim specific negotiated discount. 130 Claim submission fee.

1/1/1995

1/1/1995 2/28/1997 2/28/1997

10/16/2003

182

B19

Claim / service adjusted because of the finding of a Review Organization.

1/1/1995

10/16/2003

Claim / Service adjusted because the 164 attachment referenced on the claim was not received in a timely fashion. Claim / Service adjusted because the 163 attachment referenced on the claim was not received. Claim / service adjusted because the 107 related or qualifying claim / service was not identified on this claim. 196 Claim / service denied based on prior payer's coverage determination. Use code 136. Use code 16 and remark codes if necessary.

6/30/2004

6/30/2004

1/1/1995

6/30/2006

2/1/2007

Claim / service denied because information to indicate if the patient owns D3 the equipment that requires the part or supply was missing. Claim / service denied because procedure / treatment has not been 56 deemed 'proven to be effective' by the payer. Claim / service denied because procedure / treatment is deemed 55 experimental / investigational by the payer. Claim / service denied. Appeal 138 procedures not followed or time limits not met. Claim / Service denied. At least one Remark Code must be provided (may be A1 comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)

1/1/1995

10/16/2003

1/1/1995

1/1/1995

6/30/1999

1/1/1995

183

Claim / service denied. Claim did not D6 include patient's medical record for the service. Claim / service denied. Claim does not identify who performed the purchased D12 diagnostic test or the amount you were charged for the test.

Use code 16 and remark codes if necessary.

1/1/1995

10/16/2003

Use code 17.

1/1/1995

10/16/2003

D7

Claim / service denied. Claim lacks date of patient's most recent physician visit.

Use code 16 and remark codes if necessary. Use code 16 and remark codes if necessary. Use code 16 and remark codes if necessary. Use code 16 and remark codes if necessary.

1/1/1995

10/16/2003

Claim / service denied. Claim lacks D8 indicator that 'x-ray is available for review.'

1/1/1995

10/16/2003

D5

Claim / service denied. Claim lacks individual lab codes included in the test.

1/1/1995

10/16/2003

Claim / service denied. Claim lacks invoice or statement certifying the actual D9 cost of the lens; less discounts or the type of intraocular lens used. Claim / service denied. Completed D10 physician financial relationship form not on file.

1/1/1995

10/16/2003

Use code 17.

1/1/1995

10/16/2003

D1

Claim / service denied. Level of subluxation is missing or inadequate.

Use code 16 and remark codes if necessary.

1/1/1995

10/16/2003

Claim / service denied. Performed by a facility / supplier in which the ordering / D13 referring physician has a financial interest.

Use code 17.

1/1/1995

10/16/2003

184

Claim / service does not indicate the D4 period of time for which this will be needed.

Use code 16 and remark codes if necessary. Use code 16 with appropriate claim payment remark code. Use code 16 with appropriate claim payment remark code.

1/1/1995

10/16/2003

D17

Claim / Service has invalid non-covered days.

1/1/1995

6/30/2007

D18

Claim / Service has missing diagnosis information.

1/1/1995

6/30/2007

Claim / service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be 16 comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Use code 16 with appropriate claim payment remark code. Use code 16 with appropriate claim payment remark code.

1/1/1995

Claim / Service lacks Physician / D19 Operative or other supporting documentation

1/1/1995

6/30/2007

D20

Claim / Service missing service / product information.

1/1/1995

6/30/2007

Claim / service not covered / reduced B8 because alternative services were available; and should have been utilized.

1/1/1995

185

Claim / service rejected at this time because information from another 148 provider was not provided or was insufficient / incomplete. 127 Coinsurance -- Major Medical 2 Coinsurance Amount 72 Coinsurance day. (Handled in QTY; QTY01=CD)

6/30/2002

2/28/1997 1/1/1995 1/1/1995 10/16/2003

Contracted funding agreement 139 Subscriber is employed by the provider of services. Use Code 45 with Group Code CO or use another appropriate specific adjustment code. The Stop date of 1/1/2008 may change.

6/30/1999

A2 Contractual adjustment.

1/1/1995

1/1/2008

3 Co-payment Amount 63 Correction to a prior claim. 70 Cost outlier - Adjustment to compensate for additional costs.

1/1/1995 1/1/1995 1/1/1995 1/1/1995 Redundant to codes 26&27. 1/1/1995 1/1/1995 10/16/2003 10/16/2003 10/16/2003 10/16/2003

79 Cost Report days. (Handled in MIA15) 28 Coverage not in effect at the time the service was provided.

B3 Covered charges.

186

77

Covered days. (Handled in QTY; QTY01=CA)

1/1/1995 1/1/1995 1/1/1995 2/28/1997 1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995 1/1/1995

10/16/2003 10/16/2003

B2 Covered visits. 69 Day outlier amount. 126 Deductible -- Major Medical 1 Deductible Amount 64 Denial reversed per Medical Review. 75 Direct Medical Education Adjustment. 81 Discharges. 41 Discount agreed to in Preferred Provider contract.

10/16/2003

10/16/2003 10/16/2003

91 Dispensing fee adjustment. 76 Disproportionate Share Adjustment. 68 DRG weight. (Handled in CLP12) 18 Duplicate claim / service. 27 Expenses incurred after coverage terminated. Expenses incurred during lapse in coverage

10/16/2003

200

10/31/2006 1/1/1995 9/30/2003 1/1/1995 6/30/2005 7/1/2006

26 Expenses incurred prior to coverage. 156 Flexible spending account payments 43 Gramm-Rudman reduction. 187 Health Savings account payments

187

144

Incentive adjustment; e.g. preferred product / service.

6/30/2001 1/1/1995 1/1/1995 1/1/1995 Only use when the payment of interest is the responsibility of the patient.

121 Indemnification adjustment. 74 Indirect Medical Education Adjustment. 90 Ingredient cost adjustment.

Interest amount. This change effective 85 1/1/2008: Patient Interest Adjustment (Use Only Group code PR)

1/1/1995

B4 Late filing penalty. Lifetime benefit maximum has been 149 reached for this service / benefit category. 35 Lifetime benefit maximum has been reached. Lifetime reserve days. (Handled in QTY; QTY01=LA)

1/1/1995

10/31/2002

1/1/1995

67

1/1/1995 1/1/1995 1/1/1995 1/1/1995

10/16/2003

102 Major Medical Adjustment. 104 Managed care withholding. A5 Medicare Claim PPS Capital Cost Outlier Amount. Medicare Claim PPS Capital Day Outlier Amount. Medicare Secondary Payer Adjustment Amount.

A4

1/1/1995

99

1/1/1995 1/1/1995

10/16/2003 10/16/2003

A3 Medicare Secondary Payer liability met.

188

54

Multiple physicians / assistants are not covered in this case. National Drug Codes (NDC) not eligible for rebate; are not covered. Newborn's services are covered in the mother's Allowance. As of 004010; CAS at the claim level is optional.

1/1/1995

211

7/9/2007

128

2/28/1997

93 No Claim level Adjustments.

1/1/1995

10/16/2003

192

Non standard adjustment code from paper remittance advice.

10/31/2005

Non-covered charge(s). At least one Remark Code must be provided (may be 96 comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) 78 Non-Covered days / Room charge adjustment.

1/1/1995

1/1/1995 1/1/1995 1/1/1995

B1 Non-covered visits. 111 Not covered unless the provider accepts assignment.

Not otherwise classified or "unlisted" procedure code (CPT / HCPCS) was 189 billed when there is a specific procedure code for this procedure / service 207 NPI denial - Invalid format 206 NPI denial missing 208 NPI denial - not matched

6/30/2005

7/9/2007 7/9/2007 7/9/2007

5/23/2008

189

Original payment decision is being 193 maintained. This claim was processed properly the first time. 32 Our records indicate that this dependent is not an eligible dependent as defined. Outlier days. (Handled in QTY; QTY01=OU) Patient is covered by a managed care plan. Patient payment option / election not in effect. Use code 24.

2/28/2006

1/1/1995

80

1/1/1995

10/16/2003

120

1/1/1995

6/30/2007

106

1/1/1995 1/1/1995 6/30/1999 Refer to implementation guide for 1/1/1995 proper handling of reversals. Refer to implementation guide for 1/1/1995 proper handling of reversals.

A0 Patient refund amount. 140 Patient / Insured health identification number and name do not match.

124 Payer refund amount - not our patient.

6/30/2007

123 Payer refund due to overpayment.

6/30/2007

Payment adjusted as not furnished 112 directly to the patient and / or not documented.

1/1/1995

190

Payment adjusted as procedure postponed or canceled. This change 115 effective 1/1/2008: Payment adjusted as procedure postponed; canceled; or delayed. 169 Payment adjusted because an alternate benefit has been provided

1/1/1995

6/30/2005

Payment adjusted because coverage / B5 program guidelines were not met or were exceeded. B16 Payment adjusted because 'New Patient' qualifications were not met.

1/1/1995

1/1/1995

Payment adjusted because pre210 certification / authorization not received in a timely fashion Payment adjusted because procedure / B20 service was partially or fully furnished by another provider. 108 Payment adjusted because rent / purchase guidelines were not met.

7/9/2007

1/1/1995

1/1/1995

Payment adjusted because requested information was not provided or was insufficient / incomplete. At least one 17 Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Payment adjusted because the benefit for this service is included in the payment 97 / allowance for another service / procedure that has already been adjudicated

1/1/1995

1/1/1995

191

Payment adjusted because the patient 30 has not met the required eligibility; spend down; waiting; or residency requirements. Payment adjusted because the patient 180 has not met the required residency requirements Payment adjusted because the patient 178 has not met the required spend down requirements. Payment adjusted because the patient 179 has not met the required waiting requirements Payment adjusted because the payer 154 deems the information submitted does not support this day's supply. Payment adjusted because the payer 153 deems the information submitted does not support this dosage. Payment adjusted because the payer 152 deems the information submitted does not support this length of service. Payment adjusted because the payer 150 deems the information submitted does not support this level of service. Payment adjusted because the payer 151 deems the information submitted does not support this many services. Payment adjusted because the 182 procedure modifier was invalid on the date of service

1/1/1995

2/1/2006

6/30/2005

6/30/2005

6/30/2005

10/31/2002

10/31/2002

10/31/2002

10/31/2002

10/31/2002

6/30/2005

192

Payment adjusted because the submitted authorization number is missing; invalid; 15 or does not apply to the billed services or provider. Payment adjusted because this care may 22 be covered by another payer per coordination of benefits. Payment adjusted because this B18 procedure code and modifier were invalid on the date of service Payment adjusted because this 181 procedure code was invalid on the date of service 173 Payment adjusted because this service was not prescribed by a physician

1/1/1995

1/1/1995

1/1/1995

6/30/2005

6/30/2005

Payment adjusted because this service was not prescribed by a physician; not B17 prescribed prior to delivery; the prescription is incomplete; or the prescription is not current. Payment adjusted because this service / procedure requires that a qualifying service / procedure be received and B15 covered. The qualifying other service / procedure has not been received / adjudicated. Payment adjusted because transportation is only covered to the 117 closest facility that can provide the necessary care. Payment adjusted because treatment was deemed by the payer to have been 58 rendered in an inappropriate or invalid place of service.

1/1/1995

2/1/2006

1/1/1995

1/1/1995

1/1/1995

193

Payment adjusted due to a submission / billing error(s). At least one Remark Code 125 must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Payment adjusted due to non-covered 202 personal comfort or convenience services. Payment adjusted due to the impact of 23 prior payer(s) adjudication including payments and / or adjustments Payment adjusted for absence of precertification / authorization. This 197 change effective 1/1/2008: Payment adjusted for absence of precertification / authorization / notification. 203 Payment adjusted for discontinued or reduced service. Payment Adjusted for exceeding precertification / authorization. Payment adjusted since the level of care changed

1/1/1995

2/28/2007

1/1/1995

10/31/2006

2/28/2007

198

10/31/2006

186

6/30/2005

Payment adjusted when anesthesia is performed by the operating physician; the 194 assistant surgeon or the attending physician 129 Payment denied - Prior processing information appears incorrect. Payment denied / reduced for absence of; or exceeded referral

2/28/2006

2/28/1997

165

10/31/2004

194

Payment denied as Service(s) have been considered under the patient's medical 168 plan. Benefits are not available under this dental plan Payment denied because only one visit B14 or consultation per physician per day is covered. Payment denied because service / 113 procedure was provided outside the United States or as a result of war. Payment denied because the diagnosis 146 was invalid for the date(s) of service reported. Payment denied because the patient has 177 not met the required eligibility requirements 175 Payment denied because the prescription is incomplete Payment denied because the prescription is not current Use Codes 157; 158 or 159.

6/30/2005

1/1/1995

1/1/1995

6/30/2007

6/30/2002

6/30/2005

6/30/2005

176

6/30/2005

Payment denied because this provider B23 has failed an aspect of a proficiency testing program. 174 Payment denied because this service was not prescribed prior to delivery

1/1/1995

6/30/2005

Payment denied. The advance 116 indemnification notice signed by the patient did not comply with requirements. 25 Payment denied. Your Stop loss deductible has not been met.

1/1/1995

1/1/1995

195

Payment denied / reduced because injury 160 / illness was the result of an activity that is a benefit exclusion. Payment denied / reduced because 157 service / procedure was provided as a result of an act of war. Payment denied / reduced because the payer deems the information submitted 57 does not support this level of service; this many services; this length of service; this dosage; or this day's supply. Payment denied / reduced because the 159 service / procedure was provided as a result of terrorism. Payment denied / reduced because the 158 service / procedure was provided outside of the United States. Payment denied / reduced due to a 195 refund issued to an erroneous priority payer for this claim / service Payment denied / reduced for absence 62 of; or exceeded; pre-certification / authorization. Payment for charges adjusted. Charges 24 are covered under a capitation agreement / managed care plan. 172 Payment is adjusted when performed / billed by a provider of this specialty

9/30/2003

9/30/2003

Split into codes 150; 151; 152; 1/1/1995 153 and 154.

6/30/2007

9/30/2003

9/30/2003

2/28/2006

1/1/1995

4/1/2007

1/1/1995

6/30/2005

Payment is denied when performed / 171 billed by this type of provider in this type of facility. 170 Payment is denied when performed / billed by this type of provider.

6/30/2005

6/30/2005

196

Payment is included in the allowance for 190 a Skilled Nursing Facility (SNF) qualified stay. 100 Payment made to patient / insured / responsible party.

10/31/2005

1/1/1995

Payment / Reduction for Regulatory 137 Surcharges; Assessments; Allowances or Health Related Taxes. Per regulatory or other agreement. The provider cannot collect this amount from 209 the patient. However; this amount may be billed to subsequent payer. Refund to patient if collected. (Use Group code OA) 205 Pharmacy discount card processing fee 82 PIP days. 143 Portion of payment deferred. 132 Prearranged demonstration project adjustment.

2/28/1999

7/9/2007

7/9/2007 1/1/1995 2/28/2001 2/28/1997 10/16/2003

Predetermination: anticipated payment 101 upon completion of services or claim adjudication. 145 Premium payment withholding A7 Presumptive Payment Adjustment Previously paid. Payment for this claim / B13 service may have been provided in a previous payment. 71 Primary Payer amount. A6 Prior hospitalization or 30 day transfer requirement not met. Use code 23.

1/1/1995

6/30/2002 1/1/1995

1/1/1995

1/1/1995 1/1/1995

6/30/2000

197

65

Procedure code was incorrect. This payment reflects the correct code. Procedure / product not approved by the Food and Drug Administration.

1/1/1995

10/16/2003

114

1/1/1995 1/1/1995 1/1/1995 1/1/1995 6/30/2002 2/29/2004 1/1/1995 1/1/1995 10/31/2006 6/30/2007

94 Processed in Excess of charges. 89 Professional fees removed from charges. 44 Prompt-pay discount. 147 Provider contracted / negotiated rate expired or not on file.

161 Provider performance bonus 103 Provider promotional discount (e.g.; Senior citizen discount).

122 Psychiatric reduction. 199 Revenue code and Procedure code do not match.

Services by an immediate relative or a 53 member of the same household are not covered. 39 Services denied at the time authorization / pre-certification was requested. Services not covered because the patient is enrolled in a Hospice. Services not documented in patients' medical records.

1/1/1995

1/1/1995

B9

1/1/1995

B12

1/1/1995

Services not provided or authorized by 38 designated (network / primary care) providers.

1/1/1995

198

State-mandated Requirement for Property and Casualty; see Claim 162 Payment Remarks Code for specific explanation. 86 Statutory Adjustment. 105 Tax withholding. 134 Technical fees removed from charges. The charges were reduced because the B21 service / care was partially furnished by another physician. The claim / service has been transferred to the proper payer / processor for B11 processing. Claim / service not covered by this payer / processor. 14 The date of birth follows the date of service. The date of death precedes the date of service. The diagnosis is inconsistent with the patient's age. The diagnosis is inconsistent with the patient's gender. The diagnosis is inconsistent with the procedure. The diagnosis is inconsistent with the provider type. The disposition of this claim / service is pending further review. Duplicative of code 45.

2/29/2004

1/1/1995 1/1/1995 10/31/1998

10/16/2003

1/1/1995

10/16/2003

1/1/1995

1/1/1995

13

1/1/1995

1/1/1995

10

1/1/1995

11

1/1/1995

12

1/1/1995

133

2/28/1997

199

98

The hospital must file the Medicare claim for this inpatient non-physician service.

1/1/1995

10/16/2003

The prescribing / ordering provider is not 184 eligible to prescribe / order the service billed. The procedure code is inconsistent with 4 the modifier used or a required modifier is missing. 8 The procedure code is inconsistent with the provider type / specialty (taxonomy). The procedure code / bill type is inconsistent with the place of service. The procedure / revenue code is inconsistent with the patient's age. The procedure / revenue code is inconsistent with the patient's gender. The referring provider is not eligible to refer the service billed.

6/30/2005

1/1/1995

1/1/1995

1/1/1995

1/1/1995

1/1/1995

183

6/30/2005

The referring / prescribing / rendering 52 provider is not eligible to refer / prescribe / order / perform the service billed. 185 The rendering provider is not eligible to perform the service billed.

1/1/1995

2/1/2006

6/30/2005 1/1/1995 1/1/1995

29 The time limit for filing has expired. 51 These are non-covered services because this is a pre-existing condition

These are non-covered services because this is a routine exam or screening 49 procedure done in conjunction with a routine exam.

1/1/1995

200

These are non-covered services because 50 this is not deemed a 'medical necessity' by the payer. These services were submitted after this 166 payers responsibility for processing claims under this plan ended. D21 This (these) diagnosis(es) is (are) missing or are invalid This (these) diagnosis(es) is (are) not covered; missing; or are invalid. This (these) diagnosis(es) is (are) not covered. This (these) procedure(s) is (are) not covered. This (these) service(s) is (are) not covered. This claim is denied because the patient refused the service / procedure. This payment is adjusted based on the diagnosis. Use code 96.

1/1/1995

2/28/2005

1/1/1995

6/30/2007

47

1/1/1995

2/1/2006

167

6/30/2005

48

1/1/1995

10/16/2003

46

Use code 96.

1/1/1995

10/16/2003

155

6/30/2003

B22

1/1/1995

This payment is adjusted when performed / billed by this type of provider; B6 by this type of provider in this type of facility; or by a provider of this specialty. This product / procedure is only covered 188 when used according to FDA recommendations. This provider was not certified / eligible to B7 be paid for this procedure / service on this date of service.

1/1/1995

2/1/2006

6/30/2005

1/1/1995

201

This service / equipment / drug is not 204 covered under the patients current benefit plan 83 Total visits. 87 Transfer amount. Workers Compensation case settled. Patient is responsible for amount of this 201 claim / service through WC Medicare set aside arrangement or other agreement. (Use group code PR). W1 Workers Compensation State Fee Schedule Adjustment

2/28/2007

1/1/1995 1/1/1995

10/16/2003

10/31/2006

2/29/2000

Taken from Claim Adjustment Reason Codes: Last Update 7/9/2007, http://www.wpcedi.com/custom_html/claimadjustment.htm.

Properties of a Charge
When it is time to send a claim to insurance or send a statement, there are a number of things VersaForm must know. How does VersaForm decide how to handle a charge? For instance, where does it find out whether the charge is subject to a copay. In general, the rule that VersaForm follows is: 1. Look first at the insurance plan to get the value to start with. If there is none, use the default. 2. If there is a value in the patient's Billing Information Tab or his Insurance Tab, it can override the value from the insurance plan. 3. If there is a value that applies to the specific CPT code and fee schedule, it overrides what you have so far. 4. Finally, any information actually entered for this charge has the last word.

This table indicates where the various values are kept.


Field Default Patient CPT for Ins Patient Statement Billing Fee Charge Plan Insurance Options Info Schedule

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Copay per visit Copay Copay % Crossover Destination

Yes None None No Default fee schedule

Y Y Y Y Y Y Y Y Y Y

Fee Schedule

Used as key

Accept Assignment Patient Full Responsibility Hold Statement When to billPrimary No

Y Y (Default is Delay)*

No insurance Y claims No insurance Y claims None Y

When to billSecondary Payment Code Adjustment Code

None

*Delay in this case means that patients are not to be billed until insurance has either paid or denied.

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Procedure Explosions
A procedure explosion enables you to enter one mnemonic procedure code that represents up to 9 procedures. If you have a series of procedures that often occur together, this can be a real timesaver. For example, you may regularly give an examination and order a urinalysis and blood chemistry panel at the same time. You could have one code that represents these three charges, and thus enter them all with one click of Add Charge or Add Charge Full. You can also specify a delay in the treatment date and entry date. This is useful, for example, when there is a planned course of treatment, such as a number of physical therapy sessions or a pregnancy that should be billed over a number of months. VersaForm lets you specify the number of months you want to have billing delayed for each of the procedures.

How to Enter an Explosion


1. Click on the Add Charge or Add Charge Full buttons. 2. Type the name of the Explosion in the Code field. 3. Tab or click off the Code field. 4. VersaForm will bring up the ICD9 Codes selection window. 5. Select the ICD9 code(s) you want and click the OK button. 6. You will see the Verify Explosion of Procedure Codes window.

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7. If the list is correct, click on the OK button., if not click on the Cancel button. 8. VersaForm will create a charge line for each code in the Explosion.

See Adding a New Procedure Explosion for information on creating Explosions.

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Payments and Adjustments


Adding a Payment
1. From a patient's ledger, click the Add Payment button. 2. Enter the Payment Amount and the Payment Type. If the payment is from an insurance plan, choose that plan as the Payment Type. Otherwise, choose the payment methodCash, Visa, etc. 3. Select the Payee Account from the list of those previously defined, or type in a new one. This field marks payments to separate bank accounts within the practice. It is only used when printing deposit slips. 4. Unless this is a payment in advance, you should always indicate which charge or charges are being paid. The unpaid charges are listed in the lower portion of the screen. You can enter the amounts yourself, or you can have the system distribute the payment automatically. VersaForm can automatically pay the oldest charges first, or it can pay a proportional amount on each one. 5. Enter any deductible amount or adjustments that should be applied to each charge. 6. You may enter an Allowed Amount or an OTAF (Obligated To Accept as payment in Full) amount. Often the allowed amount is required for an electronically submitted secondary claim, and both are required if the payer is to be Medicare. 7. If the insurance plan has denied or rejected any charges, or put them in a pending status, click the applicable checkboxes. 8. If the payment amount is zero, the charge will not be marked 'PAID', since there is no payment. If you want the charge not to appear as though insurance is pending, you must check the Denied box. Otherwise the charge will still appear pending, and will not appear as "payable now" on a standard statement. Note: Although you can make a payment on a charge that has not yet been claimed, you cannot mark such a charge denied, rejected, or pended.

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Entering Payments
Entering Payments 1

Entering Payments 2

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208

Entering Payments 3

209

Entering Payments 4

Entering Payments 5

210

Entering Payments 6

211

Entering Payments 7

212

Entering Payment 8

213

Entering Payment 9

Entering Payment 10

Entering a Copay
There are two ways to enter a copay, from the Ledger and from the 214 Scheduler.

To Enter a Copay from the Ledger


1. Click the Enter Copay button on the Ledger Tab.

2. Verify the Payment Amount; change it if necessary. 3. Enter the Payment Type (cash, Visa, etc.) 4. If you want, you may enter a Description. 5. If the copay is being collected before the patient is seen, there is no charge to apply it to, and you are done. Click the Ok button. 6. If the copay is being collected after the patient is seen, click Apply Payments, and apply the copay to a charge just as you do when applying an ordinary payment. 7. Click the Ok button.

To Enter a Copay from the Scheduler


When you are checking the patient in through the copay. 1. Click the CopaY button. Scheduler you can also enter the

2. Verify the Payment Amount; change it if necessary. 3. Enter the Payment Type (cash, Visa, etc.) 215

4. If you want, you may enter a Description. 5. Click the Ok button.

Adjustments
To Add an Adjustment
1. Right-click on the line containing the charge to be adjusted. 2. Click on Enter Adjustment.

3. Enter the adjustment in the Amount field in the Adjustment for ... window.

4. You may change the Adjustment Type, if you want. 5. Svc Date will automatically fill with today's date or you can enter another date. 6. Note will automatically fill with something like "Adj 10-1-07 code 99213" where 10-107 is the Service Date and 99213 is the Code.

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Note that the adjustment will not be visible on the ledger unless you choose View, Ledger, Show Adjustments on the Windows Menu Bar.

Note: You can not adjust a payment, only a charge.

Reversing Charges, Payments and Credits


Since payments and charges cannot be erased (that would be poor accounting practice), they must be reversed when they have been erroneously entered.

To Reverse a Charge
Find the charge to be reversed, right click on that line and choose Reverse this Charge from the menu.

If payments have already been applied to the charge being reversed, the payment applications will be reversed, too. If you can't reverse the charge, you will need to adjust it to zero.

To Reverse a Payment
Find the credit to be reversed, right click on that line and choose Reverse Payments only (not the Credit) from the menu.

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This will preserve the credit and allow it to be applied to another charge.

To Reverse a Credit
Find the credit to be reversed, right click on that line and choose Reverse this Credit from the menu.

This removes the credit and any payments against charges.

Multi-Patient Payments
Payments that apply to several patients are often received from an insurance carrier. These are listed on a form called an EOB (Explanation of Benefits).

To Apply These
1. On the menu bar, choose Insurance, then Multi-Patient Payments.

. 1. The window that appears, Multi-Patient Payments Not Yet Posted..., shows any unfinished EOBs. To begin a new one, click the New button.

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2. The Multi-Patient Payment window will be shown. Think of this window as recording a single EOB.

3. Enter information in the Payment Date, Issued By and Check Number fields.

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4. Select the Payee Account from the list of those previously defined, or type in a new one. This field is for the purpose of distinguishing payments to separate accounts, usually different bank accounts, within the practice. Payee Accounts are only for creating separate Deposit Slips. 5. Enter the total check amount in the Amount field. 6. Click the Add button to enter one line for each patient for whom payment is being posted.

7. Choose the patient's Name and the Insurance Plan using the drop-downs. Enter the Amount being paid if you know it, or leave it blank. 8. If you have a second payment for a patient, use a quote mark (") to avoid looking up the patient a second time. 9. For a denial, check the Denied box. Don't enter an Amount. 10. When you are done, click the Process All button. The system will retrieve each patient's ledger in turn, and you can post the payment to the ledger just as you did for a single payment. To post to just one patients ledger, select that line and click the Payment Worksheet button. 11. Finally, click Ok. If the entire amount of the EOB has been assigned to patients, the payments you have made using the payment window will be made permanent. If not, the payments will not yet show up on the patients ledgers, and the EOB will be saved until you finish it. Notes: If you find that you must reverse the payments made in the Multi-Patient Payment window, visit each ledger that is involved in turn and reverse the payments on that ledger. If the insurance company has held back some of the money from the check (for instance, if they claim they overpaid you on an earlier payment), you will not be able to enter the full amount on each payment, because it will not balance with the check. You will have to enter a smaller amount for one or more patients. If the holdback is due to a previous overpayment, you will have to (after posting the EOB) transfer the amount from the account into which it was incorrectly entered to the account(s) on this EOB that did not get enough. See Correcting for Insurance Takebacks. 220

Deposit Slip Report


The Deposit Slip report is intended to show all payments entered on a particular date. Payments can be shown for only a particular Payee Account, or for all Payee Accounts. Payee Account is entered in the Multi-Patient Payments window, or the Payment Worksheet designating into which account in the practice the payment is to be deposited. It is an optional field defined by the user. The Deposit Slip by Payee Account report shows all payments entered for a particular date, grouped and subtotaled by Payee Account. 1. Click the Reports button on the toolbar or the Reports item in the File menu.

The Select Report window will open. 2. Click on the + to the left of Practice Management to open it.

3. Then either double click on Deposit Slip or single click on Deposit Slip and then click on either the Preview or the Print button, and you will be prompted to enter the date for the Deposit Slip. 4. You will then be prompted for the Payee Account for the Deposit Slip. 221

Select a specific Payee Account or <none specified> for all Payee Accounts. 5. The Deposit Slip will then be displayed or printed.

Balancing against the Deposit Slip


If you want to balance your Deposit Slips, you should compare them to Payments by Payment Type or Production Report -- by Code.

Issue a Refund or Transfer


You may need to refund money to a patient or transfer money from one patient to another.

Refunds
1. Open the patient's ledger from which you want to issue a refund. There must be at least one credit line with an item balance, to provide the funds for the refund. 2. On the Menu Bar, click Utilities. 3. On the Utilities drop-down menu, click Issue Refund or Transfer. The Refund for ... window will open. 4. Click on the line containing the credit to be refunded. Credits Selected will be set automatically. 5. Enter the Refund Description or accept the offered text. 6. Fill in the Refund Amount, up to the Credits Selected amount.

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7. Click the Refund button. The refund will be entered on the ledger as an adjustment with a code of Refund. If you want adjustments to be displayed on the ledger, click View on the Menu Bar, click Ledger and then click Show Adjustments if it is not checked.

Transfers
You may need to transfer money from one patient to another, for example when an insurance company has held back some money from a check. Open the patient's ledger from which you want to transfer. There must be at least one credit line with an item balance, to provide the funds for the transfer. 1. On the Menu Bar, click Utilities. 2. On the Utilities drop-down menu, click Issue Refund or Transfer. The Refund for ... window will open. 3. Click on the line containing the credit to be refunded. Credits Selected will be set automatically. 4. Enter the Refund Description or accept the offered text. 5. Fill in how much you want to transfer in the Refund Amount, up to the Credits Selected amount. 6. Click on the Transfer button. 7. Click on the Choose now button. 8. Choose a patient from the Select a Patient Chart window. 9. You can type a description to go in the new patient's chart or accept the offered text. 10. Click the OK button. The transfer will be entered on the first patient's ledger as an adjustment with a code of Transfer and on the second patient's ledger as a credit with a code of XFER.

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If you want adjustments to be displayed on the ledger, click View on the Menu Bar, click Ledger and then click Show Adjustments if it is not checked.

Correcting Mistakes
Occasionally it is necessary to correct a mistake. If the mistake involves a charge or a payment, you cannot do this by simply erasing a ledger entry. For security and to preserve the accounting trail, this is not allowed. However, VersaForm provides the ability to reverse entries and to make adjustments. These will enable you to correct most errors. Question: Patient A has a $100 charge and pays it in full. You post the patient's payment, so the patient's balance is $0. Now you discover that your contract with the insurance company requires you to make a $10 adjustment on that charge, and collect only $90. So the patient is due a $10 refund. How do we accomplish this? Answer: 1. On the patient's ledger, reverse the $100 payment, not the credit. Right click on the $100 credit line and choose Reverse Payments only (not the Credit).

2. Apply $90 to the charge, and adjust the remainder. Double click on the credit. Click on the Apply Payments button. Enter 90 in the Paid column. 224

Click on the A button. Click on the Ok button.

3. Refund the $10 to the patient. Click on Utilities. Click on Issue Refund or Transfer.

Click on a credit line to choose the credit to be transferred. Fill in the Refund Description. Fill in the Refund Amount. Click on the Refund button.

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Note: When you reverse a credit, the system will automatically generate an adjustment to offset the credit. You will not see the adjustment on the ledger unless you request it on the View menu on the Menu Bar. Question: You accidentally posted a payment to an insurance company that had already paid. Answer: You need to reverse the credit and then re-enter it. 1. Right click on the incorrect PayIns line. 2. Choose Reverse this Credit.

3. You will see "Payments have already been made from this credit. Continue?" Click on the Yes button. 4. You will see the Choose Payments to Reverse window. 5. Click on the checkbox for the payment to reverse. 6. Click the OK button.

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7. When you see "Remove the Paid status for [insurance company]?" Click on the No button. 8. Click on the Add Payment button. 9. Add the payment and apply it.

Correcting for Insurance Takebacks


Occasionally it is necessary to correct for an insurance company mistake. You cannot do this by simply erasing a ledger entry. For security, and to preserve the accounting trail, this is not allowed. However, VersaForm provides the ability to reverse entries and to make adjustments. These will enable you to correct most errors.

Example
Question: The Insurance company sends a check for $200 for patient A. You post the payment against a $200 charge for patient A. Then the insurance company decides they should not have made that payment. They inform you that they are denying it, and that you owe them $200. Later they send you a check for $500 for patient B. Patient B has a $700 charge, and the insurance is paying $700, but $200 was kept back to make up for the previous overpayment to patient A. How do we post this to the Ledger? The Ledger needs to show that a payment of $700 to patient B was received. The deposit slip needs to show a deposit of $500.

Answer:
1. On patient A's ledger, reverse the $200 payment that was paid on the $200 charge. Right click on the $200 credit line and choose Reverse Payments only (not the Credit).

Change the claim's status to Claim Sent.

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2. Click the Add Payment button. 3. Click on the Denied checkbox to mark the original $200 charge as denied, and click on the Ok button.

4. Transfer that $200 credit from patient A to patient B. Click on Utilities. Click on Issue Refund or Transfer.

Click on a credit line to choose the credit to be transferred. Fill in the Refund Description. Fill in the Refund Amount. Click on the Transfer button. 228

Click on the Choose Now button.

Select the patient to transfer to and click on the Ok button.

Enter a description and click on the Ok button. 229

5. On patient B's ledger, apply the $200 credit to the $700 charge leaving it with a balance of $500. Double click on the transfer line with the $200 credit to apply the credit.

Click on the Apply Payments button. Choose the insurance plan. Fill in the Paid amount. Click the Ok button.

6. On patient B's ledger, apply today's $500 check to the $700 charge.

Electronic Remittance Advice


The ANSI standard for this type of file is the 835 Electronic Remittance Advice. Like the 997, it comes in the form of a file that you can download. The file is not intended to be read by a person, but VersaForm can read the file and automatically process the credits, apply payments, automatically enter adjustments, apply deductions, and post remaining balances either as patient responsibility or as an adjustment.

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835 Option Setup


You have a wide range of options for controlling how the 835 processing works. Before you use the VersaForm ERA feature, you must specify the processing options that you want to use. All of the 835 processing options are set in each Insurance plan. To set ERA options, go to Setup, Insurance Plans and edit (or add) the Insurance plan that represents the entity that will be sending you 835s. Click here for detailed instructions on setting up your insurance plans.

Processing 835s
1. On the main menu at the top of the window, click on Insurance and Read EDI Info.

2. You will see:

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3. Click on Begin and VersaForm will present you with a window that allows you to navigate to the 835 file:

4. Once you have found the file, click on it and then click Open and VersaForm will read the file. 232

5. As the file is processed, progress and information messages will appear in the upper Batch Results pane, and error messages and warnings will appear in the lower Error Results pane. When the file has been processed, VersaForm will move it to the 835Processed folder or, if it was not a ANSI 997 or 835 file, to the 835Errors folder . 6. Repeat Steps 3 and 4 until you have read all of your 835 files. 7. When you have read all of your files, click the Done button. If you see any messages in the Error Results pane, it is important that you carefully review the Exceptions Report (see below) to determine if you need to take additional actions. If your system includes the ERA module, you will see three report buttons on this screen. 1. The Payments Report button. Items shown on the Payments Report represent completed processing that requires no further action on your part. Clicking the Payments Report button will show all ERA credits, payments, adjustments, deductions, and item balances that were processed without error. You will be asked to select the file that was used for processing the 835. 2. The Exceptions Report button. Items are shown on the Exceptions Report when some further action on your part may be necessary. Errors, insurance codes that cannot be automatically processed, unapplied credits and the like will cause items to be shown on the Exception Report. Consequently, you should review this report carefully to see if additional action is necessary. Clicking the Exceptions Report button will cause a display of all ERA credits that generated an error or warning. You will be asked to select the file that was used for processing the 835. 3. The Reconciliation Report button. This report shows the totals for insurance payments, VersaForm credits and payments and indicates the amounts accounted for on the Payments and Exceptions reports. You can also access the Payments, Exceptions, and Reconciliation reports through VersaForm Reports button.

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Other Things to Know


1. An 835 cannot be re-processed as that would result in duplicate ledger entries. If you attempt to re-run an 835 you will get messages indicating that this file has already been processed. 2. Once an 835 file has been processed, VersaForm no longer needs the file. You can produce reports for any 835 file processed without the file being present. 3. The Payment and Exception reports show items such as the options used and indicate if the insurance plan was the primary insurance when the 835 was processed. This information will not match the VersaForm settings if they have been changed since the 835 was read. 4. Multiple Insurance Plans You should be aware that a payment from an insurance plan might include remittance on behalf of a different insurance plan. For example, if a claim is forwarded for payment to a different plan. The 835 processing uses the options set for the insurance plan you used to submit the claim. If the two plans have different options sets, the results might not be what you expected. Using the same options for both insurance plans will produce consistent processing for all the claims covered by an insurance payment. In any event, the 835 reports will show when a payment is made on behalf of a different insurance plan.

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Insurance
Viewing Charge Status
To See More Information about a Charge
Select the line with the charge you want to know about, and right-click on it. Select Claim and Payment Details from the popup menu. The Payment, Adjustment, and Insurance Details window will show the payments and adjustments that have been applied to the charge, and also whether the item has been claimed. If it has, the status of the claim will be shown, too. If the patient has insurance, the insurance status will be shown. You can change whether the charge is to be claimed or not, or cancel an existing claim and request another one by right-clicking on the insurance status line. (Cancelling a claim tells the system not to expect paymentas might be the case when an insurance company informs you that the claim was not received.) If a claim has been created, you can right click on the insurance status line and choose Go To Claim to see more information about the claim. There you can choose to reprint the claim (if it was a paper claim) or resubmit it.

Claim and Charge Status


You can follow the status of insurance claims and the charges on them through each step of the claim process.

To See More Information about a Charge


Select the line with the charge you want to know about, and right-click. Select Claim and Payment Details from the popup menu.

The Payment, Adjustment, and Insurance Details window will show the payments and adjustments that have been applied to the charge, and also whether the item has been claimed. If it has, the status of the claim will be shown, too. 235

At the top of the Payment, Adjustment, and Insurance Details window are the details of the charge. The first pane shows the payment and adjustment details for the charge. The second pane shows the current status for the charge for each of the patient's insurance carriers. E/P/C stands for electronic / paper / crossover. Finally, the bottom pane shows the complete chronological history of statuses for this charge across all claims for all insurance carriers. Remember that a charge can appear on several claims, and a claim can have more than one charge. So a claim's status and a charge's status are not quite the same thing. To see the status of a claim (as opposed to a charge), right-click on a line in either of the bottom two panes, and select Go to Claim.

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The claim that the line refers to will be displayed in the Claim Details window.

Claim status is also shown in the Printing Paper Claims, Paper Claims and Electronic Claims batch windows which are accessible from the main menu under the Insurance menu item.

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Claim Status Lifecycle


When setting up an insurance plan in Setup, the following options affect the claim process: 1. When to Bill--Primary and Secondary 2. Crossover Destination If When to Bill--Primary is set to Create Claims, then the status of a new charge on the Patient Ledger is immediately set to B for the primary insurance ('B' means 'Bill to Insurance'). This means that the charge is queued to be billed to the primary insurance, and will be placed on a claim the next time a batch of claims to this insurance carrier is generated. Similarly, a secondary insurance carrier can be configured with When to Bill-Secondary so that the charge status is set to B 1. Immediately after it is created; 2. After the primary insurance company has paid; or 3. After the previous insurance company has paid. Since a crossover destination is submitted by the initial insurance carrier, VersaForm does not emit or print a claim for a crossover destination. But it does remember that a claim was made, so its progress can be tracked. The claim may be printed later for accounting purposes. The Crossover Destination option can be overridden in the patient's Insurance on the Registration Tab of a patient's chart.

Two other initial statuses of charges are A for Advisory and F for 'Force to Paper'. An Advisory claim is one that is sent to an insurance company for record purposes only, and no payment shall be remitted. Therefore, when an Insurance Plan's When to Bill--Primary option is set to Advisory, new charges on the ledger receive a status of A. When claims are generated for this insurance carrier, the status will then change immediately to SETTLED meaning no further action shall be taken on this charge. This will be the end of the statuses for this charge. A charge can have its status set to F for an insurance carrier which has a electronic claims processor assigned to it. In such a case, the charge will be put on a paper claim instead of an electronic one. All of the initial statuses can be manipulated directly by the user from the Payment, Adjustment and Insurance Details window. Right-click on an insurance carrier line in the second sunken pane titled Charge Status per Insurance and Claim, and a pop-up menu will appear. After a charge is placed on a claim, if its status was B or F, then it will change to SENT. This indicates the charge is awaiting adjudication by the insurance carrier. The charge can be cancelled at this time by the user from the right-click menu in the Charge Status per 238

Insurance and Claim pane or by pressing the Cancel and Re-Submit button in the Claim Details window. When the user requests that a charge on a claim be cancelled, VersaForm will cancel all charges on that claim, after first prompting the user. A charge which has a status of SENT, can also be PAID, DENIED, PENDED or REJECTED. All of these statuses are assigned by the user from the Payment for ... worksheet window which is invoked when the user presses the Add Payment button from the patient's ledger, or the Payment Worksheet button from the Multi-Patient Payments window.

PAID means the insurance carrier made a payment for the charge claimed. This status is assigned when the user enters an amount in the Paid field for the charge. DENIED means the insurance carrier denied payment for the charge claimed. This status is assigned when the user checks the Denied checkbox for the charge. PENDED means the insurance carrier has not finished adjudicating the charge claimed, but has received the claim and validated the information on it. This status is assigned when the user checks the Pended checkbox for the charge.

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REJECTED means the information for the charge claimed was incorrect, incomplete or otherwise invalid. The charge needs to be claimed again to the insurance carrier on a new claim. This status is assigned when the user checks the Rejected checkbox for the charge.

Once a charge is CANCELLED, PAID, DENIED or REJECTED, there can no longer be any further activity for this charge on this claim. To reclaim a charge which was CANCELLED, DENIED or REJECTED, the user must requeue the charge on the insurance carrier (by changing its status to B in the pane titled Charge Status Per Insurance and Claim in the Payments, Adjustments and Insurance Details window). When all of the charges on a single claim have been either CANCELLED, PAID, DENIED or REJECTED, the summary status of the claim changes from SENT to CANCELLED if all the charges were cancelled, and otherwise to SETTLED.

Secondary Insurance Overview


When a patient has two or more insurances, the claims sent to other than the Primary Insurance are, in general, called Secondary Claims.

There are Two Different Ways to Handle Secondary Claims


1. The first is to let the Primary Insurance send information on to the Secondary Insurance. This is called "Crossover". On paper claims the crossover information is sent in Box 9a 9d. VersaForm records the fact that a secondary claim was sent as a crossover. The status for the secondary insurance claim is set to SENT. On electronic claims the crossover information is sent in the file. The status for the claim to the secondary plan is set to SENT. Note: if you have set an insurance plan as a crossover destination in the Registration, Insurance Tab and have not included a Payer ID in the Setup, Insurance Plans record the claim will not include the secondary information. 2. The second method assumes the operator will process the secondary claim. In that case, assuming that you chose (3rd, 4th) Claim after previous insurance paid or Claim after primary insurance has paid in Setup Insurance Plans, When to bill-Secondary for the Secondary Insurance, VersaForm will bill the Secondary Claim after the Primary (or Previous) Claim has been settled. The Secondary Insurance generally wants to know how much the Primary Insurance paid and how much was adjusted off (the COB information). In addition, Medicare now wants to know about all of the adjustments, not just a total.

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Sending the COB Information on to the Secondary Insurance is Done in Two Different Ways
1. If you are using the ERA (Electronic Remittance Advice) feature to electronically receive and process payments (sometimes called 835 records), the adjustment and payments information is automatically recorded. 2. When you post payments and adjustments from a paper EOB you use the Payment dialog. There is a field to record the Paid amount, anything that applies to the deductible (Deduct), and adjustments (Adjust). You will also see a field for Allowed and OTAF (amount Obligated To Accept as payment in Full). If you will be sending the balance to a secondary payer on paper you will normally send a copy of the EOB with the claim. If you are going to send the claim to a secondary payer electronically and they do not require adjustments to be detailed you are done. If you are going to send the claim to a secondary payer electronically AND the secondary payer requires adjustments be detailed you must click on the EOBA button and supply more information. The sum of the adjustments you enter plus the payment received must equal the original charge. See EOB Adjustments for details on filling in the adjustments.

Setting up Secondary Insurance Claims


To successfully submit secondary insurance claims, there are 3 things to do:
1. The insurance plan must be set up for secondary claims. 2. The patient's secondary insurance must be set up in the patient chart. 3. Payments and adjustments from the primary must be recorded correctly.

1. Insurance Plans
Open Insurance Plan Setup Or Click on the Setup button in the top tool bar.

Click on the Insurance Plans Tab. To add a record click on the Add button and follow the instructions at Insurance Plan Setup.

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Locate the existing plan on the list and double click on it or click once to highlight it and then click on the Edit/View button.

The Fields to Check What You See

Crossover Destination A Crossover claim is submitted by the initial insurance carrier so VersaForm does not create a claim for a crossover destination. However, VersaForm does remember that a claim was made, so the claim's progress can be tracked. The claim may be printed later for accounting purposes. The Crossover Destination checkbox can be overridden in the Insurance Tab of the Registration Tab of a patient's chart.

A primary insurance should never have the crossover destination option set to yes so it is probably best to leave this unchecked and instead use the Crossover Destination dropdown in the patients Insurance Tab. When to Bill -- Secondary Pick the appropriate choice from the Drop-down list. (3rd, 4th) Claim after prev ins pd covers all non primary insurances.

2. Patient Chart
Open the Patient Chart Click the Open Chart button on the Toolbar.

Locate the patients name on the list and double click on it or click once to highlight it and then click on the Ok button.

Patients Insurance Click on the Registration Tab. 242

Click on the Insurance Tab. Click on the Add button.

What You See

The Number field will be automatically filled in. Fill in the same information as if it were the primary insurance except: Medicare Secondary Type Required when the destination payer (Loop 2010BB) is Medicare and Medicare is the secondary plan. Crossover Destination Use this to override the value set in Insurance Plan Setup. A Crossover claim is submitted by the initial insurance carrier so VersaForm does not create a claim for a crossover destination. However, VersaForm does remember that a claim was made, so the claim's progress can be tracked. The claim may be printed later for accounting purposes. The Crossover Destination checkbox can be overridden in the Insurance Tab of the Registration Tab of a patient's chart.

