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Manual for BC Billing in OSCAR

A copy of the handy manual for BC billing in OSCAR 9.12 written by Patti Rodger Kirkpatrick

BC Billing

Billing Medical Services Plan (MSP) with OSCAR

 

Your office data centre and Teleplan password must be set in OSCAR by your service provider.

Teleplan must be advised that you will be using the OSCAR software to transmit your billings.

In order for an invoice to be assigned to a caregiver (physician, midwife) their MSP billing number must be set in the provider record, as well as the billing number which will be paid for the claims.  

See 4.0 System Admin-

adding a provider records.

 

 

CREATE A UNIQUE BILLING SCREEN

 

Set a billing screen in OSCAR that reflects the most commonly used service codes to provide ease of access.

This sections requires ADMIN access.

 

1.Click on the ADMIN tab

2.Choose the option under the Billing Category, Manage Billing Form

3.To amend the General Practice billing form, choose it from the pop-down menu, click the radio button for service code and then click Manage

4.Enter in the service codes most often used in your clinic into the boxes listed.

(Note – OSCAR will choose codes from column 1 which are relative to the patient's age – do not change the codes in this column or typical billings for 00100 etc will not display.)  The numbers displayed on the right will determine the order that the service code will display on your billing sheet with the exception of those in column one.

5.Once you have entered all the codes click UPDATE on the bottom left of the screen

 

CREATE LINKS BETWEEN SERVICE CODES AND PROCEDURES


To ensure that billing "extras" are not missed by providers during the billing process, align codes so that when one is picked, it will automatically link to another which should be charged.

Link Service Codes with Procedures

– most offices will find that linking certain extras or procedures will ensure that billing is maximized.  As an example, billing 14560 can be linked with 00044 (mini tray fee) so that the mini tray fee is not forgotten during the billing process – it will automatically be posted when 14560 is picked.

 

1.Click on the ADMIN tab

2.Choose Manage Procedures/Fee Code Associations

 

3.Enter in the Service code you with to associate with a procedure.  If you are unsure of the service code you can enter in some text or numbers from the code and search the data base of service codes

4.Press Tab to move to the following row, and enter in the tray fee code, or search the data base by entering in text or numbers

5.Click Save  association.

Once this is complete, when the service code is chosen during billing, the associated procedure fee, or tray fee will automatically be picked as well.

 

CREATE LINKS BETWEEN SERVICE CODES AND DIAGNOSES

 

Enhance overall office efficiency in billing by linking service codes automatically with their relevant ICD9 code.

Service Codes Linked to Diagnostics

– can be created as well through the Admin Page of OSCAR for service codes which are always associated with a particular diagnosis. An example – 14560 can be linked to the diagnosis V762 or service code 14050 is linked to 250.

 

1.Click on the ADMIN tab

2.Choose Manage Procedure/Diagnostic Code Associations

 

3.Enter the Service Code into the first box, and the ICD9 code into the second box

4.Click Save association.

The diagnostic (ICD9) will automatically be entered during billing, when the service code is picked.

 

BILLING FROM THE APPOINTMENT SCREEN

 

An office visit can be billed directly from the Appointment screen, simply by clicking on the B to the right of the patient name. 

The default billing screen will be displayed as determined by the instructions above.

However, codes which are not displayed can be selected by entering the service code, or text contained in the service code description, into the white box, titled Other service/procedure/premium codes

pressing ENTER and reviewing the list of service codes returned in the search.  Click on the relevant code, click OK at the bottom of the screen.

 

 

To assign the diagnosis

Click on the box to the right of the relevant service code

Use the Tab key to move your cursor, or Click in the diagnostic code box

Enter the ICD 9 and press continue.

If not familiar with the ICD9 codes for diagnosis, entering text into this area and clicking on Code Search will return a list of diagnoses which contain the text sequence provided. 

Choose from the list and press ok.  A summary of the billing will display.

 

Review the Billing

Provider needs to review all the information and correction can be made by click “go back” button for correction .

Click Save Bill to Finish, Another bill to choose another service code with a different diagnosis, or back to make corrections.

 

The appointment slot with the patient name will now display in blue with a check mark.

