Professional Billing
Many physicians track, record and "bill" for services rendered, even when employed by Alberta Health Services (AHS) or contracted through alternate reimbursement plans. The Connect Care clinical information system (CIS) supports claims capture, generation of billing reports, submission of claims and adjudication of any funder responses. This includes billings sent to Alberta Health, Workers' Compensation and private insurers.
Prescriber-AHS Billing Relationships
There are three professional billing relationships that physicians can have with Connect Care, based upon how service claims are documented and how they are managed:
Independent Charge Capture & Independent Claims Management - Physicians track and record their charges outside of Connect Care and use a third-party billing service to submit claims and manage responses.
Connect Care Charge Capture & Independent Claims Management - Physicians use CIS tools to capture information to support professional billing claims, generate a report or export of the data, then use a third-party billing service to submit claims and manage responses.
Connect Care Charge Capture & Connect Care Claims Management - Physicians capture charges using CIS tools and rely on the CIS and AHS billing services to take care of claims submissions and response management.
Further information about who qualifies for each of the three professional billing relationships is available in short summaries and an online resource.
Patient Health Insurance Status
Irrespective of a prescriber's billing relationship with AHS, it can be important to know whether a patient's care is supported by Alberta healthcare insurance, out-of-province insurance, private or no insurance. Health insurance coverage status information is available to prescribers in a number of places:
Patient Lists, Trackboards, Schedules
A "++ AHS IP PRESCRIBER BILLING TEMPLATE" patient list template can be applied to any "My List" used within the Patient Lists activity. This list has columns for information essential to successful claims submissions, including details like patient identifiers, referring provider, and whether charge(s) have been submitted in Connect Care.
A "Billing Coverage" column shows a check-mark if the listed patient has valid within-province health insurance. Hovering over the column cell produces a pop-up display of the patient's coverage status. Double-clicking opens a more details display that includes some details of uninsured services.
The same column can be (optionally) added to Emergency trackboards, Outpatient Schedules and Reporting Workbench reports.
Patient Chart Sidebar
A sidebar "index" or "summary" appears as the default view for the right-most column (sidebar) of any chart opened to an inpatient, emergency or outpatient encounter.
A "Coverage" index link displays as "Coverage - AB" if provincial insurance is active.Â
Selecting the Coverage index link opens a sidebar showing additional links to health insurance information, as well as brief displays of current coverage, guarantor and other key details.
Selecting links within the Coverage (Service Code Capture) sidebar allows the user to jump to:
Service Code Capture Activity
Information about the current prescriber billing relationship
Details of insurance coverage
Guarantor information
Dashboards with links to billing reports appropriate to the current user's billing arrangement
Service Code Capture Activity
A Service Code Capture activity can be opened via chart search, menu search or sidebar links (as above).
A "Service Code Capture Resources" section includes links to the Coverage sidebar and other relevant information.
These options are illustrated in a short video demonstration:
More Information
Professional billing is the topic of one of the Connect Care Optimization Clinic themes, with updates to the prescriber update blogging channels:
Manual Sections
Billing Codes