Click the OK button when you are done filling in the form. What You See

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3. Ledger
Add Payment When adding a payment from the primary insurance, you may need to enter an Allowed amount and an OTAF (Obligated To Accept as payment in Full) amount. Often the allowed amount is required for an electronically submitted secondary claim, and both are required if the payer is to be Medicare. If the OTAF is blank, VersaForm uses the Allowed amount. If the Allowed amount is blank, and there is an Approved amount (from the Miscellaneous Tab in Add Charge Full), VersaForm uses the Approved amount. If you receive a paper EOB and are going to submit an electronic secondary claim, you need to click on the EOBA button and enter all the adjustments to be sent to the secondary insurance.

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Problems with Secondary Insurance Claims


Secondary insurance claims will be rejected if the information for the charge claimed was incorrect, incomplete or otherwise invalid.

Setup for Resubmitting


The charge will need to be claimed again to the insurance carrier on a new claim. From the patient Ledger, choose Add Payment, and click on the Rejected check box for the charge and then click Ok.

The icon in the Ins2 column will change to a dollar sign with a red circle and slash over it.

To reclaim the charge which was rejected, click on the rejected icon and you will go to the Payments, Adjustments and Insurance Details window.

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Right click on the rejected claim in the Charge Status Per Insurance And Claim panel and choose Rebill or mark for first billing. The Status will change to BILL. Click Ok to get back to the ledger. The icon in the Ins2 column will now change to a stack of pages.

Correct the Error


You may need to check for errors in several places. Patient Chart Go to the Registration Tab and then the Insurance Tab. Double click on the Secondary Insurance, the one with the 2 in the Number field.

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Medicare Secondary Type -- Required when the destination payer (Loop 2010BB) is Medicare and Medicare is not the primary payer. Crossover Destination -- Use this to override the value in the insurance plan's setup. A primary insurance should never have the crossover destination option set as Yes. Crossover destination is asking the user Is this the final destination of the claim? So normally it is the secondary insurance which has the crossover destination set to Yes. Make any necessary changes and click on OK.

Setup
Insurance Plans Tab Double click on the appropriate Insurance Plan.

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Crossover Destination -- Since a Crossover claim is submitted by the initial insurance carrier, VersaForm does not create a claim for a crossover destination. But it does remember that a claim was made, so the claim's progress can be tracked. It may be printed later for accounting purposes. The Crossover Destination option can be overridden in the Patient Insurance on the Registration Tab of a patient's chart.

Include Adjustments on Secondary Elec Clm -- Determines whether adjustment information should be sent with secondary claims. Some insurance companies require this. When to Bill -- Secondary -- Pick the appropriate choice from the Drop-down list. Click on OK when you are finished making any changes. Providers Tab Since each Provider has his or her own ID numbers (from Medicare, Medicaid, the Blues, etc.) the ID numbers are kept in the Provider Setup. The Edit Provider window has a special button, Edit Insurance IDs, for entering these. Submitters Tab If the practice uses Submitters (Submitters are used when providers do not submit insurance in their own name, as in a group practice), each submitter may have their own 248

IDs, too. The Edit Submitter Info window has an Edit Insurance IDs button just as the Provider Setup does.

Ledger
Add Payment You may enter an Allowed amount or an OTAF (Obligated To Accept as payment in Full) amount. Often the allowed amount is required for an electronically submitted secondary claim, and both are required if the payer is to be Medicare. If the OTAF is blank, VersaForm uses the Allowed amount. If the Allowed amount is blank, and there is an Approved amount (from the Miscellaneous Tab in Add Full Charge), VersaForm uses the Approved amount.

Proof of Filing
Often insurance companies will want you to prove you sent a claim within the allowed time. There are several ways to accomplish this. Here is one: Open the Patient Chart. View the claims details for the claim in question (click on the INS1 icon). You will see the Payment, Adjustment and Insurance Details window:

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If necessary, drag the window so you also see the patient's name. Press the PrtScr key (to the right of the F12 key). This keystroke puts a picture of the screen in the Windows Clipboard. Now start a word processor (like Word, WordPerfect, etc.). If you do not have a word processor click on the Start button, click on Run, type in: wordpad and click on OK. When the word processor is opened press Ctrl + V (this key stroke combination pastes the contents of the Windows Clipboard into your open document). Add some text. For example: This is a screen capture of our program's history for this claim. Note the date sent 07-06-07. Also note it was re-sent on 8-10-07. Print this and send it to the insurance company.

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If you have documentation from a clearing house you may want to highlight the claim number to show that it matches the above record, photocopy it and send it to the carrier.

Claim As
VersaForm has added the Claim As feature to better handle Incident-to insurance billing for Physicians' Assistants and Nurse Practitioners. In these cases the services may be performed by the PA or NP, but the billing should be done in the supervising physician's name. The incident-to rules are stated in the Medicare Carriers Manual (Part 3, Chapter II, section 2050).

How to Use the Claim As Feature


In the patient's ledger, click on the Add Charge Full button. Fill in the information as you normally do except: Choose the PA or NP as the Provider. Choose the supervising physician as the Claim As.

The claim will be prepared just as though the services were performed by the supervising physician instead of the PA or NP.

Insurance: CLIA Numbers


CLIA Numbers
CLIA stands for Clinical Laboratory Improvement Amendments. CLIA numbers are required on Medicare claims for any laboratory performing tests covered by the CLIA Act. Some states' Medicaid may want the CLIA number, too. For paper claims, the CLIA number goes in Box 23 of the 1500 claim form, but only for Medicare. For electronic claims, the CLIA number is sent in loop 2300 REF and, in some cases, loop 2400 REF, regardless of the type of insurance.

If you want to be reimbursed by Medicare for any in-house lab work, you will need to have a CLIA number associated with your Primary facility. If you want to be reimbursed by Medicare for outside lab work, you will need the CLIA number of the lab that performed the work.

There are Two Different Ways to Get CLIA Numbers on Medicare Claims
1. Use a CPT4 Code that has Needs CLIA checked in 251 Setup, CPT4 Codes.

--Or-2. Check Lab Work in the Problem/Facility Tab of the Charge.

Setting up a Facility for CLIA Numbers


1. Go to Setup, Facilities. 2. Edit/View the lab facility. 3. Enter the CLIA number in CLIA #. 4. Click the OK button.

Setting up a CPT4 Code for CLIA Numbers


1. Go to Setup, CPT4 Codes. 2. Edit/View the code that needs a CLIA number. 3. If you have a Medicare Fee Schedule, click on the checkbox for Needs CLIA for that schedule. If you don't have a separate Medicare Fee Schedule, click on the checkbox for Needs CLIA for the Default fee schedule. 4. Click the OK button.

Setting up an Insurance Plan for CLIA Numbers


1. Go to Setup, Insurance Plans. 2. Edit/View the Medicare insurance plan. 3. Choose Medicare Part B for the Claim Filing Indicator. 4. Click the OK button.

Entering Inside Lab Charges


If you are entering lab charges for Medicare, see CLIA Numbers for information on setting up for CLIA numbers.

To Bill Medicare for Inside Lab Charges


1. Click on Add Charge Full. 2. Enter the usual information on the Charge Tab, making sure that there is a Referring physician. 3. Click on the Problem/Facility Tab. 4. If you see the Quick Start Reminder, click on Continue. 5. Click Yes to the question about saving changes. 252

6. Click to check Lab Work 7. Click the OK button. On Paper Claims

If the Insurance is Medicare you will see the lab's CLIA number in Block 23.

You will also see the referring physician's name and IDs in Block 17 and the lab's name, address and IDs in Block 32. In Electronic Claims The referring physician's name and IDs will be emitted in Loop 2310A and the CLIA number will be emitted in a REF segment of Loop 2300.

Entering Outside Lab Charges


If you are entering lab charges for Medicare, see CLIA Numbers for information on setting up for CLIA numbers.

To Bill an Insurance Company for any Outside Lab Charges you Paid
1. Click on Add Charge Full. 2. Enter the usual information on the Charge Tab, making sure that there is a Referring physician. 3. Click on the Problem/Facility Tab. 4. If you see the Quick Start Reminder, click on Continue. 5. Click Yes to the question about saving changes. 6. Click to check Lab Work .

7. Fill in Purchased Svc or Lab Wk Provider from the dropdown list. 8. Fill in the Amt you paid. 9. Click the OK button. On Paper Claims You will see an X in the Yes box of Block 20 and the value of Amt under $ CHARGES.

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If the Insurance is Medicare you will see the lab's CLIA number in Block 23.

You will also see the referring physician's name and IDs in Block 17 and the lab's name, address and IDs in Block 32. In Electronic Claims The referring physician's name and IDs will be emitted in Loop 2310A and the CLIA number will be emitted in a REF segment of Loop 2300 along with the Purchased Service Provider name in 2310C.

Insurance: Print Claims


Claims Printer Setup
You can pre-set which printer your computer will use to print claims. Follow these Steps Click on the Setup button on the tool bar:

In the Setup window click on the Reports Tab:

In the Reports Setup Tab locate the line that reads - "HCFA/CMS 1500". Click on it once to highlight it [1]. Now click on the Edit/View button [2](or double-click):

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You will see the Edit Report Parameters window. Click on the down pointing arrow Printer field [1]:

in the

Highlight or click on the printer of your choice [2]. Click on the OK button [3]. From this point all claims will be printed to that printer.

Selecting the Claims Printer at Creation Time


You can set up which printer is to be used for printing claims. To do this you must be logged in as DBA, or as another user who has System Administrator authority. Then follow these steps: Click on the Setup button on the tool bar:

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In the Setup window click on the Reports Tab:

In the Reports Setup dialog locate the line that reads - HCFA/CMS 1500. Click on it once to highlight it [1]. Then click on the Edit/View button [2](or double-click):

In the Edit Report Parameters window click on Show Setup Before Printing it and then click on the OK button [2].

[1] to check

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After you have created a claim or claims the system will ask you which printer you want to use:

Click on the printer of your choice [1] and then click on the Print button [2].

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Printing Claims
To print a claim for one or more charges for a patient:
1. From the patient's 2. Click the Print button. 3. Choose Print Claims for Selected Charges from the popup menu. Ledger, select the lines containing those charges.

4. If there is more than one insurance plan, choose which one.

5. Choose whether to print the form overlay, or to print on a preprinted form. 6. If you check Preview/Edit you will have a chance to look at and modify the form. 7. Click the Ok button.

To print claims for all of one patient's charges that are waiting to be claimed:
1. From the patient's ledger, click the Print button. 2. Choose Print Claims from Queued Charges from the popup menu.

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3. Choose whether to print the form overlay, or to print on a preprinted form.

4. If you check Preview/Edit you will have a chance to look at and modify the form(s). 5. Click the Begin button. --OR-259

1. Click Insurance on the Menu Bar. 2. Choose Paper Claims. 3. Choose For Current Patient.

4. Choose whether to print the form overlay, or to print on a preprinted form. 5. Click the Begin button.

To print claims for one or more insurance plans:


1. Click Insurance on the Menu Bar. 2. Choose Paper Claims. 3. Choose For Insurance Plan.

4. In the Paper Claims window, click on the insurance plan or plans that you want to bill. To choose all plans, click on the Select All button.

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5. Click Create Claims. 6. On the Printing Paper Claims window, choose whether to print the form overlay, or to print on a preprinted form. 7. If you check Preview/Edit you will have a chance to look at and modify the form(s). 8. Click the Begin button.

Print to File
It is possible to print your claims to an ASCII text file instead of to the printer. Many electronic claims clearinghouses can accept this type of file. There are a couple of things you need to do differently if you want to send ASCII files. To use this method you have to get to the Printing Paper Claims window. There are two ways to get there. 1. From the Ledger, Print button, Print Claims from Queued Charges menu item.

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2. From the Insurance, Paper Claims menu.

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Note that the Print file name (optional) field says none. This is where you tell VersaForm where to put the claims. 1. Enter a file name in the field. 2. Click on the Begin button. 3. Click on the Done button when you are finished. Your claims will be printed to the file you named. Any existing copy of that file will be erased. Additionally, a second file will be written, with the date and time automatically added to the file name, so the file can be saved without any duplicates. For instance, if you entered claims.txt at 11:30:20 AM on 6/25/07, the additional file would be named 20070625.113020.claims.txt. The claims.txt file is not released by VersaForm until you close VersaForm. However the file with the date and time added on can be used right away.

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Claim Printing Problems


If Your Claims Won't Print
1. Make sure the insurance isn't set up for electronic claims. The Electronic Claims Processor field should be blank. Setup Insurance,

2. In the patient's ledger, make sure that the Svc Date is not in the future. 3. Try printing the claim from the patient's ledger.

To Print the CLIA Number


1. CLIA numbers are only for Medicare so the Claim Filing Indicator for the insurance plan must be Medicare Part B. 2. Lab Work 3. Needs CLIA needs to be checked on the Problem/Facility Tab of the charge. must be checked in the CPT code ( Setup, CPT4 Codes).

4. CLIA # needs to be filled in for the facility in

Setup, Facilities.

CLIA Error Message


If you get an error message about needing a CLIA for a facility other than yours, you may have put a facility in Purchased Svc or Lab Wk Provider that you meant to put in Service Facility.

Reprint, Resend and Resubmit


In VersaForm, these words have specific meanings as they relate to insurance claims. Reprinting a claim simply prints a paper claim just as it was printed before. You would do this if you needed a second copy. The claim will be unchanged. Resending a Group of electronic claims re-creates the file just as it was created before. You would do this if the claims processor denies receiving your transmission, and you need to send it again, and can't find the original file. Resubmitting one or more claims returns all unpaid charges on those claims to a status of TO BE BILLED. The next time claims are created, those charges will be included. You would do this if the claims were denied, or you had made changes and want to create new claims for the same charges. Charges which have been SENT, and for which the system is awaiting payment, cannot be resubmitted. You must mark them denied, rejected or cancelled first, whichever is appropriate.

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Reprinting a Claim
To Reprint a Claim that has been Printed
1. From the patient's ledger, right-click on one of the claimed charges. 2. Choose Claim and Payment Details.

3. The Payment, Adjustment, and Insurance Details window will open. 4. In the Charge Status Per Insurance And Claim pane, right-click on the claim you want. 5. Choose Go To Claim from the popup menu.

6. The Claim Details window will open. 7. Click on the Reprint button. --Or-1. On the Menu Bar, click Insurance, then choose Paper Claims and For Insurance Plan from the drop-down menu.

2. Choose the insurance plan for which the claim was printed. You may need to check the Show All box by clicking on it to see the particular insurance plan. 265

3. Click on the date of the claim, then click on the claim to be reprinted. 4. Click on the Re-Print button.

Resubmitting a Claim
To Resubmit a Claim that has been Printed
1. From the patient's ledger, right-click on one of the claimed charges. 2. Choose Claim and Payment Details.

3. The Payment, Adjustment, and Insurance Details window will open. 4. In the Charge Status Per Insurance And Claim pane, right-click on the claim you want. 5. Choose Go To Claim from the popup menu.

6. The Claim Details window will open. 7. Click on the Cancel and Re-Submit button. --Or-1. On the Menu Bar, click Insurance, then choose Paper Claims and For Insurance Plan from the drop-down menu.

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2. Choose the insurance plan for which the claim was printed. You may need to check the Show All box by clicking on it to see the particular insurance plan. 3. Click on the date of the claim, then click on the claim to be resubmitted. 4. Click on the Cancel and ReSubmit button.

Insurance: HCFA 1500


CMS1500 (HCFA 1500) Form 08/05
Where in VersaForm is this field's data to be found?
Block 1: Setup Insurance Plans Tab. Claim Filing Indicator.

Block 1a: Patient Registration | Insurance Tab. Subscriber ID. Block 2: Patient Registration | Demographics Tab. Last Name, First and Middle. Block 3: Patient Registration | Demographics Tab. Date of Birth. Block 4: Patient Registration | Insurance Tab. Edit/View an insurance plan. If Relationship is 'Self', "SAME" is printed, otherwise the Subscriber Information is used. Block 5: Patient Registration | Demographics Tab. Home Address. Block 6: Patient Registration | Insurance Tab. Edit/View an insurance plan. Relationship. For Primary Insurance. If Medicare, do not check Self. Block 7: Patient Registration | Insurance Tab. Edit/View an insurance plan. If Relationship is 'Self', "SAME" is printed, otherwise the Subscriber Information, Subscriber Address Fields. For Primary Insurance. Block 8: Patient Registration | Relationships Tab. Block 9: Patient Registration | Insurance Tab. For Secondary Insurance. If Relationship is 'Self', "SAME" is printed, unless Secondary is Medicare. For Medicare, if no MediGap benefits are assigned, leave blank. Block 9a: Patient Registration | Insurance Tab. For Secondary Insurance. Edit/View an insurance plan. Subscriber ID. Block 10a: Charge details. Problem/Facility Tab. Employment Related?. Block 10b: Charge details. Problem/Facility Tab. Auto Accident Date. Block 10c: Charge details. Problem/Facility Tab. Illness_Accident_Pregnancy?.

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Block 11: Patient Registration | Insurance Tab. If Medicare is Secondary, then Subscriber ID is filled in. For Medicare, 11d is always blank. Block 12: Patient Registration | Billing Info Tab. Release on File indicates that you have a signature and Patient Signature Source contains Auth for HCFA-1500 block 12 on file or Auth for HCFA-1500 blocks 12 & 13 on file. Block 13: Patient Registration | Billing Info Tab. Benefits Assigned is checked and Patient Signature Source contains Auth for HCFA-1500 block 13 on file or Auth for HCFA-1500 blocks 12 & 13 on file. Block 14: Charge details. Problem/Facility Tab. Date Condition Originated. Or, if Illness/Accident/Pregnancy is Pregnancy, then LMP. Block 15: Charge details. Problem/Facility Tab. Had similar symptom and Similar Symptom Date. Block 16: Charge details. Miscellaneous Tab. Last Worked and Return to Work. Block 17: Patient Registration | Demographics Tab Referring Physician or Charge Tab Referring. Block 17a: Setup Referring Tab, Edit/View. Insurance Defaults Qualifier and ID or Edit IDs, Qualifier and Id number. Block 17b: Setup, Referring Tab, Edit/View. NPI.

Block 18: Charge details. Problem/Facility Tab. Hospital Admit and Hospital Discharge. Block 19: Charge details. Miscellaneous Tab. Administrative Section. Fill in Claim Note and Code and select Block 19 in the drop down to the left of the text field. Block 20: Charge details. Problem/Facility Tab. Lab Work, Purchased Svc or Lab Wk Provider and Amt. Block 21: Charge details. Charge Tab. ICDs. Block 22: Not required by Medicare. Charge details. Miscellaneous Tab. Claim Reason and Original Reference No.. Block 23: Charge details. Miscellaneous Tab. Prior Auth. Num. or Lab Work checked for Medicare CLIA. Block 24a: Charge details. Charge Tab. Date of Svc and End Svc Date. Block 24b: Charge details. Charge Tab. Place of Svc. Block 24c: Charge details. Problem/Facility Tab. Emergency Related.

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Block 24d: Charge details. Charge Tab. Code and M1 through M4. For California Workers' Compensation only, VersaForm puts the first 13 characters of the Type of Service in M1 and M2. Block 24e: Charge details. Charge Tab. ICDs. For Medicare, enter only one reference number per line item. Block 24f: Charge details. Charge Tab. Charge. Block 24g: Charge details. Charge Tab. Qty. Block 24h: Charge details. Miscellaneous Tab. Administrative section, Special Program is EPSDT or CHAP. Block 24i: Rendering Provider ID Qualifier. Must select Rendering IDs for Variant in Setup Insurance Plans Tab. Medicare always fills in 24i unless you choose No Rendering IDs for Variant. Block 24j: Rendering Provider ID and NPI. Must select Rendering IDs for Variant in Setup Insurance Plans Tab. Medicare always fills in 24j unless you choose No Rendering IDs for Variant. Block 25: Setup Submitter Tab SSN or EIN or, if no Submitter, EIN for the Primary Provider. Setup User Tab SSN or

Block 26: VersaForm uses this block for the claim number or the Patient #.. Block 27: Setup Insurance Plans Tab or Patient Registration | Insurance Tab.

Block 28: Totals of Block 24f. Block 29: For Medicare, this is how much the patient has already paid for current charges. For commercial insurances, this is the total already paid for current charges. Block 30: For Medicare, this is always empty. For commercial insurances, this is Block 28 minus Block 29. Block 31: Primary Provider from the Registration Tab or Provider from the Charge Tab. Block 32: Charge details. Problem/Facility Tab. Service Facility. Block 33: Determining where this information is located is a two step process: 1. If Submit claims as Rendering Provider in the Setup Preferences Tab is checked, then the Billing Physician is the Provider in the Patient's Charge Information; otherwise the Billing Physician is the Primary Physician from Registration | Demographics.

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2. If the Billing Physician has a Submitter in the

Setup Providers Tab then the Billing

Provider is the Submitter and the information comes from the Setup Submitters Tab, otherwise the Billing Physician is the Billing Provider and the information comes from the Setup Providers Tab. Setup Insurance Plans does not affect the 1500 08/05.

The Box33 override check box in

Notes on the HCFA 1500 and CMS1500 08/05 Claim Form


Charges Going on Different Claims
The Referring Provider and any information on the Problem/Facility and/or Miscellaneous Tabs must be the same to go on a single claim. The Rendering Provider must be the same unless: 1. In Setup, Insurance Plans, On One Claim, Multiple Providers 2. In Setup, Preferences, Submit Claims as Rendering Provider is checked. is not checked.

If the same additional insurance information (from the Problem/Facility and/or Miscellaneous Tabs) applies to more than one charge, you do not have to enter the information for each charge. Instead, enter the information for the first charge then, for each additional charge, click either the Use Previous button when using Add Charge or the Use Previous Info button when using Add Charge Full. However, VersaForm looks for the previous charge information, based on the date entered, only within the last 30 days.

Adjusting the Claim Forms in the Printer


Occasionally it is necessary to adjust the printing so it falls into the boxes on the form. To do this, you can set the top or left margins in Reports Setup for the HCFA/CMS 1500.

Dates
Both birth dates must be 8 digits. All other dates must either be 6-digits or all others must be 8-digits.

Addresses
No punctuation in the address, except a hyphen in a 9-digit zip code.

Phone Numbers
No punctuation or spaces in phone numbers.

Item 4, Medicare
If Medicare is primary, leave it blank. If Medicare is secondary and the patient is the insured, enter SAME.

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Item 6
Only checked if Item 4 is filled in.

Item 7
For Medicare, when the insured's address is the same as the patient's, enter SAME. Complete this item only when Items 4, 6, and 11 are completed. For commercial claims, only filled in if Item 4 is completed..

Item 8
Only 1 box can be checked on each line.

Item 9
For Medicare, fill in the last name, first name and middle initial of the enrollee in a MediGap policy if it is different from that shown in item 2. Otherwise, enter the word SAME. If no MediGap benefits are assigned, leave blank.

Item 9a, Medicare


Enter the policy and/or group number of the MediGap insured preceded by MEDIGAP, MG, or MGAP.

Item 9b, Medicare


Leave blank if a MediGap PayerID is entered in Item 9d. Otherwise, enter the claims processing address of the MediGap insurer.

Item 9d, Medicare


Complete if there is a policy and/or group number in Item 9a. Enter the 9-digit PAYERID number of the MediGap insurer. If no PAYERID number exists, then enter the MediGap insurance program or plan name.

Items 10a to 10cc


Only one box on each line can be marked. The state postal code must be shown if 'YES' is marked in 10b for Auto Accident. Any item marked 'YES' indicates there may be other applicable insurance coverage that would be primary. Primary insurance information must then be shown in Item 11.

Item 10d, Medicare


If the patient is entitled to Medicaid, enter the patient's Medicaid number preceded by MCD.

Item 11, Medicare


If Medicare is primary, NONE. Otherwise, enter the primary insured's policy or group number and fill in Items 11a - 11c. Items 4, 6, and 7 must also be completed. 271

Item 11d, Medicare


Always blank.

Item 12
If the field Release on File in Registration | Billing Info is filled in with anything but Provider may not release data then 'SIGNATURE ON FILE' is printed. If you are not getting 'SIGNATURE ON FILE' and Release on File is not Provider may not release data, the easiest thing to do is to click on the Benefits Assigned checkbox and then click on it again to return it to its original state and then click on the OK button. The date is required only if someone actually signs the form.

Item 13
If the field Benefits Assigned in Registration | Billing Info is checked then 'SIGNATURE ON FILE' is printed, regardless of the Patient Signature Source.

Item 14
In order to put the LMP (from the Problem/Facility Tab) in Item 14, Illness/Accident/Pregnancy must be Pregnancy.

Item 15, Medicare


Always blank.

Item 17a, Medicare


If legacy IDs are required, this must be 1G followed by the UPIN.

Item 17a
If the legacy qualifier and ID do not show in 17a, go to Setup Preferences, click on the Set NPI Dates button and change the May not use Legacy ID after date under On Paper Claims to some future date.

Item 20
On a Medicare claim, if the claim has a lab (Purchased Svc or Lab Wk Provider field on the Problem/Facility Tab for the charge) and it is an outside lab (indicated by Lab or Electronic Lab in the Kind field of the facility setup) then Yes is checked. If it is any other kind of a lab, No is checked. In either case, the lab charge (if any) is printed under $Charges. If the claim has a facility that is not a lab, No is checked. On other claims, if the claim has a lab (from the Problem/Facility Tab on a charge) then Yes is checked and the lab charge is printed. If the claim has a facility that is not a lab, No is checked.

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Item 22, Medicare


Always blank.

Item 23 CLIA Number, Medicare


When billing for lab work performed in-house, this Item must contain your CLIA number. To do this, the CLIA number must first be entered in your primary facility's setup. Then: Highlight the charge and click the Edit/View button. On the Problem/Facility Tab, check the Lab Work checkbox.

If you want to use a CLIA number other than the primary facility's, put that facility in the Purchased Svc or Lab Wk Provider field on the Problem/Facility Tab.

Item 23, Authorization Number


Item 23 is filled with the value in the Prior Auth. Num. field on the Miscellaneous Tab for the charge. To reach this Tab, highlight the charge and click the Edit/View button. You cannot use Item 23 for both authorization number and CLIA number on the same charge.

Box 24B (or Block 24B or Item 24B) Place of Service


The Use Previous buttons do not affect the Place of Svc.

Item 24C, Medicare


Always blank.

Item 24D Modifier


For California Workers' Compensation only, VersaForm puts the first 13 characters of the Type of Svc in M1 and M2.

Item 24E, Medicare


Only 1 number can be entered.

Item 24H, Medicare


Always blank.

Item 24H
To get a Y, go to Charge details, Miscellaneous Tab, Administrative section, set Special Program to EPSDT or CHAP.

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Items 24I and 24J


If the legacy qualifier does not show in the shaded portion of 24I and the legacy ID does not show in the shaded portion of 24J, go to Setup Preferences, click on the Set NPI Dates button and change the May not use Legacy ID after date under On Paper Claims to some future date.

Item 25
If the patient's Primary Physician has a Submitter and Use SSN is chosen, then the Submitter's Social Security Number (SSN) is used. If the patient's Primary Physician has a Submitter and Use EIN in Claims is chosen, then the Submitter's Employer ID Number (EIN) is used. If there is no Submitter then the Primary Physician's SSN or EIN is used.

Item 26
VersaForm needs to have the claim number available in order to process ERAs, so the default is to put the claim number in Item 26. You can change this to the Patient # in Setup Insurance Plans, Edit/View and put a check in Use Patient # in Box 26.

Item 27
Item 27 is controlled by the Assigned field on the Charge (in the Charge Edit window). This is filled by default from the Patient's Registration | Insurance Tab. Yes will be checked if the value is Assigned or Clinical Lab Services Only.

Item 30, Medicare


Always blank.

Item 31
The rendering physician's name is printed here. If Claim As is filled in, then the name chosen there is used. If there is neither Provider nor Claim As, then the patient's Primary Physician's name is printed. If you are using print-to-file (Print file name), Item 31 will have 'Signature on File' in the claim file. This is acceptable and, furthermore, the information in Item 31 is not included in ANSI claims and so what is here shouldn't matter to the clearing house.

Item 32
If a Service Facility has been entered for the charge(s), its address (from the Facilities Setup) is entered here. Otherwise, on Medicare claims only, if the Place Of Svc is not Home, the Primary Physician's facility is used. This is the facility designated by the provider's Facility field in Setup Providers, or the Primary Facility if the Provider's Setup does not designate a facility. 274

Item 32b
This may look strange because the Qualifier is printed to the left of the ID, without any spaces between them. If the legacy qualifier and ID do not show in 32b, go to Setup Preferences, click on the Set NPI Dates button and change the May not use Legacy ID after date under On Paper Claims to some future date.

Item 33
If there is no Primary Physician, in the patient's chart Registration | Demographics, the name will not print regardless of whether it is the Provider's or Submitter's information being used and regardless of whether there is a Provider on the charge.

Item 33b
If the legacy qualifier and ID do not show in 33b, go to Setup Preferences, click on the Set NPI Dates button and change the May not use Legacy ID after date under On Paper Claims to some future date. This may look strange because the Qualifier is printed to the left of the ID, without any spaces between them for all but Medicare claims. Medicare claims print the Qualifier then a space and then the ID. If the patient's Primary Physician has a Submitter, then the Submitter's information is used, and the Submitter's legacy ID for this insurance plan is placed in 33b. Otherwise the Primary Physician's information is used and the Provider's legacy ID for this insurance plan is placed in 33b.

Insurance: Electronic Claims


Electronic Claims Overview
Sending claims electronically requires more information than sending paper claims. HIPAA requires the use of the ANSI (American National Standards Institute) 837 claim format, which contains even more information than previous electronic claims formats. In addition, the payers and claims processors make still more requirements (found in their companion documents or other documents). VersaForm software does much checking to make sure all these rules are followed, but software cannot do it all. You will still have to become familiar with the rules, whether by reading all the documents, or by experience. Electronic claims requires some basic Windows file management skills such as creating a folder, navigating to a folder to upload or download a file, creating text files, naming text files, using a text editor to view and print files. Other helpful Windows skills are right click, file selection, cut and paste, delete, insert, etc.

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Steps to Creating and Sending Electronic Claims


1. Complete the setup in the VersaForm software. 2. Create the file. VersaForm creates two files: one that should be sent to the electronic claims processor but is hard for a person to read, and one that is somewhat more readable, in case there is a need to look at the file. Each file contains a Group of one or more Transaction Sets, each containing one or more Claims. Groups and Transaction Sets are numbered; you can see the numbers in the Electronic Claims window. 3. Connect and send the file using communication software. For most claims processors, a communications package such as HyperTerminal (which is part of Windows) will do the job. For some, other communications programs such as ProComm, pcAnywhere or Network and Dial-up may be best. Still others use FTP or ask you to submit thru a website. Most processors will provide step-by-step instructions for setting up and using HyperTerminal (also in our Help files) and/or Network and Dial-up connections. 4. Receive an answer from the Electronic Claims Processor. According to the standard, this will be a file using the ANSI 997 format that will tell whether the file you sent was accepted for adjudication. Some processors do not send a 997, rather they send a human-readable report file. In either case, you must use your same communications software to retrieve it. 5. If you have a 997, read it into the system and check for errors. 6. If you don't have a 997. You probably have a printed report. Check the report against the original transaction set. 7. If there were errors and a transaction set was rejected, fix the errors. Then, from the Electronic Claims window, cancel the rejected claims (to let the system know not to wait for payment on those claims) and resubmit them. To do this, highlight the claims, then click the Cancel and ReSubmit button. Then click on the Create Claims button again.

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Electronic Claims Submission


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Sending Claims with HyperTerminal


HyperTerminal is a telnet communications program that ships with all flavors of Windows. It can be used to send claims data to those insurance companies that do not use the Internet to receive claims. First you need to create a HyperTerminal Connection Icon. See Creating a HyperTerminal Connection Icon, and you need to set up a folder on your C drive called Claims. (See Creating Folders for Insurance Files.)

Connecting

1. Double click on the HyperTerminal Connection Icon. 2. Click on the OK button. 3. Click on the Dial button. 4. Enter your login name and password.

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What to do after you are Connected


Once you are connected you are usually presented with a menu of options. Follow the menu until you get to the point of sending the file. When the processor's program is ready to receive files follow these steps to send your file: 1. On the HyperTerminal toolbar, click on the Send the menu bar and then click on Send File... button (or click on Transfer in

1. If you do not know the path and name of your data file click on the Browse button and you will see something like:

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2. In the Select File to Send dialog click on the pick list for the field Look in.

3. Click on the drive where you stored the file (generally the C: drive). 4. Once you have clicked on the C: drive you will see a list of folders.

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5. Double click on the folder where you stored your files, in this case Claims.

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6. Locate the file you want to send and click on it once. 7. This puts the file's name in the File name field. Note that the file ends in "NYMC.DAT". VersaForm added the date and time stamp to identify when the file was created. 8. NOTE: If you have not been dragging the files into the Sent folder after sending them, there may be many files that end in "NYMC.DAT" (or the name of the file you created). You can tell which one to send by the date and time that precedes the file name. 9. Now click on Open. 10. Finally, click on Send. The file will then be sent to the claims processor.

How to Get Your Response Files Using HyperTerminal


Before you send your first file tell HyperTerminal where to store downloaded or response files. To do this see Set up HyperTerminal to Store Downloaded Files. Many Claims Processors will start the download of their response files automatically. You generally do not have to tell HyperTerminal to start the download. 292

Hyper Terminal will place any file you download in the folder you specify in the Receive File dialog. If your Claims Processor tells you to start the download follow these steps: Click on the Receive button.

If Place received file in the following folder: does not show the proper place to store your downloaded file, type in the address or use the Browse button to point HyperTerminal to the correct folder. Click on the Receive button.

Reviewing an Electronic Claim Transaction Set


In the ANSI 837 format required by HIPAA, electronic claims are always sent as part of a Transaction Set. A transaction set may contain one claim or many. Even if there is only one claim, it must still be sent in a transaction set. VersaForm keeps a copy of each transaction set that is sent. If the claims processor sends you an error report, you can view the transaction set to determine where the error is. Transaction sets are divided into Loops; and the loops are numbered. Each loop may contain several segments, each with one grouping of information. For instance, Loop 2010AB is called "Subscriber Name", but it actually contains segments for the Subscriber Name, Subscriber Address, Subscriber City/State/ZIP Code, Subscriber Demographic Information, and so forth. Note that the segment for the Subscriber City/State/ZIP Code actually contains 3 data items.

To View a Transaction Set


1. On the Menu Bar, click on Insurance and choose Electronic Claims from the menu.

2. In the Electronic Claims window, choose the Processor you sent the claim to. The upper pane will display the groups of claims that have been sent to this processor. 3. Click on the Group No. of interest. 4. The lower pane will display all the Claims in that group. Each Claim# also includes the transaction set number in the TSet# column.

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5. Find the line containing the transaction set you want to view, right click on that line and choose View Transaction Set.

The transaction set will be displayed with loop numbers and identifying names.

Electronic Claim Problems


If the Patient doesn't Show up in the List
1. Make sure the insurance is set up for electronic claims. The Electronic Claims Processor field needs to be filled in. Setup Insurance,

2. In the patient's ledger, make sure that the Svc Date is not in the future. 3. The claim's status may be FORCE PAPER rather than BILL. In the Ledger, right click on the Bill Icon and you will see the Payment, Adjustment and Insurance Details window. If it says FORCE PAPER, right click on FORCE PAPER and choose Rebill or mark for first billing.

CLIA Error Message


If you get an error message about needing a CLIA for a facility other than yours, you may have put a facility in Purchased Svc or Lab Wk Provider that you meant to put in Service Facility.

ANSI 837 Electronic Claims


In the ANSI 837 specification, each item of data is designated by a loop number. This page tells you where in VersaForm the data for each loop can be found. 1000ASubmitter Name: This information is located under Setup, Claims Processors Tab, for the Claims Processor you are using, in Transmitter and Transmitter Id. It is drawn from the list of Submitters. 1000BReceiver Name: This information is located under Setup, Insurance Plans Tab, for the insurance plan being billed, in Name and Destination Payer Receiver Code. 2000ABilling/PayTo Provider Hierarchical Level This level contains information regarding the billing provider and payto provider. 2010AABilling Provider Name: Determining where this information is located is a three step process: 294

1. If the Billing Provider under information comes from Billing Provider.

Setup, Claims Processors Tab is not blank then the

Setup, Submitters Tab for the Submitter chosen to be the

2. If Submit claims as Rendering Provider under Setup, Preferences Tab is checked, then the Billing Physician is the Rendering Provider (Provider in the Patient's Chart, Ledger, Charge or in the Pvdr column in the Patient's Chart, Ledger); otherwise the Billing Physician is the Primary Physician from the Patient's Chart, Registration, Demographics. Setup, Providers Tab then the

3. If the Billing Physician has a Submitter under

Billing Provider is the Submitter and the information comes from the Setup, Submitters Tab, otherwise the Billing Physician is the Billing Provider and the information comes from the Setup, Providers Tab.

2010ABPayTo Provider Name: If the Billing Provider under Setup, Claims Processors Tab is not blank then the information comes from steps 2 and 3 above, otherwise this loop is not emitted. Also, if this information is the same as in loop 2010AA, then 2010AB is not emitted. 2000BSubscriber Hierarchical Level This level contains information regarding the subscriber to the insurance plan being billed. Check in Setup, Insurance Plans, under the insurance plan, Claim Filing Indicator needs to be filled in correctly. 2010BASubscriber Name: This information is located in the Patient's Chart, Registration, Insurance Tab. Add or Edit/View an insurance plan and set up the subscriber information for the plan being used. If the patient is not the subscriber, be sure to fill in the Subscriber Information and the Subscriber Address. 2010BBPayer Name: This information is located under the insurance plan the claim is being billed to. Setup, Insurance Plans Tab for

2010BCResponsible Party Name: This information is located in the Patient's Chart, Registration, Billing Info Tab under the Additional Insurance Information Heading. Check the Other Responsible Party box, then click the Edit button that shows up and fill in the Billing Address information. 2010BDCredit/Debit Card Holder Name: This information is located in Patient's Chart, Registration, Billing Info Tab under Credit Card Info.

2000CPatient Hierarchical Level 295

This level contains information regarding the patient. If the patient IS the subscriber, the information in this level will not be emitted. 2010CAPatient Name: This information is located in the Patient's Chart, Demographics. 2300Claim Information Hierarchical Level This level contains information regarding the entire claim. 2310AReferring Provider Name: This information is located under Setup, Referring Tab for the Referring Provider for this claim. The Referring Provider is selected either in the Patient's Chart, Registration, Demographics, Referring Physician or in the Patient's Chart, Ledger, Charge Tab, Referring. If a referring provider is selected in the Charge Tab Charge Information, it takes precedence. 2310BRendering Provider Information: This information is located under Setup, Providers Tab, under the Rendering Provider for this claim, Fullname, Qualifier and ID. The Rendering Provider is selected either in the Patient's Chart, Registration, Demographics Tab Primary Physician or in the Patient's Chart, Ledger, Charge Tab, Provider. If a provider is selected in the Charge Tab Charge Information, it takes precedence. If the Rendering Provider is the same as the Pay-To Provider of Loop 2000 AB or AA (Either SSN or EIN matches, and Pay-To Provider is a person) this loop is omitted. 2310CPurchased Service Provider Information: This information is located under Setup, Facilities Tab under the facility Name, ID and Qualifier. The purchased service provider is selected in the Patient's Chart, Ledger, Charge, Problem/Facility Tab Purchased Svc or Lab Wk Provider. Check the Lab Work check box if it is a lab. 2310DService Facility Location: This information is located under The service facility is selected in the Patient's Chart, Tab, Service Facility. Setup, Facilities. Registration,

Ledger, Charge, Problem/Facility

2310ESupervising Provider Information: This information is located under

Setup,

Providers Tab or the Setup, Referring Tab, under the supervising provider for this claim, Fullname, Qualifier and ID. The supervising provider is selected in the Patient's Chart, Ledger, Charge, Problem/Facility Tab Supervising Provider or Supervising Provider (referring). 2320Other Subscriber Information: The information in this loop is regarding additional subscriber details. (See 2330A for more information.)

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2330AOther Subscriber Name: This information is located in the Patient's Chart, Registration, Insurance Tab. Edit/View an insurance plan and choose something other than Self for the Relationship. Under Subscriber Information name(s), Sex and DOB are required and under Subscriber Address the address fields are required. 2330BOther Payer Name: This information is located under Setup, Insurance Plans Tab. The information in this loop is regarding the primary insurance. 2330COther Payer Patient Information: This loop contains patient demographics. The information in this loop is regarding additional patient details. 2330DOther Payer Referring Provider: This information is located under Setup, Referring Tab for the Referring Provider for this claim. The Referring Provider is selected either in the Patient's Chart, Registration, Demographics, Referring Physician or the Patient's Chart, Ledger, Charge Tab, Referring. If a Referring Provider is selected in Charge Information, it takes precedence. The information in this loop is regarding additional referring physician details. 2330EOther Payer Rendering Provider: This information is located under Setup, Providers Tab, under the Rendering Provider for this claim, Fullname, Qualifier and ID. The Rendering Provider is selected either in the Patient's Chart, Registration, Demographics, Primary Physician or in the Patient's Chart, Ledger, Charge Tab, Provider. If a provider is selected in Charge Information, it takes precedence. The information in this loop is regarding additional rendering physician details. 2330FOther Payer Purchased Service Provider: This information is located under Setup, Facilities Tab under the facility Name, ID and Qualifier. The purchased service provider is selected in the Patient's Chart, Ledger, Charge, Problem/Facility Tab Purchased Svc or Lab Wk Provider. Check the Lab Work check box if it is a lab. The information in this loop is regarding additional purchased service provider details. 2330GOther Payer Service Facility Location: This information is located under Setup, Facilities Tab. The service facility is selected in the Patient's Chart, Ledger, Charge, Problem/Facility Tab, Service Facility. The information in this loop is regarding additional service facility details. 2330HOther Payer Supervising Provider: This information is located under Setup,

Providers Tab or the Setup, Referring Tab, under the supervising provider for this claim, Fullname, Qualifier and ID. The supervising provider is selected in the Patient's Chart, Ledger, Charge, Problem/Facility Tab Supervising Provider or Supervising Provider (referring). The information in this loop is regarding additional supervising provider details. 2400Service Line Hierarchical Level 297

This level contains the information regarding the individual service lines. If the information in any particular loop is the same as the corresponding loop on the claim level (2300 loops) then that loop will not be emitted. 2410Compound Drug Information: This information is located in the Patient's Chart, Ledger, Charge, Drugs Tab. 2420ARendering Provider Information: This information is located in Setup, Providers Tab, under the Rendering Provider for this claim, Fullname, Qualifier and ID. The Rendering Provider is selected either in the Patient's Chart, Registration, Demographics, Primary Physician or in the Patient's Chart, Ledger, Charge Tab, Provider. If a provider is selected in Charge Information, it takes precedence. If the Rendering Provider is the same as the Pay-To Provider of Loop 2000 AB or AA (Either SSN or EIN matches, and Pay-To Provider is a person) this loop is omitted. 2420BPurchased Service Provider Information: This information is located under Setup, Facilities Tab under the facility Name, ID and Qualifier. The purchased service provider is selected in the Patient's Chart, Ledger, Charge, Problem/Facility Tab Lab Work check box, if it is a lab, and Purchased Svc or Lab Wk Provider. 2420CService Facility Location: This information is located under Setup, Facilities

Tab. The service facility is selected in the Patient's Chart, Ledger, Charge, Problem/Facility Tab, Service Facility for the service facility for this service line. The information in this loop is regarding additional service facility details. 2420DSupervising Provider Information: This information is located under Setup,

Providers Tab or the Setup, Referring Tab, under the supervising provider for this claim, Fullname, Qualifier and ID. The supervising provider is selected in the Patient's Chart, Ledger, Charge, Problem/Facility Tab Supervising Provider or Supervising Provider (referring). 2420EOrdering Provider Name: This information is located under Setup, Providers Tab, under the ordering provider for this claim, Fullname, Qualifier and ID. The ordering provider is selected in the Patient's Chart, Ordering Provider. Ledger, Charge, Problem/Facility Tab

2420FReferring Provider Name: This information is located under Setup, Referring Tab for the Referring Provider for this claim. The Referring Provider is selected either in the Patient's Chart, Registration, Demographics, Referring Physician or in the Patient's Chart, Ledger, Charge, Referring. If a referring provider is selected in Charge Information, it takes precedence.

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2430Line Adjudication Information: This information is located under

Setup,

Insurance Plans Tab and may be in the Patient's Chart, Ledger, Charge, EOB Adj Tab if the primary claim was on paper and the secondary claim is electronic.

Notes on 837 Electronic Claims


If you receive errors involving the following loops and/or terms, look here for more information on correcting them. ISA01: Empty the Authentication (ISA02) in order to get "00" in ISA01. ISA08: If there is nothing in 1000B NM109 (Destination Payer Receiver Code in Insurance Plans), we put ISA08 there (Receiver Id in Setup Claims Processors). Setup

ISA13: ISA13 is a group number which VersaForm increments each time a new file is created. 2000A PRV: THIN now requires you fill in Provider Type in not have a group practice. 2000B SBR: Check the Claim Filing Indicator in Setup Providers, if you do

Setup Insurance Plans.

2010AA: Make sure that there is a Submitter associated with the Provider. 2010AA: 1A means Blue Cross and 1B means Blue Shield. Setup Insurance Plans, the Default Provider ID Qualifier chooses which to use. If you are interested, you can see a list of all the Qualifiers here. 2010AA REF: Look at the submitter in and qualifiers. Setup Submitters and check the Edit IDs numbers

2300 CLM16: The only valid entry here is a P. In the charge, on the Miscellaneous Tab, check the Participation Agreement for Non-Par Provider checkbox. 2310B: If an insurance company asks for 2310B (equivalent to 24I and 24J), you have already chosen Rendering IDs in Setup Insurance Plans Variant for the insurance company, and the Provider and Submitter have the same EIN, remove the Provider's User's EIN to force generation of 2310B. If the insurance company wants the EIN in 2310B, put a dash in the User's EIN and not in the Submitter's. 2310B: If your Medicare does not want 2310B filled in for sole providers, there are several things to check. 1) In Setup Submitters, the SSN and EIN (if entered) for the Submitter that is used in the Claims Processor must be the same as those entered in the sole Provider's User, and the Submitter must have Is a Person checked. 2) In Setup Insurance Plans, the Variant for the Medicare plan must be No Rendering IDs. 3) In

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Setup Claims Processors, the Submitter must be the one above. Billing Provider doesn't matter and Is a Person is not required. Multiple Segments, ISA first or IEA last: In put a 1 in Group transaction set limit. Setup Claims Processors, for the processor,

NTE: Notes & Codes have a maximum of 80 characters. UPIN problems: The Referring physician needs the UPIN in the Insurance Defaults ID and Provider UPIN Number in the Qualifier ( up to version 3.127). Medivant: VersaForm automatically puts the date.time of creation before the filename. Medivant does not want the date.time. You must rename the file to whatever Medivant wants (e.g. IMS.CLM). Assignment Problems 2300 CLM: The CLM6 element comes from Patient Signature Source, either "Y" if it includes Block 13 or "N". The CLM7 element is "A" for Accept Assignment, "B" for Assignment Accepted on Clinical Lab Services Only, "C" for Not Assigned and "P" for Patient Refuses to Assign Benefits. The CLM8 element is also for Accept Assignment, either "Y" or "N". If you get many lines of "No service line selected for claim..." when creating claims, make sure that Accept Assignment in filled in. Claim Files When you set up a "Claims" folder, you should also set up a "Sent" folder in it. Then, after you send a claim file, move it into the Sent folder. This way it will be much easier to find the files you want to send and to read. Setup Insurance Plans for the insurance company is

837 Qualifiers
For those of you who like to know more about what is going on, here is a list of some of the qualifiers used in 837 transactions. Those in the first list, for Facilities, Providers, Referring and Submitters, are also used on the HCFA 1500 (08/05) in 17a, 24I, 32b and 33b.

