• Run through hospital Insurance verification system or call insurance automated voice response
• If referral needed, contact patient via phone or email so that patient can contact referring PCP and request referral. If referral not needed, no need to call patient

• To ensure correct claims processing
• To prevent inconvenience and improve patient experience 

• Label the chargemaster forms with patient information
• Attach them to chart for nurse (facility chargemaster) and to provider (professional chargemaster)

• To capture appropriate CPT codes for the encounter

• Collect patient signature for compliance documents (HIPAA), financial responsibility form, authorization for treatment  
• Have patient fill out past medical history form and medication list

• To ensure regulatory and institutional compliance
• To expedite care

• Have patient sign-in (paper or electronic)
• Name-banding 

• Payer requirements Name banding for patient safety and decrease rate of incorrect procedures

• Check co-payment amount: refer to the patient insurance card
• Enter amount into the EMR registration screen 
• Collect via credit card or cash 

• Patient, provider and facility are contractually obligated to pay/collect co-payment at the  encounter

Day 0 on

After encounter, at the wound and HBO clinic

• The patient sign-in sheet or scheduling template will be used to ensure that a professional and facility chargemaster is present for each patient seen in the wound/ HBO department for that date

• Reconciliation of chargemasters ensures all services are accounted for. This will allow for timely entry of charges by the RN, RN Mgr and efficient and timely reimbursement of claims

Day 0 on

After encounter, at the wound and HBO clinic

• Facility Charges: enter CPT charges after they have been reconciled into the hospital billing system ensuring that each patient encounter identification number for that visit is correct.
• Professional Charges: designated clinic staff to forward all provider chargemasters to the appropriate hospital department for charge data entry on the day of service 

• Designated Staff to check claim on EHR and verify Cost center code and Revenue code attached to claim
• Claim may be reviewed by coding and billing to ensure correct ICD-10, CPT, HCPC
• Claim may be run thru the hospital billing "scrubber module"  to ensure the correct use of modifier(s), (national correct coding initiative) NCCI Edits or Hospital payer-specific edits

• To ensure timely claim submission

• Claim is submitted to carrier electronically

• To ensure timely claim submission
• The claim is electronically transmitted from the provider or facility's computer to the Medicare Administrative Contractor (MAC). The MACs initial edits are to determine if the claims meet the basic requirements of the HIPAA standard.[3]

• Identify if payment is approved or denied
• Identify Medicare Remittance Advice (RA) remark codes [4]
  
• If denied, identify if "Errors and Omissions" are Minor or Major Denial

• Apply payment to the line item,
• Apply adjustments
• Forward coinsurance to the secondary payer or apply to patient balance if no secondary insurance

• Investigate reason for denial based on denial codes adjust claim as appropriate (e.g., not a covered service)
• Refer to medical chart documentation as needed
• Edit claim and make addendum as needed
• Resubmit claim and addendum

• For cellular based tissue products (CTP) or hyperbaric oxygen therapy (HBO) denials forward to nurse manager of HBO/wound clinic. For all other denials forward to the appropriate stakeholder
  
• Refer to medical chart documentation 
• Check trends for denied charges (are you consistently getting denials for CTP? If so, investigate)

• Verify if CPT codes and number of units of G0277 are correct
• Check if diagnosis meets medical necessity. See HBO Requirements Request Checklists in topic "HBO Treatment Indication with Protocol"
  
• Verify ICD-10. If needed, refer to the HBO ICD-10 crosswalk for single/dual diagnosis codes
• Check if authorization is in place. See form "HBO Pre-Determination/ Prior Authorization"

• Verify CPT code is correct and supports the services performed
• Verify date, time and location of the ulcer treated with CTP
• Verify the name of the CTP and how it was supplied
• Verify the amount of product units used
• Verify the amount of product units discarded
• State the reason and amount of wastage in units (This must be documented in the provider's note)
• Determine if your local MAC requires reporting of CTP wastage using the JW Modifer on the billing claim. The JW modifier is required  in physician offices
• Ensure manufacturer's serial/lot/batch or other unit identification number of graft material is documented in the chart. [6]
• Make amendments as needed 
• See topic "Cellular and/or Tissue Products"

• Electronic submission with associated attachments as needed
• Prompt attention to claims payment or denial leads to an improved revenue cycle