What does the "Accept Charges" Button do in Service Code Capture and can it be Ignored?

Question: What is the function of the "Accept Charges" button, which appears in the Service Code Capture (inpatient and outpatient), and can the button be suppressed or removed?

Context: The Service Code Capture (SCC) activity in Connect Care can be accessed as a tab within inpatient charts and as part of after-visit workflow or an independent activity in outpatient charts. Some prescribers have noticed an "Accept Charges" button towards the bottom of SCC, just above where claims (submitted billing codes) are listed.

Curiosity is increased when noting that failure to select this button does not stop billings from being recorded or processed. Understandably, the same prescribers wonder if clutter could be reduced by removing the button.

Answer: It is true that billings will be submitted and processed (in accordance with the prescriber's billing arrangement with Connect Care) if a charge is created in association with a clinical encounter, irrespective of whether the "Accept Charges" button is selected. The charges are processed when the user navigates away from the SCC (the charge status will change to "filed"). Erroneous charges can be deleted (during a grace period) even if filed.

Clicking on "Accept Charges" will immediately file the billing request while immediately performing any final validations (we do not have many of these). Given Connect Care's current configuration, there is not much to be gained by taking this extra step.

Users can suppress the "Accept Charges" button to make for a more streamlined SCC. Select the personalization button (wrench icon) near the top right of SCC and note that there is an option to "Use slim charge lists". Activating this will suppress the Accept Charges button for the current user.

Virtual Care Professional Billing Codes - COVID Considerations

We've previously posted about new Virtual Care Professional Billing codes. Questions arise related to e-consults and e-visits within and without health care facilities, with Dr Adrian Wagg providing these clarifications:

• The pandemic code 03.08CV can be billed from anywhere and can be used for inpatient virtual consults as much as any other virtual consultation.  The AMA suggests that being in the same facility should be no barrier to the use of this code.
• The code 03.03FV is for outpatient follow up only as indicated in its name description, so please use this accordingly.
• The code 03.03CV is for unreferred limited assessment, but there's nothing in the rules preventing the use of 03.03CV to bill virtual inpatient encounters.
• Note: at a minimum a physician must complete a limited assessment of a patient's condition requiring a history related to the presenting problems, appropriate records, and advice to the patient. The assessment must last a minimum of 10 minutes. An assessment that does not meet the minimum requirements or is less than 10 minutes must be claimed using 03.01AD
• Existing codes deal with telephone consultations with nursing, pharmacy and allied health staff - this is unchanged from usual practice.

All codes are fully configured and operational within Connect Care.

Virtual Care Professional Billing Claims - UPDATE

We've previously posted about the re-introduction of billing code 03.03AD to support physicians providing COVID-19 related advice to patients via telephone, teleconference or other virtual care support technologies. Unfortunately, physicians struggling with the need for more pandemic-appropriate remote care find the 03.03AD option a poor fit to things like remote chronic disease management and legacy telemedicine billing codes have an AHS facility requirement incompatible with social distancing.

New Virtual Care Codes
Alberta Health has released information about three new virtual care billing codes:

• Visit Services (03.03CV and 03.03FV)
• Consultation Services (03.08CV and 08.19CX)
• Mental Health Services (08.19CV and 08.19CW)

These codes will become available in Connect Care service code navigator within 24 hours and can be used retrospectively from March 17, 2020.

Restrictions
The new Virtual Care codes are intended for health services that cannot or should not be provided in-person during a pandemic. Physicians must meet all the usual standards applicable to the provision and documentation of clinical care, including:

• Appropriate request to initiate (e.g. referral, patient request) the health service(s)
• Appropriate clinical documentation in the legal record of care
• Time assessments should be limited to the duration of actual patient interaction
• Usual limits on number of assessments for the same patient (in-person or virtual) in the same day
• Premium (time, complexity, etc.) modifiers cannot be used
• 03.03AD should be used for virtual care services 10 minutes or less in duration

Choice of Virtual Care technology is important. The telephone can be used when this fully meets the clinical interaction need. Otherwise, AHS enterprise video conferencing (Skype for Business, AHS Zoom) has requisite privacy protections and should be used.

• Byte: Videoconferencing for Virtual Care

How can COVID Virtual Visits be Billed? - UPDATED

Question: How can COVID-19 Virtual Visits be managed and billed in Connect Care?