For Facilities, Providers, Referring and Submitters


0B: State License Number 1A: Blue Cross Provider Number 1B: Blue Shield Provider Number

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1C: Medicare Provider Number 1D: Medicaid Provider Number 1G: Provider UPIN Number 1H: CHAMPUS Identification Number 1J: Facility ID Number B3: Preferred Provider Organization Number BQ: Health Maintenance Organization Code Number EI: Employers Identification Number FH: Clinic Number G2: Provider Commercial Number G5: Provider Site Number LU: Location Number SY: Social Security Number - The social security number may not be used for Medicare. U3: Unique Supplier Identification Number (USIN) X5: State Industrial Accident Provider Number XX: NPI (not used in REF loops)

For Relationships
01: Spouse 04: Grandfather or Grandmother 05: Grandson or Granddaughter 07: Nephew or Niece 09: Adopted Child 10: Foster Child 15: Ward 17: Stepson or Stepdaughter

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19: Child 20: Employee 21: Unknown 22: Handicapped Dependent 23: Sponsored Dependent 24: Dependent of a Minor Dependent 29: Significant Other 32: Mother 33: Father 34: Other Adult 36: Emancipated Minor 39: Organ Donor 40: Cadaver Donor 41: Injured Plaintiff 43: Child Where Insured Has No Financial Responsibility 53: Life Partner G8: Other Relationship

For Providers in NM108


24: Employers Identification Number 34: Social Security Number XX: NPI

For ISA05 and ISA07


01: Duns (Dun & Bradstreet) 14: Duns Plus Suffix 27: HCFA Carrier Identification Number 28: HCFA Fiscal Intermediary Identification Number 302

29: HCFA Medicare Provider and Supplier Identification Number 20: Health Industry Number (HIN) ZZ: Mutually Defined 33: NAIC Company Code 30: U.S. Federal Tax Identification Number

Insurance: Electronic Claim Acknowledgement and ERA


Reading an EDI file
Acknowledgements and ERAs
When you send electronic claims to a clearinghouse or payer, you can receive two different types of responses. The responses are in the form of a file that you download. The first type of response is an acknowledgement that the claim was received and the second is an electronic remittance detailing the result of the claim. The latter response is often called an ERA (Electronic Remittance Advice) and is analogous to a paper EOB (Explanation of Benefits). You do not need a special version of VersaForm to process acknowledgements but processing an ERA requires that you have a version of VersaForm with this feature.

ANSI 997Acknowledgements
When you send claims you may receive an acknowledgement that the claims were received. The ANSI standard for this is the 997 Functional Acknowledgement. It comes in the form of a file that you can download. The file is not intended to be read by a person, but VersaForm can read it and show you the contents. These files often have ACK as part of their names. When a claim is rejected here, the whole transaction set it belongs to will be rejected and there will be no further mention of all the claims in that set so it is important to read these files into VersaForm.

Reading in 997 Acknowledgements


1. On the main menu at the top of the window, click on Insurance and Read EDI Info.

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2. You will see:

3. Click on the Begin button and you will be presented with a box that allows you to navigate to the 997 file. 4. Click on the file then click Open and VersaForm will read the file and move it out of the folder. 5. Repeat the process for each file you need to read. 6. Click the Done button when you have read all of the 997 files.

Using the Information from the 997


1. On the main menu again, click on Insurance and Electronic Claims.

Choose the electronic claims processor from the drop-down list. 2. The Electronic Claims window will open and show the transaction sets that you have read. 304

3. If any Claim Batches show Rejected or Partially Accepted, click on that Group to show the Claims in it.

4. Right click on the first Claim # that has a Tset Ack of Rejected. You will see:

5. Click on View 997 Functional Acknowledgment and you will see the Claim Details window.

6. Right click on the first line that has a Segment of AK4 and the Acknowledgement Error window will open.

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You will see the Error and the Original value that was sent. If Original is blank there needs to be a value entered for that field because it is required. In this case, the Error is Segment Has Data Element Errors in Loop 2330A NM1, Other Subscriber Name, and the Code is Data element too short. The name is there but the secondary insurance Subscriber Id is not. You can get more information on reading electronic claims from Washington Publishing Company. The document we use can be ordered at: http://www.wpcedi.com/store/detail.aspx?ID=56.

Statements
Statements Overview
Statements are controlled by Statement Options, which are sets of choices that are given a name so they can be re-used. The print layout of a statement is controlled by a statement format which is one of these choices. The default statement format name is kept in the System Parameters Tab as Default Statement.

Statement Headings
Statement headings are prepared in two quite different ways.

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1. Normally the heading on a statement uses the name and address of the Primary Facility. 2. However, if the patient's primary physician (as designated in the patient's Demographics Tab) has his or her address filled in, that provider's name and address are used. In this case the address comes from the Providers Tab, and the name comes from the User Tab for that provider.

Statement Options
Statement Options provide the ability, among other things, to compute interest, to delay billing, to ask the user for a statement date at run time, to do cycle billing and to define messages to be sent based on aging.

Compute Interest
You can charge interest or not and, if you do charge interest, choose how many days are interest free. Amounts on accounts receivable reports are aged from the day they are incurred regardless of your choices here.

Show Charges for How Many Days


You can choose to show all charges, or to cut off at an arbitrary number of days (the default is 180 days). A Balance Forward line will be added for any balance before the cutoff time.

Delay Billing
If you choose to delay billing the patient, no statement will be automatically printed on a charge until all insurances have been settled for that charge. Even an outstanding copay, causing a non-zero Patient Bal on the ledger, will not cause a statement to be printed until the insurances are settled. If you have your Crossover Destinations backwards, with a Yes for the primary insurance and a No for the secondary insurance, a statement will be printed after the primary insurance is settled and before the secondary insurance is settled. A choice here to not delay billing can be overridden by: 1. The patients billing information. Registration | Billing Info | Hold Statement. 2. The insurance plans information. Setup Insurance Plans | Hold Statement.

On the other hand, you can choose to print statements whenever there is any recent activity. If you do, any charges with insurance pending are shown with a payable now of zero.

Ask Operator for a Statement Date


If you check this choice, the operator can designate the date to be used for statements.

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Cycle Billing
Cycle billing allows for billing a range of patients at a time. For example, you can designate a Statement Option that produces statements for patients whose last names start with A through M by entering A for the start and MZ for the end. If you plan to use cycle billing, it is easiest to set up one Statement Option called, for example A-M. Print that Edit Statement Options screen by right clicking on it and choosing the print option. Then refer to that print out while setting up N-Z.

Messages
You can define what messages will be sent based on the number of days since either the date of service or the date of the last patient payment.

Unapplied Credits and Payable Now


On a statement, it can happen that the sum of the payable now amounts is larger than the total due. This occurs if the unapplied credits on the patients ledger exceed the outstanding balance. The unapplied credits reduce the total due amount, but they do not reduce the individual payable due amounts because they have not been applied yet. In this case the payable now amounts are not shown on the statement. Both the amounts and the column heading are omitted. If we did not do this, the statement would say that the payable due amount was larger than the total amount due, which would not make sense to the patient.

Reversals
Reversals do not show up on patient statements.

To Print one Statement


1. Go to the patients ledger. 2. Click on the Print button. 3. Choose Print a Statement.

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4. Click on a Statement Option.

To Print More Than One Statement


1. Click on Utilities. 2. Click on Statements.

3. Choose a Statement Option.

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In both cases, if you have not added any Statement Options, defaults will be used.

Viewing Previous Statements


You can view previous statements from the patient's ledger. 1. Click on the Print button. 2. Click on View Previous Statements.

3. Double click on the statement to view.

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4. You can click on the Print button if you want to print it. 5. Click on the Done button if you are finished. VersaForm automatically clears out statement images after 6 months or, in some cases, less to keep the database from becoming too large.

Printing Statements
When printing single statements, VersaForm disregards any choices you made in the Statement Options you are using that would prevent printing.

To Print One Statement


1. Go to the patients Ledger. 2. Click on the Print button. 3. Choose Print a Statement.

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4. If Statement Options have been created, you will see a list of them on a popup menu. If not, you will see a menu of the available statement formats. Click on one.

To Print More Than One Statement


1. On the Menu Bar, click on Utilities. 2. Click on Statements.

3. If Statement Options have been created, you will see a list of them on a popup menu. If not, you will see a menu of the available statement formats. Click on one.

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Printing a Superbill
To print a statement for a patient:
1. On the patient's Ledger, click the Print button. 2. Choose Print a Superbill.

3. In the Superbill window, choose the charge lines you want printed by clicking the box(es) in the Print column or click the Select All button to print all.

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4. If you want to print to the default printer, click on the Print button. 5. If you want to choose the printer, click on the Print with Setup button.

Guarantors
In VersaForm, guarantors are set up when one person or entity is to receive the statements for a number of patients. Each patient has his or her own chart and ledger and the guarantor also has a ledger. When statements are printed, a separate statement sheet is printed for each of the patients, and a summary sheet is printed for the guarantor. Insurance claims are created normally for each patient's ledger, since that is where the detailed insurance information is. If you have patients for whom a parent or other person is to receive the statements, you do not necessarily need to set up a guarantor. Simply add that other person's billing address to the patient's registration: 1. On the Patient's chart, go to the Registration Tab, and then to the Billing Info Tab.

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2. Check the Bill to Different Address box, then click the Edit button and enter the name and billing address. That is where the statements will go.

To Set up a Full-Fledged Guarantor


1. Create a chart for the guarantor, even though he or she may not be a patient. 2. Then on the chart for each of the patients, go to the Registration Tab, and then to the Billing Info Tab. 3. In the Guarantor field, choose the name of the guarantor.

The Guarantor Summary can be Viewed from the Guarantor's Ledger


1. Click the More... button on the guarantor's ledger. 2. Click Guarantor Summary.

To print the guarantor's statements


1. Click the Print Statements button.

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Searching for Patient Data


Advanced Search
The advanced search can be used to locate patients, medications, problems, and ICD9 and CPT4 codes. The query is formed by putting together a logical expression of one or more comparisons joined together by the AND or OR operators. There are four items that can be filled in to form this query. They are: Field Name: This is a drop down list of item names in the database that you are allowed to search for. For the patient list the items are Last Name and First Name. For the drug formulary the item is Drug Name and for the ICD9 codes the items are Title and ICD9_Code. Comparison: The Comparison operator is used to determine how the data in the data base will be compared with the contents in the Value field. The options are: begins with, contains, equals (=), greater than (>), greater than or equal to (>=), less than (<), less than or equal to (<=), and does not begin with. The comparison on equality is case insensitive; that is you may use either upper or lower case characters when filling in the Value field. Value: The value you want to search for. Operator: A drop down list with the operators AND and OR. Fill in this item only if you want to perform a second comparison. As an example: Last Name equals Smith and First Name begins with Kay

The Query Parameters for ... Window has the Following Functions
Ok: Closes the window and performs the query. Cancel: Closes the window and does not perform the query. Clear: Clears all the comparisons from the query window so that they may be reentered.

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Sort Parameters
The Sort Parameters window is used to reorder a list that is displayed when the Sort function is selected on the window that contains the list. When the Sort Parameters window opens you will be able to specify the sort order for one or more items from the data base. There is room for six fields in the sort specification. To deselect a field use the last line, this is blank, in the drop down list box. For each item that you decide to sort on, you can specify to sort it in either Ascending or Descending order by clicking on the appropriate button in the Direction column. Ascending is the default value.

The Sort Parameters window has two functions:


OK: Performs the sort as specified and closes the window. Cancel: Ignores the sort specification and closes the window without sorting.

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Reports
Reports Overview
The standard reports that come with VersaForm are divided into four categories: Clinical Reports General Reports Practice Management Receivables Reports (PM Receivables)

Practice Management Reports


Generally, when VersaForm technical support personnel install custom reports, they install them in a category called Custom. See Installing a Custom Report for more information. New categories can be defined on the Reports Tab in the Setup window. If you want, you can move your frequently used reports into a special category that makes them easier to find, e.g. My Reports, June's Reports, etc. However, be aware that you are moving reports, not copying them, and that you will affect everyone's VersaForm, not just yours.

Clinical Reports Overview


There are two types of reports under Clinical. Lab Reports Patient Information Reports

Lab Reports
Electronic Lab Orders Manifest

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Electronic Labs Received

HL7 Lab Results

Patient Reports
Patient History

Patient Summary

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Electronic Lab Orders Manifest Report - Clinical


The Electronic Lab Orders Manifest report prints requisition forms for outgoing electronic labs.

You specify which lab by clicking the one you want.

You also specify the date range. See Specifying Dates in Reports for more information.

Orientation
Portrait

Sorting
There are no columns as such so there is no sorting.

Items Printed
Patient's Name Patient ID A series of Labs and Panels 320

Go to Chart
Double clicking near a Patient Name takes you to his or her chart.

Show Details Filtering by


Account # Account Name Req/Ctl# (ACC) Alt Ctrl# (CD-) Patient's Name Bill Code Patient ID Alt Patient ID (PID) Date of Birth Sex Responsible Party / Insured's Information Relationship Address Phone Collection Date Coll (Collection) Time Total Volume Units of Measure Fasting Physician ID UPN / Provider # Clinical Info Test Ordered Diagnosis Codes

Electronic Labs Received Report - Clinical


The Electronic Labs Received report prints a list of labs received electronically between specified dates. See Specifying Dates in Reports for more information.

Orientation
Portrait 321

Sorting
It is sorted by Patient Name. It can not be resorted.

Columns Printed
Patient Name Patient ID A series of Date, Lab and Panel for that patient

Go to Chart
Double clicking on a Patient Name does not take you to his or her chart.

Show Details
Unchecking Show Details shows the list of Patients and their IDs.

Filtering by
Panel HL7 Files Processed Lab

HL7 Lab Results Report - Clinical


The HL7 Lab Results report prints the results of a specified electronically received lab file. It prints testing information and results of all the labs included in the file.

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Orientation
Landscape

Sorting
It is printed in the order of the received file. It can not be sorted.

Items Printed
Processing information Laboratory information Order information Patient information Specimen information Lab results

Go to Chart
Double clicking on a Patient Name does not take you to his or her chart.

Show Details
Unchecking Show Details makes a slight formatting change.

Filtering by
HL 7 Results Msg Valid HL 7 Results Msg Invalid Reason Status Reported Test Order Test Name Data Value Units of Measure Reference Range Results Range Abnormal Flags

Patient History Report - Clinical


The Patient History report prints a letterhead version of the current patient's panels. History

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Orientation
Portrait

Sorting
There is only one patient so there is no sorting.

Items Printed
The current patient's History panels

Go to Chart
The patient's chart must already be open.

Show Details
Unchecking Show Details makes no difference.

Filtering by
There are no filters.

Patient Summary Report - Clinical


The Patient Summary report prints a letterhead version of all of the current patient's information.

324

Orientation
Portrait

Sorting
There is only one patient so there is no sorting.

Items Printed
Demographics Notes Active Problems Active Allergies Current Medications Labs Ordered Labs Completed Latest Encounter

Go to Chart
The patient's chart must already be open.

Show Details
Unchecking Show Details makes no difference.

Filtering by
There are no filters. 325

General Reports Overview


There are several types of reports under General: Lists from Setup

Patient Reports Audit Report Labs Due

Lists from

Setup

CPT4 Codes List

Facilities Listing

ICD9 Codes List

Insurance Plan Listing

Provider Listing

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Referring Physicians Listing

Security - User List

Patient Reports
Appointment List

Encounter List

Patient Listing

Patient Future Appointments To run this report, you need to have a patient's chart open.

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Audit Report

Labs Due Reports


Labs Due--Labels

Labs, Studies and Other Data Due

Appointment List Report - General


The Appointment List report prints a list of appointments between specified dates. See Specifying Dates in Reports for more information.

Figure: Appointments, Sorted by Duration, Descending

Orientation
Portrait

Sorting
It is sorted by Start Time and can be sorted by all fields.

Columns Printed
Start Time Dur (Duration) 328 Patient Name Patient ID

External Billing ID (Home) Phone Visit Type

Description Comments

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details leaves a count of the number of appointments.

Filtering by
Start Time Dur (Duration) Patient Name Patient ID External Billing ID (Home) Phone Visit Type Description Comments

Audit Report - General


The Audit report prints information about who did what between specified dates. See Specifying Dates in Reports for more information.

Figure: Audit Information, Sorted by Description, Ascending

Orientation
Portrait

Sorting
It is sorted by Date/Time and can be sorted by all other fields except Patient Name.

Columns Printed
329

Session Date/Time User (Login) Name Operation Data Type

Description Patient Name Patient ID Data ID

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details removes everything.

Filtering by
Session Date/Time User (Login) Name Operation Data Type Description Patient Name Patient ID Data ID

CPT4 Codes Report - General


The CPT4 Codes report prints a list of your active CPT4 Codes.

Figure: CPT4 Codes, Sorted by Code, Descending

Orientation
Landscape

Sorting
It is sorted by CPT4 Code and can be sorted by all fields. 330

Columns Printed
(CPT4) Code Code2 Description M1 M2 Fee Schedule Charge Allowed Copay (Copay) % Qty (Quantity) Plc (Place of Service) Typ (Type of Service) Force (to Paper) AcctCode (Accounting Code) Accept (Assignment) Reminder

Go to Chart
There are no patients listed, only CPT4 Codes.

Show Details
Unchecking Show Details removes everything.

Filtering by
(CPT4) Code Code2 Description M1 M2 Fee Schedule Charge Allowed Copay (Copay) % Qty (Quantity) Plc (Place of Service) Typ (Type of Service) Force (to Paper) AcctCode (Accounting Code) Accept (Assignment) Reminder

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Encounter List Report - General


The Encounter List report prints a list of Patient Encounters between specified dates. See Specifying Dates in Reports for more information.

Figure: Encounter List, Sorted by Patient Name, Descending

Orientation
Portrait

Sorting
It is sorted by Date and Time Started, and can be sorted on all fields.

Columns Printed
Date and Time Started Encounter Description Patient Name (Whether the Encounter has been) Signed Provider

Go to Chart
Double clicking on a Patient Name does not take you to his or her chart.

Show Details
Unchecking Show Details removes everything.

Filtering by
Date and Time Started Encounter Description Patient Name (Whether the Encounter has been) Signed Provider

Facilities Listing Report - General


The Facilities Listing report prints a list of all your facilities, both active and inactive.

332

Orientation
Portrait

Sorting
It is sorted by Name and can be sorted by other fields.

Columns Printed
(Facility) ID Facility Name Phone Fax Contact Kind (of Facility) Address

Go to Chart
There are no patients listed, only Facilities.

Show Details
Unchecking Show Details leaves a count of your Facilities.

Filtering by
(Facility) ID Facility Name Phone Fax Contact Kind (of Facility) Address

ICD9 Codes Report - General


The ICD9 Codes report prints a list of all your ICD9 Codes, both active and inactive.

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Figure: ICD9 Codes List, Sorted by Description, Ascending

Orientation
Portrait

Sorting
It is sorted by ICD9 Code and can be sorted any column.

Columns Printed
Code Description Active User Defined

Go to Chart
There are no patients listed, only ICD9 Codes.

Show Details
Unchecking Show Details removes everything.

Filtering by
Code Description Active User Defined

Insurance Plan Listing Report - General


The Insurance Plan Listing report prints a list of all your Insurance Plans, both active and inactive.

334

Figure: Insurance Plan Listing, Sorted by Code, Ascending

Orientation
Portrait

Sorting
It is sorted by Plan Name and can be sorted by other fields.

Columns Printed
Plan Name (Identifier) [Code] Phone Fax Payer ID Fee Schedule Responsibility Active Address / Contact

Go to Chart
There are no patients listed, only Insurance Plans.

Show Details
Unchecking Show Details leaves a count of your Insurance Plans.

Filtering by
Plan Name (Identifier) [Code] Phone Fax Payer ID 335 Fee Schedule Responsibility Active Address / Contact

Labs Due--Labels Report - General


The Labs Due--Labels report prints a sheet of address labels with information about patients whose data is due and/or overdue by specified amounts of time.

Figure: Labs Due--Labels, Filtered for only California You need to choose a time frame for both Items Due and Items Overdue by using the Labs, Studies, and Other Data Due window.

Orientation
Portrait

Sorting
It is sorted by Due date and then the patient's name. It can not be resorted. 336

Columns Printed
Patient's first, middle and last names Street address 1 A truncated lab panel name Street address 2 City State Zip

Go to Chart
Double clicking on a Patient Name does not take you to his or her chart.

Show Details
Unchecking Show Details removes everything.

Filtering by
First Name Middle Name Last Name Street (A truncated lab) Panel Name Street 2 City State Zip

Labs, Studies and Other Data Due Report - General


The Labs, Studies and Other Data Due report prints a list of active patients whose data is due and/or overdue by specified amounts of time.

Figure: Labs, Studies and Other Data Due, Sorted by Date of Birth, Youngest to Oldest You need to choose a time frame for both Items Due and Items Overdue by using the Labs, Studies, and Other Data Due window.

337

Orientation
Portrait

Sorting
It is sorted by Due date and can be sorted by other fields.

Columns Printed
Patient Name Patient ID DOB (Date of Birth) Data Item Due Date Facility Ordered (Date) For (Which Provider)

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details removes everything.

Filtering by
338

Patient Name Patient ID DOB (Date of Birth) Data Item

Due Date Facility Ordered (Date) For (Which Provider)

Patient Future Appointments Report - General


The Patient Future Appointments report prints a list of all future appointments for the patient in the open chart.

Orientation
Portrait

Sorting
It is sorted by Date Time and can be sorted by all fields.

Columns Printed
Date Time Duration (min) Resource Visit Type Description Comments

Go to Chart
The patient's chart is already open.

Show Details
Unchecking Show Details leaves a count of the number of future appointments.

Filtering by
Date Time Duration (min)

339

Resource Visit Type

Description Comments

Patient Listing Report - General


The Patient Listing report prints a list of Active Patients and your Primary Facility's contact information.

Orientation
Portrait

Sorting
It is sorted by patient: last name, first name. It can not be resorted.

Columns Printed
Patient Name Patient ID Sex DOB Primary Physician (Home) Phone Last Seen (Date)

Go to Chart
Double clicking on a Patient Name does not take you to his or her chart.

Show Details
Unchecking Show Details makes no difference.

340

Filtering by
There are no filters possible

Provider Listing Report - General


The Provider Listing report prints a list of all your Providers, both active and inactive.

Orientation
Portrait

Sorting
It is sorted by Provider Name, first name first, and can be sorted on all the fields with headers.

Columns Printed
Provider Name Phone Cell Phone Fax Email Address (Medical) License # (License) State UPIN SSN EIN HCFA Tax ID (which to use for Box 25)

Go to Chart
There are no patients listed, only Providers.

Show Details
Unchecking Show Details leaves a count of your Providers.

Filtering by
341

Provider Name Phone Cell Phone Fax Email Address

(Medical) License # (License) State UPIN SSN EIN HCFA Tax ID (which to use for Box 25)

Referring Physicians Listing Report - General


The Referring Physicians Listing report prints a list of all your Referring Physicians, both active and inactive.

Figure: Referring Physicians, Sorted by Phone Number, Ascending

Orientation
Portrait

Sorting
It is sorted on Last Name and can be sorted by other fields.

Columns Printed
Referring Name (last name, first name and middle name) Phone Cell Phone Fax UPIN Address Email

Go to Chart
There are no patients listed, only Referring Providers.

342

Show Details
Unchecking Show Details leaves a count of your Referring Physicians.

Filtering by
Referring Name (last name, first name and middle name) Phone Cell Phone Fax UPIN Address Email

Security - User List Report - General


The Security - User List report prints a list of all Users and User Groups, both active and inactive.

Orientation
Portrait

Sorting
It is sorted first by Type (User Group, Provider and User) then by User Name. It can not be resorted.

Columns Printed
User Name Full name Type Associated Provider Status

Go to Chart
There are no patients listed, only Users.

Show Details
Unchecking Show Details does nothing.

343

Filtering by
It can not be filtered.

Practice Management Receivables Reports


VersaForm does not offer a starting date for these receivables reports because they always "start" with the oldest amount due. However, for an historical perspective, you can choose ending dates for the two "as of a date" reports. In all of these reports you can double click on a patient's name to go directly to their chart. Which of these reports you choose to run depends on what you are most interested in. If you just want to know how much money is owing, run the Account Balances and Practice Total Due. If you want to know which accounts to pursue to get the most money, run the Delinquent Accounts Receivable report. It is sorted by the total due and includes the patient's phone number. However, be aware that the amounts include both patient responsibility and insurance. If you want to know which insurance companies to pursue to get the most money, run the Aged Accounts Receivable by Primary Insurance Plan report and uncheck the Show Details checkbox. Then scroll down, looking at the Insurance Balance column.

If you want the standard 30/60/90-type report, the Aged Accounts Receivable report will give you that. The Aged A/R by Primary Provider subtotals by Primary Provider, and the Aged A/R by Rendering Physician subtotals by the Rendering Physician. If you want to see how you are doing at collecting, run either the Aged Accounts Receivable as of a date or the Aged Accounts Receivable by Primary Insurance Plan as of a date reports for today and compare to the same for a previous date. Account Balances and Practice Total Due This report is a fast way to see which patient accounts owe you how much, when the last credit was applied, and the total due to the Practice.

Delinquent Accounts Receivable This report lists all patient accounts that are not current, in order of amount owed. Unapplied credits are subtracted from the total.

344

Aged Accounts Receivable Reports All of the Aged Accounts Receivable reports show the Patient name, Patient ID, Current, 30, 60, 90, 120, Unapplied Credit and Total. The Aged Accounts Receivable report adds the Last Credit and Last Patient Payment dates.

The Aged Accounts Receivable as of a date shows the accounts as of an ending date.

The Aged Accounts Receivable by Primary Insurance Plan report splits the balance due into Insurance Balance and Patient Balance. It adds columns for the Insurance Name and Identifier and the provider's User Name. It is subtotaled by Insurance Plan.

The Aged Accounts Receivable by Primary Insurance Plan as of a date report subtotals by Insurance Plan.

The Aged A/R by Primary Provider report adds columns for the Primary Provider and the Insurance Name. It subtotals by Primary Provider.

The Aged A/R by Rendering Physician report adds columns for the Rendering Physician and the Insurance Name. It subtotals by Rendering Physician. 345

Account Balances and Practice Total Due Report - PM Receivables


The Account Balances and Practice Total Due report prints a list of patient accounts that have a positive or negative balance and the total due to the Practice from those accounts.

Figure: Account Balances and Practice Total Due, Sorted by Total Due.

Orientation
Portrait

Sorting
It is sorted by a combination of the patient's last name, first name and middle name. It can be sorted by Patient ID or Last Credit Date.

Columns Printed
Patient Name Patient ID Last Credit Date Total Due

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows just the Total due to the Practice.

Filtering by
Patient Name Patient ID Last Credit Date Total Due

346

Aged Accounts Receivable Report - PM Receivables


The Aged Accounts Receivable report prints a list of patient accounts that have a positive or negative balance, whether from insurance or from the patient.

Figure: Aged Accounts Receivable, Sorted by Unapplied Credits

Orientation
Landscape

Sorting
It is sorted by a combination of the patient's last name, first name and middle name. It can be sorted by the other columns except for Total.

Columns Printed
Patient Name Patient ID Current Over 30 Over 60 Over 90 Over 120 Unapplied Credits Total Last Credit (Date) Last Patient Payment (Date)

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows only the overall Totals.

Filtering by
Patient Name Patient ID 347 Current Over 30

Over 60 Over 90 Over 120 Unapplied Credits

Total Last Credit (Date) Last Patient Payment (Date)

Aged Accounts Receivable as of a Date Report - PM Receivables


The Aged Accounts Receivable report prints a list of patient accounts that have a positive or negative balance, whether from insurance or from the patient as of a specified date. See Specifying Dates in Reports for more information. If you choose today's date, it is a subset of the Aged Accounts Receivable report.

Figure: Aged Accounts Receivable as of a date, Sorted by Patient ID

Orientation
Landscape

Sorting
It is sorted by a combination of the patient's last name, first name and middle name. It can be sorted by the other columns except for Total.

Columns Printed
Patient Name Patient ID Current Over 30 Over 60 Over 90 Over 120 Unapplied Credits Total Insurance Balance Patient Balance

348

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows only the overall Totals.

Filtering by
Patient Name Patient ID Current Over 30 Over 60 Over 90 Over 120 Unapplied Credits Total Insurance Balance Patient Balance

Aged Accounts Receivable by Primary Insurance Plan Report - PM Receivables


The Aged Accounts Receivable by Insurance Plan report prints a list of patient accounts that have a positive or negative balance, whether from insurance or from the patient.

Orientation
Landscape

Sorting
It is sorted first by Primary Insurance Plan and then by a combination of the patient's last name, first name and middle name. It can not be resorted.

Columns Printed
Insurance Name (Insurance) Identifier

349

Current Over 30 Over 60 Over 90 Over 120 Unapplied Credits

Total Insurance Balance Patient Balance Patient Name Patient ID Provider

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details Totals. shows only the subtotals by Insurance Plan and the overall

Filtering by
Insurance Name (Insurance) Identifier Current Over 30 Over 60 Over 90 Over 120 Unapplied Credits Total Insurance Balance Patient Balance Patient Name Patient ID Provider

Aged Accounts Receivable by Primary Insurance Plan as of a Date Report - PM Receivables


The Aged Accounts Receivable by Insurance as of a date report prints a list of patient accounts that have a positive or negative balance, whether from insurance or from the patient, as of a specified date. See Specifying Dates in Reports for more information. If you choose today's date, it is a subset of the Aged A/R by Insurance Plan report.

350

Orientation
Landscape

Sorting
It is sorted first by Primary Insurance Plan and then by a combination of the patient's last name, first name and middle name. It can not be resorted.

Columns Printed
(Insurance Plan Name and Identifier) Current Over 30 Over 60 Over 90 Over 120 Unapplied Credits Total Insurance Balance Patient Balance Patient Name Patient ID

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details Totals. shows only the subtotals by Insurance Plan and the overall

Filtering by
Current Over 30 Over 60 Over 90 Over 120 Unapplied Credits Total Insurance Balance

351

Patient Balance Patient Name

Patient ID

Aged Accounts Receivable by Primary Provider Report - PM Receivables


The Aged Accounts Receivable by Primary Provider report prints a list of patient accounts that have a positive or negative balance, whether from insurance or from the patient.

Orientation
Landscape

Sorting
It is sorted first by Provider and then by a combination of the patient's last name, first name and middle name. It can not be resorted.

Columns Printed
Primary Provider Current Over 30 Over 60 Over 90 Over 120 Unapplied Credits Total Patient Name Patient ID Insurance Name

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details Totals. shows only the subtotals by Primary Provider and the overall

352

Filtering by
Primary Provider Current Over 30 Over 60 Over 90 Over 120 Unapplied Credits Total Patient Name Patient ID Insurance Name

Aged Accounts Receivable by Rendering Physician Report - PM Receivables


The Aged Accounts Receivable by Rendering Physician report prints a list of patient accounts that have a positive or negative balance, whether from insurance or from the patient. Because VersaForm does not necessarily know to which charges unapplied credits will be applied, all unapplied credits are shown under **No Rendering Physician**.

Orientation
Landscape

Sorting
It is sorted first by Rendering Physician and then by a combination of the patient's last name, first name and middle name. It can not be resorted.

Columns Printed
Rendering Physician Current Over 30 Over 60 Over 90 Over 120 Unapplied Credits Total

353

Patient Name Patient ID

Insurance Name

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details overall Totals. shows only the subtotals by Rendering Physician and the

Filtering by
Rendering Physician Current Over 30 Over 60 Over 90 Over 120 Unapplied Credits Total Patient Name Patient ID Insurance Name

Delinquent Accounts Receivable Report - PM Receivables


The Delinquent Accounts Receivable report prints a list of patient accounts that have a balance due, whether due from insurance or from the patient or from both. All unapplied credits are subtracted from the total due from the patient's account but patients with a credit balance are not included.

Figure: Delinquent Accounts Receivable, Sorted by Current

Orientation
Landscape

354

Sorting
It is sorted by Total. It can be sorted by the other columns.

Columns Printed
Patient Name Patient ID (Patient) Phone (Primary) Insurance Name Current Over 30 Over 60 Over 90 Over 120 Total

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows only the overall Totals.

Filtering by
Patient Name Patient ID (Patient) Phone (Primary) Insurance Name Current Over 30 Over 60 Over 90 Over 120 Total

Practice Management Reports


There are several types of reports under Practice Management. Activity and Production Appointment Reminders Capitation Analysis Collections Daysheet Deposit Slips ERA Insurance Claims Patients Payments

355

Scheduler

Statements

Activity and Production Reports


Activity report selections are based on the date of service, and Production report selections are based on the date the charge was entered. Otherwise they are the same. All Activity and Production reports include at least Patient Name and ID, Rendering Provider, Service and Entry Dates, Code, M1, Description, Charges, Payments and Adjustments. All Activity and Production reports ask for a range of dates. All Activity and Production reports print in landscape mode. The reports differ in what they group and subtotal by and in an added column. The Charges and Payments by Provider reports are different from the other reports in that payments and credits will be affected by refunds and adjustments in subsequent periods. So, while Activity and Production reports for a particular time period do not change, the Charges and Payments by Provider reports may change over time. Activity Report by Accounting Code Adds Accounting Code - an arbitrary code you can designate.

Activity Report by Code Adds Accept Assignment, whether the patient accepts assignment, is capitated, refuses assignment, etc.

Activity Report by Operator Adds Operator - the User that entered the information into VersaForm.

Activity Report by Patient

356

Adds Accept Assignment, whether the patient accepts assignment, is capitated, refuses assignment, etc.

Production Report by Accounting Code Adds Accounting Code - an arbitrary code you can designate for CPT4 Codes.

Production Report by Code Adds Accept Assignment, whether the patient accepts assignment, is capitated, refuses assignment, etc.

Production Report by Operator Adds Operator - the User that entered the information into VersaForm.

Production Report by Patient Adds Accept Assignment, whether the patient accepts assignment, is capitated, refuses assignment, etc.

Charges and Payments by Provider (entry dates) Adds Unapplied Credits.

Charges and Payments by Provider (service dates)

357

Adds Unapplied Credits.

Appointment Reminder Reports


Appointment Reminders by Appointment Date Prints a list of Appoint Reminder Calls made for appointments on a specified date. The fields printed include: Patient Name; Patient ID; Phone Number Called; Appointment Time; Call Date; Scheduled Resource; and Results.

Appointment Reminders by Call Date Prints a list of Appoint Reminder Calls made on a specified date for appointments. The fields printed include: Patient Name; Patient ID; Phone Number Called; Appointment Time; Call Date; Scheduled Resource; and Results.

Appointment Reminders Resource by Appointment Date Appointment Reminders Resource by Call Date

Capitation Analysis Reports


Capitation Analysis by Code and Insurance Plan

Capitation Analysis by Insurance Plan and Code

Collections Reports
The Collection Activity report lists all the collection activities between specified dates while the Collection Follow Up report lists only the last activity for each patient. Collection Activity

358

Collection Follow Up

Daysheet
Prints a list of all charge, payment and adjustment activities for a specified date. Selections are based on entry date. It is sorted first by Entry Date. It can be sorted by all other columns. The fields printed include: Date; Patient Name; Patient ID; Service Date; Entry Date; Rendering Physician; Operator; CPT4 Code; Description; Charges; Payments; and Adjustments. Double clicking on a Patient Name takes you to his or her chart. Unchecking Show Details shows just the totals for the day.

Deposit Slips
Deposit Slip Prints a list of checks and cash to be deposited for a specified date along with a total. Reversed credits are excluded. Selection based on entry date. It is grouped by Source Code. It can not be resorted. You have to choose which payee account to use. If you have no specified payee accounts, the Deposit Slip by Payee Account report is faster. The fields printed include: Source Code; Check Number / Description; and Amount. Unchecking Show Details shows subtotals by Source Code and the total.

Deposit Slip by Payee Account Prints a list of checks and cash to be deposited on a specified date along with a total. Reversed credits are excluded. Selection based on entry date. 359

It is grouped by payee account and then by Source Code. It can not be resorted. The fields printed include: Source Code; Check Number / Description; and Amount. Unchecking Show Details total. shows subtotals by Payee Account and Source Code and the

ERA Reports
The ERA reports show you how VersaForm handled electronic EOBs. The ERA Credits and Payments report lists all the payments and adjustments that were posted automatically by VersaForm. The ERA Exceptions report lists all the amounts that VersaForm did not post. The ERA Reconciliation report shows the credits accepted, the payments applied and the credits left unapplied. ERA Credits and Payments

ERA Exceptions

ERA Reconciliation

Insurance Claims Reports


Charges Not Billed to Insurance

360

Charges to be Billed to Insurance

Claims Submitted by Insurance Plan

Insurance Claims Outstanding

Insurance IDs and Qualifiers

Patient Reports
New Patients by Insurance Plan Prints a list of new patients who were registered between specified dates. It is sorted by Insurance Plan and then Patient Name. It can not be resorted. The fields printed include: Primary Insurance Plan; Patient Name; Patient ID; Insurance ID Number; Insurance Group Number; Insurance Holder Name; and Accept Assignment. Double clicking on a Patient Name takes you to his or her chart. Unchecking Show Details shows how many new patients were registered for each insurance plan and the total of new patients registered.

Patient Birthday List Prints a list of patients with birthdays in chosen month(s).

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It is sorted by date of birth, oldest to youngest. It can not be resorted. The fields printed include: Patient Name; Patient ID; Date of Birth; and Address. Double clicking on a Patient Name takes you to his or her chart. Unchecking Show Details removes everything.

Patient Info Verification Prints a letterhead form of patient information for the current patient to look at and verify. It includes demographic information, pharmacies, allergies and medications. Unchecking Show Details does nothing.

Patient List by Primary Insurance Plan Prints a list of Insurance Plans and the Patients who have that plan as their Primary Insurance. It is sorted by Insurance Plan and then by Name. The fields printed include: Patient Name; Patient ID; Subscriber ID; Group Number; Subscriber Name (if not the patient); Relationship of the subscriber to the patient; and Accept Assignment. Double clicking on a Patient Name takes you to his or her chart. Unchecking Show Details shows how many patients have each insurance plan and the total of active patients.

Patient Name Index Prints a list of active Patients and information about their insurance(s). It is sorted by Patient Name. It can be sorted by all header fields. The fields printed include: Patient Name; Patient ID; Phone; Sex; Date of Birth; Guarantor/Bill To Name; Guarantor Account Number; Accept Assignment; Primary Insurance Plan; Second Insurance Plan; Third Insurance Plan; and Fourth Insurance Plan. Double clicking on a Patient Name takes you to his or her chart. Unchecking Show Details removes everything.

Patient's Primary Insurance 362

Prints a list of active Patients and information about their primary insurance. It is sorted by Patient Name. It can be sorted on all fields. The fields printed include: Patient Name; Patient ID; Primary Insurance Plan; Subscriber ID; Group Number; Subscriber Name; Relationship of the Subscriber to the Patient; and Accept Assignment. Double clicking on a Patient Name takes you to his or her chart. Unchecking Show Details shows only the count of active patients.

Patients with a Credit Balance

Prints a list of Patients with their unapplied credits and credit balances. It is sorted by Patient Name. It can be sorted on Patient ID, Unpaid Charges and Unapplied Credits. The fields printed include: Patient Name; Patient ID; Unpaid Charges; Unapplied Credits; and Balance Due. Double clicking on a Patient Name takes you to his or her chart. Unchecking Show Details removes everything.

Payments Reports
Payment Profile by Insurance Plan

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Payment Profile by Procedure Code

Payments by Payment Type

Scheduler Reports
Schedule Reconciliation Prints a list of appointments that were scheduled between specified dates and the outcomes of the appointments. This report shows only charges and same-period reversals. Other adjustments and credits are not shown. It is sorted by Patient and then by Appointment date and time. The fields printed include: Patient Name; Patient ID; Appointment Time; Arrival Time; Cancelled Time; Appointment Date; Provider; Code; Description; and Charges. Double clicking on a Patient Name takes you to his or her chart. Unchecking Show Details shows only the total Charges.

Schedule Resources With Appointment Reminders

Statements Printed Report


Prints a list of statements printed between specified dates. It is sorted by Date (without regard to time). It can be sorted by all columns. The fields printed include: Statement Date; Amount Due; Patient Name; and Patient ID. Double clicking on a Patient Name takes you to his or her chart. Unchecking Show Details shows only the total amount due.

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Activity Report by Accounting Code - Practice Management


The Activity Report by Accounting Code prints a list of all charge, payment and adjustment activities for a range of service dates. See Specifying Dates in Reports for more information. Selections are based on the date of service, not the date the charge was entered. The Production Report by Accounting Code shows the same information, but based on entry date.

Orientation
Landscape

Sorting
It is sorted first by Accounting Code, then Service Date and then Patient Name. It can not be resorted.

Columns Printed
Acct (Accounting) Code Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician) Code M1 Description Charges Payments Adj (Adjustments)

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows the net (Charges - Payments - Adjustments) and subtotals for each Accounting Code and the overall net (Charges - Payments - Adjustments) and Totals.

Filtering by
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Acct (Accounting) Code Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician)

Code M1 Description Charges Payments Adj (Adjustments)

Activity Report by Code - Practice Management


The Activity Report by Code prints a list of all charge, payment and adjustment activities for a range of service dates. See Specifying Dates in Reports for more information. Selections are based on the date of service, not the date the charge was entered. The Production Report by Code shows the same information, based on entry date.

Orientation
Landscape

Sorting
It is sorted first by Code, then Service Date and then Patient Name. It can not be resorted.

Columns Printed
Code M1 Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician) Accept Assign. (Accepts Assignment) Description Charges Payments Adj (Adjustments)

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Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows the net (Charges - Payments - Adjustments) and subtotals for each Code and the overall net (Charges - Payments - Adjustments) and Totals.

Filtering by
Code M1 Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician) Accept Assign. (Accepts Assignment) Description Charges Payments Adj (Adjustments)

Activity Report by Operator - Practice Management


The Activity Report by Operator prints a list of all charge, payment and adjustment activities for a range of service dates. See Specifying Dates in Reports for more information. Selections are based on the date of service, not the date the charge was entered. The Production Report by Operator shows the same information, based on entry date.

Orientation
Landscape

Sorting
It is sorted first by Operator (the User that entered the data), then Patient Name and then Service Date. It can not be resorted.

Columns Printed
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Operator Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician)

Code M1 Description Charges Payments Adj (Adjustments)

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows the net (Charges - Payments - Adjustments) and subtotals for each Operator and the overall net (Charges - Payments - Adjustments) and Totals.

Filtering by
Operator Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician) Code M1 Description Charges Payments Adj (Adjustments)

Activity Report by Patient - Practice Management


The Activity Report by Patient prints a list of all charge, payment and adjustment activities for a range of service dates. See Specifying Dates in Reports for more information. Selections are based on the date of service, not the date the charge was entered. The Production Report by Patient shows the same information, based on entry date.

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Orientation
Landscape

Sorting
It is sorted first by Patient Name and then Service Date. It can not be resorted.

Columns Printed
Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician) Accept Assign. (Assignment) Code M1 Description Charges Payments Adj (Adjustments)

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows the net (Charges - Payments - Adjustments) and subtotals for each Patient and the overall net (Charges - Payments - Adjustments) and Totals.

Filtering by
Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician) Accept Assign. (Assignment) Code M1 Description Charges Payments Adj (Adjustments)

Production Report by Accounting Code - Practice Management


The Production Report by Accounting Code prints a list of all charge, payment and adjustment activities for a range of service dates. See Specifying Dates in Reports for more information. 369

Selections are based on the date the charge was entered, not the date of service. The Activity Report by Accounting Code shows the same information, based on service date.

Orientation
Landscape

Sorting
It is sorted first by Accounting Code, then Service Date and then Patient Name. It can not be resorted.

Columns Printed
Acct (Accounting) Code Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician) Code M1 Description Charges Payments Adj (Adjustments)

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows the net (Charges - Payments - Adjustments) and subtotals for each Accounting Code and the overall net (Charges - Payments - Adjustments) and Totals.

Filtering by
Acct (Accounting) Code Patient Name Patient ID Svc (Service) Date

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Entry Date MD (Rendering Physician) Code M1

Description Charges Payments Adj (Adjustments)

Production Report by Code - Practice Management


The Production Report by Code prints a list of all charge, payment and adjustment activities for a range of service dates. See Specifying Dates in Reports for more information. Selections are based on the date the charge was entered, not the date of service. The Activity Report by Code shows the same information, based on service date.

Orientation
Landscape

Sorting
It is sorted first by Code, then Service Date and then Patient Name. It can not be resorted.

Columns Printed
Code M1 Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician) Accept Assign. (Assignment) Description Charges Payments Adj (Adjustments)

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

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Show Details
Unchecking Show Details shows the net (Charges - Payments - Adjustments) and subtotals for each Code and the overall net (Charges - Payments - Adjustments) and Totals.

Filtering by
Code M1 Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician) Accept Assign. (Assignment) Description Charges Payments Adj (Adjustments)

Production Report by Operator - Practice Management


The Production Report by Operator prints a list of all charge, payment and adjustment activities for a range of service dates. See Specifying Dates in Reports for more information. Selections are based on the date the charge was entered, not the date of service. The Activity Report by Operator shows the same information, based on service date.

Orientation
Landscape

Sorting
It is sorted first by Operator (the User that entered the data), then Patient Name and then Service Date. It can not be resorted.

Columns Printed
Operator Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician)

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Code M1 Description

Charges Payments Adj (Adjustments)

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows the net (Charges - Payments - Adjustments) and subtotals for each Operator and the overall net (Charges - Payments - Adjustments) and Totals.

Filtering by
Operator Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician) Code M1 Description Charges Payments Adj (Adjustments)

Production Report by Patient - Practice Management


The Production Report by Patient prints a list of all charge, payment and adjustment activities for a range of service dates. See Specifying Dates in Reports for more information. Selections are based on the date of service, not the date the charge was entered. The Activity Report by Patient shows the same information, based on entry date.

Orientation
Landscape

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Sorting
It is sorted first by Patient Name and then Service Date. It can not be resorted.

Columns Printed
Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician) Accept Assign. (Assignment) Code M1 Description Charges Payments Adj (Adjustments)

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows the net (Charges - Payments - Adjustments) and subtotals for each Patient and the overall net (Charges - Payments - Adjustments) and Totals.

Filtering by
Patient Name Patient ID Svc (Service) Date Entry Date MD (Rendering Physician) Accept Assign. (Assignment) Code M1 Description Charges Payments Adj (Adjustments)

Charges and Payments by Provider (entry dates) - Practice Management


The Charges and Payments by Provider (entry dates) report prints a list of all charge, payment and adjustment activities for a range of entry dates. See Specifying Dates in Reports for more information. It is grouped and subtotaled by Provider. Selections are based on the date the charge was entered, not the date of service. 374

The Charges and Payments by Provider (service dates) shows the same information, based on service date. Payment dates are based on the date the payment was applied to the charge. This may differ from the entry date of the credit. This report differs from a Production report in that payments and credits will be affected by refunds and adjustments in subsequent periods. So, while a Production report for a particular time period does not change, the Charges and Payments by Provider (entry dates) may change over time.

