Ascend-IP Charges
The first part of the "Charges" documentation covers the procedures for charging for medications. The second part covers the various ways charges are transferred from the pharmacy software to the hospital financial system. Part three is a more technical overview of how Ascend-IP stores and processes charges.
Part 1: Charging for Medications
You can configure Ascend-IP to charge at various points in the medication dispensing/administration process. Ascend-IP users can set the software to (1) Charge all scheduled doses in advance (i.e., at the time the order is entered), (2) charge upon dispensing (i.e., before the dose is administered upon running the fill list), or (3) charge after the dose is administered (e.g., pharmacy staff picks up charges from a copy of the MAR). These settings can be pre-configured in the Utilities/Options/Order Entry tabbed section. (See the Order Entry Option Settings documentation). If the settings are incorrect for the charging options you want, the program may not operate as needed. For example, you may not be prompted for "starter doses" unless the setting for "charge upon dispensing" has been turned on. Note: Some Ascend-IP Interfaces allow you to "charge when the dose is administered" (e.g., BDid-Rx, Pyxis, Suremed, Omnicell, etc.) which does not require any "charge entry" work by pharmacy staff.
Charging Upon Dispensing for "Unit Dose" Type Orders
When you enter a new "unit dose" order, be sure the quantity box to the right of the order ingredient reflects the proper charge quantity per dose. For example, for "Tylenol 325: 650 mg Q4H PRN pain", the quantity should be changed from "1" (the default) to "2" tablets per dose. After the basic order data has been entered, you usually select the "Profile" or "New Order" command button to continue. Several functions are performed at this point, including prompting you for the quantity of initial starter doses (i.e., to last the patient until the medications cassettes are delivered). For scheduled medications, you'll see a list containing the dates/times of each scheduled dose, and whether it has been charged yet ("Yes" or "No"). Change the quantity of scheduled doses to dispense right now, if the default number is incorrect. This number should reflect the number of doses you want to dispense, not the number of tablets, capsules, etc.
For new non-scheduled medications (e.g., demand fill), the list will not initially contain any administration dates/times. Enter the quantity of starter doses you want to dispense. Remember, this number should reflect the number of doses, not the number of tablets, capsules, etc. Be sure to also change the transaction date if it is necessary to do so. For example, if you are charging for a medication taken from the night locker after the pharmacy closed, enter the transaction date as yesterday's date.
Most users print a "fill list" (pick list) so they know how many doses of each medication to put into the medication cassettes for the next period. With the "Charge upon dispensing" option turned on, Ascend-IP charges for the "auto-fill" (scheduled) medications automatically when the fill list is displayed or printed. The "demand fill" orders (mostly PRN orders) are not charged automatically. During the medication cart fill process, if you choose to dispense fewer (or more) scheduled doses than the fill list has charged for (e.g., a scheduled dose was not taken), you must enter the credit (or additional charge) quantity on the fill list document. You will also document any demand fill doses dispensed or returned to inventory. These charge/credit "exceptions" will be entered into the pharmacy database later on.
After filling the medication carts, you should enter the charge/credit exceptions from the fill-list in the pharmacy database. There are several ways of doing this:
Charging Upon Dispensing for "IV" Solution Type Orders
Charging for IVs is usually tied to the printing of the IV labels. Therefore, each label you print also charges for that scheduled dose. After the label is printed, if the IV is returned or not delivered for any reason, you'll need to credit that dose. Also, be sure the quantity to the right of each IV ingredient reflects the proper charge quantity per IV.
After the new IV order data has been entered, you normally select the "Profile" or "New Order" command button to continue. Several functions are performed at this point, including prompting you for the quantity of initial starter IV labels you want to print (i.e., to last the patient until the batch IVs are prepared and delivered). For scheduled IVs, you'll see a list containing the dates/times of each scheduled dose, and whether it has been charged yet ("Yes" or "No"). Enter (or modify) the quantity of labels to print as starter doses.
For a non-scheduled IV enter the charge transaction date/time for the label you want to print.
