Table of Contents

Table of Contents

percentage that you may have set under Schedule.

NOTE: Entering a negative number in the Charge field will cause the Billing

Module to not charge for this procedure on this schedule. It won’t even show up on the invoice. If you want it to appear on the invoice, but don’t want to charge for it -- or rather, charge $0.00 for it -- enter zero (0) in the Charge field.

When complete, select OK. When all the schedules are added to the procedure, select OK again.

Printing your fee schedule

Once you’ve defined the prices for all the procedures, setting different prices for each schedule, it's a good idea to print out the fee schedules as a permanent hard copy. (Some people find it easier to review hard copy than numbers on a computer screen. De gustibus non est disputandem.) If you want to print out your fee schedules:

1) From the Billing Setup screen, select Schedules. SchuyLab displays the Billing

Schedules scroll box, listing all the schedules currently defined in the system.

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2) Select the Print button at the bottom of the Billing Schedules box. SchuyLab displays a very similar box, the Print Fee Schedules box.

3) The first item on the list is “Standard Pricing”, which is your base fee schedule.

This isn’t an explicitly defined schedule -- that is, you never have to enter

“Standard” or “Base Price” as the name of a schedule. Rather, this fee schedule is compiled by SchuyLab from the base prices defined for all the procedures.

Although the Billing Schedules function will not display this schedule on the screen, it will print out for you. The Standard Pricing schedule is followed by the schedules you've defined for your system.

4) To print all the fee schedules, select the Print All button.

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5) To print one or some of the fee schedules, select them from the list. SchuyLab highlights in grey the schedules you select. In the process, the Print All button changes to become the Print Selected button.

When you’ve chosen all the fee schedules you wish to print, select Print Selected.

SchuyLab prints the fee schedules.

Setting up Custom Paper Claims

For the majority of our customers, their paper claims will use HCFA-1500 forms, and no special setup will be required. Some of our customers however, and particularly those who are not in the United States, may need to print out insurance claims with different requirements. In particular, our reports system which allows you to have tremendous control over your report’s layouts, can also be used to print claims customized to your needs.

So how would you setup one of these claim reports? First you need to create a new report type.

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Select F8. Tools.

Select Set-Up.

Select RePort Setup.

Select Reports.

SchuyLab displays the Report List Box.

From here click on New Report to bring up the Create New Report box

From here there are two ways you can go depending on what kind of form you need

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to fill out. If you are writing one form for one claim, you should choose the type

Claim from the Type dropdown list. This will make the claim information available for this report. If the form covers is a cumulative report covering multiple claims, then you should choose Invoice as the type. In either case, you should, of course, give it a descriptive name and description in the name and description boxes, so you don’t confuse it with one of your other reports.

For the moment, assume that you’ve chosen Claim and that you are creating a form for Duckworth Insurance.

After you click OK here, you will be taken to the Configure Claim Form Screen.

Here is where you can setup the format to fit your form, but the actual process for doing so is beyond the scope of this document. Section 7 of the SchuyLab User

Manual: Reports and Printing should give you the information you need to modify the report to fit your claim form.

So what do you do after you’ve created and formatted your new claim form? You need to tell SchuyLab which claims you want to use it on. You do this in the

Insurance setup which you can find in the next section.

Setting up Insurance, Clients and Doctors

Insurance

The Insurance icon is used to record information on the insurance carriers who will receive bills from you. Note that SchuyLab treats Medicare and Medicaid

(MediCal) as insurance carriers, so they need to be defined here.

To enter information on insurance carriers:

From the Define Billing screen, select Insurance.

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SchuyLab displays the Update Insurance Carriers scroll box, listing all the currently defined insurance carriers.

From here, you can print a list of all your current insurance carriers by selecting

Print. But we assume you want to create an entry for a new carrier.

Select one of the entries in the scroll box to update that insurance carrier;

OR

Select New Carrier to create a new entry.

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SchuyLab displays the Add/Update Insurance Carrier box.

Enter the insurance company’s pertinent information in this box. Most of the fields are self-explanatory. For billing purposes, the most important fields are:

ID:

SchuyLab will automatically assign an ID number to each new insurance company. You can override this if you wish.