Orientation
Landscape

Sorting
It is sorted first by Provider, then Service Date and then Patient Name. It can not be resorted.

Columns Printed
(Rendering) Provider Patient Name Patient ID Svc (Service) Date Entry Date Code M1 Description Charges Payments to Chgs (Charges) Adjusts to Chgs (Charges) Unapplied Credits

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows the subtotals for each Provider and the overall Totals.

Filtering by
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(Rendering) Provider Patient Name Patient ID Svc (Service) Date Entry Date Code

M1 Description Charges Payments to Chgs (Charges) Adjusts to Chgs (Charges) Unapplied Credits

Charges and Payments by Provider (service dates) - Practice Management


The Charges and Payments by Provider (service dates) report prints a list of all charge, payment and adjustment activities for a range of service dates. See Specifying Dates in Reports for more information. It is grouped and subtotaled by Provider. Selections are based on the date of service, not the date the charge was entered. The Charges and Payments by Provider (entry dates) shows the same information, based on entry date. Payment dates are based on the date the payment was applied to the charge. This may differ from the entry date of the credit. This report differs from an Activity report in that payments and credits will be affected by refunds and adjustments in subsequent periods. So, while an Activity report for a particular time period does not change, the Charges and Payments by Provider (service dates) may change over time.

Orientation
Landscape

Sorting
It is sorted first by Provider, then Service Date and then Patient Name. It can not be resorted.

376

Columns Printed
(Rendering) Provider Patient Name Patient ID Svc (Service) Date Entry Date Code M1 Description Charges Payments to Chgs (Charges) Adjusts to Chgs (Charges) Unapplied Credits

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows the subtotals for each Provider and the overall Totals.

Filtering by
(Rendering) Provider Patient Name Patient ID Svc (Service) Date Entry Date Code M1 Description Charges Payments to Chgs (Charges) Adjusts to Chgs (Charges) Unapplied Credits

Capitation Analysis by Code and Insurance Plan Report - Practice Management


The Capitation Analysis by Code and Insurance Plan report prints an analysis of all capitated activities for a range of service dates. See Specifying Dates in Reports for more information. VersaForm calculates totals and averages for each Insurance Plan, each Code and each Rendering Physician.

377

Orientation
Landscape

Sorting
It is sorted first by Code, then by Insurance Plan and then by service date. It is sorted by Capitation Analysis by Code and Insurance Plan and can be sorted by other fields.

Columns Printed
(Rendering) Provider Svc (Service) Code Insurance Plan Svc (Service) Date Count (of charges) Standard Chg (Charge) Actual Chg (Charge) Difference (between Standard and Actual) Insurance (Payments) Patient (Payments) Adjust (Adjustments)

Go to Chart
There are no patient names.

Show Details
Unchecking Show Details shows just the totals and averages for each Insurance Plan, each Code and each Rendering Physician.

Filtering by
Rendering Physician Code Insurance Plan Service Date 378 Standard Charge Actual Charge Difference between Standard and Actual Insurance Payments

Patient Payments

Adjustments

Capitation Analysis by Insurance Plan and Code Report - Practice Management


The Capitation Analysis by Insurance Plan and Code report prints an analysis of all capitated activities for a range of service dates. See Specifying Dates in Reports for more information. VersaForm calculates totals and averages for each Code, each Insurance Plan and each Rendering Physician.

Orientation
Landscape

Sorting
It is sorted first by Insurance Plan, then by Code and then by service date. It is sorted by Insurance Plan and Code and can be sorted by other fields.

Columns Printed
Rendering Physician Insurance Plan Code Service Date Count of charges Standard Charge Actual Charge Difference between Standard and Actual Insurance Payments Patient Payments Adjustments

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

379

Show Details
Unchecking Show Details shows just the totals and averages for each Code, each Insurance Plan and each Rendering Physician.

Filtering by

Collection Activity Report - Practice Management


The Collection Activity report prints a list of collection activities between specified dates. See Specifying Dates in Reports for more information.

Orientation
Portrait

Sorting
It is sorted by Patient Name and then the Activity Date. It can not be resorted.

Columns Printed
Patient Name Patient ID Activity Date Activity

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details does nothing.

380

Filtering by

Collection Follow Up Report - Practice Management


The Collection Follow Up report prints a list of collection followup activities between specified dates. See Specifying Dates in Reports for more information.

Orientation
Portrait

Sorting
It is sorted by followup date and then Patient Name. It can not be resorted.

Columns Printed
Follow-up Date Patient Name Patient ID Last Activity

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details removes everything.

Filtering by

ERA Credits and Payments Report - Practice Management


The ERA Credits and Payments report lists all the payments received, adjustments that were posted automatically, what VersaForm did with any item balances and information about deductibles. Once you have processed more than one ERA file, you will be asked to choose which file you want to report on. The most recent file will be at the top of the list.

381

Orientation
Landscape

Sorting
It is presented in the order the information was received and can not be resorted.

Fields Printed
Processed on (date) by (the User) From File Control Number Payer Name Payment Date Check No (Number) Check Amt (Amount) A series of information about each claim and, within each claim, information about each Code.

Go to Chart
Double clicking on a Patient Name does not take you to his or her chart.

382

Show Details
Unchecking Show Details makes a slight formatting change.

ERA Exceptions Report - Practice Management


The ERA Exceptions report lists all the amounts that VersaForm did not post. Among the possible reasons are Denied claims Credits that exceed the item balance Adjustments not selected for auto adjust Adjustments that exceed the item balance Reversals

Once you have processed more than one ERA file, you will be asked to choose which file you want to report on. The most recent file will be at the top of the list.

Orientation
Landscape

383

Sorting
It is presented in the order the information was received and can not be resorted.

Items Printed
Processed on (date) by (the User) From File Control Number Payer Name Payment Date Check No (Number) Check Amt (Amount) A series of information about each claim and, within some claims, information about some Codes.

Go to Chart
Double clicking on a Patient Name does not take you to his or her chart.

Show Details
Unchecking Show Details makes a slight formatting change.

ERA Reconciliation Report - Practice Management


The ERA Reconciliation report shows the credits accepted, the payments applied and the credits left unapplied. Once you have processed more than one ERA file, you will be asked to choose which file you want to report on. The most recent file will be at the top of the list.

Orientation
Landscape 384

Sorting
It can not be sorted.

Items Printed
Processed on (date) by (the User) From File Payer Name Check Date Control Number Check Number Check Amount Payment Date Accepted Credits -- Payment Report Accepted Credits -- Exception Report Unaccepted Credits Applied Payments -- Payment Report Applied Payments -- Exception Report Unapplied Payments

Go to Chart
There are no patient names.

Show Details
Unchecking Show Details removes information about individual checks.

Charges Not Billed to Insurance Report - Practice Management


The Charges Not Billed to Insurance report prints a list of charges that have not been billed to insurance and are not marked to bill, for a range of service dates. See Specifying Dates in Reports for more information. This report does not show charges for patients who do not have insurance.

385

Orientation
Portrait

Sorting
It is sorted by Patient Name and then Service Date. It can not be resorted.

Fields Printed
Patient Name Patient ID Primary Insurance Insurance 2 (if any) Insurance 3 (if any) Insurance 4 (if any) Service Date Provider (Username) (ICD9) Code Description Charges Item Bal (Balance)

Go to Chart
Double clicking on a Patient Name does not take you to his or her chart.

Show Details
Unchecking Show Details shows the subtotals by Patient and the overall Totals.

Filtering by
Service Date Provider (Username) (ICDD9) Code Description Charges Item Bal (Balance)

Charges to be Billed to Insurance Report - Practice Management


The Charges to be Billed to Insurance report prints a list of charges that have not been billed to insurance and are marked to bill for a range of service dates. See Specifying Dates in Reports for more information. This report does not show charges for patients who do not have insurance.

386

Orientation
Portrait

Sorting
It is sorted by Patient Name and then Service Date. It can not be resorted.

Fields Printed
Patient Name Patient ID Primary Insurance Insurance 2 (if any) Insurance 3 (if any) Insurance 4 (if any) Service Date Provider (Username) (ICD9) Code Description Charges Item Bal (Balance)

Go to Chart
Double clicking on a Patient Name does not take you to his or her chart.

Show Details
Unchecking Show Details shows the subtotals by Patient and the overall Totals.

Filtering by
Service Date Provider (Username) (ICDD9) Code Description Charges Item Bal (Balance)

Claims Submitted by Insurance Plan Report - Practice Management


The Claims Submitted by Insurance Plan report prints a list of all claims submitted for a range of claim generation dates. See Specifying Dates in Reports for more information.

387

Orientation
Portrait

Sorting
It is sorted by Insurance Plan and then Claim Number. It can not be resorted.

Columns Printed
Insurance Plan (Name and Identifier) Claim ID Claim Date Patient Name Patient ID Claim Status Total Claim (Insurance) Ins Paid

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows the subtotals by Insurance Plan and the overall Totals.

Filtering by
Insurance Plan (Name and Identifier) Claim ID Claim Date Patient Name Patient ID Claim Status Total Claim (Insurance) Ins Paid

Insurance Claims Outstanding Report - Practice Management


The Insurance Claims Outstanding report prints a list of outstanding insurance claims, how much was charged and the balance due for a range of claim sent dates. See Specifying Dates in Reports for more information. 388

Electronically submitted claims are italicized.

Orientation
Landscape

Sorting
It is sorted by Claim Number. It can not be resorted.

Columns Printed
Date Claim Sent E/P (Electronic or Paper) First Service (Date) Patient Name Patient ID Claim Num (Number) C# (Carrier Number) Group ID (Transaction Set) Trset Ack Group Ack Subscriber Name Sub. (Subscriber) ID Ins Grp (Insurance Group Number) Total Charges Balance

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details shows subtotals by Insurance Plan and the totals.

Filtering by
Date Claim Sent E/P (Electronic or Paper) 389 First Service (Date) Patient Name

Patient ID Claim Num (Number) C# (Carrier Number) Group ID (Transaction Set) Trset Ack Group Ack

Subscriber Name Sub. (Subscriber) ID Ins Grp (Insurance Group Number) Total Charges Balance

Insurance IDs and Qualifiers Report - Practice Management


The Insurance IDs and Qualifiers report prints a list of the insurance IDs and qualifiers for active Facilities, Providers, Referrings and Submitters.

Orientation
Portrait

Sorting
It is grouped so it can not be resorted.

Columns Printed
The name of the Facility, Provider, Referring or Submitter NPI Insurance Plan (Insurance) Identifier Provider ID Qualifier (Code and Description)

Go to Chart
There are no patients listed in this report.

Show Details
Unchecking Show Details shows just the Names and NPIs. 390

Filtering by
Insurance Plan (Insurance) Identifier Provider ID Qualifier (Code and Description)

Payment Profile by Insurance Plan Report - Practice Management


The Payment Profile by Insurance Plan report prints a list of payments and adjustments made by Primary Insurance plans for Service Codes between specified dates. See Specifying Dates in Reports for more information. This report does not include transactions where the Service Code is not specified or is blank.

Orientation
Portrait

Sorting
It is sorted by Insurance Plan and then by Code. It can not be resorted.

Columns Printed
Insurance Plan Svc (Service) Code Count (of Charges) Charges Payments % Pmnt to Chg (% of Payments to Charges) Days (Till the First Payment) Adjusts (Adjustments) % Adj to Chg (% Adjustments to Charges)

391

Go to Chart
There are no patient names to click on.

Show Details
Unchecking Show Details makes slight formatting changes.

Payment Profile by Procedure Code Report - Practice Management


The Payment Profile by Procedure Code report prints a list of payments and adjustments made for Service Codes by Primary Insurance plans between specified dates. See Specifying Dates in Reports for more information. This report does not include transactions where the Service Code is not specified or is blank.

Orientation
Portrait

Sorting
It is sorted by Code and then by Insurance Plan. It can not be resorted.

Columns Printed
Svc (Service) Code Insurance Plan Count (of Charges) Charges 392 Payments % Pmnt to Chg (% of Payments to Charges) Days (Till the First Payment)

Adjusts (Adjustments)

% Adj to Chg (% Adjustments to Charges)

Go to Chart
There are no patient names to click on.

Show Details
Unchecking Show Details makes slight formatting changes.

Filtering by
Filtering by

Payments by Payment Type Report - Practice Management


The Payments by Payment Type report prints a list of Payments by Payment Type between specified dates and the total. See Specifying Dates in Reports for more information.

EOB payments include those applied to patient accounts. Reversed credits are excluded. Selection is based on entry date.

Orientation
Landscape

Sorting
It is sorted by Payment Type. It can not be resorted.

Columns Printed
Payment Type Patient Name Patient ID Payment Date Entry Date Description Payee Account 393 Credit

Go to Chart
Double clicking on a Patient Name takes you to his or her chart.

Show Details
Unchecking Show Details overall Total. shows the total Credits for each Payment Type and the

Filtering by

Filtering Reports
When you preview a report, you can filter the report to include only the results you are interested in. 1. Click the Filter button. The Report Filters window will show the last set of filters that you used, if any. Each line contains one filter condition. All of the lines are ANDed together to filter the data. This means that the ALL of the conditions must be met.

2. Modify the filter as needed; you can Add, Edit/View, or Remove conditions.

394

3. When you click the OK button, the data will be filtered. To see the unfiltered data, run the report again.

Sorting Reports
You can sort by double clicking on the heading of a column. Double clicking again will resort in the opposite order. You will see the field name in red with a sort arrow pointing either down or up.

Note that blank fields often sort to the top, regardless of the sort order.

Installing a Custom Report


When we install a custom report it is delivered as a file that ends in .srd. This file will be stored in the tools folder of your VersaForm 3.0 folder.

Installing a Custom Report on Other Machines


Please follow these steps:
1. Copy the .srd file to the VersaForm 3.0\Tools folder of the target computer. 2. Start VersaForm as DBA. 3. Click on the Setup button.

4. Click on the Reports Tab. 5. Click on the Add button. 395

6. Fill in the dialog as follows:

Report Id: Will auto fill. Report Name: Should be the name as you want it to appear on the list of reports. Category: Should be Custom. Internal Name: Leave it blank for now. Orientation: Should be Portrait unless the report is wider than 8, then it should be Landscape. Access Rights: Is generally All Rights.

7. Click the OK button. 8. Now, with the new report name highlighted, click on the Import button. Be careful, because the report you select is the one that will be replaced. 9. Navigate to the VersaForm 3.0\Tools folder 10. Double click on the .srd file 11. Click on the Yes button to import. The report will be installed on this computer. Repeat the process for each machine that will need to run this report.

396

Setup
Setup Overview
This information applies to new systems. If you have an upgraded from an earlier VersaForm system, much of this data will have been transferred, but it should still be checked. Depending on the security settings in your system, you may need to be a Security Administrator to use some of the functions described here. See Access Control for a complete description of the VersaForm security features.

Basic Setup
Users Identifies all users of the system, their login user name and password. SSNs and EINs for providers are entered here. Enter each provider who will be either a primary provider or a rendering provider (i.e., a provider on a charge line). Providers must already be Users. Insurance ID numbers are entered here, but SSN and EIN are entered on the Users Tab. Click the Edit IDs button to check the ID for each insurance plan but you need to enter the Insurance Plans before you can put in the Insurance ID Numbers. If a provider is not the Billing Provider (as in a group practice), that provider needs to have a Submitter designated (usually the group), who will get paid. Preferences Various preference items, such as how a chart is to open, and whether you want to see the Chart Index. At least the Primary Facility must be completed. It supplies headings for prescriptions, statements, etc.

Providers

Facilities

397

Practice Management Setup


Need for: ICD9 codes are preinstalled but the ones that will be frequently used should be marked. CPT4 codes are preinstalled but you should mark the frequent ones and enter your fees. Mnemonics and Explosions should be set up, too. Tells how and when to submit claims for each insurance plan. For electronic claims, make sure that the Payer ID, the Claims Processor, and all ID numbers and qualifiers are filled in. Information about any facility that may be referenced on a claim as, for instance, a place of service or a lab. Click the Edit IDs button to check the ID for each insurance plan. Each one should have a qualifier. If the practice is a group, the group is entered as a submitter. If you submit electronic claims, the electronic claims submitter should be entered here, also. This is the name by which your clearinghouse (or whoever you send claims to) knows you. Click the Edit IDs button to enter the ID for each insurance plan. Each one should have a qualifier. Referring physicians addresses and ID numbers. Click the Edit IDs button to enter the ID for each insurance plan. Each one should have a qualifier. Rules for printing statements, such as whether to include amounts pending insurance. Cycle billing can also be set up here. Paper Claims? Yes Electronic Claims? Yes

ICD9 Codes

CPT4 Codes

Yes

Yes

Insurance Plans

Yes

Yes

Facilities

Yes

Yes

Submitters

Maybe

Yes

Referring

Yes

Yes

Statement Options

No

No

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Claims Processors

This holds the numbers that identify you to the processor. They must be on your claim for it to be accepted.

No

Yes

Scheduler Setup
Scheduler Resources Holidays Visit Types Who or what is to be scheduled. This would include all providers, but also might include special exam rooms, equipment, etc. Must be set up each year. Optional; allows color coding of schedule.

EMR Setup
Problems ICD9 problems are preinstalled but you can set up other problems that are not on the ICD9 list. Frequently used items can be identified for each Provider so they will appear on the short menus. Many medications are preinstalled but you can add others. This Tab also contains setup information for the NewCrop medication/allergy interaction checking feature. Frequently prescribed medications can be set up with Sig, quantity, etc so prescriptions can be written more quickly. Frequently used items can be identified for each Provider so they will appear on the short menus. Many standard lab panels and data panels are preinstalled but every specialty has others that you will want to add. For some of these you will wish to set up flowsheets. New history panels may also be defined here. Frequently used items can be identified for each Provider so they will appear on the short menus. Common values are preinstalled but others can be added. Templates and accompanying drop-downs for creating notes. Many are preinstalled but it will be worthwhile to customize them, or to create new ones, that meet your own needs.

Medications

Labs/Data

Medications, Problems and Allergies Sig Line

Templates

399

ID Lists
At this writing, each insurance company or plan identifies providers, referring providers, facilities, and submitters by an ID number that is good for that insurance only. HIPAA has mandated standardization of IDs with NPIs, but you still need to be able to send the old legacy ID numbers. Thus, until only NPIs are used, each of these must have an ID for each insurance plan. What's more, each identifier must have a qualifier that tells what kind of identifier it is! VersaForm provides a default pair of ID and Qualifier for each entity that needs an ID. This may reduce the number of IDs you need to enter, if many of them are the same. The rest are added with the Edit Insurance IDs buttons.

General The Preferences Tab


You can set many of your preferences on the Preferences Tab in the Setup Window. If you make a change that causes the OK button to be clickable, be sure to click it before leaving the Tab or you will loose the changes. You can also click the Cancel button to reject any changes made on the face of the Preferences Tab. The options on the face of the Tab only apply to the user that is logged on at the time you make changes. Each user will need to make these changes to have them apply to them.

How to Open
Click on the Setup button in the top tool bar. Click on the Preferences Tab.

What You Will See - Top Portion

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What Goes in Each Field


Field Name Information to Enter This choice determines which tab is shown when you first open a chart. If you have upgraded from DOS or have been using only the EMR part of VersaForm, it would be best to set it to Registration so you can check the Default Encounter Type Default Payment Accounting Code* Default Treatment Accounting Code* Demographics, Billing Info and Insurance Tabs. Office or Outpatient Sample

Initial Tab

Ledger

Allows you to select your most common encounter type to set as the default. A code you want to override what is in the insurance plan file.

This sets the default treatment accounting code for the EMR portion of the program. A check mark here will open a window on the left side of the chart that shows a tree-like index of all encounters for this patient. Useful in the EMR portion of the program. For practice management only - uncheck this box. If there is no open encounter when you begin to add data (for instance, a medication) to a chart, an encounter is started automatically. If this box is checked, you can set the encounter's chief complaint, encounter type, etc. Otherwise defaults are taken when available. If checked, offers you the opportunity to add details when adding a problem to a chart. If checked, allows you to have the Rendering Provider's information be used to choose the Submitter. Normally the Primary Provider's information is used to choose the Submitter.

Show Index When Chart Opens*

Always Edit New Encounter*

Always Edit New Problem* Submit claims as Rendering Provider*

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Allow Note Without Encounter* Allow Lab Without Encounter* Show existing appointments*

If checked, VersaForm still prompts you to create an encounter but allows you to continue creating a Note without an associated encounter. If checked, VersaForm still prompts you to create an encounter but allows you to continue creating a Lab without an associated encounter. If checked, the Scheduler will show you an existing appointment that is within the selected number of days of the appointment you are making.

What You Will See - Bottom Portion

What Goes in Each Field


Field Information Sample

When an electronic lab is received This section of the Preferences Tab allows you to select the message options to use when receiving electronic lab results. Choose whether to Do not send a message, Notify primary physician, or Notify only the user shown (radio button). If checked, causes a high-priority message to be sent as a result of receiving a lab that is marked abnormal. Selects the user to receive lab notification messages if the patient has no primary physician or if you have elected to send notification messages to a specific VersaForm user. Defaults to none. Notify primary physician

Messages

High priority*

Notify this user*

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When an electronic lab request is sent: Choose whether the lab should Bill the Patient's Insurance, Bill the Patient, or Bill the Practice (radio button). If checked, lab order requisitions will be automatically printed. Bill Patient's Insurance

Billing

Print Lab Order Requisition* Automatic exports Automatically export schedule changes.* Export Directory* Demographics Changes* Export Directory*

If checked, any schedule changes will be automatically exported. The folder to which schedule changes are to be exported. If checked, any demographics changes will be automatically exported. The folder to which demographics are to be exported.

C:\Schedule

C:\Demographics

* This field can be blank.

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The Completed Dialog

Other Functions
The Set NPI Dates Button
Click the Set NPI Dates button to change dates having to do with the use of NPIs. The dates you set here can be overridden by the dates set for the individual insurance plans in Setup Insurance Plans. See NPI Effective Dates for more information.

404

The View Permissions Button


Click on the View Permissions button to see the user's Effective Permissions.

Preferences Setup: Claim as Rendering


The Claim as Rendering feature allows you to have the Rendering Provider's information be used to choose the Submitter. Normally the Primary Provider's information is used to choose the Submitter. The Submitter determines what information is used in Box 33 on the HCFA 1500 form or in 2010 loops in the ANSI 837. You may want to use this feature when another doctor is standing in for the Primary Physician. Claim As Rendering is a system preference for each User.

To Change Claim As Rendering


Click on Setup. Click on the Preferences Tab. Click on the Submit claims as Rendering Provider check box to check it.

Preferences Setup: NPI Effective Dates


The NPI Effective Dates window is used to change the dates that NPIs will be used in creating claims. 405

How to Open
Click on the Setup button in the top tool bar. Click on the Preferences Tab. Click on the Set NPI Dates button.

The dates you set here can be overridden by the dates set for the individual insurance plans in Setup, Insurance Plans.

When you have the dates set as you want them, click the OK button.

What Goes in Each Field


Field Name Information to Enter Default

On Electronic Claims May use NPI on or after The date when NPIs are permitted for this insurance plan. NPI will be used if present and NPI Permitted <= today. 10/01/06

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Must use NPI on or after

The date when NPIs are required for this insurance plan. An error will occur if the NPI is not present and NPI Required <= today. The date when the old IDs are no longer permitted for this insurance plan. Legacy IDs will be sent unless Legacy ID Prohibited <= today.

05/23/07

May not use Legacy ID after On Paper Claims Use CMS1500 08/05 after May not use Legacy ID after On Paper Claims Use UB04 after May not use Legacy ID after

05/23/07

The date after which to use the new 1500 claim form. The date after which to leave the legacy ID off of the new 1500 claim form.

04/01/07

05/23/07

The date after which to use the new 1500 claim form. The date after which to leave the legacy ID off of the new 1500 claim form.

04/01/07 05/23/07

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The Users Tab


The Users Tab in the Setup Window is used to administer the Users of your system. Depending on the security settings of your system, you may need to be a Security Administrator to access the Users Tab. For complete information on VersaForm security settings, see Access Control.

The Users Tab in the Setup Window has these Functions


Add User: Adds a new User to the system. Edit/View: Edits a User. Remove: Removes a User. Print Users: Prints the Security - User List Report.

Users Setup: User Setup


Depending on the security settings of your system, you may need to be a Security Administrator to access the Users Tab. For complete information on VersaForm security settings, see Access Control.

How to Open
1. Click on the Setup button in the top tool bar or choose the Setup item on the Utilities menu. 2. Click on the Users Tab. 3. To add a User click on the Add User button. 4. To modify an existing User, locate the name on the list and double click on it or click once to highlight it and then click on the Edit/View button.

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What You Will See When You Add

NOTE: All Providers must have a User record. However, not all Users will be Providers.

What Goes in Each Field


Field Name User Login Name Information to Enter The name you will enter on the initial log-in dialog. In lists of Providers or Users the full name will be displayed along with the "User Login Name" in ( )'s. Use the drop down list to see the Providers. Each User should be assigned a Provider. A Provider would use the same name as the User. If a User is not assigned a Provider they will be limited in many of the tasks they can perform. User's first name. User's middle name or initial. User's last name. Any title used by this User. If this User is a Provider in a single doctor office this will become the tax ID - used in box 25 of HCFA1500. Sample

Doctor

Default Provider

Marcus W Welby MD

First Middle* Last Name Suffix* SSN*

Marcus W Welby MD 555-66-7878

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EIN*

If this User is a Provider in a multiple provider office this will become the tax ID - used in box 25 of HCFA1500. A check mark here indicates that this User is allowed to log into the program. If this is cleared then the User is not allowed in and will not appear on other User lists. A check mark here indicates that this User has attempted too many logins using the wrong password. This User can be reset only by a Security Administrator changing this Users password. Will this User have rights to directly modify the structure of the database and perform other administrative functions? Generally leave this unchecked. Will this User have rights to set the security level, password rules, change other User's passwords and perform other security functions? Generally leave this unchecked. Record any special information about this User.

833456789

Active

Suspended*

System Administrator*

Security Administrator*

Remarks*

Founder of clinic.

* This field may be blank.

The Completed Dialog

Note: On initial setup for a Provider follow these steps: Create a User, leaving the Default Provider blank. 410

Create a Provider using the new User as described in Provider Setup. The system will auto-fill the Default Provider field in the User record. The Default Provider field will not be editable after this action.

Other Actions
When you click Ok you will see:

Notes:

Enter the password you want to use and then click the Ok button.

Once a User has modified or added patient medical data they cannot be removed. However, they can be made inactive.

Users Setup: Adding a User to the List


From the Setup window, Click on the Users Tab: 1. Click on the Add User button. The Edit/View User Information window will open.

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2. Type in a User Login Name. 3. Choose a Default Provider if this User will not be a Provider. 4. If the User will be a Provider, fill in at least First, Last and SSN or EIN. 5. Click on the OK button.

Users Setup: Changing a User on the List


You can edit or view a User from the Users Tab in the Setup window.

To Edit or View a User


1. Click the menu. Setup button in the top tool bar or choose the Setup item on the Utilities

2. Click the Users Tab in the Setup window. 3. Double click on the User you want to edit or click on him or her and then click on the Edit/View button. 4. The Edit/View User Information window will open. 5. Make the changes you want. 6. Click the Ok button when done. Note: If the user is a provider, you may not change the Default Provider.

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Users Setup: Changing User Passwords


Every VersaForm User must have a password. Passwords are kept in the VersaForm database and are encrypted using an advanced hashing algorithm. Only the User who enters a password can know what the password is. If you forget your password, a System Administrator must reset your account by assigning you a new password. A Security Administrator can set the password rules for your system including: 1. Setting the minimum length of a password. 2. Forcing all Users to change passwords on a periodic basis. 3. Making passwords case-sensitive. 4. Requiring you to use a complex password. A complex password contains at least one upper and lower case letter, a number and a special character. 5. Preventing you from reusing passwords. The Change Password dialog will show you the current requirements when you are entering a password.

To Change Your Password


1. Click on the Utilities item in the VersaForm menu. 2. Select the Change My Password item in the list. The Change Password window will open.

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3. Type in the old password. 4. Enter the new password. The password requirements will be shown on the screen. 5. Click the Ok button when done.

To Change Another User's Password (Must be a Security Administrator)


Note: On systems set to High Security mode, only a Security Administrator can access the Users Tab. On all systems, you must be a Security Administrator to change another User's password. 1. From the Setup window, click the Users Tab 2. Select the User you want to modify. 3. Click on the Edit/View button. The Edit/View User Information window will open. 4. Click on the Set Password button. 5. Type in the new password. The password requirements will be shown on the screen. 6. Click the Ok button when done.

Users Setup: Removing a User from the List


Once a User has modified or added patient medical data they cannot be removed. However, they can be made inactive.

To Remove a User
1. Click on the Setup button in the top tool bar or choose the Setup item on the Utilities menu. 2. Click on the Users Tab. 3. Click on the User and then click on the Remove button.

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The Providers Tab


The Providers Tab in the Setup Window has these Functions
Add Provider: Adds a new Provider to the system. You will be prompted to select a User to become a Provider. All Providers must first be Users. Edit/View: Edits Provider information. Remove: Removes a Provider from the system. (VersaForm no longer allows removing Providers. Make them inactive instead.) Register: Registers the highlighted Provider with electronic prescriptions. Check Status: Checks on the electronic prescription status of the highlighted Provider. Help: Brings up the context sensitive VersaForm Help.

Providers Setup: Provider Setup


How to Open
1. Click on the Setup button in the top tool bar or choose the Setup item on the Utilities menu. 2. Click on the Providers Tab. 3. To add a record click on the Add button. 4. To modify an existing Provider, locate the name on the list and double click on it (or click once and then click on the Edit/View button). Note: A Provider must be listed in the Users table before you can create a Provider. When you click on the Add button you will be presented a list of Users. Select the User Name you assigned to this Provider:

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Click on the OK button or double click on the name.

What You Will See in the Upper Pane When You Add

Note that some fields, indicated by a grey background, are already filled in and cannot be modified. When you first create the Provider, the User EIN and User SSN fields are blank. The next time you Edit this Provider, you will see those fields filled in with information from the User's record.

What Goes in Each Field


Field Name Required Information to Enter Sample

416

Fullname

--

Automatically filled in from the User' record cannot be modified here. If it needs to be changed, change it in Setup Users.

Jane J Jones MD JJJ

Initials

No

Initials to identify this doctor. A check mark here indicates that this Provider is active in your practice. Un-check it if this Provider is no longer associated with your practice. Automatically filled in from the Users record cannot be modified here. If it needs to be changed, change it in the Users record. Check here if the Provider is a person. Enter the doctor's NPI number. The doctor's license number. Two character id for the state - you can use the drop down list. The doctor's Drug Enforcement Agency number.

Active

Yes

Provider's User Name Is a Person NPI Medical Lic. No. State DEA Number

--

Jane

-Yes Yes

P 545454545 A0787876

Yes

NY

No

Provider Type

No

This is the Taxonomy code - you can use the drop down list that identifies the various types. VersaForm will translate the type to the General appropriate number code. These numbers are Practice currently in development and tend to change ever six months. You can type the number in directly. May be required for some state's Medicare. If this is a solo practice, leave this field blank. If the Provider is part of a group or clinic use the drop-down list to choose the name of the submitter (who will submit the claims). Use the drop-down list to pick the primary facility for this Provider. Good Sam

Submitter

No

Facility

No

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User EIN

--

Automatically filled in from the Users record cannot be modified here. If it needs to be changed, change it in the User's record. Click on this to choose to use the EIN in claims. Automatically filled in from the Users record cannot be modified here. If it needs to be changed, change it in the Users record. Click on this to choose to use the SSN in claims. What type of number is to be used if there is no match for the patient's insurance in the "Edit IDs" table? Use the drop-down list. The ID to use if there is no match for the patient's insurance in the "Edit IDs" table. The doctor's pager number. The doctor's UPIN. Employer's Identification

Use EIN in claims

No

User SSN

--

Use SSN

No

Qualifier

Yes

ID Pager Universal Prov ID

Yes No No

55443321 232 343 7777 B0787876

The Completed Entry

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What You Will See in the Lower Pane

What Goes in Each Field


Field Name Required Information to Enter Sample

Provider's Address (if different from Practice Address) The doctor's street address (note there are two lines available). The doctor's e-mail address. The doctor's city. The initials for the state (note drop-down list). The doctor's Zip code. The doctor's country (2 characters only). The doctor's phone number. Phone extension. The doctor's Fax number. The doctor's pager number. 232 343 5555 44 232 343 6666 232 343 7777 42 43rd Street Ste 465 GoodDoc@msn.net New York NY

Street

No

E-Mail City State (not labeled) Zip (not labeled) Country Phone Extension Fax Pager

No No No

No No No No No No

01232

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Mobile Contact Dear Dept. Note

No No No No No

The doctor's mobile phone number. A contact person. How to address the doctor. A department. Any notes.

232 343 4444 Susan Gold Ms Gold

The Completed Entry

Other Actions
Click the OK button to save and close. Click the Cancel button to close without saving. Click on the Edit IDs button to add to, or to see a list of, insurance plans and numbers that are assigned to this Provider

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Notes
Once a Provider record has been entered into the system it cannot be removed. To suppress a Provider from the various Provider lists un-check Active .

Providers Setup: Adding a Provider to the List


To add a Provider, first add him or her as a User.
From the Setup window, Click on the Providers Tab: 1. Click on the Add button. The Select A User Window will open.

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2. Choose the User from the drop-down list and click on the OK button. 3. If you want this Provider's prescriptions and reports to use a heading different from the Primary Facility's name and address, enter the Provider's own address under Provider's Address. Otherwise leave it blank. 4. Click on the OK button.

Providers Setup: Changing a Provider on the List


You can edit or view a Provider from the Providers Tab in the Setup window.

To Edit or View a Provider


1. Click the menu. Setup button in the top tool bar or choose the Setup item on the Utilities

2. Click the Providers Tab in the Setup window. 3. Double click on the Provider you want to edit or click on him or her and then click on the Edit/View button. 4. The Edit Provider window will open. 5. Make the changes to the provider data you want. 6. Click the OK button when done.

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The Facilities Tab


The Facilities Tab in the Setup Window has these Functions
Add: Adds a new Facility to the system. Edit/View: Edits Facility information. Remove: Removes a Facility from the system if it is not being used. Pharmacy Search: If you have the Electronic Prescriptions option, this button will allow you to search for a pharmacy. Help: Brings up the context sensitive VersaForm Help.

Facilities Setup: Facilities Setup


How to Open
Click on the Setup button on the top tool bar or choose the Setup item on the Utilities menu. Click on the Facilities Tab. Click on the Add button to create a new facility. To modify an existing Facility, locate the name on the list and double click on it or click once to highlight it and then click on the Edit/View button.

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What You Will See in the Upper Pane When You Add

What Goes in Each Field


Field Name Name Required Y Information to Enter What you call this facility - a hospital name, lab name, pharmacy, etc. If this facility is one your office uses, place a check mark here. What kind of facility this is - use the pick list. If it is an outside lab, you must choose "Electronic Lab" or "Lab". A HIPAA required field - use the pick list. Generally you will use "Facility" or "Testing Laboratory", or "Independent Lab". A check here indicates that this facility is the Primary Facility - generally your office. If there is no address in a Provider record the address information in the Primary Facility will be used. There should only be one Primary Facility Sample Our Lab

Active

Kind

Clinic

Entity Identifier

Testing Laboratory

Primary Facility

Y (only one)

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Tax Id CLIA# NPI

Y N Y (04-0207)

Employer ID or SSN of this facility. Generally required by HIPAA. If this office or facility has a CLIA number. The National Provider Identifier for this facility. What ID number will be used if there is no match for the patient's insurance. This is the number that will print in box 31 of the HCFA 1500 form. What type of number is in the ID field? Use the drop down list.

83-3434333 CLIA123456 123456

ID

86-23232234

Qualifier

Employer's Identification Number

Electronic Lab Data Information See Setting Up Electronic Labs for more information on this. Y (for labs) If this is a lab, choose the type. This is required because the format of the data is slightly different for different electronic labs. Choose Insurance, Patient or Practice.

Lab

LabCorp

Billing Default Lab Folder Customer ID Vendor ID Lab Mnemonic Auto Print

Insurance

Y (for labs) Y (for labs) Y (for TO labs) Y (for TO labs) N

If this is a lab, where do the data files go? This must be unique for each electronic lab. Required for Electronic Labs. The lab will give you this information. Required for sending TO the Lab. The lab will give you this information. Required for sending TO the Lab. The lab will give you this information. Automatically print requisitions for orders TO the Lab.

C:\LabCorp

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Pharmacy Information For Electronic Prescriptions only. Pharmacy NCPDPID Pharmacy Accepts Y Will be filled in automatically when you Add a pharmacy for a patient. What prescription formats the pharmacy accepts. FAX

Form When Completed

What You Will See in the Lower Pane

What Goes in Each Field


Field Name Required Information to Enter Sample

426

Street

Two fields for the street address of this facility.

591 W. Hamilton Ave. Suite 201

E-Mail City St Zip Country Phone Extension Fax Pager Mobile Contact Dear

N Y Y Y N N N N N N N N

E-mail address of the key person at this facility. City where the facility is located. State (2 character) for this facility. You can use the drop down list. Zip code for the facility. What country? Use the two character code only. The facility's phone number. Phone extension if needed. Fax number for the facility. A pager number for this facility. A cell phone number for this facility. A contact at the facility's office. What should appear in the salutation part of a form letter. Any necessary department heading for this facility. Any special note or information to store for this facility.

janjen@ourlab.com Campbell CA 95008

408 555 9898

408 555 9899

June

Dept.

Note

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Form When Completed

Other Actions
If you want to send lab order files to an electronic lab facility, then you must ensure that VersaForm is communicating correctly with the lab on panels, providers and insurance plans. This is done by setting up a mapping of VersaForm names and IDs with the names and IDs used by the electronic lab facility. See Setting Up Electronic Labs for more information on this. Click the OK button to save and close. Click the Cancel button to close without saving. Click on the Edit Insurance IDs button to add to or see a list of insurance plans and numbers assigned to this facility

Facilities Setup: Adding a Facility to the List


To Add a Facility
From the Setup window, Click on the Facilities Tab: 1. Click on the Add button. The Edit Facility window will open.

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2. You will need to fill in at least the Name, Kind and address information. Once you have saved a Facility as an Electronic Lab or a Pharmacy, you can't change the Kind. 3. If you will be generating insurance claims, you will also need to fill in at least the Entity Identifier, Tax ID, NPI and the Insurance Defaults ID and Qualifier. 4. Click on the OK button.

Facilities Setup: Changing a Facility on the List


You can edit or view a Facility from the Facilities Tab in the Setup window.

To Edit or View a Facility


1. Click the menu. Setup button in the top Toolbar or choose the Setup item on the Utilities

2. Click the Facilities Tab. 429

3. Double click on the Facility you want to edit or click on it and then click on the Edit/View button. 4. The Edit Facility window will open. 5. Make the changes you want, but only to fields that are not grayed out. 6. Click the OK button when done.

Facilities Setup: Removing a Facility from the List


You can not remove the Primary Facility or a Facility that is being used.

To Remove a Facility
1. Click the menu. Setup button in the top Toolbar or choose the Setup item on the Utilities

2. Click the Facilities Tab. 3. Click on the Facility and then click on the Remove button.

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Setting up Electronic Labs Overview


There are several things that need to be filled in to receive and/or send electronic labs. Lab Type: Currently, VersaForm supports Enzo Clinical Lab, LabCorp, PLS, Quest Diagnostics, Spectrum and TCL. You must choose the correct type for each lab. Billing Default: For sending TO an electronic lab. The lab must know who will pay for the lab - the patient's Insurance, the Patient or the Practice. If you do not choose one here, the Labs Billing Default system parameter will be used. Lab Folder: This is the folder that will hold both incoming and outgoing lab data. The folder you specify MUST BE UNIQUE for each lab and for each versaformN database (if you have a Multi-Doc system). VersaForm will automatically create three subfolders: \LabOrders, \LabResultsErrors and \LabResultsProcessed in the Lab Folder. NOTE: If you change the electronic Lab Directory, no files are moved from the old folder or its subfolders by VersaForm. Customer ID (Submitter ID): This ID is required for all electronic labs. The lab will give you this ID. Vendor ID (Application): This ID is required for sending TO a lab. The lab will give you this ID. Lab Mnemonic (Lab Facility): This ID is required for sending TO a lab. The lab will give you this ID. Automatically print requisitions for orders TO the Lab: Whether you want to print a requisition printed when a lab order is created. If checked, the requisition report will pop up when the lab order is created and can then be printed and included with the lab sample. If you do not choose this here, the Electlab Autoprint Requisition system parameter default will be used.

Before you can Send Lab Orders, you Must Specify Three Types of IDs
Each electronic lab will have its own IDs so this must be done for every electronic lab. You must enter values for all providers, insurance plans and panels which will be used in electronic lab orders. ElectLab Provider IDs: Each Provider must be active and must be a person. After you give the lab a list of your Providers, they will give you these IDs. ElectLab Insurance IDs: After you give the lab a list of your patients' insurance plans, they will give you these IDs.

431

ElectLab Panel IDs: Each lab has its own IDs and names for lab panels. You can either work from a list that the lab supplies or, an easier way to populate this table, is to receive electronic labs for a while before sending any. Extract ElectLab Panels: If you have received electronic labs, you can extract the ElectLab Panel IDs from them. When you click on the Extract from Results button, VersaForm searches through the Lab Folder for lab results. If it finds any, it extracts the names and codes. However, it can NOT extract the Z Segment (Additional Input) value, so you will have to modify the ElectLab Panel IDs that need Z Segments. Each electronic lab will provide you with a list of which of their panels require additional input. If you fail to specify a Z Segment required by the lab, the lab orders containing those codes will be rejected.

Electronic Labs: Setting up Electronic Labs


As optional features, VersaForm can process lab results received from a lab (called one-way or inbound labs) or both send lab orders TO and receive lab results FROM an electronic lab (called round-trip labs). The setup and use of your VersaForm system depends on which of these features you have enabled on your system. Currently, VersaForm supports receiving lab results from American Esoteric Laboratories, Bio-Reference, Enzo Clinical Lab, LabCorp, PLS, Quest Diagnostics, Spectrum Laboratory Network and TCL. This section of the help provides information on Electronic Lab setup. If you are looking for operational information, see Creating Electronic Lab Orders and Processing Electronic Lab Results.

VersaForm Setup for Electronic Labs


The first step in the process of preparing for electronic labs is to add a Facility for the lab. Go to Setup Facilities and click the Add button. For more about setting up Facilities, see Facilities Setup.

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You will see the Edit Facility window:

1. Fill in the Name field with the name of the lab. You can type any name you like here but it makes sense to use a name that identifies the lab you are using. 2. Choose Electronic Lab from the Kind drop-down list. 3. Depending on your situation, fill in any or all of Entity Identifier, Tax Id, CLIA#, NPI and Insurance Defaults ID and Qualifier. 4. In the Electronic Lab Data Information section, choose the correct lab from the Lab drop-down list. 5. The Billing Default, used only for round-trip labs, tells the lab who will pay for the service: The Patient's Insurance The Patient The Practice (you).

6. If you do not set the Billing Default here, the system parameter Labs Billing Default (specified in Setup Preferences) will be used.

7. The Lab Folder field is used to specify where on your computer or network the incoming and/or outgoing labs will be placed. You must specify a unique folder for each electronic lab you create. You may have multiple electronic lab facilities but each one must have its own folder for electronic labs. If you have 433

a VersaForm Multi-Doc system, the folders must also be unique for each electronic lab facility in each database. If the folder you specify does not exist, VersaForm will create it. See Electronic Lab Folders for more information. The transmission of files to the lab from the \LabOrder subfolder and receipt of lab data into the main lab folder happens outside of VersaForm. The process of transmission belongs to the individual lab and they will normally set up the programs and procedures necessary to automatically take lab orders from your system and deposit lab results onto your system. VersaForm technical support is happy to assist the lab in setting up this process but the primary responsibility for this procedure rests with the lab. 1. The Customer ID (Submitter ID) field is required for all electronic labs. The lab will give you this identifier. 2. Both the Vendor ID (Application) and Lab Mnemonic (Lab Facility) are used only for round-trip labs. The values for these two items will be supplied by the lab. 3. The Automatically Print Requisitions for orders TO the Lab (Used only for roundtrip labs) option indicates whether you want a lab requisition printed when a lab order is created. If selected, the requisition report will pop up when the lab order is created and can then be printed and included with the lab sample. If you do not select an option here, the system parameter Automatically print requisitions (specified in Setup Preferences) will be used. 4. Fill in the address information in the Work Address section of the form. At a minimum, the Street, City, and state must be entered.

Message Options for Labs Marked Abnormal


The Setup Preferences Tab is used to select the labs messaging options. You can choose: 1. Whether or not to send a VersaForm "high-priority" message for labs that show abnormal results. High-priority messages are quickly sent to the recipient if they are currently on the VersaForm system or are delivered the next time they log on to the system. 2. To have the message sent to the patient's Primary Provider. You may specify a second User to receive the message in the case where the patient has no Primary Provider. 3. To send all lab messages to a specified User. If you are using only inbound labs, your setup is complete. For information on processing inbound labs, see Processing Electronic Lab Results. 434

Additional Setup for Round-Trip Electronic Labs


Unfortunately, there is no universal identification for lab panels or for insurance companies so you are required to use identifiers created by each lab and each lab has different identifiers. Providers have a universal identifier, either the National Provider Identifier (NPI) or the Universal Provider Identifier (UPIN). If your providers are set up ( Setup Providers) with either of these numbers, they can generally be used to send lab orders. If you do not supply these identifiers, you will also need to get an identifier from the lab for each Provider. To help you obtain and enter the necessary information, VersaForm provides three buttons on the Edit Facility window, labeled ElectLab Providers, ElectLab Insurance and ElectLab Panels. These buttons are enabled once you have saved the initial specification for an electronic lab. Each of these buttons displays a dialog designed to help you enter lab information for a specific lab and will: 1. Generate a file that you can send to the lab to request the necessary information. 2. Process the information returned FROM the lab and enter the information into VersaForm. See Setting up Electronic Lab Providers, Setting up Electronic Lab Insurance and Setting up Electronic Lab Panels for more information on the three ElectLab buttons.

Electronic Labs: Setting up Electronic Lab Providers


An electronic lab may use a Provider's NPI or UPIN, or a provider ID specified by the electronic lab to determine the provider placing a lab order. Check with your electronic lab to determine if NPIs or UPINs are acceptable or if you are required to have this provider mapping. This information must be specified in the VersaForm database before lab panels may be ordered from an electronic lab. Click the ElectLab Providers button to add to or to see a list of the mapping between VersaForm providers and provider information used by this electronic lab facility. This information is only needed if you are going to send lab order files TO the electronic lab. If you have more than one electronic lab facility, you must do this for EACH one.

