The claim review section is the last tab of In Touch EMR documentation. This serves as a review of what the claim will appear to be in In Touch Biller PRO once the user has finalized the document. The user will have the ability to edit the information in the claim review tab prior to submission.
- Refresh - It is very important that users click the refresh button to transfer over the latest information entered in the Subjective, Objective and Flowsheet tab to the claim review section. Failing to click the refresh button may result in incomplete information in the claim review section.
- ICD 10 - This information comes over from the ICD 10 selected in the Subjective tab. This reflects only the Encounter Diagnosis ICD 10 code and not the Primary Diagnosis.
- Date of Service - This automatically reflects the Date of Appointment as it appears in the Subjective Tab
- CPT code, FLG Code, MIPS G Code - This area shows the CPT Codes that were selected in the Flowsheet, the FLG Codes that were selected in the Objective and the MIPS G codes selected in the claim review tab.
- Modifiers - the system automatically provides the modifiers for each line item. But if the users would like to get options on which modifiers to use, click on the M button
to show the pop-up of the Modifier menu. This provides a list of all possible modifiers to use and the description.
Users have the ability to append the KX modifier. To review the lesson on how to append KX modifiers, click here.
- Compliance Check - when clicked, this will provide a pop-up that will inform users which CPT codes from the flowsheet were indicated in the claim review and which ones are indicated in the Plan of Care for future visits.
- Add Row - When clicked, this button will add a line item that does not have any entries (CPT Code, Modifier, FLG Code, MIPS Code, etc.) This button is NOT available for patients that have Medicare (or other Medicare Products) as their payer. Since Medicare units are specifically computed by the system to ensure that the 8-minute rule is followed correctly.
- CPT Selector - When clicked, this will open the CPT Selector Pop up similar to what is on the Flowsheet section. It allows the users to add a new CPT code to the list of codes to be submitted on the claim. This button is NOT available for patients that have Medicare (or other Medicare Products) as their payer. Since Medicare units are specifically computed by the system to ensure that the 8-minute rule is followed correctly. Users can search for the CPT Code either by the code or description, then click on Add to include that CPT code on the rows of CPT codes to be submitted on the claim.
- Supporting Diagnosis - Entering in the Supporting Diagnosis for billing is required by In Touch EMR as a safety measure to ensure depth-of-claim. You are essentially telling the insurance company that you are performing the exercises/procedures you are charging for the specified diagnosis. You must enter the supporting diagnosis for each CPT code from LEFT TO RIGHT. You are required to add at least one Supporting Diagnosis for each CPT code
- Units - the system automatically computes the units for the CPT codes based on the duration entered in the Plan of Care. Patients that have Medicare (or other Medicare Products) as their payer, will follow the 8 Minute Rule. Patients that have other payers will automatically follow the AMA 15 Minute Rule. Unless the users indicated otherwise. Users can also manually indicate which rule to follow per patient. To review the lesson on how to edit which unit computation to use for the patient, click here.
In Touch EMR also provides an Auto 15-Minute Rule feature that when turned on, the 15-minute rule will be applied automatically for a patient, if the primary payer is non-Medicare, for that particular user. This is an advanced duration-to-unit calculation setting.
Or you can also use the Universal Medicare 8 minute rule feature that when enabled, the Medicare 8 minute rule will be applied universally across all patients and all payers for that particular user.
For compliance reasons, it is important to review your payer contract and payer guidelines to answer the question "Does this payer follow the Medicare 8 minute rule or the AMA 15 minute rule?"
11. Delete -when clicked, it deletes the row.
12. Save Billing - clicking this button saves all the information that is currently in the claim review section. The Finalize button will not be available until the user clicks on Save Billing.
When Save Billing button has been clicked and there are notifications that the billing information has not been saved due to some incomplete information, the user must resolve the errors first and click Save Billing again until it provides a confirmation that the billing information has been saved. Here are some of the most common notifications:
Missing Supporting Diagnosis
Users must ensure that all the line items must have a supporting diagnosis that points to which ICD 10 code that CPT code is responding to. If there is any line items with missing supporting diagnosis, it will provide this error message.
