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The Commure Pro system allows users to hold a charge transaction for review before it is sent for final billing. When holding a charge for review, a specific reason for the hold is either automatically selected, or is manually selected by the user. For example, a provider might hold a transaction for review if they were unsure whether they had used the proper codes for billing, and they wanted a billing administrator to look at the charge transaction and correct it. In this example, the Hold Reason might be Biller Review. Once a charge has been held for review, it goes directly to the Holding Bin, and cannot be sent for final billing until it has been reviewed (and possibly corrected) by another user with the authority to do so. Typically, billing administrators and providers in supervisory positions are those who have the authority to review and resolve other user’s charge transactions. Once the reviewing user has resolved all issues and questions with a charge transaction, the hold is removed and the transaction can then be sent for final billing. You can implement the Hold for Review feature in a simple or a robust manner, depending on which best matches your organization’s workflow. This document describes both the standard options that are pre-configured upon initial installation, as well as the additional options that are available for creating a more robust Hold for Review workflow.

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Availability of the Hold for Review Feature on Web versus Handheld Platforms

Once configured, providers or administrators can use the Hold for Review feature as follows:
  • On the web platform, users can hold charges for review using all of the reasons that are available to them. Users that are authorized to resolve held charges can do so only on the web platform.
  • On the Android and Apple platforms, users can hold charges for review using all of the reasons that are available to them.

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Using Hold for Review with Other Charge Capture Features

The Hold for Review feature can be used in conjunction with the following features:
  • Automated Code Entry. The Hold for Review feature can be used in conjunction with the Automated Code Entry feature. If a user enters a master code and then submits the transaction as held for review, the appropriate auto-added charges, modifiers, and/or diagnoses are still automatically added to the (held for review) charge transaction. See Configuring Automated Code Entry.
  • Batch Charge Entry. When entering charges via the Batch Charge Entry option, the user can select one or more visits on the main screen and choose to hold them for review. See Configuring Batch Charge Entry.
  • Charge Data Master (CDM). The Hold for Review feature can be used in conjunction with a CDM. Upon submitting a charge transaction that is held for review, the appropriate CDM codes will be retrieved for the transaction, if the charge code is mapped in the CDM, and the transaction meets all of the criteria for applying CDM codes. See Implementing a Charge Data Master (CDM).
  • Custom Charge Capture Workflows. Charges generated via a Custom Charge Capture Workflow screen can be held for review. See Configuring Custom Charge Capture Screens.
  • PQRS. The Hold for Review feature can be used in conjunction with the PQRS process. Once a transaction is submitted as held for review, it is still evaluated to see if it meets the quality reporting criteria, and if so, the appropriate clinical metrics questions are presented to the provider. See Configuring PQRS/MIPS.
  • RVU Management. The Hold for Review feature can be used in conjunction with the RVU Management feature. Upon submitting a charge transaction that is held for review, the charges are saved with the appropriate RVU values (including auto-sorting those codes, possibly multiplying the RVU values, and possibly adding modifiers after saving the transaction). See Configuring RVU Management.
  • Selection of NDC Codes. Charge transactions that include NDC codes can be held for review. See Configuring the Selection of NDC Codes During Charge Capture.

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Steps for Configuring the Hold for Review Feature