The ... Electronic Lab Provider IDs Window


This dialog allows you to manage the provider mapping between your practice and the electronic lab. You may add, delete or change existing entries. To add a new provider to the list, you must know the Lab Provider ID used by the electronic lab. Contact your electronic lab to obtain this information. To make Electronic Lab Provider setup easier for your practice, VersaForm has provided two buttons in the Electronic Lab Provider IDs interface. 435

The Export Button


Pressing this button will create the file "electlab_provider_info.txt" in the Lab Folder for this electronic lab. See Format of the Electronic Lab Provider File for more information. This file should be sent to your electronic lab. You can easily send the file by attaching it to an email message. The electronic lab should import this file into a spreadsheet and fill in the requested information. Then they should export the information from the spreadsheet to the same file and return it to you. When the lab returns the file, put it in the lab's folder, return to the ... Electronic Lab Provider IDs window and use the Import button to read the information.

The Import Button


Pressing this button will extract the information from the file returned to your practice by the electronic lab. (See The Export Button above). The file must be in the Lab Folder for this electronic lab. The name of the file must be "electlab_provider_info.txt". The Provider IDs will be extracted from the file, validated and loaded into the VersaForm table which maps VersaForm provider information to electronic lab provider information.

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If You do Need to Acquire Provider IDs for the Lab


1. Click on the ElectLab Providers button. You will see the ...Electronic Lab Provider IDs window. 2. Click on the Export button and your dialog will look like this:

3. Send the file electlab_provider_info.txt (placed in the folder you selected for the lab) to the lab. You can easily send the file by attaching it to an email message. 4. When the lab returns the file, put it in the lab's folder, return to this dialog and use the Import button to read the information. If your electronic lab will not accept and return the file, you can print this list of providers, send the list to the lab and manually enter the lab information when the lab provides the numbers.

View, Modify, Add or Delete Lab Provider IDs


Click on the ElectLab Providers button see a list of the mapping between VersaForm Providers and provider information used by this electronic lab facility. To Modify a Provider, highlight the line with the Provider's name, click in the Lab Provider ID field you want to change and type in the change. To Add a Provider, click on the Add button, then choose the Provider and fill in the Lab Provider ID. To Delete a Provider, highlight the line with the Provider's name, click on the Remove button and click on the Yes button when prompted.

Notes If there are any Providers in your practice who will be requesting electronic lab orders and the Provider does not have an NPI or UPIN then you must set up a mapping between these Providers and the provider IDs used by the electronic lab for them. 437

The Provider must be active and must be a person.

Format of the Electronic Lab Provider File


The first row in this tab separated file is a heading which describes the data already in the file (VersaForm Provider ID and VersaForm Provider name, medical license and license state) and what data needs to be filled in by the electronic lab (electronic lab provider ID). Each row must contain the VersaForm Provider ID, VersaForm Provider Name, and electronic lab provider ID. The medical license information is not used by the import function but should be the same information sent to the electronic lab in the export file (see above). The VersaForm medical license information was included in the export file to help the electronic lab identify which of their providers maps to the practice provider.

Technical Information
The electronic lab provider ID information is used in lab order files sent to the electronic lab. When creating lab order files, VersaForm first checks the VersaForm database to see if the provider has an NPI. If so, VersaForm will set ORC.13.8='N' and set ORC.13.1 to the NPI. If not, and the provider has a UPIN, then VersaForm will set ORC.13.8='U' and set ORC.13.1 to the UPIN. If not then there must be an entry in the Electronic Labs Provider Mapping Table for this provider and VersaForm will set ORC.13.8='L' and set ORC.13.1 to the electronic lab provider ID.

Electronic Labs: Setting up Electronic Lab Insurance


Each electronic lab has its own IDs and names for insurance plans. This information must be specified in the VersaForm database before lab panels may be ordered from an electronic lab. Click on the ElectLab Insurance button to add to or to see a list of the mapping between VersaForm insurance plans and insurance plan information used by this electronic lab facility. This information is only needed if you are going to send lab order files TO the electronic lab. If you have more than one electronic lab facility, you must do this for EACH one.

The ... Electronic Lab Insurance IDs Window


This dialog allows you to manage the insurance plan mapping between your practice and the electronic lab. You may add or delete entries or change existing entries.

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To add a new insurance plan to the list, you must know the Lab Insurance ID and Lab Insurance Name. Contact your electronic lab to obtain this information. It may be necessary to provide the address of the insurance plan to the electronic lab in order for them to provide you with the correct information. To make Electronic Lab Insurance setup easier for your practice, VersaForm has provided two additional buttons in the Electronic Lab Insurance interface.

The Export Button


Pressing this button will create the file "electlab_insurance_info.txt" in the Lab Folder for this electronic lab. After pressing the Export button the dialog looks like:

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This "electlab_insurance_info.txt" file should be sent to your electronic lab. You can easily send the file by attaching it to an email message. The electronic lab should import this file into a spreadsheet and fill in the requested information. Then they should export the information from the spreadsheet to the same file and return it to you. When the lab returns the file, put it in the lab's folder, return to the ... Electronic Lab Insurance IDs window and use the Import button to read the information. You must check with your electronic lab to see if they will accept and return the file. If not, you must print the list of insurance companies, send the list to the lab and manually enter the lab information when the lab provides the numbers. See Format of the Electronic Lab Insurance File for more information.

The Import Button


Pressing this button will extract the information from the file returned to your practice by the electronic lab. (See The Export Button above). The file must be in the Lab Folder for this electronic lab. The name of the file must be "electlab_insurance_info.txt". The information will be extracted from the file, validated and loaded into the VersaForm table which maps VersaForm insurance information to electronic lab insurance information. See Format of the Electronic Lab Insurance File for more information.

View, Modify, Add or Delete Lab Insurance IDs


Click on the ElectLab Providers button see a list of the mapping between VersaForm Panels and panel information used by this electronic lab facility. To Modify an Insurance, click in the field you want to change and type in the change. To Add an Insurance, click on the Add button, then choose the Insurance Plan and fill in the Lab Insurance ID and Lab Insurance Name. To Delete an Insurance, highlight the line with the Insurance name, click on the Remove button and click on the Yes button when prompted.

Format of the Electronic Lab Insurance File


The first row in this tab separated file is a heading which describes the data already in the file (VersaForm insurance plan ID and VersaForm insurance name, address1, address2, city, state and zip) and what data needs to be filled in by the electronic lab (electronic lab insurance ID and electronic lab insurance name). Each row must contain the VersaForm Insurance ID, VersaForm Insurance Name, electronic lab Insurance ID, and electronic lab insurance name. The address information is not used by the import function but should be the same information sent to the electronic lab in the export file (see above). The VersaForm insurance address was included in the export file to 440

help the electronic lab identify which of their insurance plans maps to the practice insurance plan.

Technical Information
The electronic lab panel information is used in lab order files sent to the electronic lab. Electronic lab insurance ID is set in INI.4.1 and electronic lab insurance names in INI.4.2 of the lab order file.

Electronic Labs: Setting up Electronic Lab Panels


Each electronic lab has its own IDs and names for lab panels and some panels also require additional information when ordered. The labs call this additional data "z-segment" information. This information must be specified in the VersaForm database before lab panels may be ordered from an electronic lab. Click on the Electlab Panels button to add to or to see a list of the mapping between VersaForm panels and panel information used by this electronic lab facility. This information is only needed if you are going to send lab order files TO the electronic lab. If you have more than one electronic lab facility, you must do this for EACH one.

VersaForm Provides Four Methods to Load the Necessary Information for Lab Panels
1. Some VersaForm customers choose to begin electronic lab processing by using oneway (incoming) labs and converting to round-trip labs after some period of time. If this is the case for your installation, VersaForm has been collecting lab panel information each time you received and processed lab results. This data can be used to populate the necessary information for round-trip labs by clicking the Extract from Results button. The advantage of using this process is that only lab panels that you have already used are added to the lab information for outgoing orders. Remember that this process is only useful if you have already received electronic lab results. 2. Some labs provide VersaForm with a list of lab panels and the associated information used by the lab in a file. If the lab has provided this file, the Load ALL from file button will be enabled. Pressing this button will load the lab panel data needed for sending lab orders. You should be aware that this process may add several thousand lab panel names to your system. 3. If neither of the above two methods can be used, you can use the Export button to generate a file that you can send to the lab. When the lab returns the file, you put it in the lab's folder, return to the ... Electronic Lab Panel IDs window and use the Import button to read the information.

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4. If your electronic lab will not accept and return the file, you can print a list of panels, send the list to the lab and manually enter the lab information when the lab provides the numbers.

The ... Electronic Lab Panel IDs Window


This dialog allows you to manage the panel mapping between your practice and the electronic lab. You may add, delete or change existing entries. To add a new panel to the list, you must know the Lab Panel ID, Lab Panel Name, and ZSegment required by this electronic lab facility. Contact your electronic lab to obtain this information. To make Electronic Lab Panel setup easier for your practice, VersaForm has provided four buttons in the Electronic Lab Panel IDs interface.

The Export Button


Pressing this button will create the file "electlab_panel_info.txt" in the Lab Folder for this electronic lab. After pressing the Export button the dialog looks like:

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This "electlab_panel_info.txt" file should be sent to your electronic lab. You can easily send the file by attaching it to an email message. The electronic lab should import this file into a spreadsheet and fill in the requested information. Then they should export the information from the spreadsheet to the same file and return it to you. When the lab returns the file, put it in the lab's folder, return to the ... Electronic Lab Panel IDs window and use the Import button to read the information. See Format of the Electronic Lab Panel File for more information.

The Import Button


Pressing this button will extract the information from the file returned to your practice by the electronic lab. (See The Export Button above). The file must be in the Lab Folder for this electronic lab. The name of the file must be "electlab_panel_info.txt". The information will be extracted from the file, validated and loaded into the VersaForm table which maps VersaForm panel information to electronic lab panel information. See Format of the Electronic Lab Panel File for more information.

The Extract From Results Button


The extract function scans all previously processed lab results files from this electronic lab. It extracts the electronic lab panel ID and the electronic lab panel name from the file. See Technical Information for more information. Because the lab results do not contain enough information for us to determine if z-segments are required, you will asked to manually fill in the z-segment information after the extraction is complete. You must get this information about z-segments from your electronic lab.

The Load ALL From File Button


If your electronic lab provides your practice with a file created from their compendium, this button may be used to have VersaForm read that file and determine the electronic lab panel name, electronic lab panel ID and z-segment information for each record.

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Note: Invoking this function may result in many panels being loaded in the VersaForm lab panels table. For example, the LabCorp file containing data from columns A, B and BG of the LabCorp compendium loaded a little over 2,200 electronic lab Panel IDs.

View, Modify, Add or Delete Lab Panel IDs


Click on the ElectLab Providers button see a list of the mapping between VersaForm Panels and panel information used by this electronic lab facility. To Modify a Panel, click in the field you want to change and type in the change. To Add a Panel, click on the Add button, then choose the Panel and fill in the Lab Panel ID, Lab Panel Name and Z Segment (if necessary). To Delete a Panel, highlight the line with the Panel name, click on the Remove button and click on the Yes button when prompted.

Technical Information
The electronic lab panel information is used in lab order files sent to the electronic lab. Electronic lab panel ID is set in OBR.5.1 and electronic lab panel names in OBR.5.2 of the file. The z-segment will be used to determine if this panel in the order file requires a ZBL, ZCY or ZSA segment with additional information about the panel requested. The Extract from Results button extracts the electronic lab panel ID from OBR.5.1 and the electronic lab panel name from OBR.5.2 from the lab results file.

Since the lab results have already been processed, there should already be a mapping for this lab panel ID ORB.5.1 or there should already be a VersaForm panel with the same name as OBR.5.2. If there is not, then the VersaForm panel name has probably been changed and the record is ignored. The Load ALL From File Button inserts a row in the VersaForm panel mapping table for each electronic lab panel ID, unless there is already an entry for that electronic lab panel ID.

If there is already an entry for an electronic lab panel ID but the mapping panel_name or zsegment is not the same, then the record is ignored. If there is not already a mapping for the electronic lab Panel ID, then VersaForm will see if there is already a VersaForm panel with the same name as the electronic lab panel name. If that VersaForm panel name exists but is already mapped to something else, the record is ignored.

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Otherwise, VersaForm creates a VersaForm panel with that electronic lab panel name and maps it to the electronic lab panel ID, panel name and z-segment values from the record in the file. Notice that this means that, for electronic lab panel names with multiple electronic lab panel IDs, only the first one will be processed by the Load function and any others will be ignored. See above notes on how to map multiple electronic lab panel IDs with the same electronic lab panel name.

Mapping Rules
Because some electronic labs do not have unique panel names, mapping panels is difficult. VersaForm enforces the following rules: VersaForm panel names must be unique. Electronic lab panel IDs must be unique and must have a unique z-segment i.e. if panel=123 has z-segment="ZCY" it can not also have z-segment="ZSA". Only one VersaForm panel may be mapped to a electronic lab panel ID. When VersaForm processes electronic a lab results file, it first tries to determine the VersaForm panel to map to using the electronic lab panel ID in OBR.5.1 of the file. If it can not find a mapping for the electronic lab panel ID, it then looks to see if there are any mappings for the electronic lab panel name in OBR.5.2 in the file.

If there are more than one mapping for the electronic lab panel name, VersaForm will ask you which one to use. If there are no mappings for either the electronic lab panel ID or the electronic lab panel name VersaForm will see if there is already a VersaForm panel with the same panel name as the electronic lab panel name. If found, it will use that VersaForm panel and make an entry in the lab panel mapping table so that it is remembered. If there is not already a VersaForm panel with the electronic lab panel name, VersaForm will create a VersaForm panel with that name and make an entry in the lab panel mapping table so that it is remembered. Note: if OBR.12 = "G" then the electronic lab panel name used is taken from the previous OBR in that file where OBR.12 is not "G". If no such OBR exists, VersaForm uses the VersaForm panel "Missing Panel Name". Because of these rules, if your practice wants to use one of the electronic lab panels which does not have a unique electronic lab panel ID (e.g. Opiates 722401 and Opiates 766556) you must create two different VersaForm panels. In this case, you could create VersaForm panel "Opiates-722401" and another VersaForm panel "Opiates-766556". You could then use the VersaForm Electronic Lab Panel screen to 445

map VersaForm "Opiates-722401" to electronic lab panel ID 722401 and map VersaForm "Opiates-766556" to electronic lab panel ID 766556.

The Z-Segment
For electronic lab panels, you must indicate if additional input is required (z-segment). Each electronic lab will provide you with a list of which of their panels require additional input. If you fail to specify a z-segment required for a panel by the electronic lab, the lab order will be rejected by the lab because not enough information will be sent to the lab to process this lab panel request.

Format of the Electronic Lab Panel File


The first row in this tab separated file is a heading which describes the data already in the file (VersaForm Panel ID and VersaForm Panel name) and what data needs to be filled in by the electronic lab (electronic lab panel ID, electronic lab panel name and z-segment requirements). Each row must contain the VersaForm Panel ID, VersaForm Panel name, electronic lab panel ID, and electronic panel name. If this electronic lab requires z-segment information for this panel, then the z-segment information will be filled in.

Electronic Labs: Electronic Lab Folders


Setting up the Electronic Lab Folder
When you choose an Electronic Lab Lab Folder, if the folder you specify does not exist, VersaForm will create it and VersaForm will also create three subfolders \LabResultsErrors \LabResultsProcessed \LabOrders

NOTE: If you change an electronic lab folder, no files are moved from the old folder or its subfolders. For example, if you specified C:\TCLLabs as the Lab Folder, you would end up with a structure that looks like: C:\TCLLabs: This folder is used to hold lab results sent from the lab. C:\TCLLabs\LabResultsProcessed: This folder holds lab results after they have been successfully processed. VersaForm automatically moves lab results to this subfolder after processing if there are no errors. The date and time the file was processed is pre-pended to the file name to ensure that the file name is unique.

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C:\TCLLabs\LabResultsErrors: VersaForm automatically moves lab results to this subfolder after processing if an error is encountered. The date and time the file was processed is pre-pended to the file name to ensure that the file name is unique. C:\TCLLabs\LabOrders: Used only for round-trip labs, this folder holds the lab orders generated by VersaForm to be transmitted to the lab.

Using the Electronic Lab Folder


Electronic lab results files (sent from the lab) must be put in the electronic Lab Folder specified by your practice in order to be processed by VersaForm. When VersaForm processes an electronic lab result file it moves the file to the proper subfolder (depending on whether it was processed successfully or with errors). The date and time the file was processed is pre-pended to the file name to ensure that the file name is unique. When VersaForm creates a lab order file (to be sent to the lab), this file will be created in the \LabOrders subfolder. The electronic lab will provide a mechanism to remove these files from the \LabOrders subfolder and process them. If the lab results are returned to the practice electronically then the electronic lab must put the results file in the Lab Folder for that lab. The transmission of files to the lab from the \LabOrder subfolder and receipt of lab data into the main lab folder happens outside of VersaForm. The process of transmission belongs to the individual lab and they will normally set up the programs and procedures necessary to automatically take lab orders from your system and deposit lab results onto your system. VersaForm technical support is happy to assist the lab in setting up this process but the primary responsibility for this procedure rests with the lab.

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ICD9s
The IDC9 Codes Tab in the Setup Window has these Functions
Add to List: Adds a new ICD9 Code to the system. Edit/View: Edits ICD9 Code information. Remove: Removes an ICD9 Code from the system. Import Codes: You can import ICD9 Codes from a text file. Help: Brings up the context sensitive VersaForm Help.

ICD9: ICD9 Codes Setup


How to Open
Click on the Setup button on the top tool bar or choose the Setup item on the Utilities menu. Click on the ICD9 Codes Tab. Click on the Add to List button to a new create new entry. To modify an existing ICD9 Code, locate the code on the list and double click on it or click once to highlight it and then click on the Edit/View button.

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What You Will See When You Add

What Goes in Each Field


Field Name Code Information to Enter Specific ICD9 Code - as it will appear in your claims. If this ICD9 Code is one your office uses, place a check mark here. Schizophrenia NOSUnspec Sample 295.90

Active

Description The actual description for this code.

The Completed Dialog

Other Actions
Click the Add to Practice button to save and close. Click the Cancel button to close without saving. Click on the My Frequent List button to put the Code in your list of frequently used ICD9s as well as in the practice wide list. 449

ICD9: Adding a New ICD9 Code to the List


You can add a new ICD9 code from within a patient's chart. Setup or from the ICD9 Codes selection window

From the Setup window, Click on the ICD9 Codes Tab: 1. Click on the Add to List button. The ICD9 Code Setup window will open.

2. Enter the ICD9 Code. 3. Check Active .

4. Enter the Description. 5. Either click on Add to Practice to add the code to the practice-wide list or click on My Frequent List to add to the frequent list. Adding a code to the frequent list automatically adds it to the practice wide list.

ICD9: Changing an ICD9 Code on the List


You can edit or view a ICD9 Code from the ICD9 Codes Tab in the Setup window.

To Edit or View an ICD9 Code


1. Click the menu. Setup button in the top Toolbar or choose the Setup item on the Utilities

2. Click the ICD9 Codes Tab in the Setup window. 3. Double click on the ICD9 Code you want to edit or click on it and then click on the Edit/View button. If necessary, use the Search button to find the ICD9 Code. 4. The ICD9 Code Setup window will open. 5. Make the changes you want.

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6. Click on the OK button.

ICD9: Removing an ICD9 Code from the List


To Remove an ICD9 Code
1. Click on the Setup button in the top tool bar or choose the Setup item on the Utilities menu. 2. Click on the ICD9 Codes Tab. 3. If necessary, use the Search button to find the code you want to remove. 4. Click on the Code and then click on the Remove button.

ICD9: Importing ICD9 Codes


You can import codes into the ICD9 Codes List from the ICD9 Codes Tab in the Setup window. The file you import from is called ICD.TXT. It's the diagnosis codes file that you exported from the VersaForm Practice Management System (MD VersaForm). It is stored in the subdirectory "tocpr" under the VersaForm directory. If drive C is used, this will normally be "C:\Program Files\VersaForm 3.0\TOCPR\icd.txt". Field ICD9 code Size 7 Field Name Code Description Field name equivalent in VersaForm Practice Management Dcode1 Description

Description 34

Sample:
840.6,"SPRAIN SUPRASPINATUS" 840.8,"SPRAIN SHOULDER/ARM NEC" 840.9,"SPRAIN SHOULDER/ARM NOS"

To Import Codes
You can import ICD9 Codes from the ICD9 Codes Tab in the Setup window. 1. Click on the Import Codes button. 2. Select ICD.TXT file from the Select the File to Import From window. 3. Click on the Save button. 451

4. Click on the Done button when importing ends.

CPT4s
The CPT4 Codes Tab in the Setup Window has these Functions
Add to List: Adds a new CPT4 Code to the system. Edit/View: Edits CPT4 Code information. Remove: Removes a CPT4 Code from the system. Import Codes: You can import CPT4 Codes from a text file. Help: Brings up the context sensitive VersaForm Help.

CPT4: CPT4 Codes Setup


How to Open
Click on the Setup button on the top tool bar or choose the Setup item on the Utilities menu. Click on the CPT4 Codes Tab. Click on Add to List button to create a new entry. To modify an existing CPT4 Code, locate the code on the list and double click on it or click once to highlight it and then click on the Edit/View button.

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What You Will See When You Add

What Goes in Each Field


Field Name Code Information to Enter Enter a CPT code or a mnemonic for the code (for example OV2 for office visit level 2). If you used a mnemonic in the Code field, enter the true code here. Modifier 1. Modifier 2. If this code is used in your practice and you want it to appear on the list of codes put a check mark in this field. Off VisitEstablished level 2 Sample 99213 or OV2 99214 (if not in Code)

Code2* M1* M2* Active

Description

The description for this CPT code.

Explosion* Fee Schedule Charges Allowed Amount*

If this code is an Explosion put a check mark here. On the first line enter "Default". See below for additional lines. What will you charge for this service? What will is the generally allowed amount for this charge (based on insurance "allowed amounts"? Default 65.00 55.50

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Co Pay*

What is the general co-pay dollar amount for this charge (based on insurance "co pays"? What is the general co-pay percent amount for this charge (based on insurance "co pays"? Enter from the list - Each or Per Day. If you enter a number, the system will assume you mean "Each". This fills in on the charge line of the Ledger. "Each" will default to "1" when you enter the charge. If you change "Each" prior to creating a claim the charge will be multiplied by that amount to compute the total charge. If you elect "Per Day" when you enter a charge, the system will calculate the number of days between "Date of Svc" and "End Svc Date" and multiply the charge by that number to compute the total charge. There is a pick list available (hint: typing "O" will start the list with "Office"). The system will automatically translate the entry to its numeric equivalent when a claim is created. The system defaults to Office when you don't fill this field in.

Co Pay %*

Qty*

Each

Place*

Office

Type*

Type of service - a pick list is available (hint: typing "M" twice will start the list with "Medical Care). This is no longer a required field for claims, but VersaForm uses it to Medical Care indicate cases requiring special processing, like Anesthesia. This code requires a CLIA number for Medicare claims. The CLIA number for the Primary Facility will be used. Use this field to group types of procedures for reporting or management purposes. A check mark here means that this procedure will always be put on paper claims and will not be sent electronically.

Needs CLIA*

Acctg Code* Force to Paper*

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Accept Assignment*

There is a pick list available. An entry here will override any assignment selections in the Insurance Plan or Patient Registration | Billing Info dialogs. Use this to override any other setting, or leave it blank. An example would be: this procedure is not covered under a capitated plan and you would select "Fee for Service - Override Cap". An entry in this field will remind the operator about something whenever this procedure is entered. An example might be - "Send booklet on pre-natal care".

Assigned

Reminder*

* This field can be blank.

The Completed Dialog

Other Actions
Click the Add to Practice button to save the entry. Click the Cancel button to cancel the entry. Click the Add Fee Sched button to add another line with a different Charge. Examples of Fee Schedules are Medicare, Commercials, Uninsured, Professional Discounts, etc. You can have as many fee schedules as you want. However, an excessive number of them becomes cumbersome when you decide to change pricing. Click the Remove Fee button to remove the selected Fee Schedule. Click on the My Frequent List button to put the Code in your list of frequently used CPT4s as well as in the practice wide list.

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Here is an example with two fee schedules:

The Reminder Only used for Medicare will pop up each time this procedure is used when a patient (Registration | Billing Info Tab) or Insurance Plan has M in the Fee Schedule field. Note: You can add a CPT code for a missed appointment. However, it will auto bill to the insurance so you will have to manually cancel the insurance billing.

CPT4: Adding a CPT4 Code to the List


You can add a new CPT4 code from window within a patient's chart. Setup or from the Procedure Codes selection

From Either Window


1. Click on the Add to List button. The CPT4 Code Setup window will open. 2. Enter the CPT4 Code and the Description. Or type a mnemonic code, such as EKG for an electrocardiogram or OV1 for an office visit in Code. Enter modifiers, if any. If you used a mnemonic code, enter the true CPT4 code in the Code2 field. If you have just one fee for this procedure, use Default as the fee schedule. To enter several different fees for the same procedure, put each one on a separate line and identify each with its fee schedule. a. Enter the Charge either as dollars and cents (e.g., 30.00) or as whole dollars (e.g., 30). Do not use a dollar sign. b. Allowed Amount is optional. It contains the allowed amount, and gives VersaForm a way of estimating an insurance payment when you don't have an EOB. c. Co Pay and Co Pay % are optional. When these are blank, VersaForm will get the co-pay (if any) from the insurance plan setup. But sometimes a particular procedure will have a different co-pay, even for the same insurance

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plan. Enter a dollar amount (e.g., 10.00) or a percentage in the % column (e.g., 20). d. Enter a number, or each or per day in the Qty field. Qty is used if you want to have the number of units of service entered automatically, or if you want to have VersaForm automatically multiply the Charge by the quantity on the patient ledger or by the number of days of treatment. For example, if you enter 3 in Qty on the procedure form, the value 3 will be entered automatically in the Qty field on the patient ledger, so long as that field is blank. If you choose ea in Qty on the procedure form, you must enter a number in the Qty field on the patient ledger. VersaForm will multiply the cost of each item by the number on the patient ledger. If you don't enter a number, the system will use the number 1. e. Place is the place of service code to be used for this procedure on insurance forms. f. Acctg Code is optional. Enter the accounting code in Acctg Code that you would like to have recorded with this procedure. It classifies information in a way that helps you manage your practice. For instance, you might use one Acctg Code to identify lab work and another for treatments. You could then produce reports that give separate totals for these codes at the end of the month.

g. Force to paper is optional. Check it if you use electronic claims submission, but claims for this procedure and fee schedule cannot be submitted electronically. The claims will be printed on paper. h. Accept assignment is optional. Enter it here to override the usual "whether to accept assignment or not" decision for this procedure and fee schedule. If the insurance plan is capitated, and this procedure is not covered by capitation, you can tell the system here to override the capitation and treat this procedure as fee-for-service. i. Reminder is optional. Any reminder you enter here (for example, "Be sure to include the lab report") will be displayed to the operator when this code is entered for this fee schedule.

3. Either click on Add to Practice to add the code to the practice-wide list or click on My frequent List to add to the frequent list. Adding a code to the frequent list automatically adds it to the practice wide list.

CPT4: Changing a CPT4 Code on the List


You can edit or view a CPT4 Code from the CPT4 Codes Tab under Setup.

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To Edit or View a CPT4 Code


1. Click the menu. Setup button in the top tool bar or choose the Setup item on the Utilities

2. Click the CPT4 Codes Tab in the Setup window. 3. Double click on the CPT4 Code you want to edit or click on it and then click on the Edit/View button. If necessary, use the Search button to find the CPT4 Code. 4. The CPT4 Code Setup window will open. 5. Make the changes you want. 6. Click the OK button when done.

CPT4: Removing a CPT4 Code from the List


To Remove a CPT4 Code
1. Click the menu. Setup button in the top tool bar or choose the Setup item on the Utilities

2. Click the CPT4 Codes Tab. 3. If necessary, use the Search button to find the code you want to remove. 4. Click on the Code and then click on the Remove button.

CPT4: Fee Schedules


Suppose you have 50 insurance plans, all of which get charged the same fees. You can set up a fee schedule, say Fee Schedule A, with those fees. Then you don't have to enter fees for each insurance plan separately. If you have different charges for different insurance plans, you can set up more than one fee schedule.

How It Works
In the Setup CPT4 Codes Tab, charges are identified by Fee Schedule. If VersaForm knows which Fee Schedule applies to a patient, it can get the correct charge. A Fee Schedule is denoted by a code, typically just A, B, C, etc.

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You specify which Fee Schedule to use in the

Setup Insurance Plan Tab.

There is also a place for the Fee Schedule on each patient's Registration | Billing Info Tab, so you can designate any Fee Schedule for any patient.

If a patient doesn't have a Fee Schedule, or if a CPT4 code doesn't have a particular Fee Schedule, VersaForm uses the default charge for that procedure. So if you don't need Fee Schedules, just don't use them.

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CPT4: Adding a New Procedure Explosion


A procedure explosion enables you to enter one mnemonic procedure code that represents up to 9 procedures. If you have a series of procedures that often occur together, this can be a real timesaver. You can also specify a delay in the treatment date and entry date. This is useful, for example, when there is a planned course of treatment, such as a number of physical therapy sessions or a pregnancy that should be billed over a number of months. VersaForm lets you specify the number of months you want to have billing delayed for each of the procedures. First you should make a list of the procedure codes you want to be included in the explosion and whether you want any delays. The Codes must be true codes and they must already exist in VersaForm. From the Setup window, Click on the CPT4 Codes Tab: 1. Under Show, in the lower right corner of the CPT4 Codes Setup window, click on Explosions.

2. Click on the Add to List button. The Enter new explosion name window will open. 3. Type the name for the explosion and press Enter.

4. The Edit CPT Explosion windows will open.

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5. Type in the first CPT Code, any modifiers, and how many months to delay, if any. (Unchecking the Active checkbox removes a code from an existing Explosion.)

6. Click the Add button and repeat steps 5 and 6 for as many codes as you want, up to 9. 7. When you are done, click the OK button. Note: The CPT codes you put into explosions must be true codes, not mnemonics.

CPT4: Importing CPT4 Codes


You can import codes into the CPT4 Codes List from the CPT4 Codes Tab in the Setup window. If you purchased the file from VersaForm, it will have the format below. Field CPT4 Code Description Field name equivalent in MD VersaForm Practice Management (DOS) Pcode1 Description

In the AMA medium length format, this would look like: 461

99202 OFFICE/OUTPATIENT VISIT, NEW where the sixth character may be either a space or a tab character. If exported from the DOS version of MD VersaForm, it would look like: "99202","OFFICE/OUTPATIENT VISIT, NEW" When importing, if a code is not present in the list of CPT codes, it is added. If it is present, the description is updated.

To Import Codes
You can import CPT Codes from the CPT Codes Tab in the Setup window. 1. Click on the Import Codes button.

2. Indicate which import format you are using: VF Practice Management Format HCFA RVS Comma Separated Format AMA Medium Length Format

3. Press the Start button. 4. Select the CPT.TXT file in the Select the File to Import From window. 5. Click the Save button. 6. Click on the Done button when importing ends.

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Clinical (EMR) Allergies: The Allergies Tab


The Allergies Tab in the Setup Window has these Functions
Add to List: Adds a new Allergy to the system. Edit/View: Edits Allergy information. Remove: Removes a Allergy from the system. Help: Brings up the context sensitive VersaForm Help.

Allergies: Allergies Setup


How to Open
1. Click on the Setup button on the top tool bar or choose the Setup item on the Utilities menu. 2. Click on the Allergies Tab. 3. Click on Add to List button to create a new entry. 4. To modify an existing Allergy, locate the name on the list and double click on it or click once to highlight it and then click on the Edit/View button.

What You Will See

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Other Actions
Click OK to save the Allergy. Click the Cancel button to cancel the entry.

Allergies: Adding an Allergy to the List


From the Setup window, Click on the ICD9 Codes Tab: 1. Click on the Add to List button. The Allergy Setup Window will open.

2. Enter the Name of the allergen, spelling is important. If the allergen is a drug name and isn't spelled correctly, the drug-allergy checking will not catch it. 3. Click on the OK button.

Allergies: Changing an Allergy on the List


You can edit or view an Allergy from the Allergies Tab under Setup.

To Edit or View an Allergy


1. Click the menu. Setup button in the top Toolbar or choose the Setup item on the Utilities

2. Click the Allergies Tab in the Setup window. 3. Double click on the Allergy you want to edit or click on it and then click on the Edit/View button. If necessary, use the Search button to find the Allergy. 4. The Allergy Setup window will open. 5. Make the changes you want. 6. Click on the OK button.

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Allergies: Removing an Allergy from the List


To Remove an Allergy
1. Click on the Setup button in the top tool bar or choose the Setup item on the Utilities menu. 2. Click on the Allergies Tab. 3. If necessary, use the Search button to find the code you want to remove. 4. Click on the Allergy and then click on the Remove button.

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Medications
The Medications Tab in the Setup Window has these Functions
Search NewCrop Drugs: Searches NewCrop for a medication, if you have NewCrop drugs. Add Non-Standard Drug: Adds a new Medication to the system. Edit/View: Edits Medication information. Remove: Removes a Medication from the system. NewCrop Setup: Sets up to use NewCrop drugs. Monograph: Brings up a monograph on the selected Medication, if you have NewCrop drugs and there is one available. Handout: Brings up a Patient handout on the selected Medication, if you have NewCrop drugs and there is one available. Help: Brings up the context sensitive VersaForm Help.

Medications: Medications Setup


How to Open
Click on the Setup button on the top tool bar or choose the Setup item on the Utilities menu. Click on the Medications Tab. 466

Click on the Add Non-Standard Drug button to a new create new entry. To modify an existing Medication, locate the name on the list and double click on it or click once to highlight it and then click on the Edit/View button.

What You Will See When You Add a Non-Standard Drug

What Goes in Each Field


Field Name Drug Name Strength Form Route Generic Name Active Information to Enter The Medication's name. The strength. The form it comes in. Whether oral, external, etc. The generic name, if any. Yes or No. Sample Clomid 50 mg Tab 50 mg Tablet Oral (Currently VersaForm does not save this information.) Yes

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The Completed Dialog

Other Actions
Click the OK button to save and close. Click the Add to Frequent Meds button to put the Medication in your list of frequently used medications as well as in the practice-wide list. Click the Cancel button to close without saving.

Medications: Adding a Medication to the List


You can add a new Medication from the Setup window or from the Choose a Medication window from a patient's chart. From the Setup window, click on the Add Non-Standard Drug button. 1. The New Med for Medication List window will open.

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2. The grayed out data items are related NewCrop drug information. 3. Enter the Drug Name. 4. Enter the Strength; e.g., 400mg. 5. You can also enter the Form, Route and Generic Name. 6. Make sure that Active is Yes. 7. Either click on Add to Practice Meds to add the Medication to the practice-wide list or click on Add to Frequent Meds to add to the frequent list. Adding a Medication to the frequent list automatically adds it to the practice wide list.

Medications: Changing a Medication on the List


You can edit or view a Medication from the Medications Tab under Setup.

To Edit or View a Medication


1. Click the menu. Setup button in the top Toolbar or choose the Setup item on the Utilities

2. Click the Medications Tab in the Setup window. 3. Double click on the Drug Name you want to edit or click on it and then click on the Edit/View button. If necessary, use the Search button to find the Drug Name. 469

4. The Edit Medication window will open up. 5. Make the changes you want. 6. Click on the OK button. If you are using the NewCrop medication and allergy interaction checking feature of VersaForm, medication data provided by NewCrop cannot be modified.

Medications: Removing a Medication from the List


You cannot remove a Medication that is in use.

To Remove a Medication
1. Click on the Setup button in the top tool bar or choose the Setup item on the Utilities menu. 2. Click on the Medications Tab. 3. If necessary, use the Search button to find the Medication you want to remove. 4. Click on the Medication and then click on the Remove button.

Medications: Importing Medications to the List


You can import medications and prescription templates in the Medications Tab in the Setup window. If you are using the NewCrop medication and allergy interaction checking feature of VersaForm, medications imported into the system become non-standard drugs and cannot be used in checking drug and allergy interactions. The input file is a text file, with each line being either a medication or a prescription template for a medication.

A medication is a comma-separated list of items


drug_id, drug_name, route, form, strength, unit of measure, active, added by user preceded by the word medication, for example: medication 1,aspirin,oral,"caps",,,Y,Y Items not given should be indicated by a comma, as in the example.

A prescription template is also a comma-separated list of items


drug_id, sig, substitutes, refills, quantity_per_day, quantity preceded by the word medtemplate, for example:

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medtemplate 1,"2 po tid",N,3,,100 Items not given should be indicated by a comma, as in the example. These strings may all be quoted, using double quotes (").Single quotes (') must not be used they may be mistakenly used as data. Quoted strings may contain commas. The drug id plays a special role. It serves to link medtemplates with medications. Thus the drug id in a medtemplate should be the same as in the medication to which it applies, as in the examples above. It has no other purpose; permanent values are assigned by the system. Use the numbers 1, 2, 3

Medications, Prescriptions: Setup for Printing Prescriptions


The format used for printing prescriptions is listed under the Reports Tab in the Setup window under the name Prescription. The Internal Name for this report determines which format is used; different internal names signify different formats. The default for prescriptions is r_prescription_1. To get a prescription form that prints the patients address, change the Internal Name for Prescription to r _ p r e s c r i p t i o n _ w i t h _ a d d r e s s . Prescription formats satisfying the special requirements of various states may be created using appropriate tools, and imported using the Reports Setup Tab. They may have internal names other than those above.

Medications, Prescriptions: Importing a New Prescription Format


If your prescription format has been changed from the default, follow these steps to import the new format into each computer that will be printing prescriptions. 1. We will put the new format in the VersaForm 3.0\Tools subdirectory on at least one computer. For example: r_prescription_xxx_1.srd. A srd file contains a custom report. 2. You will need to copy this file to the VersaForm 3.0\Tools subdirectory on each machine that needs to print prescriptions. 3. Start VersaForm with System Administrator authority. 4. Click on the Setup button.

5. Click on the Reports Tab. 6. Locate the Prescription report:

7. Click to highlight it.

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8. Click on the Import button: 9. The Find File dialog will open, typically to the VersaForm 3.0 directory. 10. Locate the Tools folder and double click on it. 11. Locate the .srd file and double click on it. 12. Answer Yes to this question:

13. Click the OK button or press Enter:

Medications, Prescriptions: Electronic Prescriptions


As an optional feature, VersaForm can electronically send your prescriptions to a pharmacy. This transmission is done dynamically, over the Internet, whenever you select a prescription to be sent electronically. Because this is the case, you must have a high-speed Internet connection available to each VersaForm station that will be sending prescriptions. VersaForm uses the services of NewCrop LLC to send the prescription. In some cases, NewCrop processes the prescription (prescriptions that are sent via FAX) or NewCrop may use the SureScripts Electronic Prescribing Network to directly send the prescription to the receiving pharmacy. Whether the prescription is sent directly or by FAX depends on several things, including the receiving capabilities of the pharmacy. When you add this feature to your system, you will be given instructions on downloading and running a special setup program that will add the NewCrop medicines and allergies to your system. Over 30,000 medications and over 11,000 allergies will be available for you to choose from. In addition, you will be able to select from over 30,000 pharmacies in the United States who accept either FAX or direct prescriptions.

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VersaForm NewCrop Setup


After running the NewCrop setup program, you must enter two values in the VersaForm Setup screen before using this feature. On the Setup Medications Tab, click the NewCrop Setup button. Enter the values given to you for the fields Account ID and Site ID.

Requirements for Using Electronic Prescriptions


Before you can send an electronic prescription, the following items must be done: 1. The NewCrop Setup (shown above) must be completed. Because electronic prescriptions can be sent only for medications that are in the NewCrop format, you may want to convert existing VersaForm medications to NewCrop format. On the same setup screen you used to enter the Account ID and Site ID, you will see two data conversion buttons, Convert All Drugs to NewCrop Form and Convert In-use Drugs to NewCrop Form. You should, at a minimum, convert in-use medications (those that have been assigned to a patient) to NewCrop Form. The system will display a list of NewCrop medications that are potentially equivalent to the VersaForm medication and you will be asked to select the equivalent NewCrop medication. Obviously, great care must be taken during this process to ensure that the correct NewCrop medication is selected. 2. Providers who write prescriptions must be registered. Providers are registered (and charged) based on a provider/facility pair. That is, if a provider writes prescriptions for two different locations (such as a main office and a nursing home) the provider must be registered twice. In VersaForm, you must first be a User before you can be a Provider so you may need to add a second user/provider before you can register a second time. To register a provider:

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The Provider must have an assigned Facility. Providers not specifically assigned to a facility are associated with the Primary Facility. Go to Setup Providers, highlight the provider and click on the Edit/View button. Then use the Facility pull down list to select the correct facility.

Be sure the provider has both a current valid DEA Number and Medical Lic. No. with the associated State. Then click on the OK button. Click the Register button on the Provider Setup Tab. If this is the first provider registered, you will be asked to accept the NewCrop Electronic Prescription License Agreement. The next screen shows the registration status. It usually takes two working days for a registration to be completed. You can check the registration status at any time by using the Check Status button on this dialog.

3. Select pharmacies. Pharmacies you use are added as VersaForm Facilities. There are three ways you can add a pharmacy to the system: Use the Pharmacy Search button of the Setup Facilities dialog. Adding pharmacies using this method adds the pharmacy to the VersaForm list of pharmacies but does not assign a pharmacy to a patient. Open a patient chart, click the Registration Tab and then click the Pharmacies Tab and the Add button. You can assign a pharmacy from the list of VersaForm pharmacies or you can find a new pharmacy by using the Search For Pharmacies button. If you use the Search For Pharmacies button to select a pharmacy, the pharmacy selected will be added to VersaForm and assigned to this patient. After you have assigned a medication to a patient (see Adding a Medication), the Send Electronically button will ask you to select a pharmacy from the pharmacies assigned to the patient. You may also use the Search For Pharmacies button on this dialog to add a different pharmacy.

To Successfully Send an Electronic Prescription


Electronic prescriptions are sent using the Send Electronically button shown in the Medications Tab in a patient chart. Keep these items in mind when you send electronic prescriptions: 1. The prescriber must be a registered Provider. 2. You must be using a drug in NewCrop format. 3. You can not send NewCrop DEA classcode 4 or 5 drugs. However, you can fax prescriptions for scheduled drugs.

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4. The patient record must contain complete information, such as first and last name, DOB, home address and home phone number. If the patient record does not contain complete information, the prescription cannot be sent.

Checking on Prescription Status


The status of an electronic prescription is shown in the bottom pane of the Medications Tab in a patient chart. You can update the status at any time by selecting a prescription and pressing the Refresh e-Status button. You can check the status for electronic prescriptions, regardless of the patient, by clicking on the Electronic Rx menu item (near the top of the VersaForm screen) and select the Rx Status item from the list.

You can refresh any item from the list shown. To print the list, right click on an empty spot in the display area and select Print. It is important to remember that VersaForm can only tell if a prescription has been successfully sent or not. VersaForm has no way to know if or when the pharmacy filled the prescription or if the patient has received the medication.

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Labs/Data
The Labs/Data Tab
To set up your system to handle lab test results, determine what lab panels you use and what the constituent tests are. Since different clinical and reference labs have different calibrations for the same test, you may need to set up each test once for each lab (with different names, of course). All test results can optionally have the individual lab's normals saved along with the actual value as well as an abnormal indicator.

The Labs/Data Tab in the Setup Window has these Functions


Add: Creates a new test result or data item that may be associated with one or more panels. Edit/View: Allows modification of test characteristics. Remove: Removes a test that is not associated with any panel or flowsheet. Panels: Brings up the Lab Panel Editor that allows Lab Panels to be added and configured. Flowsheets: Brings up the Lab Flowsheet Editor that allows Flowsheets to be added and configured. Import: You can import Labs, Panels and Flowsheets from a text file. Help: Brings up the context sensitive VersaForm Help.

Labs/Data: Lab Test or Data Item Setup


When test results are entered they are validated against the High Normal and Low Normal values. If the result falls outside this range, a warning is issued.

How to Open
Click on the Setup button on the top tool bar or choose the Setup item on the Utilities menu. 476

Click on the Labs/Data Tab. Click on the Add button to create a new Lab. To modify an existing Lab Test or Data Item, locate the name on the list and double click on it or click once to highlight it and then click on the Edit/View button.

What You Will See

What Goes in Each Field


Field Name Item Name Information to Enter The name of the data item or test. Not used at present. Intended to correlate tests from different labs. Logical Observation Identifiers Names and Codes for identifying laboratory observations. Default Low Normal value. Can be overridden in any individual instance. Default High Normal value. Can be overridden in any individual instance. Whether the value is numeric and can therefore be range checked. Names the units of the value, e.g., grams. Not used at present. Intended for test classification. mm 8447-5 Sample BP Diastolic

Alternate Name

LOINC

Nominal Low Value

80

Nominal High Value

85

Numeric Unit of Measurement Item Type

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Allow Entry as Individual Test Active

Allows item to be ordered separately, not just as part of a panel. Whether this test is active.

Yes

The Completed Dialog

Labs/Data: Adding a Lab Test or Data Item to the List


From the Setup window, Click on the Labs/Data Tab: 1. Click on the Add button. The Datum/Test Setup Window will open.

2. Enter the test name and any other items as needed. 3. Click the OK button.

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Labs/Data: Removing a Lab Test or Data Item from the List


To Remove a Lab Test or Data Item
1. Click on the Setup button in the top tool bar or choose the Setup item on the Utilities menu. . 2. Click on the Labs/Data Tab. 3. Click on the Lab Test or Data Item to remove and click on the Remove button.

Labs/Data: Lab Panel Editor


To Add a Lab Panel
1. Click the Setup button on the Toolbar 2. Click the Labs/Data Tab of the Setup window. 3. Click on the Panels button. The Lab Panel Setup window will open.

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4. Click the Add Panel button in the lower left corner of the window. 5. Enter the new Panel Name and click the Ok button.

To Add Tests to or Remove Tests from a Lab Panel


1. Select the lab panel to modify from the list of Lab Panel names in the upper left hand corner of the Lab Panel Setup window. 2. Select the test(s) you want to add from the Data Item or Test list on the right side. Click the <<Add button. -- Or -Select the test(s) you want to remove from the Items in this Panel list on the left side. Click the Delete>> button.

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Use the Move Up and Move Down buttons to change the order of the tests in the panel. Click the Ok button.

To Add Lab Panel Prompts and/or Instructions


1. Select the lab panel to add prompts and/or instructions to from the list of Lab Panel names in the upper left hand corner of the Lab Panel Setup window. 2. Click the Edit Panel button. The Lab Panel Prompt and Instructions window will open.

3. Type the prompt and/or instructions in the edit boxes. 4. Click the OK button when you are finished.

Labs/Data: Lab Tests Low Normal/ High Normal by Age


For each lab test, the Labs by Age feature allows you to specify the normal low and high values for a specific age range. The default values for the test are defined by the test itself and will be used if the patient's age is unknown or if there are no values in the Labs by Age for the patients age. 481

To enter the Labs by Age values go to Low High by Age button.

Setup Labs/Data select a lab test and press the

The Lab Tests By Age Editor window will pop up and allow you to add, delete or modify the Labs by Age values for this lab test. You may also edit the default values for this lab test in this window.