NOTE,

however, that since Medicare and MediCal are treated as insurance for billing purposes, they need to have specific ID numbers. More on that below.

PIN:

Fee

Schedule:

Enter

your lab’s

identification number with this insurance carrier. On the HCFA-1500 form, this will be printed in space #33, right under your lab’s name.

Pull down the scroll list and select the schedule to be assigned to this insurance carrier. (The base fee schedule is the default.)

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Name,

Address,

City, St.,

Zip:

SchuyLab will print these at the top of the HCFA-

1500 form.

NOTE,

that if you have many insurance carriers with the same name, use the Name field to distinguish them in some way (e.g., “Blue Cross of Oxnard”,

“Blue Cross of Visalia”, “Blue Cross of Altadena” -- don’t just use “Blue Cross” for all of them!).

In Care of:

Plan Name:

Write Off:

Enter the name of the contact person at the insurance company who will deal with claims from your lab.

Enter the name of the insurance plan that covers your patients through this carrier.

Enter the dollar amount (if any) you will automatically write off from all claims paid by this carrier.

For setting up Medicare and MediCal ‘insurance carriers’, there are some special requirements to note:

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ID:

PIN:

GRP:

Other ID:

Fee

Schedule:

Printed

Form:

Electronic:

Modifier:

For Medicare and the various states’ Medicaid programs, the SchuyLab ID number

must

start with the letter X:

For Medicare, enter “X040” as the ID.

For MediCal, enter “X005” as the ID.

This number is for whatever ID number the insurance company has given you to personally identify your laboratory.

These fields are used for different purposes for various billing setups, particularly with electronic billing. Schuyler House will inform you if values need to go in these fields when your billing gets setup.

Pull down the scroll list and select the appropriate fee schedule. Fee Schedules are defined in the

Schedules area of Billing Setup as described earlier in this chapter. (For Medicare or Medicaid you must choose a “CPT Rule” schedule.)

This will be the HCFA-1500 form by default. Most paper billing in the USA can use this form. For some carriers you may want to use a different form that has been defined for Paper Billing. See Setting up Custom Paper Claims.

If you don’t plan to do any electronic billing, set this to “N/A” (Not Applicable). If you plan to do electronic billing, you’ll need to set up your electronic billing formats. (See the section on

Electronic Billing setup, below.) Once you’ve done that, come back to this screen and select the appropriate electronic format here.

If you want all CPT codes to be followed by a twocharacter suffix for this carrier, enter it here.

Clients

The Clients icon in Billing Setup is identical in use to the Update Group icon found in the Medical Records screen, accessed through F8. Tools. Client groups are assumed to be financial entities (as opposed to doctors, which are medical in nature

-- we distinguish between Dr. Shipley, who ordered the CBC, and Wm. Shipley,

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M.D., Inc., a California corporation). If you have not yet defined your list of clients, you should do so as part of Billing Setup.

To add or update your list of client groups:

From the Define Billing menu screen, select Clients.

SchuyLab displays the Update Clients box, listing the currently defined client groups in alphabetical order.

Type in the name, or ID number, of the client group you wish to update, and select

OK;

OR

Type in the first letter(s) of the client group you wish to update, and select Find, then choose from the list;

OR

Type in the name of the new client group you wish to create, and select OK;

OR

Select Add Client without typing anything.

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SchuyLab displays the Add/Update Client Record box.

The ID field will automatically be filled by SchuyLab, but if you prefer another number for this client, you can enter it here. Complete the remainder of the fields, as shown. For billing purposes, the most important fields are:

Fee

Schedule:

Sales:

Active:

Pull down the scroll list and select the schedule to be assigned to this client. The default will be your base schedule.

Enter the initials (or other identifying symbol) of the sales representative for this client. Sales to this client will thereafter be credited to this sales rep, in your Sales by Rep reports.

Check this box if the client is still active and should still appear in reports and as an accession possibility. If the Client is no longer with your lab, but you still need to keep legacy information you should uncheck this box rather than deleting the client.

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Individual:

Provider:

Checked if the client is a single individual, unchecked if the client is a group or organization.

Enter the client’s Medicaid (or MediCal) provider number in this field.

Tax ID#:

NPI:

Enter the client's tax ID number in this field.

