Claims and Billing (ON)

Claims and Billing is the area of Accuro that contains all the Claims and billing invoices you have for your patients. When you enter the Claims Section, the bills are displayed on different tabs:

• Daily Claims

• Unsubmitted Claims

• Not Reconciled

• Remittances

• Unmatched Remittances

• Accounts Receivable

• Tracked Claims

• Other

The remittance notes displayed when a user double-clicks on a payment period (at the bottom of the Claims window) has been updated to include filtering by Provider or Practitioner Number. The notes displayed depend upon permissions of the person viewing them i.e. they can only see items for Providers they have access to.

Billing Rules

When Billing, Accuro follows a set of Rules and checks to ensure that Provider specific default settings are applied. The Rules are checked in chronological order and once a Rule is applied the subsequent checks below are not completed. These Rules are described below with their intended functionality when creating and billing from different areas of Accuro.

Billing through the Scheduler - Rules 

1. If a Provider's default Appointment Type has a Billing Macro associated with it, a newly created Appointment with that Appointment Type will have the Billing Macro automatically applied to the Claim generated by the appointment itself. 
2. If the Patient's Last Diagnostic Code is enabled then the previously used Diagnostic Code will apply to the Claim. Adding a Billing Code/Macro which has a Procedure Code afterwards will then override the Patient's Last Diagnostic Code.
3. If a Providers Default Diagnostic Code is present then this will be added to the current Claim.
4. If none of the Rules above apply Accuro will set the diagnostic code to "0".

Billing in Claims - Rules

1. If Batch Billing is enabled, the settings will apply to the new Claim.
2. If the Patient's Last Diagnostic Code is enabled then the previously used Diagnostic Code will apply to the Claim. Adding a Billing Code/Macro which has a Procedure Code afterwards will then override the Patient's Last Diagnostic Code.
3. If a Providers Default Diagnostic Code is present then this will be added to the current Claim.
4. If none of the Rules above apply Accuro will set the diagnostic code to "0".

Switching Providers in a Claim - Rules

1. When a Provider is assigned to a Claim, the Rules from above are applied based on where the Claim is created.
2. When a different Provider is assigned to a Claim, their Rules and billing defaults will apply to the existing Claim.