MS4 Editor - Expanded Proration Maintenance, Do Your Charges Process on Your UB's and 1500's Properly?
By Bob Landers

Are your charges coming out in the correct billing format? Are charges posting to the UB or the 1500 correctly? If you are having trouble getting charges to drop to the correct form, UB or 1500, you may be delaying your reimbursements.

Here is a way to correct the problem and possibly speed your billing to make your charges drop to the correct documents and assist you in getting your remittance back in a timelier manner.

In the MS4 Editor, there are several maintenance tables that are used to adjust what is being printed on each bill. In section 1, you will be taken through an exercise of changing a single charge to appear on either a UB or 1500 depending on your needs. In Section 2, you will be taken through an exercise to change multiple charges within a bill form.

You may need to do a *MASS change, if you add many charges to your charge master and you need to direct their placement to either a UB or 1500; Section 2 explains this process. Another reason for a *MASS update would be if one of your payors wants different charges to change from a UB to a 1500 or the other way around.

Section 1: Single charge maintenance:

There are several steps to correct a charge to drop on either UB or a 1500. If a charge is to show on a 1500, the dept code must to be added to the appropriate proration code file. If a charge should only be on the UB, you need to be sure that it is not in any of the proration code files that would cause it to drop on a 1500. If a charge does not have a dept code in the UB it must have a dept code on the appropriate proration code file. If a charge has a dept code in both UB and a proration code file, a charge will be on both the UB and 1500.

The instructions below will verify that the EKG charge # 5517982 will be on the 1500 and not a UB for a Medicare Inpatient claim MCRI.

1. Get to the Billing Editor Single Entity or CBO Editor Master Menu.
2. Select option – Editor File Maintenance Manu.
3. Select option – Expanded Proration File.
4. Select line number that has the EKG Plan Name on it.
5. Place a ‘Y’ in the space to the right of “Review Proration”.
6. Enter the charge you are searching for 5517982 for our example.
7. You will see a department number is in the Summary Group. Be sure it is the correct department number for the charge and be sure if you are changing or adding a department number there is a space in the left most position of the field in order for the department number to be right justified.
8. Place a 1 in the Proration Type field.
9. Now verify the charge does not have a Summary Group number other than 099 and a Proration Type of 0 in the Medicare Inpatient MCRI proration file
10. Go back to the Expanded Proration File and select MCRI. Place MCRI in the “Enter a Plan Name and Plan #, Line#, or *add” line.
11. Place a 1 on the line “Enter a Plan Name and Plan #, Line#, or *add”.
12. Place a Y in the “Review Proration” field.
13. Enter the charge number you are searching for, # 5517982.
14. Verify there is a 099 on the Summary Group line.
15. Verify there is a 0 on the Proration Type line.
16. This completes the changing or verifying charge numbers to a certain proration plan.

Section 2: Multiple charge maintenance:

There may come a time when charges are added to your charge master and they also need to be addressed in the proration file. The updates can be made when the charge is made on the charge master side. (If there are a lot of charges being added, in addition to this step, it will slow down the process.) Next after the charges have been added to the charge master, the updates to the proration file may be done in *MASS mode in the Expanded Proration Maintenance file, as discussed below.

1. Get to the Billing Editor Single Entity or CBO Editor Master Menu.
2. Select option – Editor File Maintenance Manu.
3. Select option – Expanded Proration File.
4. Select the proration plan for maintenance by placing either the Plan Nm or line number in the space at the end of the line “Enter a Plan Name and Plan#, Line #, or *ADD”. We will use an example of RADI.
5. Place a 1, which is the choice for RADI on the space at the end of “Enter a Plan Name and Plan #, Line #, or *ADD.
6. Place a Y in the “Review Proration” field.
7. Key in *MASS into the space at the end of “Enter a Line#, Charge #, Partial Charge #, or *MASS… .
8. For our example we will add Group Number 789 to charges 5900000 thru 6000000.
9. The starting charge number is entered in the first field “Starting Charge #”, the ending charge number is entered in the second field “Ending Charge #”.
10. The group number (dept code) is entered in Group Number field and be sure you place a space in the first position so the number is right justified.
11. Place a 1 in the “Proration Code” field – this tells the system to use this Group code as an override field.
12. When the process is completed you will get a screen with the first number on the list showing the information changed. Verify that the information has been changed before continuing.

This completes the process of *MASS changing a series of charge numbers in the expanded proration table.

Additional information can be found in the MS4 Billing Editor Reference Manual Volume 1, Section 6 - Working with the Expanded Proration File. You may also contact VCS at 610-444-1233 or visit our website at www.getvitalized.com if you need clarification or additional assistance with MS4 solutions.