The National Provider Identifier is a new number that will be used by both Medicare and Medicaid to uniquely identify healthcare providers rather than using separate Medicare and Medicaid numbers. They are currently usable and starting in

May of 2007 they will be required for all Medicare transactions.

Responsible

Physician:

This field is optional and is used when all accessions from a client will normally use the same doctor record, such as when the client is an independently practicing physician. The doctor should be part of the Doctors records and you can pull them up by name or by number.

Do not bill this client:

This should be pretty self-explanatory. If this is checked off this client will not be included in client billing.

Print ‘New

Patient’

Reports:

Checked if the client’s patients should be included in ‘New Patient’ reports. (For those labs that make use of ‘New Patient’ reports functions.)

The Special Panels area is used for entering in client-specific panels associated with client being viewed. It is used in the test ordering screens if you choose to define a button as having multiple meanings depending on what client an accession is for, and is not currently used for billing.

When all the fields are complete, select OK. SchuyLab returns to the Define

Billing menu screen.

Doctors

Many payors require more than just the client’s information on the claim; they require the ordering doctor’s information as well. (For instance, space #17a of the

HCFA-1500 form.) This has to be setup outside the Billing Module altogether, but don’t worry, it’ll only take a moment.

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To update your list of doctors:

Select F8.Tools.

Select Doctor Records.

Select Update Doctor.

SchuyLab displays the Select Doctor box, allowing you to search for a doctor by name.

Type in the name, part of the name, or ID number, of the doctor you wish to update, and select OK;

If there are multiple matches you will have the option to select a doctor from a list.

If there is only one match, that doctor’s information will be brought up. If there are no matches, you will have the option of entering in a new doctor.

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SchuyLab displays the Add/Update Doctor Record box.

The ID field will automatically be filled by SchuyLab, but if you prefer another number for this doctor, you can enter it here. Complete the remainder of the fields, as shown. For billing purposes, the most important fields are:

Provider:

License:

Enter the doctor’s MediCal provider number in this field. On the HCFA-1500 form, this will print in space #17a.

Enter the doctor’s medical license ID in this field.

UPIN:

SSAN:

Enter the doctor’s UPIN (Universal Personal

Identification Number) in this field. On the

HCFA-1500 form, for Medicare claims, this will print in space #17a.

Enter the doctor’s Social Security number in this field. On the HCFA-1500 form, for insurance claims, this will print in space #17a.

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NPI:

The National Provider Identifier is a new number that will be used by both Medicare and Medicaid to uniquely identify healthcare providers rather than using separate Medicare and Medicaid numbers. They are currently usable and starting in

May of 2007 they will be required for all Medicare transactions.

When all the fields are complete, select OK.

Setting up Electronic Billing and Remittance

Electronic Billing

SchuyLab is able to write billing data -- patients’ names, tests performed, charges,

&c -- to a file, which can then be transmitted to Medicare, Medicaid or an Insurance

Clearinghouse. SchuyLab prepares the data and writes it in a format designed for the receiver.

To set up SchuyLab for electronic transmission:

From the Define Billing menu screen, select Electronic Billing.

SchuyLab displays the Update Electronic Payors box, listing the electronic payors currently defined in the system.

Select one of the payors from the list to update its information. These accounts are added to this list when you purchase Electronic Claims processing or Electronic

Remittance modules from us. Note that these are categorized as Claim or Remit,

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depending on which features have been installed and licensed.

If you click on a claim, SchuyLab displays the Update Electronic Claims box.

In the Code field, type the code name (up to eight characters) for the site to which you’re transmitting. (When setup is done, you’ll have an icon that looks like a little terminal, with the code name underneath.) Type a more complete description of the site in the Description field.

In the Telephone field, type in the phone number of the site to which you’re transmitting. If they require you to have a password before you can transmit billing data, type your password in the Password field. (SchuyLab does not transmit these.

They are for your records, and can be omitted if you wish.)

The Format field displays the electronic format in which the billing data must be written. ANSI is the standard for both Medicare and Medicaid now.

The format must still be configured for your lab. Select the Setup button.

SchuyLab displays the Configure [format] for [code name] box.

The Payor’s Organization field and Receiver ID fields are already entered for you as you can see. Depending on which organization you are sending to, some or all of the 3 different Receiver IDs will be listed. When you purchase the ability to submit claims electronically to an organization, these are part of the installation.

