Presentation on theme: "How to validate in Budget Manager Hopefully now you have reached this stage you will have downloaded the inpatient and outpatients excel files for you."— Presentation transcript:
How to validate in Budget Manager Hopefully now you have reached this stage you will have downloaded the inpatient and outpatients excel files for you desired months into a suitable folder i.e. on your desktop within a folder named validating.
The first step is to log into Budget Manager and from the main screen choose ‘Statements’
Now that you are in ‘Statements’ please click ‘Import’
The next step is to import the inpatient and out patient excel files from our suitable folder. We will import one file at a time. Let’s start with the inpatient file.
The data should have imported itself into Budget Manager and you should see a similar looking page in front of you
We now have to go to Statement date and from the drop down menu go to the last day of the particular month we are looking to validate. In this case we have imported November’s data so will choose 30 th November as our last statement date and then click ‘Save’
After we click ‘Save’, you will see a message asking ‘Do you want to check the statement items for which there is no discharge’, click ‘Yes’.
The software will now go onto Open Exeter to download the extra patients that you have been billed for but no ‘discharge’ data has been found. Click the ‘OK’ button and wait for the extra patients to be downloaded. In this section it will tell you how many extra patients there is to download from Open Exeter
After the extra patients have been downloaded you will see this screen. The next step is to click the first ‘Close X’ twice at the top right hand corner.
Now we are just about ready for the all important validating. We see our first billed patient in the middle of the screen. However what we can do is see the imported data in a more structured way. So bearing to the left, we will click onto the appropriate data date.
In front of us we see a Tree structure on the data we have just imported. At the top we see the total number of patients we are going to check in this particular month’s inpatient spells.
In the Tree structure, we firstly concentrate on this first section highlighted within the red box. The reason for this is so that we can associate the bills we have imported with our practice’s patients and link the two together and before we filter the linked episodes into the second section to accept or query the bills as shown within the blue box.
The next step is to click the ‘Auto-link’ button, The discharges we put into Budget Manager in the past will automatically marry with the imported billed data. This means that the data for a particular patient automatically matches to what that patient has been charged for. So we don’t have to review these as the system has done the work for us!
Once the patients have been matched we will see any given amount of linked patients in the ‘Linked’ section.
This will now leave us with any given amount of ‘Unlinked Patients’ that we need to link.
So we now manually have to link the unlinked patients before we can start to reject or query our bills. We do this by clicking the ‘Review’ button
Before we query the bills we want to see that the remaining unlinked patients are our patients at all! There will be various patients not being ours and hence we will reject the bills we are being charged for.
So what do we reject??.... The first bill we can automatically reject is when we see a ‘0’ in the ‘NHS Number’ section as shown below. No NHS number, No payment!
To reject a patients bill we click the ‘Reject this item’ box
To move onto the next patient we click the ‘>’ button, incidentally clicking the ‘>>’ button take you forward 10 patients at a time. The back arrow keys have the same function but backwards!
After all the ‘0’ NHS Number patients have been rejected, we will come across patients who do have a NHS Number. So by clicking the ‘Go to patient’ we may see the box below popping up ‘Patient not found’. Again this is not our patient so NO payment!
There will be times where you will see the NHS Numbers in the below column that are highlighted in red. This means that these patients are your patients who attended Secondary Care in the date(s) you are being charged for, but have no relation to the NHS Number above. So basically is it one of these patients below we may be looking for instead of the NHS number above? Most cases it isn’t and we would reject such a bill.
In this example we see that one of the dates are highlighted in red. In this case the link is the correct one, as can be seen by the matching NHS numbers, but the discharge date of the patient is different from what we put into Budget Manager, to what we are being billed for. This is ok as it is the same episode so we will link it. When we come to either accept or query the bill, we will look in our clinical system for the appropriate scanned letter to see the correct date.
When we click ‘Go to patient’ button, there will be times that the patient is yours and hence it will take you onto the ‘Data Entry’ screen below for that particular patient. This is because the billing data tells you the date(s) the patient was in Secondary Care but there is no matching Info previously entered. So how do we solve this??....
‘’There are a few ways to solve this, the first is to check in ‘Data Entry’ that we have not accidentally forgotten to add the discharge to the appropriate spell.
