Topics Claims: CMS Flag Search:  

Introduction

The CMS Flags pop-up provides the capability to change a few parameters associated with a charge code at the charge code level that are useful for CMS claims. Therefore, changes administered using CMS Flags are specific to 'Charge Code Level'. Each charge code has a CMS Flag that, when clicked, displays 'CMS Flag'.

The parameters that can be changed from the CMS Flags pop-up are:
  • DOS From Date: The user can change the 'from date of service' for the selected charge code. It is printed on Cell 24 A in the CMS 1500 form.
  • DOS Upto Date: The user can change the 'upto date of service' for the selected charge code. It is printed on Cell 24 A in the CMS 1500 form.
  • EMG: It is a checkbox and is printed on Cell 24 C in the CMS 1500 form.
  • FP: It is a checkbox and is printed on Cell 24 H in the CMS 1500 form.
  • EPSDT:   EPSDT is used for pediatric patients. If the EPSDT flag is checked on the Claims Charge row and, on the EMR side, the Specialty Test 'EPSDT Indicator Code' is selected as S2 or ST, then the tag BLD_TICK_EPSDTFP prints it as '03' in Cell 24H of the CMS 1500 paper claim; otherwise, it will print 'Y'. It prints the appropriate Specialty Test 'EPSDT Indicator Code' drop-down value 'AV'/'NU'/'S2'/'ST' associated with each charge code attached to the claim.

If the EPSDT checkbox is checked and a single option or multiple options are selected in the list box, then these are printed in Cell 24 H of the CMS 1500 and the CRC segment in Loop 2300 in EDI. The corresponding output is printed on either the CMS 1500 or the CRC segment in Loop 2300 in EDI for the following options:


Option Selected in the EPSDT List Box

Generated Output

Other   

YO

Vision

YV

Hearing

YH

Behavioral

YB

Medical

YM

Dental

YD

                                               
Patient Discount: It is the discount offered to the patient as a percentage that is specific to the charge code. When a particular charge code is billed either to the patient or the insurance company, the amount billed to them is reduced by the discount given. The discount amount is the total billed amount multiplied by the discount offered as a percentage.

Apply to All Charge Rows: It is a checkbox. Select the 'Apply to All Charge Rows' checkbox so that the discount is applied to all charge code rows present in the claim.

Info on Gray Band
There are two radio buttons under this section, and the option selected is printed on the gray band of Cell 24 in the CMS 1500.

  • General Info
  • NDC - These are in-house drugs used by clinics and are sent with HCPCS codes if associated with them. The NDC code is associated with HCPCS codes from the HCPCS Master.  NDC code-related details under it are:
  • 11-Digit Code
  • Unit  - Valid options are 'International units', 'unit', 'milligram', and 'milliliter'
  • Admin Qty

All the above details are picked up from the Assessment screen on the EMR side and are sent with the claim for billing. Details about the '11-Digit Code', 'Unit', and 'Admin Qty' fields for the charge code are displayed as they are transferred from the Assessment screen; otherwise, they can be set using the CMS Flag. The setting for NDC-related codes in the Assessment screen overrides the settings on the CMS Flag.

CoPay Assigned: CoPay is collected upfront from the patient. Using the 'CoPay Assigned' checkbox, CoPay can be assigned to a specific charge code. When the EOB is received, the 'Copay' assigned to the charge code is applied to the 'Pat' bal for that specific charge code if there is any patient responsibility; otherwise, it is moved to 'Advance'.

Do Not Send: The 'Do Not Send' checkbox feature allows a specific charge code to be discarded from billing if required. A charge code marked as 'Do Not Send' is not sent for billing, and it is highlighted with a red background on the Claims >> Edit screen at the charge code level.

OK: Click the OK button to retain the changes applied to a charge code.

Cancel: Click the Cancel button to revert the changes applied to a charge code.