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jpisariktnosi
Premolar I

Auto-Sorting by RVUs on Claims

I'm looking to sort the line items on my claims by RVUs. I thought I'd overheard someone at the conference mention this could be done, but I'm not finding where the button is to sort this way. I know where to put the RVUs. Thanks!

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6 Replies
Community Manager
Community Manager

Re: Auto-Sorting by RVUs on Claims

paula1matt.ackerman‌ can you assist with this? 

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jpisariktnosi
Premolar I

Re: Auto-Sorting by RVUs on Claims

I was informed by Ernest in Customer Service that there's no way to do this. Which is super frustrating as it can mean thousands of dollars difference in reimbursement if billed in the wrong order.

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CS Dental Employee
CS Dental Employee

Re: Auto-Sorting by RVUs on Claims

Hi Janelle, claims in Winoms can only be sorted by amount or posting. Those settings are located in Practice Preferences under the Insurance Tab>Procedure Sort Order.  Perhaps setting those fees up for Medicare or HMO as an allowable schedule to do the calculations and then based on how you have it sorted by amount or posting would automatically have in the order needed for reimbursement.

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jpisariktnosi
Premolar I

Re: Auto-Sorting by RVUs on Claims

The problem with that is that there are many states (mine included) where providers do not have to take the allowable if the service isn't covered, so we want to bill our full amount just in case a service is deemed non-covered and fully the patient's responsibility.

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omsnashville
Premolar II

Re: Auto-Sorting by RVUs on Claims

paula1, it is also a problem for us that, when a treatment plan is converted, they default to their own internal order somehow- especially when Point of Care is used. That means that all the time and attention our insurance coordinator went to inputting the treatment plan in correct order is completely undone; they have to delete all the charges and re-enter them correctly. Any information attached to that treatment plan (like pre-D's or their attachments) is also lost when we have to delete that unconverted treatment plan so it doesn't show as an "Open Treatment Plan" on that report. My phone call notes show that I spoke with Denisa @ WinOMS about this back on 7/25/12 (call ref#: 3972463), and it was a known issue at that time.

For example, this correct order:

Converted to this, without even using Point of Care:

Mind you, the RVU's set in our WinOMS for these codes are:

21196 - 42.93

21142 - 41.59

21085 - 16.44

We have our procedure sort order set to "Posting" in this example, because we wanted the ledger to reflect our input. I was able to get predictable/consistent results when switching to "Amount" as the sort order, but our prices have not always directly corresponded with RVUs, so Posting order had seemed more desirable an option.

I tried to duplicate this issue with CJ while we were at the conference, but we could not because the limited database it was drawing from. He also advised me that it is known that charges seem to change order erratically when sent up from Point of Care or the EMR Encounter, and I was able to duplicate that. For instance, in the EMR, it creates is own random order AS YOU ADD codes to your encounter, and I cannot ascertain the rhyme or reason for the new order:

They do not list in order of selection, fee, RVU, or even how they're listed on the optical ticket. It's baffling. They keep this order if sent up as "actual charges". Even more maddening, if they are sent up as a treatment plan, then later converted to actual charges, this is the order of outcome, even with "Amount" as the practice order:

*** We do not normally bill all these particular codes together, I just needed a random assortment to show the issue.

jpisariktnosi‌, the best solution that CJ and I could come up with was to (1) make sure that our fees reflect their RVU ranking (especially for medical services that are commonly converted together, like Orthognathic plans or bone grafts like 21210 & 21215), and then (2) change your sort order in Practice Preferences to "Amount"; it will list the highest price first. After all, it makes sense that our charges be based on RVUs in addition to our local geographic price indexing, so sort order is a great plus.

Regardless, the order will be scrambled when input via Point of Care/EMR Encounter until that known issue is fixed.

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CS Dental Employee
CS Dental Employee

Re: Auto-Sorting by RVUs on Claims

Janelle & Kristina,

I have been reviewing your comments and we will try our best to get this resolved soon. Support hears your concerns and I have shared them with our Development team to have this defect prioritized and changed in the software. Thank you. matt.ackerman

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