To implement the Hold for Review workflow, you must first evaluate the reasons why a charge transaction might be held for review in your organization. As a starting point, every Commure Pro system is pre-configured with two standard Hold Reasons: the Review Requested reason (the person entering the charge transaction has requested that the transaction be reviewed by someone) and the Comment Review reason (the provider has entered a comment on a charge transaction that should be reviewed by someone). You might decide that these two reasons are sufficient for your organization’s needs, or you might decide that additional custom reasons as necessary. For example, you might want to implement custom reasons such as “Biller Review” (the charge should be reviewed by a billing administrator), “Missing Documentation” (the charge should be held because it is missing required documentation) or “Hold until Discharged” (the charge should be held until the patient is discharged). For each Hold Reason, you must then determine which types of persons should be able to hold a charge for that reason (referred to as the Hold Role), and which types of persons should be able to review and “resolve” any charges that were held for that reason (referred to as the Resolve Role). The manner in which the Hold Roles and the Resolve Roles are configured for various reasons depend on the type of reason:
  • Custom Hold Reasons: The Hold Roles and Resolve Roles for custom Hold Reasons are both configured via the institution-level setting below. In this option, an administrator specifically selects roles from the Roles reference list to use as the Hold Role and the Resolve Role for each custom reason that they create. See Managing Hold Reasons and Mapping Them to Roles for more detailed information. Admin - Institution - Charge Capture - Enable Hold for Review
  • The “Review Requested” Reason:
  • The Resolve Role for this reason is set to “User” by default, but an administrator can delete this role and/or add different roles if desired, via the same institution-level setting described above: Admin - Institution - Charge Capture - Enable Hold for Review
  • The “Comment Review” Reason:
  • The Resolve Role for this reason is set to “User” by default, but an administrator can delete this role and/or add different roles if desired, via the same institution-level setting described above: Admin - Institution - Charge Capture - Enable Hold for Review The basic steps when analyzing your Hold for Review workflow are as follows:
  1. Create a complete list of potential Hold Reasons (including the standard Review Requested and Comment Review reasons).
  2. Determine which Roles you want to use as the Hold Roles and Resolve Roles for each reason. You can use a given Role as either a Hold Role, a Resolve Role, or both.
    Commure Pro recommends that you assign an administrator role as the Resolve Role for every Hold Reason. This ensures that all charges that are held for review can be resolved by an administrator, as a back up in cases where other persons with the Resolve Role fail to review the charges that are held for review.
  3. Examine the list of Roles that are already configured in your system (via Admin > System Management > Reference Lists > Roles) to determine whether you need to create additional Roles to accommodate your planned Hold Roles and Resolve Roles. For example, when analyzing your desired Hold for Review workflow, you might create a table similar to the sample table below to help you organize your thoughts:
Hold ReasonTypeHold RoleResolve Role
Review RequestedStandardDetermined by State of Hold for Review Checkbox setting. Set it to “Show Checked” or “Show Unchecked” for the appropriate users.The default is “User.”Change it to: Attending Provider Billing Administrator
Comment ReviewStandardDetermined by Hold Charge for Review when Comment Entered setting. Set it to “Yes” or “Prompt” for the appropriate users.The default is “User.”Change it to: Billing Administrator
Biller ReviewCustomProvider Billing AdministratorBilling Administrator
Missing DocumentationCustomBilling AdministratorBilling Administrator
Hold Until DischargeCustomProviderProvider Attending Provider Billing Administrator
Once you have mapped out all of your Hold Reasons and the Hold Roles and Resolve Roles necessary for each of them, you can start configuring the system. The steps are listed in the table below.
StepWhere Documented
1. (Optional) Create any additional Roles that might be necessary in order to implement the standard Review Requested and Comment Review reasons, as well as any Roles needed for additional custom reasons. Then assign those Roles to users.Creating Roles and Assigning Them to Users
2. Configure the user preferences that control the standard Review Requested and Comment Review reasons.Configuring User Preferences That Control the Standard Hold Reasons
3. Set the Reviewing User preference to Yes for any user who has a Resolve Role assigned to them.Configuring Users Who Can Resolve Charges That Are Held for Review
4. (Optional) Create any additional custom Hold Reasons that you want to implement and configure the appropriate Hold Roles and Resolve Roles for each.(Optional) Modify the Resolve Role for the standard Review Requested and Comment Review reasons.Managing Hold Reasons and Mapping Them to Roles

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Creating Roles and Assigning Them to Users

