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FOR WINDOWS® FINANCIAL ACCOUNTING
RESIDENT BILLING FEATURES AND BENEFITS


COWORKER® for Windows® Resident Billing combined with Solomon IV® Financial Accounting, more than anything else, differentiates our industry specific package from general purpose accounting systems. Long Term Healthcare billing is unique in that you have multiple payers paying for services for a single resident. Many of the billings are routine, repeating themselves, in some variation, each billing cycle. Each of the payers may have their own billing rules resulting in rather complex charges with a variety of co-payment requirements and full or partial contractual adjustments. COWORKER® for Windows® Resident Billing utilizes the power and flexibility of the computer to manage the billing process, saves you time, and increases the accuracy of your billings.


FEATURES

BENEFITS

Multi-Payer Support

Resident Billing allows you to have up to 25 payers per resident at any given time. Billing rules by payer define the way each payer is paid and relationships amongst the payers (e.g., co-payment requirements) ensuring that billings are consistent where consistency is expected. Each payer's information is reported on separately so that you can track by payer as well as by resident.

Master File Controls

Long Term Healthcare billing is typically repetitive billing based on some established standards. The master files allow you define these standards (such as account number usage, co-payment requirements, contractual adjustments, etc.) in a convenient central location providing you with easy access for making changes of a global nature and ensuring that billing consistency is maintained.

Census Driven

Billings, both room charges and ancillaries, are controlled by status period records. Each time a resident's status changes, a new status period record is added for that resident. These status period records define your census. For users of our COWORKER® for Windows® Clinical Software, status period records are cross checked with the clinical midnight census information.

Flexible Rate Determination

Resident Billing supports a very flexible room rate scheme. Room rates can be calculated from 3 optional elements (base room rate, resident's debility level, and premium charges) giving you the ability to conform to whatever way your facility prices room charges.

Automatic generation of adjustments and billing credits

Billing rules, by payer, define whether generation of charges to this payer require any co-payment amount and/or contractual adjustments. If required, these transactions are automatically generated at the same time the room or ancillary charges are generated saving you time and ensuring that billings reflect expected payments.

Convenient processing of changes within the period

Transactions related to status period records are not committed to the system until they are invoiced. You are free to make billing changes prior to invoicing and the system will sort out overlapping changes and generate the appropriate transactions based on the most recent entries.

Recurring Charge Support

Residents may have an unlimited number of recurring charges (such as laundry, cable TV, and phone). The system will continue to bill the resident for these items until which time you instruct it to stop or the cycle count is reached saving you from having to enter these charges each month and ensuring that charges are not missed..

Electronic Data Entry

The flexible and powerful transaction import process allows Resident Billing to accept electronic entry from a variety of methods including bar code systems and separate computers saving you from having to hand enter many items into the system.

Resident History

Billing history can be maintained for as long as you want providing you with quick access to past details through various reports and drill down capabilities.

Electronic Billing (UB92, HCFA 1500, and various state formats)

Electronic billing to various payers typically decreases the amount of time necessary to receive payments for billings. UB92 processing will handle not only Medicare, but, any payer that accepts the UB92 as the billing form.

Billing Logs

Billing logs by payer adhere to the requirements of your intermediaries while also providing you with a convenient report that tracks billings and payments.

Summary Reports

Summary reports collect and sort transactions in accordance with your criteria reducing the amount of time it takes you to review or audit various activities.

Clinical Records Integration

Clinical Records integration.

On-Demand Billing

You can generate an invoice or a statement for a resident or payer at any given time regardless of where you are in the normal processing cycle allowing you to create discharge statements.

Multiple Billing Cycles

Each payer can be on a different billing cycle. For example, your private pays may be on a 25th to 25th billing cycle while your Medicaid payer may be on a month-end or semi-monthly billing cycle.

Advance Billing Support

Resident Billing allows you to advance bill (pre-bill) selected room and/or ancillary charges. You control whether you treat pre-bills as revenue or liabilities. Advance billing is an effective method of collecting payments in a timely manner.

Automatic Handling of Private Portions

Private portion amounts are automatically handled by the module even if the resident is admitted and discharged several times during the month saving you from having to adjust private portion amounts to reflect already expended amounts due to a prior stay in your facility.

Automatic Handling of Retentions

Billing rules allow you to define how much of a charge will be treated as a retention amount (such as Medicare Part B payments). The retention amount is automatically generated as an adjustment saving you from having to hand enter adjustments.

Interface to Solomon Accounts Receivable

Resident Billing automatically interfaces to Solomon IV® Accounts Receivable (and subsequently General Ledger) ensuring accurate transfer of information and eliminating the need to make journal entries.

Invoicing Option

You can generate invoices and / or statements for any payer. Invoices are most appropriate for third party payers (such as HMOs) while statements are most appropriate for private payers (residents).

Multiple Open Periods

Resident Billing allows you to process multiple periods at one time. For example, you can begin processing a new period while still holding open a prior period in order to handle late arriving charge information.

Variety of billing scenarios

No matter whether your payers use a billing scenario such as a TAD (Turn-Around document), a billing form (UB92), or a case mix reimbursement variation, Resident Billing has the functionality to process those billings.

Managed Care Foundation Managed Care is a growing reality in Long Term Healthcare. Whereas the exact needs of Managed Care are dynamic in nature, Resident Billing has been designed with the foundation to collect the information you will need for Managed Care. Its flexible and rapid development tool set will allow the software to be adapted quickly and accurately as new requirements are defined.


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