Introduction
CMS Flags pop up provides capability to change few parameters associated to charge code at charge code level which are useful for CMS claims. Therefore, changes administered using CMS flags are specific to ‘Charge Code Level ‘. Each charge code has CMS Flag when clicked, displays 'CMS Flag'.
Parameters which can be changed from CMS Flags Pop up are:
- DOS from Date: User can change ‘from date of service’ for selected charge code. It is printed on Cell24 A in CMS1500 form.
- DOS Upto Date: User can change ‘upto date of service’ for selected charge code. It is printed on Cell24 A in CMS1500 form.
- EMG: It is a checkbox and is printed on Cell24 C in CMS1500 form.
- FP: It is a check box and is printed on Cell24 H in CMS1500 form.
- EPSDT: EPSDT is used for Pediatric patients; If EPSDT flag is checked on 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 the Cell 24H of CMS1500 paper claim else it will print 'Y'. It prints appropriate Specialty Test 'EPSDT Indicator Code' drop down value 'AV'/'NU'/'S2'/'ST' associated to each charge code attached to the claim.
If checkbox EPSDT is checked and single or multiple options is/are selected in the list box then these are printed in Cell24 H of CMS1500 and CRC segment in Loop 2300 in EDI. Corresponding output is printed on either CMS1500 or CRC segment in loop 2300 in EDI for the following option:
Option selected in EPSDT list box |
Generated Output |
Other |
YO |
Vision |
YV |
Hearing |
YH |
Behavioral |
YB |
Medical |
YM |
Dental |
YD |
Patient Discount: It is discount offered to patient in percentage which is specific to charge code. When a particular charge code is billed either to patient or Insurance Company then amount billed to them is lessened by discount given. Discount amount is total billed amount *discount offered in percentage.
Apply to all Charge Rows: It is a checkbox. Mark ‘Apply to all Charge Rows’ checkbox so that discount is offered to all charge code rows present in claim.
Info on Gray Band
There are two radio buttons under it and option selected under it is printed on Gray band of Cell 24 in CMS1500.
- General Info
- NDC- These are In house drugs used by clinics and is sent with HCPC codes if associated to it. NDC code is associated to HCPC codes from HCPC master. NDC codes related details under it are :
- 11-digit code
- Unit – Valid options are ‘International units’, ‘unit’, ‘milligram’, ‘milliliter’
- Admin Qty
All the above details are picked up from Assessment screen in EMR side and is sent with claim for Billing. Details about ’11-digit code’, ‘Unit’ and ‘Admin Qty’ fields for Charge Code is displayed as it is transferred from Assessment or otherwise can be set using CMS flag. The setting for 'NDC' related codes in Assessment overrides the settings on CMS flag.
Copay Assigned: CoPay is collected upfront from patient. Using checkbox 'CoPay Assigned', 'CoPay' can be assigned to a specific charge code. When EOB is received, the 'Copay' assigned to the charge code is applied to 'Pat' bal for that specific charge code if there is any patient responsibility otherwise it is moved to 'Advance'.
Do Not Send: Checkbox 'Do Not Send' feature allows a specific charge code to discard from Billing if required. Charge code marked as 'Do Not Send' is not sent for billing and it is highlighted with 'red' background on Claims >> Edit screen at charge code level.
ok: Click button 'ok' to retain the changes applied to a charge code.
cancel: Click button 'cancel' to revert the changes applied to a charge code.