Billing can also be done from the Patient's Master Demographic by choosing Create invoice.

Continue to bill as above – noting that a caregiver will not automatically be assigned to the billing – you must assign the bill provider by choosing from the drop-down menu. Billing is usually conducted in this manner for out of office visits. (It's worthwhile to create a separate billing sheet for the out of office fees most often used by the caregivers in your office...see above)

Preparing MSP Submissions

As invoices are created through OSCAR billing, the status of bill changes to “not submitted”. These invoices can be reviewed prior to transmission to MSP Teleplan through the Admin Page, Simulate Submission.

Invoices which OSCAR finds to be erroneous will be marked below with a red line. (OSCAR cannot find all billing mistakes, but is programmed to look for PHN numbers, diagnostic codes, errors in WCB claims, missing referral doctors) Corrections can be made to the invoice before you send by clicking on the invoice number, which will open the Edit Invoice screen. Make corrections where necessary then click the reprocess button at the bottom of the screen. You will see the changes you have applied. Clicking reprocess and resubmit will make your change and return you to the Simulate submission window.

Out of province PHN's (except Ontario) must be prefixed with zeros to bring the total of digits to 12 for submission to Teleplan. OSCAR will find this an error that you will learn to ignore. As well, a WCB claim without a claim number will be marked as an error – this can be overridden/ignored.

Once satisfied with the claims displayed on the simulate submission, close the window.

To transmit the file to Teleplan

  1. Click Admin

  2. Click Generate Teleplan File 2

  3. Choose the provider or choose ALL and then Click Create Report. (be patient it may take a minute)

  4. Once the hour glass disappears you will see a row of text created with today's date, a number of files, the word SEND as well as an MSP file name and an HTML filename.

  5. Click on the word Send. (OSCAR is making the connection to the MSP Teleplan website) Once the word send becomes the word SENT your transmission is complete. Claims that have been transmitted will be modified to display SUB (submitted)

     

Collecting Errors and Remittances from MSP Teleplan

Billing errors returned by Teleplan can be retrieved as often as desired by the office. Remittances will only be returned twice a month and will reflect payments made to the caregivers based upon billing cut-off and payment date.


To collect remittances and error reports

  1. Click Admin

  2. Click Manage Teleplan

  3. Click Submit Query below the option Get Remittance.
    If there are errors, the results will display in Edit invoices. The default view will return Rejections. To view PWE or Held claims, click on the radio button alongside the option and create report.
    Remittances can be seen by clicking MSP Reconciliation Reports. Reports can be viewed as a PDF file, or can be exported in a spreadsheet format by choosing the CSV format.

Correcting and Resubmitting Errors to Teleplan

Errors returned by MSP Teleplan will be returned with an accompanying error message. (For an up to date listing of all Teleplan error messages see http://www.health.gov.bc.ca/msp/infoprac/physbilling/payschedule/index.html)

To view and correct rejections

  1. Click Admin

  2. Click Edit Invoices – which will default to return the a list of all the rejected claims. (PWE errors must be viewed by clicking on radio button to the left)

  3. Choose the invoice you wish to review and correct by clicking on the error message

  4. Make modifications to the invoice as needed. (Change the service code, date, ICD9 etc.)

  5. Click reprocess to see the changes.

  6. Click resubmit to resend to Teleplan. (Reprocess & Resubmit will make the changes and process the claim directly into the queue for submission)

Bills that are to be removed from the submission which have been made in error or are not going to be collected may change the type, to Deleted, Do Not Bill, Bad Debt. Changing the 'type' will not remove the service code and will leave the bill showing as outstanding. Consideration to creating a manual service code with a value of 00.00 is recommended when using Deleted or Do Not Bill in order that the patient's invoice list does not show amounts outstanding.

Private Billing

Although fee codes for private services such as forms etc. have been suggested through the BCMA, many offices choose to set codes that best suit their demographics/and or location. OSCAR allows for practices to set the fee codes as determined by their needs. Currently, there is not a facility through OSCAR billing to change a price “on the fly”. Therefore, it is useful to create billing codes which can be used for sale incrementally; charge in units. IE – set a fee code of $10 and sell 2.5 units to incur a fee of $25 to a patient or insurer.

