Hospital Health Fund Fees – Importing Casebase Fees

FYDO now has the option to import Casebase Fees from an Excel file.
It is important to note that the file must be an Excel file and must be set out in the same way as the sample template below. There is also a link below to download a blank template:

Use the same column titles as can be seen in this spreadsheet example. 

Column headings need to be:
A – MBS
B – Casebase
C – Procedure
D – Type
E – DVA
F – OutlierDays
G – OutlierRate
H – GST
I – ExclOS
J – IgnoreStepDown
K – ExcludePrivateRoom

The above layout reflects the content, and order of information, that is displayed on the Casebase Fees tab in FYDO.

If the file is not formatted in this way, with the exact column titles, the data will not be able to be imported into FYDO or will upload into the wrong fields.

How to Format an Excel File for Casebase Fee Upload

Data from a Health Fund contract can be transferred into the relevant columns of the template, or a copy of a contract can be modified using the following steps:

  1. Save a copy of the contract (do not edit the master copy)
  2. Go to Casebase Fee tab or section in the contract
  3. Remove any lines above the header table so that there is only one header row
  4. Delete any columns that do not contain the required information as per the images above
  5. Ensure the names and order of all columns and the header row match the template exactly

How to Upload Casebase Fee File into FYDO

  1. Go to Settings & select Fees Setup

  1. Choose your location from the dropdown menu (only applicable to multi-site users)
  2. Select required Fund
  3. Ensure Same Day Fees tab is selected and Click Edit

  1. Update Start of Current Fee and End of Current Fee dates
  2. Click Save

  1. Click Casebase Fees tab
  2. Select Edit

  1. Open the Actions dropdown and select Move to Old Charges – this step is optional, however it is recommended as it ensures that episodes prior to the new contract dates are billed at the appropriate rates, otherwise all unbilled episodes will be billed at the newly loaded rates
  2. Click Save

  1. Click Edit again
  2. Utilise the Actions dropdown again to select Import Fees

  1. Click Fee Type and select Current File

  1. Click Upload Fees File and locate the relevant Excel file to be uploaded
  2. Click Upload

  1. Casebase items and fees will populate into the Casebase Fees tab
  2. Click Save
  3. Select Print to print or download, then conduct a spot check with the contract to ensure fees have populated correctly

Note:  If a Casebase item no longer exists in the new fees, but there was an old rate, the line will remain in the fees screen and Current will show as $0 (Old will show the previous rate).  If a DRG has a zero-dollar balance under the Current fees AND the Old fees, FYDO will automatically remove this line from the fees page, as it is no longer required.




MYNT Billing – Guide for Hospitals

This guide has been prepared for FYDO Hospitals that are also MYNT Billing clients.

Invoicing

The MYNT Billing team will invoice your private health fund patients two to three times per week.  Please note that this excludes uninsured, third party, Workcover and overseas patients (unless requested).

In order for the MYNT Billing Team to generate invoices, the following steps must be completed by staff at your facility:

  1. Ensure the Episode Status is Discharged

  1. Complete Theatre Screen information accurately, including the following information at a minimum;

  1. Anaesthetic Type
  2. Time In Theatre and Time Out Theatre
  3. Item numbers/Code
  4. Other Services, if required, such as prostheses, disposables, surcharges
  5. Theatre Complete tick box checked

It is imperative that facility staff ensure the accuracy of this information, as the MYNT Billing team does not have access to medical records to verify.  

  1. Ensure Episode is Coded and Grouped, by completing the Diagnosis, Procedure and DRG sections in the Coding Screen – see Hospital Coding – FYDO Wiki

For many disciplines, coding may be impacted by pathology results, or awaiting doctor verification of items performed.  If coding is on hold, please designate a Theatre on Hold reason (e.g. Pending Pathology, Awaiting Item Numbers, etc) in the Theatre Screen.  (Additional reasons can be added in Settings > Theatre Hold Reasons.)

The MYNT Billing team will run a Billing Status Report for your site, once per week, to identify any episodes that cannot be invoiced and outline the reasons for this (e.g. waiting on coding).

