Operational Reports

Table of contents:

• Program indicators
• Clinical Time billing

Program Indicators:

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Upon successful authentication, you will be directed to the patients tab as the landing page as Patient list.

• Click on the Operational Reports Tab to navigate.

Operational Reports:

In this operational report, we can observe both CCM, RPM and PCM records based on clinical time.

• In RPM,CCM and PCM Daily snapshot, we only observe the readings from the previous day that are recorded in the clinical time.
• In the RPM,CCM and PCM Monthly summary, we can see the default duration for the current month, which can be changed if necessary.

Billing:

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if needed can also bill for PCM or CCM by just clicking on the Patient Name or Patient MRN of any particular record. if you click that in PCM snap short or summary it will start billing the patient in PCM else if you click that in CCM snap short or summary it will start billing the patient in PCM.

For example:

• If you have clicked on the CCM service and then clicked on Yes to bill the time, it will navigate you to the service with the billing timer ON. This action will disable other services because when you are billing for a particular service, you can't navigate to other services such as PCM, TCM, RPM, or AWV.

  

• If you want to stop the billing, you can click on the STOP icon at the top near the header as follows.

  

• Once you STOP the billing, the other services will be enabled, and the bill will be reflected in the clinical time billing activity section.

7. If you want to bill the records that are in the Billing section, then click the checkbox at the beginning of each record.

   

• You can see an "Add Bill" button on the Top Right of the table. Click on it to show a pop-up for adding a bill as follows.

• Service - The service name will be pre-populated based on the record you selected in billings.

  Note: If you select multiple records with different services, then it will be categorised as "others."

• CPT code: - Select the CPT code based on the billing type.

• Description - Based on the CPT code, you will receive some descriptors from which you can select.

  Note: If the desired descriptor is not available, scroll to the bottom of the dropdown, click on the other option, and enter your desired descriptor.

• Provider - The provider's name will be pre-populated based on the record you selected in billings.
• Patient - The patient's name will be pre-populated based on the record you selected in billings.
• From Date - It will be pre-populated, and the date and time will be based on the oldest record selected.
• To Date - It will be pre-populated, and the date and time will be based on the newest record selected.
• Notes - Add a note that is related to the billing.

• Call Type - It will be pre-populated when you select the CPT code. It is also editable.

  After clicking on Add, the billed records will be disabled. The bill will reflect in the billing tab.

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8. To submit the bill, click on the Bills Tab to navigate to the Bills section.

• Upon navigating to the Claims tab, select the service type in which you have added the bill from clinical time.

  Note :-

• If you have added a bill with services other than clinical time, please select the 'Others' tab in the service section of the billing.
• Billing Period - will be pre-populated for the last month. Later, you can change it as needed.

1. Clicking on RPM, CCM, TCM and Others tab, will display calls list with checkboxes for each row with details as follows:

• CPT code
• Time
• From (Date & Time)
• To (Date & Time)
• Topic
• Summary
• Status
• Action

1. CPT codes are different for all types i.e., RPM, CCM, TCM and Others. CPT codes for all reimbursement types are different.
2. Billing Period- From and To date range can be selected in the Billing period to display the calls between the selected range.
3. Click on CCM tab.

1. User can use the Add Row option to add a row in the given list with entering the details like Billing Type, CPT code, topic, Provider, Patient, Date, Start Time, End time, Meeting Notes and call type.

1. To edit the call details click on the Edit icon in Action, allows user to edit the details like Billing type, CPT code, topic, Date, Provider, Meeting Notes, call type for selected row in the list.

1. User can select the record from the list and click on Submit.

1. The submitted bills cannot be edited.

1. Each reimbursement type tab have filters as shown:

• All - Shows all the CCM call logs
• New - Displays all the newly submitted calls/ bills and are represented by Blue Color
• Submitted - Displays all the submitted calls/ bills and are represented by Light Green Color
• Rejected - Displays all the rejected calls and are represented by Red color
• On-Hold - Displays the calls which are kept on-hold and are represented by Amber Color
• Approved - Displays all the approved calls and are represented by Green color

1. You can view 2 actions in the Action - Edit and Delete. All New/ Rejected bills will have these icons enabled.
2. Once the Bill is submitted/ kept on-hold and Approved, these icons will be disabled.
3. On clicking the Rejected calls/bills, User can view the Rejected reasons, which shows the date with rejected reason.