If you need to create additional Roles to use as either a Hold Role or a Resolve Role, you can do so by adding Roles to the Roles reference list (via the Admin > System Management > Reference Lists option). For example, you might create a new role called “Billing Administrator” to represent those persons who play that role in your organization. Any role from the reference list can be used as a Hold Role, a Resolve Role, or both. Please see the following topics for general information about reference lists, as well as instructions on creating new entries in a reference list:
  • Reference Lists
  • Adding Entries to a Reference List Once you have created any necessary additional roles in the Roles reference list, you must assign those roles to the users who fill them. You can assign Roles to users via the Provider Info option: go to Admin > Users > [select the user] > Provider Info. Then follow the instructions in the topic below:
  • Provider Info

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Configuring User Preferences That Control the Standard Hold Reasons

The standard Review Requested and Comment Review reasons are controlled by specific user-level settings. If you want a given user to be able to hold a charge for review for one or both of these standard reasons, then you must configure the appropriate user setting(s) below for that user.
  • The “Review Requested” Reason: A user’s ability to hold a charge for review using the Review Requested reason (i.e., the Hold Role for this reason) is based on the value of the user preference below. In addition, the Default State (Show or Hide) and the Default Value (Checked or Unchecked) are also based on this setting. Admin - User - Charge Capture - State of Hold for Review Checkbox The possible values for this setting are listed below:
    • Show Checked: When the user creates a new charge transaction, the Review Requested reason is available in the Hold for Review drop-down, and it is checked by default.
    • Show Unchecked: When the user creates a new charge transaction, the Review Requested reason is available in the Hold for Review drop-down, but it is not checked by default.
    • Hide, Checked: The Review Requested reason is not visible to the user in the Hold for Review drop-down list, but it is checked behind the scenes and the user is not able to uncheck it. As a result, all charges entered by this user are held using the Review Requested reason.
    • Hide Unchecked: The user cannot hold a charge transaction for review using the Review Requested reason (the reason is not available under the Hold for Review drop-down list). If you want to disable the Review Requested reason system-wide, then all users should be set to Hide Unchecked.
If the Review Requested reason is the only Hold Reason available to a user (i.e., their State of Hold for Review Checkbox is set to “Show Checked” or “Show Unchecked” and they do not have a Hold Role for any custom reasons with a Default State of “Show”) then a Hold for Review checkbox (on the web) or Yes/No toggle (on Apple devices) is displayed on the Charge Transaction screen for this one reason, rather than a drop-down list. On Android devices, a list is shown.
The “Comment Review” Reason: A user’s ability to hold a charge for review using the Comment Review reason (i.e., the Hold Role for this reason) is based on the value of the user preference below. In addition, the Default Value (Checked or Unchecked) is also based on this setting. The Default State is always Hide (not visible).
Admin - User - Charge Capture - Hold Charge for Review when Comment Entered The possible values for this setting are:
  • Yes: When the user enters a comment on a charge transaction, the transaction is automatically held for review using the Comment Review reason (the reason is checked behind the scenes).
  • Prompt: When the user enters a comment on a charge transaction, a prompt is displayed asking the user if they want to hold the transaction for review. If they respond Yes, it is held for review using the Comment Review reason (the reason is checked behind the scenes). If they respond No, it is not held for review (the Comment Review reason remains unchecked).
  • No: When the user enters a comment, the transaction is never held for review using the Comment Review reason. If you want to disable the Comment Review reason system-wide, then all users should be set to No.

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Configuring Users Who Can Resolve Charges That Are Held for Review

Once a charge transaction has been held for review for a particular standard or custom Hold Reason, it is sent directly to the Holding Bin where it is held until it is reviewed and resolved by a user with the authority to do so. In order to be able to resolve a charge that is held for review, a user must have one or more of the Roles that are designated as the Resolve Role for the Hold Reason on the charge transaction. For example, if the transaction was held with a Comment Review reason, then a user must have the Resolve Role that is associated with the Comment Review reason as a Role in their user profile. In addition, the user must also have the preference below set to Yes in order to be able to resolve any charge transaction that is held for review. This setting only affects users on the web platform, as that is the only platform where charges can be resolved. Admin - User - Charge Capture - Reviewing User

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Managing Hold Reasons and Mapping Them to Roles

You can add new custom Hold Reasons, or edit existing ones (including the standard Review Requested and Comment Review reasons) using the Manage option for the Enable Hold For Review setting. This option also allows you set the Hold Roles, Resolve Roles, Default State, and Default Value for a given reason.