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In the Submitter ID field, type in the ID number assigned to your lab by the payor.

You will normally have one Submitter ID for each Receiver ID.

In the Name of Contact field, type in the name of your lab’s contact person -- in other words, when the payor needs to discuss a bill from your lab, who takes the call? And the phone number to call them at is the Contact Phone on the next line.

You must also specify the Export Pathname – this will be the drive, directory and filename of the billing file that SchuyLab creates. The sample given has a file called MEDICARE being created in the A: drive which is normally the floppy disk drive. Since it will use the same filename in the same place each time, many labs like to write their billing files to floppies, so they can change it each time and can keep a copy of their old claim files. Others prefer to write to the C: drive (hard drive) which is faster, but requires the billing person who wishes to have backups of their old submissions to copy them to new file names. Also note that some payors will require that the file have a specific name, so you should check with them before setting this up. Whichever method you choose you should keep track of where you are saving the file as you will want to know this when it comes time to submit your claim.

Click Ok to return to the Update Electronic Claims box, and OK again to return to the Update Electronic Payors box.

The process for setting up a remittance is much the same as for a claim. You click on the remit account on the Update Electronic Payors box. And you get the Update

Electronic Remittance box.

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You have all the same categories as the Update Electronic Claims box, but there is a difference if you click on the Setup… button. You get the Configure [format]

Remittance for [Code] box.

The only changeable field is the Import Pathname field. This is where you can tell

SchuyLab where to look for 835 files when processing Remittances. This will normally be on your C: drive rather than your A: drive, as 835 files can be rather large. See the Electronic Remittance chapter for more information.

When you are finished you can click Ok to return to the Update Electronic

Remittance box and OK again to return to the Update Electronic Payors box. When you have updated all of your Electronic Payors you can return to the Billing Setup menu by clicking Done.

Setting up ICD-9 Codes

ICD-9 Codes

Many claims require a diagnosis code before they can be considered ready for billing. This is done through the use of ICD-9 codes. Once defined, they can be entered as part of the patient demographics (up to four ICD-9 codes per patient).

They can also be added directly to a specific claim (again, up to four ICD-9 codes per claim).

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To define ICD-9 codes for your system:

From the Define Billing menu screen, select ICD-9 Codes.

SchuyLab displays the Update ICD-9 Codes box, listing in numerical order the code categories.

Select one of the categories from the list to see which codes are on your system.

SchuyLab displays the Update ICD-9 [Code Range] [Category] box.

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You can click on a code to edit the description, print the list by clicking the Print button, or click on the Add Code button to add a code to the list. The Add ICD-9

Code box will pop up.

In the Code field, you type in the code number for the new ICD-9 code. In the

Description field, you type in a brief description of the diagnosis.

When complete, select OK. SchuyLab returns to the Update ICD-9 [Code Range]

[Category] box. Select Add Code to insert another code. Click Finished to exit this Category and return to the Update ICD-9 Codes box.

When you have entered in all the ICD-9 codes in all the categories that you desire, select Finished. SchuyLab returns to the Define Billing menu screen.

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Chapter 2 - 3Claims

Creating Claims

To begin billing on a set of claims, they have to be brought from the ‘lab’ side of the SchuyLab system to the ‘billing’ side (i.e., the Billing Module). This is done using the Bill Accessions icon.

To import claims to the Billing Module:

From the Billing Module menu screen, select Bill Accessions.

SchuyLab displays the Generate Claims box.

In the Thru Date field, enter the cutoff date for the claims you want to consider. (It will default to today’s date.)

In the Specimen Number Range, enter the first and last specimen numbers you want brought over to the ‘lab’ side of SchuyLab. (If your lab doesn’t use date-based specimen numbers, you might find it hard to remember the specimens for a certain time period. Print out an Order Log for the appropriate dates and then use the first and last specimens on the Log.) Leaving the Specimen Number Range fields blank will cause all the specimens, up to the cutoff date, to be brought over.

When all is ready, select OK. SchuyLab generates claims from the date or specimen number range that you entered, and makes those claims available to the

Billing Module.