Rejected Claims

The MYNT Billing team will review rejections daily, and strive to address any rejections within two business days.  If we are awaiting information or action from your facility in relation to a rejection, notes will be recorded in the Financial Notes tab for the episode.

Debtors

The MYNT Billing team will be responsible for following up with debtors.  A weekly Debtors Report will be sent to the site to outline reasons for any claims outstanding greater than 45 days (e.g. issues with the claim or slower payments – for example some smaller funds, as well as paper-based claims, can take longer to be paid).




Hospital Health Fund Fees – Importing DRG Fees

FYDO now has the option to import DRG fees from an Excel file.
It is important to note that the file must be an Excel file, and must be set out in the same way as the sample template below. 

Or click the link below to download a blank template:

Using the same column titles as can be seen in this spreadsheet example. 

Column headings need to be:
A – DRG
B – ChargeSD
C – ChargeIP
D – CWO
E – SSTrim
F – SSFee
G – LS1From
H -LS1To
I – LS1Fee
J – LS2From
K – LS2To
L – LS2Fee
M – LS3From
N – LS3To
O – LS3Fee
P – TRF
Q – TRFDisc
R – GST
S – Exclpros
T – ExcludePrivateRoom

The above layout reflects the content, and order of information, that is displayed in FYDO.

If the file is not formatted in this way, with the exact column titles, the data will not be able to be imported into FYDO, or will upload into the wrong fields.

How to Format an Excel File for DRG Upload

Data from a Health Fund contract can be transferred into the relevant columns of the template, or a copy of a contract can be modified using the following steps:

  1. Save a copy of the contract (do not edit the master copy)
  2. Go to DRG tab or section in the contract
  3. Remove any lines above the DRG header table so that there is only one header row
  4. Delete any columns that do not contain the required information as per the images above
  5. Ensure the names and order of all columns and the header row match the template exactly

How to Upload DRG File into FYDO

  1. Go to Settings & select Fees Setup

  1. Choose your location from the dropdown menu (only applicable to multi-site users)
  2. Select required Fund
  3. Ensure Same Day Fees tab is selected and Click Edit

  1. Update Start of Current Fee and End of Current Fee dates
  2. Click Save

  1. Click DRG Fees tab
  2. Click Edit

  1. Click More Actions and select Click to move all Current fees to Old and follow instructions – this step is optional, however it is recommended as it ensures that episodes prior to the new contract dates are billed at the appropriate rates, otherwise all unbilled episodes will be billed at the newly loaded rates
  2. Click Save

  1. Click Edit
  2. Click More Actions and select Import Fees

  1. Click Fee Type and select Current File

  1. Click Upload DRG Fees File and locate the relevant Excel file to be uploaded
  2. Click Upload

  1. DRG items and fees will populate into the DRG Fees tab
  2. Click Save
  3. Select Print to print or download, then conduct a spot check with the contract to ensure fees have populated correctly

Note:  If a DRG no longer exists in the new fees, but there was an old rate, the line will remain in the fees screen and Current will show as $0 (Old will show the previous rate).  If a DRG has a zero-dollar balance under the Current fees AND the Old fees, FYDO will automatically remove this line from the fees page, as it is no longer required.




Adding MBS Item Numbers – Hospital

Adding or amending an MBS item in FYDO for the purpose of updating descriptions, adding facility specific cosmetic codes or removing items that are no longer needed.
The item numbers are updated in FYDO with each National Procedure Bandings Update.
Facilities will be responsible for updating the Theatre Band (State) according to their relevant contracts.

  1. Go to Settings
  2. Select Items from the General menu

  1. Add all MBS Codes will update all items in your FYDO system according to the current National Procedure Bandings.
  2. Use the filters to search specific categories or groups etc
  3. Use the Show Inactive tick box to view any items that have been made inactive in the database
  4. Use the Export To option to export the list that is shown on the screen to an Excel spreadsheet
  5. Use the Search field to find a specific item number or key word to determine if the item is already in the system. All items that include the searched information in the description will also appear
  6. If the required item number displays, double click anywhere on the line to open the information
  7. If the required item number doesn’t appear, and it needs to be added, click Add Item

