Claim: Charge Entry Tab — Basic View (Enhanced Page)

The date of service for the claim.

The Date of service field must be populated before you can enter procedure and diagnosis information on the Charge Entry page.

Note: If you arrive at the Charge Entry page through the appointment workflow, this field is pre-populated based on the appointment date.

The patient's current department of care, usually the department where the patient's chart resides. The default value is the patient's primary department as shown on the Quickview. This field is sometimes used to determine the contents of the 33A (PIN) (currently used only for Medi-Cal).

The department where the service was performed.

The place of service type for the department where the services were rendered (for example, 11 | Office or 12 | Patients home). The place of service is printed in CMS-1500 Block 24B.

Determines which policy this claim should be billed under. By default, the patient's current primary policy is displayed.

Note: Deactivated payment plans do not appear in this menu unless the charge is currently assigned to that plan. You cannot assign the primary charge to a cancelled plan using this page.

For anesthesia claims generated from time sheets:

• When you change the primary payer for an existing anesthesia primary claim, athenaOne can re-create a claim's charges according to the new destination payer's anesthesia settings.
• athenaOne re-creates the charges using the original time sheet data. Claim data is otherwise preserved, including claim notes, original claim ID, prior authorization number, etc.
• When charges are re-created from the time sheet as a result of changing payers, all time sheet data is refreshed. This refresh includes, but is not limited to, data such as diagnosis codes, service department, referring provider, surgeon, etc.
• Data entered on the charge entry page, such as Reserved 19 comments and Prior Authorization data, is not affected by changing payers.

Indicates whether the provider accepts assignment of benefits from the primary payer for this claim and determines whether the Accept Assignment box will be checked off (CMS-1500 Block 27) for the primary claim.

• Y — Assigned
• N — Not Assigned
• B — Assigned on Clinical Lab Only
• P — Patient Refuses to Assign

If set to Yes, indicates that any $0 charges should be included on the claim when it is printed or submitted electronically. This setting applies to charges of $0 and to outstanding balances for a charge that result in $0. If all charges on the claim are $0, the claim is set to DROP status (or HOLD status, if appropriate) until the claim is submitted, at which time the claim is closed. This option defaults to No.

Note: If this field does not appear on the Charge Entry page and you want to use it, contact the CSC by selecting Support > Create Case or Call in the Main Menu.

Determines which secondary policy this claim should be billed under. By default, the patient's secondary policy is displayed. If the patient has no secondary policy, defaults to No Insurance/Self Pay.

Indicates whether the provider accepts assignment of benefits from the secondary payer for this claim and determines whether the Accept Assignment box will be checked off (CMS-1500 Block 27) for the secondary claim.

• Y — Assigned
• N — Not Assigned
• B — Assigned on Clinical Lab Only
• P — Patient Refuses to Assign

The factor that qualifies Medicare to be the secondary payer for the patient. This menu appears only when Medicare is the primary or secondary payer.

The authorization or referral number used for the services. Typically, this number is assigned by the payer or utilization management organization to authorize a service prior to its being rendered.

If the authorization is not listed in the Authorization menu, you can enter the authorization number in this field.

Indicates whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations. This field corresponds to CMS-1500 Block 12.

Indicates whether the insured or authorized person authorizes the primary payer to assign benefits to the provider (that is, authorizes the payer to remit payment to the provider directly). This field corresponds to CMS-1500 Block 13.

Indicates how patient signatures (for release of information and assignment of benefits) were obtained and how they are being stored by the provider. This field defaults to Signed form for both HCFA-1500 block 12 & 13 on file.

To change the default value for this field, please contact the CSC by selecting Support > Create Case or Call in the Main Menu.

The provider who renders services to the patient. This field is typically used for internal tracking and reporting purposes; the selected provider will generally not appear as the rendering provider on the claim.

The provider whose credentials you intend to submit on the claim. This can be the provider who supervised the services or an individual who was supervised by another provider. In either case, use this field to identify the provider that you want to submit on the claim. The provider you select using the Supervising provider field typically appears as the rendering provider on the claim. For example, on a CMS-1500 claim form, the provider you select using the Supervising provider field typically appears in Box 24J, and the provider's name appears in Box 31.