Mandatory Override
The Mandatory Override feature allows the user to save the Subjective information without filling out the necessary fields. These necessary fields are mandatory to be filled out to be compliant. By default, you will not be able to save the Subjective information without completely filling out the mandatory fields. To learn more about the necessary fields in the Subjective Section click here
If the Mandatory Override feature is turned on and the user failed to provide a response to one or more of the necessary mandatory fields, in the Claim Review Section, it will prompt the user to fill out that necessary mandatory fields first before saving the billing. The user must go back to the Subjective section and fill out all the necessary mandatory fields before going to the claim review to save the billing.
Plan of Care Error
If the Mandatory Plan Components features have been turned on it will require that the components of the Plan of Care are filled out before the user finalizes the documentation. To learn more about the Mandatory Plan Components, click here
If
13. Finalize Document - When clicked this button will show a pop-up that will provide the following information
- Servicing provider - this is the user working on the document currently
- Rendering provider - if the current user's classification is a PT, OT, etc, their name will be the default option in the drop-down selection but if the user is not a clinician, they will need to select a clinician from the list to be the rendering provider indicated on the document. This will be the signature that appears on the PDF of the document and rendering provider that will appear on the claim
- Rendering Provider Initials - to sign the document as finalized, the user must enter an initial
- Authorization required - Yes/No
- Finalized document - When this button is clicked, another pop-up notification will appear informing the user that once the document has been finalized, it can no longer be edited. Documents are medical records and can longer be tampered with once the document has been completed. It will be sealed.
Once the user clicked the Yes, Finalize button, the screen will go back to the Patient dashboard and the finalized document will be added to the completed document list. The user will be provided more options on the Patient Dashboard for completed documents. To review those possible options, click here.
- Print - once clicked, this will show a pop-up informing the user that the document will be downloaded in the computer and ready to be printed. If the user confirmed, it will download the document in a PDF file in the user's computer.
Additional Features
MIPS Code Reporting
This is feature allows users to report MIPS through In Touch EMR. There is built-in functionality for MIPS, that follows the CMS guidelines.
To the Medicare patients who are able to meet the criteria in the guidelines provided, the users will be prompted on the Claim Review Tab to report MIPS. The "Click here to Report MIPS Measures (Recommended)" button will appear for these patients.
But if the user would like to be prompted for MIPS reporting to all patients not just Medicare, they should turn on the Universal MIPS feature hence allowing them even if the requirements in place are not met.
Once the user clicked this button, it will provide them a pop-up to choose the appropriate G codes to report the MIPS measures. Once done, users must click the Report MIPS measures button either the top or bottom of the page.
The G codes selected in the pop-up will appear as one of the line items in the claim review section.
In Touch EMR users should follow the prompts for MIPS measures in In Touch EMR, those measures will be reported to CMS through the claim form in In Touch Biller PRO.
In terms of the current status of all your MIPS submissions, you also have the option of checking with CMS directly. For more information visit www.qpp.cms.gov
Additional buttons
The Fax and Print and Fax button are only available when there is a referring provider assigned to the patient chart.
When the Fax button is clicked, it will provide a pop-up box asking if the user would like to fax the document to the referring provider listed on the patient chart.
When the fax button is clicked, it will automatically send out the document to the referring provider's fax number as indicated in the referral resource's information.
If the Print and Fax button is clicked, it will show this pop-up that asks the user if they want to fax it to the referring provider on file and print it as well.
Same as the Fax button, it will provide a notification that the document has been faxed to the referring provider but at the same time it will also download a PDF version of the document to the user's computer.
Autopopulate Diagnosis Pointer on Claim
When enabled the Autopopulate Diagnosis Pointer on Claim feature, it will automatically populate the diagnosis pointers adjacent to the CPT code on the claim review tab for all documents for this user. This feature reduces documentation time and helps improve compliance with payor guidelines.