  1. Add the item number, or desired code, into the Number NB. This field will never be editable after it has been created & saved
  2. Add the description for the item into the Procedure Name (The Number & Procedure Name fields are both mandatory fields that are required to add an item)
  3. The Notes field is available for any notes that may be required that relate to the item. It has no effect on how the item number is billed or displayed & can only be seen by navigating to this screen
  4. Linked Procedures give the ability to add ICD procedure code base items to link to this item number. This can make coding the ICD procedures easier. (Hovering over the for the explanation of this field at any time)
  5. Category, Group & Sub Group are fields that will pre-populate when a real MBS item number is added. FYDO will look up all these values, from the MBS Schedule, and import them. These values will be updated whenever a new MBS update is loaded & there is no need to edit these manually
  6. Item Type is a field that can help categorise the item being entered. (NB. These Item Types can be added by going to Settings, Item Types & clicking Add Item Type). This field allows the user to allocate items to a group (e.g., cardiology, consults etc) and to run reports on the items that are grouped together by the category
  7. Qty on Hand can be used in conjunction with the item type
  8. Modal is not required for hospitals (this is a clinic related field)
  9. Rule is used to determine the rules to apply step downs etc for doctor billing
  10. 100% Rebate is to be ticked when the Medicare benefit is 100%, rather than 85% for in room services and is only applicable for doctor billing
  11. R-Type is to be ticked if the item requires a referral. NB. This only relates to radiology/imaging items for doctor billing
  12. Stock Item is not required for hospitals (this is a clinic related field)
  13. Ask Quantity is not required for hospitals (this is a clinic related field)
  14. Use the following to ensure the item is classified correctly, according to the relevant banding & accommodation types:
    – Theatre Band (National) – will be updated by FYDO automatically
    – Theatre Band (State)
    – Day Type – will be updated by FYDO automatically
    – Patient Class – will be updated by FYDO automatically
    – DVA Accommodation
  15. Tick Same Day Accom Band 1 Override if the item number can only have a band 1 accommodation billed in conjunction with it, regardless of the anaesthetic type or length of procedure
  16. Tick Accom Item if the item being entered is required to be billed as an accommodation fee, as per the health fund contract
  17. Tick Eclipse Code Mapping if the code being entered requires mapping to be able to be sent via Eclipse for billing. E.g., COL1, PKG38 or D001
  18. Tick Item Excluded from PSG to exclude the item from the IHC PSG/MSG segment when being sent via eclipse. E.g., for NIB endoscopy claims
  19. Tick Miscellaneous/ADA Code if the item is required to show in the Miscellaneous code section for data submission, instead of in the MBS code section. Commonly used for dental codes
  20. Tick Timebase if this item is required to be billed according to the time it takes. Ticking this box will alert the system to look in the Timebase Fees set up for the chargeable fee
  21. Click Save
  22. To Deactivate an item number, follow steps 1-4 above & click Edit
  23. Un-tick the Active box & the word will change to Inactive
  24. Click Save
  25. To Re-Activate an item, simply tick the Inactive box again & click Save
  26. To remove an item number all together click on the Blue Drop Down Arrow on the right of the screen (as seen in the first image above) and click Delete item
  27. You will be asked to confirm that you want to delete the item. Click Yes



Hospital Invoicing / Billing an Episode – Simple

Once the episode is complete, an invoice can be raised to a health fund or patient.
For an invoice to be raised, the episode needs to be:

– Admitted
– Discharged
Theatre Complete tick box checked (depending on the facility requirements)
– Coding Grouped (depending on the facility requirements)

  1. Open the Appointments Screen and locate the required episode
  2. Right Click to reveal the menu & select Create Invoice

  1. The Create Invoice page will display with the following necessary information:

  1. All patient information specific to the episode
  2. Billing information including:
    Billing Type
    Theatre Times
  3. Procedure Items being billed (drawn from Theatre Screen if entered)
  4. Other Services being billed (drawn from Theatre Screen if entered)
  5. The Bill To feature allows other services to be billed to the patient or a third-party company, even if the main invoice is being billed to a health fund. Selecting Patient from this dropdown will create a separate invoice/invoice number for the patient account
  6. The Financial Notes & Episodes notes fields will reflect notes that have been entered into the patients’ Episodes screen.
  7. As long as all required information has been previously entered into the Theatre Screen, there should be few reasons that anything on the Create Invoice page needs to be amended
  8. Click Proceed to see charges