Note: If the selected Rendering provider has a supervising provider, a note appears next to the Supervising provider field.

If you arrive at the Charge Entry page through the appointment or missing slips workflow, the default selection in the Supervising provider - Required field is as follows:

• Rendering provider — If the rendering provider is classified as a supervising provider.
• Patient's usual provider — If the rendering provider is not classified as a supervising provider.
  Note: If the patient's usual provider is not indicated in athenaOne, a link to the Quickview appear, so that you can add the usual supervising provider for the practice.

Important: Any provider whose credentials you intend to submit on claims must be configured as a supervisory provider type on the Providers page so that you can select that provider using the Supervising provider field. For example, you cannot select a physician's assistant with a provider type of PA, but you can select a physician's assistant with a provider type of PASUP.

The provider selected as the Rendering provider appears by default as the Supervising provider if the Rendering provider is one of the following provider types:

• OPTOMETRIST (OD)
• PHYSICIAN'S ASSISTANT, SUPERVISING
• LICENSED PROFESSIONAL COUNSELOR (LPC)
• DOCTOR OF PODIATRIC MEDICINE
• CLINICAL PSYCHOLOGIST (PHD)
• PHYSICAL THERAPIST (OTR)
• NURSE PRACTITIONER, SUPERVISING (NP,S)
• MD
• MS/RD
• Licensed Social Worker (LCSW)
• LICENSED PRACTICAL NURSE
• DOCTOR OF OSTEOPATHY (DO)
• CLINICAL PSYCHOLOGIST (EDD)

See the Providers page for more information about rendering and supervising providers.

Note: If the supervising provider is non-participating with a payer listed on the claim, their non-participation status is indicated.

The provider or resource that was originally scheduled for this appointment. Principally recorded for reporting purposes, this provider does not generally appear on claims.

The provider who referred this patient for services. This field defaults to the referring provider from the primary insurance policy. If you select an authorization/referral, the referring provider of the authorization overrides the selection for this field. You can click Find a provider to display the referring provider lookup tool.

Select the provider ordering services or supplies; if different from the rendering provider, click Find a provider to display the referring provider lookup tool.

The date of onset of the current illness.

LMP = Date of last menstrual period.

ED = Estimated date of delivery. If the EDD is given, the LMP is automatically calculated using the OB feature.

Enter or select the date that the patient had the same or a similar illness.

Prints in CMS-1500 Block 15.

Enter the date range for the period when the patient was hospitalized as a result of the condition related to this claim.

Prints in CMS-1500 Block 18.

Enter the date range for the period when the patient was unable to work as a result of the condition related to this claim.

Prints in CMS-1500 Block 16.

Enter the procedure code that best identifies each medical service or medical supply provided.

Important: For exploding codes with modifiers, enter both the procedure code and the modifier (separated by a comma) in the Procedure field. If you enter the procedure code without the modifier in the Procedure field, the procedure code will explode before you enter the modifier in the Modifier(s) field.

Note: If you enter more than six procedure codes and the claim is generated on paper, athenaOne generates additional claims to accommodate the charges (paper forms do not allow more than six procedure codes).

Enter the ICD-10 diagnosis code reference number that justifies the procedure listed. (Enter only one code per text box.) You can enter a period to activate the Procedure Lookup tool.

Select this option if the procedure was related to an emergency. This option corresponds to CMS-1500 Block 24I.

Use this section to record additional diagnosis codes that may be required by a payer to support value-based reimbursement but are not tied to a specific charge line or CPT code (for example, codes for pre-existing conditions). This section records any diagnoses entered on charge integration (Billing tab in athenaClinicals) that you have not associated with a procedure code. Also, you can manually enter diagnosis codes in this section to submit these codes on the claim without tying them to a specific charge line.

You can enter up to 12 diagnosis codes per claim. If the total number of diagnosis codes exceeds 12, athenaOne does not send all the diagnosis codes entered in this section on the claim. After you click Create Claim, athenaOne creates a new claim note to indicate which codes it was not able to add to the claim, and these codes move to the Internal Use - Other Diagnoses section, so that you can review them on the Claim Action or Claim Edit page.