Creating private billing codes

    1. Click Admin

    2. Click Manage Private Bill

    3. Click Add code

    4. Enter service code (Either numbers or letters as your choice. A is automatically added, as this is how OSCAR differentiates private fee codes.)

    5. Enter Description as you wish it to appear on the invoice.

    6. Enter Price

    7. Click Add

Creating a private billing sheet

  1. Click Admin

  2. Click Manage billing Form

  3. Create a Private billing form with the abbreviation PRI. Give it a description such as Private Billing

  4. Next Access this newly created billing sheet – Manage the billing form

  5. Click the Radio button for Service Codes.

Pop up window with three columns with two sections each will display. Enter codes into the first section of each column as detailed above with other billing sheets. All private codes must be prefixed with the letter A, and care should be taken to enter the service code on the form, exactly as it was created.. Any codes billed privately for can be entered in these columns. Sort into columns, and determine the order of service codes by itemizing with the number 1-20 in the second column.

 

TO BILL PRIVATELY

  1. If billing from day sheet click on B. If not search patient and click on the demographic ID and choose create invoice.

  2. Click on down arrow beside Billing type and choose private. This should result in the Private billing form created in ADMIN to display

  3. Choose physician, date of service and service location.

  4. Click on appropriate fee code and units if applicable.

  5. Enter in diagnostic code (Administrative billings can often be assigned a billing code which denotes that the visit was not for purely medical purposes. Search Admin in the billing code field)

  6. Click Continue

  7. Click on Save & Print Receipt or any of the 5 button options of Go Back, Another Bill, Save Bill and Cancel.

Creating Third Party Insurers

  1. Follow steps 1-7 to bill privately

  2. Click on Save & Print Receipt

  3. An invoice will display, allowing the option to bill to a party other than the patient.

  4. Click on add/edit address

  5. Type in Company name exactly how it will be shown on invoice and click search. (You must search every time you are entering in a new insurer, or it will not save)

  6. Enter in Insurer information and click save

  7. This will bring you back to your invoice where you must click search again to add the recently added “supplier”.

  8. Enter in company name you are billing, and as long as it has been added to the database, it will populate the invoice with an address etc.

    1. Click on update invoice

    2. To print and mail – click print!

    NB - Once insurers are entered into system they can be searched by telephone number, postal code or name

Receiving Payments on Private Bills

Once a private bill has been created payment may be applied at the time of invoice, or at a later date. If the invoice is to be sent in the mail to a third party, this will create an accounts receivable within OSCAR and will display in the accounting reports.

Accepting Payment at time of Invoice

  1. Once the invoice has been created following the steps above, payment can be accepted prior to printing the invoice. Click in Receive Payment.

  2. Apply the amount owing on the invoice, or the amount paid as applicable.

  3. Enter the form of payment (Cash, Cheque, Credit card)

  4. Print the invoice.

  5. Apply payment to the invoice; noting that this payment will be reflected in the payments and refunds(cash) report for this date.

Receiving payment on Accounts Receivable

  1. Search for the patient demographic

  2. Click on Billing History

  3. On the Left end of the Billing Display, note the invoice number associated with the private invoice.

  4. Click on the invoice number, displaying the relevant invoice, then click VIEW Invoice in the top left.

  5. Apply payment to the invoice; noting that this payment will be reflected in the payments and refunds(cash) report for this date.

Debiting Claims to MSP

 

At times, claims will need to be resent to MSP although the claim was previously paid in full. (Perhaps it was billed to the wrong physician or a the wrong fee code was used.) This process is known as Debiting a Claim.

  1. Search for the patient. From the Master Demographic access their invoice list.

  2. Change the Submission code to DEBIT REQUEST

  1. Enter in the Sequence number of the claim your are debiting. (See Billing History on the bottom right of the screen.)

  2. Click Reprocess and Resubmit.

Using the Accounting Reports

Daily Cash out Balance Sheet to Reconcile Private Billings

  1. Click on Admin

  2. Click on Accounting Reports

  3. Click on Account (which will bring up provider you would like to run report on)

  4. Click on Report type and choose Payments and Refunds (Cash).

  5. Click on Start Date and End Date

  6. Click Private (if you are doing a cash report, you won't need to see WCB, MSP or ICBC)

  7. Click on Create Report

This report will allow you to balance all cash, visa, debit and cheque incomes you have received for dates chosen. Offices should use this report to accompany and reconcile bank deposits.