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Editing Claims

Once the claims have been brought over to the Billing Module, they can be individually edited if you choose. (You may, for instance, need to prepare them for billing, or to enter EOB’s; or you might simply want to scan through the Open claims for those with incomplete information.) This is done through the Edit

Claims icon.

To edit claims that have been generated:

From the Billing Module menu screen, select Edit Claims.

SchuyLab displays the Edit Claims box.

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In the Search by Status section, select the status of the claims you wish to examine.

This is done by pulling down the status list box.

If no status is selected, SchuyLab defaults to “All” and displays claims from all statuses. Otherwise, select from one of the following:

Closed

Open

Ready

Billed

Claims whose balances have reached zero ($0.00).

Claims which are available for billing, but have yet to be examined and set to Ready.

Claims which are available for printing, electronic transmission, or invoicing.

Claims which are awaiting payment, or have been partially paid and are awaiting future transactions. These claims have a balance greater than zero.

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Similarly, in the Search by Bill Type section, select the bill type of the claims you wish to examine. (See Billing Setup for how to establish these billing types.) If no bill type is selected, SchuyLab defaults to “All” and will display claims from all billing categories.

NOTE: To review the claims that have been entered into SchuyLab without a bill type, select Open in the Search by Status field and the ‘blank space at the top of the list’ in the Search by Bill Type field. This will allow you to review all of the claims that have been entered with ‘blank’ as their bill type. (Presumably you’ll want to do something about this...)

Once the status and bill type have been selected -- or left blank for “All” -- click on the First Claim field, and enter the number of the first claim you wish to examine, and then select OK. SchuyLab displays that claim if it matches the selected status and bill type; otherwise, it displays the next matching claim.

NOTE: To display the first example in the system that matches the selected status and bill type, without knowing its specific claim number, simply select OK without entering a number in the First Claim field. Use the Next button to progress along the chain of similar claims.

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You can also bring up the claims for a specific patient by clicking on the By Patient button. This brings up the Select Patient form.

From this form you can search for a patient’s claims by name, patient ID, date of birth or client. You also can click on the results for the most recent patient accesses listed at the bottom of the window (In the example above, Test G. Patient). This can be up to 5 different patients that SchuyLab has recently brought up. When you click OK you will bring up the first of any claims that match your criteria.

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SchuyLab displays the claim information on the Edit Claim screen. The patient’s information for this claim (e.g., patient name) is displayed in the top panel of the screen.

There are a number of fields, scroll boxes, check boxes, and buttons to help you edit this claim as needed. In order, they are:

Claim (the field)

Bill Type

This field shows the Claim number being displayed; this is synonymous with the accession (specimen ID) number. The Claim number cannot be changed through this field.

Displays the Bill Type assigned to this patient when entered in the SchuyLab system. There must always be an entry in the Bill Type field, or else the claim can’t be billed. (If there’s no Bill Type, it can be added through the

Demographics button, as described below.)

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Payor

Status

Paper

Employment,

Accident,

Homebound

Displays the current payor (Medicare,

Medicaid, Insurance, Client, or Patient) for this claim.

Displays the current status of this claim. Each claim starts with a status of Open. When you’ve examined the claim and made any necessary changes to the charges or demographics, set the claim to Ready. This will make this claim available to the various billing mechanisms. The claim must be set to

Ready before it can be billed! The claim cannot be set to Ready until all the requirements of that particular Bill

Type (e.g., Medicare number, birth date, &c) have been met.

Checking this box makes the claim unavailable for electronic billing; it can only be printed. (If your SchuyLab isn’t set up for electronic billing, it doesn’t matter whether you check this box. But if you are set up for electronic billing, then if the Paper box is checked, the claim can only be printed; if left unchecked, the claim can only be sent electronically.)

These three check boxes are for use when printing on the HCFA-1500 form.

Checking the appropriate box causes the equivalent area on the form to be marked.

Diagnosis [ICD-9]

These eight entry fields show the diagnosis code(s) for this claim. If

ICD-9 codes were entered as part of

Patient Demographics, they will be displayed here. To change one of those codes, select that code, and then type in the code you want. If you want to enter

ICD-9 codes that are specific to this

claim, select a blank entry field and either type in the code, or (if you don’t know the code for a particular diagnosis) select the List button.