When the option YES is clicked, it will provide a drop-down selection between 2 options.
When '1' is selected, In Touch EMR will auto-populate the diagnosis pointer '1' for all CPT line items irrespective of the number of ICD codes selected in the encounter diagnosis section. When 'All' is selected, In Touch EMR will auto-populate 1, 2, 3 (depending on the number of ICD codes selected in the encounter diagnosis section) for all CPT line items.
It is strongly recommended that the clinician review and / or make changes to the diagnosis pointers before submitting claims. By using this feature, the clinic waives any responsibility for inaccurate claim submissions, and In Touch EMR is not responsible for any mistakes with claim submission.
Rendering Provider Authentication
By default, non-licensed clinicians like PTAs, COTAs are allowed to finalize a note, assuming the rendering provider’s approval is provided and the rendering provider's initials are entered in the system.
But when the Rendering Provider Authentication feature has been enabled, this user will no longer be able to finalize any document and generate a claim. The user will, however, be able to use 'Submit for Review' and select a rendering provider. This allows the user to send documents to a rendering provider for review.
Once clicked the pop-up box will show a drop-down list of Rendering Providers that the Servicing Provider can choose from who to send the document for review.
In this manner, non-licensed clinicians (also called ‘servicing providers’ or SP) like PTAs will be required to ‘submit documents for review’ to licensed clinicians (also called ‘rendering providers’ or RP).
In Touch EMR recommends that RPA be enabled for non-licensed clinicians since the presence of the licensed clinician is not guaranteed at all times. If the goal is to prevent non-licensed clinicians to finalize a note, especially if a licensed clinician (rendering provider) is not available to supervise and sign off on the note, then RPA should be enabled (set to ‘yes’).
When a document has been submitted for review to a rendering provider, the appointment in the calendar changes color to indicate that it is in review
When the appointment is clicked, it will also show a notification that the document has been submitted for review and indicate who sent it for review to whom.
When the Rendering Provider opens the Dashboard Control Center 1.0, there is a list of documents for review assigned to that provider. This makes it easy to keep track of which documents have been submitted to which clinician. The clinician clicks on the patient name and the patient chart will open.
In the patient chart, under documents for review, it will list all the documents that has been submitted for review.
IMPORTANT NOTE: ONLY the rendering provider to whom the document has been submitted to for review will be able to see the document. Other providers will not be able to view the document. Other providers will not see anything listed on the document for review.
The rendering provider must click the edit icon and go through the document and review it before finalizing the claim.
Disable Claim Finalize
The Disable Claim Finalize feature When enabled, the finalize claim button will be disabled for all documents for this user. This will prevent the user from being able to finalize a claim.
This is ideal for new clinicians, and in situations where claim review is being completed by administrators prior to document finalization.
Submit Claim (Prior to Finalize Note)
When the Submit Claim feature is enabled, all document types (for that user) will now show an additional button under the 'claims' tab, called 'Submit Claim'.
When this button is clicked, the user has the ability to submit the claim to In Touch Biller PRO, without finalizing the document.
In other words, the claim can be submitted for payment, while the document remains 'in progress'. In this scenario, it is entirely the clinician's responsibility to return to the note 'in progress' and finalize it as soon as possible.
This is ideal when clinicians want to transmit claims immediately, to facilitate cash-flow for the practice and plan on finalizing notes 'after the fact'. In other words, you submit a claim even though the note is not finalized yet. Although this adds flexibility to the documentation and billing process, it increases the risk of non-compliance and the probability of missed / incomplete documentation.
By using this feature, you understand that In Touch EMR is not responsible for any claim denials, and it is entirely your ethical responsibility and professional obligation to complete clinical documentation in a timely manner. You also understand and acknowledge that you are submitting claims with an increased risk of denials / refund requests, in the event that notes are not finalized on time / do not match what is billed out / changes are made to a document after the claim is billed out.
Claim Status Report
When the Claim Status Report feature has been turned on, the user will have an option to view the Claim Status Report under Add Ons - Claim Status.