Most users print "Batch IV Labels" once or twice a day. The "batch" would normally include all the labels (doses) needed for each IV order for the desired period (typically 24 hours, e.g., from 14:00 today through 13:59 tomorrow). With the "Charge upon dispensing" option turned on, Ascend-IP charges for the "auto-fill" (scheduled) IVs automatically when the labels are printed. The "demand fill" IV orders are not printed or charged automatically on a batch basis. To print/charge a batch of IV labels, select "Labels"-->"Batch IV Labels". You will see a pre-selected list of all IV order types, an effective period, and a room/bed range. Most users will not have to edit these options. Doses scheduled within the effective period, matching the highlighted order types, for patient's within the selected room/bed range, will be included in the batch. The program marks each dose as "charged" as it is printed. If an IV order is discontinued after the labels are printed (charged), and the IVs were not made or were returned, be sure to credit these doses.
The option to charge in advance applies to all scheduled medications (i.e., Unit Dose and IV solutions). Charging takes place at the time the order is scheduled as opposed to when the fill list is run or the IV labels printed. During order entry, after the SIG is entered and the "Tab" key is hit, AIP will automatically schedule and charge every dose. The order's Schedule Maintenance screen will display the dates/times of each scheduled dose; all doses will have a "Yes" in the Charged column indicating that they have been charged.
When the Automatic Charging feature is turned on, a "companion" feature - Automatic Crediting when patients/orders are DC'd - is also turned on automatically. When a patient is discharged and/or an order is discontinued, all charged doses scheduled after the effective DC date/time are automatically credited. These features save valuable time by eliminating the manual entry of credits during the medications cassettes exchange.
The automatic crediting feature does not reverse or alter miscellaneous charges or credits (i.e., non-scheduled) that have been entered by the user (i.e., via Enter ER/Misc charges or Enter Floor stock charges, or by checking the Miscellaneous charge box in charge/credit window), or charges that have been received from automatic dispensing systems (Pyxis, Suremed, Omnicell, and etc).
If you currently use the Charge upon dispensing option (i.e., via printing the fill list), you are likely to have the "Charge for starter doses" prompt turned on. You will not see this prompt appear for scheduled medications (Unit Dose or starter IV labels) if you choose to auto charge as these starter doses (i.e., to last the patient until the medications cassettes are delivered) would have already been charged at the time the order was scheduled.
Do I need to update the AIP interface(s)? YES.. CLICK HERE FOR MORE INFO. These two features should not be used with Remote Support Services or PATCOM interfaces because we don’t receive discharge times from these non-HL7 interfaces. All HL7/TCP-IP ADT interfaces are otherwise compatible.
Can I continue to charge upon dispensing but choose to have the program automatically credit the doses after DC date/time?
Yes. However, typically Auto Credit will be used in conjunction with Auto Charge.
How will the program apply credits when the effective DC date/time is back-dated?
To turn the auto charge/credit on, go to the Utilities/Options/Order Entry tab and check the box titled "Charge all scheduled doses in advance".
What if I turn the Automatic Charge feature on, then decide to turn it off?
The charges for future scheduled doses that have already been created will still persist. In this case, we recommend leaving the Automatic Credit feature turned-on to ensure unnecessary charges are not transmitted.
Part 2: Transmitting Charges to Your Financial System
Above we covered some of the ways charges are recorded for medication doses, including dispensing and charging unit doses, printing fill lists and printing IV labels. These charges must eventually be transmitted to your (hospital) financial system. The most common ways this can be done include:
Most users employ an Ascend-IP Interface to transmit charges by option 1 or 2, the fastest and most accurate ways of transmitting pharmacy charges. Option 3 requires more manual labor and is prone to keying errors. When using interface options 1 or 2, do not print charges using the Ascend-IP report ("Charges Transmitted") until after the charges have been transmitted by the interface.
Transmitting Charges Via an Interface (Option 1)
Transmitting Charges Via a Charge Transaction File (Option 2) Check with HOS to see whether you will use the Ascend-IP Interface to create your charge file (the usual way), or use an Ascend-IP "export" routine (not usual). Most users follow these steps:
Options 1 and 2 automatically include transactions with dates up to 7 days old. They also automatically mark each charge as "transmitted" (using today's date) to prevent them from being transmitted more than once.