  1. The invoice information is displayed, including:
    Accounting Period (That the revenue will be applied to)
    Bill Type
    ECLIPSE transmission status
  2. The Accommodation charges will be shown
  3. The Theatre & Other Services Charges will be displayed
  4. GST can be amended with a Right Click in the GST Field
  5. Custom Invoice Messages are able to be added. (Invoice Message Templates can also be added in Settings > Invoice / IFC Messages, so that they can easily be selected from the dropdown list)
  6. Invoice template can be selected
  7. Print & Save can be selected when the invoice isn’t able to be sent via ECLIPSE & the user requires a printed or PDF copy of the invoice
  8. Save can be selected when the invoice is able to be transmitted electronically via ECLIPSE & the user does not require a hard copy of the invoice

Once the user has selected Save for an invoice that can be transmitted electronically via ECLIPSE, they will then need to send this invoice by following the FYDO wiki instructions
Claiming Hospital – Not Yet Sent

For a more detailed explanation of FYDO invoicing please see:
Hospital Invoicing / Billing an Episode Detailed




Hospital Invoicing / Billing an Episode – Detailed

Once the episode is complete, an invoice can be raised to a health fund or patient. For an invoice to be raised, the episode needs to be Admitted & Discharged. Depending on the requirements that the facility has stipulated in System Configuration, the Theatre Complete tick box may need to be ticked in order to confirm the item numbers are correct for billing. And the episode may need to be Grouped in order for billing to be able to be done.

A simple invoicing & billing explanation can be found at:
Hospital Invoicing / Billing an Episode – Simple

  1. Navigate to the Appointments Screen
  2. Use the Search field to locate the required episode or
  3. Use the Calendar to select required date & Theatre Tabs to select required theatre
  4. Locate required episode & Right Click to reveal the menu
  5. Select Create Invoice

  1. The Create Invoice page will display with the following necessary information:

  1. All patient information specific to the episode
  2. The health fund being invoiced
  3. Billing Type can usually be left as default. This allows FYDO to review the fees entered for the health fund & bill accordingly by Casebase, Per Diem or DRG
  4. The Status of the invoice being billed: either Full Fee or Basic Fee
  5. The Accommodation Type
  6. The anaesthetic type being billed
  7. The theatre times that the invoice will be based on
  8. The Mode of Separation
  9. The items being billed
  10. The Other Services being billed
  11. The Re-order Item Numbers tick box allows users to keep the item numbers in the order they have been entered in. However, if this box is checked, then FYDO will order the item numbers from highest to lowest banding
  12. The Bill To feature allows other services to be billed to the patient or a third-party company, even if the main invoice is being billed to a health fund. Selecting Patient from this dropdown will create a separate invoice/invoice number for the patient account
  13. The Financial Notes & Episodes notes fields will reflect notes that have been entered into the patients’ Episodes screen.

    7. As long as all required information has been previously entered into the Theatre Screen, there should be few reasons that anything on the Create Invoice page needs to be amended

    8. Click Proceed to see charges

  1. The Accounting Period date, which the revenue will be applied to, is displayed. (The default date that is selected in this field is set in Settings > System Configuration)
  2. The Bill Type that has been used will be displayed
  3. The invoice’s ability to be transmitted via ECLIPSE will be shown with the tick box
  4. The Accommodation charges will be displayed
  5. The Theatre & Other Services Charges will be displayed
  6. GST will be displayed if the fees for that item have been set up to include GST. Otherwise, users are able to calculate the GST amount by Right Clicking in the GST Field
  7. Custom Invoice Messages are able to be added & the user is able to type the required messages. However, Invoice Message Templates can also be added in Settings > Invoice / IFC Messages so that they can easily be selected from the dropdown list
  8. FYDO allows for multiple Invoice Templates to be added. A default template can be set, but if another template is required, it can be selected from the Template dropdown
  9. Print & Save can be selected when the invoice isn’t able to be sent via ECLIPSE & the user requires a printed or PDF copy of the invoice
  10. Save can be selected when the invoice is able to be transmitted electronically via ECLIPSE & the user does not require a hard copy of the invoice