1. Upon clicking the download icon, you will be able to access the Summary of the CCM Episode. Additionally, you can download it by clicking on the floating download button or use the print button to print the PDF.

• we can also download the each bill document by clicking on the download icon.
• we can also download the bulk bill document by clicking on the Download Supporting Documents Button

Approve Time:

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1. The calls logs that are being submitted are saved in the Billing Portal. When the Admin logs in he can view the following screen.
2. By default, we have All Programs and All Providers selected. You can change it based on your preferences.

1. On the dashboard, count for Patients enrolled, Patients billed, Bills accepted, Bills pending will be displayed.

2. On the left-hand side, there is a table icon. Upon clicking on it, a pop-up will appear where you can select the required table columns, as shown below.

   

   

3. There are 5 filters - Status, Program, and Provider, Duration and Search Bills, using which we can search the bills to review.
4. User can filter the submitted billing list based on the Status of the bill in 4 categories.

• Submitted Bills
• Bills on Hold
• Accepted bills
• Rejected bills

1. Patients which are qualified by rules engine for the set of rules mentioned for respective CPT code, will be ready to Bill and patients which do not qualify the set of rules mentioned are rejected by rules engine.
2. User can filter the submitted billing list based on the type of billing or product (All/RPM/CCM/RTM/TCM/PMPM)
3. Click on the Status filter and select Submitted Bill option and Program filter and select CCM . The following screen can be seen.

1. User can filter the submitted billing list based on the selected duration of Date from and Date to. We can view the bills based on the Duration type - Monthly or Quarterly, by default, we have Monthly selected.

1. User can filter the submitted billing list based on the provider name for the specific center.
2. Search field will be available to search the required data on the dashboard.
3. Below the filters, we can see the table with following headers:

• Checkbox - To select all the records
• Patient EMR ID
• Patient Name
• Date of Service ( Date on which the service was provided)
• CPT Type (RPM/CCM/TCM/Others CPT code and Topic)
• Note (Meeting Notes while scheduling)
• Provider Name
• Bill details (Bill ID and Month Date, Year on which billing was submitted )
• Actions (Approve /On Hold /Reject)

1. All the submitted bills in the list, in the checkbox form, user can select the bulk actions to mark the selected bills as Approved or Rejected. And also can download the bills by clicking on the Download option.
2. Click on the checkbox and click on the Accept selected bills at the right, to submit the bills. You will view a pop-up to confirm if you want to accept the bill or not. Click on Yes to accept the bill.

3. We can also reject bulk bills by selecting the records and clicking on the "Reject selected claims" button, which will be visible in the headers once you select the bills. Upon clicking the button, a pop-up will appear where you have to enter the reason for rejecting the bills and click submit. The bills will then be seen under rejected bills.

   

4. You can perform actions - Approve, On Hold and Reject for individual calls. After the call log is being Approved/ is On Hold / Rejected. Those call logs will be categorised into Accepted/Rejected/On Hold respectively.

1. If there are no calls logs, you will see an empty state showing No records found.

1. After the bills are accepted, we can view them by selecting the Status as Accepted.
2. Here, to download the Bill report, check the box for an individual record or check the box in the header to download report for all the reports.
3. We can download the report w.r.t any Status - All, Ready to bill, Submitted, On-Hold, Rejected and Approved.

1. You can view download option at the right, click on the download to download the report. You can view it in your downloads.

2. We can also add the Billed Amount, Allowed Amount, Adjusted Amount, Balance Amount for each bill in the input field where you can enter the amount and click outside the field. It will be saved, but it is only for reference and will not be referenced anywhere else.

   

3. We also have the options of Claim Denied, Claim Failed, Closed, Patient Pending, Secondary Pending, and Claims On Hold to change the payment status of each claim. To access these options, select the submitted claim status and click on the more icon as shown in the below image.

   

   
   

4. We also have the option to upload the billing reconciliation file. You can upload an Excel file with the claims data of each patient and check the history of the uploaded file. Additionally, you can download a sample file or sample reconciliation template by clicking on the "Download Reconciliation Template" button.

   

   

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