Reports: After the charges have been transmitted by the interface (Options 1 and 2), some users want to view or print the charges that were transmitted. If Option 1 or 2 was used, the report "Charges Transmitted" would include the charges that were sent via the interface. After selecting this report, verify that the effective period is correct. For this report, the effective period refers to the transmission date for the charges (i.e., NOT the transaction dates). For example, if you transmit charges once a day and then want a printed copy of those transmitted charges, the effective period could be "00:00 Today" to "23:59 Today". This would include any transmissions made today. To make this easy, you can pre-configure this under the Utilities/Options/Report and Label Filters tab (e.g., set the effective period for "0" days ago at "00:00" to "0" days ago at "23:59").
Since this report can be printed at any time in the future (even months from now!), many users don't print it unless a hard copy is really required. For Options 1 and 2, the report should not be printed or previewed until after the charges have been transmitted by the interface.
Printing Charges for Manual Entry (Option 3)
The "Scheduled Dose" Table
When you enter an order for a scheduled medication, Ascend-IP (AIP) creates a "scheduled dose" record in the AIP database table for each dose to be administered. For example, an order for "Benadryl 25mg 2 capsules Q12H x 3 days" would have 6 "scheduled dose" records created in the table, one for each dose. In this case, each dose is for 2 capsules so the ingredient "quantity" box in the order should be changed from "1" to "2". The quantity box is found on right side of the ingredient description (e.g., "Benadryl 25mg").
Each scheduled dose record contains the date and time the dose is to be administered to the patient. For example:
Dose #1 = 11/07/2000 08:00 Dose #2 = 11/07/2000 20:00 Dose #3 = 11/08/2000 08:00...
Therefore, for any time period you may select, Ascend-IP can refer to the table of scheduled doses to determine:
For non-scheduled medications (e.g., demand fill, typically PRN orders), entries are only made into the "scheduled dose" table when you actually charge for them, not when the orders are first created. The program assumes the charge transaction date you use for non-scheduled doses is also the administration date for these doses. Therefore miscellaneous or non-scheduled charges should be given a charge transaction date that matches the date they actually received the medication. To facilitate this, Ascend-IP allows you to preset the default charge transaction date for these doses when you enter the charges.
The "Charged" Field
Each record in the "scheduled dose" table contains a "Charged" field which can be set to "Yes" or "No". If a dose has not been charged, this field is set at "No". After it has been charged, it is set to "Yes". You can configure Ascend-IP to charge at various points in the medication dispensing/administration process. For example, Ascend-IP can charge (i.e., change the field content from "No" to "Yes"):
Examples of charging upon dispensing include:
Examples of charging when the dose is administered include:
Examples of charging after the dose is administered include:
Examples of charging in advance
In each of the above cases, when the charge is applied to a specific dose, the "charged" field becomes a "Yes" value. As a result, you can reprint a fill list and reprint IV labels without incurring additional charges for those doses.
Charge "Transaction" Dates/Times
Regardless of when the charge is actually applied to the dosage record (before, during, or after administration of the dose), the "transaction" date and time associated with the charged dose will be the original "scheduled dose" date and time, or the transaction date you entered (i.e., for a non-scheduled dose). The charge "transaction" date is intended to be the date the patient received the dose. This satisfies the requirements of most third party payers, including MediCare.
Entering Credits or Additional Charges
When entering credits from the profile or order screen, the program normally tries to apply the credits in this order: (1) Credits are first applied to the most future scheduled doses that have been charged (but not transmitted). These are then reversed to "not charged". (2) Once there are no remaining un-transmitted charges to reverse, the program creates miscellaneous credit transactions for the balance of the unapplied credits.
If you want the program to record credits for a specific date rather than to future scheduled doses, check the "miscellaneous charge" box, enter the transaction date and the credit (i.e., the number of doses with a preceding "-"; e.g., "-3").
When Auto Credit is turned on, credits are applied to all scheduled doses after the effective DC date/time. Any doses scheduled after the DC date that have been charged (but not transmitted) will be removed from the Administration Times list. If a dose has been charged (and transmitted), the program creates a miscellaneous credit transaction with the effective transaction date being the date the "DC" was entered.