 

Once the user has selected Save for an invoice that can be transmitted electronically via ECLIPSE, they will then need to send this invoice by following the FYDO wiki instructions Claiming Hospital – Not Yet Sent




Hospital Health Fund Fees – Same Day Fees Set Up

When new contracts are negotiated with health funds, amended fees need to be loaded into FYDO to facilitate a seamless IFC & Billing process.
  1. Fees can be entered in Settings > Hospital > Fees Setup

  2. For multi location databases, ensure the correct Location is selected
  3. Use the Fund drop down to select the required health fund
  4. The Start of Current Fee date indicates the date that the Current Fees will be utilised from. Any episode from before the start date will utilise the Old Fees
  5. The End of Current Fee date indicates the date that the Current Fees will expire. Users will still be able to create IFC’s for admissions after the End of Current Fee date. However, the system will prohibit billing for episodes that fall after this date. (This date isn’t mandatory. However, it is a good way to ensure accounts aren’t accidentally billed at outdated prices)
  6. The Same Day Fees tab contains the Same Day Accommodation Fees and the Theatre Banding Charges 
  7. Users are also given the ability to Print the health fund fees, for the selected fund
  8. To edit these fees, click the Edit button
  9. Once in edit mode, you will be able to amend the Start of Current Fee & End of Current Fee dates to indicate when the new contract fees apply
  10. Use the More Actions drop down to Click to Move Current Fees to Old Fees before the new fees are entered. This will replicate all the current accommodation fees into the Old Fees columns
  11. Enter the new fees in the Full Fee column for the corresponding bands. (C is for Type C procedures)
  12. Once all Full Fees are entered, use the More Actions dropdown, and select Click to Move Charge into Full Rebate. This will copy all fees from the Full Fee column over into the Full Fee Rebate (Do not do this step for un-insured fees or for other ‘funds’ that don’t attract a rebate)
  13. Depending on the contract agreement, facilities may need to add the Full Fee amount into the Basic Fee column. This can easily be done by using the More Actions drop down.
  14. Repeat the same steps 10 > 12 for the Theatre Banding Charges on the right side of the screen
  15. Click Save

For further information on how to set up fees, please visit our pages:

Other Settings
Casebase Fees
Casebase Multi Fees
DRG Fees
Overnight Accommodation Fees




Hospital Health Fund Fees – Casebase Fees

When new contracts are negotiated with health funds, amended fees need to be loaded into FYDO to facilitate a seamless IFC & Billing process.
The Casebase Fees tab allows the entry of any contracted All Inclusive Procedure Fees.
For more information on adding Same Day Fees, please see our page 
Hospital Health Fund Fees – Same Day Fee Set Up

  1. Fees can be entered in Settings > Hospital > Fees Setup

2. For multi-location databases, ensure the correct Location is selected
3. Use the Fund drop down to select the required health fund
4. The Start of Current Fee date indicates the date that the Current Fees will be utilised from. Any episode from before the start date will utilise the Old Fees (See Same Day Fee Instructions to amend these dates)
5. The End of Current Fee date indicates the date that the Current Fees will expire. Users will still be able to create IFC’s for admissions after the End of Current Fee date. However, the system will prohibit billing for episodes that fall after this date. (This date isn’t mandatory. However, it is a good way to ensure accounts aren’t accidentally billed at outdated prices)
6. Select Casebase Fees tab
7. Click Edit
8. If entering an amended contract, use the Actions dropdown to select Move to Old Charge before the new fees are entered. This will replicate the Current fees across to the Old Fees columns
9. Use the bottom row to add new items
10. Use the to remove any items that are no longer required
11. Enter the item number in the MBS column
12. Enter the casebase fee, listed in the contract, in the Casebase column
13. If there is a procedure fee associated with the item number, it can be entered into the Procedure column
14. Select the relevant Type for the item being added.
Standard will prompt FYDO to bill just the fee documented in the Casebase column & no accommodation fee will be added
PerDiem-Proc will add the relevant accommodation fee to the procedure fee
PerDiem-Case will add the relevant accommodation fee to the casebase fee