If your practice has the Automatically Split Claims with Excess Diagnoses Codes setting enabled, athenaOne automatically splits claims with more than 12 diagnosis codes when the additional diagnoses are not associated with a procedure billed on the claim

You can enter up to 12 diagnosis codes per claim. If the total number of diagnosis codes exceeds 12, athenaOne automatically generates additional claims to accommodate the excess diagnoses which are not associated with a procedure billed on the claim, and links the diagnoses to placeholder procedure code 99499. After you click Create Claim, athenaOne automatically splits the claim and you can see a note automatically appear on Claim Edit.

 

When this feature creates a claim with related claims, the athenaOne system holds all claims together (and releases them together as well).

 

Setup instructions

Ask athenahealth to enable the Automatically Split Claims with Excess Diagnoses Codes setting. Contact the CSC or your onboarding project team. On the Main Menu, click Support then Create Case or Call.

 

Before you can use this feature, you must add placeholder procedure code 99499 in your fee schedule with a cost value greater than $0.00 and less than $1.00. For more information about Fee Schedules, see Fee Schedules in O-help.

Important

If the placeholder procedure code 99499 is not in your fee schedule with a cost value greater than $0.00 and less than $1.00:

• You’ll see an error when the athenaOne system tries to automatically split a claim.
• The claim will be created with a claim note explaining that overflow diagnoses were dropped

 

Checkboxes appear for any appointments scheduled for the patient on the same day and department, listed chronologically, including multi-resource slots.

These checkboxes reflect any selections made on the Check-in page. On the Charge Entry page, you need to select a reason for not requiring charge entry for any selected appointments.

Before you click the Mark Appointments As Not Requiring Charge Entry link, select the reason why this claim does not require charge entry.

Tip: You can create custom "no charge entry reasons" via the No Charge Entry Reasons page.

The post date of the charges. The default value is the current date.

Note: In athenaOne, a charge whose post date is in the month following the month of its service date (or any subsequent month following the service date) is considered late even if the service was at the very end of a month and the post date is at the beginning of the next month. You can choose to back-date the charge to either the earliest open date in the system or the charge's (from) date of service, whichever is later.

Select the reason the abortion services were performed. Compliant use of this field is applicable according to the state laws of each practice and may be provider-driven.

Consult your legal adviser or state healthcare agency for compliance guidelines.

A claim-level field typically populated by the value calculated in the anesthesia time sheet. When entering charges outside the anesthesia workflow, however, the practice user can enter the concurrency level, calculated manually, in this numeric field.

This value is typically populated from the anesthesia time sheet. However, a practice user can complete this field on the charge entry page. Further, rules can be conditioned on the anesthesia type selected.

For example, if the practice user identifies the services as a monitored anesthesia case (MAC), a rule could be created to require the user to modify the anesthesia services with a MAC modifier.

Select the primary surgeon from the menu. This menu is populated from the Referring Providers page.

The date that the primary insurance denied the claim.

Note: TPL = third party liability.

Select the result code for the breast or cervical procedures from the menu of acceptable values provided by the program.

Select the recommendation code for the breast or cervical procedures from the menu of acceptable values provided by the program.

Select the result code for the breast or cervical procedures from the menu of acceptable values provided by the program.

Select the recommendation code for the breast or cervical procedures from the menu of acceptable values provided by the program.

Select the number of months for short-term follow-up (this field is required if the recommendation code is 2).

Enter the size of the tumor in cm.

This field is required for procedures 19160, 19162, 19180, 19240.

Select the tumor stage from the menu (this field is required if tumor size is present).

Select Yes if surgery, chemotherapy, or radiation has been started; otherwise, select No.

Select a reason code if treatment has not started.

Select an adequacy code for the pap smear, if provided.

Select Yes if the claim is for a second opinion for surgery; otherwise, select No.

Enter the test/specimen number in the field provided.

Note: To enter additional notes in the Line note field, click edit (upper right corner of the charge line) and then click Add next to Line note.

Select Yes or No to indicate whether the claim is for services related to COVID‑19 care. If you select No, you cannot select answers in the remaining fields.

