Billing Conference and Cath Cases

This process helps ensure accurate and correct charge entries related to conference billing, particularly for CCS insurance, inpatient vs. outpatient classifications, and selecting the appropriate codes for billing.

In Epic start a new Charge Batch, go to:

The Epic drop down:

1. Navigate to the Billing Section:
   • Select "Billing" > "PB Charge Entry" > "Create Batch."

   • Under batch options, choose "HPF" and confirm.

     Charge Entry:

   • Once the batch is created, you’ll be directed to the first charge entry.

   • Start by entering all necessary encounter details. Tip: Begin with the MRN (Medical Record Number).

     SAR Selection:

   • For conference billing (especially CCS insurance), about 95% will involve CCS insurance-related billing.

   • Verify that the SAR (Service Authorization Request) is not a direct physician 01 type SAR. It must be an 02 SAR.

     Verify the Encounter Type:

   • To determine whether it’s an inpatient or outpatient service:
     • Go to "chart" > "chart review" > "notes/Trans".

     • Verify the Encounter Type for the date of service to confirm if it’s outpatient or inpatient.

       Determine the Doctor for Billing:

   • Case Conference billing will always be billed under the doctor who attended the conference.

   • For Cardiac Cath conference patients, billing is only done if the doctor attached to the patient name is highlighted.

     Choose the Correct Reimbursement Center:

   • In the "Reimb cntr" box, select one of these two options:
     • "SUTTER MED CTR SAC OP PB" – for outpatient.
     • "SUTTER MED CTR SAC IP PB" – for inpatient.

   • If billing as inpatient, ensure an Admission Date is included in the Claim info box.

     Select the Appropriate Codes:

   • Only two codes are used for billing:
     • Z4306 – for Medi-Cal plans.

     • 99367 – for commercial plans.

       Case Conference Billing:

   • Tip: All Case Conferences are billed as outpatient.
   • Double-check all other Cath conferences to verify if they are outpatient or inpatient.

Tip:

Case conferences will always be billed as outpatient.
For Cardiac Cath conferences, you should double-check whether they are outpatient or inpatient before proceeding with billing. Ensure the correct classification is selected to avoid errors in reimbursement and reporting.

Below is an image of what the charge should look like when the insurance is CCS.

Resource

UPDATED: 01/08/2025 DP