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Default Low Normal and Default High Normal must be specified and low must be less than high. For each line in the Labs by Age section, Min Age, Max Age, Low Normal and High Normal must be specified. Min Age must be less than Max Age. Low Normal must be less then High Normal. The age ranges may not overlap e.g. you cannot have a line for min age=10, max age=20 and another line with min age=15 because 15 is between 10 and 20. These validations will be made when you press the OK button and, if everything is valid, the changes you made will be saved in the database. The Labs by Age lines will be sorted by min age however, when you add a new line it will be inserted at the bottom of the list. The Sort button allows you to sort the new lines before you save the values. The Delete button will verify that you want to delete the Labs by Age line that is currently highlighted before it deletes that line. If you press the Cancel button or X out of the window and you have made changes (including inserts or deletes), you will be warned that your changes will be lost if you continue to cancel.

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Labs/Data: Lab Flowsheet Editor


To Add a Lab Flowsheet
1. Click the Setup button on the Toolbar. 2. Click the Labs/Data Tab of the Setup window. 3. Click the Flowsheets button. The Lab Flowsheet Editor window will open. 4. Click the Add Flowsheet button. 5. Enter the Flowsheet Name and click the Ok button.

To Add Tests to or Remove Tests from a Lab Flowsheet


1. Select the lab flowsheet to modify from list of flowsheet names in the upper left hand corner of the Lab Flowsheet Editor window. 2. Select the test you want to add from the Test Name list on the right side. Click the <<Add button. - Or Select the test you want to remove from the list titled Flowsheet Test on the left side. Click the Remove>> button. Use the Move Up and Move Down buttons to change the order of the tests in the panel. Click the Ok button when done.

The Lab Flowsheet Editor has the Following Functions


Add Flowsheet: Creates a new flowsheet. Remove Flowsheet: Removes the flowsheet from the system. All tests in the flowsheet must be removed before trying to remove the flowsheet. Delete >>: Removes this test from the flowsheet. << Add: Adds this test to the flowsheet. Use the Move Up and Move Down buttons to change the order of the tests in the panel. Ok: Closes the window and accept all changes made to any flowsheets that were added or modified. Cancel: Closes the window and reject all modifications made while this window was open. 484

Labs/Data: Grouping Lab Tests in Flowsheets


When printing flowsheets, you may group tests to make the flowsheets easier to read. To do this: 1. Insert a group name in the list of tests for the flowsheet. The group name must have been added earlier. 2. Move the group name up or down to the desired position. The group will consist of all those tests between one group name and the next.

Labs/Data: Importing Labs/Data Information


Lab test and data item setup may be imported from a text file. The file format is: Each line is a comma-separated list of fields defining a test or data item, a panel, or a flowsheet. To define a test or data item, the line must be preceded by the word test, followed by a comma. For example: test,,,"Albumin",,,,,"N" All fields must be present or indicated by a comma (as in the example), in the following order: Test type, Unit of measurement, Test name, Alternative name, Numeric, Low normal, High normal, Test group, Individual test. Test name is at present limited to 20 characters in length. Test Group is unused at present, and should always be "N". The other fields are described here. They may be quoted, with double quotes ("), as illustrated. Single quotes (') must not be used. Quoted strings may contain commas.

Panels and Flowsheets


To define a panel, the line must be preceded by the word panel, followed by a space. The first field defines the panel, and each subsequent field is a constituent test. For example: panel vitals, weight, pulse, systolic, diastolic All the tests in a panel must have already been entered. To define a flowsheet, the line must be preceded by the word flowsheet, followed by a space. The first field defines the flowsheet, and each subsequent field is a constituent test. For example: 485

flowsheet vitals, weight, pulse, systolic, diastolic All the tests in a flowsheet must have already been entered. The names of the tests and the strings may all be quoted, with double quotes ("). Single quotes (') must not be used. Quoted strings may contain commas.

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Problems
The Problems Tab
The Problems Tab in the Setup Window has these Functions
Add to List: Adds a new Problem to the system. Edit/View: Edits Problem information. Remove: Removes a Problem from the system. Import Problems: Used to import your MD VersaForm ICD9 Codes as Problems. Help: Brings up the context sensitive VersaForm Help.

Problems: Problems Setup


How to Open
Click on the Setup button on the top tool bar or choose the Setup item on the Utilities menu. Click on the Problems Tab. Click on the Add to List button to a new create new entry. To modify an existing Problem, locate the name on the list and double click on it or click once to highlight it and then click on the Edit/View button.

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What You Will See

What Goes in Each Field


Field Name Problem ICD9 Code Acute Chronic Description Information to Enter The name of the Problem. The ICD9 Code that goes with this Problem. If this Problem is Acute. If this Problem is Chronic. The description for the ECD9 Code associated with the Problem. TENSION HEADACHE Sample Acute Tension Headache 307.81

The Completed Dialog

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Click on the Select ICD9 button to fill in the ICD9 Code and ICD9 Description.

Other Actions
Click the Add to Practice button to save and close. Click the Cancel button to close without saving. Click on the My Frequent List button to put the Code in your list of frequently used ICD9s as well as in the practice wide list.

Problems: Adding a Problem to the List


You can add a new problem from chart. Setup or from the Problems Tab within a patient's

From Either Window


1. Click on the Add to List button. The Problem Setup window will open.

2. Enter the Problem name. 3. Click on the Select ICD9 button to assign an ICD9 Code that will be associated with the problem for billing purposes and to be used when screening the problem against patient medications. The ICD9 Description is automatically filled in. 4. Optionally check if the problem is normally Acute and/or Chronic. 5. Either click on Add to Practice to add the code to the practice-wide list or click on My frequent List to add to the frequent list. Adding a code to the frequent list automatically adds it to the practice-wide list. You can also import problems from a text file.

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Problems: Changing a Problem on the List


You can edit or view a Problem from the Problems Tab under Setup.

To Edit or View a Problem


1. Click the menu. Setup button in the top Toolbar or choose the Setup item on the Utilities

2. Click the Problems Tab in the Setup window. 3. Double click on the Problem you want to edit or click on it and then click on the Edit/View button. If necessary, use the Search button to find the Problem. 4. The Problem Setup window will open. 5. Make the changes you want. 6. Click on the OK button.

Problems: Removing a Problem from the List


To Remove a Problem
1. Click on the Setup button. 2. Click on the Problems Tab. 3. If necessary, use the Search button to find the problem you want to remove. 4. Select the problem and click on the Remove button.

Problems: Importing Problems


You can import problems into the Problems List from the Problems Tab in the Setup window. The file you import from is called ICD.TXT. It's the diagnosis codes file that you exported from the VersaForm Practice Management System (MD VersaForm). It is stored in the subdirectory "tocpr" under the VersaForm directory. If drive C is used, this will normally be "C:\Program Files\VersaForm 3.0\TOCPR\icd.txt". Field ICD9 code Size 7 Field Name Code Field name equivalent in VersaForm Practice Management Dcode1

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Description 34

Description

Description

Sample:
840.6,"SPRAIN SUPRASPINATUS" 840.8,"SPRAIN SHOULDER/ARM NEC" 840.9,"SPRAIN SHOULDER/ARM NOS"

To Import Problems
You can import Problems from the Problems Tab in the Setup window. 1. Click on the Import Problems button. 2. Select ICD.TXT file from the Select the File to Import From window. 3. Click on the Save button. 4. Click on the Done button when importing ends.

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Notes, Templates
Creating Templates
You can create a new template from the Setup window Templates Tab or from the Tab of any patient's chart. 1. If you are in the Notes Tab, click here for instructions. Notes

2. If using Setup, click the Templates button and then the Add button. 3. Enter the template. Right-click anywhere in the template to insert drop-downs, blank fill-ins, or database values. 4. When done, click the Save button. Give the template a unique name and pick a topic to place the template under.

Notes, Templates: Creating Templates from the Notes Tab


1. Enter the template just as you would enter a note. (You can save any note as a template.) 2. Click the Save as Template button. The Save As window will open. 3. Give the template a unique Name. 4. In the Location section, pick a topic under which to place the template. 5. Click the Ok button. You can modify templates by changing the text, or inserting drop-downs, blank fill-ins, or database values. To do this, you must edit the template.

Notes Templates: Editing Templates


You can edit Templates from the Templates Tab under Setup. 1. Click the Setup button on the Toolbar

2. Click the Templates Tab in the Setup window. 3. Click the Templates button, select the template you want then click the Edit button. 492

Alternatively, select the template in the template list on the left side of the screen, then right-click and select Edit Template. 4. Edit the template. Right-click anywhere to insert drop-downs, blank fill-ins, database values, functions or documentation tags. 5. Click the Save button when you are done making changes.

Notes Templates: Exporting Templates


Templates and Topics can be exported to a file from the Setup window, Templates Tab. When you click the Export button, you have these options: Export All Templates and Topics: Exports all your templates and topics to a single text file. Export A Template: Exports a single template. Export All Drop-Downs And Fill-ins: Exports all your Drop-downs and Fill-ins to a single text file. Export A Drop-Down: Exports a single Drop-down. Export A Fill-In: Exports a single Fill-in.

Notes, Templates: Importing Templates


You can import Templates from the Templates Tab in the Setup window. Click on the Import button.

Click on one of: Import Templates and Topics Imports templates and topics from a text file, preserving the structure. That is, it keeps templates within their topics. Import Templates 493

Imports a template from a text file. During the import process, you select a topic under which the template should be placed. Import Drop-Downs and Fill-ins Imports Drop-Downs and Fill-ins from a text file. If any of the templates, drop-downs, or fill-ins you import have names that duplicate names already used, the system will warn you. If you elect to continue, it will optionally create new names for the new versions of those items (or, in the case of importing templates and topics, for the older versions). If new names are created, all references to these items must then be checked to refer to the new version you want. The best way to see the format of the text file for any of these imports is to export the same type of object first, and inspect the resulting file. "Move" statements may be included in a template import file. They permit you to move a template from one topic to another as part of the import process. The format of the Move statement is: MOVE, TemplateName, From-topic, To_topic

Notes, Templates: Creating a New Topic


There are Two Ways to Add a Topic
1. Click on the Topics button on the Templates Tab in the Setup window. The Select a topic window will open. 2. Click on the topic in the topics tree where you want to place your new topic and click the Add button. The Topic window will open. 3. Name the topic name and click the Ok button. 4. At a later time you can move the topic by dragging it to the desired location. --OR-1. From the Templates Tab in the Setup window, right-click on the topic heading under which the new topic will reside. 2. Select Add Topic and the Topic window will open. Continue with step 3 above.

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Notes, Drop-downs
Creating Drop-downs
You can create a drop-down in the Setup window Templates Tab. 1. Click the Setup button on the toolbar.

2. Click on the Templates Tab in the Setup window. 3. Click the Drop-downs button, then click the Add button. The Drop-down editing window will appear. 4. Click the Add A Value button to add a choice to the list, then enter the choice. 5. Click in the box to the left of one or more choices to make them default values for the drop-down. 6. Enter the Associated Text. 7. Use the radio buttons to indicate: Whether several items can be chosen, or only one. Whether the text is to appear before the chosen value, or vice versa. Whether to format the choices in a paragraph or a list.

8. Click the Ok button when you are done.

Notes, Drop-downs: Editing Drop-downs


You can edit Drop-downs from the Templates Tab under Setup. 1. Click the Setup button on the Toolbar

2. Click the Templates Tab in the Setup window. 3. Click the Drop-downs button. 4. Select the Drop-down you want, then click the Edit button. 5. Make the changes you want. 6. Click the Ok button. 7. Click the Done button.

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See Creating Drop-downs for more details.

Notes, Drop-downs: Entering Drop-down Choices


Choices in a drop-down can be words or phrases, or they can be templates, blank fill-ins, database values, functions, documentation tags, or other drop-downs. In the example, for instance, the first item, <<abdominal meds>> is a drop-downa list of appropriate medications. The brackets indicate that the choice is a variableeither a template, a dropdown, a blank fill-in, or a database valuenot just a word or phrase. To insert templates, blank fill-ins, database values, or other drop-downs as choices, use the right-click menu or the Insert button.

Notes, Drop-downs: Associated Text


Each drop-down or blank fill-in may have text associated with it, to complete an idea or sentence. For instance, in a drop-down that chooses severity (mild, moderate or severe) the associated text might be: "The pain was ". Use the radio buttons to indicate whether the text appears before the value, or the value before the text. The value may also be placed in the middle of the text by inserting "<<>>" there, as: "The patient reported <<>> pain." Then, if the choice was "severe", the result would be "The patient reported severe pain."

Notes, Drop-downs: Creating Blank Fill-ins


You can add a new blank fill-in in the Setup window Templates Tab. 1. Click the Setup button on the toolbar.

2. Click on the Templates Tab in the Setup window. 3. Click the Blank Fill-ins button. 4. Click the Add button. 5. The Add a Blank Fill-in window will appear. 6. Enter the Fill-in Name. 7. Enter the default value, if any. 8. Enter the Associated Text. 9. Choose the Placement: Text First or Value First. 496

10. Click the Ok button when you are done.

Notes, Drop-downs: Blank Fill-ins

Blank Fill-ins give you a way to request a word or phrase when using a template. Each blank fill-in may have text before or after it, to complete an idea or sentence. In this blank fill-in, the associated text is "Relieved by:" If you remove the blank fill-in, the associated text also gets removed.

Notes, Drop-downs: Editing Blank Fill-ins


You can edit Blank Fill-ins from the Templates Tab under Setup. 1. Click the Setup button on the Toolbar

2. Click the Templates Tab in the Setup window. 3. Click the Blank Fill-ins button. 4. Select the Blank Fill-in you want, then click the Edit button. 5. Make the changes you want. 6. Click the Ok button. 7. Click the Done button. See Creating Blank Fill-ins for more details.

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Notes, Databases: Database Values


From the Database to the Note
You can have values from the database (primarily from the patient's chart) automatically entered in a note. For instance, if the note is to form a referral letter, the patient's name and other information from the registration data can be included.

How to Add Database Values


1. Right click in the body of the note and you will see:

2. Choose Insert Database Values. 3. You will see:

4. Click on the values you want, and they will be inserted into the note.

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If you use this process to set up a new template, do not check Process immediately and you will see something like Patient_Chart_Number. If you are filling in a note, do check Process immediately and you will get the actual chart number for this patient.

Notes, Databases: List of Database Values for Notes


Patient_Name: Full name of the patient Patient_Home_Address: Patient's home address formatted with new lines Patient_Age: Patient age in years (number only, no text) Patient_Age_Text: Patient age as text, e.g. 3 months or 25 years Patient_DOB: Patient's date of birth in mm/dd/yyyy format Patient_First_Name Patient_Last_Name Patient_Middle_Name Patient_Sex: Patient sex as M, F, or U Patient_Sex_Text: Patient sex as Male, Female, or Unknown Patient_SSN: Patient's Social Security Number Patient_Chart_Number Patient_Home_Phone Patient_Employer Patient_Primary_Physician Patient_Referring_Physician Chief_Complaint: Patient's complaint on current encounter Current_Provider: Full name of current provider Current_Provider_DEA_No: DEA number of current provider Current_Provider_Lic_State: License State of current provider Current_Provider_Lic_No: License Number of current provider Current_Vitals 499

current_time current_date he_she: "he" or "she", as the case may be Pharmacy_address Pharmacy_phone Pharmacy_contact Pharmacy_fax Pharmacy_email Secondary_Pharmacy Secondary_Pharmacy_address Secondary_Pharmacy_phone Secondary_Pharmacy_contact Secondary_Pharmacy_fax Secondary_Pharmacy_email

Notes, Databases: Database Values That Can Be Filled In From Notes


Functions that add database values have two versions, long and short. They act identically. Short +med Long Add_medication Action Specifies an entire prescription via a med template Allows user to edit medication (sig, etc.) before adding to chart. Only for non-med reactants. Use a blank allergen to allow choice of med or non-med reactants. Allows user to edit allergy before adding to chart.

+med_edit

Add_medication_edit

+allergy

Add_allergy

+allergy_edit

Add_allergy_edit

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+panel +panel_edit +prob +prob_edit +icd +cpt +cpt_icd +cpt_icd_edit View_History

Add_data_panel Add_data_panel_edit Add_problem Add_problem_edit Add_icd Add_cpt Add_cpt_icd Add_cpt_icd_edit View_History

For labs and other data. Adds the panel only; not the data.. Allows entry of data, too Adds a problem to the chart. Allows user to edit problem before adding to chart. Adds an ICD code to the current encounter. Adds a CPT code to the current encounter. Add both an ICD and a CPT to the chart, and relates them. As above, but allows editing first. Allows user to view or edit a specific history panel User can choose which history panel to view or edit

View_Choose_History View_Choose_History

Notes, Databases: Miscellaneous Template Functions


Get_Date Get_Number If_Male () If_Female () Set_Description () User can enter a date from a calendar User can enter a number from a 10-key pad Includes the parenthesized variable if the patient is male Includes the parenthesized variable if the patient is female Sets the note description

Export_billing_info Exports ICD and CPT codes for the open encounter E&M Wizard Invokes the E&M Wizard

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Left_Right Yes_No Positive_Negative

User can choose left or right User can choose yes or no User can choose positive or negative

Notes, E&M Documentation: Documentation Tags


The E&M Wizard evaluates your documentation by counting Documentation Tags. Documentation Tags are variables, and can be added to templates and drop-downs in the same way as other variables. However, in drop-downs, documentation tags are treated differently. Documentation Tags in drop-downs do not appear as choices when the drop-down is being used, although they do appear when the drop-down is being designed or modified. Documentation Tags in drop-downs are chosen automatically when any other choice (including a default) is made from that drop-down. So, if a user makes a choice from a drop-down that includes a documentation tag, that tag is recorded. o For instance, the drop-down that records the result of percussion of the patient's chest contains documentation tag "Exam Respiratory percussion of chest". When any choice (like, "chest hyperexpansion") is made from that drop-down, the tag "Exam Respiratory percussion of chest" is recorded. Later, the wizard will count that tag along with the others that have been recorded.

Documentation Tags in drop-downs are evaluated automatically; you don't have to click on them.

To Add a Documentation Tag to a Drop-down or Template


1. Right-click from Templates Setup,

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or right click from Edit A Drop-down List,

or when in Note for ....

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2. Choose Insert Documentation Tag from the menu 3. Choose the tag from the Select Documentation Tag list.

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Practice Management Insurance Setup Overview


VersaForm keeps information about insurance in several places. When you create an insurance claim, VersaForm gathers the needed data to create a correct claim. Information about each insurance plan itself is entered via the Insurance Plan Setup. Since each provider has his or her own ID numbers (from Medicare, Medicaid, Blues, etc.) the ID numbers are kept in the Provider Setup. The Provider Setup window has a special button, Edit Insurance IDs, for entering these. If the practice uses Submitters (Submitters are used when Providers do not submit insurance in their own name, as when in a group practice), each Submitter may have their own IDs, too. The Submitter Setup has an Edit Insurance IDs button just as the Providers does. Each patient may have one or more insurance plans. Each of these plans may have a different subscriber, and different starting and ending dates. This information is entered in the Insurance Tab, under the Registration Tab of the patient chart.

This is enough for paper claims, but electronic claims need more: Information about the Claim Processor (whether a clearinghouse or an insurance plan directly) is kept in the Claim Processor Setup. Here is where you enter the various IDs that identify the sender and receiver of the electronic claims. Because the Submitter of the electronic claims may be a different person or organization than the Submitter of the claims (for instance, it may be a billing service), that entity must be entered in the in the Setup Claims Processor Tab. Setup Submitters Tab, and referenced

Insurance Plans: The Insurance Tab


The Insurance Tab in the Setup Window has these Functions
Add: Adds a new CPT4 Code to the system. Edit/View: Edits CPT4 Code information. Remove: Removes an Insurance Plan. Import Plans: You can import your Insurance Plans from a text file. Export Plans: You can also export your Insurance Plans to a text file. 505

Help: Brings up the context sensitive VersaForm Help.

Insurance Plans: Insurance Plan Setup


How to Open
Click on the Setup button on the top tool bar or choose the Setup item on the Utilities menu. Click on the Insurance Plans Tab. To add an insurance plan click on the Add button. To modify an existing Plan, locate the name on the list and double click on it or click once to highlight it and then click on the Edit/View button.

The Edit Insurance Plan Info window is broken up into 6 sections:


Basic Information Patient Defaults and On One Claim CMS 1500 and 835 UB92 and Contract NPI Dates Address

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Basic Information
What You Will See

What Goes in Each Field


Field Name Information to Enter Name of the Insurance Plan. Some processors or insurance plans require a specific name. Check your documentation. It is easier to choose plans from a dropdown list if they all have different names, but they don't have to. Payer ID for this insurance company - generally supplied by the Claims Processor or by the insurance company. This is required for Electronic Claims. This goes to Loop 2330B NM109 on an ANSI 837 electronic claim. If checked this is an active plan - one that is available to add to patients. National Plan ID - a number being developed to identify specific insurance plans - obtain from the carrier or the Claims Processor. If left blank the Payer ID will be used. Sample

Plan Name

Wonder Insurance

Payer ID

01340

Active

National Plan ID

7878898

Identifier

A code to identify the plan in your system - will show in [ ] after the Plan Name in the list. Use this field to Wonder distinguish among plans with the same name. What type of claim this is - Medicare, Commercial, Medicaid, etc. Must be an item on the pick list. Required. Commercial Insurance Co.

Claim Filing Indicator

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Destination Payer Receiver Code Ins Type Code One copay per visit Co Pay

Used in Electronic Claims. Loop 1000B NM109 Should come from the Claims Processor or from the Payer. It may be the same as the Application Receiver Code GS03 in the Claims Processor. Usually you don't need to fill this in. What type of insurance plan is this. Must use the items in the pick list. If checked, the co-pay applies to the first charges posted for a day - not to each charge posted that day. The dollar amount of the copay or the percentage of the copay. Is this plan part of a crossover plan with Medicare or Medicaid? Is this a MediGap plan? If this box is checked, VersaForm will not create secondary claims automatically, as it will assume that crossover claims will be sent. Only check this box if this insurance plan will never be primary. If this plan is to be sent electronically this field must be filled in. Choose from the pick list (a list of the items in the Claims Processor Tab). If this is blank all claims will be paper claims. These are required fields. Insurance plans always want a number to identify a provider or a facility. These fields provide default values that tell what kind of qualifier is being sent. What type of number is to be used for a default if there is no assigned ID for this plan? Use the pick list. There are three items on this list - "Rendering IDs" select this if you want the rendering provider insurance ID to print in box 24 I and J of HCFA 1500. The second choice is "Northern CA Medicare" - select this if the insurance plan is for Northern California Medicare. The third is "No Rendering IDs" - select this if you are submitting to a Medicare plan that does not want rendering IDs. 15.00 or 20% Commercial

Crossover Destination

Electronic Claims Processor Default Provider ID Qualifier Default Facility ID Qualifier

ECS

Employer's Identification Number Federal Taxpayer's ID Number

Variant

Rendering IDs

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Patient Defaults and On One Claim


What You Will See

What Goes in Each Field Field Name Information to Enter Sample

Defaults for Patient Insurance Billing


Fee Schedule If you want to use a fee schedule other than the default, enter it here. (You enter the specific fees for a fee schedule in the Setup CPT4 Codes Tab). By convention, fee schedules are called A, B, etc. A required field. Whether benefits are assigned by the patient to the provider. Capitated health plans and situations where fee for service overrides capitation are indicated here, too. A required field. Whether the patient is responsible for the full charge, the copay only, or nothing. Whether statements are to be generated automatically, or are to be delayed until insurance responds. Required field. Choices are Create Claim and Create Advisory Claim. Use the pick list. If this is a secondary insurance on a Ledger, when should the claim be created? It is probably best to choose (3rd, 4th) Claim after previous insurance paid. Default

Accept Assignment

Assigned

Patient Responsibility

Copay Delay stmt for insurance payment Create Claim

Hold Statement

When to bill-Primary

When to bill-Secondary

(3rd, 4th) Claim after previous insurance paid

On One Claim

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Multiple places of service

A check mark here means that a claim can have more than one place of service. A blank here means that if two places or services are being claimed two claim forms will be created. A check mark here means that a claim can have more than one provider. A blank here means that if two doctors performed services on the claimed lines two claims will be created. How many lines do you want to print on a claim. A maximum of six lines will be printed on any claim. 6

Multiple Providers

Maximum lines

CMS 1500 and 835


What You Will See

What Goes in Each Field Field Name CMS 1500 Box 26, 33 Information to Enter Sample

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Override Box 33 Defaults?

A check mark here allows you to specify what goes in Box 33 on the HCFA. Only used if required by the insurance company. A check mark here puts the VersaForm assigned patient number in Box 26 rather than the claim number. These are radio buttons for choosing and rearranging address information. They only apply to the HCFA 1500 (12-90). These are radio buttons for what, if anything, to put in the PIN# field. They only apply to the HCFA 1500 (12-90). These are radio buttons for what, if anything, to put in the GRP# field. They only apply to the HCFA 1500 (12-90).

Use Patient # in Box 26

City, State, Zip Code and/or Phone

In PIN# field

In GRP# field

835 Electronic Remittance Advice Processing These are radio buttons for what to do when a credit cannot be fully applied. Press the button to arrange to have adjustments entered automatically. These are radio buttons for what to do about deductibles. These are radio buttons for what to do about a balance. Adjust (write off) Adjust (write off) Do not accept credit

Accept Credit

Enter Adjustments Automatically How to handle a deductible What to do about a balance

UB92 and Contract


What You Will See

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What Goes in Each Field Field Name UB92 Defaults Type of bill classification using three-digit code: 1st digit indicates type of facility, 2nd indicates type of care, 3rd indicates billing sequence. Type or print Revenue Center Code(s). Information to Enter

Type of Bill

Revenue Code Contract Info Contract Info on Claim Type Amount Percentage Terms Discount percentage Version Code Demonstration Project ID

A check mark here means that contract information will be on the claim. Only used if required by the insurance company. Type of contract information to be put on the claim. Use the pick list. Only used if required by the insurance company. Only used if required by the insurance company. Only used if required by the insurance company. Only used if required by the insurance company. Only used if required by the insurance company. Only used if required by the insurance company.

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NPI Dates
What You Will See

What Goes in Each Field Field Name NPI Dates NPI Permitted The date when NPIs are permitted for this insurance plan. NPI will be used if present and NPI Permitted <= today. The date when NPIs are required for this insurance plan. An error will occur if the NPI is not present and NPI Required <= today. The date when the old IDs are no longer permitted for this insurance plan. Legacy IDs will be sent unless Legacy ID Prohibited <= today. 10/01/06 Information to Enter Default

NPI Required

05/23/07

Legacy ID Prohibited On CMS1500: Use CMS1500 08/05 after Do not use Legacy ID after On UB04: Use UB04 after Do not use Legacy ID after

05/23/07

The date after which to use the new 1500 claim form. The date after which to leave the legacy ID off of the new 1500 claim form.

04/01/07

05/23/07

The date after which to use the UB-04 claim form instead of the UB-92. The date after which to leave the legacy ID off of the UB-04 claim form.

Address
What You Will See 513

If you click on the Copy Address button, you can choose another active insurance from which to copy the address. What Goes in Each Field Field Name Information to Enter Sample

Address Information First line of the mailing address - there is room for two address lines (P.O. Box, Suite, etc.) e-mail for the contact listed - or a general e-mail address City for the insurance company State for the insurance company - can use the drop down list Zip code for the insurance company Country for the insurance company - can be blank. If you do use it, use the 2 character code for the country Phone number to contact the insurance company Extension for the department you would normally contact Fax number to use when sending faxes 44 High Rise Drive Ste 4444 support@wi.com Des Moines IA 45454 US 454 666 7777 5454 454 666 7767

Street

E-Mail City St Zip Country Phone Extension Fax

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Pager Mobile Contact Dear Dept. Note

Pager number for someone at the company Mobile phone number for someone at the company Key contact at the insurance company for this plan How a letter would be addressed to this contact The department that handles this plan Any other information you might want to store about this plan.

454 777 4545 454 454 5585 Joe J. Jones Joe Middle Kingdom call before noon

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The Completed Dialog

516

517

Other Actions
If you will be submitting claims for Anesthesia procedures click on the Anesthesia Units button and fill in that dialog. Click the OK button to save your work.

Insurance Plans: Adding an Insurance Plan to the List


From the Setup window, Click on the Insurance Plans Tab: Click on the Add button. The Edit Insurance Plan Info window will open.

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The following items must be entered: Plan Name: Name of the Insurance Plan. Some processors or insurance plans require a specific name. Active: Must be checked for this Plan to be active. Claim Filing Indicator: What type of claim this is. Default Provider ID Qualifier: The type of ID to use as a default for this insurance for the Provider. Default Facility ID Qualifier: The type of ID to use as a default for this insurance for the Facility. Accept Assignment: Assignment information. Patient Responsibility: Whether the patient is responsible for the full charge, the copay only, or nothing. When to bill--Primary: Create Claim or Create Advisory Claim. Street, City, State and Zip: The insurance company's mailing address.

Insurance Plans: Changing an Insurance Plan on the List


You can edit or view an Insurance Plan from the Insurance Plans Tab in the Setup window.

To Edit or View an Insurance Plan


Click the Setup button in the top Toolbar or choose the Setup item on the Utilities menu. Click the Insurance Plans Tab in the Setup window. Double click on the Insurance Plan you want to edit or click on it and then click on the Edit/View button. The Edit Insurance Plan Info window will open. Make the changes you want. Click the OK button when done.

Insurance Plans: Removing an Insurance Plan from the List


You can not remove an Insurance Plan if it is being used by any patient. 519

To Remove an Insurance Plan


Click on the menu. Setup button in the top tool bar or choose the Setup item on the Utilities

Click on the Insurance Plans Tab. Click on the Insurance Plan and then click on the Remove button. If you see the Can't remove insurance plan window, you will first have to remove or inactivate the Insurance Plan for each patient listed in the window.

Insurance Plans: Importing Insurance Plans


Insurance plans can be imported from a text file.

The text file should contain the following fields as tab-separated values
insurance plan insurance_id insurance plan name insurance plan ins_lookup_name insurance plan source_of_pay insurance plan default_facility_id_qualifier insurance plan claim_filing_indicator insurance plan default_provider_id_qualifier insurance plan ins_type_code insurance plan co_pay_amt insurance plan co_pay_percent insurance plan payor_id insurance plan national_plan_id insurance plan ndc_ets_code insurance plan ndc_ppo_hmo_indicator insurance plan dest_payer_receiver_code insurance plan print_format insurance plan form_name insurance plan processor_id insurance plan per_visit insurance plan claim_maxline insurance plan multidoc insurance plan multi_plc_of_svc insurance plan variant insurance plan fee_schedule insurance plan pay_code insurance plan adj_code insurance plan discount_adj_code insurance plan ins_discount_amt insurance plan ins_discount_percent insurance plan accept_assignment insurance plan auto_stmt insurance plan patient_resp insurance plan auto_claim 520

insurance plan bill_secondary insurance plan crossover_destination insurance plan contract_info_on_claim insurance plan contract_type insurance plan contract_amount insurance plan contract_percentage insurance plan contract_code insurance plan terms_discount_percentage insurance plan demonstration_project_id insurance plan contract_version_id insurance plan active insurance plan address_id insurance address address_id insurance address name insurance address address1 insurance address last_name insurance address middle_name insurance address first_name insurance address address2 insurance address city

insurance address state insurance address zip insurance address country insurance address phone insurance address extension insurance address pager_phone insurance address mobile_phone insurance address department insurance address email insurance address fax insurance address contact insurance address dear insurance address is_person insurance address id_number insurance address note insurance address organization_lookup_name insurance address address_type insurance address updated insurance address updated_by insurance address active

To Import
You can import insurance plans from the Insurance Plans Tab in the Setup window. Click the Import Plans button. Select the import file from Select the Insurance Plan Export File window. Click on the Open button. Click on the Done button when importing ends. 521

Insurance Plans: Exporting Insurance Plans


Your Insurance Plans can be exported to a text file.

The text file will contain the following fields as tab-separated values
insurance plan insurance_id insurance plan name insurance plan ins_lookup_name insurance plan source_of_pay insurance plan default_facility_id_qualifier insurance plan claim_filing_indicator insurance plan default_provider_id_qualifier insurance plan ins_type_code insurance plan co_pay_amt insurance plan co_pay_percent insurance plan payor_id insurance plan national_plan_id insurance plan ndc_ets_code insurance plan ndc_ppo_hmo_indicator insurance plan dest_payer_receiver_code insurance plan print_format insurance plan form_name insurance plan processor_id insurance plan per_visit insurance plan claim_maxline insurance plan multidoc insurance plan multi_plc_of_svc insurance plan variant 522 insurance plan fee_schedule insurance plan pay_code insurance plan adj_code insurance plan discount_adj_code insurance plan ins_discount_amt insurance plan ins_discount_percent insurance plan accept_assignment insurance plan auto_stmt insurance plan patient_resp insurance plan auto_claim insurance plan bill_secondary insurance plan crossover_destination insurance plan contract_info_on_claim insurance plan contract_type insurance plan contract_amount insurance plan contract_percentage insurance plan contract_code insurance plan terms_discount_percentage insurance plan demonstration_project_id insurance plan contract_version_id insurance plan active insurance plan address_id insurance address address_id

insurance address name insurance address address1 insurance address last_name insurance address middle_name insurance address first_name insurance address address2 insurance address city insurance address state insurance address zip insurance address country insurance address phone insurance address extension insurance address pager_phone insurance address mobile_phone

insurance address department insurance address email insurance address fax insurance address contact insurance address dear insurance address is_person insurance address id_number insurance address note insurance address organization_lookup_name insurance address address_type insurance address updated insurance address updated_by insurance address active

To Export
You can export insurance plans from the Insurance Plans Tab in the Setup window. Click the Export Plans button. Select the Insurance Plan(s) you want to export to a file from the Export Insurances window. Click on the Export button. Choose a file name and location for the text file. Click on the Save button.

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How to Set Up for Electronic Claims


After you have filled out any necessary paperwork and submitted it to the electronic claims processor you should receive a welcome packet with your user ID, password and provider numbers. You will need payer IDs for all insurances that are to be billed electronically. Most claims processors can provide a document describing their business rules, or direct you to a web site that contains these documents. These documents are sometimes called companion documents. Before you send claims you usually must send some test claims, so the processor can verify that your claims meet their rules. When you set up the Claims Processor in VersaForm it can be in Production mode or in Test mode. In Test mode the system will create claims, but they are not marked Sent, so you can test them over and over again. When you mark the processor in Production mode, claims will be sent in earnest. Remember that not all fields in a charge need to be filled in for all Tabs. In fact, it is better to leave fields blank if they are not required, because filling them in may be considered an error. Many screens will alert you if you are missing a required field. However, many fields are required for electronic claims but not for paper, or required only sometimes, so you must know the requirements.

Do these steps in the order listed below.


Set up all Providers as Users. This must be done because of the system requirement that all Providers be Users. Set up all Providers and Submitters along with the provider numbers issued to them. The name of the person or organization that is going to submit the electronic claims must be entered as a Submitter. It could be the doctor (if a solo practitioner), or the name of the practice (if, for instance, it is a group), or the name of the billing service, if that is who is going to submit the claims.

Then, enter the claims processor information and the submitter information as described below: Solo Practice
If you haven't already, enter the Provider as a Submitter in the Enter the claims processor information in the Setup Submitters Tab. Setup Claims Processor Tab.

Enter the Provider's name (the one you just entered in the Submitters Tab) as the Transmitter. Leave the Billing Provider blank.

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Usage: On each patient's Registration, Demographics Tab, enter the solo doc as the patient's Primary Provider. In the Insurance Tab, enter the insurance plan. On the ledger charge line, you do not need to enter a Provider. When an electronic claim is created, the results will be: The PRV segment for the rendering provider will go in Loop 2000A. Loop 2010AA-Billing Provider: The solo doc. Loop 2010AB-Pay-to Provider: Not used, since the same as 2010AA. Loop 2310B-Rendering Provider: The solo doc.

Group Practice
If you haven't already, enter the group as a Submitter in the Enter the claims processor information in the Billing Provider blank. Setup Submitters Tab. Setup Claims Processor Tab. Leave the

In Setup Provider, for each Provider, set the Submitter to the group name entered earlier in the Submitters Tab. Usage: In each patient's Registration, Demographics Tab, enter the solo doc as the patient's Primary Provider. In the Insurance Tab, enter the insurance plan. On the Ledger charge line, enter the Rendering Provider (in Pvdr if using Add Charge or in Provider if using Add Charge Full ) if it is different from the Primary Provider. In the electronic claim, the results will be The PRV Segment for the Rendering Provider will go in Loop 2310B Loop 2010AA-Billing Provider: The group Loop 2010AB-Pay-to Provider: Not used, since it's the same as 2010AA Loop 2310B-Rendering Provider: The provider on the ledger line, or the Primary Provider.

Solo Practice Using a Billing Service


Enter the billing service in the Setup Submitters Tab.

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Enter the claims processor information in the Setup Claims Processor Tab. Set the Billing Provider to the billing service entered in the Submitters Tab earlier. In Setup Provider, leave Submitter blank.

Usage: In each patient's Registration, Demographics Tab, enter the solo doc as the patient's Primary Provider. In the Insurance Tab, enter the insurance plan. On the ledger charge line, you do not need to enter a Provider. In the electronic claim, the results will be The PRV segment for the rendering provider will go in Loop 2000A. Loop 2010AA-Billing Provider: Billing service. Loop 2010AB-Pay-to Provider: The solo doc. Loop 2310B-Rendering Provider: Not used, since it's the same as 2010AB.

Group Practice Using a Billing Service


Enter both the billing service and the group in the Setup Submitters Tab. Enter the claims processor information in the Setup Claims Processor Tab. Set the Billing Provider to the billing service entered in the Submitters Tab earlier. In Setup Provider, for each provider, set the Submitter to the group name entered earlier in the Submitters Tab. Usage: In each patient's Registration, Demographics Tab, enter the appropriate provider as the patient's Primary Provider. In the Insurance Tab, enter the insurance plan. On the Ledger charge line, enter the rendering provider (in Pvdr if using Add Charge or in Provider if using Add Charge Full ) if it is different from the Primary Provider. In the electronic claim, the results will be The PRV segment for the rendering provider will go in Loop 2310B. Loop 2010AA-Billing Provider: The Billing service. Loop 2010AB-Pay-to Provider: The Group. Loop 2310B-Rendering Provider: The provider on the ledger line, or the Primary Provider.

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Finally, the insurance plan setup for each plan to which you will submit electronically:
Be sure to name the appropriate processor in the Processor field. For further information, see: Claim Processor Setup Insurance Plan Setup

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Electronic Claims: The Claims Processors Tab


The purpose of this Tab is to hold the information that identifies all the players.
Specifically, these are: ANSI Processor (Receiver) Submitter (Loop 1000A) VersaForm Usage NSF HCFA 1500

Processor Transmitter (Required)

Entity that accepts transmissions Entity that has the submitter id from the carrier

AA0

N/A

Billing Provider (Loop 2010AA)

Entity that submitted the bill, and gets Billing Provider paid. If this is blank, VersaForm uses the (Optional) Provider information, so it is usually not needed.

BA0

Box 33

The Claims Processors Tab in the Setup Window has these Functions
Add: Adds a new Claim Processor to the system. Edit/View: Edits Claim Processor information. Remove: Removes a Claim Processor from the system. Help: Brings up the context sensitive VersaForm Help.

Electronic Claims: Claim Processor Setup


Setting up for Availity
If you are going to use Availity for your claims processor, Availity Setup shows you how to do it.

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How to Open
Click on the menu. Setup button on the top tool bar or choose the Setup item on the Utilities

Click on the Claims Processors Tab. Click on the Add button to create a new Claims Processor. To modify an existing Claim Processor, locate the name on the list and double click on it or click once to highlight it and then click on the Edit/View button.

What You Will See in the Top Pane

What Goes in Each Field


Field Name Information to Enter Sample

Electronic Claim Processor Info What to call this processor (an organization that receives your electronic claims) - Availity, WebMD, Medicare, Medicaid, ET&T, etc. Once you have passed testing or if we have passed testing - put a check mark here. Until then, VersaForm will generate test claims only. If this is an active processor put a check here. My State Medicare

Name

Production

Active

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Receiver ID (837 ISA08)

Generally a 5 digit number. If it was in the MD VersaForm then we imported it. This code is published by the processor and can be obtained from them. What type of number is the Receiver ID? There is a drop-down list. Generally this field will be Mutually Defined (which translates to "ZZ" in ANSI language. The name to be used when the electronic claim file is created. This is the file that you will send to the claims processor. Date and time will be added to this file name to prevent duplication. You can change the name at run time. Some claims processors require the use of a password, which they usually assign to you. This is only a place to store the password, VersaForm does not send it. It can be left blank. A place to store the modem number to send claims to if you use dial-up. VersaForm does not use it. It can be left blank. Should be 004010X098A1 (as of 10/16/03). This designates the format that this processor uses, and may change from time to time. Put a check mark if you want the processor to send you an acknowledgement (format 997) that they received your data file. Some processors support it, some don't. Do you want to use the extended character set? Generally this is left unchecked, which results in removing characters some processors do not like, for instance the "#". Implies Uppercase Only. Do you want all the data in the file to be in uppercase. Generally, Yes. Depends on the processor. An additional ID issued by the processor. This may further identify the processor and/or your office.

04350

Qualifier (837 ISA07)

Mutually Defined

Data File Name

My State MC.dat

Password (837 ISA04)

Modem Phone No.

878 878 8787

Format

004010X098A1

Request Ack?

Extended Charset?

Uppercase Only? Authentication (837 ISA02)

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Segment Terminator

Separates parts of the data file. Default is "~" - do not change unless your processor requires something different. If the character required cannot be keyed directly, you may use the decimal number that denotes that character in the ASCII sequence. Use at least 2 digits. You may need to check Extended Charset if you change this. Separates parts of the data file. Default is "*" - do not change unless your processor requires something different. See above note about decimal representation. Separates parts of the data file. Default is ":" - do not change unless your processor requires something different. See above note about decimal representation. Maximum bytes in a group of transaction sets, if your processor imposes one. Normally left blank. Maximum bytes in a single transaction set, if your processor imposes one. Normally left blank. Maximum number of transaction sets in a group. Normally left blank. Maximum number of claims in a transaction set. Normally left blank.

Data Element Separator

Subelement Separator

Group Length Limit Transaction set length limit Group transaction set limit Transaction set claim limit

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What You Will See in the Bottom Pane

What Goes in Each Field


Field Name Information to Enter Sample

Electronic Claim Submitter Info Who will be sending the claim. This is the name of a person or organization. It must have previously been Transmitter (1000A) entered on the Submitters Tab in Setup. This entity may be a medical practice, an individual provider, or it may be a billing service or other company. This designates the entity that contracted with the claims processor to send the claims. A check mark here indicates that the Transmitter is a person rather than a group or a corporation. An ID supplied by the claims processor. If you sent claims electronically in MD VersaForm this number was imported. If you have more than one database, you should request separate Transmitter IDs for each so VersaForm can keep the 835s and 997s in the correct database. Healer, Joseph J

Is a Person

Transmitter ID (1000A-NM109)

OO344355

Enter the Submitter to be paid if it is not the Transmitter. For example, if a billing service is the Transmitter but the Billing Provider Provider is to be paid. The drop down is a list of the Submitters from the Submitters Tab in Setup.

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Interchange Sender ID (Code ISA06 )

Supplied by the processor. This number is often the same as the Transmitter ID above. What type of number is the "Interchange Sender Code"? There is a drop-down list. Generally this is "Mutually Defined" which translates to "ZZ" in ANSI. What type of number is the Interchange Sender ID? There is a dropdown list. Generally this field will be Mutually Defined (which translates to "ZZ" in ANSI language. Supplied by the processor. This number is often the same as the Interchange Sender ID (Code ISA06 ), above. Generally a 5 digit number. If it was in the MD VersaForm then we imported it. This code is published by the processor and can be obtained from them. It is often same as the Receiver ID (837 ISA08), above.

OO344355

Qualifier (ISA05)

Mutually Defined

Application Sender Code (GS02) Application Receiver Code (GS03)

OO344355

04350

The ISA and GS numbers on the screen refer to the field designations in the ANSI 837 specification. They are included because your processor may refer to them in his documentation.

Other Actions
Click the OK button to save your record. The Claims Processor must be filled in before you create electronic claims. If in doubt about any of the ID numbers, contact the Electronic Claims Processor and ask for "Companion Documents".

Electronic Claims: Adding a Claim Processor


Before adding a processor, you need to add the Transmitter to the Submitters Tab. This Submitter will be needed when you get to the Transmitter field, below. If there is a Billing Provider who is different from the patient's Primary Provider or his designated submitter, you must enter it in the same way. In general, it is safest to only enter information into this form in capital letters.

To Add an Electronic Claim Processor


You can add a new Claim Processor from Setup. From the Setup window, Click on the Claims Processors Tab: 533

Click the Add button. The Electronic Claim Processor window will open.

The following items must be entered: Electronic Claim Processor Info -- Information about the processor
Name: Name of Processor Production: Make sure that the Production box DOES NOT have a check mark when creating TEST files (Typically you will need to send test files before going "live"). Active: Check if you are using this processor. Receiver ID (ISA08): Usually a Carrier ID per their Business rules. Qualifier (ISA07): Refers to the Receiver ID, above. Choose from a drop down the value they give you in the business rules. Most commonly used is Mutually Defined. (ZZ) Data File Name: The name to be used when the electronic claim file is created. This is the file that you will send to the claims processor. Date and time will be added this file name to prevent duplication. You can change the name at run time. 534

Format: Should be 004010X098A1 (as of 10/16/03). This designates the format that this processor uses, and will change from time to time. Request Ack: You are requesting an electronic acknowledgement, ANSI 997, file. Some processors support it, some don't. Extended Charset: Use of the ANSI extended character set is permitted for this processor. Implies Uppercase Only. Uppercase Only: This processor wants everything in upper case.

Electronic Claim Submitter Info -- Information that identifies you to the processor
Transmitter: Who will be sending the claim. This is the name of a person or organization, and it must have previously been entered on the Setup Submitters Tab. This entity may be a medical practice or a provider, or it may be a billing service or other company. It designates the entity that is actually sending the claims. Is a Person: Check this if the Transmitter is a person rather than an organization. Transmitter ID (Loop 1000A NM109): ID given to this submitter by the Claims Processor. Interchange Sender ID (ISA06): Typically a mailbox number or submitter ID assigned to you. It is paired with the next qualifier value. Qualifier (ISA05): Choose from the drop down the value given to you by the Claims Processor, often in the business rules. Most commonly used is Mutually Defined (ZZ). Application Sender Code (GS02): Typically a mailbox number assigned to you. Often same as ISA06 but check your business rules. Application Receiver Code (GS03): Typically the Carrier ID. Often same as ISA08 but check your business rules. The ISA and GS numbers on the screen and above refer to the field designations in the ANSI 837 specification. They are included because your processor may refer to them as such in their documentation.

Electronic Claims: Changing a Claim Processor


You can edit or view a Claim Processor from the Claims Processors Tab under Setup.

To Edit or View a Claim Processor


Click the Setup button in the top tool bar or choose the Setup item on the Utilities menu. Click the Claim Processor Tab in the Setup window.

535

Double click on the Processor you want to edit or click on it and then click on the Edit/View button. The Electronic Claim Processor window will open. Make the changes you want. Click the OK button when done.

Electronic Claims: Removing a Claim Processor


To Remove a Claim Processor
Click on the menu. Setup button in the top tool bar or choose the Setup item on the Utilities

Click on the Claims Processors Tab. Click on the Claim Processor and then click on the Remove button.