The athenahealth rules engine uses the answers to these questions to determine which COVID-19 related rules should fire on the claim, particularly when the patient is COVID-19 presumptive positive. You may notice a change in hold volume for claims related to COVID-19 care as rules adapt to changing payer requirements and as athenahealth gains more information about COVID-19 federal grant requirements.

Note: You can use the Report Builder to report on the answers to this question in the COVID-19 service type add-on. The COVID-19 Suspected display column and filter are available in the Claim category of these report types in the Report Builder: Appointment, Claim, FCC Activity, Transaction Activity, and Transaction Aging.

Select Yes or No.

The COVID-19 service type add-on appears on claims created with or without an appointment.

Note: You can use the Report Builder to report on the answers to this question in the COVID-19 service type add-on. The COVID-19 Testing display column and filter are available in the Claim category of these report types in the Report Builder: Appointment, Claim, FCC Activity, Transaction Activity, and Transaction Aging.

Select Yes or No.

You can use the answer to this question in conjunction with the COVID‑19 related patient balance hold to help you meet the CARES Act Provider Relief Fund grant requirements. For information about the COVID-19 related patient balance rule, see COVID-19 Management: Patient Balance Hold Rules Request on the Success Community.

Note: You can use the Report Builder to report on the answers to this question in the COVID-19 service type add-on. The COVID-19 Out of Network display column and filter are available in the Claim category of these report types in the Report Builder: Appointment, Claim, FCC Activity, Transaction Activity, and Transaction Aging.

Select Yes for claims with modifier -90 (Reference (Outside) Laboratory). This option indicates that your practice purchased testing kits from an outside party (CMS-1500 line 20 or equivalent).

Select the provider that supplied the purchased services. For example, a physician may purchase a diagnostic exam from an outside entity. Click Choose/view to display the Referring Provider Lookup tool.

This field is required if Purchased Services? is set to Yes.

Enter the total cost (dollar amount) of the purchased services included on the claim.

This field is required if Purchased Services? is set to Yes.

Enter the patient's weight in pounds.

This information is required for EPO claims for patients on dialysis.

Enter the patent's serum creatinine level.

Select the date the patient was last administered chemotherapy.

Use this section of the add-on to report the length of need and certification type for DMERC CMNs (excluding O2). Complete the DME section fields only for procedures where a certificate of medical necessity (CMN) from the provider is required.

Note: Do not complete these fields for oxygen therapy claims.

Select the type of certification from the menu (Initial, Renewal/Recertification, or Revised).

Enter the date that the last certification was obtained from the provider. You must enter the DME certification revision date if you indicated a DME certification type of Renewal/Recertification or Revised.

This field is used to report the length of need for this CMN. Enter the quantity in months.

Note: To submit the DME information with a DME claim, you must complete both the DME certification type and the DME CMN quantity.

Enter the date that the DME therapy began.

Use this section to report O2 CMN information. This information is required for all home oxygen therapy claims.

Select the type of certification from the menu (Initial, Renewal/Recertification, or Revised).

Enter the date that the last certification was obtained from the provider. You must enter the oxygen therapy certification revision date if you indicated an oxygen therapy certification type of Renewal/Recertification or Revised.

This field is used to report the length of need for this CMN. Enter the quantity in months.

Note: To submit the oxygen therapy information with a DME claim, you must complete both the oxygen therapy certification type and the oxygen therapy CMN quantity.

Use this field to report arterial blood gas result.

Enter the date of the arterial blood gas test.

Select an option from the menu to report the condition under which the ABG test occurred .

Use this field to report oxygen saturation blood result.

Enter the date of the oxygen saturation test.

Enter the oxygen flow rate. Valid values are 1 — 999 liters per minute and X for less than 1 liter per minute.

Used to answer question 8, 9, 10 of the Oxygen CMN. User can select multiple findings from the list.

Enter the date that the oxygen therapy began.

Use this section to report conditions related to all DMERC CMNs. If you completed the DME section or the Oxygen Therapy section, this section of the add-on is required.

Select Durable Medical Equipment or Oxygen Therapy Certification from the menu.

Select a value for the ANSI Certification Condition Code Applies indicator.