Invoice Report

This report allows you to see what has been billed for any particular provider for any chosen period of time. NOTE – this report is based upon Service Date, not upon Billing Date.


  1. Click on Admin

  2. Click on Report type and choose Invoice.

  3. Click on Account (this will bring up a list of Providers to choose from)

  4. Click on Start and End dates

  5. Click on Insurer types – ie WCB, MSP, Private, ICBC

  6. Click on Create Report


Rejection Report

This report allows you to see at a glance all rejections for any period of time.

  1. Click on Admin

  2. Click on Accounting Reports

  3. Click on Select Account which will bring up list of providers

  4. Click on report type and choose Rejections

  5. Click on start and end dates – relevant to service date.

  6. Clock on Insurers that you would like to see rejection lists for.

  7. Click on Create Report

NOTE – once Rejections have been corrected in the EDIT invoice screen under ADMIN, Billing; they will no longer appear in the rejections report. This report only displays invoices which remain with rejected status.


Write Off Report

This report displays patient claims which have been marked as Bad Debt. This report is especially significant for accounting period end reporting.

  1. Click on Admin

  2. Click on Accounting Reports

  3. Click on Select Account will bring up a list of providers

  4. Select Report Type

  5. Select start and end dates relevant to service date.

  6. Select Insurers as applicable by clicking the radio button

  7. Click on Create Report


UNBILLED REPORT

This report allows you to see all appointments where the billing may have been missed without needing to access each day sheet. The frequency which this report is run is relevant to the practice and does not require Administrative privileges.

NOTE – OSCAR will report on patients who have been marked as HERE.

  1. From the main appointment screen sheet click on Billing tab

  2. Click on Unbilled

  3. Click on Select Provider

  4. Click on Service Date Range or leave


Using the CSV or spreadsheet Export function with OSCAR reports

Although the above accounting reports provide a variety of views pertaining to fiscal needs, OSCAR also provides a feature enabling the user to manipulate data in a manner specific to the practice in a spreadsheet format. Spreadsheets allow the user to sort data and create calculations outside of OSCAR. Below is an Example of using CSV (comma separated version) Spreadsheet Export of the MSP Reconciliation report.


MSP payment to Physicians – sent to spreadsheet

From the Admin page in OSCAR choose, MSP reconciliation reports.


At the right end of the payment detail, choose CSV (comma separated version) of the BILLED. OSCAR will reply by attempting to open the REP_MSPREV.csv and will prompt you to open or SAVE. Choose Save to disk.


Open your spreadsheet program. In Open Office it is CALC.

Choose file, open, then access the REP_MSPREV.csv file from the location you just saved it.

CALC will prompt you that it is trying to open a file which has been saved in a different format than it recognizes. At this point, ensure that the program is identifying that the data in the .csv file is separated by comma. (This is where it will line up the data nicely in a spreadsheet format.)


Click OK.


You will see the spreadsheet with data in columns A to J. Note, that Item is the billing code, and column A is Practitioner. (If there is no label in Column A, move the cursor to A1 and type, practitioner.)


Now – what you want to do is sort and subtotal. We want to get a total of each service code, by doctor.

Before CALC can subtotal, it must be sorted.


Click on the tan rectangular box above the number one and to the left of Column A to select ALL. Click DATA, Sort.


When the Sort dialog box opens, click on the Options tab. Click, range contains column labels. (This will allow you to sort the columns by label, rather than just A, B, C etc.) Now click on the sort Criteria tab. Choose Sort by Practitioner, then by Item. Click OK and your list should now by sorted.


With the highlight still on, click DATA, subtotal. In the 1st group, Group by, choose Practitioner, and in the calculate subtotals for click AMOUNT and USE function sum. Then in the 2nd group click Group by, Item, Calculate subtotals for Amount, use function SUM and click OK.