Context: As the COVID-19 pandemic unfolds, physicians need to shift as much patient interaction as possible to "virtual care". This can allow isolated physicians to continue to participate in care. Additionally, avoiding patient visits to clinics and emergency rooms may blunt virus spread among patients and staff. Physicians are asked to convert as many follow up outpatient visits as possible to telephone consultations in order to maximize social distancing. Some of those encounters may require use of Virtual Care supports made available to AHS physicians. These telephone and televideo encounters have new provisions for professional billing claims.

Answer: A previously used code, HSC 03.01AD (with health condition code ICD 079.82 or 079.8) is reactivated for immediate use to support COVID-19 related patient interactions. The claim can be used provided that the patient interaction (via telephone, teleconferencing, virtual health) is:

• Providing care related to COVID-19
• Providing care for any condition when the physician or patient is in isolation.
• Limited to one claim per patient-physician combination per day.
• Can include advice, prescription management.
• Documentation of the encounter is required.
• Communication must be with the patient or patient's agent.
• Must relate to actual care and symptoms, not providing general COVID-19 information that can be gleaned from publicly available sources.
• Not to be used for Health Link communications or services.

Unfortunately, this 03.01AD code is calibrated for short interactions and, if used, precludes use of other virtual care codes. HSC 03.05JR (physician to patient telephone advice), HSC 03.01R (physician to physician secure communication), 03.01S (physician to patient secure electronic communication) remain available. HSC 03.01T (physician to patient secure video conference) is under discussion to open its availability for the virtual care technologies appropriate to the current pandemic.

How can I bill retrospectively?

Question: Sometimes busy clinicians are not able to bill for professional services at the time of a patient's hospital or clinic encounter. How can one, within the limits allowed by Alberta Health, go back and submit a claim for services performed in the past?

Answer: The Connect Care Service Code Capture (SCC) activity works best when a patient's chart is opened in a current encounter (hospital admission, clinic visit, etc.). However, it is also possible to use the SCC activity to submit claims for services associated with encounters that have already closed (patient discharged, clinic visit closed, etc.). The trick is to open the chart, then open the correct encounter, before using the SCC activity.

For services associated with inpatient admissions:

• Open the patient's chart.
• Seek the "Select Encounter" activity (tab) by finding it in the "more" list of additional chart tabs or using the global search with the keywords "select encounter" and "Jump to" the activity.

• Double-click on the "admission" encounter of interest. This will open that encounter and change the chart view to resemble an admitted patient.
• Seek the SCC activity (tab) by finding it in the "more" drop-list or use the global search with the keyword "service code".

• You can use the SCC activity as if the patient is still admitted, taking care to navigate to the correct date for the billable service using the date selector at the top left of the SCC activity display.

For services associate with outpatient (clinic) encounters:

• Open the correct patient chart and select the correct outpatient encounter as described above.
• Note that an attempt to open the outpatient encounter will cause a query to appear if the encounter is already closed (if the encounter was not closed, the encounter provider can proceed immediately to the SCC activity and enter a professional billing charge).
• In order to add a service charge to a past closed encounter, it is necessary to open the outpatient encounter for "addendum".

• Once the encounter is opened for addending, go to the "Wrap Up" chart tab and work with the SCC activity to record the appropriate professional billing charge.
• Remember to close ("sign") the encounter when finished.

How can I generate a report of recent professional billings?

Professional billing reports are available through the Reporting Workbench workspace. A generic report can be accessed and run. It can also be saved as one or more personal favourite reports. These can be tuned to focus on specific time intervals, contexts (e.g. inpatient, outpatient) or even billing codes.

• Tip: Finding Billing Reports

Which Physicians use Connect Care for Professional Billing?

Question: Most physicians who are required to enter billing claims in Connect Care know who they are, especially those in alternative reimbursement plans and service contracts with Alberta Health Services. But there may be uncertainty about grey areas, like fee-for-service physicians on time-limited contracts with group plans.

Answer: See a 1-pager summarizing how professional billing is supported in Connect Care. For the most part, physicians who have billed through eCLINICIAN will shift to billing through Connect Care. All physicians working through clinical and academic ARPs (AMHSP) will have been informed about whether their plan has arranged to shadow bill through Connect Care.

Those arrangements include the locum and fee-for-service physicians seconded or contracted to the ARP to fill clinical service gaps. They are expected to bill through Connect Care.

Physicians who have an independent billing service are able to take advantage of Connect Care for claim capture, then generating a report for provision to their billing service.

• Manual: Professional Billing
• Byte: Connect Care Professional Billing Supports