• Yes — The condition codes in the Condition Indicators field apply.
• No — The condition codes in the Condition Indicators field do not apply.

Select one or more condition codes describing either the patient or the equipment status.

If you selected the condition code "38 - Certification signed by the physician is on file at the supplier's office," you must provide the date that the certification was signed by the physician.

Enter the patient's weight in pounds. The patient's weight is required when submitting claims to Medicare Durable Medical Equipment Regional Carriers with certificates of medical necessity.

Use this section to report responses to CMN questions.

Use this field to report the CMN form number. (must be a valid OMB approved CMN form number, excluding alpha characters).

This field is used to report a CMN question number. (You can enter multiple questions, if needed.) Type a question mark, the number and letter, and then press the Tab key. Additional fields (Response, Date, etc.) appear.

Note: For multi-part questions that are not numbered individually, assign letters left to right, top to bottom, keeping the question number constant. Must include both number and letter together in this field.

Select the response to the CMN question (Yes, No, or Not applicable).

Enter the date (if the CMN question requires a date response).

Enter the percentage (if the CMN question requires a percent response).

Enter the required information (if the CMN question requires a text or uncodified response).

Note: These fields of information do not appear until a number is provided in the question number/letter field.

Enter the patient's weight in pounds.

Enter the number of times the patient has given birth.

Select the appropriate option for pregnancy desirability.

Select all routine medical services provided.

Select all lab services provided.

Select all STD tests and diagnoses administered.

Select Yes if HIV pre-test counseling was provided.

Select the result of an administered HIV test (negative or positive). If no test was given, select not tested.

Select all providers of medical services.

The value in this field is controlled by the interface; however, users can manually modify this value.

Enter the date of the patient's prescription.

Select Yes if the patient is homebound; otherwise select No.

Click Find a hospice or HHA to select a hospice or home health agency.

Note: A claim rule assigns HOLD status to all claims billed with procedure codes 99374, 99375, 99377, 99378, G0179, G0180, G0181, and G0182 that do not contain the complete name and address of the Hospice/HHA facility and Medicare ID number.

Select Yes if the provider is an employee of the hospice.

This flag is necessary for all Medicare claims involving physician services to hospice patients.

Enter the serum lot number if required by state law for health data reporting.

Note: You can report only one serum lot (or batch) number per claim. You must create an additional claim if you need to report a second serum batch number.

Select Yes to indicate that the rendering provider on the claim is also the delivering provider. Select No to indicate that the rendering provider on the claim is not the delivering provider.

Note: When the provider of antepartum care is the same as the delivering provider, denials are common because of global coverage for pregnancies. For antepartum care, it is important to indicate when this care is provided by the delivering provider.

This field is automatically populated with the information from the OB episode. This information is required in some states — for example, Indiana Medicaid — or if the Last menstrual period field is populated.

This field is automatically populated with the date from the OB episode.

This field is automatically populated with the date from the OB episode.

Select the reason why a provider did not obtain a service authorization for a service that state law (for example, New York State Medicaid) requires an authorization for.

Select the reason why a claim was filed past the filing date or the reason why a claim transmitted in response to a request for information was delayed.

Select the program under which services provided to the patient were performed.

Enter the clinical trial registry number. CMS requires a clinical trial registry number on claims associated with clinical trial participation.

National Drug Code (NDC) information is copied from your practice's fee schedule, unless you enter it manually.

When you enter a valid number in the NDC number field, athenaOne displays the corresponding athenaCodesource trade name below the field. This information allows you to confirm that the NDC number entered is correct for the procedure code.

NDC is an 11-digit number with the format "xxxxx-xxxx-xx." If one segment is not formatted correctly, add a leading "0" to that segment (for example, 12345-123-12 becomes 12345-0123-12). For more information, see NDC number formatting.

Note: To edit the NDC number or dosage for a procedure code, click the edit procedure fees link on the Fee Schedules page.

Enter the patient's weight in pounds.

If a patient’s Out-of-Network Billing consented amount was entered in the appointment AND a signed consent form was attached, you’ll see that amount in this field.

Note: If no signed consent form was uploaded, the cost estimate will NOT carry over to the consented amount in Charge Entry, as it is assumed that the patient did not consent to paying Out-of-Network rates.