Electronic Claims: Creating Folders for Insurance Files


If you send claims electronically, you should make a special folder to hold the files you send and those you receive. Create the Claims folder.

On the Windows Desktop, double click on My Computer

Double click on the C drive Right click in a white space. Left click on New.

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Left click on Folder.

A New Folder icon will be displayed with the words "New Folder" highlighted.

Type in Claims. Press Enter. While you are here, you should make a Sent subfolder in the Claims folder for storing claims after you send them. Double click on the Claims folder. Continue with steps 4, 5 and 6 above.

Instead of typing Claims, type Sent and Enter. Close the Claims folder. Create the shortcut to the Claims folder. Right click on the Claims folder. Click on Send To. Click on Desktop (create shortcut).

Close the C:\ drive and close My Computer.

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You will see

on your Windows Desktop.

When VersaForm asks you where to store your claims file store it in the Claims folder located on the C drive.

Electronic Claims: Creating a HyperTerminal Connection Icon


First, Create the HyperTerminal Connection
From the Windows Desktop follow these steps:

Click on Start. Click on Programs (or All Programs). Click on Accessories. Click on Communications. Click on the HyperTerminal program. You will see:

In the Name field enter the name of a claims processor (like Medicare). 538

Click on one of the telephone icons. Click on OK. On the next screen:

In Area code put the area code for the processor. In Phone number put the seven digit phone number The Connect using field should show your modem. Use the drop-down to pick the modem. You must have a modem installed on the computer to use HyperTerminal. Click on OK.

Click on Cancel. 539

Close HyperTerminal. You will see:

Click Yes.

Second, Create the Shortcut Icon


Click on Start. Click on Programs (or All Programs). Click on Accessories. Click on Communications. Click on the HyperTerminal folder. Right click on Medicare.ht.

Click on Send To. Click on Desktop (create shortcut).

Escape 5 times to get out of the Programs menu. On the Windows Desktop, right click on the Shortcut to Medicare.ht icon.

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Click on Rename.

You will see:

Type Medicare and Enter.

Electronic Claims: Set up HyperTerminal to Store Downloaded Files


Once you tell HyperTerminal a specific place to download files, it will remember where that is. Click on the Receive File button. Receive File... (or click on Transfer in the menu bar and then click on

541

If you see:

Type in the drive and path where you will store your claims and response files.

Click on Cancel. Hyper Terminal will remember the folder you typed in and place all download files there.

Electronic Claims: 835 Options Setup


How to Open
On the top tool bar click on the Click on the Insurance Plans Tab. Find the insurance plan that represents the entity that will be sending you 835s and double click on it or click once to highlight it and then click on the Edit/View button. Move the top slider down until you see the section 835 Electronic Remittance Advice Processing section. Setup button.

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What You Will See

You can see that you have choices in four areas: Credits, Adjustments, Deductibles and Item Balances. Credits

Normally, when a payment is received, the patient item balance is large enough to receive the payment. However, if you have already manually posted this payment or if the patient has made a payment that you applied to this charge, there may not be sufficient balance to apply the payment. If the credit is accepted, this will result in an unapplied credit. If you had already posted the payment, accepting the credit would result in a duplicate credit (which you would later have to reverse). You may choose to either accept the credit, Accept credit, or not, Do not accept credit, if the payment cannot be fully applied. The default is Do not accept credit. This gives you a warning if it is a duplicate; if not, you can easily apply it manually. After an initial period, you may want to change this choice to Accept credit. Auto Adjustment

The 835 may contain lots of "adjustments", but many of them may be adjustments from the payer's point of view, not from your point of view. This choice lets you select one or more 543

insurance codes that will automatically be entered as VersaForm adjustments if they appear in the 835 file. Clicking on the Enter Adjustments Automatically button displays the following dialog:

As an 835 is processed, any line item that matches a code you selected will result in a VersaForm adjustment. You may add as many codes for auto-adjustment as you want. At least for Medicare, you should probably always add the two codes shown, as they represent the amount not allowed by the insurance plan. Here is an alphabetized list of EOBA Codes by Reason. And here is a list of EOBA Codes by Code Number. You do not have to edit this list in every insurance plan if you click on Apply this list to all insurance plans. Deductibles

Here you select the action that you want taken for primary insurance companies if the 835 includes one or more deductible amounts. Normally, deductible amounts are considered patient responsibility, Make it the Patient's Responsibility, and the 835 processing will record the items as a deductible, replacing any amount that may be currently set as the 544

deductible. Alternatively, you can choose to Adjust (write off) the amount or elect to manually post the items by selecting the Do Nothing radio button. Item Balances

Finally, for primary insurance companies, you select the action you want to take if the item has an outstanding balance after the adjustments and deductibles have been processed. Normally the remaining balance is the responsibility of the patient, Make it the Patient's Responsibility. Alternatively, you can choose to Adjust (write off) the remaining balance, or decide to postpone the decision by selecting the Do Nothing radio button.

Multiple Insurance Plans


You should be aware that a payment from an insurance plan might include remittance on behalf of a different insurance plan. For example, if a claim is forwarded for payment to a different plan. The 835 processing uses the options set for the insurance plan you used to submit the claim. If the two plans have different options sets, the results might not be what you expected. Using the same options for both insurance plans will produce consistent processing for all the claims covered by an insurance payment. In any event, the 835 reports will show when a payment is made on behalf of a different insurance plan.

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The Submitters Tab


The Submitters Tab in the Setup Window has these Functions
Add: Adds a new Submitter to the system. Edit/View: Edits Submitter information. Remove : Removes a Submitter from the system. Register: Registers the highlighted Submitter with electronic prescriptions. Check Status: Checks on the electronic prescription status of the highlighted Submitter. Help: Brings up the context sensitive VersaForm Help.

Submitters: Submitter Setup


How to Open
Click on the menu. Setup button in the top tool bar or choose the Setup item on the Utilities

Click on the Submitters Tab. To add a Submitter click on the Add button. To modify an existing Submitter locate the name on the list and double click on it or click once to highlight it and then click on the Edit/View button.

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What You Will See in the Top Pane

What Goes in Each Field


Field Name Last Name Information to Enter If the Submitter is a clinic, enter the full name of the Clinic here. If the Submitter is an individual, enter the Last Name. If the Submitter is a clinic, leave this field blank. If the Submitter is an individual, enter the first name here. If the Submitter is a clinic, leave this field blank. If the Submitter is an individual, enter the middle name here. If the Submitter is a clinic, leave this field blank. If the Submitter is an individual, enter the Suffix here. For example: "M.D.". The Universal Provider ID (also known as UPIN) for the individual provider or clinic. The Drug Enforcement Agency ID, if one is assigned, goes here. The Facility for this Submitter. This comes from the Facility table. The Practice U78787 Sample Our Healing Clinic

First*

Middle*

Suffix*

UPID*

DEA#*

Facility ID*

ID2*

Enter a code to identify this Submitter on the various lists. Use TP up to 2 characters.

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Provider Type*

This is the new Taxonomy code. There is a drop down list that identifies the various types. A hidden table will translate the type to the appropriate number code. These numbers are currently in development and tend to change every six months. You can type the number in directly. May be required for some state's Medicare. The practice license number. The state that issued the above license. If the submitter is a not person, fill in this field with the Employer Identification Number, otherwise leave blank. Click here to use the EIN for tax purposes (Box 25 of HCFA/CMS 1500). If the submitter is an individual, fill in this field with the Social Security Number. Click here to use the SSN for tax purposes (Box 25 of HCFA/CMS 1500). A checkmark here tells the system that the submitter is an individual. A checkmark here allows this submitter to appear on the various lists of submitters.

Family Practice

Medical License#* State* EIN* Use EIN in claims* SSN*

OHC123456 CA 83-3456789

a dot

Use SSN* Is a Person* Active

a dot

Insurance Defaults ID What number should be used if there is no match for the patients insurance in the "Edit IDs" table. What type of number is the ID? Use the drop down list. OHC123456 State license number

Qualifier

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What You Will See in the Bottom Pane

What Goes in Each Field


Field Name Information to Enter The street address for this submitter. There are two fields for this information. The e-mail address for this Submitter. The city for this submitter. The state for this submitter. Sample 591 W. Hamilton Ave. Suite 201 manager@ourclinic.com Campbell CA

Street

E-Mail* City State (not labeled) Zip (not labeled) Country* Phone* Extension* Fax* Pager* Mobile*

The zip code for this submitter The country where this submitter resides. Two letter code. Best to leave blank if it is US. The submitter's office phone number. Phone extension if needed. Fax number for the submitter. A pager number for this submitter. A cell phone number for this submitter.

95008

US 408 555 9898

408 555 8787

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Contact

A contact at the submitters office - generally someone who does billing work. What should appear in the salutation part of a form letter. Any department heading for this submitter. For example: "Medical Records". Any special note or information to store for this submitter.

June

Dear*

Dept.*

Note*

* This field can be blank.

The Completed Dialog

Other Actions
Click the OK button to save and close. Click the Cancel button to close without saving. Click on the Edit IDs button to add to or see a list of insurance plans and numbers they have assigned to this submitter:

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Submitters: Adding a Submitter to the List


From the Setup window, Click on the Submitters Tab: Click on the Add button. The Edit Submitter Info window will open.

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The Following Items Must be Entered Last Name: If the Submitter is a clinic, enter the full name of the Clinic here. If the Submitter is an individual, enter the Last Name. EIN or SSN: The tax ID of a corporation or the SSN of an individual. Active: Must be checked to be active. Insurance Defaults ID: The type of ID to use as a default for this Submitter. Insurance Defaults Qualifier: The qualifier for the above ID. Street, City, State and Zip: The Submitter's billing address. Contact: A Contact person.

Submitters: Changing a Submitter


You can edit or view a Submitter from the Submitters Tab in the Setup window.

To Edit or View a Submitter


Click the Setup button in the top tool bar or choose the Setup item on the Utilities menu. Click the Submitters Tab in the Setup window. 552

Double click on the Submitter you want to edit or click on it and then click on the Edit/View button. The Edit Submitter Info window will open. Make the changes you want. Click the OK button when done.

Submitters: Removing a Submitter


You may remove a Submitter only if has not been used.

To Remove a Submitter
Click on the menu. Setup button in the top tool bar or choose the Setup item on the Utilities

Click on the Submitters Tab. Click on the Submitter and then click on the Remove button.

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The Referring Tab


The Referring Tab in the Setup Window has these Functions
Add: Adds a new Referring to the system. Edit/View: Edits Referring information. Remove: Removes a Referring from the system. Help: Brings up the context sensitive VersaForm Help.

Referring Setup: Referring Provider Setup


How to Open
Click on the Setup button in the top tool bar. Click on the Referring Tab. To add a Referring Provider click on the Add button. To modify an existing Referring Provider, locate the name on the list and double click on it or click once to highlight it and then click on the Edit/View button.

What You Will See

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What Goes in Each Field


Field Name Required Information to Enter for Claims Referring Provider's last name Referring Provider's first name Referring Provider's middle name or initial. MD, DO, etc. Referring Provider's UPIN number. A check mark here indicates that the referral is from a person. A check mark here indicates that you take referrals from this doctor and you have an active association. If this is unchecked the name will not show up on lists of referring physicians. This is the "taxonomy code", which identifies your specialty. There is a drop down list that identifies the various types. VersaForm will translate the type to the appropriate number code. These codes do change periodically. You can type the code in directly. Use it only when referral depends on specialty. Y Referring Provider's NPI number. If the referring provider is a clinic enter the employer tax ID. If the referring provider is an individual enter the SSN. Overrides the normal choice in an electronic HIPAAcompliant claim. 878878787 0123456789 Sample Healer Ian A MD A123456

Last Name Y First Middle Suffix UPIN Is a Person Y N N N

Active

Provider Type

NPI EIN

SSN Use EIN or SSN in claims Insurance Defaults

555

ID

Enter the Referring Provider's UPIN here. Required A123456 for electronic claims. Use the drop down list to select Provider UPIN Number. Provider UPIN Number

Qualifier

What You Will See in the Lower Pane

What Goes in Each Field


Field Name Required for Claims Information to Enter The Referring Provider's street address (note there are two lines available). The Referring Provider's e-mail address. The Referring Provider's city. The initials for the state (note dropdown list). The Referring Provider's Zip code. The Referring Provider's country (2 characters only). Sample 42 43rd Street Ste 465 GoodDoc@msn.net New York NY

Street

No

E-Mail City State (not labeled) Zip (not labeled) Country

No No No

No

01232

No

556

Phone Extension Fax

No No No

The Referring Provider's phone number. Phone extension. The Referring Provider's Fax number. The Referring Provider's pager number. The Referring Provider's mobile phone number. A contact person. How to address the Referring Provider. A department. Any notes.

232 343 5555 44 232 343 6666

Pager

No

232 343 7777

Mobile Contact Dear Dept. Note

No No No No No

232 343 4444 Susan Gold Ms Gold

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The Completed Dialog

Other Actions
Once used in a charge, a Referring Provider cannot be removed. Instead, uncheck Active .

Click the OK button to save and close. Click the Cancel button to close without saving. Using the Edit Insurance IDs button is usually unnecessary for Referring Providers.

Referring Setup: Adding a Referring Provider to the List


From the Setup window, Click on the Referring Tab: Click on the Add button. The Edit Referring Provider Info window will open.

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The following items must be entered: Last Name and First: The Referring Provider's Last and First Names. UPIN: The Referring Provider's UPIN number. Active: Must be checked to be active. Insurance Defaults ID: The Referring Provider's UPIN number. Insurance Defaults Qualifier: Provider UPIN Number.

Referring Setup: Changing a Referring Provider on the List


You can edit or view a Referring Provider from the Referring Tab in the Setup window.

To Edit or View a Referring Provider


Click the Setup button in the top tool bar or choose the Setup item on the Utilities menu. Click the Referring Tab in the Setup window. Double click on the Referring Provider you want to edit or click on him or her and then click on the Edit/View button. The Edit Referring Provider window will open. 559

Make the changes you want. Click the OK button when done.

Referring Setup: Removing a Referring Provider from the List


You may remove a Referring Provider only if he or she has not been used.

To Remove a Referring Provider


Click on the menu. Setup button in the top tool bar or choose the Setup item on the Utilities

Click on the Referring Tab. Click on the Referring Provider and then click on the Remove button.

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Statement Options
Statement Options allow your statements to be customizednot just the appearance, but how the statement represents the patients account. In Setup, choose Statement Options and click the Add button.

Enter a name for these options in the Option Name field. Pick a name that indicates how you will use itfor example, Standard Statement. Assigning a name to the statement printing options and saving them will enable you to use this set of options again. Move the cursor to the Statement Format field and click the down arrow to see a pick list of the print formats installed on the system. If you want to have interest computed, check the Compute Interest? box. Enter the number of Interest Free Days you want. If you don't enter a number, the default is 60 days. Note: If you do want to compute interest, each patient for which interest is to be charged must have an annual percentage rate in Interest Rate in the charts Information Tab. Registration Billing

Decide how far back you want to list the activity on the statement. Then enter the number of days back to itemize the billing items and payments on the statement in Show Charges/Credits how many days back?. For example, to itemize the last 60 days activity, enter 60. To itemize all the activity (the billing items and payments), regardless of how far back it goes, check the Show All box. All activity on the ledger that is older than the number of days entered will be combined into one line labeled Balance Forward. The Delay Billing field refers to the situation when insurance is pending. If you do not want these balances to appear as payable on the statements while insurance is still pending (even though the patient will eventually have to pay them), you can show them as zero by choosing the Delay Billing option. If you make no choice, the choice entered for the patients insurance plan will be used. For instance, suppose the charge is $100, and the patient balance is $20, and the insurance hasnt paid yet. If youve chosen Delay, then the PAYABLE NOW amount on this line would be zero. Later, when the insurance pays, the patient balance would become payable, and PAYABLE NOW would be $20. No statements will be printed for accounts that have a zero balance unless you check Print zero balance statements if there is recent activity?. Check Ask operator for a statement date? to prompt for the date you want printed on the statement. 561

The Cycle Billing fields are used only when printing statements in batches. They control which patients' statements are to be printed. Enter any Messages that you want to have printed on the statement. Normally, the calculation for when to send the aging messages is based on the actual age of the receivable in the account. If you prefer to base this calculation on the patient's last payment date instead, click the radio button for Last Patient Payment. Anything you enter in the Message for All Statements field will be printed on every statement. Then the appropriate Over 30, Over 60, etc., message will be printed, depending on the age of the outstanding balance. When you are finished, click the OK button. This option will now be offered when you print statements.

Statement Options Setup: The Statement Options Tab


The Statement Options Tab in the Setup Window has these Functions
Add: Adds a new Statement Option to the system. Edit/View: Edits Statement Options information. Remove: Removes a Statement Options from the system. Help: Brings up the context sensitive VersaForm Help.

Statement Options Setup: Statement Options Setup


How to Open
Click on the Setup button in the top tool bar. Click on the Statement Options Tab. To add an option, click on the Add button.

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To modify an existing Statement Option, locate the name on the list and double click on it or click once to highlight it and then click on the Edit/View button.

What You Will See

What Goes in Each Field


Field Name Option Name Information to Enter The name you want displayed when you print statements. Use the pick list to select the style of statement you want. w/tear off puts a return address in the top third of the page so a patient can tear it off and it will fit in a window envelope with the window on the right site. Sample My Statements

Statement Format

Letterhead Statement

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Compute Interest?*

A check mark here will compute interest based on Interest Free Days and the interest rate you have entered on each chart ( Billing Tab). Registration |

Interest Free Days*

How many days must elapse from the date of the charge until you start to calculate interest. Enter the number of days that should show on a statement. For example 180 (the default), will show all entries for the last 180 days (6 months) with a "Balance Forward" line for items older than 180 days. If this is blank, Show All is assumed. A check mark here will override the previous field and show all line items on the statement. This option will set the amount payable on each line to $0.00 if insurance is pending. Setting this option overrides what is on the Insurance Plan record or the Billing Tab of patient registration. Use the drop-down list to set it. The default is Delay billing if insurance is pending. If the option chosen is to delay billing when insurance is pending, statements with a zero patient balance will not be automatically printed. Otherwise, only statements with a zero total balance due will not be automatically printed. A statement will be printed regardless of this setting if you print a statement from a patient's ledger. However, any charges that are pending with insurance will be marked Pending and will show zero due. Generally if a Ledger has a zero balance a statement will not print. If you put a check mark here a Ledger with a zero balance will print, if some activity (for instance, a payment) has occurred within the last 30 days. Delay billing if insurance is pending.

Show Charges/Credits how many days back?*

180

Show All

Delay Billing

Print zero balance statements if there is recent activity?

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Ask operator for a statement date?

If Yes, then the date you input will be the date printed on the statement. If you want to print a part of the alphabet enter the starting name here. An A will start with the first last name that starts with "A" (Aaron). An A D will start with the first last name that starts with "AD" (Adams). If you want to print a part of the alphabet enter the ending name here. A G will stop printing statements with the last name starting with "G". To assure you get all of the names that start with "G" enter G Z . The messages on the bottom of the screen will print based on the number of days since the service was performed. The message is based on the oldest balance. The messages on the bottom of the screen will print based on the number of days since the patient last made a payment. The message is based on the oldest balance from that date. This message will appear on all statements you print. This message prints if the oldest balance is in the "Current" field on the Ledger, or if the Last Patient Payment was within 30 days of the date the statement is being printed. This message prints if the oldest balance is in the "Over 30" field on the Ledger, or if the Last Patient Payment was within 60 days of the date the statement is being printed. This message prints if the oldest balance is in the "Over 60" field on the Ledger, or if the Last Patient Payment was within 90 days of the date the statement is being printed. Thank you for choosing us. Thank you for your prompt payment. Please send your payment as soon as possible. Your account is getting behind. Please call the office.

Cycle Billing/Name to start with*

Cycle Billing/Name to end with*

GZ

Base timing of message on Aged Balance

Base Timing of message on Last Patient Payment Message for all Statements*

Current Accts Message*

Over 30 Message*

Over 60 Message*

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Over 90 Message*

This message prints if the oldest balance is in the "Over 90" field on the Ledger, or if the Last Patient Payment was within 120 days of the date the statement is being printed. This message prints if the oldest balance is in the "Over 120" field on the Ledger, or if the Last Patient Payment was within 150 days of the date the statement is being printed.

Pay this month or your account will go to collections. We are sending your account to collections.

Over 120 Message*

* This field can be blank.

The Completed Dialog

Other Actions
Click the OK button to save this work. Click the Cancel button to close the dialog without saving your work.

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Statement Options Setup: Adding a Statement Option


From the Setup window, Click on the Statement Options Tab: Click on the Add button. The Edit Statement Option window will open.

The following items must be entered:


Option Name: A name for the Statement Option. Statement Format: Choose one of the available formats. Show Charges/Credits how many days back? or Show All: Either accept 180 days, type in another number of days, or check the Show All checkbox. Delay Billing: Choose one of the available options.

Statement Option Setup: Changing a Statement Option


You can edit or view a Statement Option from the Statement Options Tab in the Setup window. 567

To Edit or View a Statement Option


Click the Setup button in the top tool bar or choose the Setup item on the Utilities menu. Click the Statement Options Tab in the Setup window. Double click on the Statement Option you want to edit or click on it and then click on the Edit/View button. The Edit Statement Options window will open. Make the changes you want. Click the OK button when done.

Statement Option Setup: Removing a Statement Option


To Remove a Statement Option
Click on the menu. Setup button in the top tool bar or choose the Setup item on the Utilities

Click on the Statement Options Tab. Click on the Statement Option and then click on the Remove button.

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National Provider Identifier (NPI)


The National Provider Identifier (NPI) is now here. All HIPAA covered healthcare providers, whether they are individuals or organizations, will have to use NPIs to identify themselves in HIPAA standard transactions. You will still need other identification as well, at least for a while, so don't remove any old IDs. HIPAA covered entities such as providers completing electronic transactions, healthcare clearinghouses and large health plans, must use only the NPI to identify covered healthcare providers in standard transactions by May 23, 2007. Small health plans must use only the NPI by May 23, 2008. Note: These dates have been changed for many insurance plans. You can go to http://www.cms.hhs.gov/apps/npi/01_overview.asp for more information and to http://www.cms.hhs.gov/NationalProvIdentStand/03_apply.asp#TopOfPage to get an application form. You can go to https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do to obtain NPIs for other providers and to make sure that your NPI and other IDs are correctly crosswalked. There will also be changes to the CMS-1500 (HCFA 1500) form to accommodate NPIs. The Form CMS-1500 (08-05) will be effective January 1, 2007 and mandatory by April 2, 2007. Note: These dates have been changed for many insurance plans. VersaForm has places to put your NPIs. You can start entering your numbers as soon as you receive them. You will also need to clean up any IDs that are missing their qualifiers.

NPI Setup: Adding NPIs


Click on the Setup button and choose the Facilities, Providers, Referring and Submitters Tabs to add NPIs. While you are in those Tabs, you should check that other identifying fields are also correct, e.g. EIN, Use EIN in claims or Use SSN, and Insurance Defaults ID and Qualifier.

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For Providers

For Submitters

For Referring Providers

For Facilities

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NPI Setup: NPIs and Claims


VersaForm is now able to include NPIs in insurance claims.

Electronic Claims
Whether NPIs are included depends on three dates: The NPI is permitted date (defaults to 10/1/06). The NPI is required date (defaults to 5/23/07). The legacy ID is prohibited date (defaults to 5/23/07). NPIs will be included if they are present and the May use NPI on or after date is before today. An error will occur if NPIs are not present and the Must use NPI on or after date is before today. A legacy ID will also be included, unless the May not use Legacy ID after date is before today. NPIs affect all facilities and all providers: billing providers, referring providers, supervising providers, rendering providers and purchased service providers.

Paper Claims
Whether NPIs are included depends on two dates: The Use CMS1500 08/05 after date (defaults to 1/02/07). The May not use legacy ID after date (defaults to 5/23/07).

UB-92 or UB-04
Whether NPIs are included depends on two dates: The Use UB04 after date (defaults to 5/02/07). The May not use legacy ID after date (defaults to 5/20/07).

Changing NPI Dates


For all Insurance Plans
If you want to change the NPI dates for all insurance plans, go to click on the Set NPI Dates button. Setup Preferences and

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For an Insurance Plan


If a few insurance plans are using different dates, the dates can be changed in Setup Insurance Plans. Click on the insurance plan and click on the Edit/View button. You will find the dates under NPI Dates at the bottom of the top section. The dates shown will be 00/00/00 unless you change them. These dates override those set in Preferences.

NPI Setup: NPIs and VersaForm


VersaForm versions after 3.132 are able to both send NPIs electronically and to print them on the new 1500 claim forms. Versions after 3.134 are able to print UB-04s.

Choosing Whether to Use NPIs


For All Insurance Plans
If you do not want to send NPIs, go to button. Setup Preferences and click on the Set NPI Dates

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For Electronic Claims, replace the May use NPI on or after date, Must use NPI on or after date and the May not use Legacy ID after date with some future dates. For Paper Claims, replace the Use CMS1500 08/05 after date and the May not use Legacy ID after date with some future dates. For UB-04s, replace the Use UB04 after date and the May not use Legacy ID after date with some future dates.

For Individual Insurance Plans


If you have already changed the NPI Dates in Setup Insurance Plans for some plans, those dates override dates entered in the NPI Effective Dates in Setup Preferences. You can return control of the NPI dates from the Insurance Plan to the Preferences by replacing the date(s) you entered in the Insurance Plan(s) with 00/00/00. You Delete the numbers to return them to 0s. On the other hand, you can override the NPI Effective Dates in some insurance plans by editing the NPI Dates in Setup Preferences for

Setup Insurance Plans.

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Choosing to Send NPIs Electronically


You choose whether to send NPIs in electronic claims by changing the May use NPI on or after (NPI Permitted) and Must use NPI on or after (NPI Required) dates in the NPI Effective Dates window or NPI Dates as shown above. If the May use NPI on or after date is before today VersaForm will send NPIs as the primary Identification Codes if they are available; otherwise it will send the EIN or SSN. If the Must use NPI on or after date is after today VersaForm will not generate the claim if there are missing NPIs. If the May not use Legacy IDs on or after (Legacy ID Prohibited) date is before today VersaForm will not send the old IDs, e.g. tax ID or Blue Cross, Blue Shield or Medicare IDs.

Choosing Whether to Use the New 1500 Form


You choose which 1500 form to use by setting the NPI Effective Dates or NPI Dates as shown above. If the Use CMS1500 08/05 after date is after today then VersaForm will print the old 1500 (12-90) form; if the date is before today, the new 1500 (08/05) form. The Do not use Legacy ID after date tells VersaForm when to stop including the old IDs, e.g. tax ID or Blue Cross, Blue Shield or Medicare IDs.

Choosing Whether to Use the UB-04 or UB-92 Form


You choose which UB form to use by setting the NPI Effective Dates or NPI Dates as shown above. If the Use UB04 after date is after today then VersaForm will print the old UB92 form; if the date is before today, the new UB-04 form. The Do not use Legacy ID after date tells VersaForm when to stop including the old IDs, e.g. tax ID or Blue Cross, Blue Shield or Medicare IDs.

Adding NPIs
Click on the Setup button and choose the Facilities, Providers, Referring and Submitters Tabs to add NPIs.

For Providers

While you are in Edit Provider, you should check that other identifying fields are also correct, e.g. EIN, Use EIN in claims or Use SSN, and Qualifier and ID under Insurance Defaults.

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You should also make sure that all IDs in the Edit Provider ID List window have their Qualifiers filled in. The IDs in the Edit IDs list are called Legacy IDs.

For Submitters

While you are in Edit Submitter Info, you should check that other identifying fields are also correct, e.g. EIN, Use EIN in claims or Use SSN, and ID and Qualifier under Insurance Defaults. You should also make sure that all IDs in the Edit Submitter ID List window have their Qualifiers filled in. The IDs in the Edit IDs list are called Legacy IDs.

For Referring Providers

While you are in Edit Referring Provider Info, you should check that other identifying fields are also correct, e.g. UPIN and ID and Qualifier under Insurance Defaults. Note that there is now a Suffix field so you can clean up the names. You should also make sure that any IDs in the Edit Referring ID List window have their Qualifiers filled in. For Referring Providers, it is usually best to put the UPIN in as the Insurance Default ID and Provider UPIN Number as its Qualifier. The IDs in the Edit IDs list are called Legacy IDs.

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For Facilities

While you are in Edit Facility, you should check that other identifying fields are also correct, e.g. Tax Id and ID and Qualifier under Insurance Defaults. You should also make sure that any IDs in the Edit Facility ID List window have their Qualifiers filled in. For Facilities, it is usually best to put the Tax ID in as the Insurance Default ID and Federal Taxpayer's ID Number as its Qualifier. The IDs in the Edit IDs list are called Legacy IDs.

NPI Setup: Notes on NPIs


NPI Dates
We have heard many different reports about when NPIs should be used. In general, most ANSI electronic claims can include NPIs. At this time, June 1, 2007, most still want the legacy IDs as well. The paper claims are less consistent. Many companies can accept the new CMS1500 (08/05) and some even require them. Most do still want the legacy IDs.

If your claims do not show your legacy IDs


Go to Setup Preferences and click on the Set NPI Dates button. Change the May not use Legacy ID after date to some future date.

If an insurance company wants you to send NPIs and most plans do not want NPIs
Go to Setup Insurance Plans and Edit/View the plan. For electronic claims, change the NPI Permitted and NPI Required dates to some past dates. Make sure that the Legacy ID Prohibited date is set to some time after the Permitted and Required dates. For paper claims, change the Use CMS1500 (08/05) after date to some past date. Make sure that the Do not use Legacy ID after date is set to some time after the Use date. For UB-92, change the Use UB04 after date to some past date. Make sure that the Do not use Legacy ID after date is set to some time after the Use date. 576

If an insurance company wants you to not send NPIs and most plans want NPIs
Go to Setup Insurance Plans and Edit/View the plan. For electronic claims, change the NPI Permitted and NPI Required dates to some future dates. Make sure that the Legacy ID Prohibited date is set to some time after the Permitted and Required dates. For paper claims, change the Use CMS1500 (08/05) after date to some future date. Make sure that the Do not use Legacy ID after date is set to some time after the Use date. For UB-92, change the Use UB04 after date to some future date. Make sure that the Do not use Legacy ID after date is set to some time after the Use date.

Taxonomy Codes instead of Legacy IDs


In a few states, Medicaid is asking for taxonomy codes to replace legacy IDs in 33b, 24I and J, and even 17a. This is not included in the official definition of the CMS1500 (08/05). However, we have modified VersaForm to allow the taxonomy qualifier, ZZ, in the Edit Insurance IDs Lists window.

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The Scheduler Resources Tab


The Scheduler Resources Tab in the Setup Window has these Functions
Add: Adds a new Resource to the system. Edit/View: Edits Resource information. Remove: Removes a Resource from the Scheduler. HOlidays: Lets you set up holidays in the Scheduler. VersaForm does not automatically put in any holidays. Visit Types: Lets you define Visit Types and add color to them. Appt Reminder: Sets up the optional feature for automatic patient calls. Help: Brings up the context sensitive VersaForm Help.

Schedule Setup: Schedule Resources Setup


How to Open
Click on the Setup button in the top tool bar. Click on the Scheduler Resources Tab. To add a resource, click on the Add button. To modify an existing Resource, locate the name on the list and double click on it or click once to highlight it and then click on the Edit/View button.

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What You Will See

What Goes in Each Field


Field Name Resource User, if resource is a user Schedule Increments Allow Overbooking Information to Enter The name you want to appear on the list of resources when you open the Scheduler. Use the drop down list to choose a specific user by name. Use the drop down list to select the length of the normal appointment A check mark here will allow you to schedule more than one appointment for this resource at the same time. A check mark here will make the resource appear in the list of resources when the Scheduler is on screen. A check mark here will allow VersaForm to make appointment reminder calls for this resource. Use the drop down to indicate the start time for each day of the week. If the office is not open on a specific day leave that field blank. Mon-Fri at 8:30 am. Sample Dr. Welby

Doctor

15

Active

Appt Reminder

Start Time Sunday - Saturday

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End Time - Sunday - Saturday

Use the drop down to indicate the end of the day for each day of the week. If the office is not open on a specific day leave that field blank.

Mon-Fri at 4:30 pm.

The M - F to Monday button will copy the times you have entered for Monday to Tuesday through Friday. The All to Sunday button will copy the times you have entered for Sunday to the rest of the days.

The Completed Dialog

Other Actions
To save the record click the OK button. To quite without saving click the Cancel button. To add recurring times and/or dates when the resource will not be available click on the Add Event button.

Scheduler Setup: Adding a Scheduler Resource


To Add a Scheduler Resource
From the Setup window, Click on the Scheduler Resources Tab: Click on the Add button. The Resource Properties Window will open.

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Type in a name for the Resource. If the Resource is a User, choose the his or her name from the drop-down list. Fill in the Schedule Increment and any other fields you want. (See Schedule Resources Setup for more information.) Add Events, if you want. (See Schedule Resource Events for more information.) When you are finished, click on the OK button.

Scheduler Setup: Schedule Resource Events


How to Open
Click on the Setup button in the top tool bar. Click on the Scheduler Resources Tab. To add a resource, click on the Add button. (See Schedule Resources Setup for more information on adding Resources.) To modify an existing Resource, locate the name on the list and double click on it or click once to highlight it and then click on the Edit/View button. Click on the Add Event button to add an event or on the Edit Event button to change one.

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What You Will See

What Goes in Each Field


Field Name Event Event Time Start Information to Enter What event name should be displayed. Examples are: Lunch, Surgery times, Seminar, Vacation Sample

Lunch

Use the drop down list to indicate what time the event begins.

12:00 pm

Event Use the drop down list to indicate what time the event ends. Time End Recurrence Every Day Weekday s A click here tells the system that this Event occurs every day at the time indicated A click here tells the system that this Event occurs every weekday (Mon-Fri) at the time indicated.

1:30 pm

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Field Name

Information to Enter A click here tells the system that this Event occurs once each week. A dialog will appear asking which day of the week.

Sample

Weekly

A click here tells the system that this Event occurs every second week. A dialog will appear asking which day of the week. BiWeekly

A click here tells the system that this Event occurs once a month. A dialog will appear allowing you to choose which week of the month and which day of the week (4th week on Friday)

Monthly or which day of the month (6th).

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Field Name

Information to Enter A click here tells the system that this Event occurs once a year. A dialog will appear allowing you to choose the week of the month, day of that week and month of the year (3rd week, on Tuesday, in February).

Sample

Yearly or the day of the month and month of the year (6th day in February).

Start and End Dates Start Date: End Date: When this event starts. 01-012003 12-312004

When this event ends.

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Here is an Example

Click the OK button to save the Event. Once an event has been entered you can edit it or click the Remove Event button to remove it.

Scheduler Setup: Adding Holidays


How to Open
Click on the Setup button in the top tool bar. Click on the Scheduler Resources Tab. Click on the HOlidays button. Click on the Add button to add a Holiday. To delete an existing Holiday, locate the name on the list, click on it and then click on the Remove button.

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What You Will See

What Goes in Each Field


Field Name Information to Enter Sample

Holiday Date Click on the Description

to use the calendar to choose the date. 07-04-2008 4th of July

Name the Holiday.

Click the Ok button to save the Holiday.

Scheduler Setup: Changing a Scheduler Resource


You can edit or view a Scheduler Resource from the Scheduler Resources Tab in the Setup window.

To Edit or View a Scheduler Resource


Click the Setup button in the top Toolbar or choose the Setup item on the Utilities menu. Click the Scheduler Resources Tab in the Setup window. Double click on the Resource you want to edit or click on it and then click on the Edit/View button. The Resource Properties window will open.

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Make the changes you want. Click the OK button when done.

Scheduler Setup: Adding Visit Types


How to Open
Click on the menu. Setup button in the top tool bar or choose the Setup item on the Utilities

Click on the Scheduler Resources Tab. Click on the Visit Types button.

To Delete an Existing Visit Type


Locate the name on the list and click on it . Click on the Remove button.

To Add a Visit Type


Click on the Add button. You will see the Enter visit type window.

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Type in a name. Click on Ok.

Coloring the Visit Type


Click on the Choose Color button. You will see the Color window.

You can choose one of the Basic colors by clicking on one of the colored squares. Remember that you will have black characters so don't choose a color that is too dark. To get more usable colors, click on the Define Custom Colors >> button. It will show your Basic color in the Color|Solid field.

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Click somewhere along the vertical bar on the right side to modify the color or click anywhere in the rainbow of colors to pick a starting color and then you can modify it by clicking along the vertical bar. Click the OK button to choose that color. Click on a Visit Type other than the one you just changed to see how the color looks. Click Ok when you are done.

Scheduler Setup: Removing a Scheduler Resource


To Remove a Scheduler Resource
1. Click on the Setup button in the top tool bar or choose the Setup item on the Utilities menu. 2. Click on the Scheduler Resources Tab. 3. Click on the Resource and then click on the Remove button. 4. If the Resource has been used, you will be asked if you want to remove it anyway.

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5. Click the OK button if you want to remove it.

Scheduler Setup: Appointment Reminders


As an optional feature VersaForm can send information to an appointment reminder service that will make phone calls to your patients for you. The VersaForm appointment reminder feature will make telephone reminder calls to all patients who request a reminder and make an appointment with a schedule resource with Appt Reminder checked. A typical reminder message might be: "Hello, this is an appointment reminder from [practice_name]. A member of your household has an appointment at [time] on [date] with [resource]. Press 1 to confirm this appointment." Note: if the resource has not been set up in advance, the message will skip the "with [resource]" part of the message. Before using Appointment Reminders, you will need to set up the Resources and the Scheduler.

Set up the Resources


Click the Setup button in the menu bar and select the Scheduler Resources Tab. For each schedule resource for which appointment reminders make sense, click the Edit/View button, check Appt Reminder in the dialog and click the OK button.

Once you have set up all your resources, print out the Schedule Resources With Appointment Reminders report. Fill in the name and phone number of the person in your office who will record the appointment reminder messages to be played to the patients, and your time zone so that the phone calls are made at a reasonable time of day. Then Fax the 590

report to VersaForm technical support at 408-370-3393 or send it to VersaForm at 591 W. Hamilton Avenue, Suite 230, Campbell, CA 95008. After receiving your list, VersaForm will provide you with a patient calls Server IP, User Name and Password. These must be filled in during the dialog invoked by clicking the Appt Reminder button.

Set up the Scheduler


1. Click the Setup button in the menu bar and select the Scheduler Resources Tab. Fill in the Server IP, User Name and Password that VersaForm provided you. These must be filled in during the dialog invoked by clicking the Appt Reminder button.

2. You can specify whether Appt Reminder in New Appointment or Edit Appointment defaults to no (N) or yes (Y). Unless you change it, this will default to no. 3. You can specify the number of days before an appointment that the reminder call should be made (from 1 to 7 days). Unless you change it, this will default to 2. 4. The Call Date Option allows you to specify the rules for determining the call date for appointments. The appointment reminder call will be made Num Days Before Appt days before the appointment.

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If Call Date Option is Call Any Day Except Holiday or Call M - F Except Holiday, and the call date is a holiday, then the call will be made the day before the holiday. If Call Date Option is Call M - F or Call M - F Except Holiday then the call date will be the weekday before the holiday. 5. Enter the Default Area Code only if you are confident that it applies to ALL patient home, work and cell phones that do not already include area codes. If you specify a Default Area Code and the patient phone number is 7 digits long then, when the appointment reminder is made, the default area code will be automatically pre-pended to the phone number to make a 10 digit telephone number. If you do not specify a Default Area Code, then 7 digit phone numbers will fail validation when the appointment is made and you will be prompted to enter the proper area code at that time. 6. During the appointment reminder telephone message, the patient may be given the option to cancel the appointment (by pressing a certain button on their telephone). If a patient cancels an appointment this way, the user you select under Cancel Appt Notify User will be sent a high priority message with enough information to cancel the appointment in VersaForm. This will happen the morning after the appointment Scheduler button and click the reminder call was made. This user can go to the Cancel Appt button to remove that appointment from VersaForm. 7. VersaForm will automatically delete appointments that have been cancelled by the patient call recipient unless you change Cancel Appointment Delete Appointment to N.

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Security Setup: Access Control Overview


VersaForm provides four mechanisms for controlling security in your system:
Support for Users with Special Authorities Providing Two System Security Levels Controlling the Set of Users Who can Login to the System Controlling What Patient and Practice Information Users can See and Modify

Users with Special Authorities


There are two special attributes that can be granted to a User. User Authorities are granted in the Users Tab in the Setup window. You cannot grant a User Authority to another User unless you already have the authority being granted. The User Authorities are:

System Administrator
A System Administrator is allowed to view and change critical system settings such as setting the options for VersaForm backups. In addition, a System Administrator is granted all permissions (see the Controlling What Users can See and Modify section below) for viewing and changing all patient and practice data.

Security Administrator
A Security Administrator is allowed to view and change system settings relating to logins, passwords, and system security levels. Only a Security Administrator is allowed to change another User's password. A Security Administrator is not automatically granted all user permissions. The same User can be both a System Administrator and a Security Administrator. VersaForm requires that at least one User be a System Administrator and at least one User be a Security Administrator. The built-in User DBA satisfies this requirement as DBA is both a System and Security Administrator and these authorities cannot be removed from this User. You can (and should) change the password for the DBA User to limit the use of this User. The first User added when installing VersaForm is also both a System and Security Administrator but these authorities can be removed.

System Security Levels


The Security level is selected in the Access Control Tab in the Setup window. The two levels of System Security are:

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Standard
When the system is set to Standard Security: 1. The password rules have no effect and passwords may be of any length, contain any characters, etc. 2. Passwords are not case-sensitive. 3. Reports are not restricted based on Administrator authorities. 4. A System Administrator can prevent users from using the Remember my user name and password for the login screen. 5. If a User login fails, the system will provide specific information about what caused the failure, such as bad User name or incorrect password. 6. Three login attempts are permitted using an incorrect password and then the system will exit but the User is not suspended and can try again by restarting VersaForm.

High
When the system is set to high security: 1. Only a Security Administrator can: Use the Access Control and Users Tabs in the Setup window. Set a User inactive. Grant Security Administrator authority to another User. Use the Audit and the Security User List reports. Change the password rules. Allow users to use the Remember my user name and password for the login screen.

2. The password rules become effective. 3. Passwords are case-sensitive. 4. You may be required to use a complex password. A complex password contains at least one upper case letter, one lower case letter, one number and one special character. 5. Consecutive attempts to login using the wrong password will cause a User to be suspended. The number of attempts is set by a Security Administrator. A suspended User can only be reset by the process of a Security Administrator assigning a new password to the User. 595

6. You may be prevented from reusing passwords. 7. The system will not provide information on the cause of login failures.

Controlling User Login


Every VersaForm User must have a password. Passwords are kept in the VersaForm database and are encrypted using an advanced hashing algorithm. Only the User who enters a password can know what the password is. If you forget your password, a System Administrator must reset your account by assigning you a new password. Using the Access Control Tab in the Setup window, a Security Administrator can set the password rules for your system including: Permitting or disallowing use of the Remember my user name and password for the login screen. Setting the System to the Standard or High Security Level. Setting the minimum length of a password. Forcing all users to change passwords on a periodic basis. Making passwords case-sensitive. Requiring you to use a complex password. A complex password contains at least one upper case letter, one lower case letter, one number and one special character. Preventing Users from reusing passwords. Setting the maximum number of login failures (caused by supplying an incorrect password) to allow before suspending a User.

The Change Password window will show you the current requirements when you are entering a password. (See Changing User Passwords for more information.)

Controlling What Users can See and Modify


VersaForm controls access to patient and practice data using a system of permissions that are assigned to groups. User Groups can be established, and Users can belong to them. All Users belong to the AllUsers Group. Patient Groups can be established, and patients can belong to them. All patients belong to the All Patients Group. Permissions to access patient data are assigned to combinations of a User Group and a Patient Group. For instance, if User Smith belongs to User Group 1, and User Group 1 can

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view encounters for Patient Group 2, then Smith can view encounters for any patient in Patient Group 2. Permissions to access non-patient data are assigned to User Groups. For instance, if User Jones belongs to User Group 1 and User Group 1 can change vocabularies, then Jones can change vocabularies. Permissions are assigned by category. In each category, the following permissions can be assigned: View: Select data for viewing on work station. Create: Create new data. Change: Change existing data. Delete: Delete data that has not been signed off. Sign: Certify data as clinically correct. Print: Pint reports, listings, or portions of patients' records.

Each of these permissions can be Yes, No, or Defer. When a permission is Defer, it does not determine the effective permission. This is usually because the permission will be determined by membership in some other User Group or Patient Group. Because users and patients can belongs to several groups the User's effective permission is a combination of the separate permissions. Users with System Administrator authority are automatically granted all permissions.

Security Setup: User Groups


To Administer User Group Membership
1. From the Setup window, click the Access Control Tab. 2. Click on the User Groups button. 3. Choose the User Group to administer. 4. The Remove >> button removes a User from the current User Group. --Or-The << Add button adds a User to the current User Group. 5. Click the Ok button to close the window and accept the changes made to the current User Groups, or click the Cancel button to reject the changes. 597

Security Setup: Adding a User Group


User groups provide a convenient way of administering user access privileges. For instance, you might create a User Group for a Provider and then assign the clinicians that work with that Provider to that group.

To Add a User Group


1. From the Setup window, click the Access Control Tab. 2. Click on the User Groups button. 3. The User Groups window will open.

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4. Click on the Add Group button in the lower left corner of the window. 5. The Enter new User Group Name window will open.

6. Enter the group name and click the Ok button. 7. Use the <<Add button to add users to the group as desired. See User Groups for more information.

Security Setup: Removing a User Group


To Remove a User Group
1. From the Setup window, click the Access Control Tab. 2. Click on the User Groups button. The Patient Groups window will open. 3. Choose the User Group you want to remove. 4. Using the Remove>> button, remove all the Users from the User Group. 599

5. Click on the Remove Group button. 6. Click OK. 7. Click Ok. Note: You can not remove User Group AllUsers.

Security Setup: Setting User Group Permissions


User Group Permissions set the permissions for non-patient data. 1. From the Setup window, click the Access Control Tab: 2. Click the User Group Permissions button. The User Group Access Permissions window will open.

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3. Select the User Group. 4. Select the access permissions that you want to grant or deny. The choices of Yes, No and Defer will determine the effective permissions that apply to a given User Group. See Effective Permissions for more information on determining permissions. 5. Click Ok when you are done, or Save Permissions if you want to set permissions for another group. The Remove Permissions button will set all the permissions to Defer.

Security Setup: Patient Groups


To Administer Patient Group Membership
1. From the Setup window, click the Access Control Tab. 2. Click on the Patient Groups button. 3. Choose the Patient Group to administer. The Remove >> button removes a Patient from the current Patient Group. --Or-The << Add button adds a Patient to the current Patient Group.

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Click the Ok button to close the window and accept the changes made to the current Patient Groups, or click the Cancel button to reject the changes.

Security Setup: Adding a Patient Group


To Add a Patient Group
1. From the Setup window, click the Access Control Tab. 2. Click on the Patient Groups button. The Patient Groups window will open.

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3. Click on the Add Group button in the lower left corner of the window. The Enter new Patient Group Name window will open.

