User Guide — Charge Review
The charge review workflow is the charge integration process for athenaClinicals providers and authorized billing staff who use the Billing tab (or the Claim: Billing tab) and the Charge Entry tab to select procedure codes and systematically create an encounter's corresponding claim electronically. This workflow effectively eliminates the need for paper billing slips in the office and significantly reduces data entry.
Features and workflows
When the provider uses the Billing tab to enter the procedure codes and clicks the Save button, the charge integration logic captures the claim information so that it can populate the Charge Entry tab fields with the charge information.
Workflow Step 1: Checkout
In the Checkout stage of the 5-stage patient encounter, an authorized billing staff member follows the usual checkout procedures, using the Patient tab. Next, the authorized billing staff member clicks the Claim: Billing tab.
Workflow Step 2: Review the procedures for billing
When the Claim: Billing tab appears, the billing staffer should locate the Services section to ensure that the Bill? checkbox (at the far right) is checked for each billable service, and to check any checkboxes that were missed.
After all the Bill? checkboxes are checked, the billing staffer clicks the Save & Go To Charge Entry button to display the Charge Entry tab.
Note: The Save & Go To Charge Entry button remains disabled until the patient is checked out. You cannot create charges for a patient in an appointment status of 1 or 2.
Workflow Step 3: Charge Entry tab
When the Charge Entry tab appears, all the procedures from the Claim: Billing tab are pre-populated in the charge line data fields.
You do not need to enter the charge line information manually, using a paper billing slip, because the fields are prepopulated. The billing staff member can click the Create Claim button on the Charge Entry tab to create the claim from the Claim: Billing tab information.
Charge integration logic
The charge integration logic populates the fields in the Charge Entry tab by mapping the billing tab fields of data to the charge entry data fields as follows:
| Billing Tab fields | Charge Entry page fields |
|---|---|
| Procedure Code | Procedure |
| Modifiers (Non-Fee Affecting) | Procedure to the right of the procedure code and/or any fee affecting modifiers, comma separated |
| Units | Units |
| Diagnosis | Diagnoses Justifying this Procedure |
Note: The Charge Entry tab can accept up to 12 diagnosis codes per claim and four diagnosis codes per procedure code. If more than six diagnosis codes are documented but not used, athenaClinicals drops any diagnosis codes beyond the first six. This note refers only to diagnosis codes that are not used.
Note: After a claim is created, the Save & Go To Charge Entry button is replaced by the Save & Go To Claim Review button.
Note: Exploding codes are not affected by the charge integration workflow. athenaClinicals will pass procedure code information to auto-populate the Charge Entry tab.