The automatic crediting feature does not reverse or alter miscellaneous charges or credits (i.e., non-scheduled) that have been entered by the user (i.e., via Enter ER/Misc charges or Enter Floor stock charges, or by checking the Miscellaneous charge box in charge/credit window), or charges that have been received from automatic dispensing systems (Pyxis, Suremed, Omnicell, and etc).
When entering additional charges from the profile or order screen, the program normally tries to apply the charge to the next uncharged scheduled dose. If you want the program to charge for an extra dose that is not on the scheduled dose list, check the "miscellaneous charge" box, enter the transaction date and the number of doses to charge.
Note: Miscellaneous charges or credits do not appear on the list of scheduled doses for the order, but they are accounted for on the charge/credit transaction list that appears at the bottom of each order screen. They are also included when you view the profile with the "Charges" option button selected (profile: upper left).
Charge Processing ("Transmitting")
Most facilities "process" charges each day. By "process", we mean that the charges are read from the pharmacy database "schedule dose" table and sent to the hospital financial system (i.e., "transmitted"). The charge transmission process can include:
Charge "Transmitted" Dates/Times
Regardless of the processing method, each charge is marked as "transmitted" as soon as it is processed (i.e., as soon as it is printed, put in a file, or successfully sent via an interface). The program marks a scheduled dose/charge as "transmitted" by placing the date and time of the transmission into the schedule dose table. Once a charge has been "transmitted", it cannot be resent using normal methods. This prevents the same charges from accidentally being sent more than once. It also makes it easy for the program to find charges that have not been transmitted for any reason because they don't have a transmitted date/time!). For example, an interface might be "down", or someone might enter a late charge and back-date it 2 days. In these cases, the program would include these "non-transmitted" charges with the next transmission and mark them with the "transmitted date/time" then.
Therefore, in most cases, charge "transaction" (administration) dates are not the same as charge "transmission" (sent) dates. Typically, charges are transmitted "today" but are comprised of charge transactions dated "yesterday" (or earlier).
Let's follow through with an example of charging upon dispensing, using the "Benadryl 25mg 2 capsules Q12H x 3 days" order. When this order is entered, the six "scheduled dose" records would be created. Let's assume that the pharmacist dispenses the first dose and charges for it. The "scheduled dose" table would then look like this:
Administration time Charged Transmitted
- 11/07/2000 08:00 Yes
- 11/07/2000 20:00 No
- 11/08/2000 08:00 No
- 11/08/2000 20:00 No
- 11/09/2000 08:00 No
- 11/09/2000 20:00 No
Next, we'll print a fill list (charging automatically as we print). We'll assume today is "11/07/2000" and the effective period for the fill list will be 11/07/2000 03:00 through 11/08/2000 02:59. Therefore, the fill list will include the "11/07/2000 20:00" and "11/08/2000 08:00" doses for our Benadryl order. Following the printing of the fill list, the "scheduled dose" table charges would look like this.
Administration time Charged Transmitted
- 11/07/2000 08:00 Yes
- 11/07/2000 20:00 Yes
- 11/08/2000 08:00 Yes
- 11/08/2000 20:00 No
- 11/09/2000 08:00 No
- 11/09/2000 20:00 No
The next day (11-08-2000) we process charges. With Ascend-IP you can set the "effective period" for your charge processing as well. Most facilities set it for the previous day. Assuming that we have chosen to process charges at 11:30 AM, and the effective period is set to "11-07-2000 00:00" through "11-07-2000 23:59", the table would look like this when we are done:
Administration time Charged Transmitted
- 11/07/2000 08:00 Yes 11/08/2000 11:30
- 11/07/2000 20:00 Yes 11/08/2000 11:30
- 11/08/2000 08:00 Yes
- 11/08/2000 20:00 No
- 11/09/2000 08:00 No
- 11/09/2000 20:00 No
In this example, on any given day, the dispensing process (e.g., fill list) is configured to charge when we dispense, in advance of medication administration, and the charge processing / transmission step / not until the next day.