If it doesn’t look as though there is anything linking the bill to the patients ‘Data Entry’ records we have to log into our Clinical System to see if there was a discharge letter scanned in. This is to assure us the reason why you are being billed for that Secondary care spell.
When searching for the scanned letter we may not find it and hence there is nothing to say or give a reason to accept the bill because we as a practice have no proof it happened. So ‘No’ scanned letter(s) ‘No’ payment!
If we do find the appropriate scanned letter in our Clinical System with the corresponding date spell in Secondary care, it seems that we have accidentally forgot to add this info prior in Budget Manager. So now we have to go back into ‘Data Entry’ and create the referral and then add the discharge so that we can link it to the billed spell.
Once we have created the patients episode in ‘Data Entry’, go back to the main screen and click on ‘Find Discharge’ then the discharge will appear below. Highlight this discharge and then click on ‘Link’ (get a screenshot of a highlighted discharge and pressing’link)
Once we have done all the reviewing and linked the ‘Unlinked’ patients we should have ‘0’ patients left to do in this section. All that we should see is a set given of Linked and rejected
In the ‘Rejected’ section there will be any given amount given of rejections we have previously rejected. We can click the ‘Report’ button to get a report and this report will be our first one that we send back to your PCT for them to argue the case on behalf of yourselves.
At this stage all we have done is linked the bills to the patients in our practice we. The next step is now to get all these linked patients and filter them through to the bottom section to either accept the price of charge or query it. To do this we click the ‘Auto- accept’ button.
The next step is to concentrate on the section shown within the box. We now should have the amount of linked patients filtered through into either ‘Accepted’ because the bill matches what we entered previously and the others we have to decide on will go into ‘Undecided’. Click on the ‘Review’ button to carry onto the next step.
So we are now going to review the linked patients to either accept what we have been charged for or query the bill. We do this by choosing either ‘Accept’ or ‘Query’ buttons shown within the red circle.
In the large red circle this section tells us ‘our’ original prediction cost (referral) of a particular patient, the cost it came back as when we added the discharge info and the ‘actual cost’ the NHS Trust has billed you. If the price difference is not that big maybe you will decide to accept the bill.
If the price difference is totally unacceptable and we are not going to accept the bill, we will click the ‘Query’ button
When bills don’t match the discharges we entered previously in Budget Manager, this section within the red circle will inform you in red text more information as to why you have been charged differently. So in a lot of cases out HRG codes are different which we would possible want to check up on in our Clinical System for a scanned discharge letter to confirm that or possibly your patient spent more days in hospital and a ‘Long stay supplement’ has been added to which we would normally accept or again check on our Clinical System for more confirmation.
There may be cases where the ‘Actual cost’ you are being charged is less than what we predicted it would be. If this is so, well it would be safe to think that we ‘will’ accept the bill instead of querying it and potentially having to spend more money.
While reviewing our bills, in this section shown within the red circle, we can review our ‘Referrals’, ‘Discharges’ and also the bill within ‘Billed item’
By either choosing ‘Referral’ or ‘Discharge’ we can also edit them if we wish by clicking on the ‘Edit’ button This is in case we think we made a previous error after getting more information from e.g. our scanned letter in our Clinical System. It may be that the ‘Actual cost’ is correct and our information in ‘Data Entry’ is incorrect.
By clicking ‘Billed item’ it will take you to the screen below. If we are unhappy with the ‘link’ we did before we can ‘unlink’ by clicking the ‘Unlink’ box.
To move onto the next bill we choose the ‘Next’ button and if we want to stop our reviewing and continue at a later date choose the ‘Set’ button next to Bookmark.
Eventually after reviewing all the ‘Undecided’ bills, we should have any given numbers only within ‘Accepted’ or ‘Queried’ with nothing in ‘Undecided’. The ‘Queried’ section like the ‘Rejected’ section we run a report of and send it back to your PCT for them to argue the case on behalf of yourselves.
We can run reports for all sections and when the report is generated at the bottom of it we can see the actual cost for that particular report. We can then wish to either choose ‘Save’, ‘Copy’ or ‘Print’ from the generated report.
We can always check all of our statements by choosing the appropriate one we want within the section shown in the red circle. This section will build up month after month with new In patient and Out patients statements that we can review as we wish.
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