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jpisariktnosi
Premolar I

Medical/Dental Billing Issues

I find that the WinOMS workspace section has been quite ignored by the development team. For instance, the billing section feels like a dental software that you just added a few features to so we could bill medical. Here are some of my major issues having billed medical and dental in the software for the past 4 years. From what I understood after speaking to several people at the summit, there is no other way to do these than the work-arounds noted below. Sorry, this might be lengthy!

1) The system automatically defaults to sending to medical first or dental. Oral surgery isn't that cut and dry, and that button should be unnecessary. If a patient as 2 dental insurances, the system defaults to billing to insurance listed first in the demographics. It would be great if it did this for ANY insurances- whatever is on top for that particular patient- be it a medical or dental insurance- gets billed first. In essence, there is no need for an system-wide decision that ALL claims go dental or medical first. For example, a patient has all thirds out under anesthesia and they have medical coverage. The system automatically bills to dental. I would have to go to the ledger, highlight the line items, edit, select the medical insurance to bill, then go into the claims area and change the medical claim to submitting electronically (it sets up automatically this way as going paper. If I want it to go electronically, I have to set the claim up by dragging over the medical insurance on every single line item), then stop the dental claim from going out. Since not all accounts are like this, I spend the last hour of my day opening every patient account we saw that day to see if their claim needs special attention.

2) Many medical insurances want things billed via units. (So if we took out 3 teeth as D7240s, only one line item is sent with 3 units listed). However, most dental insurances want it by line item, since they keep track of tooth numbers. I know that there are ways in the system to actually put in units and have the ledger do the multiplication. But putting it on the ledger initially as units then doesn't allow you to break it back into line items when you are ready to bill dental without reposting procedures and messing with production reports. The only way I have found to do it is to charge each line item, then only allow one of each code to be applied to the medical claim, change the units, then get the claim all set up to bill and before hitting transmit, go into the physical coding of the claim and change the amounts so they match the units. (I don't recommend anyone actually do this, as changing one small thing incorrectly will ruin your claim. But I'm honestly going into the coding so much that I've pretty much figured out what everything means and does). After medical pays, I then set all line items to bill to dental.

3) While diagnosis codes aren't currently needed on dental claims, they are REQUIRED on medical claims. I know how to add them via editing the ledger, and I know how to add them per line item via the workspace treatment plan, but our providers send up everything via the encounter form in point of care. On that screen, there's no way to put diagnosis codes on individual line items, which is incredibly important for proper payment. One customer rep told me that the provider should just write a note in the system for which line items get which diagnosis code and have the person processing the charges fix it, but that makes that part of your system no more useful than just sending up a paper version and having someone type it in.

4) The reporting that we now get for transmission reports and claims statuses are so lacking in the info we used to get from Emdeon. We don't even get enough patient information sometimes to easily find the account in WinOMS!

5) When calling insurance companies, you almost always need the insurance subscriber's name and date of birth. This is easy to find in the system by editing the patient workspace, opening the insurance screen, and clicking the ellipses next to the subscriber's name. This works wonderfully if there's only one person in the system with that name. If there's not, every person with that name will show up on the left-hand side. I don't necessarily mind that you do this (I can work around that), but the one you've chosen as the actual subscriber doesn't end up on top even! So if you open that up and there's 15 people (which is not uncommon with last names like Smith, Jones, Johnson, etc), you have no idea which is the actual subscriber.

6) Someone mentioned it elsewhere and I will second it- it would be wonderful to have a better way to move around payments money than just by line item. A simple "switch all to ins resp" or "transfer all balance to pt" would be helpful!

This is all of the insurance issues I can think of with WinOMS. Thanks!

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4 Replies
omsnashville
Premolar II

Re: Medical/Dental Billing Issues

Thanks for that vote on #6! That's been a highly desired item for ages.

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jpisariktnosi
Premolar I

Re: Medical/Dental Billing Issues

While it means our problems persist, it's at least nice to know that I'm not alone in my frustration. Though apparently I should've split all these comments into separate threads if I want any response!

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steve132221
Canine III

Re: Medical/Dental Billing Issues

I agree with #3, in particular. One of the issues we constantly see is that diagnosis codes are processed (when the encounter is submitted) in alphabetical order of code, not on the order they were selected. That really leads to a lot of back end work to correct the codes for the proper order. 

One other issue we see a lot of is this -- Let's say someone comes in for an excision biopsy of a lesion of the vestibule of the mouth (40810 for example), and it turns out to be leukoplakia of the oral cavity (K13.21). In preparation for the lab results, we enter Z87.891 into the diagnosis code list (so we don't forget to report that the patient has a history of nicotine use), but upon receipt of the results, we enter K13.21 into the diagnosis list for 40810. We reorder the list so that K13.21 is first, and Z87.891 is second, but since Z87.891 was technically entered before K13.21, the claim form will still have Z87.891 as diagnosis pointer "A". So, the claim will read a diagnosis order of "BA", instead of "AB". 

Would it be possible to make the order of diagnoses correspond appropriately to the diagnosis pointers?

- Steve

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jpisariktnosi
Premolar I

Re: Medical/Dental Billing Issues

This shouldn't matter. Insurance *should* go by the order of the pointers, not by the order of diagnosis codes. They would see that B is the primary diagnosis and place B's Dx code as the primary one for that line item.

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