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jpisariktnosi
Premolar I

Old data is "sticking" to codes

I'm having yet more issues with the system "remembering" how a specific code was set up and using those settings any time we then transfer treatment from a treatment plan to actual charges or are submitting/resubmitting claims. My current example is this (though this is in no way unique):

The ADA created the new "initial 15 min" anesthesia codes. It got initially set up in our system in a way that it was not being put on medical claims. A patient was seen Jan 3rd and we've been trying to get the claim in full to her medical insurance ever since. We just today realized that the issue (which was corrected the first week of Jan) was not corrected on her account, so all the while it's been being resubmitted without the anesthesia code. The ONLY way to fix this issue is to delete the line item and re-post. I'd done this for everyone else that got the charges posted before the fix and I'd assumed hers had been fixed, too, but since there's no way to actually see this, it got overlooked.

Here are the issues this creates for us:

- There is no way to tell what corrections were made to a code and when. We have absolutely 0 way to look at someone's ledger or treatment plan and know if the charges will be processed correctly. This was a HUGE issue a few years ago when our local BCBS changed wanting anesthesia in units instead of mins. You also can't tell if the issue was fixed on an account unless the fix was done on a different day and the item was re-posted.

- The claims tab is not an accurate representation of what the claim actually looks like. You can think everything is set up correctly, but I can only know for sure if I a) change every claim to paper, check it over, then move it back to electronic or b) go into the edbir folder, pull up the electronic claim notepad (which I don't recommend anyone do, since it can majorly screw up your electronic claim if you touch something wrong- I've only delved into it because of how many front-end issues we have that can get solved by editing the back-end claim), and check. Neither of these options is feasible to do on every patient every day just in case something *might* be wrong.

- I understand that you might think of it as a fairly simple fix- delete the charge and re-post it. But that becomes an accounting nightmare if your doctors get paid based on their monthly production. While I can change the date of service of a posted item, I can't change the posted date, so if it crosses into a new month, our accountant has extra work trying to figure out production numbers. And further, if we don't catch it before the claim goes out, we waste 30 days while the incorrect claim is processed, then have to resubmit and wait an additional 30 days for the corrected claim to get processed before we get paid.

Someone please correct me if you feel otherwise, but I can't come up for a reason why we would want that old data to stay. If we're editing a code, we're doing it for a reason (ie, it needs to be fixed for an insurance company), and will always in the future need it to be done that way. Just because someone was treatment planned when a code was supposed to be one way does not mean that the insurance company will then say "oh, ok, you can bill that claim differently since she was treatment planned that way." This just wastes time on our end and creates major frustration. I spent a long time on the phone with support trying to get this issue fixed today (and more time typing this up) because I didn't remember and had no way of telling that almost 5 months ago I switched something relatively minor on a code's set-up that was continuing to effect how the claim was billing to insurance.

Any thoughts on how we might be able to fix this issue?

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