If a patient’s consented amount is missing at Charge Entry or Claim Edit: you can check the patient’s appointment to see if a signed consent form was attached, and then enter the consented amount.

For details, see the O-help topic: To view and edit patient's Out-of-Network Billing consented amount at Charge Entry or Claim Edit .

Provider ordering services or supplies, if different from the rendering provider.

You can type a period to access the Referring Provider Lookup tool.

Enter the date that the patient was last seen by the physician supervising care for the underlying condition.

Enter the prior authorization tracking number for the patient's original $3,700 worth of care. This number is required when a patient exceeds $3,700 worth of therapeutic care in one year, but the patient is re-authorized for more therapy.

Select Yes to indicate that additional documentation is required.

Enter a control number for the required attachment.

Select the type of paperwork attachment from the menu.

Select the method of transmission for the additional paperwork from the menu (for example, By Fax, Email, or Electronically Only).

Enter the date that the patient was last seen by the physician supervising care for the underlying condition.

Enter the date that care was assumed by another provider during post-operative care if the claim has Modifier 54 (for Surgical care only) or Modifier 55 (for post-operative care only).

Required on Medicare claims involving shared post-operative care. See Relinquished care date (below).

Enter the date that the provider filing the claim ceased post-operative care — that is, the last day of care by this provider — if the claim uses Modifier 54 (for Surgical care only) or Modifier 56 (for Pre-op management only).

Required on Medicare claims involving shared post-operative care. See Assumed care date (above).

Click Find a provider to search for the reference lab.

Select the provider ordering services or supplies if different from the rendering provider (the Referring Provider Lookup tool is available).

Required for procedure codes (HCPCS) that describe:

• Diagnostic radiology
• Diagnostic laboratory
• Durable Medical Equipment (DME)
• Orthotics Prosthetics

Medicare claims are placed in HOLD status if you do not enter either a referring provider or an ordering provider for the types of service described above.

Enter the date of the initial treatment for the patient's underlying condition.

Enter the date that the last X-ray was taken (for example, to demonstrate a subluxation of the spine).

Select the nature of the patient's condition necessitating spinal manipulation from the menu.

A - Acute Condition

C - Chronic Condition

D - Non-acute

E - Non-Life Threatening

F - Routine

G - Symptomatic

M - Acute Manifestation of a Chronic Condition

Enter a description of the patient's underlying condition.

Enter the date of acute manifestation for the patient's underlying condition.

Select Yes or No.

The Telehealth service type add-on appears only when the claim is created without an appointment. If an appointment is associated with the claim, the appointment should have the Telehealth Distant Site Visit appointment type class applied (see To add Telehealth Distant Site Visit to your available appointment types).

Note: The athenahealth rules engine uses the Telehealth Distant Site Visit appointment type class or the Telehealth service type add-on information to identify the claim as telehealth and apply the appropriate billing rules per payer guidelines.

Select the Received option if the patient received a clinical breast exam during the visit.

Select the override type from the menu. To exclude the visit from UDS reporting, select Non-UDS Visit.

Note: The UDS service type add-on works only on claims. If you create a clinical encounter with no associated claim, athenaOne automatically flags the encounter as a UDS visit type for reporting, and you cannot change the visit type in athenaOne. Your UDS report details (filtered and raw files) will include all encounters, in addition to claims.

Visit type (Clinic or Virtual) selected by athenaOne based on the department's place of service code (POS 02 - Telehealth), certain modifiers on procedure codes on the claim or encounter (.GT, .G0, or .95), or certain procedure codes. Virtual visits are reported on UDS Table 5 - Staffing and Utilization.

Note: You can find the list of virtual-only procedure codes on the 2019 CPT inclusion and exclusion list on the Success Community.

To override the value in the Clinic or Virtual field of the UDS STAO, select Clinic or Virtual from the menu.

Indicates whether an EPSDT referral was given to the patient.

Indicate a reason why an EPSDT referral was given. Required if an EPSDT referral was given.

Indicate a second reason why an EPSDT referral was given.

Indicate a third reason why an EPSDT referral was given.