Dream Factory by TruBridge Ideas Portal
In RCM it is possible to set a claim to hold once a rejection notice has come back on remittances. The hold status is to allow for corrections to be made to the claim and re-submitted via RCM. On the TBEHR side, however, it doesn't recognize the claim is still in progress, but is set to a Rejected status and any remaining balance falls to patient's responsibility. To prevent a patient statement from going out, billers have to either add a bill switch to the account or setup another claim and set it to an "Unchecked" status to reflect the Billing "Hold" status for the account. It would make the billing process more efficient if TBEHR could recognize RCM's bill hold statuses and allow for the billed claims that are set to RCM Hold statuses to be set to hold status in TBEHR without the need for putting Bill Switch or additional Unchecked claim on the account to prevent a statement from going out.
Our monthly statement preview is over 2000 accounts. Due to the size, it makes it almost impossible to review every account prior to sending statements to make sure that we are not sending inaccurate bills to patients for denied claims or rejected claims that are not patient responsibility. This type of hold would enable us to send accurate billing and gain trust with our patients by sending accurate bills. This hospital has been on CPSI since 1996 and has a bad reputation in the community because of inaccurate patient statements. Bill switches cause unnecessary continuous review of statements, and we have had to adjust balances due to the Texas timely billing law because these bill switches are not always removed timely. We have 11 months and 1 day to bill a patient and after that we have to write it off.