Procedure for handling patient care services paid from internal funds
There is a significant volume of patient care that is paid from internal sources. The most common case is where services are paid from drug studies. Also included are services paid from traditional grant sources, including government grants, contracts, gift and endowment income and departmental research funds (typically 93xxxx). Historically, these services have often been handled outside of normal patient billing channels. With the introduction of more formal compensation plans, cost accounting by function, and emphasis on controlling costs, it is becoming more important to understand the volumes of services being rendered regardless of payment source. This requires that all patient services be captured and valued. The procedures below are designed to accomplish these objectives within the context of Washington University’s Financial Information System (FIS) and the WUSBCS Billing and Accounts Receivable subsystem (BAR) licensed from IDX.
Capture of patient volumes
In order to have consistent procedures in clinical settings, it is recommended that visit slips be prepared for all patients, including those supported from internal transfers of funds. Where the patient visit is funded from drug studies, or grant funds, the Financial Status Code (FSC) on the invoice should be 801, Research Case. Since this is a “case”, the invoice must be linked to an “employer case.” The FSC on the account should indicate the regular third party insurance or self-pay. Note that by linking an invoice to an “employer” case, the invoice is moved to the “employer” account (an example of an “employer” in this context would be the Department of Internal Medicine). If the visit is partially supported by internal funds, and partially funded from traditional third parties, two visit slips are strongly recommended. One visit slip would reflect the internal sale. The second slip would reflect the external sale.
Clearly indicate on the visit slip the source of funding, including the FIS cost center (e.g. 22-1234-12345A). It would be expected that the party responsible for payment (e.g. the investigator) would provide these codes in advance to the clinic or department providing the services. Normal pricing will apply unless there is a specific departmental policy or an arrangement between the service provider and the research investigator. If a discount has been granted, the agreed upon price should be entered on the visit slip. Note that for government sponsored grants and contracts, the amount charged can only include the direct costs of providing services. The visit slip should also show discount code 755, Internal Research Credit, which indicates that this was a research visit funded by internal funds. The resulting amount is the amount that will be charged to the drug study, grant, or other internal source. The original copy of the visit slip should be batched and keyed as normal. A copy of the visit slip must be sent to the departmental business office, or in accordance with departmental procedures, for processing. Please note that our IDX BAR can only accept one discount code, and the code must be the one indicated above.
Posting of services in BAR
All research activity in BAR will be valued and reported in standard and special reports using standard pricing or as keyed over-rides by the department. Charge entry should also include the discount code 755, Internal Research Credit. This dollar value will be reflected in gross charges and will be associated with the relative value units in production reports. The automatic discount will be applied during the monthly closing to resolve the balance on the invoice and will appear on the IDX reports under the payment category of Internal Funds Transfer. If a visit slip indicates only some services are to be paid from internal sources, it is necessary to create two invoices. One invoice is to be prepared as indicated above. The second invoice would be prepared for billing to insurance or the patient in accordance with departmental policy.
Posting of services in FIS
The business office of the department providing the services should create a journal document if the internal source of funds is on a department number for which they have FIS authorization, otherwise an Interdepartmental Invoice (ID) document should be routed for approval to the department number responsible for payment. When charging either government grants and contracts or other funds (clinical trials, gifts, endowment or department funds), credit ledger class 12, budget-object 81-80 (note that there is no overhead assessed against this credit code).
The debit side of the transaction should be budget/object 3580 for internally purchased services. The budget/object codes for services purchased from outside vendors are in the series 41-0x.
Effective with services posted 9/1/98 and after, each department will handle their own interdepartmental transfer of funds associated with these services. Because the service will be automatically adjusted at time of entry there will no longer be an accounts receivable invoice for the WUSBCS Special Billing Unit to process as they had in the past.