15. The DVA column is where the DVA codes are added (e.g. the “H” codes etc.). NB. All DVA items, with an associated item number, will need to be entered with the item number in the MBS column & will need to be billed using the MBS item number. FYDO will then send the associated DVA code via ECLIPSE to ensure claims are transmitted successfully
16. Enter the outlier days, listed in the contract, in the Outlier Days column
17. Enter the outlier fee, listed in the contract, in the Outlier Rate column
18. Tick Ignore Step down if facilities wish to ensure certain fees are not subject to the usual percentage breakdown and are calculated at 100%, even when the item is performed as a secondary or subsequent procedure.
19. Tick the GST box if the fee that has been entered is inclusive of GST
20. Tick the Exclude Other Services box if the other services/prosthesis are unable to have a charge raised when billed with the item number. E.g., If a contract stipulates that any prosthesis used is included in the casebase fee. NB for this function to work, each applicable prosthesis code will need the Exclude fee when billing tick box ticked. 
21. Tick Exclude Private Room if hospitals are unable to charge for a private room add-on for certain admissions, while still allowing the private room add-on charge to be applied to all other Case Base or DRG fees.
22. Once all details have been entered click Save

For further information on how to set up fees, please visit our pages:

Other Settings
Casebase Multi Fees
DRG Fees
Overnight Accommodation Fees




IFC for an Episode that is partially covered by the Health Fund

There will be some instances where insured patients need to pay for part of their procedure.
Maybe some of the procedures is classified as a cosmetic procedure, maybe they have restrictions on their level of cover & the hospital is able to raise a charge to the patient for those extra procedures.
Maybe the hospital is contracted for 2nd Tier rates and can charge a patient gap or they want to charge a credit card surcharge to the patient.
Whatever the case may be, FYDO accommodates this split method of billing the health fund AND the patient seamlessly.

The first step in this process is to ensure the patient is entered with their Health Fund Details for the episode. And then adding the items to the Edit Appointment Screen.

As seen below, FYDO gives the option to Send Invoice To the Health Fund or the Patient. This allows the user to select certain items that will be billed to the patient.

Each facility is able to add their own “codes” to the Other Services list in FYDO. This can be done by following the instructions for Adding Other Services Codes (Hospital) and then adding the corresponding fees by following the instructions for Adding Fees for Other Service Codes (Hospitals)

After all required information is entered, the user can click Save. They will then be prompted to review the information, as FYDO wants to be sure that the items are being bill correctly.

Therefore click Ignore and Save.

From here, the user is able to proceed to creating the IFC. This is where we will be able to see that the items being billed to the health fund will attract a rebate. And the items being billed to the patient will not attract a rebate.

Once the IFC is produced the patient will be able to clearly see which items attract a health fund rebate & which items do not.

For information in receipting payments for these types of episodes visit these instructions for




Receipting for an Episode that is partially covered by the Health Fund

There will be some instances where insured patients need to pay for part of their procedure.
Maybe some of the procedures is classified as a cosmetic procedure, maybe they have restrictions on their level of cover & the hospital is able to raise a charge to the patient for those extra procedures.
Maybe the hospital is contracted for 2nd Tier rates and can charge a patient gap or they want to charge a credit card surcharge to the patient.
Whatever the case may be, FYDO accommodates this split method of billing the health fund AND the patient seamlessly.

To create an IFC for a patient whose admission is only partially covered by the health fund, see instructions on Creating an IFC for an Episode that is Partially Covered by the Health Fund

To receipt the patient for their Insured & Uninsured portions of their payment at the same time navigate to the appointments screen, right click on the episode & select Excess/Deposit.

Then use the Fund Excess section to receipt the payment that is required to go towards the Insured Fund Invoice and use the Patient Account Deposit section to receipt the payment that is required to go towards the Uninsured Patient Invoice.

Click Save & Print to produce a copy of the receipts for the patient.

If you navigate to the History/Episodes screen you will be able to see that there has been an Insured Invoice Number raised, along with an Uninsured Invoice Number raise.