This will total, by service code per doctor amounts which should match the MSP payment for this period. Clear out any of the colums that you don't need, like the code, payment date, sequence number, DC#. Click on the column heading to select that entire column, then choose Edit, Delete Cells, and choose to delete the entire column.


Now, you can copy and paste the summaries for each physician to their pay sheet. Just remember when you are pasting, choose paste special, and click numbers. (You don't need to paste the formulas as the rows are going to be different once moved to the pay sheet.


OTHER BILLING MISCELLANY


On-line Teleplan Interface

MSP’s Teleplan Web Access is currently not available as a link within OSCAR. The website address is https://teleplan.hnet.bc.ca/TeleplanBroker . Teleplan Support Centre phone number 1.866.456.6950

  1. Log on using your data centre number as user name preceded by TTU

  2. Enter in your current password. This will be the same password you use in OSCAR for Teleplan submissions and is set every 42 days through Manage Teleplan in OSCAR Admin.
    (If this password is inadvertently set while accessing the Teleplan site, see Frequently Asked Questions below)


Options at the TELEPLAN Website


Send Claims – Should not used by OSCAR users

Retrieve Remittances – Should not used by OSCAR users

Other Processing & Logs – by clicking on this option you can retrieve data files such as fee codes, a list of ICD9 3 – 5 character codes, MSP fee schedule rates, adjustment codes, rural retention premium codes and diagnostic facilities listing various labs etc.

Check Eligibility – Used to check if patient’s coverage is up to date, or to find out patient’s correct name as registered with MSP. You must have the PHN, date of birth and date of service you would like checked to gather information

Change Password – should not be used by OSCAR users, password should be changed within OSCAR

Help – provides a menu with instructions how to do all the above, in addition to what the minimum requirements are to use Teleplan billing

Sign off – used to log off web page.


In addition to these options you can retrieve close off dates and Teleplan system unavailable schedules. (Times when Teleplan will be down, usually maintenance or database organization related.)


OSCAR BILLING FAQ'S



What does a Sequence Error mean – where will the error display?


A sequence error means that the last number of your previous submission batch and the first number of your new submission batch have not matched up sequentially.

A sequence error will show up at the top of your teleplan group report during Generate Teleplan File.


Sequence Error – what should you check?
In the Teleplan Group Report, have all generated claims been marked SENT? Should any batches remain with the status SEND, these need to be submitted first, even if they display 0/0 claims.


Understanding your Teleplan report


There are 7 columns in your teleplan group report. The first two columns, Provider and Group number are blank.

  1. Creation – refers to the date the submission has been created.

  2. Claims/Records – indicates the number of claims in that particular submission

  3. Teleplan – indicates the status either “Send” indicating it is ready to be sent, or “Sent” indicating it has already been completed.

  4. MSP File name – You will see that each submission begins with the letter H and has a subsequent letter beside each month. Example HA, HB, HC. The first letter is always the same, the second letter indicates the month, ie: January is A, February is B, etc. and the following numbers indicate the date the submission was created. The final 3 digits indicate the number of submissions created that month. EG: HC090320 081520 009 would indicate that this is the 9th submission created in March, this one in particular on the 20th of March 09.


What are the steps to changing a password in OSCAR when prompted by Teleplan?


Teleplan requires that data centre passwords are changed every 42 days. Should your password have expired, you will be returned an error message during OSCAR's Generate Teleplan process. A Message will display on the Generate Teleplan screen – LDAP Error - Password is invalid.
1. Access the ADMIN tab
2. From ADMIN choose Manage Teleplan in the Billing section
3. Enter the password as you currently know it
4. Then create a new password in the space below for NEW password , and then reenter it in the space directly to the right.
5. Then press Submit.


What Happens if the Data Centre Password is Changed at the Teleplan Site?

If the data centre password is inadvertently changed while visiting the online teleplan site, or directly with a teleplan agent on the phone, OSCAR and Teleplan will not be able to “shake hands” The remedy for this error is to access the ADMIN page in OSCAR. Set Password – and in this area enter the password as was set on the teleplan site. Immediately enter this as the current password, and change it!


If the password was manually changed by an agent at teleplan, the instructions above apply.

**Teleplan only allows temporary passwords to be used ONCE – making it necessary to change the password within OSCAR immediately.

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