Description
Based on your settings for the various levels of billing, the system assigns the appropriate lab account number during order entry so that the charges for the order are credited to the correct entity.
Access
Internal Billing Settings
- Define billing status rules in the Billing Status Rules administration page.
- Assign billing status rules to hosts or insurance companies (for all hosts or for specific hosts) or insurance plans (for all hosts or for specific hosts) in the Hosts or Insurance administration pages.
- Assign internal billing account numbers in the Hosts administration pages.
- Determine whether the system displays internal or external billing information on the Order Patient Samples page using a setting on the Locations administration page.
- Determine whether the system displays internal or external billing on requisitions and manifests and/or in HL7 messages using a setting on the Hosts administration page.
External Billing Settings
- Adjust the user-level (or ordering provider-level) billing settings in the Lab Accounts page (accessed from the User page in the My Preferences section of the program or from the Users administration page) or in the Account Number Pop-up during order entry.
- Adjust the location-level billing settings in the Location Lab Accounts page in the This Location section of the program.
- Only a system administrator may adjust practice-level billing settings in the Practices administration page.
Technical Manual
Definition of Billing Levels
There are two types of billing in the system: "internal billing" and "external billing." The system considers the billing relationship between the business entity using the system and the laboratories performing the testing for that business entity to be "internal billing," while the billing status/account number settings for users, locations, and practices is "external billing."
Once you define one or more billing status rules for internal billing, you may do the following:
- Assign the billing status rule to the host, insurance company (for all hosts or for specific hosts), or insurance plan (for all hosts or for specific hosts) it applies to. See the Hosts or Insurance topics.
- Define on the Hosts page the internal account number for the billing status, as well as define the billing status (internal or external) that appears on the host's requisition and the billing status that is sent to the host via an HL7 message. See the Hosts topic.
- Configure on the Locations page which billing status appears on the Order Patient Samples page based on the user's signed-in location. See the Locations topic.
| Host-specific insurance plan | These rules apply to specific hosts for the insurance plan. |
|---|---|
| Insurance plan | These rules apply to all hosts that use this plan. |
| Host-specific insurance company | These rules apply to specific hosts for the insurance company. |
| Insurance company | These rules apply to all hosts that use this company. |
| Testing host | These rules apply to the selected host if it is the testing location. |
| User-level (Ordering Provider-level) settings | These settings are used for orders placed by specific providers. Non-provider users will not have these settings. Adjust the user-level billing settings on the Lab Accounts page or on the Account Number Pop-up during order entry. |
| Location-level settings | These settings are used for orders sent to specific locations. Adjust the location-level billing settings in the Location Lab Accounts page. See the Location Lab Accounts topic. |
| Practice-level settings | These settings are used for orders when no location-level or user-level settings are available, or when the Orchard Administrator has set up a practice-level lab account to override the location-level and user-level settings. See the Practices topic. |
Assigning Lab Account Numbers to Orders
The system assigns lab account numbers when you place an order.
When you reach the Order Patient Samples page during order entry, the system automatically assigns the lab account number for billing based on the check it performs.
As the system checks your billing settings to assign the lab account number, it first looks to see whether to display the internal or external billing account information. This setting is located on the Locations administration page.
| Internal Billing | When displaying internal billing information based on billing status rules, the system displays the account number from the Hosts administration page. |
|---|---|
| External Billing | When displaying external billing information, the system reviews your billing settings in the following order: User, Location, and then Practice.
You may manually make some modifications to the automatically assigned lab account number on the Account Number Pop-up. |
| Internal Billing | The system displays the billing status from either the Hosts or Insurance administration pages, depending on the level at which the billing status rule is set. |
| External Billing |
|
| Allow Client Bill for Medicare for this practice | Select the setting (which supersedes the Allow Client Bill setting, if enabled) for the practice the user is associated with. If the Medicare type insurance company/plan allows client bill, users can select client bill for order choices, as long as the ordering practice allows Medicare type insurance to use client bill. If the Medicare insurance is set to allow client bill, but the practice is set to not allow client bill for Medicare, then the system will not allow client bill. |
| Allow Client Bill | Select to allow practices or providers to bill the client for testing. |