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Viewing the Current List of Hold Reasons

To view the current list of Hold Reasons:
  1. Select Admin > Institution > Charge Capture > Enable Hold for Review > Manage. The Manage Hold for Review Reasons screen is displayed. All reasons are immediately shown by default, sorted in alphabetic order.
  2. (Optional) To view information for specific reasons, enter text into the Search field. Only the reasons that contain that text in their name are shown. The column contents are described below. Any column heading that has arrows indicates that you can click it to sort the list by that item.
    • Reasons: The name of the Hold Reason.
    • Hold - Role: The role(s) that can hold a charge transaction for review, using this reason.
    • Hold - Default State: The default state (Show means visible, and Hide means not visible) for this reason when a user creates a new charge transaction.
    • Hold - Default Value: The default value (Checked or Unchecked) for this reason when a user creates a new charge transaction.
    • Resolve - Role: The role(s) that can resolve a charge transaction after it has been held for review for this reason.
    • Edit icon : Click to open the Edit Reason-Roles Mapping screen so that you can modify the reason or its mapping.
    • Delete icon : Click to delete a reason.
  • Active checkbox : Click this checkbox to make a reason active or inactive. active checkbox

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Adding a New Hold Reason

To add a new custom Hold Reason, follow the steps below.
  1. Select Admin > Institution > Charge Capture > Enable Hold for Review > Manage. The Manage Hold for Review Reasons screen is displayed and all reasons are shown by default.
  2. Check the list to make sure that the reason you are about to add does not already exist.
  3. Select the Create new Reason-Roles Mapping button. The Create Reason-Roles Mapping screen is displayed.
  4. Complete the fields on the screen as follows:
    1. Reason (required): Enter a reason for holding a charge for review. The name should be brief but descriptive enough that all users will understand how and when it should be used.
    2. Active: Check this box to make this reason available for use as soon as you save it. Or, leave it unchecked if you are not yet ready to implement it.
    3. Hold - Roles: Select one or more Roles that should be able hold a charge transaction for review, using this Reason. Click the Search icon to view the full list of roles and then select one or more from the list. If you leave this field blank, then users of any role can hold a charge for review for this reason.
    4. Hold - Default State (required): Select the default state (visible or not visible) for this reason when a user creates a new charge transaction.
      • Show: The reason is visible in the Hold for Review drop-down when a user creates a new charge transaction.
      • Hide: The reason is not visible in the Hold for Review drop-down when a user creates a new charge transaction.
If a user has only one custom reason that is visible to them (i.e., they have the Hold Role for only one custom reason with a Default State of “Show”), and the Review Requested reason is not visible for them either (i.e., their State of Hold for Review Checkbox preference is set to “Hide, Unchecked”), then a Hold for Review checkbox (on the web) or a Yes/No toggle (on Apple devices) is displayed on the Charge Transaction screen for their one custom reason, rather than a drop-down list. On Android devices, a list is shown.
  1. Hold - Default Value (required): Select the default value (checked or not checked) for this reason when a user creates a new charge transaction.
    • Checked: The reason is selected by default (checked) when a user creates a new charge transaction. If its default state is Show, then users will see that it is selected (checked) in the Hold for Review drop-down. If its default state is Hide, then it is checked behind the scenes.
    • Unchecked: The reason is not selected by default (unchecked) when a user creates a new charge transaction. If its default state is Show, then users will see that it is unchecked in the Hold for Review drop-down. If its default state is Hide, then it is unchecked behind the scenes.
If you set the Default State to Hide and the Default Value to Unchecked, then you are essentially making this reason inactive, since it will not appear in the Hold for Review drop-down list for any user, and no one will be able to select it.
  1. Resolve - Roles: Select one or more Roles that should be able to resolve a charge transaction that has been held for review using this Reason. Click the Search icon to view the full list of roles and then select one or more from the list. If you leave this field blank, then users of any role can resolve charges that were held for this Reason (as long as their Reviewing User preference is also set to Yes).
  2. Click the Save button to save the new Hold Reason.
  3. Repeat Step 3 through Step 5 to add more Hold Reasons.
  4. When you are done adding Hold Reasons, click X at the top right of the Manage Hold for Review Reasons screen, and then click Save on the Charge Capture settings screen.