SchuyLab displays the Select ICD-9

Codes window, listing the already entered codes with their corresponding diagnoses, and allowing you to search for codes.

In the Search by code or phrase field, type in all or part of the ICD9 Code or

Description. Click on the Search button. Any matches to the search will appear in the space below. Select the desired codes from the list, and then click on select.

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When you are finished adding codes, click on the Ok button to save your changes.

SchuyLab returns to the Edit Claims screen, with the selected codes entered in the

Diagnosis fields. You can have up to four ICD-9 codes per claim.

Charged, Paid,

Adjusted, Balance

These fields are calculated automatically by SchuyLab and are recalculated automatically when items are added or removed. Charged is the total of all charges on the claim. Paid is the total of all payments made.

Adjusted is the total of all adjustments

(such as Write-offs). The Balance is how much is still owed after Payments and Adjustments.

Note

Claim (the button)

Put notes or comments on the claim.

The comments placed here should apply to the claim as a whole, rather than to a single line item. (See the section on Transactions, below, for printable billing notes that apply to a single line item.)

This option lets you ‘jump’ to another claim number you want to view, without having to go one by one through the claims in sequence.

Prev

Next

Charge, Payment,

Write Off

Accesses the previous claim matching the search criteria (if any).

Accesses the next claim matching the search criteria (if any).

These functions will be discussed in the section on Transactions, below.

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Price $

Results...

Select this button to reprice the line items on this claim. If there have been any changes in prices (e.g., altering the fee schedule, changing the patient’s

Bill Type, whatever), they’ll be recalculated and a new value displayed in the Total field. If a new bundling has been set up on this claim (after it was generated), SchuyLab will also rebundle the tests. The claim status must be Open or Ready for the Price $ button to work.

Selecting this button allows you to view the results of the lab tests actually run on the patient. Use this button to insure that all of the tests performed are being billed as procedures.

Select F10. Done to leave this screen and return to the Edit Claim screen.

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Patient...

Selecting this button displays the

Patient Demographics screen. This is the same screen that’s accessed through the Patient Processing screen, on the ‘lab’ side of SchuyLab. Any changes or additions made to this screen from Billing will be visible and accessible to the lab. Likewise, changes made to this screen through the lab side will be reflected here.

Notes added to this screen will print out on the patient report, not the claim! Do not enter printable billing notes on this screen.

The most important things in Patient Demographics, as far as billing is concerned, are probably the Name and Address, Other ID, Medicare and Medicaid numbers, the Diagnosis (ICD-9) Codes, the Bill Type, the Doctor and Client names, and the

Insurance. Most of those are self-explanatory, and in any case are discussed more thoroughly in the SchuyLab User’s Manual. Insurance requires a bit more explanation, so follow along:

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Insurance

The Insurance? button on the Patient Demographics screen lets you enter policy information on the patient.

Selecting that button causes SchuyLab to display the Add

Insurance Policy 1 screen.

Most labs will only have to use four possible Relationships: Self (the default),

Spouse, Child, and Other. If the Relationship field is set to Self, SchuyLab automatically defaults to the name and address on the Patient Demographics screen.

If any other choice in that scroll box is selected, you have the option of entering pertinent information into any of the fields. (Note that, if you choose Spouse, the last name will automatically be set to the Patient’s last name, and the Gender will automatically be set to the opposite of the Patient. Hey, anything to make your life easier.) There are also additional relationships labeled Child1, Child2, etc. Unless the insurance requires that children be numbered (which is currently only in

Curaçao) you should just use Child instead.

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Complete the fields for the patient’s primary insurance. If the patient has only a single insurance coverage, select OK. If there’s a second insurance policy, select

Other? SchuyLab displays the Add Insurance Policy 2 box.

This is a duplicate of the Add Insurance 1 box. Simply complete the information for the patient’s secondary insurance, in the same way you did for the primary insurance. Then select OK. SchuyLab returns to the Patient Demographics screen.

When you’re done entering or altering data through the Patient Demographics screen, select F10. Done to save the changes and leave the screen. SchuyLab returns to the Edit Claim screen.

NOTE: In some cases, you may have to re-generate a claim for the changes in

Patient Demographics to take effect. Simply use the Bill Accession icon, and bring that single claim across from the ‘lab’ side again.

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