Clinical Content Review™ Module

If you haven't yet reviewed the documentation for the workflow, please see the UR Suite & Billing Module Workflow Overview resource.

Overview

The purpose of the content review is to sort you documentation to back up what your company will be billing for. Future additions to this feature include automatic chart preparation when charts are requested from payers as well. You can think of the content review as the bridge between authorization, documentation, and billing.

Note: the patient must have an active authorization for billing to proceed to the billing census.

Reviewing and Organizing Content

At the moment, documentation is what powers the content review. If the document has not made it to the status of closed or ready for review along with a date/time of service it will not be visible from this section. You can run a billable services report to look for delinquencies in documentation if you feel there are cases of that.

Combining Documentation

When you navigate to the content review via the main menu Utilization Review > Content Review you will be presented with a blank white screen. You must select a patient from the type ahead field in the top left corner to begin.

After selecting the patient, choose a date range for the content you would like to sort.

Once you have done that you will be able to combine and apply that review of your documentation. 

Combine Services

Select the services that you wish to include in your institutional (or inclusive) billing. Leave out the documents that may be billed separated or you do not want to bill for. 

Click on the "combine services" after you choose the items you would like to be combined. For example, you may include several group notes and an individual progress note as part of the days service for the residential level of care. 

Mark the Services for Billing
Choose which items are supporting what billable services. You have three choices by default:

1. Additional (or professional billing)

2. Inclusive (or institutional / hospital billing)

3. Do not bill (no bill will be created)

Note: the services shown are set up in your billing rules.

Apply the Review
After the review is applied, you will be able to move forward to the billing census and add these services. Simply mark "apply review" once you're happy with your documentation sorting and your changes will be saved. 

Create the Billing Census
After you have sorted all patients content for that billable time period, you will now proceed to the billing census where you can choose the items being billed that have been supported by your clinical content.