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Editing or Deleting a Hold Reason

You may delete or edit any custom Hold Reason. The standard Review Requested and Comment Review reasons cannot be deleted, and there are also limitations to the changes that you can make when editing them, as described below: Limitations when editing the Review Requested reason:
  • Active: This reason cannot be made inactive using the Active checkbox, although if you set the State of Hold for Review Checkbox preference to “Hide, Unchecked” for all users, it has the same net effect of making this reason inactive.
    • Hold Role: This field is not available for editing. Instead, any user who has their State of Hold for Review Checkbox set to “Show Checked” or “Show Unchecked” can hold a charge transaction for review, using the Review Requested reason. Or if it is set to “Hide, Checked,” the charge transaction is automatically held for review using the Review Requested reason.
    • Default State and Default Value: These fields are not available for editing. Instead they are based on the value of the user’s State of Hold for Review Checkbox setting (“Show Checked,” “Show Unchecked,” “Hide, Checked,” or “Hide, Unchecked”).
    • Resolve Role: By default, the Resolve Role is set to “User.” However, you can delete this role and/or add different roles if desired. Limitations when editing the Comment Review reason:
  • Active: This reason cannot be made inactive using the Active checkbox, although if you set the Hold Charge for Review when Comment Entered preference to “No” for all users, it has the same net effect of making this reason inactive.
    • Hold Role: This field is not available for editing. Instead, any user who has their Hold Charge for Review when Comment Entered set to “Yes” or “Prompt” can hold a charge transaction for review, using the Comment Review reason.
    • Default State and Default Value: These fields are not available for editing. Instead, the Default State when entering a new charge transaction is always Hide (not visible). The Default Value is based on the value of the user’s Hold Charge for Review when Comment Entered setting. If set to Yes, and the user enters a comment, the Comment Review reason is checked behind the scenes. If set to “Prompt” and the user enters a comment, and then responds Yes or No to the prompt, the Comment Review reason is checked or unchecked, respectively, behind the scenes.
    • Resolve Role: By default, the Resolve Role is set to “User.” However, you can delete this role and/or add different roles if desired. To edit or delete a Hold Reason (keeping the limitations above in mind for the standard reasons):
  1. Select Admin > Institution > Charge Capture > Enable Hold for Review > Manage. The Manage Hold for Review Reasons screen is displayed and all reasons are shown by default.
  2. Click one of the icons below for the row that you want to edit or delete:
    • Delete icon : Click to delete the Hold Reason. Please note that you cannot delete a reason that is currently being used on a charge that is held for review, and a warning message is shown if you attempt to do so. You must first resolve all charge transactions that are held for the reason, before you can delete the reason here.
    • Edit icon : Click to open the Edit Reason-Roles Mapping screen so that you can modify the information, such as the Hold Role, Resolve Role, Default State, or Default Value. See Adding a New Hold Reason for a full description of each field. When you are done making changes, click the Save button.
  3. Repeat Step 2 to edit or delete additional Hold Reasons.
  4. When you are done editing/deleting entries, click X at the top right of the Manage Hold for Review Reasons screen, and then click Save on the Charge Capture settings screen.