4. Enter the group name and click the Ok button. 5. Click the Ok button. Patients are added to patient groups from the Registration Tab on the Patient Chart. However, you can also administer patient group membership from this window.

Security Setup: Removing a Patient Group


There are two ways to remove a Patient from a Patient Group: from the patient's chart and from the Setup window.

To Remove a Patient Group from the Patient's Chart


From the Patient's chart: 1. Click on the Registration Tab. 603

2. Click on the

Security Tab.

3. Uncheck the checkbox of the Group from which you want to remove the Patient.

4. Click the OK button.

To Remove a Patient Group from the Setup Window


From the Setup window: 1. Click the Access Control Tab. 2. Click on the Patient Groups button. The Patient Groups window will open.

3. Click on the Remove Group button towards the lower left corner of the window. 4. The Remove Patient Group window will open.

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5. Choose the Group Id and click the OK button. 6. Click the Ok button.

Security Setup: Setting Patient Group Permissions


Patient Group Permissions set the permissions for patient data. From the Setup window, click the Access Control Tab: Click the User Group / Patient Group Permissions button. The User Group/Patient Group Access Permissions window will open.

Select the User Group and the Patient Group.

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Select the access permissions that you want to grant or deny. The choices of Yes, No and Defer will determine the effective permissions that apply to a given User and Patient Group. See Effective Permissions for more information on determining permissions. Click Ok when you are done, or Save Permissions if you want to set permissions for another group. The Remove Permissions button will set all the permissions to Defer.

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Other Setup
Encounter Type Setup
To add or remove encounter types, use the Encounter Types Tab in the Setup window. They can also be added from the Encounters Tab on the patient's chart.

Note: Encounter types can be removed even after they have been used, since they are not, strictly speaking, a controlled vocabulary.

Reports Setup
To change Report characteristics, use the Reports Tab in the Setup window. Highlight the report you want to change and click the Edit/View button.

What Goes in each Field


Field Name Printer Show Setup Before Printing Information to Enter Choose a printer from the list. Click to have the Printer Setup box displayed. Sample Default

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Report Name Show in Report List Category Internal Name Orientation Access Rights

The name to be shown in the report list.

List of Patients

If not checked, then non-DBA users will not see it. In which section of the report list to show this report. The name of the PowerBuilder or InfoMaker report to be run. Which way to orient the printing on the paper. Access Right needed to access this report. Extra margin at the top of the page. This is printerdependent and must be determined by trial and error. On many printers, nothing happens unless the number is greater than 250 and then every 500 moves the margin 1 inch. Margins are effective only for the HCFA/CMS 1500 report, and then only if the form overlay is not printed. Accounting r_patient_list Landscape Admin

Top Margin (and Bottom, Left Margin and Right)

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Administrators can add and remove reports and change the table entry that gives the internal name of a report. This enables the DBA to change the characteristics of certain reports. This feature is used to set up special prescription formats.

Special Reports
If a special version of a report is needed (for instance, a particular states version of a prescription form), it may be created using PowerBuilder or InfoMaker. If the report is to be called from the Reports window, or if it is a prescription form, it may be imported.

Importing Reports
Instructions for importing reports are here. Initially all reports are in REPORTS.PBL and MY_REPORTS.PBL is empty. When a report is imported, it is placed in MY_REPORTS.PBL. When a report is run, the Reports window (and the prescription printing process) searches MY_REPORTS.PBL before the standard report library REPORTS.PBL. Thus the imported report, rather than the standard report, is the one that is run. If MY_REPORTS.PBL is returned to its initial state (empty), the original reports will become effective.

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When the import process puts the imported report in MY_REPORTS.PBL it uses the internal name of the report selected on the screen. If the selected report does not have an internal name, the name of the version being imported is used. Reports can be exported to text files and imported from an exported report. This provides a way to move reports between systems.

Reports that can't be Imported


Some reports are called from the program directly rather than from the Reports window. Examples are statements and superbills. These cannot be imported. These must be placed in the file MY_REPORTS.PBD by VersaForm personnel.

Sig Line Setup


To add or remove Sig lines, use the Sig Line Tab in the Setup window. They can also be added from the Medications Tab of the Patient's chart.

When entering a prescription, just type in a new Sig and you will see the New Sig window:

Note: Sig lines can be removed even after they have been used, since they are not, strictly speaking, a controlled vocabulary.

System Parameters
The Following Parameters that Affect System Operation may be Altered by the User
Parameter Name Always Edit New Problem Billing Auto Associate Procedure Billing System Name Default Value No No MD VersaForm 7.0

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Billing Without Diagnostic Codes No Debug Switch Default Encounter Type Initial Tab NOTE QUICK START Printer Default Printer 1 Report Default Font Report Font 1 Report Font 2 Show Browser Upon Open Summary Data Panel 2 Office Visit Summary Add this parameter with Yes or No. Yes for extra prompts. Default not specified Arial, -10 400, Default, Anyfont, No, No, 100 Arial, -10 400, Default, Anyfont, No, No, 100 Arial, -10 400, Default, Anyfont, No, No, 100 Yes Past Medical History

Set Up Backups
The Backups Tab allows you to examine the state of the database backups in your system and permits you to select the times when backups are to be made. In order to use these facilities, the User ID you used to log on to VersaForm must have VersaForm System Administrator authority. In addition, most of the functions provided require that you be running on the machine where your SQL Server is located (your Server machine). If you do not have VersaForm System Administrator authority or you are running on a client station and attempt to perform a function that requires you be running on the Server, you will get a message indicating the problem.

Databases
While you probably think of your data as a single database, there are actually a number of databases used for your data. Some databases hold only control information such as the users allowed access to databases, the names of your VersaForm databases, etc. while others (such as the VersaForm database itself) hold your client and practice information.

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Types of Backups
These are two types of backups taken by the VersaForm system. A Full backup is a complete snapshot of all of the information in a database at the time it was taken. A Log backup contains only the information that was changed since the last backup, whether it was Full or Log. Log backups are, of course, much smaller in size and faster to do that Full backups. Only Full backups are taken of smaller databases that are only infrequently changed, such as the control databases mentioned above. For larger and more volatile databases, such as your VersaForm database, Full backups are taken daily and Log backups are taken frequently (usually every hour) so that you can restore the data, if required, to a recent point in time.

The Databases
The names you see in the list of databases to backup include: msdb and master these two databases are Microsoft SQL control databases that contain, among other things, the names of users allowed access to databases, the names of other databases, etc. They are small databases and are infrequently changed. You change these databases when, for example, you add a user to VersaForm. Only Full backups are taken of these databases. VF_Master the VersaForm control database. This database contains information such as the backup schedule for the system and, in the case of a VersaForm Multi-Doc system, the number and names of the VersaForm databases. This is a small database and is infrequently changed. You change this database when, for example, you change the backup schedule or add a VersaForm database in the Multi-Doc version of VersaForm. Only Full backups are taken of this database. Any other databases shown in the list are VersaForm databases. If you do not use the MultiDoc version of VersaForm, only one additional database will be shown. These databases contain your practice and client data, can be quite large, and are usually changed frequently. Most of the operations you perform in VersaForm change information in these databases. Each of your VersaForm databases get a Full backup daily and, in addition, Log backups every hour to ensure that you can restore the data to a recent state.

How to Open
Click on the Setup button in the top tool bar. Click on the Backups Tab.

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When you click on the Backups Tab, you are presented with the Database Backup Information Tab. This Tab shows, for each database, the last time a Full backup was taken, the time of day when Full backups are taken, how frequently Log backups are taken (if they are used), the number of log backups that currently exist for the most recent Full backup, and an indicator showing if the backup system has detected any errors while taking backups. If any of your databases indicates an error has occurred, you should contact technical support for help in determining the cause of the error.

Editing the Backup Schedule


Select a database by clicking on its name and use the Edit button to modify the backup schedule for a database.

You can change the hour of the day when the Full backup is taken but it is critical that you choose an hour when your Server machine is normally running. If the Server is not on at the selected time, no Full backup will be taken. For databases that use Log backups, you may select the frequency of Log backups from every hour to every twelve hours. When VersaForm is installed, the Log backup interval is set to every hour. Unless you have some specific reason to reduce the frequency of Log backups, we recommend that you do not do so. Log backups take very little time, even on large databases, and reducing the frequency will limit your options for restoring your data.

Listing the Backups


Select a database by clicking on its name and use the List Backups button to display a complete list of all of the backups for the database. Click OK to get out of the list.

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Taking Manual Backups


Click the Manual Backup button to force a Full backup for all of the databases. If you elect to perform Full backups in this way, be sure to wait for the backups to complete before performing any additional VersaForm functions.

Changing the Backup Location


Pressing the Location button allows you to specify a new location for the database backups.

If you are short on disk space, this feature permits you to move the VersaForm backups to a different disk to increase the amount of space available for taking backups. You may also use this feature to move to a different folder on the same disk, perhaps to facilitate your periodic removable disk backups. The current backups are moved to the new location selected. The location specified must be on a local, non-removable disk. This means that you may not select a network disk or a local CD as the VersaForm backup location

Displaying the Log


Press the Display Log button to see the contents of the backup log. This file shows the results of each backup and contains error messages if any backup errors have occurred. Click OK to get out of the list.

Empty the Log


Press the Empty Log button to clear the contents of the backup log and click the Yes button.

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You should periodically clear the log, perhaps once a week, to ensure that it does not occupy too much space on your system. Clearing the backup log does not alter any of your database backups.

Setting up Electronic Pharmacies


You will need an Internet connection to set up and use Electronic Pharmacies. Electronic Pharmacies are set up through the patient chart.

In the Patient's Chart


In a patient's chart, go to the Click on the Add button. If you have previously entered some Pharmacies, you will see a list of Pharmacies not already used by this patient. Click on the Search For Pharmacies button. You will see the Select Pharmacy window. Registration Tab and then click on the Pharmacies Tab.

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Fill in some information. For example, to find nearby pharmacies, fill in the 5-digit ZIP code. To only use a certain chain, fill in the first part of the Pharmacy Name. The more information you fill in, the fewer pharmacies you are likely to find. Click on the Search button. If there are any matches, they will show up in a list. To choose one, click on it and then click on the OK button.

In the Facilities Tab of the Setup Window


You will find all Pharmacies added through the patients' charts in the Facilities Tab. All necessary information will be filled in by the process of choosing pharmacies for patients.

WIA and VersaForm Image Utility


To implement the WIA capabilities of Windows XP follow these steps:
1. Open a Command window by clicking on Start.

2. Click on Run.

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3. Type: cmd

4. Press the Enter key or click on the OK button. 5. In the Command window type: c d \ w i n d o w s \ s y s t e m 3 2

6. Press Enter. 7. Now type: r e g s v r 3 2 w i a a u t . d l l

8. Press Enter. 9. This will register the WIA drivers in your XP computer .

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10. Click on the OK button. 11. Type: e x i t 12. Press Enter.

To use the WIA capability to scan multiple pages in VersaForm:


Open a Patient Chart. Click on the Images Tab. Click on the Add Image button. To scan multiple pages select Scan via WIA and view.

In the next dialog select which type of scan you will use.

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Click on the Scan button. The current page on the scanner will be read in and displayed.

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Close this by clicking on the X in the upper right corner. Now choose to Add Page. You will be given the chance to view the other scanned pages.

Repeat until completed. When done click on Save.

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The Desktop
The Scheduler
The Scheduler keeps track of patient appointments. You can open the patient's chart directly from the scheduler and even post the copays from the scheduler. To begin, click the Scheduler button just below the Menu Bar. You can also click the

Desktop button and then select the Schedule Tab.

The Scheduler has the Following Functions


Add Appt: Adds a new appointment for a patient. Cancel Appt: Cancels the selected appointment. Cancelled appointments will show up in the Schedule Reconciliation report. Edit/View: Edit/View the appointment data. Find a Time: Brings up the Search for an Appointment Time window. Search: Allows you to find the next appointment time for a particular patient. Patient Chart: Opens the chart of the patient whose appointment has been selected. Print: Prints the schedule using the Appointment Form Kit in Letters.

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Adding an Appointment
To Add an Appointment
1. Select the hour during which you want the appointment to be scheduled by clicking it in the Schedule Tab of the Desktop for ... window. 2. Click on the Add Appt button. 3. The New Appointment for ... window will open. 4. If there is an open chart, the patient's name will appear in Patient. If you want a and select the patient's name from the list, different person, click the drop-down or if this is a new patient, enter the patient's name. 5. Enter any additional information, as you wish. 622

6. Click the OK button when done.

The No Show Report


You can Generate a No Show Report by the Following Steps
Run the Schedule Reconciliation report (under the Practice Management reports) for the time frame in which you are interested. Click the Filter button. If there are any filters, remove them. (Highlight each filter and click the Remove button.) Click the Add button. Choose Column Name arrived. Choose contains for the Test. Type show into Test Against.

Click the OK button. Click the OK button.

The remaining patients in the report are those that had No Shows.

Scheduling Appointment Reminders


In order to make appointment reminder telephone calls, VersaForm must have 10 digit telephone numbers. These must include the area code and must not include extensions. See Appointment Reminders for setup instructions. 623

When you schedule a new appointment or edit an existing appointment ( Scheduler then Add Appt or Edit/View) the Appointment for ... dialog shows appointment reminder information in the lower pane. If the patient wants an appointment reminder, and is scheduling an appointment for a resource where Appointment Reminder is available, set Appt Reminder to Yes. You may specify the number of days before the appointment to make the call (1-7) or you can use the default. You can specify that the call be made to the patient's home, work or cell phone. If you select Home, the dialog will automatically fill in the current home phone number. If you select Work, the dialog will automatically fill in the current work phone number. If you select Cell, the dialog will automatically fill in the current cell phone number. When you click the OK button, the appointment reminder information will be validated. If the phone number is 7 digits, and Default Area Code is filled in (see above) to make it a valid 10 digit phone number. Area codes may not begin with 0. Exchange codes may not begin with 0. Extra existing characters in the phone number (blanks, parentheses, dashes) are ignored and what is left must be exactly 10 digits. Do not include extensions! A seven digit phone number with a three digit extension will be interpreted as a ten digit phone number with an area code and the wrong phone number will be used for the appointment reminder telephone call.

Appointment reminder calls are made by the patient calls server on the call date. The results are available the morning following the call date via the appointment reminder reports. 624

If you have chosen to have someone notified about cancelled appointments, they will receive a message about any appointments that were cancelled by the call recipient. If you have chosen to have VersaForm delete cancelled appointments, it will do so as soon as a report with cancellations comes back from the patient calls server.

VersaForm Reports for Appointment Reminders


Click the Reports button and expand the list of Practice Management reports. Select either Appointment Reminders by Call Date or Appointment Reminders by Appt Date. In both of these reports, the results will be blank if the date of the report is not after the call date. The Call Date report shows all appointment reminder calls to be made on a certain call day. It will be sorted by appointment date and time. Notice that the appointments will not necessarily be on the same day if some patients requested calls N days before the appointment and other patients requested calls M days before the appointment. The Appointment Date report shows all appointment reminder information for all appointments on a certain day. It will be sorted by appointment date and time. Notice that the call dates will not necessarily be the same if some patients requested calls N days before the appointment and other patients requested calls M days before the appointment.

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Letters
Letters
The Letters Tab on the Desktop can
Print predefined form letters. Let you define your own form letters. Let you define the recipients. Merge data with the letters. Send the letters to predefined lists of recipients. In some cases, print labels for the list of recipients. Desktop button just below the Menu Bar. Then select the Letters Tab.

To begin, click the

To use predefined letters, select the letter from the list. To simply print the letters, click the Batch Print All button. This will print one letter for each recipient on the predefined list. One of the predefined letters, the Patient Letter, does not have any content--it has only a letterhead and an address. It is intended that you write your own message by modifying the letter. To print a letter or to modify the letter or the list of recipients, click the Edit button. When the Letters and Labels window opens, you will see three Tabs: Letter, Labels and Data.

To Print a Letter
You must first retrieve the data to be merged with the body of the letter. On the Data Tab, click the Retrieve button. Then return to the Letter Tab. To see the final merged letters, click the Show Merged button. You can use the arrow keys to see any of the letters. The First letter previous letter . the next letter , or the last letter . , the

Then, when you are ready, click one of the print buttons to print the letters. Either Print One or Print All. You can also preview the letter by using the Preview button. You can also adjust the margins in the Preview window. 626

To Modify a Letter
To modify the list of recipients, use the Data Tab. The recipient list is defined by the SQL in the lower window. (If you are able to program SQL, feel free.) Click the Retrieve button to see the list of recipients that are selected by the SQL.

Modifying the Data


You can modify the recipient list by a procedure called "query by example". To do this, click the Select Records button. A table will appear in the Enter your selection criteria pane. The table shows all the columns that can be tested--you can put conditions in any column. For instance, if there is a column for Last Name, you can enter a specific last name, say Jones, in that column, and click the Retrieve button. All the entries with the last name of Jones will be selected. If you enter instead >Jones and retrieve, all the entries with a last name after Jones in the alphabet will be chosen. You can do the same thing with dates, amounts, or any column that is called for by the SQL statement and shown in the Enter your selection criteria pane.. Some shortcuts are available: If you are sending the Patient Letter, you can select a single patient in the following way: click the drop-down arrow in the small window labeled SQL. Then select Single Patient from the list, and you can choose the patient you want to send to, from the patient list. If you were on a particular patient's chart when you opened the desktop, that patient's name will be displayed as a shortcut button. These shortcuts are not useful for any of the letters other than the Patient Letter, because the other letters need more data than the shortcut provides. (Warning: A number of SQL choices are available in the SQL drop-down, but some SQL choices do not match some of the letters. If this is the case, you may see error messages, or the letter may not be filled in completely.) Finally, click the Retrieve button. This retrieves the list, and the data is ready to be merged with the letter. Do not click the Save button after modifying the data. If you want to save it, use the SaveAs button and give it a descriptive name.

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Modifying the Letter


On the Letter Tab, you can modify the letter by typing. You can also insert fields to be merged by clicking the Insert Field button. Do not click the Save button after modifying the letter unless you really want to change the basic letter. It is better to use the SaveAs button and give it a more descriptive name.

Labels
If the Labels Tab is enabled, you can print labels too (or instead). Select the label size and type from the drop-down at the top, and you will see the labels displayed. Just click the Print button. (For some types of letters, the Labels Tab is disabled, because the selection of recipients does not permit printing labels).

Predefined Letters and Forms


The following letters and forms are pre-defined.
Appointment Reminder Creates a letter for each patient with an appointment in a specified interval. Collection Letter Creates a letter for each patient with these values on the Collection screen: Send Batch Letter is checked and Letter Type = Collection Letter. Custom Data Recall Letter Creates a letter advising patients who have recall dates entered in the Registration, Custom Data Tab, within a specified interval. For more information, click here. Final Request Not presently in use. Final Request for Payment Creates a letter for each patient with these values on the Collection screen: end Batch Letter is checked and Letter Type = Final Request for Payment. Insurance Tracer Creates an insurance tracer letter, either in response to the Tracer button on the Claim Details window, or for all claims that have been sent or resubmitted. In the latter case you can use the Select Records button on the Data Tab to get just the letters you want. Note on Special Letterhead This Letter is designed for printing Patient Notes with a letterhead of your design. Modify it to look just like you want. See Printing Patient Notes for more information.

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Note Patient Form Kit This is similar to the Patient Form Kit, but it can be used to print Patient Notes. See Printing Patient Notes for more information. Patient Form Kit Enables you to arrange patient information fields to print on a preprinted form such as an encounter form or a lab request. Patient Letter Creates a letter to a patient, with name, address, etc. Content is up to you. Recall Letter Creates a letter for each patient with a lab or data panel that is incomplete. You can use the Select Records button on the Data Tab to get just the letters you want.

Selecting a Range of Names in a Patient Letter


Click on the Desktop button.

Click on the Letters Tab. Double click on Patient Letter. Click on the Data Tab. Click on the Select Records button. In the first row under last name type: L i k e a % (or the letter of the alphabet you want to use) In the second row, type: L i k e b % (or the letter of the alphabet you want to use) You can enter a third, fourth, fifth, etc. row to meet your needs.

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Click on the Retrieve button and you will see a list of all the names that start with the letters you chose.

To print labels, click on the Labels Tab.

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Select the type of labels you want to print on from the drop-down menu. Click on the Print button. When done click on the Close button. Note: Do not save the letter.

Patient Recall Letters


Custom Data Recall Letters
Custom Data Recall Letters are based on two fields which must be present in the Custom Data Tab under the Registration Tab. If your system does not have them, you must create them using the Modify button of the Custom Data Tab. The two fields must be named r e c a l l d a t e and r e c a l l r e a s o n , and they must be spelled exactly as they are here. To use the Custom Data Recall Letter, fill in the two fields with the desired recall date and reason. The Desktop, Letters function will select all patients with the appropriate dates, and create letters for them. 631

NOTE: If you want to make changes to the Custom Data Recall Letter, edit the letter and save it under a different name and make your changes to the new letter.

Standard Recall Letters


The Desktop, Letters function also has a Recall Letter that is based on the use of a scheduled lab test or data panel. You can use these recall letters only if you have the EMR module. The list that is created for these letters will include each patient who has an incomplete data or lab panel. To narrow down the list you must select the records you want using Query by Example (see Letters).

Patient Form Kit


The Patient Form Kit provides a way of customizing and filling in an encounter form, a lab request form, or another form that requires information about a patient.

Customizing the Patient Form Kit


1. Click Desktop, then the Letters Tab. 2. Double-click the Patient Form Kit. 3. Use the SaveAs button to save the form that you just opened under a new name (For instance, "Encounter Form"). Don't use the Save button. 4. Now double-click the new form you created.

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5. Customize the form. Choose the fields you need from the list produced by the Insert Field button.

6. Then move the fields until they print in the correct places on the form you intend to use. 7. If you need to modify the margins to get the fields to print where you want them, you can change the margins by using the Preview button. 8. While you are customizing, test it early and often. You can use the procedure below.

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Using the Form


Once you have created a form, using it is simple: Before you begin, the patient's chart should be open. 1. Click Desktop, then the Letters Tab.

2. Double-click the form you have designed using the Patient Form Kit. 3. Click the Data Tab.

4. Click the button with the patient's name on it

. 5. Click the Letter 6. Click the Show Merged button. Click the Print All button, and choose a printer if necessary. Tab.

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Messages
The Messages/Reminders Tab allows you to send messages to and receive messages from other VersaForm users, and to set reminders for yourself. Think of a reminder or a "to-do list item" as simply a message to yourself.

The Add button is used to create a new message or reminder. The Edit/View button will open up a window to allow you to change an existing message or reminder. The Patient Chart button will take you directly to the referenced patient's chart. The Print button will print a list of all the existing messages and reminders. The Refresh button checks for recent messages. The Patient (which contains the name of the current patient) button automatically chooses the patient the message is about.

Choosing which messages are to be displayed


Initially the Messages/Reminders Tab displays only open messages addressed to you. By making selections under Show These Messages at the bottom of the window, you can have the following options:

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Include messages for all users, not just yourself Include messages created since a certain date, and exclude all others. Include only messages regarding a particular patient. Include completed messages, instead of just open (that is, not completed) ones.

After you make your selections, click the Refresh button, and the list of messages will be refreshed according to your instructions.

The Message Timer


Messages marked for immediate notification are sent to the addressee when he/she next logs on. When you are logged on, the system looks for new messages every so many seconds. The number of seconds is called the Message Timer Interval. By default this interval is 30 seconds, but it may be changed by an entry in the System Parameters Tab of the Setup window. If the Message Timer Interval is set to 0 the system will not check for new messages. In this case you must check the Messages/Reminders Tab periodically for new messages.

Creating a Message
To Create a New Message
1. Click on the Desktop button. 2. If necessary, click on the Messages/Reminders Tab. 3. Click the Add button. 4. Click on the For drop-down message to. and select the User(s) you want to send this

5. If the message has a task that needs to be done before a certain date, select that date from the Due drop-down. 6. Choose a Priority, if applicable. 7. Select when you would like to have the user alerted to your message. Selecting Notify as soon as possible. will alert the user about your message either right away if they're logged on to the system, or the next time they do log on. Notify when the selected patient's chart is opened. will attach this message to a patient's chart. Select the patient in the Patient drop down or, if a chart is open, click on the patient's name, and the next time the user you are sending the message to opens that chart, they will be alerted to your message. 636

Reading Messages
If a message is sent to you while you are logged in, a message box will pop up to alert you that you have new messages, and will ask if you would like to read them now.

If you do wish to read them, click the Yes button and the New Messages for ... window will show a list of your currently unread messages. To read a particular message, click on the message and click the Edit/View button. Once you have read the message and would not like to be alerted by it again, check the Read? check box, then click the OK button.

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The Physicians Dashboard


The Physician's Dashboard is a fast way for the doctor to keep track of what needs to be done.

The Physicians Dashboard is Divided into Six Areas


On the Left
Unsigned Encounters Images Not Reviewed Labs Not Reviewed

On the Right
Notes Not Signed or Not Reviewed Appointments Messages and Reminders

Each area can be minimized in its column to just the title and column headings. Maximizing will not take up more than one third of the column unless another area is minimized in that column. All of the areas that have more lines than will show on the screen have scroll bars for moving through the lines. Double left clicking on any patient name will bring up that patients chart. All columns in each area can be sorted by double left clicking on the column title. Double left clicking again will reverse the order of the sort. Sorting will always put blank values at the top.

Unsigned Encounters

Lists Patient, Description and Date.

Images Not Reviewed

Lists Patient, Open Images, Created date and Type. 638

Labs Not Reviewed

Lists Patient, Panel and Ordered date.

Notes Not Signed or Not Reviewed

Lists Patient, Description, S (for signed) and R (for reviewed).

Appointments

Lists Time, Patient, In and Description. The date can be changed a day-at-a-time by clicking on the left or right arrows on either side of the date listed.

Messages and Reminders

Lists From, Message, Re and Date.

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Backup
Backup Overview
In order to help you protect your data, VersaForm has provided a database backup system. The purpose of the backup system is to make regular backups of your VersaForm databases so that you can recover in the event of a failure. Loss of data is not a common occurrence, but it does happen. If you have not planned for backup and recovery before data loss happens, you may find it impossible to recover your information. VersaForm backups alone do NOT protect you from a disk failure (see Types of Failures). The VersaForm database backups are by default placed on the same disk, and in the same folder (usually \VersaForm 3.0\cprdb\backup) that contains the VersaForm databases, so it is essential that you take regular disk backups on other media. If your disk fails, neither the database nor the backups can be accessed so they won't be of any use unless you have a backup of the disk on some other media such as tape, CD or another disk. If you work in a large installation, you may have a Data Administrator or IT department that performs backups of your disks. If you are in a smaller group, you must make your own provisions for regular backups of your disks. We recommend that you back up the entire backup folder (usually \VersaForm 3.0\cprdb\backup). This contains multiple backups, so it may be very large. However, most backup programs compress the files, so usually the backups will fit on a CD-ROM or a tape. If they do not, you can select only the most recent backup files and back those up to your backup medium.

Backup Practices
1. Keep at least some of your backups offsite. Otherwise a fire or other accident could destroy everything. A weekly offsite copy is a good idea. 2. Do not overwrite all of your backup media. We suggest taking one backup per week out of the cycle, and making that the offsite copy. 3. Have an occasional "fire drill". You need to verify that your backups really provide the ability to restore your files.

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Moving the Location of your Backups


You may want to move your backups to a separate disk drive to free up space on the disk that contains the database. VersaForm will not accept a removable device for the backup location. To move the location of your backups to a different folder, click on the Location button on the Setup Backups Tab. An information window will open up:

After you click OK, you will see a window with a path and folder; simply change this to the desired folder and click Ok.

If you do change the backup location, VersaForm will move the current backups to the new location, which could take a long time if you have a large database.

Types of Failures
To understand your options, you should know that a data failure could be caused by: 1. A total disk failure. In this case neither the VersaForm database nor the VersaForm backups can be accessed. You would need to restore your disk backup. Your data could only be recovered to the last time you took a disk backup. If, for example, you take disk backups once a week, you run the risk of losing a week's worth of data. It 641

could be even worse than that if, for whatever reason, the disk backup could not be restored. You can see why it is important to do regular backups and to keep more than one or two disk backups in the backup cycle. The frequency of backups is your decision and should be based on the amount of information loss you can tolerate. Notice that a catastrophic event such as your building burning down is the same type of failure except that it assumes that you stored the disk backups at some other location. You did, right? 2. Some type of internal data corruption. VersaForm uses a modern database server written by Microsoft to hold your information. This system is robust and has many features to prevent and detect corrupted data caused by programs. While this type of failure is unlikely, the VersaForm support staff could assist you to recover your data if it should happen. This recovery would use the VersaForm database backups. 3. Inadvertent or unintentional erasure of the data files holding your information. Probably the most common cause of data loss is unintentional erasure of data. Power failures are another common cause (that is why your server should be protected by a UPS). The VersaForm support staff can help you recover from this type of failure using the VersaForm database backups.

Where Is My Data?
If you purchased a single-user version of VersaForm, the VersaForm program, your database Server, and your data all reside on the same computer so there should be no confusion over which disk needs to have regular disk backups. If you purchased a multi-user system, however, only one of your computers holds the VersaForm data. During installation, one computer was selected to be the Server. It is the VersaForm Server computer that holds your data. All other computers hold only the VersaForm client programs. A disk or computer failure on a client computer would not result in the loss of VersaForm data, although you might lose data from other programs.

When Your Backup is not Running


The two major reasons for backup problems are changing the date on the computer and the SQL Server Agent is not running. Changing the date confuses the backup system. You should not change the computer's date in order to change data entry dates in VersaForm. If you are running SQL 2000, the SQL Server Agent needs to be set to auto-start when the computer starts up.

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If you are running SQL 2000, do the following steps:


1. On the server computer, double left click on the SQL Server icon tray (in the bottom right corner of the screen, near the clock). in the system

2. In the SQL Server Service Manager window that comes up, change Services to SQL Server Agent. 3. If Auto-start service when OS starts is not checked, click on it to check it. 4. Close the Service Manager by clicking on the X at the top right corner. 5. Using Windows Explorer, go to the VersaForm Tools folder, usually C:\Program Files\VersaForm 3.0\tools, and double left click on checkback.exe to run it. This will refresh all the backup procedure files. 6. Then run a manual backup. Log into VersaForm as a user with System Administrator authority. Go to Setup and choose the Backups Tab.

Click on the Manual Backup button. If your database is large, it may take a few minutes for the backup to run. You will not see any indication of activity, so just wait for it to finish.

Once you have completed these steps, you should no longer see warnings about the VersaForm backups.

If you are running SQL 2005, do the following steps:


1. Using Windows Explorer, go to the VersaForm Tools folder, usually C:VersaForm 3.0\tools, and double left click on checkback2005.exe to run it. 643

This will refresh all the backup procedure files. 2. Check your Scheduled Tasks. Click on your Windows Start button. Choose Control Panel, or Settings and then Control Panel. Choose Performance and Maintenance and then Scheduled Tasks or just Scheduled Tasks. Double left click on the VersaForm Backups icon. The Run field should be "C:\VersaForm 3.0\vf_backup.bat" (or "C:\Program Files\VersaForm 3.0\vf_backup.bat"). The Start in field should be "C:\VersaForm 3.0" (or "C:\Program Files\VersaForm 3.0"). Run as should be NT AUTHORITY\SYSTEM. Run only if logged on should be unchecked. Enabled should be checked. Click on the Schedule Tab. Schedule Task should be Daily. Start time should be 12:00 AM. Every should be 1 day(s). Click the OK button, and close the Scheduled Tasks and Control Panel windows.

3. Then run a manual backup. Log into VersaForm as a user with System Administrator authority. Go to Setup and choose the Backups Tab.

Click on the Manual Backup button. If your database is large, it may take a few minutes for the backup to run. You will not see any indication of activity, so just wait for it to finish.

Once you have completed these steps, you should no longer see warnings about the VersaForm backups.

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Manual vs. Automatic Backup


VersaForm uses facilities that are part of the Microsoft software to perform database backups. The facilities available vary depending on the operating system and the SQL Server running on the machine where you installed the VersaForm Server. If you installed the VersaForm Server on a machine running Windows NT, Windows 2000, Windows XP, or Windows Vista, VersaForm automatically performs backups of your data. Full backups are performed once a day, and intermediate backups (called log backups) are performed once every hour, on the hour during the time that your VersaForm Server is running. For many failures, this means that the VersaForm technical support staff could help you to restore your system to the hour preceding the failure. The backups for any given day replace the backup taken on the same day seven days ago, so up to seven days of backups are kept on the system depending on how many days a week your system runs. If for some reason the backup does not run automatically, you should run the manual backup. Click on the the prompts. Setup button, the Backups Tab, and the Manual Backup button, then follow

Legacy Installs
If you installed the VersaForm Server on a machine running Windows 98 or Windows Me, you will need to manually perform database backups. To facilitate your taking backups, the VersaForm install placed an icon, named VFBackup, on your desktop. To take a database backup you click on the icon. Clicking on the icon will cause a DOS Window to open and commands to be issued to backup the database. You should check the window for error messages. If you have a scheduler on your machine, you could include this task in your schedule. Otherwise, you must remember to regularly take backups of the database. Each manual backup replaces the backup for that day, i.e., if you take three backups on Monday, the Monday backup will have the last backup that you took on Monday. Up to seven days of backups are kept on the system depending on how many days a week you run your system. Remember that your recovery options depend on the frequency of your backups.

How to Copy Backup Files to a CD or DVD

1. Open My Computer

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2. Open the C drive

3. Open the VersaForm 3.0 Folder

4. Open the cprdb Folder

5. Open the Backup Folder

6. Open the VersaForm Folder

7. Click on the Folders Icon 8. Or, if you don't have a Folders Icon, click on the View menu, Explorer Bar, Folders. 9. Arrange the Left pane so you can see the CD

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10. Come back to the Right pane. Click on the first file for the day you want to back up, hold down the Shift key and click on the last file for that day.

11. Put the mouse on one of the highlighted files, click and hold the left mouse button. Drag the files on top of the CD.

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12. Let go of the mouse button this will copy the files to the CD. 13. Once the copy has finished, double click the CD.

14. Again click on the Folder Icon 15. Finally, click on Write these files to CD

Or, if you don't have a Folders Icon, right click on the CD and click on Write these files to CD

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Database Topics
Microsoft SQL Servers
VersaForm uses the Microsoft SQL Server to provide database access and support for your information. There are basically four versions of the Microsoft SQL Server, two SQL 2000 versions and two SQL 2005 versions. New installations will be using SQL Server 2005.

SQL 2005
1. The entry-level version, called Express. VersaForm Systems Corporation has redistribution rights for this product and, as of version 3.137 of VersaForm, Express was installed as part of your VersaForm installation if you did not already have a Microsoft SQL Server running. 2. The full version, Microsoft SQL Server 2005. The Express system contains all of the features of the full version and is fully compatible with the full version should you need to upgrade. There is a restriction that may force you to upgrade to a full version: Express limits your database size to 4GB. If your database grows beyond this size you are required to upgrade. You should never wait until this happens, of course, and VersaForm will warn you if your database is approaching 4GB in size.

SQL 2000
1. The entry-level version, called the Microsoft SQL Server 2000 Desktop Engine (MSDE 2000). VersaForm Systems Corporation has redistribution rights for this product and MSDE was installed as part of your VersaForm installation if you did not already have a Microsoft SQL Server running. 2. The full version, simply called Microsoft SQL Server 2000. Although there are several flavors of the full version, we recommend either the Microsoft SQL Server 2000 Standard Edition or the Microsoft SQL Server 2000 Enterprise Edition if you need to upgrade from the MSDE version. The MSDE system contains all of the features of the full version and is fully compatible with the full version should you need to upgrade. In addition, MSDE is capable of running on most versions of Windows and you need not install a separate machine to run the MSDE server. There are, however, two restrictions that may force you to upgrade to a full version. They are:

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1. MSDE limits your database size to 2GB. If your database grows beyond this size you are required to upgrade. You should never wait until this happens, of course, and VersaForm will warn you if your database is approaching 2GB in size. 2. MSDE supports a maximum of five concurrent users. If you have more than five copies of VersaForm running, you will experience performance degradations and should consider upgrading. The full versions offer other advantages including extended support for multiple processors, support for databases up to 1million terabytes in size, support for larger amounts of system RAM, and the inclusion of a graphical administration tool, called the Enterprise Manager. If you need to install the Microsoft SQL Server Standard or Enterprise Edition, you should be aware that you may also need to purchase and install Windows 2003 Server if you do not already have it, and perhaps even a new machine if your current machines do not meet the minimum hardware requirements for Windows 2003 Server.

How to Move VersaForm from One Server to Another


Do not use these instructions to simply move a database from one disk to another on the same server. This document explains the how to move an existing installation of VersaForm from one server to another. This document is written for the IT professional who already understands how to install a SQL Server and who has had some experience using SQL statements. If you are not comfortable following the instructions in this document, you should seek the services of an IT support organization. Up until 2007, VersaForm shipped with Microsoft SQL Server 2000 Desktop Engine (MSDE 2000). Starting in 2007, we added support for SQL 2005. At that point, we started shipping both SQL Server 2005 Express Edition (Express) and MDSE.

What you need to do depends on both which version is running on the old server and which version you want to run on the new server.
If you are installing a full SQL Server 2005 (not SQL Express or MSDE) go to Installing a Full SQL Server 2005. If you are installing MSDE (SQL Server 2000 Desktop Edition) or Express (SQL Server 2005 Express Edition), the VersaForm install will install these versions for you. (Setup.exe will install Express and Setup2000.exe will install MSDE.) If you are moving from MSDE to a new MSDE, go to MSDE to MSDE. 651

If you are moving from Express to a new Express, go to Express to Express. If you are moving from MSDE to a new Express, go to MSDE to Express.

Useful Views in the VersaForm Database


These views may be used in creating ad-hoc reports. Watch the video. They may make the creation of some reports easier, saving the effort of assembling the needed data by joining the individual tables. View v_claim_transaction_status Data Shows the latest status of each transaction (i.e., charge) and insurance carrier Shows status of each claim and last claim event (except printing) Shows the unapplied balance on each credit Shows name and address of insurance plans Collects the information needed to write a tracer letter for a claim Provides consolidation of patient billing and patient insurance information with the default info in the insurance plan table Shows the insurance claim submitter for each patient's primary insurance Demographic information and addresses for patients Name and other information for providers Names and addresses of referring physicians Name and other information for schedule resources

v_claim_status v_credit_unapplied_balance v_insurance_plans v_insurance_tracer_info

v_patient_ins_billing

v_patient_submitters v_patients v_providers v_referring_physicians v_schedule_resources

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v_transaction_item_balance vv_appointments vv_incomplete_labs

Item balance, patient balance, and aging for each transaction (i.e., charge) Appointment information--time, patient, etc. Incomplete labs. Histories and custom patient data are filtered out. Patients and their CPT codes and the ICD codes attached to the CPTs.

vv_patient_cpt_icd

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Interfaces
Instant Medical History
Instant Medical History is a program can be used in conjunction with VersaForm to allow patients to enter their own history. Quoting from Primetime Medical Software (which publishes IMH). "Instant Medical History is designed to gather a medical history prior to the encounter. Patients respond to branching, multiple-choice questionnaires from our extensive medical knowledgebase. Our output provides physicians with enough information to begin a focused patient interview, saving valuable physician time. Additional benefits are the reduction in transcription and the improved documentation." If IMH is installed, VersaForm will recognize it and will enable the Instant Medical History item on the Utilities menu.

To Use it:
1. Open the chart of the patient for whom history will be taken. 2. From the Utilities menu, start Instant Medical History. 3. When the patient is finished, Instant Medical History will not close. You must enter the password to close it. This prevents the patient's having access to the VersaForm system. Initially the password is "vf"; you may change this in the Instant Medical History configuration. 4. Close Instant Medical History. The results of the history will be placed into the patient's chart, in the Notes Tab.

Setup
In order to interface with VersaForm as described above, Instant Medical History must be installed in c:\program files\primetime Medical Software\Primetime Instant Medical History\.

Schedule Export
The Schedule export feature has both a automatic and manual interfaces. The automatic export is selected by choosing this option in the Preferences Tab of the Setup window. The user must supply the folder name used to hold the export files if the automatic option is chosen. If the automatic option is selected, an export file is produced each time a change is made to the schedule.

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The manual interface is invoked from the Utilities menu and firsts asks for the date range to use for the export. It then displays a file dialog and allows the user to select the folder\file to be used for the export. If there are no items in the schedule for the selected date range, an error message is displayed. Otherwise, the system creates the file and writes the data as a comma separated text file containing character data. As with all CSV files, missing fields appear as two commas in a row.

The fields that are exported are:


Name Id Data Type int Example 333 Required Comment Yes (unique id for each schedule item) (Y means the appointment was deleted)*

Deleted* Resource_id Resource Date/Time Duration (Mins) Patient_id Visit_type Description

Y/N int

N 12

Yes Yes Yes Yes Yes Yes No No No

varchar(100) Dr Jones datetime int int varchar(15) varchar(50) 6/23/2005 10:00:00 AM 15 33 Brief Follow up visit Office or Outpatient

(same id as export demographics) (user defined values) (user defined values) (pre-populated list, user can modify) (user comments) Y means new patient

Encounter_type varchar(50) Comments New_patient

varchar(100) Remove stitches No Y/N Y No

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Arrived Room

datetime

6/26/2005 10:00:00 AM

No No

varchar(100) Exam 2B

* If the Deleted value is set (Y), no additional information is supplied

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Charge Capture
The VersaForm Charge Capture feature allows users to import charge data generated in external systems in order to use the extensive Practice Management facilities for insurance and patient billing. The data to be imported must use the HL7 (Health Level Seven) format for medical data interchange. Specifically, the following segments are supported for importing charge data: MSH EVN {PID [PV1] {FT1 [{PR1}] } [{IN1}] } This diagram follows the HL7 standard notation where [ ] is an optional entry and { } shows that repeated segment or segment sets are allowed.

Segment usage notes


MSG: A standard HL7 message header. The MSH.10 element (Message Control ID) must be unique and must be present. EVN: A standard HL7 Event Type segment. The information in this segment is simply saved in the VersaForm database. EVN.2 event type code must be P03 and the EVN.5 event reason code must be 02. PID: A standard HL7 Patient Identification segment. The information in this segment is used to uniquely identify a patient. The PID.3 External Patient ID element must match a VersaForm patient ID. The patient information (first name, last name, etc.) is checked against the same information for the patient id in the VersaForm database. If the information is badly mismatched (different last names, for example) the data is rejected. If the information is a partial match (different middle names, for example) the user is asked if the data should be accepted and charges generated.

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PV1: A standard HL7 Patient Visit segment. The information is saved in the VersaForm database but is ignored by VersaForm. FT1: A standard HL7 Financial Transaction segment. VersaForm extracts and saves the icd9 code, icd9 description, cpt4 code, cpt4 description, provider last name, provider first name, and transaction date. Processing this segment creates a VersaForm charge for the patient. PR1: A standard HL7 Procedures segment. (Used when multiple procedures are reported at the same time). VersaForm extracts and saves the icd9 code, icd9 description, cpt4 code, cpt4 description, provider last name, provider first name, and transaction date. Processing this segment creates a VersaForm charge for the patient. IN1: A standard HL7 Insurance segment. VersaForm ignores this segment. The raw data is saved for historical purposed but the segment is not processed.

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Importing Lab Results Overview


The Lab Results feature allows you to receive lab results data generated by a lab for your patients. Lab results are read using the Electronic Labs, Import ElectLab Results option in the menu bar. When a result is read, an optional feature sends a notification message to a selected User that a lab result has arrived. This would normally be the patients Primary Physician but you can choose a different user to receive the message. In addition, you can elect to have a high-priority message sent if the lab results show an abnormal result. The message options for lab results are set using the Preferences Tab in the Setup window. VersaForm currently supports receiving lab results from Bio-Reference, LabCorp, Quest Diagnostics, Enzo Clinical Labs, and TCL. Only final results for lab data are supported. The data to be imported must use the HL7 (Health Level Seven) format for medical data interchange. While the HL7 specification sets the standard for the format and content of the data to be received, different labs have used different interpretations of the standard and, consequently, VersaForm supports several different data format/content combinations. (See Format of HL7 Lab Results Data and Format of HL7 Lab Order Data for technical specifications.)

Setup for Electronic Lab Results


Before reading Lab Results, you must establish a facility that contains the customer ID assigned to you by the lab. To do this, go to Setup Facilities and add a facility for each of the labs you are using. Under the section Electronic Lab Data Information, choose the appropriate lab from the pull-down list and enter your customer ID (sometimes called the submitter ID) in the Customer ID (Submitter ID) field. See Setting up Electronic Labs for more on how to set up electronic labs. You should also choose the options for sending messages when labs are received. To set the message options, go to Setup Preferences and choose the message options that you prefer in the When an electronic lab is received: section.

Processing Lab Results from an Electronic Lab


Electronic lab results files (sent from the lab) must be put in the electronic lab folder specified by your practice in order to be processed by VersaForm. If you have more than one electronic lab facility, you will be prompted to specify the facility. If there is only one file in the lab's folder, VersaForm will process it. If there are multiple files in the folder, VersaForm will ask if you want to process ALL of them or select a single file. If you specify a single file, then VersaForm will process the file you select. If you specify process ALL, it will loop thru all the files in the folder and process them one at a time. At the end of the loop it will indicate how many files were processed successfully and how many files had errors. In 659

either case, processed files are moved to the appropriate subfolder \LabResultsProcessed or \LabResultsErrors. (See Processing Electronic Lab Results for more information.)

Deleting Electronic Labs for a Patient


Open a patient chart and go to the Labs/Data Tab. Select the lab you want to delete and press the Remove button. If the lab results were received electronically, you will get a message that says "These lab results were received from the lab electronically. Do you want to remove it from the list?" If you say yes, the lab will not be deleted, but it will be marked invalid but it will no longer show in the list. See Mapping Lab Results to VersaForm Labs below.

Mapping Lab Results to VersaForm Labs


When VersaForm processes an electronic lab result file it moves the file to the proper subfolder (depending on whether it was processed successfully or with errors). The date and time the file was processed is pre-pended to the file name to ensure that the file name is unique. When VersaForm processes an electronic lab results file, it may be the result of a VersaForm lab order request (round-trip lab) in which case there should already be a lab in the VersaForm data base for it, or it may be a one-way lab which means there may or may not already be a lab in the VersaForm data base for it. If it is a round-trip lab, then OBR.3.1 should be the VersaForm lab id for that lab. VersaForm makes sure the VersaForm lab is for the same patient, same panel, same electronic lab facility (or facility is null), lab is not complete, lab is not used for other lab results, lab order date is within 30 days, there is no data for this lab and lab is valid. If so, VersaForm will update that lab. If a lab with this lab id exists but it has been marked invalid (because someone deleted it) then you have the option of using the invalid lab or creating a new lab. If you use the invalid lab, it will be marked valid if the lab result is successfully processed. If OBR.3.1 was not a VersaForm lab id that satisfied the criteria described above then VersaForm checks to see if there are any VersaForm labs that satisfy the criteria. If there is only one, then VersaForm updates it. If there is more than one, you will be asked if one of them should be used or if a new lab should be inserted. If there are no labs that satisfy the criteria above, VersaForm inserts a new lab. The reports Electronic Labs Received and HL7 Lab Results may be used to see lab results. Note: As of March 2008, only final lab results are accepted by VersaForm. Intermediate results will not be processed.

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